Apparent Diffusion Coefficient Value Changes and Clinical Correlation in 90 Cases of Cytomegalovirus-Infected Fetuses with Unremarkable Fetal MRI Results.

BACKGROUND AND PURPOSE: Cytomegalovirus is the leading intrauterine infection. Fetal MR imaging is an accepted tool for fetal brain evaluation, yet it still lacks the ability to accurately predict the extent of the neurodevelopmental impairment, especially in fetal MR imaging scans with unremarkable findings. Our hypothesis was that intrauterine cytomegalovirus infection causes diffusional changes in fetal brains and that those changes may correlate with the severity of neurodevelopmental deficiencies. MATERIALS AND METHODS: A retrospective analysis was performed on 90 fetal MR imaging scans of cytomegalovirus-infected fetuses with unremarkable results and compared with a matched gestational age control group of 68 fetal head MR imaging scans. ADC values were measured and averaged in the frontal, parietal, occipital, and temporal lobes; basal ganglia; thalamus; and pons. For neurocognitive assessment, the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) was used on 58 children in the cytomegalovirus-infected group. RESULTS: ADC values were reduced for the cytomegalovirus-infected fetuses in most brain areas studied. The VABS-II showed no trend for the major domains or the composite score of the VABS-II for the cytomegalovirus-infected children compared with the healthy population distribution. Some subdomains showed an association between ADC values and VABS-II scores. CONCLUSIONS: Cytomegalovirus infection causes diffuse reduction in ADC values in the fetal brain even in unremarkable fetal MR imaging scans. Cytomegalovirus-infected children with unremarkable fetal MR imaging scans do not deviate from the healthy population in the VABS-II neurocognitive assessment. ADC values were not correlated with VABS-II scores. However, the lack of clinical findings, as seen in most cytomegalovirus-infected fetuses, does not eliminate the possibility of future neurodevelopmental pathology.

Region-specific reductions in brain apparent diffusion coefficient in cytomegalovirus-infected fetuses.

OBJECTIVE: To evaluate the effects of cytomegalovirus (CMV) infection on apparent diffusion coefficient (ADC) values of the fetal brain in utero. METHODS: In this retrospective analysis we compared 58 fetal head magnetic resonance imaging (fhMRI) scans of PCR-verified CMV-infected fetuses, obtained in 2008-2012, with those of a normal control group of 36 gestational age (GA)-matched uninfected fetuses scanned between 2006 and 2012. Estimated GA at infection ranged from 1 to 32 weeks, and fhMRI was performed at 24 to 38 weeks. The frontal, parietal, temporal and occipital lobes (mainly white matter), basal ganglia, thalamus, pons and cerebellum were analyzed by assessing ADC values. Two pregnancies were terminated and postmortem confirmation was available in these cases. RESULTS: ADC values of CMV-infected fetuses correlated significantly and negatively with GA in all brain regions except the basal ganglia. The cerebellum had the greatest reduction (r = -0.52, P < 0.0001). Maternal age correlated positively with ADC in the frontal lobe (P < 0.05). GA at infection and overt pathological changes did not affect ADC significantly. Compared with non-infected fetuses, ADC values of affected fetuses were significantly reduced in the frontal (P < 0.0001), parietal (P < 0.0001), occipital (P = 0.0005) and temporal (P = 0.001) lobes and thalamus (P = 0.006). CONCLUSION: CMV infection of the fetal brain results in a highly significant, region-dependent reduction of ADC values in the frontal, parietal, occipital and temporal lobes and thalamus, probably reflecting hypercellularity and inclusion bodies in damaged areas. Further studies are needed to determine if reduction in ADC values may serve as a prognostic factor in CMV-infected fetuses. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Revised protocol for whole-body CT for multi-trauma patients applying triphasic injection followed by a single-pass scan on a 64-MDCT.

