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1.
NMR Biomed ; : e5266, 2024 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-39358992

RESUMEN

Efficient abdominal coverage with T1-mapping methods currently available in the clinic is limited by the breath hold period (BHP) and the time needed for T1 recovery. This work develops a T1-mapping framework for efficient abdominal coverage based on rapid T1 recovery curve (T1RC) sampling, slice-selective inversion, optimized slice interleaving, and a convolutional neural network (CNN)-based T1 estimation. The effect of reducing the T1RC sampling was evaluated by comparing T1 estimates from T1RC ranging from 0.63 to 2.0 s with reference T1 values obtained from T1RC = 2.5-5 s. Slice interleaving methodologies were evaluated by comparing the T1 variation in abdominal organs across slices. The repeatability of the proposed framework was demonstrated by performing acquisition on test subjects across imaging sessions. Analysis of in vivo data based on retrospectively shortening the T1RC showed that with the CNN framework, a T1RC = 0.84 s yielded T1 estimates without significant changes in mean T1 (p > 0.05) or significant increase in T1 variability (p > 0.48) compared to the reference. Prospectively acquired data using T1RC = 0.84 s, an optimized slice interleaving scheme, and the CNN framework enabled 21 slices in a 20 s BHP. Analyses across abdominal organs produced T1 values within 2% of the reference. Repeatability experiments yielded Pearson's correlation, repeatability coefficient, and coefficient of variation of 0.99, 2.5%, and 0.12%, respectively. The proposed T1 mapping framework provides full abdominal coverage within a single BHP.

2.
Front Genet ; 15: 1335839, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39350769

RESUMEN

Background: Previous studies have suggested an association between Type 1 diabetes (T1D) and autoimmune diseases (AIDs), but the causal relationship remains unclear. Therefore, this study utilizes publicly available Genome-Wide Association Studies (GWAS) databases and employs a two-sample Mendelian Randomization (MR) approach to explore the causal relationships between T1D and systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and inflammatory bowel disease (IBD). Methods: Summary GWAS data for T1D, SLE, RA, and IBD were downloaded from open GWAS databases and the International Inflammatory Bowel Disease Genetics Consortium (IIBDGC). We employed a series of methods to select instrumental variables closely related to T1D. To enhance the reliability of our conclusions, we applied multiple robust analytical methods, with the inverse variance weighted (IVW) method as the primary approach. Validation and meta-analysis were conducted using the FinnGen consortium. Additionally, we assessed heterogeneity, pleiotropy, and sensitivity to ensure the robustness of our conclusions. Results: A potential causal association was found between T1D and SLE (OR = 1.37, 95% CI = 1.26 - 1.49, P < 0.001), which was further confirmed by meta-analysis. Similarly, a potential causal association was found between T1D and RA (OR = 1.32, 95% CI = 1.17 - 1.50, P < 0.001), and this was also confirmed by meta-analysis. Although the association between T1D and IBD showed P < 0.05, the leave-one-out test did not pass, and further meta-analysis indicated no significant statistical association between them. Conclusion: Our study reveals the relationships between T1D and three clinically common autoimmune diseases (SLE, RA, and IBD). This research supplements previous studies and provides a reference for future clinical work.

3.
World J Gastrointest Surg ; 16(9): 2942-2952, 2024 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-39351558

RESUMEN

BACKGROUND: Gastrointestinal stromal tumors (GISTs) vary widely in prognosis, and traditional pathological assessments often lack precision in risk stratification. Advanced imaging techniques, especially magnetic resonance imaging (MRI), offer potential improvements. This study investigates how MRI imagomics can enhance risk assessment and support personalized treatment for GIST patients. AIM: To assess the effectiveness of MRI imagomics in improving GIST risk stratification, addressing the limitations of traditional pathological assessments. METHODS: Analyzed clinical and MRI data from 132 GIST patients, categorizing them by tumor specifics and dividing into risk groups. Employed dimension reduction for optimal imagomics feature selection from diffusion-weighted imaging (DWI), T1-weighted imaging (T1WI), and contrast enhanced T1WI with fat saturation (CE-T1WI) fat suppress (fs) sequences. RESULTS: Age, lesion diameter, and mitotic figures significantly correlated with GIST risk, with DWI sequence features like sphericity and regional entropy showing high predictive accuracy. The combined T1WI and CE-T1WI fs model had the best predictive efficacy. In the test group, the DWI sequence model demonstrated an area under the curve (AUC) value of 0.960 with a sensitivity of 80.0% and a specificity of 100.0%. On the other hand, the combined performance of the T1WI and CE-T1WI fs models in the test group was the most robust, exhibiting an AUC value of 0.834, a sensitivity of 70.4%, and a specificity of 85.2%. CONCLUSION: MRI imagomics, particularly DWI and combined T1WI/CE-T1WI fs models, significantly enhance GIST risk stratification, supporting precise preoperative patient assessment and personalized treatment plans. The clinical implications are profound, enabling more accurate surgical strategy formulation and optimized treatment selection, thereby improving patient outcomes. Future research should focus on multicenter studies to validate these findings, integrate advanced imaging technologies like PET/MRI, and incorporate genetic factors to achieve a more comprehensive risk assessment.

