Analysis of the small chromosomal Prionium serratum (Cyperid) demonstrates the importance of reliable methods to differentiate between mono- and holocentricity.

For a long time, the Cyperid clade (Thurniceae-Juncaceae-Cyperaceae) was considered a group of species possessing holocentromeres exclusively. The basal phylogenetic position of Prionium serratum (Thunb.) Drège (Thurniceae) within Cyperids makes this species an important specimen to understand the centromere evolution within this clade. In contrast to the expectation, the chromosomal distribution of the centromere-specific histone H3 (CENH3), alpha-tubulin and different centromere-associated post-translational histone modifications (H3S10ph, H3S28ph and H2AT120ph) demonstrate a monocentromeric organisation of P. serratum chromosomes. Analysis of the high-copy repeat composition resulted in the identification of two centromere-localised satellite repeats. Hence, monocentricity was the ancestral condition for the Juncaceae-Cyperaceae-Thurniaceae Cyperid clade, and holocentricity in this clade has independently arisen at least twice after differentiation of the three families, once in Juncaceae and the other one in Cyperaceae. In this context, methods suitable for the identification of holocentromeres are discussed.

Benefits and pitfalls of iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) imaging in clinical application of the cervical spine MR.

AIM: To evaluate efficacy of T2-weighted (T2W) iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL)-fast spin echo (FSE) imaging of the cervical spine. MATERIALS AND METHODS: The cervical spine of 100 symptomatic patients was imaged using routine magnetic resonance imaging (MRI) versus IDEAL-FSE imaging. The signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), and image quality were analysed. To compare the diagnostic efficiency of degenerative spondylopathy, evaluations of spondylolisthesis, retrolisthesis, disc herniation, myelopathy, disc degeneration, and bone marrow oedema were also performed. RESULTS: IDEAL-FSE showed significantly higher SNRs and CNRs (all p<0.001) than fat-suppressed (FS) T2W-FSE. Sixteen of 100 patients had cervical spine instrumentation; in those patients, IDEAL-FSE provided significantly better uniformity of fat suppression (p<0.001) and fewer metallic artefacts (p<0.001). For patients without instrumentation, FS T2W-FSE showed significantly better overall image quality (p<0.001) and homogeneity of the cerebrospinal fluid (CSF; p<0.001) with fewer motion artefacts (p<0.001). IDEAL-FSE, however, provided significantly better uniformity of fat suppression (p<0.001). There were no significant differences in the diagnoses of spondylolisthesis, retrolisthesis, disc herniation, or myelopathy between IDEAL and FS T2W images. The only significant differences between the IDEAL and FS T2W images were noted when diagnosing degenerative disc disease at the C2-3 and C5-6 disc levels (p=0.019, p=0.002, respectively) and bone marrow oedema at C3 vertebral body (p=0.029). CONCLUSION: T2W IDEAL-FSE imaging should only be considered as an additional sequence to conventional FS T2W images in patients with poor fat suppression or severe metallic artefacts.

High-concentration iodinated contrast media for T1-weighted direct magnetic resonance arthrography.

AIM: To quantify in vitro the T1-weighted (T1W) expression of iodinated contrast media (CM), and to compare the in vivo performances of iodinated CM and gadolinium-based CM for T1W direct magnetic resonance imaging (MRI) arthrography. MATERIALS AND METHODS: An in vitro study on a 1.5 T MRI system was performed using Gd-DOTA, a mixture of iopromide and Gd-DOTA, and iopromide alone. The fat-suppressed (FS) T1W signal intensities were measured and analysed. In an in vivo study, 15 normal rabbits were used to compare the expression of iopromide (370 mg iodine/ml), and the mixture of iopromide and diluted Gd-DOTA. In nine of the 15 rabbits, extra-articular administrations of CM were performed to mimic the situation of CM leak. The rabbits were scanned on a 1.5 T MRI system, and the FS T1W sequence and an axial iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) T1W sequence were acquired. Signal intensities were measured and signal-to-noise ratios (SNR) were analysed. RESULTS: In the in vitro study, a higher SNR was noted in a higher concentration of iopromide, and the highest SNR of iopromide was 45.9% of that of Gd-DOTA. In the in vivo study, the iopromide and the mixture were well identified in all rabbits. The SNRs of the intra-articular and extra-articular iopromide and the mixture were significantly higher than the SNR of the muscles in the FS T1W images (all, p<0.01) and the IDEAL images (all, p<0.01). CONCLUSIONS: A high-concentration iodinated CM can provide good imaging quality for T1W direct MRI arthrography, and may be an alternative option in certain clinical situations.

