Navigator-triggered and breath-hold 3D MRCP using compressed sensing: image quality and method selection factor assessment.

PURPOSE: To examine whether MRCP using a combination of compressed sensing and sensitivity encoding with navigator-triggered and breath-hold techniques (NT C-SENSE and BH C-SENSE, respectively) have comparable image quality to that of navigator-triggered MRCP using only sensitivity encoding (NT SENSE) at 1.5-T. METHODS: Fifty-one participants were enrolled in this prospective study between July and October 2018 and underwent the three 3D MRCP sequences each. The acquisition time and relative duct-to-periductal contrast ratios (RC values) of each bile duct segment were obtained. Visualization of the bile and main pancreatic ducts, background suppression, artifacts, and overall image quality were scored on 5-point scales. Mean and median differences in RC values and qualitative scores of NT C-SENSE and BH C-SENSE relative to NT SENSE were calculated with 95% confidence intervals (CIs). RESULTS: Acquisition time of NT SENSE, NT C-SENSE, and BH C-SENSE were 348, 143 (mean for both), and 18 s (for all participants), respectively. The RC value of each bile duct segment was inferior, but the lower limits of the 95% CIs of the mean differences were ≥ - 0.10, for both NT C-SENSE and BH C-SENSE. The visualization score of the intrahepatic duct in BH C-SENSE was inferior to that in NT SENSE (lower 95% CI limit, - 1.5). In both NT C-SENSE and BH C-SENSE, the 95% CIs of the median differences in the other qualitative scores were from - 1.0 to 0.0. CONCLUSION: NT C-SENSE and BH C-SENSE have comparable image quality to NT SENSE at 1.5-T.

Dual-frequency MR elastography to differentiate between inflammation and fibrosis of the liver: Comparison with histopathology.

BACKGROUND: Differentiation between inflammation and fibrosis is an important clinical distinction in patients with chronic liver disease, which has been difficult so far with MR elastography. PURPOSE: To investigate whether dual-frequency MR elastography can estimate necroinflammation of the liver and improve diagnostic performance for the staging of liver fibrosis. STUDY TYPE: Retrospective. SUBJECTS: In all, 30 patients (14 males, 16 females) with chronic liver disease. FIELD STRENGTH/SEQUENCE: 1.5T/dual-frequency MR elastography at 60-Hz and 80-Hz vibration frequencies. [Correction added on November 12, 2019, after first online publication: The field strength in the preceding sentence was corrected.] ASSESSMENT: Necroinflammation activity and fibrosis were assessed using the METAVIR scoring system. Stiffness values at 60-Hz (G60-Hz ) and 80-Hz (G80-Hz ) were obtained with an MR elastogram. The difference value between G80-Hz and G60-Hz (ΔG) was calculated. Four values (G60-Hz , G80-Hz , G60-Hz - ΔG, and G80-Hz + ΔG) were generated to estimate necroinflammation and fibrosis. STATISTICAL TESTS: The ΔG were correlated with necroinflammation activity grade and fibrosis stage using Spearman's rank correlation. Diagnostic performance of the four values for necroinflammation activity grade and fibrous stage was assessed by using area under the receiver operating characteristic curve (AUC). RESULTS: The mean value of G80-Hz (6.23 ± 3.67 kPa) was significantly higher than that of G60-Hz (5.27 ± 3.14 kPa) (P < 0.0001). The ΔG demonstrated a strong correlation with necroinflammation grade (ρ = 0.625, P < 0.001) and no correlation with fibrosis stage (ρ = 0.306, P = 0.113). The AUC of the G80-Hz and G80-Hz + ΔG showed higher accuracy for necroinflammation, and optimal cutoff values yielded better discrimination of ≥A1, ≥A2, and = A3. The AUC demonstrated that all the generated values had high diagnostic performance (≥0.87 for all) for fibrosis. DATA CONCLUSION: Dual-frequency MR elastography shows potential in estimating necroinflammation of the liver and may improve diagnostic performance for staging liver fibrosis. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1053-1064.

Exercise-based cardiac rehabilitation for patients with catheter ablation for persistent atrial fibrillation: A randomized controlled clinical trial.