4.
Nanotechnology ; 2024 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-39353465

RESUMEN

Many studies have been conducted on the use of ultra-small iron oxide nanoparticles (USIONs) (d < 3 nm) as potential positive magnetic resonance imaging (MRI)-contrast agents (CAs); however, there is dearth of research on clustered USIONs. In this study, nearly monodispersed clustered USIONs were synthesized using a simple two-step one-pot polyol method. First, USIONs (d = 2.7 nm) were synthesized, and clustered USIONs (d = 27.9 nm) were subsequently synthesized through multiple cross-linking of USIONs with poly(acrylic acid-co-maleic acid) (PAAMA) polymers with many -COOH groups. The clustered PAAMA-USIONs exhibited very weak ferromagnetism owing to the magnetic interaction between superparamagnetic USIONs; this was evidenced by their appreciable r1= 3.9 s‒1mM‒1and high r2/r1ratio of 14.6. Their ability to function as a dual-modal T1/T2MRI-CA in T1-weighted MRI was demonstrated when they simultaneously exhibited positive and negative contrasts in T1-weighted MRI of tumor model mice after intravenous injection. They displayed positive contrasts at the kidneys, bladder, heart, and aorta and negative contrasts at the liver and tumor. .

6.
Cell Transplant ; 33: 9636897241283728, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39361612

RESUMEN

Human islets can be transplanted into the portal vein for T1 diabetes, and a similar procedure is being used in a clinical trial for stem cell-derived beta-like cells. Efforts have been underway to find an alternative transplant site that will foster better islet cell survival and function. Although conceptually attractive, the subcutaneous (SC) site has yielded disappointing results, in spite of some improvements resulting from more attention paid to vascularization and differentiation factors, including collagen. We developed a method to transplant rat islets in a disk of type 1 collagen gel and found improved efficacy of these transplants. Survival of islets following transplantation (tx) was determined by comparing insulin content of the graft to that of the pre-transplant islets from the same isolation. At 14 days after transplantation, grafts of the disks had more than double the recovered insulin than islets transplanted in ungelled collagen. SC grafts of disks had similar insulin content to grafts in a kidney site and in epididymal fat pads. In vivo disks underwent contraction to 10% of initial volume within 24 h but the islets remained healthy and well distributed. Whole mount imaging showed that residual donor vascular cells within the islets expanded and connected to ingrowing host blood vessels. Islets (400 rat islet equivalents (IEQ)) in the collagen disks transplanted into an SC site of NOD scid IL2R gammanull (NSG) mice reversed streptozotocin (STZ)-induced diabetes within 10 days as effectively as transplants in the kidney site. Thus, a simple change of placing islets into a gel of collagen 1 prior to transplantation allowed a prompt reversal of STZ-induced diabetes using SC site.


Asunto(s)
Trasplante de Islotes Pancreáticos , Trasplante de Islotes Pancreáticos/métodos , Animales , Ratas , Ratones , Masculino , Colágeno Tipo I/metabolismo , Islotes Pancreáticos/metabolismo , Diabetes Mellitus Experimental/terapia , Geles , Humanos , Insulina/metabolismo , Supervivencia de Injerto
7.
Cureus ; 16(9): e68611, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39371824

