Haemophilia A and B - evaluation of the Swedish prophylactic regimen by magnetic resonance imaging.

INTRODUCTION: Sweden has been a pioneer in the prophylactic treatment of haemophilia. Magnetic resonance imaging (MRI) can detect small changes in joints and can therefore give an indication of a risk of developing arthropathy. AIM: To use MRI to evaluate the outcome of the Swedish 'high-dose regimen' and correlate the findings to age, bleeds, joint score and physical activity. METHODS: The study group comprised 48 Swedish male patients, mean age 25 years (range 12-33 years), with severe or moderate haemophilia A or B. Data on the Haemophilia Joint Health Score (HJHS) were available and physical activity was evaluated by a self-reported questionnaire. RESULTS: MRI score was recorded in 188 joints. Twenty out of 48 patients had a score of ≥1 (range 1-13) in 31 joints of which 3/31 scores were in the knees and 28/31 in the ankles. No correlation was found between the number of recorded bleeds and the MRI score or between HJHS and MRI score. There was no correlation between the physical activity and the number of joint bleeds per se, but a trend (OR 3.0) that those most physically active (19/48; 39.6%), more frequently had an MRI score of ≥1 with an overweight for the right ankle. CONCLUSION: The Swedish prophylactic model offers protection against haemophilia joint arthropathy but will still not prevent osteochondral changes in some patients at young age. MRI of the ankles can signal risk of future arthropathy and indicate need to modify the prophylactic regimen.

Postprandial triglyceride levels rather than fat distribution may reflect early signs of disturbed fat metabolism in Iraqi immigrants.

PURPOSE: Previous studies have shown that at a similar body mass index, Middle Eastern immigrants are more insulin resistant and at higher risk for type 2 diabetes (T2D) than native Europeans. Insulin resistance is strongly associated with disturbed fat metabolism and cardiovascular disease (CVD). However, fat metabolism is poorly investigated comparing Middle Eastern and European ethnicities. METHODS: This observational study included 26 Iraqi and 16 Swedish-born men without T2D or clinical risk factors for CVD. An oral fat tolerance test (OFTT) was performed, where plasma triglycerides (p-TG) were measured for 6 h. mRNA expression and adipocyte size were measured in subcutaneous adipose tissue biopsies collected prior to OFTT, and magnetic resonance imaging was conducted to assess body fat distribution. RESULTS: The median p-TG accumulation was higher and the clearance slower among Iraqis than Swedes. None of the groups reached their fasting p-TG (Iraqis 1.55 mmol/l; Swedes 0.95 mmol/l) after 6 h (Iraqis p-TG 3.10 mmol/l; Swedes p-TG 1.50 mmol/l). Adipocyte size, mRNA expression, and fat accumulation in the liver, muscle and abdomen were similar in both groups. CONCLUSION: Postprandial p-TG levels rather than fat distribution may reflect early signs of disturbed fat metabolism in Iraqi immigrants without CVD risk factors.

Favorable fatty acid composition in adipose tissue in healthy Iraqi- compared to Swedish-born men - a pilot study using MRI assessment.

Middle Eastern immigrants are at high-risk for insulin resistance. Fatty acid composition (FAC) plays an important role in the development of insulin resistance but has not been investigated in people of Middle Eastern ancestry. Here, the aim was to assess the FAC in visceral and subcutaneous adipose tissue (VAT and SAT) in healthy Iraqi- and Swedish-born men using a magnetic resonance imaging (MRI) method.This case-control study included 23 Iraqi- and 15 Swedish-born middle-aged men, without cardiometabolic disease. Using multi-echo MRI of the abdomen, the fractions of saturated, monounsaturated, and polyunsaturated fatty acids (fSFA, fMUFA, and fPUFA) were estimated in VAT and SAT. SAT was further analyzed in deep and superficial compartments (dSAT and sSAT).In all depots, fPUFA was significantly higher and fSFA significantly lower in Iraqi men, independently of age and BMI. In both Iraqi- and Swedish-born men, higher fPUFA and lower fMUFA were found in sSAT vs. dSAT. Among Iraqi men only, higher fPUFA and lower fMUFA were found in SAT vs. VAT.Iraqi-born men presented a more favorable abdominal FAC compared to Swedish-born men. This MRI method also revealed different FACs in different abdominal depots. Our results may reflect a beneficial FAC in Middle Eastern immigrants.