AIMS: The efficacy and safety of cardiac rehabilitation for patients with persistent atrial fibrillation who restored sinus rhythm after catheter ablation remains unclear. The aim of the present study was to evaluate the effects of cardiac rehabilitation on exercise capacity, inflammatory status, cardiac function, and safety in patients with persistent atrial fibrillation who had catheter ablation. METHODS: In this randomized controlled study, 61 patients treated with catheter ablation for persistent atrial fibrillation (male, 80%; mean age, 66 ± 9 years) were analyzed. Thirty patients underwent cardiac rehabilitation (rehabilitation group), whereas the remaining 31 patients received usual care (usual care group). The rehabilitation group underwent endurance and resistance training with moderate intensity, at least three times per week for six months. Six-minute walk distance, muscle strength, serum high-sensitivity C-reactive protein, plasma pentraxin 3, left ventricular ejection fraction and atrial fibrillation recurrence were assessed at baseline and at six-month follow-up. RESULTS: In the rehabilitation group, significant increases in the six-minute walk distance, handgrip strength, leg strength and left ventricular ejection fraction and significant decreases in high-sensitivity C-reactive protein and plasma pentraxin 3 concentrations were observed at six-month follow-up compared with baseline (all p < 0.05). No significant changes were observed in the usual care group. During the six-month follow-up period, the number of patients with atrial fibrillation recurrence was six (21.4%) in the rehabilitation group and eight (25.8%) in the usual care group (risk ratio, 0.83; 95% confidence interval, 0.33 to 2.10). CONCLUSIONS: Cardiac rehabilitation improved exercise capacity without increasing the risk for atrial fibrillation recurrence. It may also be effective in managing systemic inflammatory status and systolic left ventricular function in patients with persistent atrial fibrillation treated with catheter ablation.

Possible association between successful intubation via the right nostril and anatomical variations of the nasopharynx during nasotracheal intubation: a multiplanar imaging study.

PURPOSE: Most reported cases of nasopharyngeal laceration following impingement during nasotracheal intubation involved tube insertion via the right nostril. We postulated that recesses on the posterior wall of the nasopharynx might be associated with tube impingement. Using multiplanar imaging and clinical statistics, we evaluated whether anatomical variations in the recesses are related to successful intubation via the right nostril. METHODS: Using multiplanar computed tomography (CT) images of 97 patients, we investigated the locations of recesses relative to the mid-sagittal plane, nasal floor plane and posterior end of the nasal septum, and their shapes. Incidents of impingement of the tube during nasotracheal intubation and the shapes of the fossa of Rosenmüller on CT images were retrospectively evaluated in 170 patients. RESULTS: Eustachian tube orifices were located approximately 10 mm laterally from the sagittal plane, and approximately 10 mm above the nasal floor plane. The fossa of Rosenmüller was vertically elongated and located 7 mm laterally from the mid-sagittal plane. Pharyngeal bursae were found in 15 % of the subjects. Patients with failed insertion via the right nostril due to impingement frequently had a wide opening of the fossa of Rosenmüller. CONCLUSIONS: Successful intubation via the right nostril is related to the anatomy of structures on the posterior nasopharyngeal wall, particularly recesses located close to the path of nasotracheal tube insertion. Nasopharyngeal anatomical variations should be considered when one notices any resistance to advancement of the tube into the nasopharynx during nasotracheal intubation.

Differentiation of lung neoplasms with lepidic growth and good prognosis from those with poor prognosis using computer-aided 3D volumetric CT analysis and FDG-PET.

BACKGROUND: Many studies have reported that transverse computed tomography (CT) imaging findings correlate with prognosis of patients with small peripheral lung neoplasm with lepidic growth. However, no studies have examined this correlation with the aid of three-dimensional (3D) CT data. PURPOSE: To determine the most efficacious imaging factor for differentiation of lepidic growth type lung neoplasms with good prognosis from those with poor prognosis. MATERIAL AND METHODS: We evaluated CT findings, nodule patterns, SUVmax on FDG-PET/CT, as well as nodule volume and ratios of solid parts to nodule volume that were semi-automatically measured on CT images of 64 pulmonary nodules of ≤ 2 cm in 60 consecutive patients (24 men and 36 women; mean age, 65 years). For logistic modeling, we used all of the significant factors observed between the neoplasms with good and with poor prognosis as independent variables to estimate the statistically significant factors for discriminating invasive adenocarcinomas with lepidic growth (lesions with poor prognosis, n=42) from the other neoplasms, including preinvasive lesions (lesions with good prognosis, n=22), resulting in a recommendation for the optimal criterion for predicting lesions with poor prognosis. RESULTS: The logistic regression model identified the ratio of the solid part to the whole volume of a pulmonary nodule as the only significant factor (P=0.04) for differentiating lepidic growth type lung neoplasms with good prognosis from those with poor prognosis. A ratio of 0.238 or more showed the highest discriminatory accuracy of 84% with 91% sensitivity and 76% specificity. CONCLUSION: Computer-aided analyses of pulmonary nodules proved most useful for establishing the optimal criterion for differentiation of lepidic growth type lung neoplasms with good prognosis from those with poor prognosis.

Thin-section CT findings in peripheral lung cancer of 3 cm or smaller: are there any characteristic features for predicting tumor histology or do they depend only on tumor size?

