BioMed Research International: Radiology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. The Impact of Combining a Low-Tube Voltage Acquisition with Iterative Reconstruction on Total Iodine Dose in Coronary CT Angiography Tue, 23 May 2017 09:38:56 +0000 Objectives. To assess the impact of combining low-tube voltage acquisition with iterative reconstruction (IR) techniques on the iodine dose in coronary CTA. Methods. Three minipigs underwent CCTA to compare a standard of care protocol with two alternative study protocols combining low-tube voltage and low iodine dose with IR. Image quality was evaluated objectively by the CT value, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in the main coronary arteries and aorta and subjectively by expert reading. Statistics were performed by Mann–Whitney test and Chi-square analysis. Results. Despite reduced iodine dose, both study protocols maintained CT values, SNR, and CNR compared to the standard of care protocol. Expert readings confirmed these findings; all scans were perceived to be of at least diagnostically acceptable quality on all evaluated parameters allowing image interpretation. No statistical differences were observed (all values > 0.11), except for streak artifacts () which were considered to be more severe, although acceptable, with the 80 kVp protocol. Conclusions. Reduced tube voltage in combination with IR allows a total iodine dose reduction between 37 and 50%, by using contrast media with low iodine concentrations of 200 and 160 mg I/mL, while maintaining image quality. Toon Van Cauteren, Gert Van Gompel, Kaoru Tanaka, Douwe E. Verdries, Dries Belsack, Koenraad H. Nieboer, Inneke Willekens, Paul Evans, Sven Macholl, Guy Verfaillie, Steven Droogmans, Johan de Mey, and Nico Buls Copyright © 2017 Toon Van Cauteren et al. All rights reserved. Quantitative Aortic Distensibility Measurement Using CT in Patients with Abdominal Aortic Aneurysm: Reproducibility and Clinical Relevance Tue, 18 Apr 2017 07:33:39 +0000 Purpose. To investigate the reproducibility of aortic distensibility () measurement using CT and assess its clinical relevance in patients with infrarenal abdominal aortic aneurysm (AAA). Methods. 54 patients with infrarenal abdominal aortic aneurysm were studied to determine their distensibility by using 64-MDCT. Aortic cross-sectional area changes were determined at two positions of the aorta, immediately below the lowest renal artery (level 1.) and at the level of its maximal diameter (level 2.) by semiautomatic segmentation. Measurement reproducibility was assessed using intraclass correlation coefficient (ICC) and Bland-Altman analyses. Stepwise multiple regression analysis was performed to assess linear associations between aortic and anthropometric and biochemical parameters. Results. A mean distensibility of and was found. ICC proved excellent consistency between readers over two locations: 0.92 for intraobserver and 0.89 for interobserver difference in level 1. and 0.85 and 0.79 in level 2. Multivariate analysis of all these variables showed sac distensibility to be independently related () to BMI, diastolic blood pressure, and AAA diameter. Conclusions. Aortic distensibility measurement in patients with AAA demonstrated high inter- and intraobserver agreement and may be valuable when choosing the optimal dimensions graft for AAA before endovascular aneurysm repair. Yunfei Zha, Gongling Peng, Liang Li, Chunying Yang, Xuesong Lu, and Zhoufeng Peng Copyright © 2017 Yunfei Zha et al. All rights reserved. Characterization of Focal Liver Lesions Indistinctive on B Mode Ultrasound: Benefits of Contrast-Enhanced Ultrasound Tue, 11 Apr 2017 00:00:00 +0000 Aim. The aim of this prospective study was to evaluate the additional value of contrast-enhanced ultrasound (CEUS) in identifying and characterizing of focal liver lesions (FLLs) that are indistinctive on B mode ultrasound (BMUS). Methods. The study focused on 70 consecutive patients (male 46, female 24; mean age, 53.1 years ± 10). All lesions were detected by MRI but could not be clearly visualized by BMUS. CEUS was performed by injected SonoVue® (Bracco Imaging Spa, Milan, Italy) as a quick bolus into the antecubital vein. All lesions were proved by pathologic and MRI findings as primary or metastatic hepatic malignancies. Results. On CEUS, 45 (64.2%) FLLs displayed arterial hyperenhancement and 55 (78.5%) lesions showed hypoenhancement in portal venous and late phase (PVLP). Homogeneous and complete hyperenhancement pattern during the arterial phase is highly suspicious for HCC in liver cirrhosis (96.8%). Arterial isoenhancement and early washout during PVLP are characteristic for metastasis (73.3%). For recurrence lesions, arterial hyperenhancement and isoenhancement during PVLP are more common (60%). Conclusion. CEUS may provide added diagnostic values in FLLs appearing indistinctive on BMUS. Presence of early arterial enhancement and washout during PVLP may be helpful for detection of those lesions. Yi Dong, Feng Mao, Jiaying Cao, Peili Fan, and Wen-Ping Wang Copyright © 2017 Yi Dong et al. All rights reserved. Numerical Evaluation of Image Contrast for Thicker and Thinner Objects among Current Intraoral Digital Imaging Systems Sun, 09 Apr 2017 07:30:34 +0000 The purpose is to evaluate the performance of current intraoral digital detectors in detail using a precise phantom and new method. Two aluminum step wedges in 0.5 mm steps were exposed by two photostimulable phosphor plate (PSP) systems—one with automatic exposure compensation (AEC) and the other without AEC—and a CCD sensor. Images were obtained with 3 doses at 60 kV. The effect of metallic material also was evaluated. The contrast-to-noise ratio (CNR) for thinner steps and the low contrast value (LCV) for thicker steps were obtained. The CCD system was the best under all conditions (), although the Gray value was sensitive to the dose, and the Gray value-dose relation varied greatly. The PSP system with AEC was superior to that without AEC for the LCV () but was inferior to it regarding the CNR (). CNR and LCV in the PSP system without AEC were not affected by the metallic plate. Intraoral digital imaging systems should be chosen according to their diagnostic purpose. PSP system with AEC may be the best for detecting molar proximal caries, whereas the PSP system without AEC may be better for evaluating small bone regeneration in periodontal disease. The CCD system provided the best performance. Oyunbat Dashpuntsag, Midori Yoshida, Ryosuke Kasai, Naoki Maeda, Hidehiko Hosoki, and Eiichi Honda Copyright © 2017 Oyunbat Dashpuntsag et al. All rights reserved. Incidental Paratracheal Air Cysts on Thoracic CT and Their Association with Chronic Inflammatory Lung Disease Wed, 15 Mar 2017 00:00:00 +0000 Purpose. To determine the association between the progression of upper lung fibrosis and paratracheal air cysts (PACs) size. Materials and Methods. The thoracic CT images of 4573 patients were reviewed for the prevalence, size, and location of PACs and their communication with trachea. In addition, the presence of upper lung fibrosis, emphysema, and bronchiectasis was evaluated in patients with PACs and compared with a control group without PACs. Upper lung fibrosis was analyzed using a fibrosis score system. Results. The prevalence of PACs was 6.8%. Communication with tracheal lumen was demonstrated by 31.5% of patients with PACs. The prevalence of fibrosis, emphysema, and bronchiectasis in patients with PACs were 67.5%, 21.9%, and 28.3%, respectively. The prevalence of fibrosis was significantly different in the two groups by univariable and multivariable analysis (odds ratio = 2.077, ). 140 patients with fibrosis among PAC group underwent a previous or follow-up CT; the prevalence with increase in PAC sizes was higher in patients with increase in fibrosis score than those without it (66.2% versus 17.3%, ). Conclusions. PACs appear to be highly related to upper lung fibrosis and moderately related to bronchiectasis. In patients with fibrosis, PAC sizes tended to increase with the progression of upper lung fibrosis. Ha Yeon Kim, Kyung Hee Lee, Yeo Ju Kim, Ha Young Lee, Ga Ram Kim, Yong Sun Jeon, Jung Soo Kim, Young Sam Kim, and Jun Ho Kim Copyright © 2017 Ha Yeon Kim et al. All rights reserved. MR Lymphangiography: A Practical Guide to Perform It and a Brief Review of the Literature from a Technical Point of View Tue, 07 Mar 2017 00:00:00 +0000 We propose a practical approach for performing high-resolution MR lymphangiography (MRL). We shall discuss and illustrate the technical approach for the visualization of lymphatic vessels in patients suffering from lymphedema, how to distinguish lymphatic vessels from veins, and MRL role in supermicrosurgery treatment planning. A brief review of literature, from a technical point of view, is also reported. Francesco Giuseppe Mazzei, Francesco Gentili, Susanna Guerrini, Nevada Cioffi Squitieri, Duccio Guerrieri, Paolo Gennaro, Michele Scialpi, Luca Volterrani, and Maria Antonietta Mazzei Copyright © 2017 Francesco Giuseppe Mazzei et al. All rights reserved. Impact of Different Analytic Approaches on the Analysis of the Breast Fibroglandular Tissue Using Diffusion Weighted Imaging Thu, 02 Mar 2017 08:28:57 +0000 Purpose. This study investigated the impact of the different region of interest (ROI) approaches on measurement of apparent diffusion coefficient (ADC) values in the breast firbroglandular tissue (FT). Methods. Breast MR images of 38 women diagnosed with unilateral breast cancer were studied. Percent density (PD) and ADC were measured from the contralateral normal breast. Four different ROIs were used for ADC measurement. The measured PD and ADC were correlated. Results. Among the four ROIs, the manually placed small ROI on FT gave the highest mean ADC (ADC = 1839 ± 343 [×10−6 mm2/s]), while measurement from the whole breast gave the lowest mean ADC (ADC = 933 ± 383 [×10−6 mm2/s]). The ADC measured from the whole breast was highly correlated with PD with . In slice-to-slice comparison, the central slices with more FT had higher ADC values than the peripheral slices did, presumably due to less partial volume effect from fat. Conclusions. Our results indicated that the measured ADC heavily depends on the composition of breast tissue contained in the ROI used for the ADC measurements. Women with low breast density showing lower ADC values were most likely due to the partial volume effect of fatty tissues. Yoon Jung Choi, Jeon-Hor Chen, Hon J. Yu, Yifan Li, and Min-Ying Su Copyright © 2017 Yoon Jung Choi et al. All rights reserved. Assessment of Longitudinal Reproducibility of Mice LV Function Parameters at 11.7 T Derived from Self-Gated CINE MRI Wed, 22 Feb 2017 12:45:44 +0000 The objective of this work was the assessment of the reproducibility of self-gated cardiac MRI in mice at ultra-high-field strength. A group of adult mice () was followed over 360 days with a standardized MR protocol including reproducible animal position and standardized planning of the scan planes. From the resulting CINE MRI data, global left ventricular (LV) function parameters including end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and left ventricular mass (LVM) were quantified. The reproducibility of the self-gated technique as well as the intragroup variability and longitudinal changes of the investigated parameters was assessed. Self-gated cardiac MRI proved excellent reproducibility of the global LV function parameters, which was in the order of the intragroup variability. Longitudinal assessment did not reveal any significant variations for EDV, ESV, SV, and EF but an expected increase of the LVM with increasing age. In summary, self-gated MRI in combination with a standardized protocol for animal positioning and scan plane planning ensures reproducible assessment of global LV function parameters. Zhi Zuo, Anne Subgang, Alireza Abaei, Wolfgang Rottbauer, Detlef Stiller, Genshan Ma, and Volker Rasche Copyright © 2017 Zhi Zuo et al. All rights reserved. A Registration Method Based on Contour Point Cloud for 3D Whole-Body PET and CT Images Tue, 21 Feb 2017 00:00:00 +0000 The PET and CT fusion image, combining the anatomical and functional information, has important clinical meaning. An effective registration of PET and CT images is the basis of image fusion. This paper presents a multithread registration method based on contour point cloud for 3D whole-body PET and CT images. Firstly, a geometric feature-based segmentation (GFS) method and a dynamic threshold denoising (DTD) method are creatively proposed to preprocess CT and PET images, respectively. Next, a new automated trunk slices extraction method is presented for extracting feature point clouds. Finally, the multithread Iterative Closet Point is adopted to drive an affine transform. We compare our method with a multiresolution registration method based on Mattes Mutual Information on 13 pairs (246~286 slices per pair) of 3D whole-body PET and CT data. Experimental results demonstrate the registration effectiveness of our method with lower negative normalization correlation (NC = −0.933) on feature images and less Euclidean distance error (ED = 2.826) on landmark points, outperforming the source data (NC = −0.496, ED = 25.847) and the compared method (NC = −0.614, ED = 16.085). Moreover, our method is about ten times faster than the compared one. Zhiying Song, Huiyan Jiang, Qiyao Yang, Zhiguo Wang, and Guoxu Zhang Copyright © 2017 Zhiying Song et al. All rights reserved. Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience Mon, 13 Feb 2017 00:00:00 +0000 Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare. Most of them coexist with celiac axis stenosis/occlusion due to median arcuate ligament (MAL) compression or atherosclerosis. The aim of this study was to evaluate the cause of celiac axis lesion and characterize the anatomy of the aneurysms. These findings may have important management implications. Material and Methods. A retrospective analysis of 15 patients with true PAAAs was performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT scanner. We evaluated the most probable cause of celiac axis lesion. Aneurysms were characterized by their number, location, size, and morphology. Location of the aneurysms was classified either as pancreaticoduodenal arteries (PDA) or as dorsal pancreatic arteries (DPA) as they may represent different collateral pathways between superior mesenteric artery and celiac trunk. Results. A total of 32 true PAAAs were identified. Celiac trunk was occluded in 12 patients and critically narrowed in 3 patients. Celiac axis lesion was categorized as secondary to MAL compression in 14 cases and due to atherosclerosis in 1 case. The most common location of the aneurysms was inferior pancreaticoduodenal arteries. Only in 1 case aneurysms involved both PDA and DPA. Conclusions. Coexistence of PAAAs with celiac axis compression as well as involvement of either PDAs or DPAs has important therapeutic implications. The uninvolved collateral pathway may be sufficient to preserve effective circulation in celiac trunk branches in case of resection or embolization of the aneurysms. However, further studies are crucial to confirm our findings. Robert Antoniak, Laretta Grabowska-Derlatka, Ireneusz Nawrot, Andrzej Cieszanowski, and Olgierd Rowiński Copyright © 2017 Robert Antoniak et al. All rights reserved. A Study of 358 Cases of Locally Advanced Nasopharyngeal Carcinoma Receiving Intensity-Modulated Radiation Therapy: Improving the Seventh Edition of the American Joint Committee on Cancer T-Staging System Tue, 07 Feb 2017 10:36:18 +0000 To evaluate the rationality and limitations of the seventh edition of the American Joint Committee on Cancer (the 7th AJCC edition) T-staging system for locally advanced nasopharyngeal carcinoma (NPC). The prognosis of 358 patients with stage T3/T4 NPC treated with intensity-modulated radiotherapy (IMRT) was analyzed with the Kaplan–Meier method or the log-rank test. The 7th AJCC staging system of NPC has some limitations in that the T category is neither the significant factor in OS/LRFS nor the independent prognostic factor in OS/LRFS/DMFS/DFS (). After adjustment by anatomic structures, univariate analysis has shown that the adjusted-T category has statistical significance between T3 and T4 for OS (86.4% and 71.3%, ), LRFS (97% and 90.9%, ), DMFS (90.9% and 77.2%, ), and DFS (86.2% and 67.5%, ), and multivariate analysis has shown that the adjusted-T category is an independent prognostic factor for OS/DMFS/DFS (with the exception of LRFS). Then, GTV-P was taken into consideration. Multivariate analysis showed that these nT categories serve as suitable independent prognostic factors for OS/DMFS/DFS () and LRFS (HR = 3.131; 95% CI, 1.090–8.990; ). The 7th AJCC staging system has limitations and should be improved by including the modifications suggested, such as anatomic structures and tumor volume adjustment. Qin Zhou, Yuxiang He, Yajie Zhao, Yin Wang, Weilu Kuang, and Liangfang Shen Copyright © 2017 Qin Zhou et al. All rights reserved. Histograms of Oriented 3D Gradients for Fully Automated Fetal Brain Localization and Robust Motion Correction in 3 T Magnetic Resonance Images Mon, 30 Jan 2017 06:53:56 +0000 Fetal brain magnetic resonance imaging (MRI) is a rapidly emerging diagnostic imaging tool. However, automated fetal brain localization is one of the biggest obstacles in expediting and fully automating large-scale fetal MRI processing. We propose a method for automatic localization of fetal brain in 3 T MRI when the images are acquired as a stack of 2D slices that are misaligned due to fetal motion. First, the Histogram of Oriented Gradients (HOG) feature descriptor is extended from 2D to 3D images. Then, a sliding window is used to assign a score to all possible windows in an image, depending on the likelihood of it containing a brain, and the window with the highest score is selected. In our evaluation experiments using a leave-one-out cross-validation strategy, we achieved 96% of complete brain localization using a database of 104 MRI scans at gestational ages between 34 and 38 weeks. We carried out comparisons against template matching and random forest based regression methods and the proposed method showed superior performance. We also showed the application of the proposed method in the optimization of fetal motion correction and how it is essential for the reconstruction process. The method is robust and does not rely on any prior knowledge of fetal brain development. Ahmed Serag, Gillian Macnaught, Fiona C. Denison, Rebecca M. Reynolds, Scott I. Semple, and James P. Boardman Copyright © 2017 Ahmed Serag et al. All rights reserved. Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation Mon, 30 Jan 2017 00:00:00 +0000 Although it is widely accepted that uterine artery embolization (UAE) is an effective therapeutic strategy for postpartum hemorrhage (PPH), no consensus has been reached regarding the efficacy of UAE in patients with PPH with disseminated intravascular coagulation (DIC). This single-center retrospective cohort study included patients treated with UAE using NBCA for PPH between 2010 and 2015. The patients were divided into DIC and non-DIC groups, according to the obstetrical DIC score and the overt DIC diagnostic criteria issued by the International Society of Thrombosis and Haemostasis (ISTH), and their clinical outcomes were compared. There were 28 patients treated with UAE using NBCA. Complete hemostasis was achieved by UAE in 19 of 28 patients. In eight of nine patients with unsuccessful hemostasis, surgical hemostatic interventions were performed after UAE, and hemostasis was achieved in seven patients. UAE using NBCA showed no significant intergroup differences in complete hemostasis according to the presence or absence of DIC based on obstetrical DIC score (70% versus 62.5%, ) or ISTH DIC score (54.5% versus 76.5%, ). UAE using NBCA may be a useful first-choice treatment for PPH with DIC. Soichiro Obata, Michi Kasai, Junko Kasai, Kazuo Seki, Zenjiro Sekikawa, Izumi Torimoto, Shigeo Takebayashi, Fumiki Hirahara, and Shigeru Aoki Copyright © 2017 Soichiro Obata et al. All rights reserved. CNS Metastases from Bone and Soft Tissue Sarcomas in Children, Adolescents, and Young Adults: Are They Really So Rare? Tue, 24 Jan 2017 00:00:00 +0000 Purpose. To check whether primary involvement of brain/spinal cord by bone/soft tissue sarcomas’ metastases in children is as rare as described and to present various morphological forms of bone/soft tissue sarcomas’ CNS metastases. Methods. Patients with first diagnosis in 1999–2014 treated at single center were included with whole course of disease evaluation. Brain/spinal canal magnetic resonance imaging (MRI)/computed tomography were performed in cases suspicious for CNS metastases. Extension from skull/vertebral column metastases was excluded. Results. 550 patients were included. MRI revealed CNS metastases in 19 patients (incidence 3.45%), 14 boys, aged 5–22 years. There were 12/250 osteosarcoma cases, 2/200 Ewing’s sarcoma, 1/50 chondrosarcoma, 3/49 rhabdomyosarcoma (RMS), and 1/1 malignant mesenchymoma. There were 10 single metastases and 7 cases of multiple ones; in 2 RMS cases only leptomeningeal spread in brain and spinal cord was found. Calcified metastases were found in 3 patients and hemorrhagic in 4. In one RMS patient there were numerous solid, cystic, hemorrhagic lesions and leptomeningeal spread. Conclusions. CNS metastases are rare and late in children with bone/soft tissue sarcomas, although in our material more frequent (3.45%) than in other reports (0.7%). Hematogenous spread to brain and hemorrhagic and calcified lesions dominated in osteosarcoma. Ewing sarcoma tended to metastasize to skull bones. Soft tissue sarcomas presented various morphological forms. Monika Bekiesinska-Figatowska, Agnieszka Duczkowska, Marek Duczkowski, Hanna Bragoszewska, Anna Romaniuk-Doroszewska, Beata Iwanowska, Sylwia Szkudlinska-Pawlak, Jaroslaw Madzik, Katarzyna Bilska, and Anna Raciborska Copyright © 2017 Monika Bekiesinska-Figatowska et al. All rights reserved. Instrument Variables for Reducing Noise in Parallel MRI Reconstruction Thu, 19 Jan 2017 00:00:00 +0000 Generalized autocalibrating partially parallel acquisition (GRAPPA) has been a widely used parallel MRI technique. However, noise deteriorates the reconstructed image when reduction factor increases or even at low reduction factor for some noisy datasets. Noise, initially generated from scanner, propagates noise-related errors during fitting and interpolation procedures of GRAPPA to distort the final reconstructed image quality. The basic idea we proposed to improve GRAPPA is to remove noise from a system identification perspective. In this paper, we first analyze the GRAPPA noise problem from a noisy input-output system perspective; then, a new framework based on errors-in-variables (EIV) model is developed for analyzing noise generation mechanism in GRAPPA and designing a concrete method—instrument variables (IV) GRAPPA to remove noise. The proposed EIV framework provides possibilities that noiseless GRAPPA reconstruction could be achieved by existing methods that solve EIV problem other than IV method. Experimental results show that the proposed reconstruction algorithm can better remove the noise compared to the conventional GRAPPA, as validated with both of phantom and in vivo brain data. Yuchou Chang, Haifeng Wang, Yuanjie Zheng, and Hong Lin Copyright © 2017 Yuchou Chang et al. All rights reserved. Effects of Liver Fibrosis Progression on Tissue Relaxation Times in Different Mouse Models Assessed by Ultrahigh Field Magnetic Resonance Imaging Wed, 18 Jan 2017 11:33:57 +0000 Recently, clinical studies demonstrated that magnetic resonance relaxometry with determination of relaxation times T1 and may aid in staging and management of liver fibrosis in patients suffering from viral hepatitis and steatohepatitis. In the present study we investigated T1 and in different models of liver fibrosis to compare alternate pathophysiologies in their effects on relaxation times and to further develop noninvasive quantification methods of liver fibrosis. MRI was performed with a fast spin echo sequence for measurement of T1 and a multigradient echo sequence for determination of . Toxic liver fibrosis was induced by injections of carbon tetrachloride (1.4 mL CCl4 per kg bodyweight and week, for 3 or 6 weeks) in BALB/cJ mice. Chronic sclerosing cholangitis was mimicked using the ATP-binding cassette transporter B4 knockout (Abcb4) mouse model. Untreated BALB/cJ mice served as controls. To assess hepatic fibrosis, we ascertained collagen contents and fibrosis scores after Sirius red staining. T1 and correlate differently to disease severity and etiology of liver fibrosis. shows significant decrease correlating with fibrosis in CCl4 treated animals, while demonstrating significant increase with disease severity in Abcb4 mice. Measurements of T1 and may therefore facilitate discrimination between different stages and causes of liver fibrosis. Andreas Müller, Katrin Hochrath, Jonas Stroeder, Kanishka Hittatiya, Günther Schneider, Frank Lammert, Arno Buecker, and Peter Fries Copyright © 2017 Andreas Müller et al. All rights reserved. Robust Retinal Blood Vessel Segmentation Based on Reinforcement Local Descriptions Wed, 18 Jan 2017 08:09:20 +0000 Retinal blood vessels segmentation plays an important role for retinal image analysis. In this paper, we propose robust retinal blood vessel segmentation method based on reinforcement local descriptions. A novel line set based feature is firstly developed to capture local shape information of vessels by employing the length prior of vessels, which is robust to intensity variety. After that, local intensity feature is calculated for each pixel, and then morphological gradient feature is extracted for enhancing the local edge of smaller vessel. At last, line set based feature, local intensity feature, and morphological gradient feature are combined to obtain the reinforcement local descriptions. Compared with existing local descriptions, proposed reinforcement local description contains more local information of local shape, intensity, and edge of vessels, which is more robust. After feature extraction, SVM is trained for blood vessel segmentation. In addition, we also develop a postprocessing method based on morphological reconstruction to connect some discontinuous vessels and further obtain more accurate segmentation result. Experimental results on two public databases (DRIVE and STARE) demonstrate that proposed reinforcement local descriptions outperform the state-of-the-art method. Meng Li, Zhenshen Ma, Chao Liu, Guang Zhang, and Zhe Han Copyright © 2017 Meng Li et al. All rights reserved. Diffusion Kurtosis Imaging Detects Microstructural Changes in the Brain after Acute Alcohol Intoxication in Rats Wed, 18 Jan 2017 00:00:00 +0000 The aim of this study was to test the technical feasibility of diffusion kurtosis imaging (DKI) in the brain after acute alcohol intoxication. Diffusion tensor imaging (DTI) and DKI during 7.0 T MRI were performed in the frontal lobe and thalamus before and 30 min, 2 h, and 6 h after ethyl alcohol administration. Compared with controls, mean kurtosis values of the frontal lobe and thalamus first decreased by 44% and 38% within 30 min ( all) and then increased by 14% and 46% at 2 h (frontal lobe, ; thalamus, ) and by 29% and 68% at 6 h (frontal lobe, ; thalamus, ) after acute intake. Mean diffusivity decreased significantly in both the frontal lobe and the thalamus at various stages. However, fractional anisotropy decreased only in the frontal lobe, with no detectable change in the thalamus. This demonstrates that DKI possesses sufficient sensitivity for tracking pathophysiological changes at various stages associated with acute alcohol intoxication and may provide additional information that may be missed by conventional DTI parameters. Xi-ran Chen, Jie-ying Zeng, Zhi-Wei Shen, Ling-mei Kong, and Wen-bin Zheng Copyright © 2017 Xi-ran Chen et al. All rights reserved. Three-Class Mammogram Classification Based on Descriptive CNN Features Sun, 15 Jan 2017 13:44:31 +0000 In this paper, a novel classification technique for large data set of mammograms using a deep learning method is proposed. The proposed model targets a three-class classification study (normal, malignant, and benign cases). In our model we have presented two methods, namely, convolutional neural network-discrete wavelet (CNN-DW) and convolutional neural network-curvelet transform (CNN-CT). An augmented data set is generated by using mammogram patches. To enhance the contrast of mammogram images, the data set is filtered by contrast limited adaptive histogram equalization (CLAHE). In the CNN-DW method, enhanced mammogram images are decomposed as its four subbands by means of two-dimensional discrete wavelet transform (2D-DWT), while in the second method discrete curvelet transform (DCT) is used. In both methods, dense scale invariant feature (DSIFT) for all subbands is extracted. Input data matrix containing these subband features of all the mammogram patches is created that is processed as input to convolutional neural network (CNN). Softmax layer and support vector machine (SVM) layer are used to train CNN for classification. Proposed methods have been compared with existing methods in terms of accuracy rate, error rate, and various validation assessment measures. CNN-DW and CNN-CT have achieved accuracy rate of 81.83% and 83.74%, respectively. Simulation results clearly validate the significance and impact of our proposed model as compared to other well-known existing techniques. M. Mohsin Jadoon, Qianni Zhang, Ihsan Ul Haq, Sharjeel Butt, and Adeel Jadoon Copyright © 2017 M. Mohsin Jadoon et al. All rights reserved. Multislice Analysis of Blood Flow Values in CT Perfusion Studies of Lung Cancer Tue, 10 Jan 2017 00:00:00 +0000 Objectives. Tumour heterogeneity represents a key issue in CT perfusion (CTp), where all studies are usually based on global mean or median values of perfusion maps, often computed on whole tumour. We sought to determine whether, and to what extent, such global values can be representative of tumour heterogeneity, with respect to single slices, and could be used for therapy assessment. Materials and Methods. Twelve patients with one primary non-small cell lung cancer lesion were enrolled in this study, for a total amount of 26 CTp examinations and 118 slices. Mean and median blood flow (BF) values, calculated voxel-based, were computed on each slice and the whole tumour. To measure functional heterogeneity, entropy was calculated on BF values as well. Results. Most of the slices were not represented by the global BF values computed on the whole tumour. In addition, there are a number of lesions having equivalent global BF values, but they are composed of slices having very different heterogeneity distributions, that is, entropy values. Conclusions. Global mean/median BF values of the single slices separately should be considered for clinical assessment, only if interpreted through entropy computed on BF values. The numerical equivalence between global BF values of different lesions may correspond to different clinical status, thus inducing possible errors in choice of therapy when considering global values only. Silvia Malavasi, Domenico Barone, Giampaolo Gavelli, and Alessandro Bevilacqua Copyright © 2017 Silvia Malavasi et al. All rights reserved. Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach Wed, 04 Jan 2017 09:32:51 +0000 Aim. To investigate the value of contrast-enhanced ultrasound (CEUS) guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT) decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6) who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US) guidance group (). All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3%) and larger (14.1 ± 10.7 mm versus 32.3 ± 18.5 mm) nonenhanced necrotic areas. More inner (20.0% versus 6.7%) and surrounding (18.3% versus 2.7%) major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%). The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%). Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management. Feng Mao, Yi Dong, Zhengbiao Ji, Jiaying Cao, and Wen-Ping Wang Copyright © 2017 Feng Mao et al. All rights reserved. Structure Prior Effects in Bayesian Approaches of Quantitative Susceptibility Mapping Tue, 20 Dec 2016 06:43:32 +0000 Quantitative susceptibility mapping (QSM) has shown its potential for anatomical and functional MRI, as it can quantify, for in vivo tissues, magnetic biomarkers and contrast agents which have differential susceptibilities to the surroundings substances. For reconstructing the QSM with a single orientation, various methods have been proposed to identify a unique solution for the susceptibility map. Bayesian QSM approach is the major type which uses various regularization terms, such as a piece-wise constant, a smooth, a sparse, or a morphological prior. Six QSM algorithms with or without structure prior are systematically discussed to address the structure prior effects. The methods are evaluated using simulations, phantom experiments with the given susceptibility, and human brain data. The accuracy and image quality of QSM were increased when using structure prior in the simulation and phantom compared to same regularization term without it, respectively. The image quality of QSM method using the structure prior is better comparing, respectively, to the method without it by either sharpening the image or reducing streaking artifacts in vivo. The structure priors improve the performance of the various QSMs using regularized minimization including L1, L2, and TV norm. Shuai Wang, Weiwei Chen, Chunmei Wang, Tian Liu, Yi Wang, Chu Pan, Ketao Mu, Ce Zhu, Xiang Zhang, and Jian Cheng Copyright © 2016 Shuai Wang et al. All rights reserved. 