Orthodontic appliances and MR image artefacts: An exploratory in vitro and in vivo study using 1.5-T and 3-T scanners.

PURPOSE: The aim of this study was to assess the artefacts of 12 fixed orthodontic appliances in magnetic resonance images obtained using 1.5-T and 3-T scanners, and to evaluate different imaging sequences designed to suppress metal artefacts. MATERIALS AND METHODS: In vitro, study casts of 1 adult with normal occlusion were used. Twelve orthodontic appliances were attached to the study casts and scanned. Turbo spin echo (TSE), TSE with high readout bandwidth, and TSE with view angle tilting and slice encoding for metal artefact correction were used to suppress metal artefacts. Artefacts were measured. In vivo, 6 appliances were scanned: 1) conventional stainless-steel brackets; 2) nickel-free brackets; 3) titanium brackets; 4) a Herbst appliance; 5) a fixed retainer; and 6) a rapid maxillary expander. The maxilla, mandible, nasopharynx, tongue, temporomandibular joints, and cranial base/eye globes were assessed. Scores of 0, 1, 2, and 3 indicated no artefacts and minor, moderate, and major artefacts, respectively. RESULTS: In vitro, titanium brackets and the fixed retainer created minor artefacts. In vivo, titanium brackets caused minor artefacts. Conventional stainless-steel and nickel free brackets, the fixed retainer, and the rapid maxillary expander caused major artefacts in the maxilla and mandible. Conventional stainless-steel and nickel-free brackets caused major artefacts in the eye globe (3-T). TSE with high readout bandwidth reduced image artefacts in both scanners. CONCLUSION: Titanium brackets, the Herbst appliance, and the fixed retainer caused minor artefacts in images of neurocranial structures (1.5-T and 3-T) when using TSE with high readout bandwidth.

Quantitative 1 H MRI and MRS of fatty acid composition.

Adipose tissue as well as other depots of fat (triglycerides) are increasingly being recognized as active contributors to the human function and metabolism. In addition to the fat concentration, also the fatty acid chemical composition (FAC) of the triglyceride molecules may play an important part in diseases such as obesity, insulin resistance, hepatic steatosis, osteoporosis, and cancer. MR spectroscopy and chemical-shift-encoded imaging (CSE-MRI) are established methods for non-invasive quantification of fat concentration in tissue. More recently, similar techniques have been developed for assessment also of the FAC in terms of the number of double bonds, the fraction of saturated, monounsaturated, and polyunsaturated fatty acids, or semi-quantitative unsaturation indices. The number of papers focusing on especially CSE-MRI-based techniques has steadily increased during the past few years, introducing a range of acquisition protocols and reconstruction algorithms. However, a number of potential sources of bias have also been identified. Furthermore, the measures used to characterize the FAC using both MRI and MRS differ, making comparisons between different techniques difficult. The aim of this paper is to review MRS- and MRI-based methods for in vivo quantification of the FAC. We describe the chemical composition of triglycerides and discuss various potential FAC measures. Furthermore, we review acquisition and reconstruction methodology and finally, some existing and potential applications are summarized. We conclude that both MRI and MRS provide feasible non-invasive alternatives to the gold standard gas chromatography for in vivo measurements of the FAC. Although both are associated with gas chromatography, future studies are warranted.

Quantified small bowel motility in patients with ulcerative colitis and gastrointestinal symptoms: a pilot study.

