Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differentiation of soft tissue sarcoma from benign lesions: a systematic review of literature.

OBJECTIVE: To systematically review the literature assessing the role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) in the differentiation of soft tissue sarcomas from benign lesions. MATERIALS AND METHODS: A comprehensive literature search was performed with the following keywords: multiparametric magnetic resonance imaging, DCE-MR perfusion, soft tissue, sarcoma, and neoplasm. Original studies evaluating the role of DCE-MRI for differentiating benign soft-tissue lesions from soft-tissue sarcomas were included. RESULTS: Eighteen studies with a total of 965 imaging examinations were identified. Ten of twelve studies evaluating qualitative parameters reported improvement in discriminative power. One of the evaluated qualitative parameters was time-intensity curves (TIC), and malignant curves (TIC III, IV) were found in 74% of sarcomas versus 26.5% benign lesions. Six of seven studies that used the semiquantitative approach found it relatively beneficial. Four studies assessed quantitative parameters including Ktrans (contrast transit from the vascular compartment to the interstitial compartment), Kep (contrast return to the vascular compartment), and Ve (the volume fraction of the extracellular extravascular space) in addition to other parameters. All found Ktrans, and 3 studies found Kep to be significantly different between sarcomas and benign lesions. The values for Ve were variable. Additionally, eight studies assessed diffusion-weighted imaging (DWI), and 6 of them found it useful. CONCLUSION: Of different DCE-MRI approaches, qualitative parameters showed the best evidence in increasing the diagnostic performance of MRI. Semiquantitative and quantitative approaches seemed to improve the discriminative power of MRI, but which parameters and to what extent is still unclear and needs further investigation.

MRI-based Neuropathy Score Reporting And Data System (NS-RADS): multi-institutional wider-experience usability study of peripheral neuropathy conditions among 32 radiology readers.

OBJECTIVE: To determine the inter-reader reliability and diagnostic performance of classification and severity scales of Neuropathy Score Reporting And Data System (NS-RADS) among readers of differing experience levels after limited teaching of the scoring system. METHODS: This is a multi-institutional, cross-sectional, retrospective study of MRI cases of proven peripheral neuropathy (PN) conditions. Thirty-two radiology readers with varying experience levels were recruited from different institutions. Each reader attended and received a structured presentation that described the NS-RADS classification system containing examples and reviewed published articles on this subject. The readers were then asked to perform NS-RADS scoring with recording of category, subcategory, and most likely diagnosis. Inter-reader agreements were evaluated by Conger's kappa and diagnostic accuracy was calculated for each reader as percent correct diagnosis. A linear mixed model was used to estimate and compare accuracy between trainees and attendings. RESULTS: Across all readers, agreement was good for NS-RADS category and moderate for subcategory. Inter-reader agreement of trainees was comparable to attendings (0.65 vs 0.65). Reader accuracy for attendings was 75% (95% CI 73%, 77%), slightly higher than for trainees (71% (69%, 72%), p = 0.0006) for nerves and comparable for muscles (attendings, 87.5% (95% CI 86.1-88.8%) and trainees, 86.6% (95% CI 85.2-87.9%), p = 0.4). NS-RADS accuracy was also higher than average accuracy for the most plausible diagnosis for attending radiologists at 67% (95% CI 63%, 71%) and for trainees at 65% (95% CI 60%, 69%) (p = 0.036). CONCLUSION: Non-expert radiologists interpreted PN conditions with good accuracy and moderate-to-good inter-reader reliability using the NS-RADS scoring system. CLINICAL RELEVANCE STATEMENT: The Neuropathy Score Reporting And Data System (NS-RADS) is an accurate and reliable MRI-based image scoring system for practical use for the diagnosis and grading of severity of peripheral neuromuscular disorders by both experienced and general radiologists. KEY POINTS: • The Neuropathy Score Reporting And Data System (NS-RADS) can be used effectively by non-expert radiologists to categorize peripheral neuropathy. • Across 32 different experience-level readers, the agreement was good for NS-RADS category and moderate for NS-RADS subcategory. • NS-RADS accuracy was higher than the average accuracy for the most plausible diagnosis for both attending radiologists and trainees (at 75%, 71% and 65%, 65%, respectively).