125I Seeds Radiation Induces Paraptosis-Like Cell Death via PI3K/AKT Signaling Pathway in HCT116 Cells Mon, 19 Dec 2016 14:28:39 +0000 125I seeds brachytherapy implantation has been extensively performed in unresectable and rerecurrent rectal carcinoma. Many studies on the cancer-killing activity of 125I seeds radiation mainly focused on its ability to trigger apoptosis, which is the most well-known and dominant type of cell death induced by radiation. However our results showed some unique morphological features such as cell swelling, cytoplasmic vacuolation, and plasma membrane integrity, which is obviously different to apoptosis. In this study, clonogenic proliferation was carried out to assay survival fraction. Transmission electron microscopy was used to analyze ultrastructural and evaluate morphologic feature of HCT116 cells after exposure to 125I seeds radiation. Immunofluorescence analysis was used to detect the origin of cytoplasmic vacuoles. Flow cytometry analysis was employed to detect the size and granularity of HCT116 cells. Western blot was performed to measure the protein level of AIP1, caspase-3, AKT, p-Akt (Thr308), p-Akt (Ser473), and -actin. We found that 125I seeds radiation activated PI3K/AKT signaling pathway and could trigger paraptosis-like cell death. Moreover, inhibitor of PI3K/AKT signaling pathway could inhibit paraptosis-like cell death induced by 125I seeds radiation. Our data suggest that 125I seeds radiation can induce paraptosis-like cell death via PI3K/AKT signaling pathway. Lelin Hu, Hao Wang, Yong Zhao, and Junjie Wang Copyright © 2016 Lelin Hu et al. All rights reserved. Method of Individual Adjustment for 3D CT Analysis: Linear Measurement Tue, 13 Dec 2016 09:04:07 +0000 Introduction. We aim to regularize measurement values in three-dimensional (3D) computed tomography (CT) reconstructed images for higher-precision 3D analysis, focusing on length-based 3D cephalometric examinations. Methods. We measure the linear distances between points on different skull models using Vernier calipers (real values). We use 10 differently tilted CT scans for 3D CT reconstruction of the models and measure the same linear distances from the picture archiving and communication system (PACS). In both cases, each measurement is performed three times by three doctors, yielding nine measurements. The real values are compared with the PACS values. Each PACS measurement is revised based on the display field of view (DFOV) values and compared with the real values. Results. The real values and the PACS measurement changes according to tilt value have no significant correlations (). However, significant correlations appear between the real values and DFOV-adjusted PACS measurements (). Hence, we obtain a correlation expression that can yield real physical values from PACS measurements. The DFOV value intervals for various age groups are also verified. Conclusion. Precise confirmation of individual preoperative length and precise analysis of postoperative improvements through 3D analysis is possible, which is helpful for facial-bone-surgery symmetry correction. Dong Kyu Kim, Dong Hun Choi, Jeong Woo Lee, Jung Dug Yang, Ho Yun Chung, Byung Chae Cho, and Kang Young Choi Copyright © 2016 Dong Kyu Kim et al. All rights reserved. Detection of the Single-Session Complete Ablation Rate by Contrast-Enhanced Ultrasound during Ultrasound-Guided Laser Ablation for Benign Thyroid Nodules: A Prospective Study Wed, 23 Nov 2016 14:04:34 +0000 This study aimed to investigate the single-session complete ablation rate of ultrasound-guided percutaneous laser ablation (LA) for benign thyroid nodules. LA was performed in 90 patients with 118 benign thyroid nodules. Contrast-enhanced ultrasound (CEUS) was used to evaluate complete nodule ablation one day after ablation. Thyroid nodule volumes, thyroid functions, clinical symptoms and complications were evaluated 1, 3, 6, 12, and 18 months after ablation. Results showed that all benign thyroid nodules successfully underwent LA. The single-session complete ablation rates for nodules with maximum diameters ≤2 cm, 2-3 cm and ≥3 cm were 93.4%, 70.3% and 61.1%, respectively. All nodule volumes significantly decreased than that one day after ablation (); at the final evaluation, the volume decreased from  mL to  mL. Thyroid functions did not show significant differences at one month after ablation compared with that before (). Three patients had obvious pain during ablation; one (1.1%) had recurrent laryngeal nerve injury, but the voice returned to normal within 6 months after treatment. Thus, ultrasound-guided LA can effectively inactivate benign thyroid nodules. LA is a potentially viable minimally invasive treatment that offers good cosmetic effects. Shuhua Ma, Ping Zhou, Xiaomin Wu, Shuangming Tian, and Yongfeng Zhao Copyright © 2016 Shuhua Ma et al. All rights reserved. Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms: Post Hoc Analysis from the Prospective Study Sun, 20 Nov 2016 14:20:45 +0000 The aim of this study is to describe premature microbubbles destruction with contrast-enhanced voiding urosonography (ce-VUS) in children using 2nd-generation ultrasound contrast agents (UCA) and to hypothesize about the reason. 141 children (61 females and 80 males) were included in the study, with mean age of 3.3 years (range 4 weeks–16.0 years), who underwent ce-VUS examination between 2011 and 2014. Premature destruction of the microbubbles in the urinary bladder during ce-VUS was observed in 11 children (7.8%). In all these cases the voiding phase of ce-VUS examination could not be performed because of destroyed UCA microbubbles. This was noted in anxious, crying infants and children with restricted voiding. The premature destruction of ultrasound contrast agent during ce-VUS is an underreported, important limitation of ce-VUS, which prevents evaluation of the voiding phase and the establishment of vesicoureteric reflux (VUR). This was particularly noted in crying infants and children. Maciej Piskunowicz, Dominik Swieton, Dorota Rybczynska, Arkadiusz Szarmach, Edyta Szurowska, and Menno Pruijm Copyright © 2016 Maciej Piskunowicz et al. All rights reserved. Corrigendum to “Design of CGMP Production of 18F- and 68Ga-Radiopharmaceuticals” Wed, 09 Nov 2016 07:24:31 +0000 Yen-Ting Chi, Pei-Chun Chu, Hao-Yu Chao, Wei-Chen Shieh, and Chuck C. Chen Copyright © 2016 Yen-Ting Chi et al. All rights reserved. Diagnostic Value of CT Arthrography for Evaluation of Osteochondral Lesions at the Ankle Mon, 07 Nov 2016 11:36:27 +0000 Background. To retrospectively determine the diagnostic value of computed tomography arthrography (CTA) of the ankle in the evaluation of (osteo)chondral lesions in comparison to conventional magnetic resonance imaging (MRI) and intraoperative findings. Methods. A total of patients had CTAs and MRI of the ankle; in 17/79 cases surgical reports with statements on cartilage integrity were available. Cartilage lesions and bony defects at talus and tibia were scored according to defect depth and size by two radiologists. Statistical analysis included sensitivity analyses and Cohen’s kappa calculations. Results. On CTA, 41/79 and 31/79 patients had full thickness cartilage defects at the talus and at the tibia, respectively. MRI was able to detect 54% of these defects. For the detection of full thickness cartilage lesions, interobserver agreement was substantial (0.72 0.05) for CTA and moderate (0.55 0.07) for MRI. In surgical reports, 88–92% and 46–62% of full thickness defects detected by CTA and MRI were described. CTA findings changed the further clinical management in 15.4% of cases. Conclusions. As compared to conventional MRI, CTA improves detection and visualization of cartilage defects at the ankle and is a relevant tool for treatment decisions in unclear cases. Jan S. Kirschke, Sepp Braun, Thomas Baum, Christian Holwein, Christoph Schaeffeler, Andreas B. Imhoff, Ernst J. Rummeny, Klaus Woertler, and Pia M. Jungmann Copyright © 2016 Jan S. Kirschke et al. All rights reserved. Magnetization Transfer and Amide Proton Transfer MRI of Neonatal Brain Development Thu, 03 Nov 2016 13:19:46 +0000 Purpose. This study aims to evaluate the process of brain development in neonates using combined amide proton transfer (APT) imaging and conventional magnetization transfer (MT) imaging. Materials and Methods. Case data were reviewed for all patients hospitalized in our institution’s neonatal ward. Patients underwent APT and MT imaging (a single protocol) immediately following the routine MR examination. Single-slice APT/MT axial imaging was performed at the level of the basal ganglia. APT and MT ratio (MTR) measurements were performed in multiple brain regions of interest (ROIs). Data was statistically analyzed in order to assess for significant differences between the different regions of the brain or correlation with patient gestational age. Results. A total of 38 neonates were included in the study, with ages ranging from 27 to 41 weeks’ corrected gestational age. There were statistically significant differences in both APT and MTR measurements between the frontal lobes, basal ganglia, and occipital lobes (APT: frontal lobe versus occipital lobe and other groups ; MTR: frontal lobe versus occipital lobe and other groups ). Furthermore, APT and MTR in above brain regions exhibited positive linear correlations with patient gestational age. Conclusions. APT/MT imaging can provide valuable information about the process of the neonatal brain development at the molecular level. Yang Zheng, Xiaoming Wang, and Xuna Zhao Copyright © 2016 Yang Zheng et al. All rights reserved. Early Inflammatory Response following Traumatic Brain Injury in Rabbits Using USPIO- and Gd-Enhanced MRI Thu, 27 Oct 2016 11:57:18 +0000 Purpose. To monitor the inflammatory response (IR) following traumatic brain injury (TBI) before and after the rehabilitation of the blood-brain barrier (BBB) in rabbits using USPIO- and Gd-enhanced MRI. Materials and Methods. Twenty white big-eared rabbits with mild TBI (mTBI) were randomly and equally divided into four groups. Rabbits were sacrificed for the brain specimens immediately after the last MRI-monitoring. Sequences were tse-T1WI, tse-T2WI, Gd-T1WI, and USPIO-T1WI. Dynamical MRI presentations were evaluated and compared with pathological findings for each group. Results. Twenty-four hours after injury, all rabbits displayed high signal foci on T2WI, while only 55% lesions could be found on Gd-T1WI and none on USPIO-T1WI. The lesions were enhanced on Gd-T1WI in 100% subjects after 48 h and the enhancement sizes augmented to the largest after 72 h. At the time point of 72 h after TBI, 90% lesions were enhanced by USPIO. Five days after injury, 19 lesions showed decreased Gd-enhancement and one disappeared; however, USPIO-enhancement became larger than before. Pathological findings showed microglias slightly appeared in dense leukocytes at 48 h, but became the dominant inflammatory cells after five days. Conclusions. Dynamic IR following injury could be monitored by combination of Gd- and USPIO-MRI in mTBI rabbits. Lin Ouyang, Si Zeng, Gang Zheng, and Guang Ming Lu Copyright © 2016 Lin Ouyang et al. All rights reserved. Automatic Detection of Pectoral Muscle Region for Computer-Aided Diagnosis Using MIAS Mammograms Tue, 25 Oct 2016 11:18:39 +0000 The computer-aided detection (CAD) systems have been developed to help radiologists with the early detection of breast cancer. This system provides objective and accurate information to reduce the misdiagnosis of the disease. In mammography, the pectoral muscle region is used as an index to compare the symmetry between the left and right images in the mediolateral oblique (MLO) view. The pectoral muscle segmentation is necessary for the detection of microcalcification or mass because the pectoral muscle has a similar pixel intensity as that of lesions, which affects the results of automatic detection. In this study, the mammographic image analysis society database (MIAS, 322 cases) was used for detecting the pectoral muscle segmentation. The pectoral muscle was detected by using the morphological method and the random sample consensus (RANSAC) algorithm. We evaluated the detected pectoral muscle region and compared the manual segmentation with the automatic segmentation. The results showed 92.2% accuracy. We expect that the proposed method improves the detection accuracy of breast cancer lesions using a CAD system. Woong Bae Yoon, Ji Eun Oh, Eun Young Chae, Hak Hee Kim, Soo Yeul Lee, and Kwang Gi Kim Copyright © 2016 Woong Bae Yoon et al. All rights reserved. The Evaluation of the Clinical, Laboratory, and Radiological Findings of 16 Cases of Brucellar Spondylitis Thu, 08 Sep 2016 17:47:01 +0000 Objective. To evaluate the clinical, laboratory, and radiological presentation of 16 cases of brucellar spondylitis. Methods. The clinical manifestations, laboratory tests, and imaging findings of 16 patients (aged from 24 to 66 years) with brucellar spondylitis treated between September 2012 and September 2014 at the Second Affiliated Hospital of Xi’an Jiaotong University (Xi’an, China) were retrospectively analyzed. Results. Clinical manifestations included high fever, severe pain, sweating, and fatigue. One patient had epididymitis, and two showed clear signs of spinal nerve damage. Laboratory tests showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein content. Serum brucella agglutination tests were positive, and 11 brucella blood cultures were positive. Imaging manifestations mainly consisted of abnormal signals in the intervertebral space or abnormal signals in the adjacent vertebral bodies (16/16, 100%) in magnetic resonance imaging (MRI), disc space narrowing (14/16, 88%) in X-ray and MRI, or bone destruction and sclerosis around the damaged zone (13/16, 81%) in computed tomography, with rare cases of psoas abscess (2/16, 13%) and sequestrum (1/16, 6%). Conclusion. Since brucellar spondylitis exhibited characteristic clinical and imaging manifestations, it could be diagnosed with specific laboratory tests. Early MRI examination of suspected cases could improve rapid diagnosis. Baohui Yang, Hongbo Hu, Jie Chen, Xijing He, and Haopeng Li Copyright © 2016 Baohui Yang et al. All rights reserved. Immediate Adverse Reactions to Gadolinium-Based MR Contrast Media: A Retrospective Analysis on 10,608 Examinations Mon, 29 Aug 2016 07:12:52 +0000 Background and Purpose. Contrast media (CM) for magnetic resonance imaging (MRI) may determine the development of acute adverse reactions. Objective was to retrospectively assess the frequency and severity of adverse reactions associated with gadolinium-based contrast agents (GBCAs) injection in patients who underwent MRI. Material and Methods. At our center 10608 MRI examinations with CM were performed using five different GBCAs: Gd-BOPTA (MultiHance), Gd-DTPA (Magnevist), Gd-EOBDTPA (Primovist), Gd-DOTA (Dotarem), and Gd-BTDO3A (Gadovist). Results. 32 acute adverse reactions occurred, accounting for 0.3% of all administration. Twelve reactions were associated with Gd-DOTA injection (0.11%), 9 with Gd-BOPTA injection (0.08%), 6 with Gd-BTDO3A (0.056%), 3 with Gd-EOB-DTPA (0.028%), and 2 with Gd-DTPA (0.018%). Twenty-four reactions (75.0%) were mild, four (12.5%) moderate, and four (12.5%) severe. The most severe reactions were seen associated with use of Gd-BOPTA, with 3 severe reactions in 32 total reactions. Conclusion. Acute adverse reactions are generally rare with the overall adverse reaction rate of 0.3%. The most common adverse reactions were not severe, consisting in skin rash and hives. Vincenza Granata, Marco Cascella, Roberta Fusco, Nicoletta dell’Aprovitola, Orlando Catalano, Salvatore Filice, Vincenzo Schiavone, Francesco Izzo, Arturo Cuomo, and Antonella Petrillo Copyright © 2016 Vincenza Granata et al. All rights reserved. A Novel Two-Step Technique for Retrieving Fractured Peripherally Inserted Central Catheter Segments Migrating into the Heart or the Pulmonary Artery Tue, 23 Aug 2016 13:17:57 +0000 Objective. To report the experience of a percutaneous technique for retrieving fractured peripherally inserted central catheter (PICC) segments migrating into the heart or the pulmonary artery. Method. From April 2013 to July 2015, we performed percutaneous retrieval of fractured PICC segments migrating into the heart or the pulmonary artery in five cancer patients who had undergone chemotherapy via PICC. The fractures were diagnosed with chest plain radiography. The patients included three cases of breast cancer, one case of rectal cancer, and one case of lower limb Ewing’s tumor. The fractures were retained in the vessels of the patients for 1 to 3 days. All the fractures were retrieved by using a novel two-step technique in the digital subtraction angiography (DSA) suite. This two-step technique involves inserting a pigtail catheter to the heart or the pulmonary artery to grasp the fractured catheter fragment and bring it to the lower segment of the inferior vena cava, followed by grasping and removing the catheter fragment with a retrieval loop system of the vena cava filter retrieval set. Result. The fractured PICC segments were removed successfully in all five patients via unilateral (four patients) or bilateral (one patient) femoral vein access. No complications occurred during the interventional procedure. Conclusion. Percutaneous retrieval can be a safe, convenient, and minimally invasive method for the removal of fractured PICC segments. The technique reported in this paper will be applicable for the retrieval of fractured PICC segments and other catheter fragments migrating into the heart or the pulmonary artery. Juan Peng, Xiao-Ming Zhang, Lin Yang, Hao Xu, Nan-Dong Miao, Yong-Jun Ren, Kang Liu, Xu-Li Min, Ke Yang, Shi Yang, and Cheng Yang Copyright © 2016 Juan Peng et al. All rights reserved. Gamma-Ray Treatment of Echinococcus Protoscoleces prior to Implantation in Mice Reduces Echinococcosis Tue, 16 Aug 2016 14:31:44 +0000 Echinococcosis is a serious parasitic disease caused by Echinococcus tapeworms. Protoscoleces are sometimes released during surgical treatment for hydatid cysts, causing the recurrence of echinococcosis. Protoscoleces may be susceptible to radiation therapy. In this study Echinococcus protoscoleces were cultured in vitro and then divided into four different γ-ray irradiation dose groups (10 Gy, 20 Gy, 40 Gy, and 80 Gy) and a blank group. The protoscoleces were then implanted into the abdominal cavity of mice. Four months later, we observed that the incidence and weight of cysts declined with the increase of irradiation dose. γ-ray irradiation can suppress the generation of Echinococcus originated from protoscolex, the reason of which is due to the damaging to the structure of Echinococcus. Irradiation may prevent echinococcosis recurrence after surgical removal of hydatid cysts. Qing Yuan, Bo Li, Shiping Jiang, Qiang Zhao, Ji Duo, and Xiang Huang Copyright © 2016 Qing Yuan et al. All rights reserved. Volumetric Magnetic Resonance Imaging Study of Brain and Cerebellum in Children with Cerebral Palsy Thu, 04 Aug 2016 10:17:46 +0000 Introduction. Quantitative magnetic resonance imaging (MRI) studies are rarely used in the diagnosis of patients with cerebral palsy. The aim of present study was to assess the relationships between the volumetric MRI and clinical findings in children with cerebral palsy compared to control subjects. Materials and Methods. Eighty-two children with cerebral palsy and 90 age- and sex-matched healthy controls were collected. Results. The dominant changes identified on MRI scans in children with cerebral palsy were periventricular leukomalacia (42%) and posthemorrhagic hydrocephalus (21%). The total brain and cerebellum volumes in children with cerebral palsy were significantly reduced in comparison to controls. Significant grey matter volume reduction was found in the total brain in children with cerebral palsy compared with the control subjects. Positive correlations between the age of the children of both groups and the grey matter volumes in the total brain were found. Negative relationship between width of third ventricle and speech development was found in the patients. Positive correlations were noted between the ventricles enlargement and motor dysfunction and mental retardation in children with cerebral palsy. Conclusions. By using the voxel-based morphometry, the total brain, cerebellum, and grey matter volumes were significantly reduced in children with cerebral palsy. Piotr Kułak, Elżbieta Maciorkowska, and Elżbieta Gościk Copyright © 2016 Piotr Kułak et al. All rights reserved. Radiation Exposure to Staff in Intensive Care Unit with Portable CT Scanner Sun, 31 Jul 2016 10:07:22 +0000 Background. Bedside radiological procedures pose a risk of radiation exposure to ICU staff. The perception of risk may increase the degree of caution among the health care staff and raise new barriers preventing patients from obtaining prompt care. Objective. The aim of this study was to estimate the annual cumulative radiation dose to individual ICU staff. Methods. In this prospective study, forty subjects were required to wear thermoluminescent dosimeter badges during their working hours. The badges were analyzed to determine the exposure after 3 months. Results. A total of 802 radiological procedures were completed at bedside during the study period. The estimated annual dosage to doctors and nurses on average was 0.99 mSv and 0.88 mSv (), respectively. Residents were subjected to the highest radiation exposure (1.04 mSv per year, ). The radiation dose was correlated with day shift working hours (; ) and length of service (; ). Conclusions. With standard precautions, bedside radiological procedures—including portable CT scans—do not expose ICU staff to high dose of ionizing radiation. The level of radiation exposure is related to the daytime working hours and length of service. Zhichao Xie, Xuelian Liao, Yan Kang, Jiangqian Zhang, and Lingli Jia Copyright © 2016 Zhichao Xie et al. All rights reserved. Quantitative Biomedical Imaging: Techniques and Clinical Applications Mon, 25 Jul 2016 12:36:15 +0000 Guang Jia, Steven B. Heymsfield, Jinyuan Zhou, Guang Yang, and Yukihisa Takayama Copyright © 2016 Guang Jia et al. All rights reserved. CBCT-Aided Microscopic and Ultrasonic Treatment for Upper or Middle Thirds Calcified Root Canals Mon, 25 Jul 2016 06:08:39 +0000 Root canal calcification is considered a great challenge during root canal treatment. Although the application of ultrasonic instruments and dental operating microscope (DOM) has advantages, dealing with calcified root canals still suffers a great risk of failure because of limited information about the location, length, and direction of obliteration on periapical radiographs. In this work, a cone-beam computed tomography- (CBCT-) aided method aimed at solving complicated calcified root canals in which conventional approaches could not work was proposed. Thirteen teeth with sixteen calcified canals (12 calcified in the upper third, 4 calcified in the middle third), which cannot be negotiated with conventional methods, were treated with the aid of CBCT. The location of calcification and depth of instrumentation and operating direction were calculated and assessed in three dimensions with ultrasonic instruments under DOM. In all thirteen teeth, canals with upper and middle thirds calcification were treated successfully. Finally, a guideline was proposed to help achieve consistent apical patency in calcified canals. Ying-Ming Yang, Bin Guo, Li-Yang Guo, Yan Yang, Xiao Hong, Hong-Ying Pan, Wen-Ling Zou, and Tao Hu Copyright © 2016 Ying-Ming Yang et al. All rights reserved. Fuzzy Clustering Applied to ROI Detection in Helical Thoracic CT Scans with a New Proposal and Variants Mon, 18 Jul 2016 17:10:35 +0000 The detection of pulmonary nodules is one of the most studied problems in the field of medical image analysis due to the great difficulty in the early detection of such nodules and their social impact. The traditional approach involves the development of a multistage CAD system capable of informing the radiologist of the presence or absence of nodules. One stage in such systems is the detection of ROI (regions of interest) that may be nodules in order to reduce the space of the problem. This paper evaluates fuzzy clustering algorithms that employ different classification strategies to achieve this goal. After characterising these algorithms, the authors propose a new algorithm and different variations to improve the results obtained initially. Finally it is shown as the most recent developments in fuzzy clustering are able to detect regions that may be nodules in CT studies. The algorithms were evaluated using helical thoracic CT scans obtained from the database of the LIDC (Lung Image Database Consortium). Alfonso Castro, Alberto Rey, Carmen Boveda, Bernardino Arcay, and Pedro Sanjurjo Copyright © 2016 Alfonso Castro et al. All rights reserved. Accuracy and Precision of Three-Dimensional Low Dose CT Compared to Standard RSA in Acetabular Cups: An Experimental Study Sun, 10 Jul 2016 10:30:43 +0000 Background and Purpose. The gold standard for detection of implant wear and migration is currently radiostereometry (RSA). The purpose of this study is to compare a three-dimensional computed tomography technique (3D CT) to standard RSA as an alternative technique for measuring migration of acetabular cups in total hip arthroplasty. Materials and Methods. With tantalum beads, we marked one cemented and one uncemented cup and mounted these on a similarly marked pelvic model. A comparison was made between 3D CT and standard RSA for measuring migration. Twelve repeated stereoradiographs and CT scans with double examinations in each position and gradual migration of the implants were made. Precision and accuracy of the 3D CT were calculated. Results. The accuracy of the 3D CT ranged between 0.07 and 0.32 mm for translations and 0.21 and 0.82° for rotation. The precision ranged between 0.01 and 0.09 mm for translations and 0.06 and 0.29° for rotations, respectively. For standard RSA, the precision ranged between 0.04 and 0.09 mm for translations and 0.08 and 0.32° for rotations, respectively. There was no significant difference in precision between 3D CT and standard RSA. The effective radiation dose of the 3D CT method, comparable to RSA, was estimated to be 0.33 mSv. Interpretation. Low dose 3D CT is a comparable method to standard RSA in an experimental setting. Cyrus Brodén, Henrik Olivecrona, Gerald Q. Maguire Jr., Marilyn E. Noz, Michael P. Zeleznik, and Olof Sköldenberg Copyright © 2016 Cyrus Brodén et al. All rights reserved. Acoustic Cavitation Enhances Focused Ultrasound Ablation with Phase-Shift Inorganic Perfluorohexane Nanoemulsions: An In Vitro Study Using a Clinical Device Thu, 23 Jun 2016 07:12:17 +0000 Purpose. To investigate whether acoustic cavitation could increase the evaporation of a phase-shift inorganic perfluorohexane (PFH) nanoemulsion and enhance high intensity focused ultrasound (HIFU) ablation. Materials and Methods. PFH was encapsulated by mesoporous silica nanocapsule (MSNC) to form a nanometer-sized droplet (MSNC-PFH). It was added to a tissue-mimicking phantom, whereas phosphate buffered saline (PBS) was added as a control (PBS-control). HIFU ( W,  s) exposures were performed in both phantoms with various duty cycles (DC). US images, temperature, and cavitation emissions were recorded during HIFU exposure. HIFU-induced lesions were measured and calculated. Results. Compared to PBS-control, MSNC-PFH nanoemulsion could significantly increase the volume of HIFU-induced lesion (). Peak temperatures were 78.16 ± 5.64°C at a DC of 100%, 70.17 ± 6.43°C at 10%, 53.17 ± 4.54°C at 5%, and 42.00 ± 5.55°C at 2%, respectively. Inertial cavitation was much stronger in the pulsed-HIFU than that in the continuous-wave HIFU exposure. Compared to 100%-DC exposure, the mean volume of lesion induced by 5 s exposure at 10%-DC was significantly larger, but smaller at 2%-DC. Conclusions. MSNC-PFH nanoemulsion can significantly enhance HIFU ablation. Appropriate pulsed-HIFU exposure could significantly increase the volume of lesion and reduce total US energy required for HIFU ablation. Lu-Yan Zhao, Jian-Zhong Zou, Zong-Gui Chen, Shan Liu, Jiao Jiao, and Feng Wu Copyright © 2016 Lu-Yan Zhao et al. All rights reserved. Transient Global Amnesia following Neural and Cardiac Angiography May Be Related to Ischemia Tue, 21 Jun 2016 09:40:32 +0000 Introduction. Transient global amnesia (TGA) following angiography is rare, and the pathogenesis has not been illustrated clearly till now. The aim of this research is to explore the pathogenesis of TGA following angiography by analyzing our data and reviewing the literature. Methods. We retrospectively studied 20836 cases with angiography in our hospital between 2007 and 2015 and found 9 cases with TGA following angiography. The data of these 9 cases were analyzed. Results. We found all 9 cases with TGA following neural angiography (5 in 4360) or cardiac angiography (4 in 8817) and no case with TGA following peripheral angiography (0 in 7659). Statistical difference was found when comparing the neural and cardiac angiography group with peripheral group (). Two cases with TGA were confirmed with small acute infarctions in hippocampus after angiography. This might be related to the microemboli which were rushed into vertebral artery following blood flow during neural angiography or cardiac angiography. There was no statistical difference when comparing the different approaches for angiography () and different contrast agents (). Conclusion. Based on the positive findings of imaging study and our analysis, we speculate that ischemia in the medial temporal lobe with the involvement of the hippocampus might be an important reason of TGA following angiography. Hongzhou Duan, Liang Li, Yang Zhang, Jiayong Zhang, Ming Chen, and Shengde Bao Copyright © 2016 Hongzhou Duan et al. All rights reserved. Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings Wed, 15 Jun 2016 08:07:53 +0000 Objectives. The aim of this study was to detect factors associated with small bowel obstruction (SBO) caused by bezoars on multidetector computed tomographic findings. Methods. We retrospectively reviewed 61 patients who had bezoars in the small bowels on MDCT. The patients were divided into SBO patients group and non-SBO patients group. The mean values of the diameter, volume, and CT attenuation as well as location and characteristics of the bezoars were compared between the two groups. Multivariate analysis was performed to determine factors associated with SBO. Results. There were 32 patients (52.5%) in the SBO group and 29 patients (47.5%) in the non-SBO group. The bezoars in the SBO group had greater values of each mean diameter and mean volume than those in the non-SBO group ( cm versus  cm, ,  cm3 versus  cm3, , resp.) and had a lower CT attenuation than the non-SBO group ( versus , ). The SBO group had higher prevalence of phytobezoar appearance (75.0% versus 10.3%, ). Major diameters of bezoar and phytobezoar were significant independent risk factors associated with SBO (odds ratio = 36.09, 8.26, resp., and , 0.044, resp.). Conclusions. Major diameter of bezoar or phytobezoar is a potential risk factor associated with SBO. Lian-qin Kuang, Da-wei Zhao, Cheng Cheng, and Yi Wang Copyright © 2016 Lian-qin Kuang et al. All rights reserved. Aberrant Resting-State Functional Connectivity Density in Patients with Hepatitis B Virus-Related Cirrhosis Tue, 14 Jun 2016 12:32:02 +0000 There is increasing evidence that cirrhosis may affect functional connectivity among various brain regions in patients prior to onset of overt hepatic encephalopathy (HE). However, most investigators have focused mainly on alterations in functional connectivity strengths, and the changes in functional connectivity density (FCD) are largely unknown. Here, we investigated alterations in resting-state FCD in patients with hepatitis B virus-related cirrhosis (HBV-RC) without overt HE. Totally, 31 patients with HBV-RC without overt HE and 30 age- and sex-matched healthy controls underwent resting-state functional MRI examinations. FCD mapping was employed to compute local and global FCD maps. Then, short-range and long-range FCD values were calculated and voxel-based comparisons were performed between the two groups. The HBV-RC group showed significant decreases in FCD, including decreased short-range FCDs in the bilateral middle cingulum gyrus/precuneus, the bilateral cuneus, and the left lingual gyrus/inferior occipital gyrus and decreased long-range FCD in the bilateral cuneus/precuneus. In addition, the decreased long-range FCD in the bilateral cuneus/precuneus in the HBV-RC group was related to performance on the psychometric hepatic encephalopathy score (PHES) test. These findings suggest aberrant functional connectivity density in cirrhotic patients prior to overt HE onset, which may provide better insight into understanding the pathophysiological mechanisms underlying the cirrhotic-related cognitive impairment. Xiao-Fei Lv, Hua-Wang Wu, Li Tian, Lu-Jun Han, Jing Li, Ying-Wei Qiu, Gui-Hua Jiang, Xue-Lin Zhang, Rong Zhang, and Chuan-Miao Xie Copyright © 2016 Xiao-Fei Lv et al. All rights reserved. High b-Value Diffusion MRI to Differentiate Recurrent Tumors from Posttreatment Changes in Head and Neck Squamous Cell Carcinoma: A Single Center Prospective Study Tue, 07 Jun 2016 11:19:55 +0000 Recently DW-MR Imaging has shown promising results in distinguishing between recurrent tumors and posttreatment changes in Head and Neck Squamous Cell Carcinoma (HNSSC). Aim of this study was to evaluate the diagnostic performances of DWI at high b-value (b = 2000 s/mm2) compared to standard b-value (b = 1000 s/mm2) and values () to differentiate recurrent tumors from posttreatment changes after treatment of HSNCC. 