BACKGROUND: Gastrointestinal (GI) symptoms are common in patients with ulcerative colitis (UC), even when the disease is in remission, possibly due to abnormalities in GI motility. Small bowel motility can be assessed globally and in specific intestinal regions during magnetic resonance enterography (MRE) using a displacement mapping technique. PURPOSE: To investigate whether small bowel motility in MRE differs between patients with UC and controls, and if altered motility correlates with GI symptoms. MATERIAL AND METHODS: In 2016-2018, patients who were admitted for MRE, regardless of clinical indication, were consecutively invited to the study. Healthy volunteers were recruited. The participants completed a questionnaire regarding GI symptoms and relevant clinical data were reviewed in the medical records. The dynamic imaging series obtained during MRE were sent for motility mapping and a motility index (MI) was calculated in jejunum, ileum and terminal ileum in all participants. RESULTS: In total, 224 patients and healthy volunteers were enrolled in the study. Fifteen were diagnosed with UC and 22 were considered healthy controls. In UC, the prevalence of GI symptoms was higher than in controls (P < 0.001), both in remission and in active disease. There was no correlation between GI symptoms and small bowel motility in UC. Jejunal motility was lower in UC than in controls (P = 0.049). CONCLUSION: Jejunal motility is decreased in UC compared with healthy controls, but there is no relationship between small bowel motility and GI symptoms in UC.

Motility index measured by magnetic resonance enterography is associated with sex and mural thickness.

BACKGROUND: Recently, a technique has been developed to use magnetic resonance enterography (MRE) for the evaluation of small bowel motility. The hypothesis was that assessment of the motility index (MI) should reflect differences in motility between clinical conditions. AIM: To aim of the present observational, cross-sectional study was to evaluate the use of the MI in daily clinical practice. METHODS: All consecutive patients aged 18-70 years who were referred for MRE at the Department of Radiology during a 2-year period were asked to participate. Healthy volunteers were included as controls. MRE was prepared and conducted in accordance with clinical routines. On the day of examination, all the participants had to complete the visual analog scale for irritable bowel syndrome (IBS) and IBS-symptom severity scale. Maps of MI were calculated from dynamic MR images. ANOVA was used to evaluate differences in MI between groups, classified as healthy, Crohn's disease, ulcerative colitis, IBS, other assorted disorders and dysmotility. Logistic and linear regression were applied to the MI values. All medical records were scrutinized for medical history. RESULTS: In all, 224 examinations were included (inclusion prevalence 76.3%), with 22 controls and 202 patients. There was a significant difference in the MI of the jejunum (P = 0.021) and terminal ileum (P = 0.007) between the different groups. The MI was inversely associated with the mural thickness of the terminal ileum in men (P < 0.001) and women (P = 0.063) after adjustments, and tended to be lower in men than in women (P = 0.056). Subjectively observed reduction of motility on MRI was accomplished by reduced MI of terminal ileum in men (P < 0.001) and women (P = 0.030). In women, diarrhea was inversely associated with the MI of the jejunum (P = 0.029), and constipation was positively associated with the MI of the terminal ileum (P = 0.039). CONCLUSION: Although MIs differ across diseases, a lower MI of the terminal ileum is mainly associated with male sex and an increased mural thickness. Symptoms are weakly associated with the MI.

Volumetric analysis of small bowel motility in an unselected cohort of patients with Crohn's disease.

BACKGROUND: Quantified terminal ileal motility during magnetic resonance enterography (MRE) has been suggested to be used as a biomarker of Crohn's disease (CD). The aim of the present study was to evaluate this method in clinical practice. METHODS: Healthy volunteers and all consecutive patients referred to MRE during a 2-year period were asked to participate and complete the Irritable Bowel Syndrome-Symptom Severity Scale (IBS-SSS) to assess gastrointestinal symptoms. Medical records were scrutinized, and motility indices (MIs) were calculated from MR images. KEY RESULTS: Twenty-two healthy controls and 134 examinations with CD were included (inclusion rate: 76.3%). Patients with CD had increased mural thickness of the terminal ileum, increased fecal calprotectin, and more symptoms than controls. Patients with active CD had increased mural thickness of ileum and terminal ileum, higher MR activity indices, and signs of inflammation in laboratory analyses, but similar symptoms, compared with inactive disease. After exclusion of sole colon disease (n = 13), MI inversely correlated with mural thickness in terminal ileum, and MI was lower in active disease versus controls in ileum (P = .019) and terminal ileum (P = .005), and versus inactive disease in terminal ileum (P = .044). The area under the curve of MI in terminal ileum was 0.736 for active CD against healthy controls (P = .002) and 0.682 for active against inactive CD (P = .001). MIs were similar in controls and inactive CD. CONCLUSIONS AND INTERFERENCES: MI reflects inflammatory activity in the intestine. Alterations in MI did not explain symptomatology in inactive CD, without measurable inflammatory parameters in morphology or laboratory analyses.