RESUMEN

Background Type 1 diabetes (T1D) is an autoimmune disorder that results in the destruction of pancreatic beta cells, causing a shortage of insulin secretion. The development of T1D is influenced by both genetic predisposition and environmental factors, such as vitamin D. This vitamin is known for its ability to regulate the immune system and has been associated with a decreased risk of T1D. However, the specific ways in which vitamin D affects immune regulation and the preservation of beta cells in T1D are not yet fully understood. Gaining a better understanding of these interactions is essential for identifying potential targets for preventing and treating T1D. Methods The analysis focused on two Gene Expression Omnibus (GEO) datasets, namely, GSE55098 and GSE50012, to detect differentially expressed genes (DEGs). Enrichr (Ma'ayan Laboratory, New York, NY) was used to perform enrichment analysis for the Gene Ontology (GO) biological process and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. The Search Tool for the Retrieval of Interacting Genes 12.0 (STRING) database was used to generate a protein-protein interaction (PPI) network. The Cytoscape 3.10.1 (Cytoscape Team, San Diego, CA) was used to analyze the PPI network and discover the hub genes. Results The DEGs in both datasets were identified using the GEO2R tool, with a particular focus on genes exhibiting contrasting regulations. Enrichment analysis unveiled the participation of these oppositely regulated DEGs in processes relevant to the immune system. Cytoscape analysis of the PPI network revealed five hub genes, MNDA, LILRB2, FPR2, HCK, and FCGR2A, suggesting their potential role in the pathogenesis of T1D and the response to vitamin D. Conclusion The study elucidates the complex interaction between vitamin D metabolism and immune regulation in T1D. The identified hub genes provide important knowledge on the molecular pathways that underlie T1D and have the potential to be targeted for therapeutic intervention. This research underscores the importance of vitamin D in the immune system's modulation and its impact on T1D development.

8.
Magn Reson Imaging ; 114: 110250, 2024 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-39368520

RESUMEN

BACKGROUND: The T2* technique, used for quantifying myocardial iron content (MIC), has limitations in detecting early myocardial iron overload (MIO). The in vivo mapping of the myocardial T1 relaxation time is a promising alternative for the early detection and management of MIO. METHODS: 32 ß-thalassemia major (ßTM) patients aged 11.5 ± 4 years and 32 healthy controls were recruited and underwent thorough clinical and laboratory assessments. The mid-level septal iron overload was measured through T1 mapping using a modified Look-Locker inversion recovery sequence with a 3 (3 s) 3 (3 s) 5 scheme. Septum was divided at the mentioned level into 3 zones corresponding to segments 8 and 9 in the cardiac segmentation model. RESULTS: 21.9 % of ßTM had clinical cardiac morbidity. The cut-off of T1 mapping of hepatic and myocardium to differentiate between the patients and control groups was ≤466 and ≥ 923 ms respectively. The T1 technique was able to detect 4 patients with high MIC, two of them were not detected by the T2* technique. There was a statistically significant correlation between the average T1 values of the studied zones in patients with ßTM and the liver iron content (LIC), the T1 values within segment 8 of the liver, age of patients, the age at first transfusion, age of splenectomy and serum ferritin value. CONCLUSION: The addition of the T1 mapping sequence to the conventional T2* technique was able to increase the efficacy of the MIC detection protocol by earlier detection of MIO. This would guide chelation therapy to decrease myocardial morbidity.

10.
Pediatr Radiol ; 2024 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-39382638

RESUMEN

BACKGROUND: Lymphatic imaging is becoming increasingly important in the management of patients with congenital heart disease. However, the influence of the intravenous contrast agent ferumoxytol on lymphatic imaging is not well understood. OBJECTIVE: To evaluate the impact of intravenous ferumoxytol on T1-weighted and T2-weighted lymphatic imaging in patients with congenital heart disease. MATERIALS AND METHODS: We included consecutive patients receiving ferumoxytol-enhanced 3D angiography for congenital heart disease evaluation. The visibility of the thoracic duct was reviewed on the T1-weighted 3D inversion recovery balanced-steady-state free precession (SSFP) with respiratory navigator gating sequence which is routinely used for angiography and the heavily T2-weighted turbo spin echo sequence which is employed for lymphatic imaging. Data on demographics and time interval between contrast administration and imaging were collected. Statistical analyses were performed using t-tests for continuous variables and chi-squared tests for categorical variables. RESULTS: One hundred nineteen consecutive patients with a mean age of 12.46 years±7.7 years were included. Of these, 45 cases underwent both T1-weighted and T2-weighted imaging; the other 74 underwent only T1-weighted imaging. Of the 45 patients, 20 had thoracic duct enhancement on T1-weighted imaging; among the 26 sedated, only 2 showed enhancement, while 18 of 19 non-sedated patients showed enhancement (P<0.001), indicating a strong association between sedation and reduced thoracic duct visibility. If T2-weighted imaging was performed after contrast administration, the thoracic duct was not visible on those images. For all 45 cases of visible thoracic duct in the entire cohort, the time from contrast administration to imaging ranged from 8 min up to 75 min. CONCLUSION: The enhancement of the thoracic lymphatic duct on T1-weighted imaging, coupled with degradation observed on T2-weighted imaging, suggests that intravenously administered ferumoxytol rapidly enters the lymphatic fluid. To prevent T2 shortening from degrading the imaging results, T2-weighted imaging for lymphatic evaluation should be performed prior to the administration of ferumoxytol. Sedation and, by inference, fasting may influence this property and warrant further investigation in future studies.