20 patients (16 M, 4 F) underwent MR Imaging between 2 and 16 months (mean 7) after treatment. Besides morphological sequences, we performed single-shot echo-planar DWI at b = 1000 s/mm2 and b = 2000 s/mm2, and corresponding ADC maps were generated (ADC1000 and ADC2000, resp.). By considering contrast-enhanced T1-weighted images as references, ROIs were drawn in order to evaluate mean ADC1000, ADC2000, and . The mean ADC1000 and ADC2000 in recurrent tumors were significantly lower than those in posttreatment changes ( and , resp.). Moreover, the mean between the two groups showed a statistically significant difference (). Sensitivity, specificity, and accuracy of were 82.0%, 100%, and 90%, respectively, by considering an optimal cutoff value of 65.5%. is a promising value to differentiate between recurrent tumors and posttreatment changes in HNSCC and may be more useful than ADC1000 and ADC2000. Angela Acampora, Gaetana Manzo, Giacomo Fenza, Giuseppina Busto, Antonietta Serino, and Andrea Manto Copyright © 2016 Angela Acampora et al. All rights reserved. Three-Dimensional Computer-Aided Detection of Microcalcification Clusters in Digital Breast Tomosynthesis Wed, 04 May 2016 13:40:04 +0000 We propose computer-aided detection (CADe) algorithm for microcalcification (MC) clusters in reconstructed digital breast tomosynthesis (DBT) images. The algorithm consists of prescreening, MC detection, clustering, and false-positive (FP) reduction steps. The DBT images containing the MC-like objects were enhanced by a multiscale Hessian-based three-dimensional (3D) objectness response function and a connected-component segmentation method was applied to extract the cluster seed objects as potential clustering centers of MCs. Secondly, a signal-to-noise ratio (SNR) enhanced image was also generated to detect the individual MC candidates and prescreen the MC-like objects. Each cluster seed candidate was prescreened by counting neighboring individual MC candidates nearby the cluster seed object according to several microcalcification clustering criteria. As a second step, we introduced bounding boxes for the accepted seed candidate, clustered all the overlapping cubes, and examined. After the FP reduction step, the average number of FPs per case was estimated to be 2.47 per DBT volume with a sensitivity of 83.3%. Ji-wook Jeong, Seung-Hoon Chae, Eun Young Chae, Hak Hee Kim, Young-Wook Choi, and Sooyeul Lee Copyright © 2016 Ji-wook Jeong et al. All rights reserved. Automatic Extraction of Appendix from Ultrasonography with Self-Organizing Map and Shape-Brightness Pattern Learning Tue, 12 Apr 2016 13:23:02 +0000 Accurate diagnosis of acute appendicitis is a difficult problem in practice especially when the patient is too young or women in pregnancy. In this paper, we propose a fully automatic appendix extractor from ultrasonography by applying a series of image processing algorithms and an unsupervised neural learning algorithm, self-organizing map. From the suggestions of clinical practitioners, we define four shape patterns of appendix and self-organizing map learns those patterns in pixel clustering phase. In the experiment designed to test the performance for those four frequently found shape patterns, our method is successful in 3 types (1 failure out of 45 cases) but leaves a question for one shape pattern (80% correct). Kwang Baek Kim, Doo Heon Song, and Hyun Jun Park Copyright © 2016 Kwang Baek Kim et al. All rights reserved. Comparison of Imaging Characteristics of 124I PET for Determination of Optimal Energy Window on the Siemens Inveon PET Tue, 22 Mar 2016 09:43:38 +0000 Purpose.124I has a half-life of 4.2 days, which makes it suitable for imaging over several days over its uptake and washout phases. However, it has a low positron branching ratio (23%), because of prompt gamma coincidence due to high-energy γ-photons (602 to 1,691 keV), which are emitted in cascade with positrons. Methods. In this study, we investigated the optimal PET energy window for 124I PET based on image characteristics of reconstructed PET. Image characteristics such as nonuniformities, recovery coefficients (RCs), and the spillover ratios (SORs) of 124I were measured as described in NEMA NU 4-2008 standards. Results. The maximum and minimum prompt gamma coincidence fraction (PGF) were 33% and 2% in 350~800 and 400~590 keV, respectively. The difference between best and worst uniformity in the various energy windows was less than 1%. The lowest SORs of 124I were obtained at 350~750 keV in nonradioactive water compartment. Conclusion. Optimal energy window should be determined based on image characteristics. Our developed correction method would be useful for the correction of high-energy prompt gamma photon in 124I PET. In terms of the image quality of 124I PET, our findings indicate that an energy window of 350~750 keV would be optimal. A Ram Yu, Hee-Joung Kim, Sang Moo Lim, and Jin Su Kim Copyright © 2016 A Ram Yu et al. All rights reserved. Intraoperative Contrast Enhanced Ultrasound Evaluates the Grade of Glioma Wed, 16 Mar 2016 09:53:59 +0000 Objective. The aim of our study was to investigate the value of intraoperative contrast enhanced ultrasound (CEUS) for evaluating the grade of glioma and the correlation between microvessel density (MVD) and vascular endothelial growth factor (VEGF). Methods. We performed intraoperative conventional ultrasound (CUS) and CEUS on 88 patients with gliomas. All of the patients have undergone surgery and obtained the results of pathology. All patients have undergone intraoperative CUS and CEUS to compare the characteristics of different grade gliomas and the results of CUS and CEUS were compared with pathological results. Results. The time to start (TTS) and time to peak (TTP) of low grade glioma (LGG) were similar to those of edema and normal brain surrounding glioma. The enhanced extent of LGG was higher than that of the normal brain and edema. The TTS and TTP of high grade glioma were earlier than those of the edema and normal brain surrounding glioma. The enhancement of HGG was higher than that of LGG. The absolute peak intensity (API) was correlated with MVD and VEGF. Conclusion. Intraoperative CEUS could help in determining boundary of peritumoral brain edema of glioma. Intraoperative CEUS parameters in cerebral gliomas could indirectly reflect the information of MVD and VEGF. Ling-Gang Cheng, Wen He, Hong-Xia Zhang, Qian Song, Bin Ning, Hui-Zhan Li, Yan He, and Song Lin Copyright © 2016 Ling-Gang Cheng et al. All rights reserved. Application of Arterial Spin Labelling in the Assessment of Ocular Tissues Tue, 15 Mar 2016 07:17:04 +0000 Arterial spin labelling (ASL) is a noninvasive magnetic resonance imaging (MRI) modality, capable of measuring blood perfusion without the use of a contrast agent. While ASL implementation for imaging the brain and monitoring cerebral blood flow has been reviewed in depth, the technique is yet to be widely used for ocular tissue imaging. The human retina is a very thin but highly stratified structure and it is also situated close to the surface of the body which is not ideal for MR imaging. Hence, the application of MR imaging and ASL in particular has been very challenging for ocular tissues and retina. That is despite the fact that almost all of retinal pathologies are accompanied by blood perfusion irregularities. In this review article, we have focused on the technical aspects of the ASL and their implications for its optimum adaptation for retinal blood perfusion monitoring. Retinal blood perfusion has been assessed through qualitative or invasive quantitative methods but the prospect of imaging flow using ASL would increase monitoring and assessment of retinal pathologies. The review provides details of ASL application in human ocular blood flow assessment. E. Vaghefi and B. Pontré Copyright © 2016 E. Vaghefi and B. Pontré. All rights reserved. Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT: Theoretical Models and Current Implementation Thu, 10 Mar 2016 14:22:11 +0000 Technological advances in magnetic resonance imaging (MRI) and computed tomography (CT), including higher spatial and temporal resolution, have made the prospect of performing absolute myocardial perfusion quantification possible, previously only achievable with positron emission tomography (PET). This could facilitate integration of myocardial perfusion biomarkers into the current workup for coronary artery disease (CAD), as MRI and CT systems are more widely available than PET scanners. Cardiac PET scanning remains expensive and is restricted by the requirement of a nearby cyclotron. Clinical evidence is needed to demonstrate that MRI and CT have similar accuracy for myocardial perfusion quantification as PET. However, lack of standardization of acquisition protocols and tracer kinetic model selection complicates comparison between different studies and modalities. The aim of this overview is to provide insight into the different tracer kinetic models for quantitative myocardial perfusion analysis and to address typical implementation issues in MRI and CT. We compare different models based on their theoretical derivations and present the respective consequences for MRI and CT acquisition parameters, highlighting the interplay between tracer kinetic modeling and acquisition settings. G. J. Pelgrim, A. Handayani, H. Dijkstra, N. H. J. Prakken, R. H. J. A. Slart, M. Oudkerk, P. M. A. Van Ooijen, R. Vliegenthart, and P. E. Sijens Copyright © 2016 G. J. Pelgrim et al. All rights reserved. Computer-Assisted Classification Patterns in Autoimmune Diagnostics: The AIDA Project Thu, 03 Mar 2016 07:40:09 +0000 Antinuclear antibodies (ANAs) are significant biomarkers in the diagnosis of autoimmune diseases in humans, done by mean of Indirect ImmunoFluorescence (IIF) method, and performed by analyzing patterns and fluorescence intensity. This paper introduces the AIDA Project (autoimmunity: diagnosis assisted by computer) developed in the framework of an Italy-Tunisia cross-border cooperation and its preliminary results. A database of interpreted IIF images is being collected through the exchange of images and double reporting and a Gold Standard database, containing around 1000 double reported images, has been settled. The Gold Standard database is used for optimization of a CAD (Computer Aided Detection) solution and for the assessment of its added value, in order to be applied along with an Immunologist as a second Reader in detection of autoantibodies. This CAD system is able to identify on IIF images the fluorescence intensity and the fluorescence pattern. Preliminary results show that CAD, used as second Reader, appeared to perform better than Junior Immunologists and hence may significantly improve their efficacy; compared with two Junior Immunologists, the CAD system showed higher Intensity Accuracy (85,5% versus 66,0% and 66,0%), higher Patterns Accuracy (79,3% versus 48,0% and 66,2%), and higher Mean Class Accuracy (79,4% versus 56,7% and 64.2%). Amel Benammar Elgaaied, Donato Cascio, Salvatore Bruno, Maria Cristina Ciaccio, Marco Cipolla, Alessandro Fauci, Rossella Morgante, Vincenzo Taormina, Yousr Gorgi, Raja Marrakchi Triki, Melika Ben Ahmed, Hechmi Louzir, Sadok Yalaoui, Sfar Imene, Yassine Issaoui, Ahmed Abidi, Myriam Ammar, Walid Bedhiafi, Oussama Ben Fraj, Rym Bouhaha, Khouloud Hamdi, Koudhi Soumaya, Bilel Neili, Gati Asma, Mariano Lucchese, Maria Catanzaro, Vincenza Barbara, Ignazio Brusca, Maria Fregapane, Gaetano Amato, Giuseppe Friscia, Trai Neila, Souayeh Turkia, Haouami Youssra, Raja Rekik, Hayet Bouokez, Maria Vasile Simone, Francesco Fauci, and Giuseppe Raso Copyright © 2016 Amel Benammar Elgaaied et al. All rights reserved. Development of High-Field Permanent Magnetic Circuits for NMRI/MRI and Imaging on Mice Mon, 29 Feb 2016 12:06:52 +0000 The high-field permanent magnetic circuits of 1.2 T and 1.5 T with novel magnetic focusing and curved-surface correction are developed. The permanent magnetic circuit comprises a magnetic yoke, main magnetic steel, nonspherical curved-surface magnetic poles, plugging magnetic steel, and side magnetic steel. In this work, a novel shimming method is proposed for the effective correction of base magnetic field () inhomogeneities, which is based on passive shimming on the telescope aspheric cutting, grinding, and fine processing technology of the nonspherical curved-surface magnetic poles and active shimming adding higher-order gradient coils. Meanwhile, the magnetic resonance imaging dedicated alloy with high-saturation magnetic field induction intensity and high electrical resistivity is developed, and nonspherical curved-surface magnetic poles which are made of the dedicated alloy have very good anti-eddy-current effect. In addition, the large temperature coefficient problem of permanent magnet can be effectively controlled by using a high quality temperature controller and deuterium external locking technique. Combining our patents such as gradient coil, RF coil, and integration computer software, two kinds of small animal Micro-MRI instruments are developed, by which the high quality MRI images of mice were obtained. Guangxin Wang, Huantong Xie, Shulian Hou, Wei Chen, and Xiuhong Yang Copyright © 2016 Guangxin Wang et al. All rights reserved. Fast 3-Breath-Hold 3-Dimensional Tagging Cardiac Magnetic Resonance in Patients with Hypertrophic Myocardial Diseases: A Feasibility Study Sun, 28 Feb 2016 14:18:36 +0000 Tagging CMR has been established as the standard reference for measurement of myocardial strain. The current 2D tagging technique requires multiple breath-holds to cover the whole heart and cannot show the 3D motions of the left ventricle. We performed fast 3-breath-hold 3D tagging with localized tagging preparation and complementary spatial modulation of magnetization in 10 patients with hypertrophic myocardial diseases and 6 normal volunteers. The left wall motion was observed at any view angle, which allowed for the identification of regional and global hypokinesis using the fast 3D tagging. Although a decrease in the circumferential strain and LGE were observed at the basal septum in hypertrophic cardiomyopathy, they were not located together in each patient. In hypertensive heart disease, the decrease in circumferential strain was observed more widely than LGE, and the summed strain of all segments was significantly decreased. The decrease in strain and LGE were observed diffusely in cardiac amyloidosis. In conclusion, fast 3-breath-hold 3D tagging is feasible for the regional and global strain analysis. The location of reduced circumferential strain is not necessarily the same as that of LGE and is related to the global cardiac function in patients with hypertrophic myocardial diseases. Yasuo Amano, Fumi Yamada, Hidenobu Hashimoto, Makoto Obara, Kuniya Asai, and Shinichiro Kumita Copyright © 2016 Yasuo Amano et al. All rights reserved. Diffusion-Weighted Imaging of Small Peritoneal Implants in “Potentially” Early-Stage Ovarian Cancer Sun, 28 Feb 2016 13:54:51 +0000 Introduction. MRI is established modality for the diagnosis of ovarian malignancies. Advances in MRI technology, including DW imaging, could lead to the further increase in the sensitivity of MRI for the detection of peritoneal metastases. The aim of this study was to assess the accuracy of DW imaging for detection of peritoneal metastatic disease in patients suspected of having potentially early ovarian cancer and secondly to evaluate ADC values of peritoneal implants. Materials and Methods. The prospective study group consisted of 26 women with sonographic or/and CT diagnosis of suspected ovarian tumor. Based on the results of the above imaging, in none of them was extraovarian spread of disease or ascites recognized. All patients underwent MRI with DW imaging. Results. Overall, 18 extraovarian peritoneal lesions were found on DW images in 10 from 26 examined patients. All implants had diameter ≤10 mm. The presence of all lesions diagnosed by MRI was confirmed intraoperatively. Histopathologic findings in 17 proofs confirmed ovarian cancer. PPV was 94%. On all DW images (with b values of 0, 50, 100, 150, 200, 400, 800, and 1200 s/mm2) the mean signal intensities of peritoneal lesions were significantly higher than the mean signal intensities of normal adjacent tissue (). Laretta Grabowska-Derlatka, Pawel Derlatka, Wojciech Szeszkowski, and Andrzej Cieszanowski Copyright © 2016 Laretta Grabowska-Derlatka et al. All rights reserved. Diffusion-Weighted Imaging with Two Different -Values in Detection of Solid Focal Liver Lesions Thu, 25 Feb 2016 12:43:47 +0000 One hundred and eighty-two consecutive patients with suspected liver disease were recruited to receive diffusion-weighted imaging (DWI) with two different -values, in comparison with T2-weighted imaging (T2WI). The detection rate of three MR sequences in solid focal liver lesions (FLLs) and subgroup analyses were performed. Our prospective study found that DWI600 was equivalent to DWI100 and T2WI for the detection of solid FLLs overall but was significantly more accurate in the detection of malignant solid FLLs and lesions larger than 10 mm. Da-wei Yang, Ke-yang Wang, Xun Yao, Hui-yi Ye, Tao Jiang, Yuan Liu, Jia-yin Gao, Min Chen, Cheng Zhou, and Zheng-han Yang Copyright © 2016 Da-wei Yang et al. All rights reserved. X-Ray Scatter Correction on Soft Tissue Images for Portable Cone Beam CT Tue, 16 Feb 2016 14:25:47 +0000 Soft tissue images from portable cone beam computed tomography (CBCT) scanners can be used for diagnosis and detection of tumor, cancer, intracerebral hemorrhage, and so forth. Due to large field of view, X-ray scattering which is the main cause of artifacts degrades image quality, such as cupping artifacts, CT number inaccuracy, and low contrast, especially on soft tissue images. In this work, we propose the X-ray scatter correction method for improving soft tissue images. The X-ray scatter correction scheme to estimate X-ray scatter signals is based on the deconvolution technique using the maximum likelihood estimation maximization (MLEM) method. The scatter kernels are obtained by simulating the PMMA sheet on the Monte Carlo simulation (MCS) software. In the experiment, we used the QRM phantom to quantitatively compare with fan-beam CT (FBCT) data in terms of CT number values, contrast to noise ratio, cupping artifacts, and low contrast detectability. Moreover, the PH3 angiography phantom was also used to mimic human soft tissues in the brain. The reconstructed images with our proposed scatter correction show significant improvement on image quality. Thus the proposed scatter correction technique has high potential to detect soft tissues in the brain. Sorapong Aootaphao, Saowapak S. Thongvigitmanee, Jartuwat Rajruangrabin, Chalinee Thanasupsombat, Tanapon Srivongsa, and Pairash Thajchayapong Copyright © 2016 Sorapong Aootaphao et al. All rights reserved. Diagnostic Value of Magnetic Resonance Spectroscopy in Radiation Encephalopathy Induced by Radiotherapy for Patients with Nasopharyngeal Carcinoma: A Meta-Analysis Wed, 03 Feb 2016 14:20:04 +0000 In this study, articles in English and Chinese were selected from available electronic databases prior to September 2014. The metabolic concentrations and patterns of N-acetylaspartic acid (NAA), Choline (Cho), Creatine (Cr), NAA/Cr, NAA/Cho, and Cho/Cr ratios in radiotherapy-induced radiation encephalopathy by proton magnetic resonance spectroscopy were extracted. A meta-analysis was performed to quantitatively synthesize findings of these studies. Weighted mean difference (WMD) and 95% confidence intervals (95%CIs) were calculated using random or fixed effective models. Heterogeneity between studies was assessed using the Cochrane test and statistics. The results indicated that a total of 4 researches involving 214 patients met inclusion criteria. Depending on methodologies of selected studies, control groups were referred to as healthy subjects. The combined analysis revealed that there was no significant difference in value of Cr between radiotherapy group and healthy control group (WMD = −1.483, 95% CI: −67.185–64.219, ). However, there were significant difference in values of NAA (WMD = −18.227, 95%CI: −36.317–−0.137, ), Cho (WMD = 38.003, 95%CI: 5.155–70.851, ), NAA/Cr (WMD = −1.175, 95%CI: −1.563–−0.787, ), NAA/Cho (WMD = −1.108, 95%CI: −2.003–0.213, ), and Cho/Cr (WMD = −0.773, 95%CI: 0.239–1.307, ). In conclusion, MRS can be regarded as an effective and feasible imaging test for radiotherapy-induced radiation encephalopathy in NPC patients. Wang-Sheng Chen, Jian-Jun Li, Lan Hong, Zeng-Bao Xing, Fen Wang, and Chang-Qing Li Copyright © 2016 Wang-Sheng Chen et al. All rights reserved. Characterization of Enhancing MS Lesions by Dynamic Texture Parameter Analysis of Dynamic Susceptibility Perfusion Imaging Wed, 13 Jan 2016 11:31:26 +0000 Purpose. The purpose of this study was to investigate statistical differences with MR perfusion imaging features that reflect the dynamics of Gadolinium-uptake in MS lesions using dynamic texture parameter analysis (DTPA). Methods. We investigated 51 MS lesions (25 enhancing, 26 nonenhancing lesions) of 12 patients. Enhancing lesions () were prestratified into enhancing lesions with increased permeability (EL+; ) and enhancing lesions with subtle permeability (EL−; ). Histogram-based feature maps were computed from the raw DSC-image time series and the corresponding texture parameters were analyzed during the inflow, outflow, and reperfusion time intervals. Results. Significant differences () were found between EL+ and EL− and between EL+ and nonenhancing inactive lesions (NEL). Main effects between EL+ versus EL− and EL+ versus NEL were observed during reperfusion (mainly in mean and standard deviation (SD): EL+ versus EL− and EL+ versus NEL), while EL− and NEL differed only in their SD during outflow. Conclusion. DTPA allows grading enhancing MS lesions according to their perfusion characteristics. Texture parameters of EL− were similar to NEL, while EL+ differed significantly from EL− and NEL. Dynamic texture analysis may thus be further investigated as noninvasive endogenous marker of lesion formation and restoration. Rajeev K. Verma, Johannes Slotboom, Cäcilia Locher, Mirjam R. Heldner, Christian Weisstanner, Eugenio Abela, Frauke Kellner-Weldon, Martin Zbinden, Christian P. Kamm, and Roland Wiest Copyright © 2016 Rajeev K. Verma et al. All rights reserved. Analysis of Residual DSBs in Ataxia-Telangiectasia Lymphoblast Cells Initiating Apoptosis Wed, 06 Jan 2016 11:29:58 +0000 In order to examine the relationship between accumulation of residual DNA double-strand breaks (DSBs) and cell death, we have used a control and an ATM (Ataxia-Telangiectasia Mutated) defective cell line, as Ataxia-Telangiectasia (AT) cells tend to accumulate residual DSBs at long times after damage infliction. After irradiation, AT cells showed checkpoint impairment and a fraction of cells displayed an abnormal centrosome number and tetraploid DNA content, and this fraction increased along with apoptosis rates. At all times analyzed, AT cells displayed a significantly higher rate of radiation-induced apoptosis than normal cells. Besides apoptosis, 70–85% of the AT viable cells (TUNEL-negative) carried ≥10 γH2AX foci/cell, while only 12–27% of normal cells did. The fraction of AT and normal cells undergoing early and late apoptosis were isolated by flow cytometry and residual DSBs were concretely scored in these populations. Half of the γH2AX-positive AT cells undergoing early apoptosis carried ≥10 γH2AX foci/cell and this fraction increased to 75% in late apoptosis. The results suggest that retention of DNA damage-induced γH2AX foci is an indicative of lethal DNA damage, as cells undergoing apoptosis are those accumulating more DSBs. Scoring of residual γH2AX foci might function as a predictive tool to assess radiation-induced apoptosis. Teresa Anglada, Mariona Terradas, Laia Hernández, Anna Genescà, and Marta Martín Copyright © 2016 Teresa Anglada et al. All rights reserved. Improvement in the Detection of Cystic Metastatic Papillary Thyroid Carcinoma by Measurement of Thyroglobulin in Aspirated Fluid Mon, 04 Jan 2016 13:45:26 +0000 Cystic change in metastatic lymph nodes of papillary thyroid carcinoma (PTC) is a diagnostic challenge for fine needle aspiration (FNA) because of the scant cellularity. The aim of this study was to evaluate the measurement of thyroglobulin in fine needle aspirate (Tg-FNA) for detecting metastatic PTC in patients with cystic neck lesions and to validate the optimal cutoff value of Tg-FNA. A total of 75 FNA specimens of cystic lesions were identified, including 40 of metastatic PTC. Predetermined threshold levels of 0.04 (minimum detection level), 0.9, 10.0, and 77.0 ng/mL (maximum normal serum-Tg level) were used to evaluate the diagnostic accuracy of Tg-FNA for metastatic PTC detection. The areas under the receiver operating characteristic curve for diagnosing metastatic PTC of Tg-FNA values of 0.04, 0.9, 10.0, and 77.0 ng/mL were 0.5 (95% confidence interval [CI], 0.382–0.618), 0.645 (95% CI, 0.526–0.752), 0.945 (95% CI, 0.866–0.984), and 0.973 (95% CI, 0.907–0.996), respectively. With a cutoff value of 77.0 ng/mL, the combination of Tg-FNA and FNA cytology showed superior diagnostic power (97.5% sensitivity and 100% specificity) compared to FNA cytology alone (80% sensitivity and 100% specificity). We recommend a Tg-FNA cutoff of 77.0 ng/mL, the maximum normal serum-Tg level, for cystic neck lesions. Yong Wang, Huan Zhao, Yi-Xiang J. Wang, Min-Jie Wang, Zhi-Hui Zhang, Li Zhang, Bin Zhang, Anil T. Ahuja, Chun-Wu Zhou, Yu-Xin Jiang, and Hui-Qin Guo Copyright © 2016 Yong Wang et al. All rights reserved. Contrast-Enhanced Ultrasonography Features of Breast Malignancies with Different Sizes: Correlation with Prognostic Factors Thu, 31 Dec 2015 16:03:26 +0000 This study was to investigate the correlation between contrast-enhanced ultrasonography (CEUS) characteristics with prognostic factors in breast cancers with different sizes. A retrospective analysis of CEUS characteristics of 104 pathologically proven malignant lesions from 104 women was conducted. Lesions were divided into two groups according to their size measured by US (Group 1: maximum diameter ≤20 mm; Group 2: maximum diameter >20 mm). Features including enhancement degree, order and pattern, enlargement of the enhancement area, and penetrating vessels on CEUS were evaluated. Pathologic prognostic factors, including estrogen and progesterone receptor status, and the expression of c-erb-B2, p53, Ki-67, and VEGF were assessed. Comparison of enhancement pattern parameters between Group 1 and Group 2 showed statistically significant differences (). A significant correlation was found between enlargement of the enhancement area and ER positivity in Group 1 (). In Group 2 the absence of penetrating vessels was significantly associated with VEGF negativity () and ER negativity (). Centripetal enhancement reflected VEGF negativity () in lesions with diameter >20 mm. Thus, breast cancers with different sizes show different CEUS features; small breast cancers show homogeneous enhancement pattern while cancers with diameter >20 mm show homogeneous enhancement pattern. Some CEUS characteristics of differently sized breast cancers could be correlated with prognostic factors, which may be useful in prognosis assessment. Li-Xia Zhao, Hui Liu, Qing Wei, Guang Xu, Jian Wu, Hui-Xiong Xu, Rong Wu, and Huan Pu Copyright © 2015 Li-Xia Zhao et al. All rights reserved. Assessment of Random Error in Phantom Dosimetry with the Use of Error Simulation in Statistical Software Thu, 31 Dec 2015 08:58:49 +0000 Objective. To investigate if software simulation is practical for quantifying random error (RE) in phantom dosimetry. Materials and Methods. We applied software error simulation to an existing dosimetry study. The specifications and the measurement values of this study were brought into the software (R version 3.0.2) together with the algorithm of the calculation of the effective dose (). Four sources of RE were specified: () the calibration factor; () the background radiation correction; () the read-out process of the dosimeters; and () the fluctuation of the X-ray generator. Results. The amount of RE introduced by these sources was calculated on the basis of the experimental values and the mathematical rules of error propagation. The software repeated the calculations of multiple times () while attributing the applicable RE to the experimental values. A distribution of emerged as a confidence interval around an expected value. Conclusions. Credible confidence intervals around in phantom dose studies can be calculated by using software modelling of the experiment. With credible confidence intervals, the statistical significance of differences between protocols can be substantiated or rejected. This modelling software can also be used for a power analysis when planning phantom dose experiments. R. C. Hoogeveen, E. P. Martens, P. F. van der Stelt, and W. E. R. Berkhout Copyright © 2015 R. C. Hoogeveen et al. All rights reserved. Impact of Fibrotic Tissue on Shear Wave Velocity in Thyroid: An Ex Vivo Study with Fresh Thyroid Specimens Thu, 31 Dec 2015 06:47:24 +0000 We sought to elucidate the correlation between shear wave velocity (SWV) and fibrosis in thyroid by precisely assessing pathological structures inside 5 × 5 mm2 regions of interest (ROIs) of resected specimens, under conditions that excluded physical artifacts. The materials were unselected thyroid and lymph node specimens resected during thyroid surgery. Immediately after surgery, fresh unfixed thyroid and metastatic lymph node specimens were suspended in gel phantoms, and SWV was measured. Upon pathological examination of each specimen, the extent of fibrosis was graded as none, moderate, or severe. A total of 109 specimens were evaluated: 15 normal thyroid, 16 autoimmune thyroiditis, 40 malignant nodules, 19 benign thyroid nodules, and 19 metastatic lymph nodes. When all specimens were classified according to the degree of fibrosis determined by pathological imaging, the mean SWV was  m/s for no fibrosis,  m/s for moderate fibrosis, and  m/s for severe fibrosis. The SWVs of samples with moderate and severe fibrosis were significantly higher than those of samples without fibrosis. The results of this study demonstrate that fibrosis plays an important role in determining stiffness, as measured by SWV in thyroid. Takahiro Fukuhara, Eriko Matsuda, Yukari Endo, Ryohei Donishi, Shoichiro Izawa, Kazunori Fujiwara, Hiroya Kitano, and Hiromi Takeuchi Copyright © 2015 Takahiro Fukuhara et al. All rights reserved. Optimal Experiment Design for Monoexponential Model Fitting: Application to Apparent Diffusion Coefficient Imaging Mon, 28 Dec 2015 08:58:17 +0000 The monoexponential model is widely used in quantitative biomedical imaging. Notable applications include apparent diffusion coefficient (ADC) imaging and pharmacokinetics. The application of ADC imaging to the detection of malignant tissue has in turn prompted several studies concerning optimal experiment design for monoexponential model fitting. In this paper, we propose a new experiment design method that is based on minimizing the determinant of the covariance matrix of the estimated parameters (D-optimal design). In contrast to previous methods, D-optimal design is independent of the imaged quantities. Applying this method to ADC imaging, we demonstrate its steady performance for the whole range of input variables (imaged parameters, number of measurements, and range of -values). Using Monte Carlo simulations we show that the D-optimal design outperforms existing experiment design methods in terms of accuracy and precision of the estimated parameters. Mohammad Alipoor, Stephan E. Maier, Irene Yu-Hua Gu, Andrew Mehnert, and Fredrik Kahl Copyright © 2015 Mohammad Alipoor et al. All rights reserved. Enhanced Classification of Interstitial Lung Disease Patterns in HRCT Images Using Differential Lacunarity Tue, 22 Dec 2015 06:53:53 +0000 The analysis and interpretation of high-resolution computed