In vivo comparison of MRI-based and MRS-based quantification of adipose tissue fatty acid composition against gas chromatography.

PURPOSE: To compare MR-based fatty acid composition (FAC) quantification methods against the gold standard technique, gas chromatography (GC), with comparison of a free and a constrained signal model. The FAC was measured in the healthy and edematous legs of lymphedema patients. METHODS: In vivo MRS and MRI data were acquired from 19 patients at 3 T. Biopsies were collected from subcutaneous adipose tissue of both thighs during liposuction. The saturated, monounsaturated, and polyunsaturated fatty acid fractions (fSFA , fMUFA and fPUFA , respectively) were estimated with the MR-based methods using two signal models: free and constrained (number of methylene-interrupted double bonds expressed in number of double bonds, based on GC data). Linear regression, Bland-Altman plots, and correlation coefficients were used to evaluate the MR methods against the GC of the biopsies. Paired t-test was used to compare the FAC difference between edematous and healthy legs. RESULTS: The estimated parameters correlated well with the GC data (rSFA , rMUFA , and rPUFA = 0.82, 0.81 and 0.89, respectively) using the free model MRI-based approach. In comparison, the MRS-based method resulted in weaker correlations and larger biases compared with MRI. In both cases, correct estimation of fMUFA and fPUFA fractions were not possible using the constrained model. The difference in FAC of healthy and edematous legs were estimated to 0.008 (P = .01), -0.009 (P = .005), and 0.002 (P = .03) for fSFA , fMUFA , and fPUFA . CONCLUSION: In this study, MRI-based FAC quantification was highly correlated, although slightly biased, compared with GC, whereas the MRS-based approach resulted in weaker correlations. Small but significant differences could be found between the healthy and edematous legs of lymphedema patients using GC analysis.

Dynamic 2D and 3D mapping of hyperpolarized pyruvate to lactate conversion in vivo with efficient multi-echo balanced steady-state free precession at 3 T.

The aim of this study was to acquire the transient MRI signal of hyperpolarized tracers and their metabolites efficiently, for which specialized imaging sequences are required. In this work, a multi-echo balanced steady-state free precession (me-bSSFP) sequence with Iterative Decomposition with Echo Asymmetry and Least squares estimation (IDEAL) reconstruction was implemented on a clinical 3 T positron-emission tomography/MRI system for fast 2D and 3D metabolic imaging. Simulations were conducted to obtain signal-efficient sequence protocols for the metabolic imaging of hyperpolarized biomolecules. The sequence was applied in vitro and in vivo for probing the enzymatic exchange of hyperpolarized [1-13 C]pyruvate and [1-13 C]lactate. Chemical shift resolution was achieved using a least-square, iterative chemical species separation algorithm in the reconstruction. In vitro, metabolic conversion rate measurements from me-bSSFP were compared with NMR spectroscopy and free induction decay-chemical shift imaging (FID-CSI). In vivo, a rat MAT-B-III tumor model was imaged with me-bSSFP and FID-CSI. 2D metabolite maps of [1-13 C]pyruvate and [1-13 C]lactate acquired with me-bSSFP showed the same spatial distributions as FID-CSI. The pyruvate-lactate conversion kinetics measured with me-bSSFP and NMR corresponded well. Dynamic 2D metabolite mapping with me-bSSFP enabled the acquisition of up to 420 time frames (scan time: 180-350 ms/frame) before the hyperpolarized [1-13 C]pyruvate was relaxed below noise level. 3D metabolite mapping with a large field of view (180 × 180 × 48 mm3 ) and high spatial resolution (5.6 × 5.6 × 2 mm3 ) was conducted with me-bSSFP in a scan time of 8.2 seconds. It was concluded that Me-bSSFP improves the spatial and temporal resolution for metabolic imaging of hyperpolarized [1-13 C]pyruvate and [1-13 C]lactate compared with either of the FID-CSI or EPSI methods reported at 3 T, providing new possibilities for clinical and preclinical applications.