Percutaneous ultrasound-guided needle tenotomy for treatment of chronic tendinopathy and fasciopathy: a meta-analysis.

OBJECTIVES: To systematically assess the efficacy of percutaneous ultrasound-guided needle tenotomy (PUNT) in the treatment of chronic tendinopathy and fasciopathy. METHODS: A comprehensive literature search was performed with the following search terms: tendinopathy, tenotomy, needling, Tenex, fasciotomy, ultrasound-guided, and percutaneous. Inclusion criteria consisted of original studies evaluating pain or function improvement after PUNT. Meta-analyses investigating standard mean differences were performed to assess the pain and function improvement. RESULTS: Thirty-five studies with 1674 participants (1876 tendons) were enrolled in this article. Of which 29 articles were included in meta-analysis and the remaining 9 articles without enough numeric data were included in descriptive analysis. PUNT significantly alleviated pain with the standard mean difference of 2.5 (95% CI: 2.0-3.0; p < 0.05), 2.2 (95% confidence interval (CI): 1.8-2.7; p < 0.05), and 3.6 (95% CI: 2.8-4.5; p < 0.05) points in short-term, intermediate-term, and long-term follow-up intervals, respectively. It was also associated with marked improvement in function with 1.4 (95% CI: 1.1-1.8; p < 0.05), 1.8 (95% CI: 1.3-2.2; p < 0.05), and 2.1 (95% CI: 1.6-2.6; p < 0.05) points, respectively in short-term, intermediate-term, and long-term follow-ups. CONCLUSION: PUNT improved pain and function at short-term intervals with persistent results on intermediate- and long-term follow-ups. PUNT can be considered an appropriate minimally invasive treatment for chronic tendinopathy with a low rate of complications and failures. CLINICAL RELEVANCE: Tendinopathy and fasciopathy are two common musculoskeletal complaints that can cause prolonged pain and disability. PUNT as a treatment option could improve pain intensity and function. KEY POINTS: • The best improvement in pain and function was achieved after the first 3 months following PUNT and was continued to the intermediate- and long-term follow-ups. • No significant difference was found between different tenotomy methods in terms of pain and function improvement. • PUNT is a minimally invasive procedure with promising results and low complication rates for treatments of chronic tendinopathy.

Cystic lesions and bursae around the knee: do they matter in knee osteoarthritis?

The cause of knee osteoarthritis (OA) and knee pain associated with OA is not well understood. Periarticular cystic lesions and bursae around the knee are among the most common morphologic features identified on MRI in the setting of OA. Despite widespread association of these lesions with knee OA and their inclusion in semiquantitative MRI scoring assessment systems for knee OA, the role that these lesions play in the development of knee pain and OA remains uncertain. In this discussion, we review the cystic lesions and bursae most commonly associated with OA of the knee, examine their relation and role in whole organ imaging assessments of OA, and present the literature investigating the associations of periarticular cysts and cyst-like lesions with knee pain and OA.

Preoperative MRI Shoulder Findings Associated with Clinical Outcome 1 Year after Rotator Cuff Repair.

Background Investigation of the use of preoperative MRI for providing prognostic information regarding clinical outcome following rotator cuff repair has been limited. Purpose To determine whether patients with more severe rotator cuff tears of the shoulder at preoperative MRI have a greater degree of residual pain and disability after rotator cuff repair. Materials and Methods This retrospective study included a cohort of 141 patients who underwent surgical repair of a full-thickness rotator cuff tear at a single institution between April 16, 2012, and September 3, 2015. The mean patient age was 56.8 years, and there were 100 men (mean age, 56.1 years) and 41 women (mean age, 56.3 years). Patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) survey (lower score indicates less pain and disability) before and 1 year after surgery. One musculoskeletal radiologist blinded to the DASH scores measured the maximal anterior-posterior width and medial-lateral retraction of the rotator cuff tear on the preoperative MRI and assessed tendon degeneration and composite muscle atrophy and fatty infiltration using categorical grading scales (grade 0 indicates no tendon degeneration or muscle atrophy and fatty infiltration, and higher grades indicate incrementally more severe tendon degeneration or muscle atrophy and fatty infiltration). Generalized estimating equation models were used to determine the association between preoperative MRI findings and the postoperative DASH score. Results There was a significant positive association (P < .05) between the measured tear width (estimate, 2.05), measured tear retraction (estimate, 3.52), and tendon degeneration grade (estimate, 1.59) and the postoperative DASH score. There was no significant association (P = .49) between the composite muscle atrophy and fatty infiltration grade (estimate, 0.31) and the postoperative DASH score. Conclusion Patients with larger rotator cuff tears, more tendon retraction, and more severe tendon degeneration have worse clinical outcome scores 1 year after rotator cuff repair. © RSNA, 2019.