tomography (HRCT) images of the chest in the presence of interstitial lung disease (ILD) is a time-consuming task which requires experience. In this paper, a computer-aided diagnosis (CAD) scheme is proposed to assist radiologists in the differentiation of lung patterns associated with ILD and healthy lung parenchyma. Regions of interest were described by a set of texture attributes extracted using differential lacunarity (DLac) and classical methods of statistical texture analysis. The proposed strategy to compute DLac allowed a multiscale texture analysis, while maintaining sensitivity to small details. Support Vector Machines were employed to distinguish between lung patterns. Training and model selection were performed over a stratified 10-fold cross-validation (CV). Dimensional reduction was made based on stepwise regression (-test, value < 0.01) during CV. An accuracy of 95.8 ± 2.2% in the differentiation of normal lung pattern from ILD patterns and an overall accuracy of 94.5 ± 2.1% in a multiclass scenario revealed the potential of the proposed CAD in clinical practice. Experimental results showed that the performance of the CAD was improved by combining multiscale DLac with classical statistical texture analysis. Verónica Vasconcelos, João Barroso, Luis Marques, and José Silvestre Silva Copyright © 2015 Verónica Vasconcelos et al. All rights reserved. A Novel Statistical Approach for Brain MR Images Segmentation Based on Relaxation Times Mon, 21 Dec 2015 09:45:07 +0000 Brain tissue segmentation in Magnetic Resonance Imaging is useful for a wide range of applications. Classical approaches exploit the gray levels image and implement criteria for differentiating regions. Within this paper a novel approach for brain tissue joint segmentation and classification is presented. Starting from the estimation of proton density and relaxation times, we propose a novel method for identifying the optimal decision regions. The approach exploits the statistical distribution of the involved signals in the complex domain. The technique, compared to classical threshold based ones, is able to globally improve the classification rate. The effectiveness of the approach is evaluated on both simulated and real datasets. Fabio Baselice, Giampaolo Ferraioli, and Vito Pascazio Copyright © 2015 Fabio Baselice et al. All rights reserved. Brain Parenchymal Fraction: A Relatively Simple MRI Measure to Clinically Distinguish ALS Phenotypes Sun, 13 Dec 2015 09:47:22 +0000 Even though neuroimaging and clinical studies indicate that amyotrophic lateral sclerosis (ALS) manifests with distinct clinical phenotypes, no objective test exists to assess upper motor degeneration in ALS. There is great interest in identifying biomarkers of ALS to allow earlier diagnosis and to recognize disease subtypes. Current quantitative neuroimaging techniques such as T2 relaxometry and diffusion tensor imaging are time-consuming to use in clinical settings due to extensive postprocessing requirements. Therefore, we aimed to study the potential role of brain parenchymal fraction (BPF) as a relatively simple quantitative measure for distinguishing ALS phenotypes. T1-weighted MR images of brain were obtained in 15 neurological controls and 88 ALS patients categorized into 4 distinct clinical phenotypes, upper motor neuron- (UMN-) predominant ALS patients with/without corticospinal tract (CST) hyperintensity on T2/PD-weighted images, classic ALS, and ALS with frontotemporal dementia (ALS-FTD). BPF was calculated using intracranial grey matter, white matter, and cerebrospinal fluid volumes obtained in control and ALS subgroups using SPM8 software. Only ALS-FTD patients had significant reduction in BPF when compared to controls and nondemented ALS patients. Correlation of clinical measures such as disease duration with BPF further supports the view that the BPF could be a potential biomarker for clinical diagnosis of ALS-FTD patients. Venkateswaran Rajagopalan and Erik P. Pioro Copyright © 2015 Venkateswaran Rajagopalan and Erik P. Pioro. All rights reserved. Development of a Rapid Cartilage Damage Quantification Method for the Lateral Tibiofemoral Compartment Using Magnetic Resonance Images: Data from the Osteoarthritis Initiative Wed, 02 Dec 2015 07:16:42 +0000 The purpose of this study was to expand and validate the cartilage damage index (CDI) to detect cartilage damage in the lateral tibiofemoral compartment. We used an iterative 3-step process to develop and validate the lateral CDI: development (100 knees), testing (80 knees), and validation (100 knees). The validation set included 100 knees from the Osteoarthritis Initiative that was enriched to include all grades of lateral joint space narrowing (JSN, 0–3). Measurement of the CDI was rapid at 7.4 (s.d. 0.73) minutes per knee pair (baseline and follow-up of one knee). The intratester reliability is good (intraclass correlation coefficient (3, 1 model) = 0.86 to 0.98). At baseline, knees with greater KL grade and lateral JSN had a lower mean CDI (i.e., greater cartilage damage). Baseline lateral CDI is associated with both lateral JSW ( to 0.85, ) and HKA ( to −0.33, ). The SRM is good (lateral femur SRM = −0.76; lateral tibia SRM = −0.73; lateral tibiofemoral total SRM = −0.87). The lateral tibiofemoral CDI quantification allows for rapid evaluation and is reliable and responsive, with good construct validity. It may be an efficient method to measure lateral tibiofemoral articular cartilage in large clinical and epidemiologic studies. Ming Zhang, Jeffrey B. Driban, Lori Lyn Price, Grace H. Lo, Eric Miller, and Timothy E. McAlindon Copyright © 2015 Ming Zhang et al. All rights reserved. A New Approach Using Manganese-Enhanced MRI to Diagnose Acute Mesenteric Ischemia in a Rabbit Model: Initial Experience Thu, 26 Nov 2015 12:50:58 +0000 Purpose. Manganese-enhanced MRI (MEMRI) has been applied to a wide range of biological and disease research. The purpose of the study was to use MEMRI to diagnose the acute mesenteric ischemia (AMI). Methods. The institutional experimental animal ethics committee approved this study. To optimize the dose of Mn2+ infusion, a dose-dependent curve was obtained using Mn2+-enhanced T1 map MRI by an intravenous infusion 2.5–20 nmol/g body weight (BW) of 50 nmol/L MnCl2. The eighteen animals were divided into control, sham-operated, and AMI groups. AMI models were performed by ligating the superior mesenteric artery (SMA). T1 values were measured on T1 maps in regions of the small intestinal wall and relaxation rate (ΔR1) was calculated. Results. A nonlinear relationship between infused MnCl2 solution dose and increase in small intestinal wall ΔR1 was observed. Control animal exhibited significant Mn2+ clearance over time at the dose of 15 nmol/g BW. In the AMI model, ΔR1 values (0.95 ± 0.13) in the small intestinal wall were significantly lower than in control group (2.05 ± 0.19) after Mn2+ infusion (P < 0.01). Conclusion. The data suggest that MEMRI shows potential as a diagnostic technique that is directly sensitive to the poor or absent perfusion in AMI. Da-wei Zhao, Cheng Cheng, Lian-qin Kuang, Yu-long Zhang, Hai-yun Cheng, Jia-yan Min, and Yi Wang Copyright © 2015 Da-wei Zhao et al. All rights reserved. Quantitative Evaluation of Growth Plates around the Knees of Adolescent Soccer Players by Diffusion-Weighted Magnetic Resonance Imaging Thu, 26 Nov 2015 06:55:12 +0000 Purpose. To quantitatively evaluate growth plates around the knees in adolescent soccer players utilizing the diffusion-weighted MR imaging (DWI). Methods. The knees and adjacent growth plates of eleven 14-year-old male soccer players were evaluated by MRI before (end of season’s summer break) and after two months of intense soccer training. MRI evaluation was conducted in coronal plane by PD-FSE and DWI. All images were screened for any major pathological changes. Later, central growth plate surface area (CGPSA) was measured and the apparent diffusion coefficient (ADC) values were calculated in two most central coronal slices divided into four regions: distal femur medial (DFM), distal femur lateral (DFL), proximal tibia medial (PTM), and proximal tibia lateral (PTL). Results. No gross pathology was diagnosed on MRI. CGPSA was not significantly reduced: DFM 278 versus 272, DFL 265 versus 261, PTM 193 versus 192, and PTL 214 versus 210. ADC decrease was statistically significant only for PTM: DFM 1.27 versus 1.22, DFL 1.37 versus 1.34, PTM 1.13 versus 1.03 (), and PTL 1.28 versus 1.22. Conclusions. DWI measurements indicate increased cellularity in growth plates around knees in footballers most prominent in PTM after intense training. No detectable differences on a standard PD-FSE sequence were observed. Zmago Krajnc, Mitja Rupreht, and Matej Drobnič Copyright © 2015 Zmago Krajnc et al. All rights reserved. Dynamic Contrast-Enhanced CT Characterization of Xp11.2 Translocation/TFE3 Gene Fusions versus Papillary Renal Cell Carcinomas Mon, 09 Nov 2015 08:12:37 +0000 Purpose. To compare the differences of CT characteristics between renal cell carcinomas (RCCs) associated with Xp11.2 translocation/TFE3 gene fusions (Xp11.2 RCCs) and papillary cell renal cell carcinomas (PRCCs). Methods. CT images and clinical records of 64 patients (25 Xp11.2 RCCs, 15 type 1 and 24 type 2 PRCCs) were analyzed and compared retrospectively. Results. Xp11.2 RCC more frequently affected young ( years) women (16/25, 64%) with gross hematuria (12/25, 48%), while PRCC more frequently involved middle-aged ( years) men (28/39, 71.8%) asymptomatically. Xp11.2 RCC tended to be heterogeneous density with some showing circular calcification. Lesion sizes of Xp11.2 RCC ( cm) and type 2 PRCC ( cm) were significantly larger than that of type 1 PRCC ( cm). Xp11.2 RCC contained more cystic components (22/25, 88%) than type 1 PRCC (all solid) and type 2 PRCC (9/24, 36.0%). Type 1 PRCC (13/15, 86.7%) and Xp11.2 RCC (21/25, 84.0%) showed more clear boundary than type 2 PRCC (12/24, 50.0%). Conclusion. CT features including diameter, boundary, attenuation, nature, and circular calcification of the tumor, combined with demographic information and symptoms, may be useful to differentiate Xp11.2 RCC from different subtypes of PRCC. Jian He, Kefeng Zhou, Bin Zhu, Gutian Zhang, Xiaogong Li, Hongqian Guo, Weidong Gan, Zhengyang Zhou, and Tian Liu Copyright © 2015 Jian He et al. All rights reserved. Magnetic Resonance Image Sequence Influences the Relationship between Bone Marrow Lesions Volume and Pain: Data from the Osteoarthritis Initiative Mon, 02 Nov 2015 13:48:50 +0000 Subchondral bone marrow lesions (BMLs) are related to structural and symptomatic osteoarthritis progression. However, it is unclear how sequence selection influences a quantitative BML measurement and its construct validity. We compared quantitative assessment of BMLs on intermediate-weighted fat suppressed (IW FS) turbo spin echo and 3-dimensional dual echo steady state (3D DESS) sequences. We used a customized software to measure 30 knees’ (24- and 48-month MR images) BMLs on both sequences. The results showed that the IW FS sequences have much larger BML volumes (median: IW FS = 1840 mm3; DESS = 191 mm3) and BML volume change (between 24 and 48 months) than DESS sequence and demonstrate more BML volume change. The 24-month BML volume on IW FS is correlated with BML volume on DESS ( = 0.83). BML volume change on IW FS is not significantly correlated with change on DESS. The 24-month WOMAC pain is correlated with the 24-month BMLs on IW FS ( = 0.39) but not DESS. The change in WOMAC pain is correlated with BML volume change on IW FS ( = 0.37) but not DESS. Overall, BML quantification on IW FS offers better validity and statistical power than BML quantification on a 3D DESS sequence. Ming Zhang, Jeffrey B. Driban, Lori Lyn Price, Grace H. Lo, and Timothy E. McAlindon Copyright © 2015 Ming Zhang et al. All rights reserved. Hepatic and Splenic Acoustic Radiation Force Impulse Shear Wave Velocity Elastography in Children with Liver Disease Associated with Cystic Fibrosis Mon, 02 Nov 2015 12:05:55 +0000 Background. Liver disease associated with cystic fibrosis (CFLD) is the second cause of mortality in these patients. The diagnosis is difficult because none of the available tests are specific enough. Noninvasive elastographic techniques have been proven to be useful to diagnose hepatic fibrosis. Acoustic radiation force impulse (ARFI) imaging is an elastography imaging system. The purpose of the work was to study the utility of liver and spleen ARFI Imaging in the detection of CFLD. Method. 72 patients with cystic fibrosis (CF) were studied and received ARFI imaging in the liver and in the spleen. SWV values were compared with the values of 60 healthy controls. Results. Comparing the SWV values of CFLD with the control healthy group, values in the right lobe were higher in patients with CFLD. We found a SWV RHL cut-off value to detect CFLD of 1.27 m/s with a sensitivity of 56.5% and a specificity of 90.5%. CF patients were found to have higher SWC spleen values than the control group. Conclusions. ARFI shear wave elastography in the right hepatic lobe is a noninvasive technique useful to detect CFLD in our sample of patients. Splenic SWV values are higher in CF patients, without any clinical consequence. Teresa Cañas, Araceli Maciá, Rosa Ana Muñoz-Codoceo, Teresa Fontanilla, Patricia González-Rios, María Miralles, and Gloria Gómez-Mardones Copyright © 2015 Teresa Cañas et al. All rights reserved. Parameterization of the Age-Dependent Whole Brain Apparent Diffusion Coefficient Histogram Mon, 02 Nov 2015 11:22:15 +0000 Purpose. The distribution of apparent diffusion coefficient (ADC) values in the brain can be used to characterize age effects and pathological changes of the brain tissue. The aim of this study was the parameterization of the whole brain ADC histogram by an advanced model with influence of age considered. Methods. Whole brain ADC histograms were calculated for all data and for seven age groups between 10 and 80 years. Modeling of the histograms was performed for two parts of the histogram separately: the brain tissue part was modeled by two Gaussian curves, while the remaining part was fitted by the sum of a Gaussian curve, a biexponential decay, and a straight line. Results. A consistent fitting of the histograms of all age groups was possible with the proposed model. Conclusions. This study confirms the strong dependence of the whole brain ADC histograms on the age of the examined subjects. The proposed model can be used to characterize changes of the whole brain ADC histogram in certain diseases under consideration of age effects. Uwe Klose, Marion Batra, and Thomas Nägele Copyright © 2015 Uwe Klose et al. All rights reserved. MR Prediction of Liver Function and Pathology Using Gd-EOB-DTPA: Effect of Liver Volume Consideration Sun, 01 Nov 2015 12:18:03 +0000 Purpose. To evaluate whether the diagnostic performance of Gd-EOB-DTPA-enhanced MRI in evaluating liver function and pathology is improved by considering liver volume (LV). Methods. This retrospective study included 104 patients who underwent Gd-EOB-DTPA-enhanced MRI before liver surgery. For each patient, using the precontrast and hepatobiliary phase images, we calculated the increase rate of the liver-to-spleen signal intensity ratio (LSR), that is, the “ΔLSR,” and the increase rate of the liver-to-muscle signal intensity ratio (LMR), that is, the “ΔLMR.” ΔLSR × LV and ΔLMR × LV were also calculated. The correlation of each MR parameter with liver function data or liver pathology was assessed. The correlation coefficients were compared between ΔLSR (ΔLMR) and ΔLSR (ΔLMR) × LV. Results. The correlation coefficient between ΔLSR (ΔLMR) × LV and cholinesterase was significantly higher than that between ΔLSR (ΔLMR) and cholinesterase. The correlation coefficient between ΔLSR (ΔLMR) × LV and the degree of fibrosis or necroinflammatory activity was significantly lower than that between ΔLSR (ΔLMR) and the degree of fibrosis or necroinflammatory activity. Conclusion. The inclusion of liver volume may improve Gd-EOB-DTPA-based predictions of liver function, but not in predictions of liver pathology. Dai Shimamoto, Akihiro Nishie, Yoshiki Asayama, Yasuhiro Ushijima, Yukihisa Takayama, Nobuhiro Fujita, Ken Shirabe, Tomoyuki Hida, Yuichiro Kubo, and Hiroshi Honda Copyright © 2015 Dai Shimamoto et al. All rights reserved. The Preoperative CT-Scan Can Help to Predict Postoperative Complications after Pancreatoduodenectomy Thu, 29 Oct 2015 13:52:11 +0000 After pancreatoduodenectomy, complication rates are up to 40%. To predict the risk of developing postoperative pancreatic fistula or severe complications, various factors were evaluated. 110 consecutive patients undergoing pancreatoduodenectomy at our institute between January 2012 and September 2014 with complete CT scan were retrospectively identified. Pre-, per-, and postoperative patients and pathological information were gathered. The CT-scans were analysed for the diameter of the pancreatic duct, attenuation of the pancreas, and the visceral fat area. All data was statistically analysed for predicting POPF and severe complications by univariate and multivariate logistic regression analyses. The POPF rate was 18%. The VFA measured at umbilicus (OR 1.01; 95% CI = 1.00–1.02; ) was an independent predictor for POPF. The severe complications rate was 33%. Independent predictors were BMI (OR 1.24; 95% CI = 1.10–1.42; ), ASA class III (OR 17.10; 95% CI = 1.60–182.88; ), and mean HU (OR 0.98; 95% CI = 0.96–1.00; ). In conclusion, VFA measured at the umbilicus seems to be the best predictor for POPF. BMI, ASA III, and the mean HU of the pancreatic body are independent predictors for severe complications following PD. Femke F. Schröder, Feike de Graaff, Donald E. Bouman, Marjolein Brusse-Keizer, Kees H. Slump, and Joost M. Klaase Copyright © 2015 Femke F. Schröder et al. All rights reserved. Alteration of Regional Homogeneity within the Sensorimotor Network after Spinal Cord Decompression in Cervical Spondylotic Myelopathy: A Resting-State fMRI Study Thu, 29 Oct 2015 09:51:32 +0000 There is a lack of longitudinal research to evaluate the function of neurons’ adaptive changes within the sensorimotor network (SMN) following recovery after cervical cord decompression. Regional homogeneity (ReHo) may provide information that is critical to fully understand CSM-related functional neural synchrony alterations. The purpose of this study was to assess the ReHo alterations of resting state-functional MRI (rs-fMRI) within pre- and postdecompression CSM and healthy controls (HC) and its correlations with clinical indices. Predecompression CSM demonstrated a significantly lower ReHo in the left primary sensory cortex and primary motor cortex (PostG/PreG) but enhanced ReHo in the right superior parietal lobule (SPL) compared with HC. In comparison with predecompression CSM, the postdecompression CSM showed increased ReHo in the left PostG/PreG but significantly lower ReHo in the right SPL compared with HC patients. Abnormal ReHo regions in pre- or postdecompression CSM showed no significant correlation with the Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) scores, and disease duration (). This result demonstrated disrupted regional homogeneity within SMN in CSM. This adaptive change in the brain may favor the preservation of sensorimotor networks before and after cervical cord decompression and clinical symptoms independent of ReHo within SMN. Yongming Tan, Fuqing Zhou, Lin Wu, Zhili Liu, Xianjun Zeng, Honghan Gong, and Laichang He Copyright © 2015 Yongming Tan et al. All rights reserved. Self-Trained Supervised Segmentation of Subcortical Brain Structures Using Multispectral Magnetic Resonance Images Sun, 25 Oct 2015 11:12:00 +0000 The aim of this paper is investigate the feasibility of automatically training supervised methods, such as k-nearest neighbor (kNN) and principal component discriminant analysis (PCDA), and to segment the four subcortical brain structures: caudate, thalamus, pallidum, and putamen. The adoption of supervised classification methods so far has been limited by the need to define a representative training dataset, operation that usually requires the intervention of an operator. In this work the selection of the training data was performed on the subject to be segmented in a fully automated manner by registering probabilistic atlases. Evaluation of automatically trained kNN and PCDA classifiers that combine voxel intensities and spatial coordinates was performed on 20 real datasets selected from two publicly available sources of multispectral magnetic resonance studies. The results demonstrate that atlas-guided training is an effective way to automatically define a representative and reliable training dataset, thus giving supervised methods the chance to successfully segment magnetic resonance brain images without the need for user interaction. Michele Larobina, Loredana Murino, Amedeo Cervo, and Bruno Alfano Copyright © 2015 Michele Larobina et al. All rights reserved. Availability of Software-Based Correction of Mandibular Plane for the Vertical Measurement of the Mandible in Cone Beam Computed Tomography Thu, 22 Oct 2015 14:24:55 +0000 Objectives. To investigate the availability of correction of mandibular plane using software for vertical measurements in cone beam computed tomography (CBCT) according to the sites of the mandible. Methods. CBCT scans of six dry mandibles were performed at 0-, 5-, 10-, 15-, and 20-degree angles relative to CBCT scanning table. Using the imaging software, mandibular planes of the different angles were corrected to that of 0-degree angle on the CBCT images. Before and after correction of the mandibular planes, the distance from the mandibular canal to the alveolar crest was measured at M1, M2, and M3 areas of the mandible and vertical measurements were statistically compared with those of 0-angle location using the paired t-test. Results. Prior to correction, the vertical measurements increased as the angle increased. The greatest differences of measurements were observed in M3 areas . After correction, a strong correlation was found in measurements between the 0-degree angle and the other angles in all sites of the mandible . Conclusions. The vertical measurements of CBCT were significantly influenced by mandibular positioning. When CBCT scans are performed at angles other than 0-degree angle, software-based correction of the mandibular plane can be a reliable tool for the accurate vertical measurements in CBCT. Sang-Sun Han, Kwang-Min Lee, and Kee-Deog Kim Copyright © 2015 Sang-Sun Han et al. All rights reserved. Molecular Imaging with MRI: Potential Application in Pancreatic Cancer Thu, 22 Oct 2015 08:31:44 +0000 Despite the variety of approaches that have been improved to achieve a good understanding of pancreatic cancer (PC), the prognosis of PC remains poor, and the survival rates are dismal. The lack of early detection and effective interventions is the main reason. Therefore, considerable ongoing efforts aimed at identifying early PC are currently being pursued using a variety of methods. In recent years, the development of molecular imaging has made the specific targeting of PC in the early stage possible. Molecular imaging seeks to directly visualize, characterize, and measure biological processes at the molecular and cellular levels. Among different imaging technologies, the magnetic resonance (MR) molecular imaging has potential in this regard because it facilitates noninvasive, target-specific imaging of PC. This topic is reviewed in terms of the contrast agents for MR molecular imaging, the biomarkers related to PC, targeted molecular probes for MRI, and the application of MRI in the diagnosis of PC. Chen Chen, Chang Qiang Wu, Tian Wu Chen, Meng Yue Tang, and Xiao Ming Zhang Copyright © 2015 Chen Chen et al. All rights reserved. Value of Contrast-Enhanced Ultrasound in Guidance of Percutaneous Biopsy in Peripheral Pulmonary Lesions Tue, 20 Oct 2015 08:45:20 +0000 Objectives. To investigate the value of contrast-enhanced ultrasound (CEUS) in guidance of percutaneous biopsy in peripheral pulmonary lesions. Methods. This study focused on 53 patients (male: 38, female: 15, and mean age: 55.7 years ± 10.7) with 53 single peripheral pulmonary lesions. Before core needle (16-gauge) percutaneous biopsy, CEUS were performed in all lesions, with injection of 2.4 mL SonoVue (Bracco, Italy). The contrast-enhancement pattern, display rate of internal necrosis (nonenhanced) and active (obviously enhanced) areas, biopsy success rate, and pathological diagnosis rate were recorded. Results. All the peripheral pulmonary lesions were proved pathologically as benign lesions (), primary malignancies (), or metastasis (). Forty (86.9%) malignant lesions and 4 (57.1%) benign lesions showed internal necrosis areas on CEUS. The detection rate and average size of internal necrosis areas had been significantly improved compared to conventional ultrasound (). After CEUS, core needle percutaneous biopsies were performed successfully in the active areas of all lesions. The sampling success rate and pathological diagnosis rate were 100% and 98.1%. Conclusions. CEUS before biopsy provided useful diagnostic information about peripheral pulmonary lesions. By depicting internal necrotic and active areas, it is a promising technique for guaranteeing the accuracy, success, and safety of core needle biopsy. Yi Dong, Feng Mao, Wen-Ping Wang, Zhen-Biao Ji, and Pei-Li Fan Copyright © 2015 Yi Dong et al. All rights reserved. Smooth Muscle Cells of Penis in the Rat: Noninvasive Quantification with Shear Wave Elastography Thu, 15 Oct 2015 07:09:50 +0000 Purpose. Smooth muscle cells (SMCs) of cavernosum play an important role in erection. It is of great significance to quantitatively analyze the level of SMCs in penis. In this study, we investigated the feasibility of shear wave elastography (SWE) on evaluating the level of SMCs in penis quantitatively. Materials and Methods. Twenty healthy male rats were selected. The SWE imaging of penis was carried out and then immunohistochemistry analysis of penis was performed to analyze the expression of alpha smooth muscle actin in penis. The measurement index of SWE examination was tissue stiffness (TS). The measurement index of immunohistochemistry analysis was positive area percentage of alpha smooth muscle actin (AP). Results. Sixty sets of data of TS and AP were obtained. The results showed that TS was significantly correlated with AP and the correlation coefficient was −0.618 (). The result of TS had been plotted against the AP measurements. The relation between the two results has been fitted with quadric curve; the goodness-of-fit index was 0.364 (). Conclusions. The level of SMCs in penis was successfully quantified in vivo with SWE. SWE can be used clinically for evaluating the level of SMCs in penis quantitatively. Jia-Jie Zhang, Xiao-Hui Qiao, Feng Gao, Ming Bai, Fan Li, Lian-Fang Du, and Jin-Fang Xing Copyright © 2015 Jia-Jie Zhang et al. All rights reserved. K-Optimal Gradient Encoding Scheme for Fourth-Order Tensor-Based Diffusion Profile Imaging Mon, 14 Sep 2015 09:59:33 +0000 The design of an optimal gradient encoding scheme (GES) is a fundamental problem in diffusion MRI. It is well studied for the case of second-order tensor imaging (Gaussian diffusion). However, it has not been investigated for the wide range of non-Gaussian diffusion models. The optimal GES is the one that minimizes the variance of the estimated parameters. Such a GES can be realized by minimizing the condition number of the design matrix (-optimal design). In this paper, we propose a new approach to solve the -optimal GES design problem for fourth-order tensor-based diffusion profile imaging. The problem is a nonconvex experiment design problem. Using convex relaxation, we reformulate it as a tractable semidefinite programming problem. Solving this problem leads to several theoretical properties of -optimal design: (i) the odd moments of the -optimal design must be zero; (ii) the even moments of the -optimal design are proportional to the total number of measurements; (iii) the -optimal design is not unique, in general; and (iv) the proposed method can be used to compute the -optimal design for an arbitrary number of measurements. Our Monte Carlo simulations support the theoretical results and show that, in comparison with existing designs, the -optimal design leads to the minimum signal deviation. Mohammad Alipoor, Irene Yu-Hua Gu, Andrew Mehnert, Stephan E. Maier, and Göran Starck Copyright © 2015 Mohammad Alipoor et al. All rights reserved. Radiological Imaging for Assessing the Respectability of Hilar Cholangiocarcinoma: A Systematic Review and Meta-Analysis Tue, 01 Sep 2015 13:25:40 +0000 Hilar cholangiocarcinoma (HCC) remains one of the most difficult tumors to stage and treat. The aim of the study was to assess the diagnostic efficiency of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computer tomography (PET/CT) in evaluating the resectability of HCC. A systematic search was performed of the PubMed, EMBASE, and Cochrane databases. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for individual studies and pooled data as well as test for heterogeneity and public bias. Our data showed that CT had the highest pooled sensitivity at 95% (95% CI: 91–97), whereas PET/CT had the highest pooled specificity at 81% (95% CI: 69–90). The area under the curve (AUC) of CT, MRI, and PET/CT was 0.9269, 0.9194, and 0.9218, respectively. In conclusion, CT is the most frequently used imaging modality to assess HCC resectability with a good sensitivity and specificity. MRI was generally comparable with that of CT and can be used as an alternative imaging technique. PET/CT appears to be the best technique in detecting lymph node and distant metastasis in HCC but has no clear role in helping to evaluate issues of local resectability. Hongchen Zhang, Jian Zhu, Fayong Ke, Mingzhe Weng, Xiangsong Wu, Maolan Li, Zhiwei Quan, Yingbin Liu, Yong Zhang, and Wei Gong Copyright © 2015 Hongchen Zhang et al. All rights reserved. A Novel Foam Contrast Agent Suitable for Fluoroscopic Interventional Procedure: Comparative Study of Physical Properties and Experimental Intervention in Animal Model Thu, 20 Aug 2015 08:56:09 +0000 In fluoroscopic contrast study for interventional procedure, liquid contrast agent may be diluted in body fluid, losing its contrast effect. We developed a novel contrast agent of “foam state” to maintain contrast effect for enough time and performed a comparative study of physical properties and its usefulness in experimental intervention in animal model. The mean size of microbubble of foam contrast was  µm. The viscosity was  cP (centipoise) and the specific gravity was 0.616. The foam decayed slowly and it had 97.5 minutes of half-life. In terms of the sustainability in a slow flow environment, foam contrast washed out much more slowly than a conventional contrast. In experimental colonic stent placement, foam contrast revealed significantly better results than conventional contrast in procedure time, total amount of contrast usage, and the number of injections (). Our foam contrast has high viscosity and low specific gravity and maintains foam state for a sufficient time. Foam contrast with these properties was useful in experimental intervention in animal model. We anticipate that foam contrast may be applied to various kinds of interventional procedures. Jin Ho Hwang, Hong Suk Park, Soowon Seo, In Wook Choo, Young Soo Do, Sung Wook Choo, Sung Wook Shin, Kwang Bo Park, Sung Ki Cho, Dongho Hyun, and Sooyoun Lim Copyright © 2015 Jin Ho Hwang et al. All rights reserved. Different Plaque Composition and Progression in Patients with Stable and Unstable Coronary Syndromes Evaluated by Cardiac CT Mon, 03 Aug 2015 09:43:48 +0000 Objective. To compare the quantity, subtype, and progression of atherosclerosis by cardiac computed tomography (CT) and intravascular ultrasound (IVUS) in patients with stable (SAP) and unstable angina pectoris or non-ST-elevation myocardial infarction (UAP/n-STEMI). Methods. Forty patients with SAP and 20 with UAP/n-STEMI underwent cardiac CT and angiography with IVUS at baseline and after one year. Atherosclerotic segments were divided into calcified, mixed, or noncalcified subtypes, and significant stenoses were registered. Results. Thirty-two SAP and 15 UAP/n-STEMI patients completed the CT follow-up. At baseline, the number of atherosclerotic segments was higher in UAP/n-STEMI than in SAP (). UAP/n-STEMI patients had more segments with noncalcified plaques () whereas SAP patients had more segments with calcified plaques (). The number of segments with significant stenosis did not differ between the groups, but noncalcified plaques more frequently caused significant stenoses in UAP/n-STEMI than in SAP patients (). After one year the number of segments with atherosclerosis increased in SAP patients (). The number of atherosclerotic segments remained unchanged in UAP/n-STEMI patients. However, composition was altered as the number of segments with noncalcified plaques decreased (). IVUS data confirmed the CT findings. Conclusion. Quantity, subtype, and progression of atherosclerosis differ between SAP and UAP/n-STEMI patients. Maiken Glud Dalager, Morten Bøttcher, Jesper Thygesen, Gratien Andersen, and Hans Erik Bøtker Copyright © 2015 Maiken Glud Dalager et al. All rights reserved. Acoustic Radiation Force Impulse Technology in the Differential Diagnosis of Solid Breast Masses with Different Sizes: Which Features Are Most Efficient? Thu, 16 Jul 2015 10:52:53 +0000 Purpose. To evaluate diagnostic performance of acoustic radiation force impulse (ARFI) technology for solid breast masses with different sizes and determine which features are most efficient. Materials and Methods. 