Is good muscle function a protective factor for early signs of knee osteoarthritis after anterior cruciate ligament reconstruction? The SHIELD cohort study protocol.

Introduction: Knee injury history and increased joint load, respectively, are major risk factors for the development of knee osteoarthritis (OA). Lower extremity muscle function, such as knee muscle strength, influence joint load and may be important for the onset of knee OA. However, the role of muscle function as a possible modifiable protective mechanism for the development of OA after anterior cruciate ligament reconstruction (ACLR) is not clear. Methods and analysis: In this prospective cohort study, 100 patients (50% women, 18-35 years) with ACLR will be recruited from Skåne University Hospital, Sweden and Oslo University Hospital, Norway. They will be assessed with a comprehensive test battery of muscle function including muscle strength, muscle activation, hop performance, and postural orientation as well as patient-reported outcomes, one year (baseline) and three years (follow-up) after ACLR. Primary predictor will be knee extension strength, primary outcome will be patient-reported knee pain (Knee injury and Osteoarthritis Outcome Score, subscale pain) and secondary outcomes include compositional MRI (T2 mapping) and turnover of cartilage and bone biomarkers. Separate linear regression model will be used to elucidate the influence of each baseline muscle function variable on the outcomes at follow-up, adjusted for baseline values. Twenty non-injured individuals will also be assessed with MRI. This study is approved by The Regional Ethical Review Board in Lund (Sweden) and Oslo (Norway). Discussion: This study may have important clinical implications for using muscle function to screen for risk of early-onset knee OA and for optimizing exercise therapy after knee injury.

Assessment of Subfascial Muscle/Water and Fat Accumulation in Lymphedema Patients Using Magnetic Resonance Imaging.

Background: In patients with arm or leg lymphedema, more fat has been found in the epifascial compartment of the edematous limb compared to the healthy limb. However, not much is known about subfascial fat accumulation in these patients. This study aims to investigate the intramuscular and intermuscular fat and muscle/water volume in lymphedema patients. The excess of intramuscular and intermuscular fat volume was also compared to the excess epifascial fat volume, the excess limb volume, and the duration of lymphedema. Methods and Results: Data from 13 patients (seven arm and six leg lymphedemas) were acquired using a 1.5 T magnetic resonance imaging (MRI) scanner before liposuction and at five time points (4 days, 4 weeks, 3 months, 6 months, and 1 year) after liposuction. From water-fat imaging, fat and muscle/water volumes within the intramuscular and intermuscular compartments were calculated. The relative excess volume was defined as (volume of edematous limb-volume of healthy limb)/volume of healthy limb. Elevated relative excess volumes of intramuscular and intermuscular fat were found at all time points. A decrease in the relative excess volume of muscle/water over time was found. This decrease was not correlated to the relative excess of epifascial fat volume, the relative excess of limb volume, or the duration of lymphedema. Conclusions: An excess fat volume was found in the intramuscular and intermuscular compartments in lymphedema patients. The results suggest that the subfascial compartment needs to be studied separately as no correlation between intramuscular/intermuscular fat accumulation and other measured parameters was found.

Increased perfusion in dynamic gadolinium-enhanced MRI correlates with areas of bone repair and of bone necrosis in patients with Kienböck's disease.