11.
Oncol Lett ; 28(6): 565, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-39385951

RESUMEN

The present study aimed to compare the effectiveness of two abbreviated magnetic resonance imaging (MRI) protocols in assessing the response to neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. Data from the examinations of 62 patients with rectal cancer who underwent neoadjuvant CRT and standard contrast-enhanced rectal MRI were retrospectively evaluated. Standard contrast-enhanced T2-weighted imaging (T2-WI), post-contrast T1-weighted imaging (T1-WI) and diffusion-weighted imaging (DWI) MRI, as well as two abbreviated protocols derived from these images, namely protocol AB1 (T2-WI and DWI) and protocol AB2 (post-contrast fat-suppressed (FS) T1-WI and DWI), were assessed. Measurements of lesion length and width, lymph node short-axis length, tumor staging, circumferential resection margin (CRM), presence of extramural venous invasion (EMVI), luminal mucin accumulation (MAIN), mucinous response, mesorectal fascia (MRF) involvement, and MRI-based tumor regression grade (mrTRG) were obtained. The reliability and compatibility of the AB1 and AB2 protocols in the evaluation of tumor response were analyzed. The imaging performed according to the AB1 and AB2 protocols revealed significant decreases in lesion length, width and lymph node size after CRT. These protocols also showed reductions in lymph node positivity, CRM, MRF, EMVI.Furthermore, both protocols were found to be reliable in determining lesion length and width. Additionally, compliance was observed between the protocols in determining lymph node size and positivity, CRM involvement, and EMVI after CRT. In conclusion, the use of abbreviated MRI protocols, specifically T2-WI with DWI sequences or post-contrast FS T1-WI with DWI sequences, is effective for evaluating tumor response in patients with rectal cancer following neoadjuvant CRT. The AB protocols examined in this study yielded similar results in terms of lesion length and width, lymph node positivity, CRM involvement, EMVI, MAIN, and MRF involvement.

12.
Magn Reson Imaging ; 114: 110248, 2024 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-39357626

RESUMEN

PURPOSE: To gauge the utility of multiparametric MRI in characterizing pathologic changes after iodinated contrast-induced acute kidney injury (CI-AKI) in rats. METHODS: We randomly grouped 24 rats injected with 8 g iodine/kg of body weight (n = 6 each) and 6 rats injected with saline as controls. All rats underwent T1, T2 mapping and diffusion kurtosis imaging (DKI) after contrast injection at 0 (control), 1, 3, 7, 13 days. T1, T2, and mean kurtosis (MK) values were performed in renal outer/inner stripes of outer medulla (OSOM and ISOM) and cortex (CO), and their diagnosis performance for CI-AKI also been evaluated. Serum creatinine (SCr), insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor metalloproteinase 2 (TIMP-2), aquaporin-1 (AQP1), α-smooth muscle actin (α-SMA), and histologic indices were examined. RESULTS: Compared with controls, urinary concentrations of both TIMP-2 and IGFBP7 were obviously elevated from Day 1 to Day 13 (all p < 0.05). T2 values were significantly higher than control group for Days 1 and 3, and T1 and MK increased were more remarkable at all time points (Days 1-13) in CI-AKI (all p < 0.05) than control group. Changes in T1 and MK strongly correlated with renal injury scores of all anatomical compartments and with expression levels of AQP1 and moderately correlated with α-SMA. Changes in T2 values correlating moderately with renal scores of CO, ISOM and OSOM and AQP1. The MK obtained the highest area under the receiver operating characteristic (ROC) curve of 0.846 with a sensitivity of 70.8 % and specificity of 88.9 %. CONCLUSIONS: Combined use of multiparametric MRI could be a valid noninvasive method for comprehensive monitoring of CI-AKI. Among these parameters, MK may achieve the best diagnostic performance for CI-AKI.