BACKGROUND: Ground-glass opacity (GGO) is reported to be characteristic to lepidic growth of neoplasm in subsolid nodules. In solid nodules of lung cancer, however, there is no characteristic feature to be reported. PURPOSE: To study if there are any thin-section CT findings characteristic to tumor histology or if they are only related to tumor size in solid nodules of the lung cancer. MATERIAL AND METHODS: This study included 106 solid peripheral lung cancers of 3 cm or smaller (56 adenocarcinomas, 33 squamous cell carcinomas, and 17 small cell carcinomas) in which 16-slice CT with 1 mm collimation was performed before surgery. Six morphologic findings (presence or absence of lobulation, coarse spiculation, air bronchogram, cavity, pleural tag, and pleural-based lesion) and four measurements (ratio of the greatest transverse and vertical diameter to the shortest transverse diameter and density of lobulation and coarse spiculation) on thin-section CT images were evaluated. Density of lobulation (coarse spiculation) was defined as the ratio of lobulation (coarse spiculation) number to the greatest transverse diameter of a nodule. RESULTS: Air bronchogram (P < 0.01) was the only significant factor for predicting lung adenocarcinoma. The prevalence of air bronchogram was significantly greater in adenocarcinoma than in squamous cell carcinoma (P < 0.01) or small cell carcinoma (P < 0.01). As the tumor size advanced, significantly positive linear trends were seen in the prevalence of lobulation (P < 0.01), coarse spiculation (P < 0.01), and pleural tag (P < 0.01), and the mean values of density of lobulation (P < 0.01) and coarse spiculation (P < 0.01), while the significant negative linear trend was seen in the ratio of vertical diameter to the shortest transverse (P = 0.02). CONCLUSION: Air bronchogram on thin-section CT is characteristic feature of solid adenocarcinoma of the lung. However, other thin-section CT findings are irrelevant to tumor histology and related only to tumor size.

Diagnosis of regional node metastases in lung cancer with computer-aided 3D measurement of the volume and CT-attenuation values of lymph nodes.

RATIONALE AND OBJECTIVES: The aim of this study is to assess the usefulness of computer-aided three-dimensional (3D) measurement of volume and computed tomography (CT) attenuation values of nodes for diagnosing nodal metastases of lung cancer. MATERIALS AND METHODS: We measured three diameters, their ratios, volume, and CT values in 3D images of 191 nodes (64 malignant; 162 of <1 cm in short diameter) in 26 consecutive patients who underwent contrast-enhanced, thin-section, multidetector row CT before surgery. We separately studied statistically significant factors in a group of all nodes and in another group of nodes of <1 cm in short diameter with logistic modeling and evaluated their diagnostic accuracy. RESULTS: Significant factors were CT values (P < .001) and short diameter (P = .001) for the total node group, and CT values (P = .030) and 3D volume (P = .035) for the <1 cm node group. Optimal 83% accuracy was obtained with a criterion of short diameter of >7.4 mm and CT values of >103 Hounsfield unit (HU) for the total node group, whereas optimal 76% accuracy was obtained with a criterion of 3D volume of >1282 mm(3) or CT values of >103 HU for the <1 cm node group. CONCLUSION: 3D measurement may be useful for diagnosing nodal metastases.

F18-FDG PET-CT analyses of small peripheral adenocarcinoma of the lung.

BACKGROUND: Radiological discrimination of histologic subtypes of small peripheral adenocarcinoma of the lung is clinically important. Although there are many articles in which CT findings were used for this purpose, there are only a few reports on the capability of FDG PET-CT findings for histologic classification of this tumor. PURPOSE: To investigate the correlation between visual assessment or maximum standard uptake values (SUVmax) on F18-FDG PET-CT and histology grading of small peripheral adenocarcinoma of the lung. MATERIAL AND METHODS: Proportions of positive PET-CT diagnoses and SUVmax were retrospectively reviewed on 96 solitary pulmonary nodules of ≤2 cm in 90 consecutive patients. Tumors were classified into four groups according to Noguchi's classification (group 1 [n = 10], atypical adenomatous hyperplasia and type A tumors; group 2 [n = 12], type B tumors; group 3 [n = 42], type C tumors; group 4 [n = 32], types D, E, and F tumors). Proportions of positive PET-CT diagnoses and mean SUVmax of lesions among four groups were compared using trend tests to examine if there is a significant linear correlation with the progression of the histology grading of tumors. Then, an optimal threshold of SUVmax was proposed to best discriminate tumors of poor (groups 3 and 4) from good (groups 1 and 2) prognosis. RESULTS: There was a significant linear trend for both visual assessment (P < 0.01) and SUVmax (P < 0.01). A SUVmax of 0.42 showed the highest accuracy of 84% with 95% sensitivity and 50% specificity for predicting tumors of poor prognosis. A SUVmax of 2.05 showed 100% specificity with 49% sensitivity, and 60% accuracy. Positive visual diagnoses showed accuracy of 83% with 90% sensitivity and 59% specificity. CONCLUSION: Visual assessment and SUVmax on PET-CT correlated well with the histology grading of small peripheral adenocarcinoma of the lung.

Stereoselective conversion of anhydrovinblastine into vinblastine utilizing an anti-vinblastine monoclonal antibody as a chiral mould.

Dimeric indole alkaloid, anhydrovinblastine, which can be obtained from catharanthine and vindoline in a high yield, was converted stereoselectively into vinblastine through alternating oxidation-reduction with oxygen and NaBH(3)CN in the presence of anti-vinblastine monoclonal antibody.