BACKGROUND: Osteonecrosis of the lunate, Kienböck's disease, can lead to fragmentation of the lunate, carpal collapse, and severe osteoarthritis. Since the etiology of Kienböck's disease is impaired circulation, a diagnostic method capable of assessing perfusion would be valuable. Recent studies have suggested that dynamic contrast-enhanced (DCE) MR examinations at 3 T can assess perfusion in healthy carpal bones. PURPOSE: To evaluate the use of DCE-MR for assessing perfusion in the lunate bone in patients with Kienböck's disease. Furthermore, to compare perfusion with histopathology with a focus on bone viability. STUDY TYPE: Prospective case-control study. POPULATION: Fourteen patients with Kienböck's disease and a control group of 19 healthy subjects. Field Strength: 3 T with T1 -weighted fat-saturated contrast-enhanced gradient echo series. ASSESSMENT: Features of the enhancement curves from the DCE-MR examinations, time to peak (TTP), maximum slope (MS), and maximum enhancement (ME) assessed by a radiologist. Six of 14 patients were surgerized with lunate excision, allowing comparison between features of the enhancement curves and histopathology. STATISTICAL TESTS: Mann-Whitney U-test. P < 0.05 was considered a statistically significant difference. RESULTS: Patients with Kienböck's disease showed significantly higher and faster perfusion parameters compared with the control group, the mean value of the TTP in patients was 126.73 sec, in controls 189.79 sec (P = 0.024), ME in patients 173.55 AU, in controls 28.46 AU (P < 0.001), and MS in patients 5.04 AU, in controls 1.06 AU (P < 0.001). When compared with histopathology, increased perfusion was seen in areas of bone formation but also in necrosis. Areas of normal bone showed low perfusion. DATA CONCLUSION: DCE-MRI at 3 T can diagnose altered perfusion in patients with Kienböck's disease. Increased perfusion cannot definitely be used as a marker of bone viability. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:481-489.

Engage In or Refrain From? A Qualitative Exploration of Premarital Sexual Relations Among Female College Students in Tehran.

This study explored the factors that educated young Iranian women consider when they decide whether to have premarital sex. Using a purposive sampling method, 30 in-depth interviews were conducted with female college students in both government and private universities in Tehran in 2005-2006. The respondents included unmarried women who had experienced sexual relations, unmarried women who had abstained, and married women. Young women's considerations for premarital sex included (1) marriage meaning and motivations; (2) compliance with family values and expectations; (3) perceived gender and social norms of premarital sex; (4) importance of religiosity; and (5) sexual knowledge and self-efficacy. Marriage meaning and motivation seem to be the central pillar in the complex decision to engage in or refrain from premarital sex among female college students. These considerations have theoretical implications for understanding premarital relationships and sex in a conservative setting. Finally, some shifts are occurring in the meaning of marriage and sexual mores among educated young women in Iran; these changes are discussed.

Spectroscopic differences in posterior insula in patients with chronic temporomandibular pain.