Distinction between pyogenic brain abscess and necrotic brain tumour using 3-tesla MR spectroscopy, diffusion and perfusion imaging.

The purpose of this study is to compare the effectiveness of relative cerebral blood volume, apparent diffusion coefficient and spectroscopic imaging in differentiating between cerebral abscesses and necrotic tumours. In the prospective study, a 3-tesla MR unit was used to perform proton MR spectroscopy, diffusion and perfusion imaging in 20 patients with cerebral abscesses and 26 patients who had solitary brain tumours (14 high-grade gliomas and 12 metastases). We found the mean apparent diffusion coefficient value at the central cavities of the cerebral abscesses to be significantly lower than in necrotic tumours. The mean relative cerebral blood volume values of the necrotic tumour wall were statistically significantly higher than the mean relative cerebral blood volume values of the cerebral abscess wall by the Student's t-test. The proton spectra obtained revealed amino acids only in the cerebral abscesses. Although the conventional MRI characteristics of cerebral abscesses and necrotic tumours may sometimes be similar, diffusion, perfusion-weighted and spectroscopic MRI enables distinction between the two.

Hepatocellular carcinoma - issues in imaging.

The imaging diagnosis of hepatocellular carcinoma is challenging as benign hypervascular lesions and arterioportal shunts (pseudolesions) often mimic it. There is also overlap in the imaging appearance from dysplastic and regenerating nodules. This article addresses the above imaging problems, examines proposed non-invasive imaging criteria for the diagnosis of hepatoma and discusses the optimal imaging modality.

High resolution CT of Wegener's granulomatosis--case reports.

Computed Tomography (CT) of the chest was performed in three patients with Wegener's granulomatosis to define the anatomical basis of pulmonary involvement. Nodules, masses with cavitation, and areas of parenchymal opacities were typical manifestations on CT images. An extremely wide variety of radiologic findings were demonstrated in addition to the commonly described cavitary nodules.

Dynamic contrast-enhanced subtraction and delayed MRI of gastric tumors: radiologic-pathologic correlation.

PURPOSE: Our goal was to determine whether dynamic MR subtraction images could be used to detect and stage gastric tumors. METHOD: Dynamic MR subtraction images were prospectively performed in 20 patients without gastric lesions and in 39 patients with gastric tumors. The flat- or depressed-type early gastric cancers were excluded. The MR findings were assessed for layered pattern of the normal gastric wall, detectability of tumors, enhanced pattern of tumor, and depth of the tumor invasion. Surgical specimens were obtained from 30 of the patients with tumors, and histopathologic sections were made in the dynamic MR scanning direction. RESULTS: The three-layered structure of the normal gastric wall was apparent in more of the dynamic MR subtraction images (60%) than of the nonsubtraction images (30%) in the control group. All 39 gastric tumors were detected by MRI. The intact inner layers overlying stromal tumors and outer layers interrupted by advanced gastric cancers were clear on the subtracted images. MRI accurately T-staged 88% of the gastric cancers. CONCLUSION: Dynamic MR subtraction images can be used to identify gastric tumors and to stage gastric cancers.

MR cholangiography in the evaluation of neonatal cholestasis.