271 solid breast masses in 242 women were examined with ARFI, and their shear wave velocities (SWVs), Virtual Touch tissue imaging (VTI) patterns, and area ratios (ARs) were measured and compared with their histopathological outcomes. Receiver operating characteristic curves (ROC) were calculated to assess diagnostic performance of ARFI for small masses (6–14 mm) and big masses (15–30 mm). Results. SWV of mass was shown to be positively associated with mass size (). For small masses, area under ROC (Az) of AR was larger than that of SWV () and VTI pattern (); no significant difference was found between Az of SWV and that of VTI pattern (). For big masses, Az of VTI pattern was less than that of SWV () and AR (); no significant difference was identified between Az of SWV and that of AR (). Conclusions. For big masses, SWV and AR are both efficient measures; nevertheless, for small masses, AR seems to be the best feature. Min Bai, Hui-Ping Zhang, Jin-Fang Xing, Qiu-Sheng Shi, Ji-Ying Gu, Fan Li, Hui-Li Chen, Xue-Mei Zhang, Yun Fang, and Lian-Fang Du Copyright © 2015 Min Bai et al. All rights reserved. Validation of Quantitative Measurements in Cardiovascular Imaging Sun, 12 Jul 2015 07:23:31 +0000 Peter M. A. van Ooijen, Marco Francone, Joachim Lotz, and Volker Rasche Copyright © 2015 Peter M. A. van Ooijen et al. All rights reserved. Regadenoson-Stress Dynamic Myocardial Perfusion Improves Diagnostic Performance of CT Angiography in Assessment of Intermediate Coronary Artery Stenosis in Asymptomatic Patients Sun, 05 Jul 2015 08:52:41 +0000 The prospective study included 54 asymptomatic high-risk patients who underwent coronary CT angiography (CTA) and regadenoson-induced stress CT perfusion (rsCTP). Diagnostic accuracy of significant stenosis (≥50%) determination was evaluated for CTA alone and CTA + rsCTP in 27 patients referred to ICA due to the positive rsCTP findings. Combined evaluation of CTA + rsCTP had higher diagnostic accuracy over CTA alone (per-segment: specificity 96 versus 68%, ; per-vessel: specificity 95 versus 75%, ) and high overruling rate of rsCTP was proved in intermediate stenosis (40–70%). Results demonstrate a significant additional value of rsCTP in the assessment of intermediate coronary artery stenosis found with CTA. Jan Baxa, Milan Hromádka, Jakub Šedivý, Lucie Štěpánková, Jiří Moláček, Bernhard Schmidt, Thomas Flohr, and Jiří Ferda Copyright © 2015 Jan Baxa et al. All rights reserved. Semiautomatic, Quantitative Measurement of Aortic Valve Area Using CTA: Validation and Comparison with Transthoracic Echocardiography Mon, 29 Jun 2015 06:38:04 +0000 Objective. The aim of this work was to develop a fast and robust (semi)automatic segmentation technique of the aortic valve area (AVA) MDCT datasets. Methods. The algorithm starts with detection and cropping of Sinus of Valsalva on MPR image. The cropped image is then binarized and seed points are manually selected to create an initial contour. The contour moves automatically towards the edge of aortic AVA to obtain a segmentation of the AVA. AVA was segmented semiautomatically and manually by two observers in multiphase cardiac CT scans of 25 patients. Validation of the algorithm was obtained by comparing to Transthoracic Echocardiography (TTE). Intra- and interobserver variability were calculated by relative differences. Differences between TTE and MDCT manual and semiautomatic measurements were assessed by Bland-Altman analysis. Time required for manual and semiautomatic segmentations was recorded. Results. Mean differences from TTE were −0.19 (95% CI: −0.74 to 0.34) cm2 for manual and −0.10 (95% CI: −0.45 to 0.25) cm2 for semiautomatic measurements. Intra- and interobserver variability were 8.4 ± 7.1% and 27.6 ± 16.0% for manual, and 5.8 ± 4.5% and 16.8 ± 12.7% for semiautomatic measurements, respectively. Conclusion. Newly developed semiautomatic segmentation provides an accurate, more reproducible, and faster AVA segmentation result. V. Tuncay, N. Prakken, P. M. A. van Ooijen, R. P. J. Budde, T. Leiner, and M. Oudkerk Copyright © 2015 V. Tuncay et al. All rights reserved. The Fetal Modified Myocardial Performance Index: Is Automation the Future? Mon, 22 Jun 2015 06:20:32 +0000 The fetal modified myocardial performance index (Mod-MPI) is a noninvasive, pulsed-wave Doppler-derived measure of global myocardial function. This review assesses the progress in technical refinements of its measurement and the potential for automation to be the crucial next step. The Mod-MPI is a ratio of isovolumetric to ejection time cardiac time intervals, and the potential for the left ventricular Mod-MPI as a tool to clinically assess fetal cardiac function is well-established. However, there are wide variations in published reference ranges, as (1) a standardised method of selecting cardiac time intervals used in Mod-MPI calculation has not been established; (2) cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms; and (3) ultrasound machine settings and ultrasound system type have been found to affect Mod-MPI measurement. Collectively these factors create potential for significant inter- and intraobserver measurement variability. Automated measurement of the Mod-MPI may be the next key development which propels the Mod-MPI into routine clinical use. A novel automated system of Mod-MPI measurement is briefly presented and its implications for the future of the Mod-MPI in fetal cardiology are discussed. Priya Maheshwari, Amanda Henry, and Alec W. Welsh Copyright © 2015 Priya Maheshwari et al. All rights reserved. Free-Breathing 3D Imaging of Right Ventricular Structure and Function Using Respiratory and Cardiac Self-Gated Cine MRI Sun, 21 Jun 2015 12:35:24 +0000 Providing a movie of the beating heart in a single prescribed plane, cine MRI has been widely used in clinical cardiac diagnosis, especially in the left ventricle (LV). Right ventricular (RV) morphology and function are also important for the diagnosis of cardiopulmonary diseases and serve as predictors for the long term outcome. The purpose of this study is to develop a self-gated free-breathing 3D imaging method for RV quantification and to evaluate its performance by comparing it with breath-hold 2D cine imaging in 7 healthy volunteers. Compared with 2D, the 3D RV functional measurements show a reduction of RV end-diastole volume (RVEDV) by 10%, increase of RV end-systole volume (RVESV) by 1.8%, reduction of RV systole volume (RVSV) by 21%, and reduction of RV ejection fraction (RVEF) by 12%. High correlations between the two techniques were found (RVEDV: 0.94; RVESV: 0.85; RVSV: 0.95; and RVEF: 0.89). Compared with 2D, the 3D image quality measurements show a small reduction in blood SNR, myocardium-blood CNR, myocardium contrast, and image sharpness. In conclusion, the proposed self-gated free-breathing 3D cardiac cine imaging technique provides comparable image quality and correlated functional measurements to those acquired with the multiple breath-hold 2D technique in RV. Yanchun Zhu, Jing Liu, Jonathan Weinsaft, Pascal Spincemaille, Thanh D. Nguyen, Martin R. Prince, Shanglian Bao, Yaoqin Xie, and Yi Wang Copyright © 2015 Yanchun Zhu et al. All rights reserved. Use of Contrast-Enhanced Ultrasound in Carotid Atherosclerotic Disease: Limits and Perspectives Sun, 21 Jun 2015 12:05:43 +0000 Contrast-enhanced ultrasound (CEUS) has recently become one of the most versatile and powerful diagnostic tools in vascular surgery. One of the most interesting fields of application of this technique is the study of the carotid atherosclerotic plaque vascularization and its correlation with neurological symptoms (transient ischemic attack, minor stroke, and major stroke) and with the characteristics of the “vulnerable plaque” (surface ulceration, hypoechoic plaques, intraplaque hemorrhage, thinner fibrous cap, and carotid plaque neovascularization at histopathological analysis of the sample after surgical removal). The purpose of this review is to collect all the original studies available in literature (24 studies with 1356 patients enrolled) and to discuss the state of the art, limits, and future perspectives of CEUS analysis. The results of this work confirm the reliability of this imaging study for the detection of plaques with high risk of embolization; however, a shared, user-friendly protocol of imaging analysis is not available yet. The definition of this operative protocol becomes mandatory in order to compare results from different centers and to validate a cerebrovascular risk stratification of the carotid atherosclerotic lesions evaluated with CEUS. Gianfranco Varetto, Lorenzo Gibello, Claudio Castagno, Simone Quaglino, Matteo Ripepi, Emilio Benintende, Andrea Gattuso, Paolo Garneri, Stefano Zan, Giacomo Capaldi, Ugo Bertoldo, and Pietro Rispoli Copyright © 2015 Gianfranco Varetto et al. All rights reserved. Validation and Development of a New Automatic Algorithm for Time-Resolved Segmentation of the Left Ventricle in Magnetic Resonance Imaging Sun, 21 Jun 2015 11:38:06 +0000 Introduction. Manual delineation of the left ventricle is clinical standard for quantification of cardiovascular magnetic resonance images despite being time consuming and observer dependent. Previous automatic methods generally do not account for one major contributor to stroke volume, the long-axis motion. Therefore, the aim of this study was to develop and validate an automatic algorithm for time-resolved segmentation covering the whole left ventricle, including basal slices affected by long-axis motion. Methods. Ninety subjects imaged with a cine balanced steady state free precession sequence were included in the study (training set , test set ). Manual delineation was reference standard and second observer analysis was performed in a subset (). The automatic algorithm uses deformable model with expectation-maximization, followed by automatic removal of papillary muscles and detection of the outflow tract. Results. The mean differences between automatic segmentation and manual delineation were EDV −11 mL, ESV 1 mL, EF −3%, and LVM 4 g in the test set. Conclusions. The automatic LV segmentation algorithm reached accuracy comparable to interobserver for manual delineation, thereby bringing automatic segmentation one step closer to clinical routine. The algorithm and all images with manual delineations are available for benchmarking. Jane Tufvesson, Erik Hedström, Katarina Steding-Ehrenborg, Marcus Carlsson, Håkan Arheden, and Einar Heiberg Copyright © 2015 Jane Tufvesson et al. All rights reserved. Development of an Ex Vivo, Beating Heart Model for CT Myocardial Perfusion Sun, 21 Jun 2015 10:36:42 +0000 Objective. To test the feasibility of a CT-compatible, ex vivo, perfused porcine heart model for myocardial perfusion CT imaging. Methods. One porcine heart was perfused according to Langendorff. Dynamic perfusion scanning was performed with a second-generation dual source CT scanner. Circulatory parameters like blood flow, aortic pressure, and heart rate were monitored throughout the experiment. Stenosis was induced in the circumflex artery, controlled by a fractional flow reserve (FFR) pressure wire. CT-derived myocardial perfusion parameters were analysed at FFR of 1 to 0.10/0.0. Results. CT images did not show major artefacts due to interference of the model setup. The pacemaker-induced heart rhythm was generally stable at 70 beats per minute. During most of the experiment, blood flow was 0.9–1.0 L/min, and arterial pressure varied between 80 and 95 mm/Hg. Blood flow decreased and arterial pressure increased by approximately 10% after inducing a stenosis with FFR ≤ 0.50. Dynamic perfusion scanning was possible across the range of stenosis grades. Perfusion parameters of circumflex-perfused myocardial segments were affected at increasing stenosis grades. Conclusion. An adapted Langendorff porcine heart model is feasible in a CT environment. This model provides control over physiological parameters and may allow in-depth validation of quantitative CT perfusion techniques. Gert Jan Pelgrim, Marco Das, Ulrike Haberland, Cees Slump, Astri Handayani, Sjoerd van Tuijl, Marco Stijnen, Ernst Klotz, Matthijs Oudkerk, Joachim E. Wildberger, and Rozemarijn Vliegenthart Copyright © 2015 Gert Jan Pelgrim et al. All rights reserved. Importance of Reference Muscle Selection in Quantitative Signal Intensity Analysis of T2-Weighted Images of Myocardial Edema Using a T2 Ratio Method Sun, 21 Jun 2015 09:08:40 +0000 Objectives. The purpose of our study was to identify the suitability of various skeletal muscles as reference regions for calculating the T2 SI ratio for a semiautomated quantification of the extent of myocardial edema with T2-weighted images. Methods. Thirty-four patients with acute myocardial infarction (MI) were enrolled. The extent of myocardial edema was determined by T2 SI ratio map, using 4 different muscles as reference: major and minor pectoralis, serratus anterior, teres minor-infraspinatus, and subscapularis. The size of myocardial edema as visually quantified was used as the standard of truth. The control group consisted of 15 patients with chronic MI. Intra- and interobserver variability were assessed. Results. Due to poor image quality four patients were excluded from the analysis. In acute MI patients, serratus anterior muscle showed the strongest correlation with the visual analysis (; ) and low inter- and intraobserver variability, while the other muscles resulted in a significant interobserver variability. In contrast, the use of other muscles as a reference led to overestimating edema size. Conclusions. In acute MI patients, serratus anterior resulted to be the most reliable and reproducible muscle for measuring the extent of myocardial edema. Iacopo Carbone, Helene Childs, Ahmed Aljizeeri, Naeem Merchant, and Matthias G. Friedrich Copyright © 2015 Iacopo Carbone et al. All rights reserved. A Novel Restraining Device for Small Animal Imaging Exams: Validation in Rabbits Sun, 31 May 2015 08:06:51 +0000 Objective. To develop, validate, and patent a Restraining Device for Small Animal Imaging Exams (RDSAIE) that allows exams to be comfortably conducted without risks to animals and professionals. Methods. A RDSAIE with a mobile cover and shelf was built with transparent acrylic material. A total of six anesthetized rabbits were used to perform the following imaging exams of the skull: Cone Beam Computed Tomography, Magnetic Resonance Imaging, and Scintigraphy. Results. The device showed great functionality and full visibility of the animal behavior, which remained fully stabilized and immobilized in either the horizontal or vertical position without the need for a person to remain in the test room to assist them. The procedures were performed without difficulty, and images of good resolution and without artifacts were obtained. Conclusion. The RDSAIE is comfortable, safe, efficient, and ergonomic. It allows the easy placement of animals in different body positions, including the vertical, the maintenance of postural stability, and full visibility. It may be constructed for animals heavier than 4 kg and it is adaptable for translational studies in anima nobile. Carlos Henrique Barbosa, Antonio Carlos Carvalho, Sérgio de Souza, Fernanda Machado, Fábio Guedes, André Monteiro, and Alberto Schanaider Copyright © 2015 Carlos Henrique Barbosa et al. All rights reserved. Contrast-Enhanced Ultrasound Thu, 28 May 2015 08:32:08 +0000 Hui-Xiong Xu, Hans Peter Weskott, Ji-Bin Liu, and Rong-Qin Zheng Copyright © 2015 Hui-Xiong Xu et al. All rights reserved. Use of Contrast-Enhanced Ultrasound to Study Relationship between Serum Uric Acid and Renal Microvascular Perfusion in Diabetic Kidney Disease Tue, 26 May 2015 07:27:59 +0000 Purpose. To investigate the relationship between uric acid and renal microvascular perfusion in diabetic kidney disease (DKD) using contrast-enhanced ultrasound (CEUS) method. Materials and Methods. 79 DKD patients and 26 healthy volunteers were enrolled. Renal function and urine protein markers were tested. DKD patients were subdivided into two groups including a normal serum uric acid (SUA) group and a high SUA group. Contrast-enhanced ultrasound (CEUS) was performed, and low acoustic power contrast-specific imaging was used for quantitative analysis. Results. Normal controls (NCs) had the highest levels of AUC, AUC1, and AUC2. Compared to the normal SUA DKD group, high SUA DKD patients had significantly higher IMAX, AUC, and AUC1 (). DKD patients with low urinary uric acid (UUA) excretion had significantly higher AUC2 compared to DKD patients with normal UUA (). Conclusion. Hyperuricemia in DKD patients was associated with a renal ultrasound image suggestive of microvascular hyperperfusion. The CEUS parameter AUC1 holds promise as an indicator for renal microvascular hyperperfusion, while AUC2 might be a useful indicator of declining glomerular filtration rate in DKD patients with decreased excretion of uric acid. Ling Wang, Jia-Fen Cheng, Li-Ping Sun, Ya-Xiang Song, Le-Hang Guo, Jun-Mei Xu, Tian-Fu Wu, Chandra Mohan, Ai Peng, Hui-Xiong Xu, and Xin-Ying Liu Copyright © 2015 Ling Wang et al. All rights reserved. Utility of Contrast-Enhanced Transabdominal Ultrasonography to Diagnose Early Chronic Pancreatitis Tue, 19 May 2015 11:50:06 +0000 Purpose. The purpose of this study was to establish the relationship between the grade of chronic pancreatitis (CP) and pancreatic blood flow as measured by contrast-enhanced transabdominal ultrasonography (CEUS) and to diagnose early CP easily. Methods. This pilot study was conducted in 8 patients with CP, 7 patients with early CP, and 6 control participants. After injecting 0.015 mL/kg of perflubutane by manual bolus, values in one region of interest (ROI) in pancreatic parenchyma and one ROI including the superior mesenteric artery (SMA) were measured. Results. The ratio of blood flow in the SMA and pancreatic parenchyma increased with grade of CP and was significantly higher in patients with CP (5.41; 2.10–11.02) than in patients with early CP (2.46; 1.41–5.05) and control participants (2.32; 1.25–3.04) , , resp.). The ratio of blood flow in the SMA and pancreatic parenchyma correlated with grade of CP , . Conclusion. The ratio of blood flow correlates with grade of CP on CEUS. This safe and convenient method may be useful to diagnose early CP. Nobuaki Azemoto, Teru Kumagi, Tomoyuki Yokota, Masashi Hirooka, Taira Kuroda, Mitsuhito Koizumi, Yoshinori Ohno, Hirofumi Yamanishi, Masanori Abe, Morikazu Onji, and Yoichi Hiasa Copyright © 2015 Nobuaki Azemoto et al. All rights reserved. The Role of Contrast-Enhanced Ultrasound in Selection Indication and Improveing Diagnosis for Transthoracic Biopsy in Peripheral Pulmonary and Mediastinal Lesions Mon, 18 May 2015 13:59:07 +0000 Objective. To investigate the value of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of peripheral lung and mediastinal lesions. Methods. Of 142 patients, 82 patients received CEUS before biopsy and were defined as CEUS group. The remaining 60 patients only underwent conventional ultrasound (US) before biopsy and were served as US group. The information of CEUS was used for selecting indication and instructing biopsy. The imaging features, number of punctures, diagnostic successful rate, and complication rate between the two groups were compared. Results. Necrosis was demonstrated in 43.9% of the lesions in CEUS group and in 6.7% of US group (). Detection rate of lesion hidden in pulmonary atelectasis in CEUS group was 13.4%, which was statistically higher than 1.7% of US group (). The diagnostic success rate was 96.3% for CEUS group and 80% for US group, respectively (). The average number of punctures was and , respectively. There was no significant difference in complications between CEUS group and US group. Conclusions. CEUS could play an important role in selecting proper indication and improving diagnostic accuracy rate of lung biopsy. Song Wang, Wei Yang, Hui Zhang, Qian Xu, and Kun Yan Copyright © 2015 Song Wang et al. All rights reserved. Contrast-Enhanced Endoscopic Ultrasonography for Pancreatic Tumors Mon, 18 May 2015 13:31:11 +0000 Objectives. To investigate the usefulness of contrast-enhanced endoscopic ultrasonography (CE-EUS) for histological differentiation of pancreatic tumors. Methods. CE-EUS was performed for consecutive patients having a pancreatic solid lesion, and tumors were classified into three vascular patterns (hypervascular, isovascular, and hypovascular) at two time phases (early-phase and late-phase). Correlation between vascular patterns and histopathology of resected pancreatic cancer (PC) tissues was ascertained. Results. The final diagnoses of 147 examined tumors were PC , inflammatory mass , autoimmune pancreatitis , neuroendocrine tumor , and others . In late-phase images, 104 of 109 PCs had the hypovascular pattern, for a diagnostic sensitivity and specificity of 94% and 71%, respectively. Of 28 resected PCs, 10 had isovascular, and 18 hypovascular, patterns on the early-phase image. Early-phase isovascular PCs were more likely to be differentiated than were early-phase hypovascular PCs (6 well and 4 moderately differentiated versus 3 well, 14 moderately, and 1 poorly differentiated, . Immunostaining revealed that hypovascular areas of early-phase images reflected heterogeneous tumor cells with fibrous tissue, necrosis, and few vessels. Conclusion. CE-EUS could be useful for distinguishing PC from other solid pancreatic lesions and for histological differentiation of PCs. Yasunobu Yamashita, Jun Kato, Kazuki Ueda, Yasushi Nakamura, Yuki Kawaji, Hiroko Abe, Junya Nuta, Takashi Tamura, Masahiro Itonaga, Takeichi Yoshida, Hiroki Maeda, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, and Masao Ichinose Copyright © 2015 Yasunobu Yamashita et al. All rights reserved. Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline Mon, 18 May 2015 13:05:01 +0000 Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are both regarded as primary liver cancers, having different biological behaviors and prognoses. Correct differentiation between them is essential for surgical planning and prognosis assessment. In 2005, the American Association for the Study of Liver Diseases (AASLD) recommended that noninvasive diagnosis of HCC is achievable by a single dynamic technique (including contrast-enhanced ultrasound (CEUS)) showing intense arterial uptake followed by washout of contrast in the venous-delayed phases. However, CEUS has been dropped from the diagnostic techniques in the latest AASLD guideline according to the opinion of some authors from Europe that CEUS may offer false positive HCC diagnosis in patients with ICC. Since the update of AASLD guideline has been released, increased attention has been paid to this interesting topic. Remarkable controversy over this issue is present and this removal was not well received in Europe and Asia. This commentary summarized the opinions for the role of CUES in differentiation between HCC and ICC in recent years. It is concluded that prospective studies with strict design and large case series are mandatory to solve the controversies and stratification of ICC in terms of tumor size and liver background is also essential. Le-Hang Guo and Hui-Xiong Xu Copyright © 2015 Le-Hang Guo and Hui-Xiong Xu. All rights reserved. Effects of Gray-Scale Ultrasonography Immediate Post-Contrast on Characterization of Focal Liver Lesions Mon, 18 May 2015 12:02:57 +0000 This study compared the imaging features of conventional gray scale ultrasound (US) before and after contrast-enhanced ultrasound (CEUS) for focal liver lesions and 22 evaluated the role of US post-CEUS in characterizing liver lesions. 126 patients with 158 focal liver lesions underwent CEUS and US post-CEUS examination and entered this study. There were 74 hepatocellular carcinomas (HCC), 43 hepatic metastases, and 41 hemangiomas. Imaging features of US pre-CEUS and US post-CEUS were analyzed offsite by two blinded experienced radiologists to evaluate size, boundary, echogenicity, internal texture, posterior acoustic enhancement, spatial resolution, and contrast resolution. In the end with pathological and clinical evidence, the diagnostic accuracy rate of US pre-CEUS was 53.8% (85/158 lesions), lower than that of CEUS (88.0%, 139/158 lesions); with the complementation of US post-CEUS the rate rose to 93.0% (147/158 lesions). US post-CEUS could improve the visibility of typical structures of focal liver lesions and might provide important complementary information for CEUS diagnosis. It also increases the visibility of small liver lesions compared with US pre-CEUS and helps to guide local interventional procedure. Wei Yang, Min-Hua Chen, Wei Wu, Ying Dai, and Zhi-Hui Fan Copyright © 2015 Wei Yang et al. All rights reserved. Recent Experiences and Advances in Contrast-Enhanced Subharmonic Ultrasound Mon, 18 May 2015 11:35:04 +0000 Nonlinear contrast-enhanced ultrasound imaging schemes strive to suppress tissue signals in order to better visualize nonlinear signals from blood-pooling ultrasound contrast agents. Because tissue does not generate a subharmonic response (i.e., signal at half the transmit frequency), subharmonic imaging has been proposed as a method for isolating ultrasound microbubble signals while suppressing surrounding tissue signals. In this paper, we summarize recent advances in the use of subharmonic imaging in vivo. These advances include the implementation of subharmonic imaging on linear and curvilinear arrays, intravascular probes, and three-dimensional probes for breast, renal, liver, plaque, and tumor imaging. John R. Eisenbrey, Anush Sridharan, Ji-Bin Liu, and Flemming Forsberg Copyright © 2015 John R. Eisenbrey et al. All rights reserved. Application of Combined Two-Dimensional and Three-Dimensional Transvaginal Contrast Enhanced Ultrasound in the Diagnosis of Endometrial Carcinoma Mon, 18 May 2015 11:22:19 +0000 Objective. The goal of this study was to explore the clinical value of combining two-dimensional (2D) and three-dimensional (3D) transvaginal contrast-enhanced ultrasounds (CEUS) in diagnosis of endometrial carcinoma (EC). Methods. In this prospective diagnostic study, transvaginal 2D and 3D CEUS were performed on 68 patients with suspected EC, and the results of the obtained 2D-CEUS and 3D-CEUS images were compared with the gold standard for statistical analysis. Results. 2D-CEUS benign endometrial lesions showed the normal uterine perfusion phase while EC cases showed early arrival and early washout of the contrast agent and nonuniform enhancement. The 3D-CEUS images differed in central blood vessel manifestation, blood vessel shape, and vascular pattern between benign and malignant endometrial lesions . Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of transvaginal 2D-CEUS and 2D-CEUS combined with 3D-CEUS for diagnosis of benign and malignant endometrial lesions were 76.9%, 73.8%, 64.5%, 83.8%, and 75.0% and 84.6%, 83.3%, 75.9%, 89.7%, and 83.8%, respectively. Conclusion. 3D-CEUS is a useful supplement to 2D-CEUS and can clearly reveal the angioarchitecture spatial relationships between vessels and depth of myometrial invasion in EC. The combined use of 2D and 3D-CEUS can offer direct, accurate, and comprehensive diagnosis of early EC. Hui-li Zhou, Hong Xiang, Li Duan, Gulinaer Shahai, Hui Liu, Xiang-hong Li, and Rui-xue Mou Copyright © 2015 Hui-li Zhou et al. All rights reserved. Application of Contrast-Enhanced Ultrasound in Cystic Pancreatic Lesions Using a Simplified Classification Diagnostic Criterion Mon, 18 May 2015 10:09:10 +0000 Objective. Classification diagnosis was performed for cystic pancreatic lesions using ultrasound (US) and contrast-enhanced ultrasound (CEUS) to explore the diagnostic value of CEUS by comparison with enhanced CT. Methods. Sixty-four cases with cystic pancreatic lesions were included in this study. The cystic lesions of pancreas were classified into four types by US, CEUS, and CT: type I unilocular cysts; type II microcystic lesions; type III macrocystic lesions; and type IV cystic lesions with solid components or irregular thickening of the cystic wall or septa. Results. Eighteen type I, 7 type II, 10 type III, and 29 type IV cases were diagnosed by CT. The classification results by US were as follows: 6 type I; 5 type II; 4 type III; and 49 type IV cases. Compared with the results by enhanced CT, the kappa value was 0.36. Using CEUS, 15, 6, 12, and 31 cases were diagnosed as types I–IV, respectively. The kappa value was 0.77. Conclusion. CEUS has obvious superiority over US in the classification diagnostic accuracy in cystic pancreatic lesions and CEUS results showed substantial agreement with enhanced CT. CEUS could contribute to the differential diagnosis of cystic pancreatic diseases. Zhihui Fan, Kun Yan, Yanjie Wang, Jianxing Qiu, Wei Wu, Lei Yang, and Minhua Chen Copyright © 2015 Zhihui Fan et al. All rights reserved. Multimodality MRI Findings in Patients with End-Stage Renal Disease Mon, 04 May 2015 12:57:24 +0000 Patients with end-stage renal disease (ESRD) suffer from a number of complex neurological complications including vascular damage and cognitive dysfunction. It is of great significance to detect the neurological complications and improve the prognosis of ESRD patients. Many new noninvasive MRI techniques have been steadily used for the diagnosis of occult central nervous system complications in ESRD patients. This gives an opportunity to understand the pathophysiological mechanisms of these neurological disorders. This paper is a review that presents the MRI findings of occult brain damage in ESRD patients, outlines the applications of advanced MRI techniques, and introduces a brief perspective in this study field. Hui Juan Chen, Long Jiang Zhang, and Guang Ming Lu Copyright © 2015 Hui Juan Chen et al. All rights reserved. Comparison of Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging and Arterial Spin Labeling MR Imaging in Gliomas Sun, 05 Apr 2015 11:37:55 +0000 Gliomas grading is important for treatment plan; we aimed to investigate the application of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in gliomas grading, by comparing with the three-dimensional pseudocontinuous arterial spin labeling (3D pCASL). 