Background and aims Chronic pain including temporomandibular disorder (TMD) pain involves a complex interplay between peripheral and central sensitization, endogenous modulatory pathways, cortical processing and integration and numerous psychological, behavioral and social factors. The aim of this study was to compare spectroscopic patterns of N-Acetyl-aspartate (NAA), total creatine (tCr), choline (Cho), myo-inositol (MI), glutamate (Glu), and the combination of Glu and glutamine in the posterior insula in patients with chronic generalized or regional chronic TMD pain (gTMD and rTMD, respectively) compared to healthy individuals (HI) in relation to clinical findings of TMD pain. Methods Thirty-six female patients with chronic rTMD or gTMD with at least 3 months duration were included in the study. Ten healthy women were included as controls. All participants completed a questionnaire that comprised assessment of degrees of depression, anxiety, stress, catastrophizing, pain intensity, disability and locations. A clinical Diagnostic Criteria for Temporomandibular Disorders examination that comprised assessment of pain locations, headache, mouth opening capacity, pain on mandibular movement, pain on palpation and temporomandibular joint noises was performed. Pressure-pain threshold (PPT) over the masseter muscle and temporal summation to pressure stimuli were assessed with an algometer. Within a week all participants underwent non-contrast enhanced MRI on a 3T MR scanner assessing T1-w and T2-w fluid attenuation inversion recovery. A single-voxel 1H-MRS examination using point-resolved spectroscopy was performed. The metabolite concentrations of NAA, tCr, Cho, MI, Glu and Glx were analyzed with the LC model. Metabolite levels were calculated as absolute concentrations, normalized to the water signal. Metabolite concentrations were used for statistical analysis from the LC model if the Cramér-Rao bounds were less than 20%. In addition, the ratios NAA/tCr, Cho/tCr, Glu/tCr and MI/tCr were calculated. Results The results showed significantly higher tCr levels within the posterior insula in patients with rTMD or gTMD pain than in HI (p=0.029). Cho was negatively correlated to maximum mouth opening capacity with or without pain (rs=-0.42, n=28, p=0.031 and rs=-0.48, n=28, p=0.034, respectively) as well as pressure-pain threshold on the hand (rs=-0.41, n=28, p=0.031). Glu was positively correlated to temporal summation to painful mechanical stimuli (rs=0.42, n=26, p=0.034). Conclusions The present study found that increased concentrations of Cho and Glu in the posterior insular cortex is related to clinical characteristics of chronic TMD pain, including generalized pain. These findings provide new evidence about the critical involvement of the posterior insular cortex and the neurobiology underlying TMD pain in both regional and generalized manifestations. Implications The findings in this study have indirect implications for the diagnosis and management of TMD patients. That said, the findings provide new evidence about the critical involvement of the posterior insular cortex and the neurobiology underlying TMD pain in both regional and generalized manifestations. It is also a further step towards understanding and accepting chronic pain as a disorder in itself.

Lymphedema Leads to Fat Deposition in Muscle and Decreased Muscle/Water Volume After Liposuction: A Magnetic Resonance Imaging Study.

BACKGROUND: Lymphedema leads to adipose tissue deposition. Water-fat magnetic resonance imaging (MRI) can quantify and localize fat and water. The presence of excess fat and excess water/muscle in the subfascial compartment of the lymphedematous limb has not been investigated before. The aim of this study was to investigate epifascial and subfascial fat and water contents in patients with chronic lymphedema before and after liposuction. METHODS AND RESULTS: Seven patients with arm lymphedema and six with leg lymphedema were operated on. The limbs were examined with water-fat MRI before liposuction (baseline) and at five time points. Complete reduction of the excess limb volumes was achieved. The excess epifascial fat was evident in the edematous limbs and a drop was seen following surgery. There were differences in excess water at all time points. At 1 year there was a decrease in excess water. Excess subfascial fat was seen in the edematous limbs at all time points. Subfascial excess water/muscle did not show any differences after surgery. However, starting from 3 months there was less subfascial water/muscle compared with baseline. CONCLUSIONS: Subfascial fat in the lymphedematous limbs did not change. In contrast, the water in the subfascial compartment was reduced over time, which may represent a decrease of muscle volume after treatment due to less mechanical load after liposuction. Using water-fat MRI-based fat quantification, the fat and water contents may be quantified and localized in the various compartments in lymphedema.

High-Resolution MR Imaging of Muscular Fat Fraction-Comparison of Three T2-Based Methods and Chemical Shift-Encoded Imaging.