13.
Sci Rep ; 14(1): 23302, 2024 10 07.
Artículo en Inglés | MEDLINE | ID: mdl-39375521

RESUMEN

This study aimed to elucidate mid- to long-term radiological and respiratory outcomes in patients aged 7-11 years at index surgery with Marfan syndrome and early-onset scoliosis (EOS) in a retrospective multicenter study. Primary outcomes were final thoracic height and final percentage of predicted vital capacity (%VC) at or after 16 years of age. We identified 21 (6 male and 15 female) patients with a mean age of 9.9 years and mean follow-up period of 149.3 months. Fifteen patients underwent primary fusion, whereas six underwent growth-friendly surgery (GFS). The mean preoperative and final T1-T12 heights were 204.0 mm and 248.0 mm, respectively. Final pulmonary function tests were available for 16 patients, and the mean final %VC was 54.0% with 10 patients exhibiting a final %VC < 60%. A significant moderate association was observed between the final T1-T12 height and final %VC. The predicted final T1-T12 height required for a final %VC of 60% was approximately 260 mm. Although most older patients with Marfan syndrome and EOS acquired a considerably large final T1-T12 height, a larger thoracic height was required for satisfactory respiratory function in many cases; hence, GFS may be indicated even in this population.


Asunto(s)
Síndrome de Marfan , Escoliosis , Humanos , Síndrome de Marfan/complicaciones , Síndrome de Marfan/diagnóstico por imagen , Síndrome de Marfan/fisiopatología , Síndrome de Marfan/cirugía , Escoliosis/cirugía , Escoliosis/diagnóstico por imagen , Escoliosis/fisiopatología , Femenino , Masculino , Niño , Estudios Retrospectivos , Resultado del Tratamiento , Adolescente , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Pruebas de Función Respiratoria , Capacidad Vital , Edad de Inicio , Vértebras Torácicas/cirugía , Vértebras Torácicas/diagnóstico por imagen , Estudios de Seguimiento
14.
Eur Radiol Exp ; 8(1): 109, 2024 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-39377962

RESUMEN

BACKGROUND: Longitudinal T1 relaxation time is a key imaging biomarker. In addition, T1 values are modulated by the administration of T1 contrast agents used in patients with tumors and metastases. However, in clinical practice, dedicated T1 mapping sequences are often not included in brain MRI protocols. The aim of this study is to address the absence of dedicated T1 mapping sequences in imaging protocol by deriving T1 maps from standard T1-weighted sequences. METHODS: A phantom, composed of 144 solutions of paramagnetic agents at different concentrations, was imaged with a three-dimensional (3D) T1-weighed turbo spin-echo (TSE) sequence designed for brain imaging. The relationship between the T1 values and the signal intensities was established using this phantom acquisition. T1 mapping derived from 3D T1-weighted TSE acquisitions in four healthy volunteers and one patient with brain metastases were established and compared to reference T1 mapping technique. The concentration of Gd-based contrast agents in brain metastases were assessed from the derived T1 maps. RESULTS: Based on the phantom acquisition, the relationship between T1 values and signal intensity (SI) was found equal to T1 = 0.35 × SI-1.11 (R2 = 0.97). TSE-derived T1 values measured in white matter and gray matter in healthy volunteers were equal to 0.997 ± 0.096 s and 1.358 ± 0.056 s (mean ± standard deviation), respectively. Mean Gd3+ concentration value in brain metastases was 94.7 ± 30.0 µM. CONCLUSION: The in vivo results support the relevance of the phantom-based approach: brain T1 maps can be derived from T1-weighted acquisitions. RELEVANCE STATEMENT: High-resolution brain T1 maps can be generated, and contrast agent concentration can be quantified and imaged in brain metastases using routine 3D T1-weighted TSE acquisitions. KEY POINTS: Quantitative T1 mapping adds significant value to MRI diagnostics. T1 measurement sequences are rarely included in routine protocols. T1 mapping and concentration of contrast agents can be derived from routine standard scans. The diagnostic value of MRI can be improved without additional scan time.