PURPOSE: To evaluate the usefulness of magnetic resonance (MR) cholangiography in excluding biliary atresia as the cause of neonatal cholestasis. MATERIALS AND METHODS: MR cholangiography was performed on 10 control and 16 jaundiced neonates and infants aged 3 days to 5 months. Diagnosis of biliary atresia (n = 6) was confirmed with surgery and liver biopsy, with or without surgical cholangiography. Diagnosis of neonatal hepatitis (n = 9) was confirmed with clinical follow-up until jaundice resolved. In one infant, paucity of intrahepatic ducts was diagnosed at liver biopsy. MR cholangiography was performed with respiratory-triggered, heavily T2-weighted turbo spin-echo and optional inversion-recovery turbo spin-echo sequences. Diagnosis of biliary atresia was based on nonvisualization of either the common bile duct or common hepatic duct. Cholescintigraphy with technetium 99m disofenin was performed in all 16 jaundiced patients. RESULTS: In the 10 controls, the nine patients with neonatal hepatitis, and the one infant with paucity of intrahepatic ducts, MR cholangiography clearly depicted the gallbladder and common hepatic and common bile ducts. MR cholangiography was 100% accurate in excluding biliary atresia as the cause of neonatal cholestasis, while 99mTc disofenin cholescintigraphic findings were false-positive in four of 10 patients with nonobstructive cholestasis. CONCLUSION: MR cholangiography can be used to depict the major biliary structures of neonates and small infants and to exclude biliary atresia as the cause of neonatal cholestasis by allowing visualization of the biliary tract.

Emphysematous pyelonephritis: imaging diagnosis and follow-up.

We conducted the study to evaluate the efficacy and roles of different imaging modalities in the diagnosis and follow-up of emphysematous pyelonephritis (EPN) and to correlate imaging findings with clinical outcome. Retrospective analysis of the imaging studies and clinical outcome were performed in 28 consecutive patients with EPN. They were all initially treated with CT-guided percutaneous drainage (PCD). The imaging studies performed included plain abdominal radiography (KUB) (n = 28), sonography (US)(n = 24), intravenous urography (IVU)(n = 5), retrograde pyelography (RP)(n = 20) and computed tomography (CT)(n = 28). Follow-up imaging studies included CT(n = 23) and renal scintigraphy (n = 15). The sensitivities of detecting abnormal gas in EPN on KUB and US were 66% and 88%. The mortality rate was 11%, not associated with different types, stages or renal involvement. On the follow-up CT performed within one month of PCD, type I EPN evolved into type II in 86% of the cases. On the long-term follow-up CT, renal atrophy and focal scarring were revealed in the diffuse and focal renal involvement of EPN. The mean split renal function shown on the follow-up scintigraphy was 30%. We concluded KUB and US were valuable for screening EPN, although CT was the most specific and sensitive. Follow-up CT studies not only demonstrate the response of treatment but also depict the different courses and the results of different types and renal involvement of EPN, although not associated with mortality rate.

Diagnostic efficacy of non-breath-hold magnetic resonance cholangiopancreatography.

Magnetic resonance cholangiopancreatography (MRCP) is an emerging imaging technique for direct visualization of biliary and pancreatic ducts without the need for an invasive procedure, ionizing radiation, or iodine contrast media administration. The purpose of this study was to evaluate the efficacy of non-breath-hold MRCP in depicting normal and diseased biliary and pancreatic ducts. A retrospective analysis of 162 patients who underwent MRCP was performed, and a comparison between MRCP and direct cholangiography was made. The overall accuracy of MRCP in diagnosing malignant and benign pancreaticobiliary diseases was also calculated. MRCP depicted more than three hepatic segments in 99% of patients with dilated intrahepatic ducts and in 63% of patients with nondilated intrahepatic ducts. MRCP demonstrated the main hepatic duct, gallbladder, and cystic duct in 100%, 89%, and 72% of patients, respectively. The dilated extrahepatic duct, nondilated extrahepatic duct, dilated pancreatic duct, and nondilated pancreatic duct were visualized in 100%, 98%, 95%, and 77% of patients, respectively. The accuracy of MRCP in diagnosing hepatolithiasis, cholecystolithiasis, and choledocholithiasis was 96%, 97%, and 96%, respectively. The obstruction levels and characteristics determined by MRCP were in agreement with those determined from direct cholangiography in 98% of malignant obstructions and 89% of benign obstructions. The overall accuracy of a combination of MRCP and conventional magnetic resonance imaging in diagnosing pancreaticobiliary diseases was 81% for malignant diseases, 86% for benign diseases, and 82% for stone diseases. We conclude that non-breath-hold MRCP can reliably depict normal and diseased pancreaticobiliary ducts except for cystic ducts and nondilated pancreatic ducts.