Postoperative Imaging Findings Associated with Transpalpebral Craniotomy Approach to Anterior Cranial Fossa.

Background and Purpose The transpalpebral "eyelid" approach is a novel alternative to the traditional ciliary or supraciliary incision for supraorbital frontal craniotomy and access to the anterior cranial fossa. Though a prior publication from our institution has described the surgical approach in detail along with cosmetic and clinical outcomes, postoperative imaging findings have not yet been described. As this surgical technique becomes more widely practiced, it is essential for neuroradiologists, oculoplastic surgeons, and skull base neurosurgeons to be familiar with the expected postoperative imaging findings, especially those that prompt subsequent intervention. Materials and Methods A retrospective, institutional review board approved review was performed of 102 patients who underwent transpalpebral surgical approach at Allegheny General Hospital from June 2007 through May 2015. Operative reports, pathology reports, preoperative imaging, postoperative imaging, and postoperative clinical documentation were reviewed. Results Forty-nine percent of patients had solely benign expected postoperative imaging findings, 37% had various atypical findings not requiring further intervention (most commonly asymmetric globe protrusion and bone cement in a paranasal sinus), 6% had findings prompting minimally invasive bedside procedures (most commonly pseudomeningocele), and 8% had findings requiring surgical intervention. Conclusion The majority of imaging following the transpalpebral approach showed typical, benign findings, such as minimal pneumocephalus and asymmetric globe protrusion. Nonetheless, members of the clinical team should be aware of the small number of findings requiring intervention, especially pseudomeningocele.

The Role of Imaging in Determining Return to Play.

Return-to-play (RTP) predictions focus on how long it takes an athlete to return to their full athletic activity after sustaining an injury. This article focuses on the role of imaging and the radiologist in RTP predictions for the most common and controversial injuries affecting athletes.

Common Cervical and Cerebral Vascular Variants.

Successful open and endovascular carotid artery intervention depends on a thorough foundational knowledge of cervical and intracranial vascular anatomy. It is essential for the carotid interventionist to be familiar with the common and rare variants of the cervical and intracranial vasculature, and to understand the implications of these variants for the performance of carotid intervention with protection of the distal circulation. This article provides interventionists with a basic description of the normal and relevant variant vascular anatomy from the aortic arch to the circle of Willis, and outlines the potential difficulties that specific variants may present for endovascular therapy.

Angiotensin-II mediates nonmuscle myosin II activation and expression and contributes to human keloid disease progression.

Aberrant fibroblast migration in response to fibrogenic peptides plays a significant role in keloid pathogenesis. Angiotensin II (Ang II) is an octapeptide hormone recently implicated as a mediator of organ fibrosis and cutaneous repair. Ang II promotes cell migration but its role in keloid fibroblast phenotypic behavior has not been studied. We investigated Ang II signaling in keloid fibroblast behavior as a potential mechanism of disease. Primary human keloid fibroblasts were stimulated to migrate in the presence of Ang II and Ang II receptor 1 (AT1), Ang II receptor 2 (AT2) or nonmuscle myosin II (NMM II) antagonists. Keloid and the surrounding normal dermis were immunostained for NMM IIA, NMM IIB, AT2 and AT1 expression. Primary human keloid fibroblasts were stimulated to migrate with Ang II and the increased migration was inhibited by the AT1 antagonist EMD66684, but not the AT2 antagonist PD123319. Inhibition of the promigratory motor protein NMM II by addition of the specific NMM II antagonist blebbistatin inhibited Ang II-stimulated migration. Ang II stimulation of NMM II protein expression was prevented by AT1 blockade but not by AT2 antagonists. Immunostaining demonstrated increased NMM IIA, NMM IIB and AT1 expression in keloid fibroblasts compared with scant staining in normal surrounding dermis. AT2 immunostaining was absent in keloid and normal human dermal fibroblasts. These results indicate that Ang II mediates keloid fibroblast migration and possibly pathogenesis through AT1 activation and upregulation of NMM II.