Asunto(s)
Neoplasias Encefálicas , Medios de Contraste , Imagen por Resonancia Magnética , Fantasmas de Imagen , Prueba de Estudio Conceptual , Humanos , Imagen por Resonancia Magnética/métodos , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/secundario , Masculino , Femenino , Adulto , Imagenología Tridimensional/métodos , Persona de Mediana Edad , Encéfalo/diagnóstico por imagen
16.
J Exp Biol ; 2024 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-39385728

RESUMEN

We investigated the renal function of the brackish water clam, Ruditapes philippinarum, employing magnetic resonance imaging (MRI). This kidney consists of two renal tubules, a glandular (GT) and a saccular (ST) tubule. After exposure to seawater containing manganese ion (Mn2+) at 20℃, the intensity of the T1-weighted MRI and longitudinal relaxation rates (1/T1=R1) of the kidney were increased. In the ST, haemolymph containing Mn2+ entered directly from the auricle, and the Mn2+ concentration ([Mn2+]) increased in the initial part of the ST. Thereafter, [Mn2+] was almost constant until the posterior end of the kidney. The GT received haemolymph from the pedal sinus via the visceral sinus. The GT runs parallel inside the ST, and [Mn2+] increased progressively until it merged with the ST. In a range of seawater with [Mn2+] from 1 to 30 mol·l-1, the [Mn2+] increased 12 fold in the posterior part of the ST, compared to the ambient [Mn2+]. Based on these results, the epithelium of the initial part of the ST reabsorbs water from luminal fluid, building up a higher osmotic pressure. Using this osmotic gradient, hypertonic water is reabsorbed via the epithelium of the GT to the ST, and then transferred to the haemolymph via the epithelium of the ST. Excess water is excreted as urine. This model was supported by the increases in the [Mn2+] in the ST when the clams were exposed to seawater containing Mn2+ at salinity from 26.0 to 36.0‰, showing that the parallel-current system works in hypotonic seawater.

17.
Cureus ; 16(9): e69279, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39398778

RESUMEN

Scleredema diabeticorum is a rare connective tissue complication of diabetes, most typically observed in adults with longstanding type 2 diabetes. Patients develop reticular dermis thickening with a peau d'orange appearance at the upper back and neck that occasionally extends over the deltoids and lower back. While considered a benign disorder, it may signify more significant diabetes and can be functionally and cosmetically impairing with insidious onset, few to no effective treatments, and low spontaneous remission potential. Treatment options are limited; however, radiation therapy has shown clinical benefit in severe cases. Common treatment utilizes 20-24 Gy in 10-12 fractions with retreatment sometimes required for adequate symptom control. Here, we present a case of extensive, treatment-refractory diabetic scleredema status post six separate prior treatments with electron radiotherapy with clinical progression of disease, including involvement of anterior neck limiting jaw and neck range of motion. Volumetric modulated arc therapy (VMAT) was utilized to cover all areas of extensive disease and to treat deeper tissues, which we postulated may decrease skin and underlying tissue tightness and provide clinically meaningful improvements in range of motion. A 57-year-old female with longstanding type 1 diabetes and a six-year history of biopsy-confirmed scleredema presented with treatment-refractory disease in 2022 of the upper back, bilateral upper arms, and neck. Her disease distribution included 270 degrees around her neck, making electron therapy unviable. She had previously undergone multiple treatments, including six separate electron radiotherapy treatment courses to her back, shoulders, and posterior neck between 2016 and 2020 (ranging from 12 Gy in 6 fractions to 24 Gy in 12 fractions for each course), psoralen UV-A therapy, physiotherapy, methotrexate, and percussive therapy. To address the disease extending anteriorly around her neck and below her jaw, as well as the posterior involvement of her shoulders, back, and neck, a more extensive VMAT re-irradiation plan was developed. The plan successfully delivered 20 Gy in 10 fractions to areas of clinically evident disease. Toxicity was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) scoring system at the time of treatment and at the three-month follow-up. Functional improvement, patient satisfaction, skin texture, and induration were assessed during treatment and at her follow-up visit. Following VMAT re-irradiation, the patient denied scorable toxicity and noted the return of mobility in her neck and jaw. We concluded that VMAT-based re-irradiation is a safe and effective option for patients with treatment-refractory scleredema diabeticorum that is non-responsive or not amenable to electron therapy.