Imaging features of simultaneous occurrence of renal and pancreatic foreign body granuloma due to chronically retained gauze: a case report.

Herein we are reporting a case of simultaneous occurrence of renal and pancreatic foreign body granuloma due to retained gauze. The different imaging features of the two lesions make correct preoperative diagnosis difficult. Foreign body granulomas due to retained surgical gauze or sponges should be considered in patients who have previous histories of operations and who also have a mass in the surgical bed. Simultaneous occurrence of foreign body granuloma away from primary surgical field is also possible.

Gd(DTPA-BBA) as a contrast agent in magnetic resonance imaging in rats.

Gadolinium (III)-di(benzyl carbamoylmethyl) diethylenetrinitrilotriacetic acid [Gd(DTPA-BBA)] is a newly developed paramagnetic complex designed for use as a hepatobiliary-specific contrast agent. The purpose of this study was to examine the relaxivity, biodistribution, and magnetic resonance (MR) imaging characteristics of Gd(DTPA-BBA) in rats. Our results showed that the T1 relaxivity of Gd(DTPA-BBA) (3.89 dm3/mmol/s in aqueous solution) was similar to that of Gd(III) diethylenetriamine-pentaacetate [Gd(DTPA)]2- (4.08 dm3/mmol/s) and Gd(III) benzyloxypropionicte-traacetate [Gd(BOPTA)]2- (4.40 dm3/mmol/s). Biodistribution studies indicated that Gd(DTPA-BBA) exhibited hepatobiliary and urinary elimination. In MR imaging studies, Gd(DTPA-BBA) provided biphasic enhancement of normal liver parenchyma, which was characterized by an initial steep increase in enhancement followed by a plateau. The initial relative enhancement (RE%) of the liver, at 1 minute after administration of 0.2 mmol/kg Gd(DTPA-BBA) was 113 +/- 19. The plateau RE% of the liver (48 +/- 13) occurred within 10 minutes and persisted for at least 60 minutes after injection of the contrast agent. In addition, Gd(DTPA-BBA) provided better RE% of the liver than [Gd(DTPA)]2-. The contrast RE% of liver abscess capsules reached a plateau within 5 minutes after injection of 0.1 mmol/kg Gd(DTPA-BBA). Although the hepatic enhancement of Gd(DTPA-BBA) was inferior to that of [Gd(BOPTA)]2-, the results suggest that Gd(DTPA-BBA) has potential as an MR contrast agent for nonspecific and hepatobiliary uses.

Cerebral perfusion in children with Alice in Wonderland syndrome.

Alice in Wonderland syndrome (AIWS) is characterized by visual hallucinations and bizarre perceptual distortions. Technetium-99m hexamethylpropyleneamine tomography (SPECT) brain scans were performed in four patients during the acute stage of AIWS. Two patients were demonstrated to have Epstein-Barr virus infections. One had abnormal (EEG) findings. The visual-evoked potential, cranial CT, and MRI findings were negative. The decreased cerebral perfusion areas in all patients were near the visual tract and visual cortex. All involved some regions of the temporal lobe. In most patients with AIWS, the EEG, CT, and MRI are unable to determine the precise pathologic areas. However, a SPECT brain scan may demonstrate abnormal perfusion areas and explain the clinical presentations.

Inflammatory/infectious diseases and neoplasms of colon. Evaluation with CT.