AIM: To evaluate a revised protocol for whole-body computed tomography (CT) for multi-trauma patients in an emergency department and compare it to conventional protocols. MATERIALS AND METHODS: Forty-two of 82 multi-trauma patients underwent unenhanced CT examinations of the head, cervical spine, and upper abdomen, followed by an arterial-phase contrast-enhanced CT examination of the thorax and a porto-venous scan of the abdomen and pelvis (conventional protocol). The other 40 patients underwent unenhanced CT examinations of the head, cervical spine, and upper abdomen, followed by a one-step acquisition of the thorax, abdomen, and pelvis using a 64-section multidetector CT (MDCT) system following a triphasic injection (revised protocol). Contrast enhancement was measured in the ascending, descending, and abdominal aorta, common iliac arteries, inferior vena cava (IVC), liver, spleen, and kidneys. Image count, radiation dose, total acquisition time, mediastinal artefacts, and image quality of each area were reviewed. RESULTS: Mean enhancement values in the ascending and descending aorta were significantly greater with the conventional protocol. Enhancement of the abdominal aorta, iliac arteries, IVC, liver, spleen, and kidneys was significantly greater with the revised protocol. Mediastinal streak artefacts were present in all conventional protocol images and absent in all revised protocol images. Image quality using the revised protocol was significantly better (p < 0.002). The mean effective radiation dose was significantly lower (p = 0.005), and image number reduced (p < 0.001). CONCLUSION: The revised triphasic injection single-pass whole-body imaging protocol was superior to the conventional protocol using 64-MDCT. It enabled better vascular and abdominal parenchymal imaging with reduction in radiation dose and image overload.

Computerised analysis of liver texture with correlation to needle biopsy.

AIM: To assist in tissue characterisation for the non-invasive diagnosis of diffuse fatty liver infiltration by providing quantitative indices of ultrasonic (US) backscatter with correlation to histology. METHODS AND MATERIALS: US images from patients referred to US-guided liver needle biopsy (LNB) for persistently elevated liver enzymes or serologically positive markers for viral hepatitis were recorded. The histopathological reports were reviewed. Steatosis, inflammation and degree of fibrosis were scored from 0 (normal) to 3 (severe). Patients with level 3 steatosis without inflammation or fibrosis were selected. US images from twenty-four healthy subjects served as control. Four textural indices were calculated for a selected ROI corresponding to the biopsy site. Sensitivity and specificity of discrimination between the two groups were evaluated. RESULTS: Fatty and healthy livers formed two distinct clusters. However, in all parametric subspaces there was a slight overlap between the groups with a few numbers of cases located across the dichotomy line.The sensitivity for all the indices was high (90 - 100 %). The specificity for each of the indices was moderate. The co-occurrence local homogeneity index yielded the highest specificity (88.5 %), with a sensitivity equivalent to two of the other indices (90 %). CONCLUSIONS: Highly accurate "ultrasonic biopsy" may be obtained for severe fatty liver. The described indices can serve as a tool in US computer- aided diagnosis (CAD) of diffuse parenchymal liver disease, in particular for severe steatosis of the liver.

Withholding information from cancer patients as a physician's decision under risk.

When cancer is diagnosed, the physician may face a dilemma regarding disclosure of information to the patient. While he or she may feel a responsibility to maintain the patient's hope, even through the withholding of information, there is a risk involved: if treatment fails, the patient will eventually know the truth. Patients who would rather live their final days in peace rather than undergo unpleasant treatment of an uncertain nature may be furious and frustrated that they have been deprived of this liberty, ending their lives feeling worse than they would have had they been told the truth at the outset. The author applies three theories of decision making under uncertainty (expected utility theory, prospect theory, and regret theory) to the physician's problem of whether and to what extent to withhold information from a cancer patient, deriving comparative predictions with regard to the relationships between the physician's behavior and illness, patient, and physician characteristics. The results help explain why physicians whose norm of behavior is full disclosure sometimes opt to withhold information and why junior physicians are more likely to disclose the truth than their senior colleagues, as well as the empirical findings that physicians tend to disclose more truthful information to patients the greater the severity of illness and the more inquisitive the patient.

Phobic disorder, psychotherapy, and risk-taking: an economic perspective.

Phobic disorders are receiving much attention in psychiatric practice today. Agoraphobia, the most common of the phobic disorders, involves the risk of experiencing a panic attack in public places, thus discouraging the worker from fully participating in the labor market. This paper applies the economic tools of rational choice under uncertainty to the analysis of agoraphobia, with the purpose of gaining more insight as regards the extent of deviation from normal work behavior (which presumably responds to incentives) and the effectiveness of psychotherapy in treating work-avoidance, challenging the popular claim that the cost of psychotherapy helps ensure its success.