24 patients (13 high grade gliomas and 11 low grade gliomas) underwent IVIM DWI and 3D pCASL imaging before operation; maps of fast diffusion coefficient (), slow diffusion coefficient (), fractional perfusion-related volume (), and apparent diffusion coefficient (ADC) as well as cerebral blood flow (CBF) were calculated and then coregistered to generate the corresponding parameter values. We found CBF and were higher in the high grade gliomas, whereas ADC, , and were lower (all ). In differentiating the high from low grade gliomas, the maximum areas under the curves (AUC) of , CBF, and ADC were 0.857, 0.85, and 0.902, respectively. CBF was negatively correlated with in tumor (, ). ADC was positively correlated with in both tumor and white matter (, and , , resp.). There was no correlation between CBF and in both tumor and white matter (). IVIM DWI showed more efficiency than 3D pCASL but less validity than conventional DWI in differentiating the high from low grade gliomas. Yuankai Lin, Jianrui Li, Zhiqiang Zhang, Qiang Xu, Zhenyu Zhou, Zhongping Zhang, Yong Zhang, and Zongjun Zhang Copyright © 2015 Yuankai Lin et al. All rights reserved. Magnetic Resonance Comparison of Left-Right Heart Volumetric and Functional Parameters in Thalassemia Major and Thalassemia Intermedia Patients Thu, 02 Apr 2015 11:34:04 +0000 Objectives. To evaluate a population of asymptomatic thalassemia major (TM) and thalassemia intermedia (TI) patients using cardiovascular magnetic resonance (CMR). We supposed that TI group could be differentiated from the TM group based on and that the TI group could demonstrate higher cardiac output. Methods. A retrospective analysis of 242 patients with TM and TI was performed (132 males, 110 females; mean age years; 186 TM, 56 TI). Iron load was assessed by measurements; volumetric functions were analyzed using steady-state-free precession sequences. Results. Significant difference in left-right heart performance was observed between TM with iron overload and TI patients and between TM with iron overload and TM without iron overload (); no significant differences were observed between TM without iron overload and TI patients. A significant correlation was observed between and ejection fraction of right ventricle- (RV-) ejection fraction of left ventricle (LV); an inverse correlation was present among values and end-diastolic volume of LV, end-systolic volume of LV, stroke volume of LV, end-diastolic volume of RV, end-systolic volume of RV, and stroke volume of RV. Conclusions. CMR is a leading approach for cardiac risk evaluation of TM and TI patients. Carlo Liguori, Francesca Pitocco, Ilenia Di Giampietro, Aldo Eros De Vivo, Emiliano Schena, Francesco Giurazza, Francesco Sorrentino, and Bruno Beomonte Zobel Copyright © 2015 Carlo Liguori et al. All rights reserved. To Evaluate the Damage of Renal Function in CIAKI Rats at 3T: Using ASL and BOLD MRI Sun, 29 Mar 2015 14:08:45 +0000 Purpose. To investigate noninvasive arterial spin-labeling (ASL) and blood oxygen level-dependent imaging (BOLD) sequences for measuring renal hemodynamics and oxygenation in contrast induced acute kidney injury (CIAKI) rat. Materials and Methods. Thirteen SD rats were randomly grouped into CIAKI group and control group. Both ASL and BOLD sequences were performed at 24 h preinjection and at intervals of 0.5, 12, 24, 48, 72, and 96 h postinjection to assess renal blood flow (RBF) and relative spin-spin relaxation rate , respectively. Results. For the CIAKI group, the value of RBF in the cortex (CO) and outer medulla (OM) of the kidney was significantly decreased () at 12–48 h and regressed to baseline level () at 72–96 h. In OM, the value of was increased at 0.5–48 h () and not statistically significant () at 72 and 96 h. Conclusions. RBF in OM and CO and oxygen level in OM were decreased postinjection of CM. ASL combining BOLD can further identify the primary cause of the decrease of renal oxygenation in CIAKI. This approach provides means for noninvasive monitoring renal function during the first 4 days of CIAKI in clinical routine work. Wen-bo Chen, Long Liang, Bin Zhang, Chun-ling Liu, Hong-jun Liu, Hai-ying Luo, Qiong-xin Zeng, Chang-hong Liang, Guan-shu Liu, and Shui-xing Zhang Copyright © 2015 Wen-bo Chen et al. All rights reserved. Diagnostic and Interventional Radiology for Liver Diseases Tue, 24 Mar 2015 10:14:04 +0000 Satoru Murata, Pascal Niggemann, Edward W. Lee, and Per Kristian Hol Copyright © 2015 Satoru Murata et al. All rights reserved. Recent Advances in Molecular Magnetic Resonance Imaging of Liver Fibrosis Sun, 22 Mar 2015 09:42:25 +0000 Liver fibrosis is a life-threatening disease with high morbidity and mortality owing to its diverse causes. Liver biopsy, as the current gold standard for diagnosing and staging liver fibrosis, has a number of limitations, including sample variability, relatively high cost, an invasive nature, and the potential of complications. Most importantly, in clinical practice, patients often reject additional liver biopsies after initiating treatment despite their being necessary for long-term follow-up. To resolve these problems, a number of different noninvasive imaging-based methods have been developed for accurate diagnosis of liver fibrosis. However, these techniques only reflect morphological or perfusion-related alterations in the liver, and thus they are generally only useful for the diagnosis of late-stage liver fibrosis (liver cirrhosis), which is already characterized by “irreversible” anatomic and hemodynamic changes. Thus, it is essential that new approaches are developed for accurately diagnosing early-stage liver fibrosis as at this stage the disease may be “reversed” by active treatment. The development of molecular MR imaging technology has potential in this regard, as it facilitates noninvasive, target-specific imaging of liver fibrosis. We provide an overview of recent advances in molecular MR imaging for the diagnosis and staging of liver fibrosis and we compare novel technologies with conventional MR imaging techniques. Zhiming Li, Jihong Sun, and Xiaoming Yang Copyright © 2015 Zhiming Li et al. All rights reserved. Ultrafast Cone-Beam Computed Tomography: A Comparative Study of Imaging Protocols during Image-Guided Therapy Procedure Sun, 22 Mar 2015 08:59:42 +0000 Objective. To evaluate two ultrafast cone-beam CT (UF-CBCT) imaging protocols with different acquisition and injection parameters regarding image quality and required contrast media during image-guided hepatic transarterial chemoembolization (TACE). Methods. In 80 patients (male: 46, female: 34; mean age: 56.8 years; range: 33–83) UF-CBCT was performed during TACE for intraprocedural guidance. Imaging was performed using two ultrafast CBCT acquisition protocols with different acquisition and injection parameters (imaging protocol 1: acquisition time 2.54 s, and contrast 6 mL with 3 s delay; imaging protocol 2: acquisition time 2.72 s, and contrast 7 mL with 6 s delay). Image evaluation was performed with both qualitative and quantitative methods. Contrast injection volume and dose parameters were compared using values from the literature. Results. Imaging protocol 2 provided significantly better image quality than protocol 1 at the cost of slightly higher contrast load and patient dose. Imaging protocol 1 provided good contrast perfusion but it mostly failed to delineate the tumors . On the contrary, imaging protocol 2 showed excellent enhancement of hepatic parenchyma, tumor, and feeding vessels. Conclusion. Tumor delineation, visualization of hepatic parenchyma, and feeding vessels are clearly possible using imaging protocol 2 with ultrafast CBCT imaging. A reduction of required contrast volume and patient dose were achieved due to the ultrafast CBCT imaging. Jijo Paul, Annamma Chacko, Mohammad Farhang, Shahram Kamali, Mohsen Tavanania, Thomas Vogl, and Bita Panahi Copyright © 2015 Jijo Paul et al. All rights reserved. Measurement of Liver Iron Concentration by MRI Is Reproducible Sun, 22 Mar 2015 08:48:04 +0000 Purpose. The objectives were (i) construction of a phantom to reproduce the behavior of iron overload in the liver by MRI and (ii) assessment of the variability of a previously validated method to quantify liver iron concentration between different MRI devices using the phantom and patients. Materials and Methods. A phantom reproducing the liver/muscle ratios of two patients with intermediate and high iron overload. Nine patients with different levels of iron overload were studied in 4 multivendor devices and 8 of them were studied twice in the machine where the model was developed. The phantom was analysed in the same equipment and 14 times in the reference machine. Results. FeCl3 solutions containing 0.3, 0.5, 0.6, and 1.2 mg Fe/mL were chosen to generate the phantom. The average of the intramachine variability for patients was 10% and for the intermachines 8%. For the phantom the intramachine coefficient of variation was always below 0.1 and the average of intermachine variability was 10% for moderate and 5% for high iron overload. Conclusion. The phantom reproduces the behavior of patients with moderate or high iron overload. The proposed method of calculating liver iron concentration is reproducible in several different 1.5 T systems. José María Alústiza, José I. Emparanza, Agustín Castiella, Alfonso Casado, Adolfo Garrido, Pablo Aldazábal, Manuel San Vicente, Nerea Garcia, Ana Belén Asensio, Jesús Banales, Emma Salvador, Aranzazu Moyua, Xabier Arozena, Miguel Zarco, Lourdes Jauregui, and Ohiana Vicente Copyright © 2015 José María Alústiza et al. All rights reserved. Diffusion-Weighted MRI for the Assessment of Liver Fibrosis: Principles and Applications Thu, 19 Mar 2015 16:54:19 +0000 The importance of an early identification of hepatic fibrosis has been emphasized, in order to start therapy and obtain fibrosis regression. Biopsy is the gold-standard method for the assessment of liver fibrosis in chronic liver diseases, but it is limited by complications, interobserver variability, and sampling errors. Several noninvasive methods have been recently introduced into clinical routine, in order to detect liver fibrosis early. One of the most diffuse approaches is represented by diffusion-weighted liver MRI. In this review, the main technical principles are briefly reported in order to explain the rationale for clinical applications. In addition, roles of apparent diffusion coefficient, intravoxel incoherent motion, and relative apparent diffusion coefficient are also reported, showing their advantages and limits. Stefano Palmucci, Giuseppina Cappello, Giancarlo Attinà, Giovanni Fuccio Sanzà, Pietro Valerio Foti, Giovanni Carlo Ettorre, and Pietro Milone Copyright © 2015 Stefano Palmucci et al. All rights reserved. Diagnostic Value of MRI Proton Density Fat Fraction for Assessing Liver Steatosis in Chronic Viral C Hepatitis Thu, 19 Mar 2015 13:18:14 +0000 Objective. To assess the diagnostic performance of a T1-independent, T-corrected multiecho magnetic resonance imaging (MRI) technique for the quantification of hepatic steatosis in a cohort of patients affected by chronic viral C hepatitis, using liver biopsy as gold standard. Methods. Eighty-one untreated patients with chronic viral C hepatitis were prospectively enrolled. All included patients underwent MRI, transient elastography, and liver biopsy within a time interval <10 days. Results. Our cohort of 77 patients included 43/77 (55.8%) males and 34/77 (44.2%) females with a mean age of 51.31 ± 11.27 (18–81) years. The median MRI PDFF showed a strong correlation with the histological fat fraction (FF) (, 95% CI 0.637 to 0.836, ), and the correlation was influenced by neither the liver stiffness nor the T decay. The median MRI PDFF result was significantly lower in the F4 subgroup (). The diagnostic accuracy of MRI PDFF evaluated by AUC-ROC analysis was 0.926 (95% CI 0.843 to 0.973) for and 0.929 (95% CI 0.847 to 0.975) for . Conclusions. Our MRI technique of PDFF estimation allowed discriminating with a good diagnostic accuracy between different grades of hepatic steatosis. Francesco Paparo, Giovanni Cenderello, Matteo Revelli, Lorenzo Bacigalupo, Mariangela Rutigliani, Daniele Zefiro, Luca Cevasco, Maria Amico, Roberto Bandelloni, Giovanni Cassola, Gian Luca Forni, and Gian Andrea Rollandi Copyright © 2015 Francesco Paparo et al. All rights reserved. Focus on Diffusion MR Investigations of Musculoskeletal Tissue to Improve Osteoporosis Diagnosis: A Brief Practical Review Tue, 10 Mar 2015 11:50:34 +0000 Nowadays, a huge number of papers have documented the ability of diffusion magnetic resonance imaging (D-MRI) to highlight normal and pathological conditions in a variety of cerebral, abdominal, and cardiovascular applications. To date, however, the role of D-MRI to investigate musculoskeletal tissue, specifically the cancellous bone, has not been extensively explored. In order to determine potentially useful applications of diffusion techniques in musculoskeletal investigation, D-MRI applications to detect osteoporosis disease were reviewed and further explained. Silvia Capuani, Guglielmo Manenti, Riccardo Iundusi, and Umberto Tarantino Copyright © 2015 Silvia Capuani et al. All rights reserved. Diffusion Weighted MR Imaging of Primary and Recurrent Middle Ear Cholesteatoma: An Assessment by Readers with Different Expertise Mon, 02 Feb 2015 08:24:55 +0000 Introduction and Purpose. Diffusion weighted imaging (DWI) has been proven to be valuable in the diagnosis of middle ear cholesteatoma. The aims of our study were to evaluate the advantage of multi-shot turbo spin echo (MSh TSE) DWI compared to single-shot echo-planar (SSh EPI) DWI for the diagnosis of cholesteatoma. Material and Methods. Thirty-two patients with clinical suspicion of unilateral cholesteatoma underwent preoperative MRI (1.5T) with SSh EPI and MSh TSE. Images were separately analyzed by 4 readers with different expertise to confirm the presence of cholesteatoma. Sensitivity, specificity, diagnostic accuracy, and positive (PPV) and negative predictive values (NPV) were assessed for each observer and interrater agreement was assessed using kappa statistics. Diagnosis was obtained at surgery. Results. Overall MSh TSE showed higher diagnostic accuracy and lower negative predictive value (NPV) compared to conventional SSh EPI. Interreader agreement between the observers revealed the superiority of MSh TSE compared to SSh EPI. Interrater agreement among all the four observers was higher by using MSh TSE compared to SSh EPI. Conclusion. Our findings suggest that MSh TSE DWI has higher sensitivity for detection of cholesteatoma and lower probability of misdiagnosis. MSh TSE DWI is useful in guiding less experienced observers to the diagnosis. A. Elefante, M. Cavaliere, C. Russo, G. Caliendo, M. Marseglia, D. Cicala, D. Piccolo, A. Di Lullo, L. Brunetti, A. Palma, M. Iengo, and A. Brunetti Copyright © 2015 A. Elefante et al. All rights reserved. Acute Effects of Alcohol on the Human Brain: A Resting-State fMRI Study Mon, 02 Feb 2015 06:42:58 +0000 The aim of this study is to assess the value of resting-state fMRI in detecting the acute effects of alcohol on healthy human brains. Thirty-two healthy volunteers were studied by conventional MR imaging and resting-state fMRI prior to and 0.5 hours after initiation of acute alcohol administration. The fMRI data, acquired during the resting state, were correlated with different breath alcohol concentrations (BrAC). We use the posterior cingulate cortex/precuneus as a seed for the default mode network (DMN) analysis. ALFF and ReHo were also used to investigate spontaneous neural activity in the resting state. Conventional MR imaging showed no abnormalities on all subjects. Compared with the prior alcohol administration, the ALFF and ReHo also indicated some specific brain regions which are affected by alcohol, including the superior frontal gyrus, cerebellum, hippocampal gyrus, left basal ganglia, and right internal capsule. Functional connectivity of the DMN was affected by alcohol. This resting-state fMRI indicates that brain regions implicated are affected by alcohol and might provide a neural basis for alcohol’s effects on behavioral performance. Hongyi Zheng, Lingmei Kong, Lanmei Chen, Haidu Zhang, and Wenbin Zheng Copyright © 2015 Hongyi Zheng et al. All rights reserved. Frequency-Dependent Amplitude Alterations of Resting-State Spontaneous Fluctuations in Late-Onset Depression Sun, 01 Feb 2015 10:38:48 +0000 There is limited amplitude of low-frequency fluctuation (ALFF) of resting-state functional magnetic resonance imaging (fMRI) studies in late-onset depression (LOD) but reported different results. This may be due to the impact of different frequency bands. In this study, we examined the ALFF in five different frequency bands (slow-6: 0–0.01 Hz; slow-5: 0.01–0.027 Hz; slow-4: 0.027–0.073 Hz; slow-3: 0.073–0.167 Hz, and slow-2: 0.167–0.25 Hz) within the whole brain during resting-state fMRI in 16 LOD patients and 16 normal control (NC) subjects. The ALFF of primary effect of disease was widely distributed over left cerebellum anterior lobe, left cerebellum posterior lobe, left middle orbitofrontal gyrus, left superior occipital, and right superior parietal, while the interaction effect of disease and frequency was distributed over right superior frontal gyrus. Further relationship analysis findings suggest these abnormal ALFF may relate to cognitive dysfunction of LOD. Therefore, our data show that LOD patients have widespread abnormalities in intrinsic brain activity, which is dependent on the frequency band, and suggest that future studies should take the frequency bands into account when measuring intrinsic brain activity. Yingying Yue, Xize Jia, Zhenghua Hou, Yufeng Zang, and Yonggui Yuan Copyright © 2015 Yingying Yue et al. All rights reserved. CT Perfusion: Technical Developments and Current and Future Applications Wed, 28 Jan 2015 11:56:04 +0000 Maria Antonietta Mazzei, Lorenzo Preda, Alessandro Cianfoni, and Luca Volterrani Copyright © 2015 Maria Antonietta Mazzei et al. All rights reserved. Discrimination between Newly Formed and Aged Thrombi Using Empirical Mode Decomposition of Ultrasound B-Scan Image Wed, 28 Jan 2015 08:56:10 +0000 Ultrasound imaging is a first-line diagnostic method for screening the thrombus. During thrombus aging, the proportion of red blood cells (RBCs) in the thrombus decreases and therefore the signal intensity of B-scan can be used to detect the thrombus age. To avoid the effect of system gain on the measurements, this study proposed using the empirical mode decomposition (EMD) of ultrasound image as a strategy to classify newly formed and aged thrombi. Porcine blood samples were used for the in vitro induction of fresh and aged thrombi (at hematocrits of 40%). Each thrombus was imaged using an ultrasound scanner at different gains (15, 20, and 30 dB). Then, EMD of ultrasound signals was performed to obtain the first and second intrinsic mode functions (IMFs), which were further used to calculate the IMF-based echogenicity ratio (IER). The results showed that the performance of using signal amplitude of B-scan to reflect the thrombus age depends on gain. However, the IER is less affected by the gain in discriminating between fresh and aged thrombi. In the future, ultrasound B-scan combined with the EMD may be used to identify the thrombus age for the establishment of thrombolytic treatment planning. Jui Fang, Yung-Liang Wan, Chin-Kuo Chen, and Po-Hsiang Tsui Copyright © 2015 Jui Fang et al. All rights reserved. Functional Relevance of Coronary Artery Disease by Cardiac Magnetic Resonance and Cardiac Computed Tomography: Myocardial Perfusion and Fractional Flow Reserve Tue, 27 Jan 2015 08:30:18 +0000 Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR) has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT) has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT), functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach. Gianluca Pontone, Daniele Andreini, Andrea Baggiano, Erika Bertella, Saima Mushtaq, Edoardo Conte, Virginia Beltrama, Andrea Igoren Guaricci, and Mauro Pepi Copyright © 2015 Gianluca Pontone et al. All rights reserved. Smaller Anterior Cruciate Ligament Diameter Is a Predictor of Subjects Prone to Ligament Injuries: An Ultrasound Study Thu, 22 Jan 2015 12:21:46 +0000 Purpose. To test if diameter of normal anterior cruciate ligament (ACL) can be measured by ultrasound (US), to see if there is a relationship between smaller ACL diameter and ACL injury, and to assess agreement between radiologists in measuring ACL diameter in cases and matched controls. Materials and Methods. In this ethics committee-approved study, maximum diameter of ACL near tibial insertion site was measured by static and dynamic US study in 25 normal contralateral knees of subjects who suffered noncontact ACL injury and in 25 matched control subjects. Results. ACL was visualized as a thick linear hypoechoic band inserted approximately 11 mm caudal to the tibial plateau and the intercondylar eminence. Maximum diameter of contralateral ACL near tibial insertion site among injured subjects was significantly smaller than in noninjured subjects (0.62 ± 0.07 cm versus 0.81 ± 0.06 cm; ). In the regression analysis, the diameter of ACL near tibial insertion site was found significantly proportional to body weight and not significantly associated to height, gender, and age. Conclusion. Diameter of normal ACL near tibial insertion site can be measured by US and the maximum diameter is significantly smaller among subjects with noncontact ACL injury. US is a promising modality that can be used as an excellent screening test to detect subjects especially aspiring athletes prone to ACL injury. Very strong agreement was observed between radiologists in measuring ACL diameter. Parag Suresh Mahajan, Prem Chandra, Vidya Chander Negi, Abhilash Pullincherry Jayaram, and Sheik Akbar Hussein Copyright © 2015 Parag Suresh Mahajan et al. All rights reserved. Coronary Arteries Segmentation Based on the 3D Discrete Wavelet Transform and 3D Neutrosophic Transform Wed, 14 Jan 2015 14:02:13 +0000 Purpose. Most applications in the field of medical image processing require precise estimation. To improve the accuracy of segmentation, this study aimed to propose a novel segmentation method for coronary arteries to allow for the automatic and accurate detection of coronary pathologies. Methods. The proposed segmentation method included 2 parts. First, 3D region growing was applied to give the initial segmentation of coronary arteries. Next, the location of vessel information, HHH subband coefficients of the 3D DWT, was detected by the proposed vessel-texture discrimination algorithm. Based on the initial segmentation, 3D DWT integrated with the 3D neutrosophic transformation could accurately detect the coronary arteries. Results. Each subbranch of the segmented coronary arteries was segmented correctly by the proposed method. The obtained results are compared with those ground truth values obtained from the commercial software from GE Healthcare and the level-set method proposed by Yang et al., 2007. Results indicate that the proposed method is better in terms of efficiency analyzed. Conclusion. Based on the initial segmentation of coronary arteries obtained from 3D region growing, one-level 3D DWT and 3D neutrosophic transformation can be applied to detect coronary pathologies accurately. Shuo-Tsung Chen, Tzung-Dau Wang, Wen-Jeng Lee, Tsai-Wei Huang, Pei-Kai Hung, Cheng-Yu Wei, Chung-Ming Chen, and Woon-Man Kung Copyright © 2015 Shuo-Tsung Chen et al. All rights reserved. MRA Study on Variation of the Circle of Willis in Healthy Chinese Male Adults Mon, 05 Jan 2015 13:55:04 +0000 Aim. To investigate the morphology and variation of the circle of Willis (COW) in healthy Chinese male adults. Materials and Methods. We analyzed cerebral magnetic resonance angiography (MRA) images of 2,246 healthy subjects using typical magnetic resonance imaging (MRI) and MRA. 3D-time of flight (TOF) MRA method was applied to all subjects and the classification was therefore achieved according to the integrity level of COW and the developmental situation of vessels. Results. The overall incidence of COW integrity was 12.24%, with 7.57% nonvariation integral COW. The incidences of partial integrity and nonintegrity were 70.17% and 17.59%, respectively. The integrity rate of anterior circulation was 78.58%, with a close correlation with A1 segment of the anterior cerebral artery (ACA-A1) developmental condition. The developmental variation rate of ACA-A1 was 28.23% and the variation of the right side was higher than that of the left side. The nonintegrity rate of posterior circulation was 83.93% as the hypoplasia of P1 segment of the posterior cerebral artery (PCA-P1) with an incidence rate of 15.85% for PCA-P1 variation. Conclusions. The COW variation is a common phenomenon among the healthy subjects. MRA could enable reflecting the physiological morphology of COW in a comprehensive manner. Chuanya Qiu, Yong Zhang, Caixia Xue, Shanshan Jiang, and Wei Zhang Copyright © 2015 Chuanya Qiu et al. All rights reserved. Feasibility Study of Automated Framework for Estimating Lung Tumor Locations for Target-Based Patient Positioning in Stereotactic Body Radiotherapy Mon, 05 Jan 2015 13:12:48 +0000 Objective. To investigate the feasibility of an automated framework for estimating the lung tumor locations for tumor-based patient positioning with megavolt-cone-beam computed tomography (MV-CBCT) during stereotactic body radiotherapy (SBRT). Methods. A lung screening phantom and ten lung cancer cases with solid lung tumors, who were treated with SBRT, were employed to this study. The locations of tumors in MV-CBCT images were estimated using a tumor-template matching technique between a tumor template and the MV-CBCT. Tumor templates were produced by cropping the gross tumor volume (GTV) regions, which were enhanced by a Sobel filter or a blob structure enhancement (BSE) filter. Reference tumor locations (grand truth) were determined based on a consensus between a radiation oncologist and a medical physicist. Results. According to the results of the phantom study, the average Euclidean distances of the location errors in the original, Sobel-filtered, and BSE-filtered images were 2.0 ± 4.1 mm, 12.8 ± 9.4 mm, and 0.4 ± 0.5 mm, respectively. For clinical cases, these were 3.4 ± 7.1 mm, 7.2 ± 11.6 mm, and 1.6 ± 1.2 mm, respectively. Conclusion. The feasibility study suggests that our proposed framework based on the BSE filter may be a useful tool for tumor-based patient positioning in SBRT. Satoshi Yoshidome, Hidetaka Arimura, Katsumasa Nakamura, Yoshiyuki Shioyama, Kazushige Atsumi, Yasuhiko Nakamura, Hideki Yoshikawa, Kei Nishikawa, and Hideki Hirata Copyright © 2015 Satoshi Yoshidome et al. All rights reserved. Neuroimaging of Brain Networks and Function Thu, 01 Jan 2015 13:06:31 +0000 Hengyi Rao, Danny Jiongjiong Wang, Yihong Yang, and Yong He Copyright © 2015 Hengyi Rao et al. All rights reserved. Gender Differences in Cerebral Regional Homogeneity of Adult Healthy Volunteers: A Resting-State fMRI Study Thu, 01 Jan 2015 11:34:30 +0000 Objective. We sought to use the regional homogeneity (ReHo) approach as an index in the resting-state functional MRI to investigate the gender differences of spontaneous brain activity within cerebral cortex and resting-state networks (RSNs) in young adult healthy volunteers. Methods. One hundred and twelve healthy volunteers (56 males, 56 females) participated in the resting-state fMRI scan. The ReHo mappings in the cerebral cortex and twelve RSNs of the male and female groups were compared. Results. We found statistically significant gender differences in the primary visual network (PVN) (, with Bonferroni correction) and left attention network (LAtN), default mode network (DMN), sensorimotor network (SMN), executive network (EN), and dorsal medial prefrontal network (DMPFC) as well (, uncorrected). The male group showed higher ReHo in the left precuneus, while the female group showed higher ReHo in the right middle cingulate gyrus, fusiform gyrus, left inferior parietal lobule, precentral gyrus, supramarginal gyrus, and postcentral gyrus. Conclusions. Our results suggested that men and women had regional specific differences during the resting-state. The findings may improve our understanding of the gender differences in behavior and cognition from the perspective of resting-state brain function. Chunsheng Xu, Chuanfu Li, Hongli Wu, Yuanyuan Wu, Sheng Hu, Yifang Zhu, Wei Zhang, Linying Wang, Senhua Zhu, Junping Liu, Qingping Zhang, Jun Yang, and Xiaochu Zhang Copyright © 2015 Chunsheng Xu et al. All rights reserved. Advances in Molecular Pathway-Directed Cancer Systems Imaging and Therapy Sun, 21 Dec 2014 13:16:45 +0000 David J. Yang, Lan Pham, Mei-Hsiu Liao, Fan-Lin Kong, Hiroji Uemura, and Yen-Yu Ian Shih Copyright © 2014 David J. Yang et al. All rights reserved. Interfractional Variations of Tumor Centroid Position and Tumor Regression during Stereotactic Body Radiotherapy for Lung Tumor Sun, 07 Dec 2014 10:44:34 +0000 Purpose. To determine interfractional changes of lung tumor centroid position and tumor regression during stereotactic body radiation therapy (SBRT). Methods and Materials. 34 patients were treated by SBRT in 4-5 fractions to a median dose of 50 Gy. The CT scans acquired for verification were registered with simulation CT scans. The gross target volume (GTV) was contoured on all verification CT scans and compared to the initial GTV in treatment plan system. Results. The mean (standard deviation, SD) three-dimension vector shift was  mm. The mean interfractional variations of tumor centroid position were  mm in anterior-posterior (AP) direction,  mm in superior-inferior (SI) direction, and  mm in right-left (RL) direction. Large interfractional variations (5 mm) were observed in 5 fractions (3.3%) in RL direction, 16 fractions (10.5%) in SI direction, and 36 fractions (23.5%) in AP direction. Tumor volume did not decrease significantly during lung SBRT. Conclusions. Small but insignificant tumor volume regression was observed during lung SBRT. While the mean interfractional variations of tumor centroid position were minimal in three directions, variations more than 5 mm account for approximately a third of all, indicating additional margin for PTV, especially in AP direction. Yanan Sun, Yufei Lu, Siguo Cheng, Wei Guo, Ke Ye, Huiyun Zhao, Xiaoli Zheng, Dingjie Li, Shujuan Wang, Chengliang Yang, and Hong Ge Copyright © 2014 Yanan Sun et al. All rights reserved. Quantification of an External Motion Surrogate for Quality Assurance in Lung Cancer Radiation Therapy Sun, 30 Nov 2014 07:43:32 +0000 The purpose of this work was to validate the stability of the end exhale position in deep expiration breath hold (DEBH) technique for quality assurance in stereotactic lung tumor radiation therapy. Furthermore, a motion analysis was performed for 20 patients to evaluate breathing periods and baseline drifts based on an external surrogate. This trajectory was detected using stereo infrared (IR) cameras and reflective body markers. The respiratory waveform showed large interpatient differences in the end exhale position during irradiation up to 18.8 mm compared to the global minimum. This position depends significantly on the tumor volume. Also the baseline drifts, which occur mostly in posterior direction, are affected by the tumor size. Breathing periods, which depend mostly on the patient age, were in a range between 2.4 s and 7.0 s. Fifteen out of 20 patients, who showed a reproducible end exhale position with a deviation of less than 5 mm, might benefit from DEBH due to smaller planning target volumes (PTV) compared to free breathing irradiation and hence sparing of healthy tissue. Patients with larger uncertainties should be treated with more complex motion compensation techniques. Jens Wölfelschneider, Tobias Brandt, Sebastian Lettmaier, Rainer Fietkau, and Christoph Bert Copyright © 2014 Jens Wölfelschneider et al. All rights reserved. Differentiation of Benign Angiomatous and Microcystic Meningiomas with Extensive Peritumoral Edema from High Grade Meningiomas with Aid of Diffusion Weighted MRI Sun, 16 Nov 2014 07:51:57 +0000 Objective. To determine whether angiomatous and microcystic meningiomas which mimic high grade meningiomas based on extent of peritumoral edema can be reliably differentiated as low grade tumors using normalized apparent diffusion coefficient (ADC) values. Methods. Preoperative magnetic resonance imaging (MRI) of seventy patients with meningiomas was reviewed. Morphologically, the tumors were divided into 3 groups. Group 1 contained 12 pure microcystic, 3 pure angiomatoid and 7 mixed angiomatoid and microcystic tumors. Group 2 included World Health Organization (WHO) grade II and WHO grade III tumors, of which 28 were atypical and 9 were anaplastic meningiomas. Group 3 included WHO grade I tumors of morphology different than angiomatoid and microcystic. Peritumoral edema, normalized ADC, and cerebral blood volume (CBV) were obtained for all meningiomas. Results. Edema index of tumors in group 1 and group 2 was significantly higher than in group 3. Normalized ADC value in group 1 was higher than in group 2, but not statistically significant between groups 1 and 3. CBV values showed no significant group differences. Conclusion. A combination of peritumoral edema index and normalized ADC value is a novel approach to preoperative differentiation between true aggressive meningiomas and mimickers such as angiomatous and microcystic meningiomas. Avetis Azizyan, Paula Eboli, Doniel Drazin, James Mirocha, Marcel M. Maya, and Serguei Bannykh Copyright © 2014 Avetis Azizyan et al. All rights reserved. Partial Splenic Embolization with Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma Accompanied by Thrombocytopenia Mon, 15 Sep 2014 00:00:00 +0000 Background. Thrombocytopenia often makes the introduction of systemic treatment difficult in patients with cirrhosis and hepatocellular carcinoma (HCC). We retrospectively evaluated the long-term effects of partial splenic embolization (PSE) with transarterial chemoembolization (TACE) in patients with HCC patients accompanied by thrombocytopenia. Patients and Methods. Twenty-one patients with HCC complicated by severe thrombocytopenia (platelet count, <5.0 × 104/mm3) were treated with PSE and TACE. Both the safety and platelet-increasing effect was evaluated in these patients. Results. Seventeen of 21 patients (81.0%) showed increased platelet counts to ≥5.0 × 104/mm3. Subsequently, 13 patients (61.9%) successfully received systemic chemotherapy. Platelet counts and serum levels of total bilirubin, as well as neutrophil counts, improved significantly one month after treatment. However, serum levels of albumin and hemoglobin decreased significantly one month after treatment. Severe adverse events, including acute liver failure and portal vein thrombus, were observed in two patients. Conclusion. PSE with selective TACE made it possible for patients with HCC and severe thrombocytopenia to receive systemic chemotherapy. Although PSE with TACE was safe and tolerable for most patients, the extent of PSE with TACE in a wide area of the liver may increase the risk for fatal liver failure. Yoshihiko Ooka, Tetsuhiro Chiba, Sadahisa Ogasawara, Tenyu Motoyama, Eiichiro Suzuki, Akinobu Tawada, Fumihiko Kanai, and Osamu Yokosuka Copyright © 2014 Yoshihiko Ooka et al. All rights reserved. Perfusion in the Tissue Surrounding Pancreatic Cancer and the Patient’s Prognosis Thu, 11 Sep 2014 08:58:24 +0000 Objective. The objective was to investigate the relationship between prognosis in case of pancreatic cancer and perfusion in tissue surrounding pancreatic cancer using perfusion CT. Methods. We enrolled 17 patients diagnosed with inoperable pancreatic adenocarcinoma. All patients were examined by perfusion CT and then underwent chemotherapy using gemcitabine. The time density curve (TDC) of each CT pixel was analyzed to calculate area under the curve (AUC) and blood flow (BF) using a mathematical algorithm based on the single-compartment model. To measure the AUC and BF of tumor ( and ) and peritumoral tissue ( and ), regions of interest were manually placed on the cancer and in pancreatic tissue within 10 mm of proximal pancreatic parenchyma. Survival days from the date of perfusion CT were recorded. Correlation between AUC or BF and survival days was assessed. Results. We found a significant correlation between or and survival days ( or 0.0005). Higher or values were associated with shorter survival. We found no significant correlation between or and survival. Conclusions. Our results suggest that assessments of perfusion in pancreatic tissue within 10 mm of proximal pancreatic parenchyma may be useful in predicting prognosis. Yoshihiro Nishikawa, Yoshihisa Tsuji, Hiroyoshi Isoda, Yuzo Kodama, and Tsutomu Chiba Copyright © 2014 Yoshihiro Nishikawa et al. All rights reserved. Volume Change and Liver Parenchymal Signal Intensity in Gd-EOB-DTPA-Enhanced Magnetic Resonance Imaging after Portal Vein Embolization prior to Hepatectomy Thu, 11 Sep 2014 07:40:41 +0000 Purpose. To investigate the liver volume change and the potential of early evaluation by contrast-enhanced magnetic resonance imaging (MRI) using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) after portal vein embolization (PVE). Materials and Methods. Retrospective evaluations of computed tomography (CT) volumetry of total liver and nonembolized areas were performed before and 3 weeks after PVE in 37 cases. The percentage of future liver remnant (%FLR) and the change ratio of %FLR (%FLR ratio) were calculated. Prospective evaluation of signal intensities (SIs) was performed to estimate the role of Gd-EOB-DTPA-enhanced MRI as a predictor of hypertrophy in 16 cases. The SI contrast between embolized and nonembolized areas was calculated 1 week after PVE. The change in SI contrast before and after PVE (SI ratio) was also calculated in 11 cases. Results. %FLR ratio significantly increased, and SI ratio significantly decreased (both ). There were significant negative correlations between %FLR and SI contrast and between %FLR and SI ratio (both ). Conclusion. Hypertrophy in the nonembolized area after PVE was indicated by CT volumetry, and measurement of SI contrast and SI ratio in Gd-EOB-DTPA-enhanced MRI early after PVE may be useful to predict the potential for hepatic hypertrophy. Ayako Akiba, Satoru Murata, Takahiko Mine, Shiro Onozawa, Tetsuro Sekine, Yasuo Amano, Youichi Kawano, Eiji Uchida, and Shin-ichiro Kumita Copyright © 2014 Ayako Akiba et al. All rights reserved. Improved Efficacy of Transcatheter Arterial Chemoembolization Using Warmed Miriplatin for Hepatocellular Carcinoma Mon, 08 Sep 2014 07:03:20 +0000 The aim of this study was to evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) using warmed and nonwarmed miriplatin for hepatocellular carcinoma. Eighty patients (117 nodules), treated between January 2010 and June 2013, were evaluated. Thirty-two and 85 nodules were treated with nonwarmed and warmed miriplatin, respectively. The efficacy of TACE was evaluated on a per nodule basis according to treatment effect (TE). Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. TE grades were significantly improved in the warmed group compared to the nonwarmed group (nonwarmed: TE 4, 12.5%; TE 3, 0%; TE 2, 15.6%; TE 1, 71.9%; warmed: TE 4, 34.1%; TE 3, 5.9%; TE 2, 9.4%; TE 1, 50.6%; ) . Multivariate analysis revealed significant impact of warming miriplatin on objective response rate (odds ratio, 12.35; 95% confidence interval, 2.90–90.0; ). CTCAE grades of elevated aspartate and alanine transaminase after TACE were significantly higher in the warmed group ( and 0.0068, resp.); however, all adverse events were only transient. The use of warmed miriplatin in TACE significantly improved TE without causing serious complications. Daisuke Yasui, Satoru Murata, Shiro Onozawa, Takahiko Mine, Tatsuo Ueda, Fumie Sugihara, Chiaki Kawamoto, Eiji Uchida, and Shin-ichiro Kumita Copyright © 2014 Daisuke Yasui et al. All rights reserved. Patched Targeting Peptides for Imaging and Treatment of Hedgehog Positive Breast Tumors Mon, 08 Sep 2014 06:41:50 +0000 High tumor hedgehog expression is correlated with poor prognosis in invasive ductal carcinoma. Peptides which bind the patched receptor have recently been reported to have a growth inhibitory effect in tumors with activated hedgehog signaling. We sought to examine growth inhibition with these peptides in breast cancer cells and use these peptides as molecular imaging probes to follow changes in hedgehog expression after chemotherapy. Significant growth inhibition was observed in breast cancer cell lines treated with PTCH-blocking peptides. Significant in vitro uptake was observed with both FITC- and 99mTc-EC-peptide conjugates. In vivo imaging studies displayed greater accumulation of 99mTc-labeled peptides within tumors as compared to adjacent muscle tissue. Patched receptor expression increased after treatment and this correlated with an increase in tumor radiotracer uptake. These studies suggest that peptides which bind the sonic hedgehog docking site in patched receptor correlate with patched expression and can be used to image patched in vivo. Further, our data suggest that radiolabeled peptides may enable us to examine the activity of the hedgehog signaling pathway and to evaluate response to anti-cancer therapies. Daniel Smith, Fanlin Kong, David Yang, Richard Larson, Jennifer Sims-Mourtada, and Wendy A. Woodward Copyright © 2014 Daniel Smith et al. All rights reserved. Highlighting the Structure-Function Relationship of the Brain with the Ising Model and Graph Theory Thu, 04 Sep 2014 00:00:00 +0000 With the advent of neuroimaging techniques, it becomes feasible to explore the structure-function relationships in the brain. When the brain is not involved in any cognitive task or stimulated by any external output, it preserves important activities which follow well-defined spatial distribution patterns. Understanding the self-organization of the brain from its anatomical structure, it has been recently suggested to model the observed functional pattern from the structure of white matter fiber bundles. Different models which study synchronization (e.g., the Kuramoto model) or global dynamics (e.g., the Ising model) have shown success in capturing fundamental properties of the brain. In particular, these models can explain the competition between modularity and specialization and the need for integration in the brain. Graphing the functional and structural brain organization supports the model and can also highlight the strategy used to process and organize large amount of information traveling between the different modules. How the flow of information can be prevented or partially destroyed in pathological states, like in severe brain injured patients with disorders of consciousness or by pharmacological induction like in anaesthesia, will also help us to better understand how global or integrated behavior can emerge from local and modular interactions. T. K. Das, P. M. Abeyasinghe, J. S. Crone, A. Sosnowski, S. Laureys, A. M. Owen, and A. Soddu Copyright © 2014 T. K. Das et al. All rights reserved. Design of CGMP Production of 18F- and 68Ga-Radiopharmaceuticals Tue, 02 Sep 2014 12:32:43 +0000 Objective. Radiopharmaceutical production process must adhere to current good manufacturing process (CGMP) compliance to ensure the quality of precursor, prodrug (active pharmaceutical ingredient, API), and the final drug product that meet acceptance criteria. We aimed to develop an automated system for production of CGMP grade of PET radiopharmaceuticals. Methods. The hardware and software of the automated synthesizer that fit in the hot cell under cGMP requirement were developed. Examples of production yield and purity for 68Ga-DOTATATE and 18F-FDG at CGMP facility were optimized. Analytical assays and acceptance criteria for cGMP grade of 68Ga-DOTATATE and 18F-FDG were established. Results. CGMP facility for the production of PET radiopharmaceuticals has been established. Radio-TLC and HPLC analyses of 68Ga-DOTATATE and 18F-FDG showed that the radiochemical purity was 92% and 96%, respectively. The products were sterile and pyrogenic-free. Conclusion. CGMP compliance of radiopharmaceuticals has been reviewed. 68Ga-DOTATATE and 18F-FDG were synthesized with high radiochemical yield under CGMP process. Yen-Ting Chi, Pei-Chun Chu, Hao-Yu Chao, Wei-Chen Shieh, and Chuck C. Chen Copyright © 2014 Yen-Ting Chi et al. All rights reserved. Abnormal Functional Resting-State Networks in ADHD: Graph Theory and Pattern Recognition Analysis of fMRI Data Sun, 31 Aug 2014 00:00:00 +0000 The framework of graph theory provides useful tools for investigating the neural substrates of neuropsychiatric disorders. Graph description measures may be useful as predictor variables in classification procedures. Here, we consider several centrality measures as predictor features in a classification algorithm to identify nodes of resting-state networks containing predictive information that can discriminate between typical developing children and patients with attention-deficit/hyperactivity disorder (ADHD). The prediction was based on a support vector machines classifier. The analyses were performed in a multisite and publicly available resting-state fMRI dataset of healthy children and ADHD patients: the ADHD-200 database. Network centrality measures contained little predictive information for the discrimination between ADHD patients and healthy subjects. However, the classification between inattentive and combined ADHD subtypes was more promising, achieving accuracies higher than 65% (balance between sensitivity and specificity) in some sites. Finally, brain regions were ranked according to the amount of discriminant information and the most relevant were mapped. As hypothesized, we found that brain regions in motor, frontoparietal, and default mode networks contained the most predictive information. We concluded that the functional connectivity estimations are strongly dependent on the sample characteristics. Thus different acquisition protocols and clinical heterogeneity decrease the predictive values of the graph descriptors. Anderson dos Santos Siqueira, Claudinei Eduardo Biazoli Junior, William Edgar Comfort, Luis Augusto Rohde, and João Ricardo Sato Copyright © 2014 Anderson dos Santos Siqueira et al. All rights reserved. Motion Freeze for Respiration Motion Correction in PET/CT: A Preliminary Investigation with Lung Cancer Patient Data Thu, 28 Aug 2014 15:05:43 +0000 Purpose. Respiratory motion presents significant challenges for accurate PET/CT. It often introduces apparent increase of lesion size, reduction of measured standardized uptake value (SUV), and the mismatch in PET/CT fusion images. In this study, we developed the motion freeze method to use 100% of the counts collected by recombining the counts acquired from all phases of gated PET data into a single 3D PET data, with correction of respiration by deformable image registration. Methods. Six patients with diagnosis of lung cancer confirmed by oncologists were recruited. PET/CT scans were performed with Discovery STE system. The 4D PET/CT with the Varian real-time position management for respiratory motion tracking was followed by a clinical 3D PET/CT scan procedure in the static mode. Motion freeze applies the deformation matrices calculated by optical flow method to generate a single 3D effective PET image using the data from all the 4D PET phases. Results. The increase in SUV and decrease in tumor size with motion freeze for all lesions compared to the results from 3D and 4D was observed in the preliminary data of lung cancer patients. In addition, motion freeze substantially reduced tumor mismatch between the CT image and the corresponding PET images. Conclusion. Motion freeze integrating 100% of the PET counts has the potential to eliminate the influences induced by respiratory motion in PET data. Tzung-Chi Huang, Kuei-Ting Chou, Yao-Ching Wang, and Geoffrey Zhang Copyright © 2014 Tzung-Chi Huang et al. All rights reserved. Radiofrequency Thermoablation of HCC Larger Than 3 cm and Less Than 5 cm Proximal to the Gallbladder without Gallbladder Isolation: A Single Center Experience Thu, 28 Aug 2014 07:04:08 +0000 Radiofrequency ablation (RFA) is an effective minimally invasive treatment for nonsurgical hepatocellular carcinoma (HCC), but ablation of tumors close to the gallbladder could be associated with several complications. We report our experience on the treatment of HCC close to the gallbladder with RFA. Eight RFA procedures were performed in eight patients with HCC larger than 3 cm and less than 5 cm close to the gallbladder. In all cases, a percutaneous approach was used. There were no major complications. Only in two patients a minimal wall thickening of the gallbladder was observed. Contrast enhanced computed tomography carried out after 30 days from the first procedure showed complete necrosis in seven patients (87%). Only one patient had local recurrence at 11 months of followup. Although limited, our experience suggests that, after careful preprocedural planning, in experienced hands and with appropriate technology, percutaneous RFA could be safely performed even for lesions larger than 3 cm located in close adjacency to the gallbladder. Antonio Orlacchio, Fabrizio Chegai, Costantino Del Giudice, Mariangela Massaccesi, Elisa Costanzo, Elena Di Caprera, and Giovanni Simonetti Copyright © 2014 Antonio Orlacchio et al. All rights reserved. Visual Learning Alters the Spontaneous Activity of the Resting Human Brain: An fNIRS Study Thu, 28 Aug 2014 00:00:00 +0000 Resting-state functional connectivity (RSFC) has been widely used to investigate spontaneous brain activity that exhibits correlated fluctuations. RSFC has been found to be changed along the developmental course and after learning. Here, we investigated whether and how visual learning modified the resting oxygenated hemoglobin (HbO) functional brain connectivity by using functional near-infrared spectroscopy (fNIRS). We demonstrate that after five days of training on an orientation discrimination task constrained to the right visual field, resting HbO functional connectivity and directed mutual interaction between high-level visual cortex and frontal/central areas involved in the top-down control were significantly modified. Moreover, these changes, which correlated with the degree of perceptual learning, were not limited to the trained left visual cortex. We conclude that the resting oxygenated hemoglobin functional connectivity could be used as a predictor of visual learning, supporting the involvement of high-level visual cortex and the involvement of frontal/central cortex during visual perceptual learning. Haijing Niu, Hao Li, Li Sun, Yongming Su, Jing Huang, and Yan Song Copyright © 2014 Haijing Niu et al. All rights reserved. New Imaging Strategies Using a Motion-Resistant Liver Sequence in Uncooperative Patients Wed, 27 Aug 2014 08:07:47 +0000 MR imaging has unique benefits for evaluating the liver because of its high-resolution capability and ability to permit detailed assessment of anatomic lesions. In uncooperative patients, motion artifacts can impair the image quality and lead to the loss of diagnostic information. In this setting, the recent advances in motion-resistant liver MR techniques, including faster imaging protocols (e.g., dual-echo magnetization-prepared rapid-acquisition gradient echo (MP-RAGE), view-sharing technique), the data under-sampling (e.g., gradient recalled echo (GRE) with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA), single-shot echo-train spin-echo (SS-ETSE)), and motion-artifact minimization method (e.g., radial GRE with/without k-space-weighted image contrast (KWIC)), can provide consistent, artifact-free images with adequate image quality and can lead to promising diagnostic performance. Understanding of the different motion-resistant options allows radiologists to adopt the most appropriate technique for their clinical practice and thereby significantly improve patient care. Bong Soo Kim, Kyung Ryeol Lee, and Myeng Ju Goh Copyright © 2014 Bong Soo Kim et al. All rights reserved. In Vitro Demonstration of Focused Ultrasound Thrombolysis Using Bifrequency Excitation Wed, 27 Aug 2014 07:33:13 +0000 Focused ultrasound involving inertial cavitation has been shown to be an efficient method to induce thrombolysis without any pharmacological agent. However, further investigation of the mechanisms involved and further optimization of the process are still required. The present work aims at studying the relevance of a bifrequency excitation compared to a classical monofrequency excitation to achieve thrombolysis without any pharmacological agent. In vitro human blood clots were placed at the focus of a piezoelectric transducer. Efficiency of the thrombolysis was assessed by weighing each clot before and after sonication. The efficiencies of mono- (550 kHz) and bifrequency (535 and 565 kHz) excitations were compared for peak power ranging from 70 W to 220 W. The thrombolysis efficiency appears to be correlated to the inertial cavitation activity quantified by passive acoustic listening. In the conditions of the experiment, the power needed to achieve 80% of thrombolysis with a monofrequency excitation is reduced by the half with a bifrequency excitation. The thermal effects of bifrequency and monofrequency excitations, studied using MR thermometry measurements in turkey muscle samples where no cavitation occurred, did not show any difference between both types of excitations when using the same power level. Izella Saletes, Bruno Gilles, Vincent Auboiroux, Nadia Bendridi, Rares Salomir, and Jean-Christophe Béra Copyright © 2014 Izella Saletes et al. All rights reserved. CT Findings in Acute, Subacute, and Chronic Ischemic Colitis: Suggestions for Diagnosis Wed, 27 Aug 2014 06:45:06 +0000 Purpose. This paper aims at evaluating CT findings of occlusive and nonocclusive ischemic colitis (IC), in correlation with the etiology and the different phases of the disease. Materials and Methods. CT examination and clinical history of 32 patients with proven IC were retrospectively reviewed. The CT findings were analyzed according to the different phases of the disease (acute, subacute, and chronic). Results. Among the 32 CT examinations performed in the acute phase, 62.5% did not present signs of occlusion of the superior mesenteric artery (SMA) or inferior mesenteric artery (IMA), whereas IMA occlusion was detected in 37.5% of CT examinations. In the acute phase, the presence of pericolic fluid was found in 100% of patients undergoing progressive resorption from acute to subacute phase if an effective reperfusion occurred; the bowel wall thickening was observed in 28.1% patients in acute phase and in 86.4% patients evaluated in subacute phase. The unthickened colonic wall was found in all conditions where ischemia was not followed by effective reperfusion (71.9% of cases), and it was never found in chronic phase, when the colon appeared irregularly thickened. Conclusion. CT allows determining the morphofunctional alterations associated with the IC discriminating the occlusive forms from the nonocclusive forms. CT, furthermore, allows estimating the timing of ischemic damage. Francesca Iacobellis, Daniela Berritto, Dominik Fleischmann, Giuliano Gagliardi, Antonio Brillantino, Maria Antonietta Mazzei, and Roberto Grassi Copyright © 2014 Francesca Iacobellis et al. All rights reserved. Early Glottic Cancer: Role of MRI in the Preoperative Staging Thu, 14 Aug 2014 09:06:44 +0000 Introduction. Clinical staging is the most important time in management of glottic cancer in early stage (I-II). We have conducted a prospective study to evaluate if magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) about tumoral extension, to exactly choose the most appropriate surgical approach, from organ preservation surgery to demolitive surgery. Materials and Methods. This prospective study was conducted on 26 male patients, with suspected laryngeal neoplasia of glottic region. The images of MRI and CT were analyzed to define the expansion of glottic lesion to anterior commissure, laryngeal cartilages, subglottic and/or supraglottic site, and paraglottic space. The results of MRI and CT were compared with each other and with the pathology report. Results. CT accuracy was 70% with low sensitivity but with high specific value. MRI showed a diagnostic accuracy in 80% of cases, with a sensitivity of 100% and high specificity. Statistical analysis showed that MRI has higher correlation than CT with the pathology report. Conclusion. Our study showed that MRI is more sensitive than CT in the preoperative staging of early glottic cancer, to select exactly the eligible patients in conservative surgery of the larynx, as supracricoid laryngectomy and cordectomy by CO2 laser. Eugenia Allegra, Pierpaolo Ferrise, Serena Trapasso, Orazio Trapuzzano, Antonio Barca, Stefania Tamburrini, and Aldo Garozzo Copyright © 2014 Eugenia Allegra et al. All rights reserved. CT Perfusion in the Characterisation of Renal Lesions: An Added Value to Multiphasic CT Wed, 13 Aug 2014 00:00:00 +0000 Objective. To prospectively evaluate if computed tomography perfusion (CTp) could be a useful tool in addition to multiphasic CT in renal lesion characterisation. Materials and Methods. Fifty-eight patients that were scheduled for surgical resection of a renal mass with a suspicion of renal cell carcinoma (RCC) were enrolled. Forty-one out of 58 patients underwent total or partial nephrectomy after CTp examination, and a pathological analysis was obtained for a total of 49 renal lesions. Perfusion parameters and attenuation values at multiphasic CT for both lesion and normal cortex were analysed. All the results were compared with the histological data obtained following surgery. Results. PS and MTT values were significantly lower in malignant lesions than in the normal cortex ( and , resp.); PS, MTT, and BF values were also statistically different between oncocytomas and malignant lesions. According to ROC analysis, the accuracy, sensitivity, and specificity to predict RCC were 95.92%, 100%, and 66.7%, respectively, for CTp whereas they were 89.80%, 93.35%, and 50%, respectively, for multiphasic CT. Conclusion. A significant difference between renal cortex and tumour CTp parameter values may suggest a malignant renal lesion. CTp could represent an added value to multiphasic CT in differentiating renal cells carcinoma from oncocytoma. Francesco Giuseppe Mazzei, Maria Antonietta Mazzei, Nevada Cioffi Squitieri, Chiara Pozzessere, Lorenzo Righi, Alfredo Cirigliano, Susanna Guerrini, Domenico D’Elia, Maria Raffaella Ambrosio, Aurora Barone, Maria Teresa del Vecchio, and Luca Volterrani Copyright © 2014 Francesco Giuseppe Mazzei et al. All rights reserved. Reduced Time CT Perfusion Acquisitions Are Sufficient to Measure the Permeability Surface Area Product with a Deconvolution Method Tue, 12 Aug 2014 00:00:00 +0000 Objective. To reduce the radiation dose, reduced time CT perfusion (CTp) acquisitions are tested to measure permeability surface (PS) with a deconvolution method. Methods and Materials. PS was calculated with repeated measurements while truncating the time density curve (TDC) at different time values in 14 CTp studies using CTp 4D software (GE Healthcare, Milwaukee, WI, US). The median acquisition time of CTp studies was 59.35 sec (range 49–92 seconds). To verify the accuracy of the deconvolution algorithm, a variation of the truncated PS within the error measurements was searched, that is, within 3 standard deviations from the mean nominal error provided by the software. The test was also performed for all the remaining CTp parameters measured. Results. PS maximum variability happened within 25 seconds. The PS became constant after 40 seconds for the majority of the active tumors (10/11), while for necrotic tissues it was consistent within 1% after 50 seconds. A consistent result lasted for all the observed CTp parameters, as expected from their analytical dependance. Conclusion. 40-second acquisition time could be an optimal compromise to obtain an accurate measurement of the PS and a reasonable dose exposure with a deconvolution method. Francesco Giuseppe Mazzei, Luca Volterrani, Susanna Guerrini, Nevada Cioffi Squitieri, Eleonora Sani, Gloria Bettini, Chiara Pozzessere, and Maria Antonietta Mazzei Copyright © 2014 Francesco Giuseppe Mazzei et al. All rights reserved. Development of a Hybrid Magnetic Resonance and Ultrasound Imaging System Thu, 07 Aug 2014 09:04:43 +0000 A system which allows magnetic resonance (MR) and ultrasound (US) image data to be acquired simultaneously has been developed. B-mode and Doppler US were performed inside the bore of a clinical 1.5 T MRI scanner using a clinical 1–4 MHz US transducer with an 8-metre cable. Susceptibility artefacts and RF noise were introduced into MR images by the US imaging system. RF noise was minimised by using aluminium foil to shield the transducer. A study of MR and B-mode US image signal-to-noise ratio (SNR) as a function of transducer-phantom separation was performed using a gel phantom. This revealed that a 4 cm separation between the phantom surface and the transducer was sufficient to minimise the effect of the susceptibility artefact in MR images. MR-US imaging was demonstrated in vivo with the aid of a 2 mm VeroWhite 3D-printed spherical target placed over the thigh muscle of a rat. The target allowed single-point registration of MR and US images in the axial plane to be performed. The system was subsequently demonstrated as a tool for the targeting and visualisation of high intensity focused ultrasound exposure in the rat thigh muscle. Victoria Sherwood, John Civale, Ian Rivens, David J. Collins, Martin O. Leach, and Gail R. ter Haar Copyright © 2014 Victoria Sherwood et al. All rights reserved. Patients with Poor Response to Antipsychotics Have a More Severe Pattern of Frontal Atrophy: A Voxel-Based Morphometry Study of Treatment Resistance in Schizophrenia Wed, 23 Jul 2014 11:05:22 +0000 Approximately 30% of schizophrenia patients do not respond adequately to the therapy. Previous MRI studies have suggested that drug treatment resistance is associated with brain morphological abnormalities, although region-of-interest analysis of MR studies from nonresponder and responder patients failed to demonstrate a statistically significant difference between these two schizophrenia subgroups. We have used a voxel-based analysis of segmented MR studies to assess structural cerebral differences in 20 nonresponder and 15 responder patients and 16 age-matched normal volunteers. Differences between the three groups emerged bilaterally mainly at the level of the superior and middle frontal gyri, primarily due to reduced grey matter volumes in nonresponders, as compared to both normal volunteers and responder patients. Post hoc direct comparison between the two schizophrenia subgroups demonstrated significantly reduced grey matter volumes in middle frontal gyrus bilaterally, in the dorsolateral aspects of left superior frontal gyrus extending into postcentral gyrus and in the right medial temporal cortex. Our results extend and integrate previous findings suggesting a more severe atrophy in nonresponder schizophrenia patients, compared to responder patients, mainly at the level of the superior and middle frontal gyri. Longitudinal studies in drug-naïve patients are needed to assess the role of these associations. Mario Quarantelli, Olga Palladino, Anna Prinster, Vittorio Schiavone, Barbara Carotenuto, Arturo Brunetti, Angela Marsili, Margherita Casiello, Giovanni Muscettola, Marco Salvatore, and Andrea de Bartolomeis Copyright © 2014 Mario Quarantelli et al. All rights reserved. Role of CT Perfusion in Monitoring and Prediction of Response to Therapy of Head and Neck Squamous Cell Carcinoma Mon, 21 Jul 2014 09:46:46 +0000 This review aims to summarize the technique and clinical applications of CT perfusion (CTp) of head and neck cancer. The most common pathologic type (90%) of head and neck cancer is squamous cell carcinoma (HNSCC): its diagnostic workup relies on CT and MRI, as they provide an accurate staging for the disease by determining tumour volume, assessing its extension, and detecting of lymph node metastases. Compared with conventional CT and MRI, CTp allows for obtaining measures of tumour vascular physiology and functional behaviour, and it has been demonstrated to be a feasible and useful tool in predicting local outcomes in patients undergoing radiation therapy and chemotherapy and may help monitor both treatments. Lorenzo Preda, Sonia Francesca Calloni, Marco Elvio Manlio Moscatelli, Maria Cossu Rocca, and Massimo Bellomi Copyright © 2014 Lorenzo Preda et al. All rights reserved. Alteration of Interictal Brain Activity in Patients with Temporal Lobe Epilepsy in the Left Dominant Hemisphere: A Resting-State MEG Study Mon, 21 Jul 2014 00:00:00 +0000 Resting MEG activities were compared between patients with left temporal lobe epilepsy (LTLE) and normal controls. Using SAMg2, the activities of MEG data were reconstructed and normalized. Significantly elevated SAMg2 signals were found in LTLE patients in the left temporal lobe and medial structures. Marked decreases of SAMg2 signals were found in the wide extratemporal lobe regions, such as the bilateral visual cortex. The study also demonstrated a positive correlation between the seizure frequency and brain activities of the abnormal regions after the multiple linear regression analysis. These results suggested that the aberrant brain activities not only were related to the epileptogenic zones, but also existed in other extratemporal regions in patients with LTLE. The activities of the aberrant regions could be further damaged with the increase of the seizure frequency. Our findings indicated that LTLE could be a multifocal disease, including complex epileptic networks and brain dysfunction networks. Haitao Zhu, Jinlong Zhu, Tiezhu Zhao, Yong Wu, Hongyi Liu, Ting Wu, Lu Yang, Yuanjie Zou, Rui Zhang, and Gang Zheng Copyright © 2014 Haitao Zhu et al. All rights reserved. Automated Synthesis of 18F-Fluoropropoxytryptophan for Amino Acid Transporter System Imaging Sun, 20 Jul 2014 11:19:02 +0000 Objective. This study was to develop a cGMP grade of [18F]fluoropropoxytryptophan (18F-FTP) to assess tryptophan transporters using an automated synthesizer. Methods. Tosylpropoxytryptophan (Ts-TP) was reacted with K18F/kryptofix complex. After column purification, solvent evaporation, and hydrolysis, the identity and purity of the product were validated by radio-TLC (1M-ammonium acetate : methanol = 4 : 1) and HPLC (C-18 column, methanol : water = 7 : 3) analyses. In vitro cellular uptake of 18F-FTP and 18F-FDG was performed in human prostate cancer cells. PET imaging studies were performed with 18F-FTP and 18F-FDG in prostate and small cell lung tumor-bearing mice (3.7 MBq/mouse, iv). Results. Radio-TLC and HPLC analyses of 18F-FTP showed that the Rf and Rt values were 0.9 and 9 min, respectively. Radiochemical purity was >99%. The radiochemical yield was 37.7% (EOS 90 min, decay corrected). Cellular uptake of 18F-FTP and 18F-FDG showed enhanced uptake as a function of incubation time. PET imaging studies showed that 18F-FTP had less tumor uptake than 18F-FDG in prostate cancer model. However, 18F-FTP had more uptake than 18F-FDG in small cell lung cancer model. Conclusion. 