The purpose of this study is to review the computed tomography (CT) appearance of infectious and inflammatory diseases, and neoplasms of colon. Forty-five patients with 25 cases of colonic neoplasms and 20 cases of inflammatory and infectious diseases of colon were evaluated based on CT findings of colonic wall thickening (> 5 mm, soft tissue density versus pure wall edema or both), length of the involved segment (short (< or = 5 cm) versus long segment), pericolic infiltration, mesenteric infiltration, lateroconal fascial thickening, mechanical ileus, ascites, contiguous terminal ileum involvement, distribution of the diseased colon, and abscess formation. The results were compared using chi-square test or Fisher's exact test. Our results showed that colonic wall thickening of soft tissue density with or without edema and pure bowel wall edema were the two statistically significant findings in differential diagnosis of colon (p < 0.05). We concluded that CT is a good imaging tool to make differential diagnosis between infectious/ inflammatory diseases and neoplasms.

Preclinical evaluation of Fe-(5-C2H5-EHPG)- as a contrast agent in MR imaging of hepatobiliary system.

Iron(III)-N, N'-ethylenebis[2-(2-hydroxy-5-phenyl)glycine] [Fe-(5-C2H5-EHPG)-] is a paramagnetic complex designed for use as a hepatobiliary agent. Test procedures included synthesis, characterization, toxicity evaluation, biodistribution and experiments for animal MR images. The dose of LD50 in acute toxicity test of Fe-(5-C2H5-EHPG)- in mice was 3.49 mmol/kg. 111In-(5-C2H5-EHPG)- biodistribution studies revealed that the activities were (4.78 +/- 0.97, 5.34 +/- 0.91, 4.53 +/- 0.35)%ID and (0.88 +/- 0.18, 0.99 +/- 0.17, 0.84 +/- 0.06)%ID/gm in the liver at time intervals of 10, 30 and 60 minutes after injection; (5.76 +/- 0.15, 5.75 +/- 0.15, 4.00 +/- 0.04)%ID and (0.49 +/- 0.03, 0.49 +/- 0.05, 0.34 +/- 0.01)%ID/gm in the blood; (1.27 +/- 0.91, 1.46 +/- 1.00, 1.52 +/- 0.46) %ID and (0.89 +/- 0.17, 1.02 +/- 0.18, 1.06 +/- 0.08)%ID/gm in the kidneys, respectively. The results of image enhancement correlated well to the biodistribution. Analysis of the MR images showed degrees of maximal parenchymal % increase of signal to noise ratio (S/N) was 42.09 +/- 3.59% for normal liver at 30 minutes postinjection, which exceeded the value of pathologic liver with bile duct obstruction 16 hours 17.26 +/- 6.6 %, 1 week 19.80 +/- 6.46% and 4 weeks 32.20 +/- 9.01%, respectively, and acute hepatitis 16.50% +/- 4.02%. Persistent enhancement plateau was documented up to 60 minutes after injection and normalized to precontrast value within 22 hours. The common duct was opacified at 10-15 minutes after injection of contrast agent. These results indicated that the Fe-(5-C2H5-EHPG)- could be rapidly extracted from the blood stream by the hepatocytes and excreted into the bile duct. The initial evaluation of Fe-(5-C2H5-EHPG)- demonstrated that Fe-(5-C2H5-EHPG)- was well suited for enhancement of normal liver parenchyma and was compromised with deterioration of liver function. However, the increase of the liver intensities in the animal model of the total biliary obstruction group normalized to precontrast value within 22 hours, which indicated that renal clearance as an effective alternative pathway for biliary excretion. In conclusion, these results indicate that Fe-(5-C2H5-EHPG)- has the potential of becoming a safe and reliable magnetopharmaceutical for the hepatobiliary system.

Calcification in retroperitoneal non-Hodgkin lymphoma prior to treatment: a case report.