Chemical shift-encoded imaging (CSEI) is the most common magnetic resonance imaging fat-water separation method. However, when high spatial resolution fat fraction (FF) images are desired, CSEI might be challenging owing to the increased interecho spacing. Here, 3 T2-based methods have been assessed as alternative methods for obtaining high-resolution FF images. Images from the calf of 10 healthy volunteers were acquired; FF maps were then estimated using 3 T2-based methods (2- and 3-parameter nonlinear least squares fit and a Bayesian probability method) and CSEI for reference. In addition, simulations were conducted to characterize the performance of various methods. Here, all T2-based methods resulted in qualitatively improved high-resolution FF images compared with high-resolution CSEI. The 2-parameter fit showed best quantitative agreement to low-resolution CSEI, even at low FF. The estimated T2-values of fat and water, and the estimated muscle FF of the calf, agreed well with previously published data. In conclusion, T2-based methods can provide improved high-resolution FF images of the calf compared with the CSEI method.

Health Risks in Same-Sex Attracted Ugandan University Students: Evidence from Two Cross-Sectional Studies.

Widespread discrimination across much of sub-Saharan Africa against persons with same-sex sexuality, including recent attempts in Uganda to extend criminal sanctions against same-sex behavior, are likely to have profound effects on this group's health, health care access, and well-being. Yet knowledge of the prevalence of same-sex sexuality in this region is scarce. This study aimed to systematically examine prevalence of same-sex sexuality and related health risks in young Ugandan adults. We conducted two cross-sectional survey studies in south-western Uganda targeting student samples (n = 980, n = 1954) representing 80% and 72% of the entire undergraduate classes attending a university in 2005 and 2010, respectively. A questionnaire assessed items concerning same-sex sexuality (same-sex attraction/fantasies, same-sex sexual relations), mental health, substance use, experience of violence, risky sexual behavior, and sexual health counseling needs. Our findings showed that same-sex sexual attraction/fantasies and behavior were common among male and female students, with 10-25% reporting having sexual attraction/fantasies regarding persons of the same-sex, and 6-16% reporting same-sex sexual relations. Experiences of same-sex sexuality were associated with health risks, e.g. poor mental health (2010, AOR = 1.5; 95% CI: 1.0-2.3), sexual coercion (2010, AOR 2.9; CI: 1.9-4.6), and unmet sexual health counseling needs (2010, AOR 2.2; CI: 1.4-3.3). This first study of young adults in Uganda with same-sex sexuality found high levels of health needs but poor access to health care. Effective response is likely to require major shifts in current policy, efforts to reduce stigmatization, and reorientation of health services to better meet the needs of this vulnerable group of young people.

Computational postprocessing quantification of small bowel motility using magnetic resonance images in clinical practice: An initial experience.

PURPOSE: To study the feasibility and to gauge the potential clinical impact of quantifying small bowel motility using magnetic resonance imaging (MRI) in a larger population with a spectra of gastrointestinal conditions with impaired small bowel motility. MATERIALS AND METHODS: Data were gathered retrospectively from a cohort of 127 patients undergoing MR enterography (1.5 Tesla) in 2011. Cine motility sequences were processed with validated motility analysis software and a parametric motility map was generated. Regions of interests were drawn in the jejunum, ileum, and terminal ileum, and Jacobian standard deviation mean motility index' score (MIS) was calculated. Patients were divided into Crohn's disease (CD), ulcerative colitis, irritable bowel syndrome, and healthy subjects. RESULTS: In CD, terminal ileum motility was lower in comparison to healthy subjects (mean difference: -0.1052 arbitrary units, 95% confidence interval: -0.1981--0.0122, P = 0.018). Subgrouping of CD showed that the difference was recognized in patients with disease limited to the small bowel (mean difference: -0.1440 arbitrary units, 95% confidence interval: -0.2491--0.0389, P = 0.002). Visible dysmotility of terminal ileum on MRI reflected a reduced MIS compared with normal motility (0.22 ± 0.09 and 0.33 ± 0.15 arbitrary units, respectively, P = 0.043). Motility correlated negatively between ileum and age (P = 0.021), and between terminal ileum and C-reactive protein in ulcerative colitis (P = 0.031). CONCLUSION: Motility quantitation revealed a significant difference in motility of terminal ileum in patients with small bowel CD compared with healthy subjects, concording with visible dysmotility and inflammatory changes. J. Magn. Reson. Imaging 2016;44:277-287.