Once-daily enoxaparin in the outpatient setting versus unfractionated heparin in hospital for the treatment of symptomatic deep-vein thrombosis.

BACKGROUND: Once- and twice-daily low-molecular-weight heparin administered in hospital have been shown to be effective and safe for treating deep-vein thrombosis. The aim of this study was to compare the efficacy and safety of deep-vein thrombosis treatment using once-daily subcutaneous enoxaparin in the outpatient setting with intravenous unfractionated heparin in hospital. METHODS: This randomized, parallel-group, open-label study was conducted in 18 centers in 4 countries. In total, 298 patients with symptomatic deep-vein thrombosis who were eligible for home treatment were randomized to treatment with enoxaparin in the outpatient setting (1.5 mg/kg subcutaneously once-daily) or unfractionated heparin in hospital (5000 IU bolus and 1250 IU/hour intravenous infusion) for > or =5 days. Clinical endpoints were assessed during a 6-month follow-up period. RESULTS: Among all patients treated with enoxaparin, there was a trend towards fewer recurrent deep-vein thromboses (1.3% vs. 5.4%; p = 0.060) and pulmonary emboli (1.3% vs. 4.1%; p = 0.17) compared with patients treated with unfractionated heparin. When considering a post-hoc combined endpoint of deep-vein thrombosis and pulmonary embolism, significantly fewer events occurred in the enoxaparin group than in the unfractionated-heparin group (2.7% vs. 8.8%; p = 0.026). The incidences of bleeding events and adverse events in the enoxaparin and unfractionated-heparin groups were similar. CONCLUSIONS: Once-daily subcutaneous enoxaparin in the outpatient setting is at least as effective and as well tolerated as in-hospital intravenous unfractionated heparin for treatment of deep-vein thrombosis.

Lymphocyte-facilitated tumour cell adhesion to endothelial cells: the role of high affinity leucocyte integrins.

AIM: Lymphocytes transiently express an active form of the beta_2 integrin LFA-1 (LFA-1Af) which has conformational changes in extracellular domains enabling higher affinity binding to the ligand ICAM-1. In this study, we investigated the role of lymphocytes bearing LFA-1Af as potential mediators of binding of ICAM-1-positive tumour cells to endothelium. METHODS: LFA-1 expression on 51Cr-PBLs was modulated in order to express high affinity LFA-1Af and conjugates were formed with 35S-labelled COLO526. The binding of the conjugates to resting or IL-1beta-stimulated human umbilical vein endothelial cells (HUVECs) was then assessed via a modified radioactive HUVEC binding assay. In addition, the binding of PBL-COLO526 conjugates to HUVECs was demonstrated by confocal microscopy. RESULTS: The binding of COLO526 to endothelial cells did not change significantly between unstimulated and stimulated HUVECs. In addition, pre-incubating the COLO526 with fresh PBLs did not significantly alter the binding of COLO526 to resting or activated HUVECs; whereas, in the presence of PBLs with LFA-1Af, the COLO526 conjugate binding dramatically increased from basal levels to 41% on resting HUVECs and 81% on stimulated HUVECs. COLO526-PBL(LFA-1Af) conjugate adhesion to stimulated HUVECs was inhibited by blocking antibody to LFA-1 (50%), VLA-4 (32%) or L-selectin (40%). Antibodies to the HUVEC adhesion molecules ICAM-1, VCAM-1 and E-selectin also inhibited COLO526-PBL(LFA-1Af) conjugate binding to activated HUVECs by 79, 60 and 73%, respectively. CONCLUSIONS: PBLs bearing LFA-1Af can enhance COLO526 adhesion to both resting and activated HUVECs. Furthermore, blocking studies demonstrate that a range of pathways are involved in this phenomenon (LFA-1/ICAM-1, VLA4/VCAM-1, L-selectin/E-selectin). These studies have identified a novel alternative pathway for lymphocyte-facilitated tumour cell adhesion to endothelial cells.