Calcification in malignant lymphoma before treatment is rare. Here we report a case of low grade non-Hodgkin lymphoma of sclerosing type presenting as a retroperitoneal calcified mass. The calcification was demonstrated with various imaging modalities, including conventional radiographs, sonography, computed tomography (CT) and magnetic resonance (MR) imaging. This case and other isolated reports show that radiographical examinations may, rarely, reveal calcification in lymphoma prior to treatment.

Imaging diagnosis of cavernous hemangioma of the rib--one case report and review of the literature.

Osseous hemangioma is a benign neoplasm, rarely located in the ribs. A 56-year-old female patient without specific complaint had a large extrapleural lesion on chest posteroanterior radiograph. Expansile destruction of left seventh rib and relatively fine trabeculation were noticed in the mass from plain roentgenogram and computed tomography (CT). Contrast enhancement in noncalcified component of the lesion was revealed. Pleural effusion, lung parenchymal or mediastinal abnormality were not identified. Resection of the lesion with part of the originating rib was carried out. The pathologic diagnosis was cavernous hemangioma. We present a case with a large rib hemangioma which often leads to difficulty in radiologically differential diagnosis with other common malignant rib tumors. We also review the literature about hemangioma and malignant neoplasms of the ribs.

MR imaging of sports-related muscle injuries.

Magnetic resonance (MR) imaging of the thighs of 26 baseball athletes and one softball athlete were studied to evaluate muscle injuries. We documented the abnormalities present in MR imaging after a muscle injury and evaluated the role of MR imaging in muscle injuries. Fifteen of the athletes showed muscle abnormalities in MR images. These include muscle strains without tear, muscle tear, scar and chronic tendon injury. Having the advantages of high tissue contrast and multiplanar display capability, MR allowed direct visualization of the injured muscles and characterization of traumatic lesions. We conclude that MR could be a good imaging modality for evaluating muscle injuries.

An autopsy-proved case of AIDS in Taiwan.

The first case of AIDS positively identified in a non-foreigner in Taiwan was a 25-year-old unmarried male who had practiced homosexuality for ten years. The patient began to have abdominal pain accompanied with loose stools and weight loss in June 1985, followed by fever, cough, headache, dizziness, and loss of memory. Facial hyperpigmentation and extensive oroesophageal candidiasis were noted. Laboratory studies showed severe lymphopenia with a reversed T-helper to T-suppressor ratio, cutaneous anergy and polyclonal gammopathy. Human immunodeficiency virus (HIV) antibodies were positive by ELISA and Western blot, and the virus was isolated from the blood. At autopsy, disseminated cytomegalovirus infection, extensive CNS toxoplasmosis and early lesions of Kaposi's sarcoma were demonstrated. The detection of HIV in the adrenal medulla supports the consensus that the virus is neurotropic.

A mass vaccination program in Taiwan against hepatitis B virus infection in infants of hepatitis B surface antigen-carrier mothers.

To combat hepatitis B virus (HBV) infection in Taiwan, a mass immunoprophylaxis program was launched on July 1, 1984, aiming first at prevention of chronic HBV carriage from perinatal mother-to-infant infection. In the first 15-month period, 352,721 (78%) of 450,585 pregnant women were screened for hepatitis B surface antigen (HBsAg); HBsAg was present in 62,359 (18%), with 50% of them categorized as highly infectious. Infants born to HBsAg-positive women were given 5 micrograms of a plasma-derived hepatitis B vaccine at ages 1, 5, and 9 weeks, with a booster at age 12 months. Infants of highly infectious carrier mothers received an additional 0.5 mL of hepatitis B immune globulin within 24 hours after birth. The coverage rate of the hepatitis B immune globulin was 77% in 27,375 infants born to highly infectious mothers, and that of the first, second, third, and the fourth doses of vaccine was 88%, 86%, 84%, and 71%, respectively, in infants of 55,620 carrier mothers. The reported untoward reactions to immunization were negligible. We conclude that a mass hepatitis B vaccination program is feasible in hyperendemic areas such as Taiwan; this should be a significant step toward the effective control of HBV infection in these areas.