18.
Nano Lett ; 2024 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-39400054

RESUMEN

Traditional macromolecules or nanoscale Mn2+ chelate-based magnetic resonance imaging (MRI) contrast agents (CAs) suffer from complicated and laborious synthesis processes, relatively low kinetic stability and T1 relaxivity, limiting their clinical applications. Herein, we fabricated a series of kinetically inert Mn2+ chelate-backboned polymers, P(MnL-PEG), through a facile and one-pot polymerization process. Particularly, P(MnL-PEG)-3 demonstrates a significantly higher T1 relaxivity of 23.9 Mn mM-1 s-1 at 1.5 T than that of previously reported small molecules and macromolecules or nanoscale Mn2+ chelate-based CAs. Due to its high T1 relaxivity, extended blood circulation, hepatocyte-specific uptake, and kidneys metabolism, P(MnL-PEG)-3 presents significantly enhanced contrast in blood vessel, liver, and kidneys imaging compared to clinical Gd3+-based CAs (Gd-EOB-DTPA and Gd-DOTA) at a dosage of 0.05 mmol Mn/Gd kg-1 BW, and can accurately diagnose orthotopic H22 liver tumors in vivo in animal models. We anticipate that this work will promote the development of clinically relevant MRI CAs.

19.
Magn Reson Med ; 2024 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-39402014

RESUMEN

PURPOSE: To develop a new method for free-breathing 3D extracellular volume (ECV) mapping of the whole heart at 3 T. METHODS: A free-breathing 3D cardiac ECV mapping method was developed at 3 T. T1 mapping was performed before and after contrast agent injection using a free-breathing electrocardiogram-gated inversion recovery sequence with spoiled gradient echo readout. A linear tangent space alignment model-based method was used to reconstruct high-frame-rate dynamic images from (k,t)-space data sparsely sampled along a random stack-of-stars trajectory. Joint T1 and transmit B1 estimation were performed voxel-by-voxel for pre- and post-contrast T1 mapping. To account for the time-varying T1 after contrast agent injection, a linearly time-varying T1 model was introduced for post-contrast T1 mapping. ECV maps were generated by aligning pre- and post-contrast T1 maps through affine transformation. RESULTS: The feasibility of the proposed method was demonstrated using in vivo studies with six healthy volunteers at 3 T. We obtained 3D ECV maps at a spatial resolution of 1.9 × 1.9 × 4.5 mm3 and a FOV of 308 × 308 × 144 mm3, with a scan time of 10.1 ± 1.4 and 10.6 ± 1.6 min before and after contrast agent injection, respectively. The ECV maps and the pre- and post-contrast T1 maps obtained by the proposed method were in good agreement with the 2D MOLLI method both qualitatively and quantitatively. CONCLUSION: The proposed method allows for free-breathing 3D ECV mapping of the whole heart within a practically feasible imaging time. The estimated ECV values from the proposed method were comparable to those from the existing method.

20.
Magn Reson Med ; 2024 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-39370883

RESUMEN

PURPOSE: To develop a 3D free-breathing cardiac multi-parametric mapping framework that is robust to confounders of respiratory motion, fat, and B1+ inhomogeneities and validate it for joint myocardial T1 and T1ρ mapping at 3T. METHODS: An electrocardiogram-triggered sequence with dual-echo Dixon readout was developed, where nine cardiac cycles were repeatedly acquired with inversion recovery and T1ρ preparation pulses for T1 and T1ρ sensitization. A subject-specific respiratory motion model relating the 1D diaphragmatic navigator to the respiration-induced 3D translational motion of the heart was constructed followed by respiratory motion binning and intra-bin 3D translational and inter-bin non-rigid motion correction. Spin history B1+ inhomogeneities were corrected with optimized dual flip angle strategy. After water-fat separation, the water images were matched to the simulated dictionary for T1 and T1ρ quantification. Phantoms and 10 heathy subjects were imaged to validate the proposed technique. RESULTS: The proposed technique achieved strong correlation (T1: R2 = 0.99; T1ρ: R2 = 0.98) with the reference measurements in phantoms. 3D cardiac T1 and T1ρ maps with spatial resolution of 2 × 2 × 4 mm were obtained with scan time of 5.4 ± 0.5 min, demonstrating comparable T1 (1236 ± 59 ms) and T1ρ (50.2 ± 2.4 ms) measurements to 2D separate breath-hold mapping techniques. The estimated B1+ maps showed spatial variations across the left ventricle with the septal and inferior regions being 10%-25% lower than the anterior and septal regions. CONCLUSION: The proposed technique achieved efficient 3D joint myocardial T1 and T1ρ mapping at 3T with respiratory motion correction, spin history B1+ correction and water-fat separation.

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