18F-FTP could be synthesized with high radiochemical yield. Assessment of upregulated transporters activity by 18F-FTP may provide potential applications in differential diagnosis and prediction of early treatment response. I-Hong Shih, Xu-Dong Duan, Fan-Lin Kong, Michael D. Williams, Kevin Yang, Yin-Han Zhang, and David J. Yang Copyright © 2014 I-Hong Shih et al. All rights reserved. Magnetic Resonance Imaging for the Normal Mesostenium and Involvement of the Mesostenium in Acute Pancreatitis Sun, 20 Jul 2014 09:11:45 +0000 The main point of this paper is to study MRI findings of the normal mesostenium and the involvement of the mesostenium in acute pancreatitis and to discuss the relationship between the involvement of the mesostenium and the severity of acute pancreatitis. In clinical practice, the mesenterical involvement in acute pancreatitis was often observed on MRI in daily works, which was little recorded in the reported studies. We conducted the current study to assess the mesenterical involvement in acute pancreatitis with MRI. We found that the mesenterical involvement of acute pancreatitis patients is common on MRI. The mesenterical involvement has a positive correlation with the MR severity index and the Acute Physiology and Chronic Healthy Evaluation II scoring system. It has been shown that MR can be used to visualize mesenterical involvement, which is a supplementary indicator in evaluating the severity of acute pancreatitis and local and systemic complications. Xiao Xiao Chi, Xiao Ming Zhang, Tian Wu Chen, Wei Tang, Bo Xiao, Yi Fan Ji, and Xiao Hua Huang Copyright © 2014 Xiao Xiao Chi et al. All rights reserved. Total Bolus Extraction Method Improves Arterial Image Quality in Dynamic CTAs Derived from Whole-Brain CTP Data Wed, 16 Jul 2014 11:54:55 +0000 Background and Purposes. The 320-detector row CT scanner enables visualization of whole-brain hemodynamic information (dynamic CT angiography (CTA) derived from CT perfusion scans). However, arterial image quality in dynamic CTA (dCTA) is inferior to arterial image quality in standard CTA. This study evaluates whether the arterial image quality can be improved by using a total bolus extraction (ToBE) method. Materials and Methods. DCTAs of 15 patients, who presented with signs of acute cerebral ischemia, were derived from 320-slice CT perfusion scans using both the standard subtraction method and the proposed ToBE method. Two neurointerventionalists blinded to the scan type scored the arterial image quality on a 5-point scale in the 4D dCTAs in consensus. Arteries were divided into four categories: (I) large extradural, (II) intradural (large, medium, and small), (III) communicating arteries, and (IV) cerebellar and ophthalmic arteries. Results. Quality of extradural and intradural arteries was significantly higher in the ToBE dCTAs than in the standard dCTAs (extradural , large intradural , medium intradural , and small intradural ). Conclusion. The 4D dCTAs derived with the total bolus extraction (ToBE) method provide hemodynamic information combined with improved arterial image quality as compared to standard 4D dCTAs. Elyas Ghariq, Adriënne M. Mendrik, Peter W. A. Willems, Raoul M. S. Joemai, Eidrees Ghariq, Evert-jan Vonken, Matthias J. P. van Osch, and Marianne A. A. van Walderveen Copyright © 2014 Elyas Ghariq et al. All rights reserved. KPG Index versus OPG Measurements: A Comparison between 3D and 2D Methods in Predicting Treatment Duration and Difficulty Level for Patients with Impacted Maxillary Canines Wed, 09 Jul 2014 13:26:36 +0000 Aim. The aim of this study was to test the agreement between orthopantomography (OPG) based 2D measurements and the KPG index, a new index based on 3D Cone Beam Computed Tomography (CBCT) images, in predicting orthodontic treatment duration and difficulty level of impacted maxillary canines. Materials and Methods. OPG and CBCT images of 105 impacted canines were independently scored by three orthodontists at and after 1 month (), using the KPG index and the following 2D methods: distance from cusp tip and occlusal plane, cusp tip position in relation to the lateral incisor, and canine inclination. Pearson’s coefficients were used to evaluate the degree of agreement and the with Yates correction test was used to assess the independence between them. Results. Inter- and intrarater reliability were higher with KPG compared to 2D methods. Pearson’s coefficients showed a statistically significant association between all the indexes, while the with Yates correction test resulted in a statistically significant rejection of independency only for one 2D index. Conclusions. 2D indexes for predicting impacted maxillary canines treatment duration and difficulty sometimes are discordant; a 3D index like the KPG index could be useful in solving these conflicts. Domenico Dalessandri, Marco Migliorati, Luca Visconti, Luca Contardo, Chung How Kau, and Conchita Martin Copyright © 2014 Domenico Dalessandri et al. All rights reserved. Therapeutic Potential of Tacrolimus on Acute Myocardial Infarction in Minipigs: Analysis with Serial Cardiac Magnetic Resonance and Changes at Histological and Protein Levels Wed, 09 Jul 2014 00:00:00 +0000 This study investigates the therapeutic potential of intracoronary tacrolimus against acute myocardial infarction (AMI) in minipigs with serial cardiac magnetic resonance (CMR) and changes at histological and protein levels. Twelve minipigs subjected to permanent left anterior descending artery ligation were randomized as tac-treated group (, with intracoronary tacrolimus treatment) and controls . CMR with cine and late gadolinium enhancement (LGE) studies were performed on postoperative days 2, 5, and 21. There were no significant differences in left ventricular function (LVF), contractility, and LGE between the two groups on day 2. On day 5, the tac-treated group showed a significantly higher ejection fraction, smaller infarct, and lower day-5/day-2 infarct ratio than controls. On day 21, the controls demonstrated further deterioration of LVF and infarct. Contrastingly, the tac-treated animals demonstrated preservation of LVF, contractility, significantly smaller infarct, and lower day-21/day-2 infarct ratios compared with those on day 5 and controls. The in vivo CMR results were correlated with in vitro findings on histology, immunostaining, and Western blotting which revealed significantly less fibrosis, higher vascularities, less CD68+ and CD40+ inflammatory cells, lower expressions of inflammatory (MMP-9, NF-B, and TNF-), and apoptotic (Bax, Caspase-3, c-PARP) biomarkers, respectively, in tac-treated AMI minipigs than controls. Sheung-Fat Ko, Hon-Kan Yip, Steve Leu, Chen-Chang Lee, Jiunn-Jye Sheu, Chia-Chang Lee, Shu-Hang Ng, Chung-Cheng Huang, Min-Chi Chen, and Cheuk-Kwan Sun Copyright © 2014 Sheung-Fat Ko et al. All rights reserved. A Low-Interaction Automatic 3D Liver Segmentation Method Using Computed Tomography for Selective Internal Radiation Therapy Thu, 03 Jul 2014 11:48:19 +0000 This study introduces a novel liver segmentation approach for estimating anatomic liver volumes towards selective internal radiation treatment (SIRT). The algorithm requires minimal human interaction since the initialization process to segment the entire liver in 3D relied on a single computed tomography (CT) slice. The algorithm integrates a localized contouring algorithm with a modified k-means method. The modified k-means segments each slice into five distinct regions belonging to different structures. The liver region is further segmented using localized contouring. The novelty of the algorithm is in the design of the initialization masks for region contouring to minimize human intervention. Intensity based region growing together with novel volume of interest (VOI) based corrections is used to accomplish the single slice initialization. The performance of the algorithm is evaluated using 34 liver CT scans. Statistical experiments were performed to determine consistency of segmentation and to assess user dependency on the initialization process. Volume estimations are compared to the manual gold standard. Results show an average accuracy of 97.22% for volumetric calculation with an average Dice coefficient of 0.92. Statistical tests show that the algorithm is highly consistent and independent of user initialization ( and Fleiss’ ). Mohammed Goryawala, Seza Gulec, Ruchir Bhatt, Anthony J. McGoron, and Malek Adjouadi Copyright © 2014 Mohammed Goryawala et al. All rights reserved. MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke’s Encephalopathy: A Review Tue, 24 Jun 2014 10:18:22 +0000 Wernicke’s encephalopathy (WE) is a severe neurological syndrome caused by thiamine (vitamin B1) deficiency and clinically characterized by the sudden onset of mental status changes, ocular abnormalities, and ataxia. Apart from chronic alcoholism, the most common cause of WE, a lot of other conditions causing malnutrition and decreasing thiamine absorption such as gastrointestinal surgical procedures and hyperemesis gravidarum must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, leading to persistent dysfunctions and, in some cases, to death. Nowadays, MR imaging of the brain, showing T2 and FLAIR hyperintensities in typical (thalami, mammillary bodies, tectal plate, and periaqueductal area) and atypical areas (cerebellum, cranial nerve nuclei, and cerebral cortex), is surely the most important and effective tool in the diagnostic assessment of WE. The aim of this paper is to propose a state of the art of the role of MR imaging in the early diagnosis of this complex disease. Gaetana Manzo, Angela De Gennaro, Attilio Cozzolino, Antonietta Serino, Giacomo Fenza, and Andrea Manto Copyright © 2014 Gaetana Manzo et al. All rights reserved. Altered Modular Organization of Functional Connectivity Networks in Cirrhotic Patients without Overt Hepatic Encephalopathy Thu, 05 Jun 2014 14:14:52 +0000 Minimal hepatic encephalopathy (MHE) is associated with changes in functional connectivity. To investigate the patterns of modular changes of the functional connectivity in the progression of MHE, resting-state functional magnetic resonance imaging was acquired in 24 MHE patients, 31 cirrhotic patients without minimal hepatic encephalopathy (non-HE), and 38 healthy controls. Newman’s metric, the modularity value, was maximized and compared in three groups. Topological roles with the progression of MHE were illustrated by intra- and intermodular connectivity changes. Results showed that the value of MHE patients was significantly lower than that of controls rather than that of non-HE patients , which was correlated with neuropsychological test scores rather than the ammonia level and Child-Pugh score. Less intrasubcortical connections and more isolated subcortical modules were found with the progression of MHE. The non-HE patients had the same numbers of connect nodes as controls and had more hubs compared with MHE patients and healthy controls. Our findings supported that both intra- and intermodular connectivity, especially those related to subcortical regions, were continuously impaired in cirrhotic patients. The adjustments of hubs and connector nodes in non-HE patients could be a compensation for the decreased modularity in their functional connectivity networks. Gang Zheng, Liping Zhang, Long Jiang Zhang, Qiang Li, Zhiying Pan, Xue Liang, Donghong Shi, and Guang Ming Lu Copyright © 2014 Gang Zheng et al. All rights reserved. Biomedical Imaging: Role and Opportunities of Medical Imaging in the “Omics” Era Wed, 04 Jun 2014 09:31:26 +0000 Tzu-Chen Yen, Dimitris Visvikis, Tinsu Pan, and Yu-Hua Dean Fang Copyright © 2014 Tzu-Chen Yen et al. All rights reserved. Intrinsic Functional Connectivity Networks in Healthy Elderly Subjects: A Multiparametric Approach with Structural Connectivity Analysis Thu, 29 May 2014 16:16:34 +0000 Intrinsic functional connectivity magnetic resonance imaging (iFCMRI) provides an encouraging approach for mapping large-scale intrinsic connectivity networks (ICNs) in the “resting” brain. Structural connections as measured by diffusion tensor imaging (DTI) are a major constraint on the identified ICNs. This study aimed at the combined investigation of ten well-defined ICNs in healthy elderly subjects at single subject level as well as at the group level, together with the underlying structural connectivity. IFCMRI and DTI data were acquired in twelve subjects (68 ± 7 years) at a 3T scanner and were studied using the tensor imaging and fiber tracking software package. The seed-based iFCMRI analysis approach was comprehensively performed with DTI analysis, following standardized procedures including an 8-step processing of iFCMRI data. Our findings demonstrated robust ICNs at the single subject level and conclusive brain maps at the group level in the healthy elderly sample, supported by the complementary fiber tractography. The findings demonstrated here provide a methodological framework for future comparisons of pathological (e.g., neurodegenerative) conditions with healthy controls on the basis of multiparametric functional connectivity mapping. Martin Gorges, Hans-Peter Müller, Albert C. Ludolph, Volker Rasche, and Jan Kassubek Copyright © 2014 Martin Gorges et al. All rights reserved. Advances in Miniaturized Instruments for Genomics Thu, 29 May 2014 07:41:01 +0000 In recent years, a lot of demonstrations of the miniaturized instruments were reported for genomic applications. They provided the advantages of miniaturization, automation, sensitivity, and specificity for the development of point-of-care diagnostics. The aim of this paper is to report on recent developments on miniaturized instruments for genomic applications. Based on the mature development of microfabrication, microfluidic systems have been demonstrated for various genomic detections. Since one of the objectives of miniaturized instruments is for the development of point-of-care device, impedimetric detection is found to be a promising technique for this purpose. An in-depth discussion of the impedimetric circuits and systems will be included to provide total consideration of the miniaturized instruments and their potential application towards real-time portable imaging in the “-omics” era. The current excellent demonstrations suggest a solid foundation for the development of practical and widespread point-of-care genomic diagnostic devices. Cihun-Siyong Alex Gong and Kin Fong Lei Copyright © 2014 Cihun-Siyong Alex Gong and Kin Fong Lei. All rights reserved. Considering Angle Selection When Using Ultrasound Electrode Displacement Elastography to Evaluate Radiofrequency Ablation of Tissues Tue, 27 May 2014 06:35:41 +0000 Percutaneous radiofrequency ablation (RFA) is a minimally invasive treatment to thermally destroy tumors. Ultrasound-based electrode-displacement elastography is an emerging technique for evaluating the region of RFA-induced lesions. The angle between the imaging probe and the RFA electrode can influence electrode-displacement elastography when visualizing the ablation zone. We explored the angle effect on electrode-displacement elastography to measure the ablation zone. Phantoms embedded with meatballs were fabricated and then ablated using an RFA system to simulate RFA-induced lesions. For each phantom, a commercial ultrasound scanner with a 7.5 MHz linear probe was used to acquire raw image data at different angles, ranging from 30° to 90° at increments of 10°, to construct electrode-displacement images and facilitate comparisons with tissue section images. The results revealed that the ablation regions detected using electrode-displacement elastography were highly correlated with those from tissue section images when the angle was between 30° and 60°. However, the boundaries of lesions were difficult to distinguish, when the angle was larger than 60°. The experimental findings suggest that angle selection should be considered to achieve reliable electrode-displacement elastography to describe ablation zones. Jingjing Xia, Qiang Li, Pin-Yu Chen, Zhuhuang Zhou, Chiao-Yin Wang, Hao-Li Liu, Jianfu Teng, and Po-Hsiang Tsui Copyright © 2014 Jingjing Xia et al. All rights reserved. A Functional Polymorphism of the MAOA Gene Modulates Spontaneous Brain Activity in Pons Sun, 25 May 2014 12:31:18 +0000 Objective. To investigate the effects of a functional polymorphism of the monoamine oxidase A (MAOA) gene on spontaneous brain activity in healthy male adolescents. Methods. Thirty-one healthy male adolescents with the low-activity MAOA genotype (MAOA-L) and 25 healthy male adolescents with the high-activity MAOA genotype (MAOA-H) completed the 11-item Barratt Impulsiveness Scale (BIS-11) questionnaire and were subjected to resting-state functional magnetic resonance imaging (rs-fMRI) scans. The amplitude of low-frequency fluctuation (ALFF) of the blood oxygen level-dependent (BOLD) signal was calculated using REST software. ALFF data were related to BIS scores and compared between genotype groups. Results. Compared with the MAOA-H group, the MAOA-L group showed significantly lower ALFFs in the pons. There was a significant correlation between the BIS scores and the ALFF values in the pons for MAOA-L group, but not for the MAOA-H group. Further regression analysis showed a significant genotype by ALFF values interaction effect on BIS scores. Conclusions. Lower spontaneous brain activity in the pons of the MAOA-L male adolescents may provide a neural mechanism by which boys with the MAOA-L genotype confers risk for impulsivity and aggression. Hui Lei, Xiaocui Zhang, Xin Di, Hengyi Rao, Qingsen Ming, Jibiao Zhang, Xiao Guo, Yali Jiang, Yidian Gao, Jinyao Yi, Xiongzhao Zhu, and Shuqiao Yao Copyright © 2014 Hui Lei et al. All rights reserved. A Novel Method for Intraoral Access to the Superior Head of the Human Lateral Pterygoid Muscle Sun, 18 May 2014 00:00:00 +0000 Background. The uncoordinated activity of the superior and inferior parts of the lateral pterygoid muscle (LPM) has been suggested to be one of the causes of temporomandibular joint (TMJ) disc displacement. A therapy for this muscle disorder is the injection of botulinum toxin (BTX), of the LPM. However, there is a potential risk of side effects with the injection guide methods currently available. In addition, they do not permit appropriate differentiation between the two bellies of the muscle. Herein, a novel method is presented to provide intraoral access to the superior head of the human LPM with maximal control and minimal hazards. Methods. Computational tomography along with digital imaging software programs and rapid prototyping techniques were used to create a rapid prototyped guide to orient BTX injections in the superior LPM. Results. The method proved to be feasible and reliable. Furthermore, when tested in one volunteer it allowed precise access to the upper head of LPM, without producing side effects. Conclusions. The prototyped guide presented in this paper is a novel tool that provides intraoral access to the superior head of the LPM. Further studies will be necessary to test the efficacy and validate this method in a larger cohort of subjects. Aleli Tôrres Oliveira, Anderson Aparecido Camilo, Paulo Roberto Valle Bahia, Antonio Carlos Pires Carvalho, Marcos Fabio DosSantos, Jorge Vicente Lopes da Silva, and André Antonio Monteiro Copyright © 2014 Aleli Tôrres Oliveira et al. All rights reserved. Quantifying Cerebellum Grey Matter and White Matter Perfusion Using Pulsed Arterial Spin Labeling Thu, 15 May 2014 15:27:47 +0000 To facilitate quantification of cerebellum cerebral blood flow (CBF), studies were performed to systematically optimize arterial spin labeling (ASL) parameters for measuring cerebellum perfusion, segment cerebellum to obtain separate CBF values for grey matter (GM) and white matter (WM), and compare FAIR ASST to PICORE. Cerebellum GM and WM CBF were measured with optimized ASL parameters using FAIR ASST and PICORE in five subjects. Influence of volume averaging in voxels on cerebellar grey and white matter boundaries was minimized by high-probability threshold masks. Cerebellar CBF values determined by FAIR ASST were 43.8 ± 5.1 mL/100 g/min for GM and 27.6 ± 4.5 mL/100 g/min for WM. Quantitative perfusion studies indicated that CBF in cerebellum GM is 1.6 times greater than that in cerebellum WM. Compared to PICORE, FAIR ASST produced similar CBF estimations but less subtraction error and lower temporal, spatial, and intersubject variability. These are important advantages for detecting group and/or condition differences in CBF values. Xiufeng Li, Subhendra N. Sarkar, David E. Purdy, and Richard W. Briggs Copyright © 2014 Xiufeng Li et al. All rights reserved. Tract-Based Spatial Statistics: Application to Mild Cognitive Impairment Mon, 12 May 2014 10:12:55 +0000 Rationale and Objectives. The primary objective of the current investigation was to characterize white matter integrity in different subtypes of mild cognitive impairment (MCI) using tract-based spatial statistics of diffusion tensor imaging. Materials and Methods. The study participants were divided into 4 groups of 30 subjects each as follows: cognitively healthy controls, amnestic MCI, dysexecutive MCI, and Alzheimer’s disease (AD). All subjects underwent a comprehensive neuropsychological assessment, apolipoprotein E genotyping, and 3-tesla MRI. The diffusion tensor was reconstructed and then analyzed using tract-based spatial statistics. The changes in brain white matter tracts were also examined according to the apolipoprotein E ε4 status. Results. Compared with controls, amnestic MCI patients showed significant differences in the cerebral white matter, where changes were consistently detectable in the frontal and parietal lobes. We found a moderate impact of the apolipoprotein E ε4 status on the extent of white matter disruption in the amnestic MCI group. Patients with AD exhibited similar but more extensive alterations, while no significant changes were observed in dysexecutive MCI patients. Conclusion. The results from this study indicate that amnestic MCI is the most likely precursor to AD as both conditions share significant white matter damage. By contrast, dysexecutive MCI seems to be characterized by a distinct pathogenesis. Yau-Yau Wai, Wen-Chuin Hsu, Hon-Chung Fung, Jiann-Der Lee, Hsiao-Lung Chan, Ming-Lun Tsai, Yu-Chun Lin, Yih-Ru Wu, Leslie Ying, and Jiun-Jie Wang Copyright © 2014 Yau-Yau Wai et al. All rights reserved. Figure of Image Quality and Information Capacity in Digital Mammography Thu, 08 May 2014 12:49:36 +0000 Objectives. In this work, a simple technique to assess the image quality characteristics of the postprocessed image is developed and an easy to use figure of image quality (FIQ) is introduced. This FIQ characterizes images in terms of resolution and noise. In addition information capacity, defined within the context of Shannon’s information theory, was used as an overall image quality index. Materials and Methods. A digital mammographic image was postprocessed with three digital filters. Resolution and noise were calculated via the Modulation Transfer Function (MTF), the coefficient of variation, and the figure of image quality. In addition, frequency dependent parameters such as the noise power spectrum (NPS) and noise equivalent quanta (NEQ) were estimated and used to assess information capacity. Results. FIQs for the “raw image” data and the image processed with the “sharpen edges” filter were found 907.3 and 1906.1, correspondingly. The information capacity values were and  bits/mm2. Conclusion. It was found that, after the application of the postprocessing techniques (even commercial nondedicated software) on the raw digital mammograms, MTF, NPS, and NEQ are improved for medium to high spatial frequencies leading to resolving smaller structures in the final image. Christos M. Michail, Nektarios E. Kalyvas, Ioannis G. Valais, Ioannis P. Fudos, George P. Fountos, Nikos Dimitropoulos, Grigorios Koulouras, Dionisis Kandris, Maria Samarakou, and Ioannis S. Kandarakis Copyright © 2014 Christos M. Michail et al. All rights reserved. Evaluation of Inhibitory Effect of Recreational Drugs on Dopaminergic Terminal Neuron by PET and Whole-Body Autoradiography Tue, 29 Apr 2014 11:02:36 +0000 There is little investigation for the functional roles of peripheral dopamine. [18F]FDOPA has been used in cancer imaging (i.e., neuroendocrine and tumors pancreatic tumors) and neuroimaging (i.e., Parkinson’s disease and Huntington’s disease). Here, we accessed side effects of recreational drugs such as ketamine, cocaine, and methamphetamine on dopamine neurons in peripheral organs by using positron emission tomography (PET) imaging and quantitative whole-body autoradiography (QWBAR) with [18F]FDOPA. The images were applied for the measurement of specific binding ratios (SBRs) of striatum with the cerebellum as the reference region. Clear striatal [18F]FDOPA-derived radioactivity was observed. Moderate level of radiotracer accumulation was presented in the mucosal layers of the stomach and small intestine. The medulla layers of kidney had higher radioactivity than that of the cortex. Blocking images markedly eliminated the specific binding of [18F]FDOPA in the striatum and in peripheral organs such as stomachs, intestines, and kidney. Ketamine showed the highest inhibitory effect on striatal [18F]FDOPA-derived radioactivity followed by cocaine and methamphetamine. The current results demonstrated a useful crossing-validating tool that enhances the capability of [18F]FDOPA for further investigations of the alteration of dopaminergic neurons in the brain disorder or cancer diseases in peripheral tissues. Skye Hsin-Hsien Yeh, Ming-Hsien Lin, Fan-Lin Kong, Chi-Wei Chang, Li-Chung Hwang, Chien-Feng Lin, Jeng-Jong Hwang, and Ren-Shyan Liu Copyright © 2014 Skye Hsin-Hsien Yeh et al. All rights reserved. Early Treatment Response Monitoring Using 2-Deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography Imaging during Fractionated Radiotherapy of Head Neck Cancer Xenografts Mon, 28 Apr 2014 09:24:38 +0000 Background. To determine the optimal timing and analytic method of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (PET) imaging during fractionated radiotherapy (RT) to predict tumor control. Methods. Ten head neck squamous cell carcinoma xenografts derived from the UT-14-SCC cell line were irradiated with 50 Gy at 2 Gy per day over 5 weeks. Dynamic PET scans were acquired over 70 minutes at baseline (week 0) and weekly for seven weeks. PET data were analyzed using standard uptake value (SUV), retention index (RI), sensitivity factor (SF), and kinetic index (Ki). Results. Four xenografts had local failure (LF) and 6 had local control. Eighty scans from week 0 to week 7 were analyzed. RI and SF after 10 Gy appeared to be the optimal predictors for LF. In contrast, SUV and Ki during RT were not significant predictors for LF. Conclusion. RI and SF of PET obtained after the first week of fractionated RT were the optimal methods and timing to predict tumor control. Jiayi Huang, John L. Chunta, Mitual Amin, David Y. Lee, Inga S. Grills, Ching-Yee Oliver Wong, Brian Marples, Di Yan, and George D. Wilson Copyright © 2014 Jiayi Huang et al. All rights reserved. GRE T2-Weighted MRI: Principles and Clinical Applications Wed, 16 Apr 2014 13:39:56 +0000 The sequence of a multiecho gradient recalled echo (GRE) T2-weighted imaging (T2WI) is a relatively new magnetic resonance imaging (MRI) technique. In contrast to T2 relaxation, which acquires a spin echo signal, T2 relaxation acquires a gradient echo signal. The sequence of a GRE T2WI requires high uniformity of the magnetic field. GRE T2WI can detect the smallest changes in uniformity in the magnetic field and can improve the rate of small lesion detection. In addition, the T2 value can indirectly reflect changes in tissue biochemical components. Moreover, it can be used for the early diagnosis and quantitative diagnosis of some diseases. This paper reviews the principles and clinical applications as well as the advantages and disadvantages of GRE T2WI. Meng Yue Tang, Tian Wu Chen, Xiao Ming Zhang, and Xiao Hua Huang Copyright © 2014 Meng Yue Tang et al. All rights reserved. The Role of Imaging in Radiation Therapy Planning: Past, Present, and Future Thu, 10 Apr 2014 06:44:02 +0000 The use of ionizing radiation for cancer treatment has undergone extraordinary development during the past hundred years. The advancement of medical imaging has been critical in helping to achieve this change. The invention of computed tomography (CT) was pivotal in the development of treatment planning. Despite some disadvantages, CT remains the only three-dimensional imaging modality used for dose calculation. Newer image modalities, such as magnetic resonance (MR) imaging and positron emission tomography (PET), are also used secondarily in the treatment-planning process. MR, with its better tissue contrast and resolution than those of CT, improves tumor definition compared with CT planning alone. PET also provides metabolic information to supplement the CT and MR anatomical information. With emerging molecular imaging techniques, the ability to visualize and characterize tumors with regard to their metabolic profile, active pathways, and genetic markers, both across different tumors and within individual, heterogeneous tumors, will inform clinicians regarding the treatment options most likely to benefit a patient and to detect at the earliest time possible if and where a chosen therapy is working. In the post-human-genome era, multimodality scanners such as PET/CT and PET/MR will provide optimal tumor targeting information. Gisele C. Pereira, Melanie Traughber, and Raymond F. Muzic Jr. Copyright © 2014 Gisele C. Pereira et al. All rights reserved. Rational Design of a Triple Reporter Gene for Multimodality Molecular Imaging Mon, 07 Apr 2014 12:31:51 +0000 Multimodality imaging using noncytotoxic triple fusion (TF) reporter genes is an important application for cell-based tracking, drug screening, and therapy. The firefly luciferase (fl), monomeric red fluorescence protein (mrfp), and truncated herpes simplex virus type 1 thymidine kinase SR39 mutant (ttksr39) were fused together to create TF reporter gene constructs with different order. The enzymatic activities of TF protein in vitro and in vivo were determined by luciferase reporter assay, -FEAU cellular uptake experiment, bioluminescence imaging, and micropositron emission tomography (microPET). The TF construct expressed in H1299 cells possesses luciferase activity and red fluorescence. The tTKSR39 activity is preserved in TF protein and mediates high levels of -FEAU accumulation and significant cell death from ganciclovir (GCV) prodrug activation. In living animals, the luciferase and tTKSR39 activities of TF protein have also been successfully validated by multimodality imaging systems. The red fluorescence signal is relatively weak for in vivo imaging but may expedite FACS-based selection of TF reporter expressing cells. We have developed an optimized triple fusion reporter construct DsRedm-fl-ttksr39 for more effective and sensitive in vivo animal imaging using fluorescence, bioluminescence, and PET imaging modalities, which may facilitate different fields of biomedical research and applications. Ya-Ju Hsieh, Luen Hwu, Chien-Chih Ke, Skye Hsin-Hsien Yeh, Chien-Feng Lin, Fu-Du Chen, Hsin-Ell Wang, Kang-Ping Lin, Ran-Chou Chen, and Ren-Shyan Liu Copyright © 2014 Ya-Ju Hsieh et al. All rights reserved. Acute Ethanol-Induced Changes in Edema and Metabolite Concentrations in Rat Brain Tue, 25 Mar 2014 09:10:25 +0000 The aim of this study is to describe the acute effects of EtOH on brain edema and cerebral metabolites, using diffusion weight imaging (DWI) and proton magnetic resonance spectroscopy (1H-MRS) at a 7.0T MR and to define changes in apparent diffusion coefficient (ADC) values and the concentration of metabolites in the rat brain after acute EtOH intoxication. ADC values in each ROI decreased significantly at 1 h and 3 h after ethanol administration. ADC values in frontal lobe were decreased significantly compared with other regions at 3 h. For EtOH/Cr+PCr and cerebral metabolites (Cho, Tau, and Glu) differing over time, no significant differences for Ins, NAA, and Cr were observed in frontal lobes. Regression analysis revealed a significant association between TSEtOH/Cr+PCr and TSCho, TSTau, TSGlu, and TSADC. The changes of ADC values in different brain regions reflect the process of the cytotoxic edema in vivo. The characterization of frontal lobes metabolites changes and the correlations between TSEtOH/Cr+PCr and TSCho, TSTau, and TSGlu provide a better understanding for the biological mechanisms in neurotoxic effects of EtOH on the brain. In addition, the correlations between TSEtOH/Cr+PCr and TSADC will help us to understand development of the ethanol-induced brain cytotoxic edema. Huimin Liu, Wenbin Zheng, Gen Yan, Baoguo Liu, Lingmei Kong, Yan Ding, Zhiwei Shen, Hui Tan, and Guishan Zhang Copyright © 2014 Huimin Liu et al. All rights reserved. Development and Evaluation of an Open-Source Software Package “CGITA” for Quantifying Tumor Heterogeneity with Molecular Images Mon, 17 Mar 2014 08:18:09 +0000 Background. The quantification of tumor heterogeneity with molecular images, by analyzing the local or global variation in the spatial arrangements of pixel intensity with texture analysis, possesses a great clinical potential for treatment planning and prognosis. To address the lack of available software for computing the tumor heterogeneity on the public domain, we develop a software package, namely, Chang-Gung Image Texture Analysis (CGITA) toolbox, and provide it to the research community as a free, open-source project. Methods. With a user-friendly graphical interface, CGITA provides users with an easy way to compute more than seventy heterogeneity indices. To test and demonstrate the usefulness of CGITA, we used a small cohort of eighteen locally advanced oral cavity (ORC) cancer patients treated with definitive radiotherapies. Results. In our case study of ORC data, we found that more than ten of the current implemented heterogeneity indices outperformed SUVmean for outcome prediction in the ROC analysis with a higher area under curve (AUC). Heterogeneity indices provide a better area under the curve up to 0.9 than the SUVmean and TLG (0.6 and 0.52, resp.). Conclusions. CGITA is a free and open-source software package to quantify tumor heterogeneity from molecular images. CGITA is available for free for academic use at Yu-Hua Dean Fang, Chien-Yu Lin, Meng-Jung Shih, Hung-Ming Wang, Tsung-Ying Ho, Chun-Ta Liao, and Tzu-Chen Yen Copyright © 2014 Yu-Hua Dean Fang et al. All rights reserved. Pushing CT and MR Imaging to the Molecular Level for Studying the “Omics”: Current Challenges and Advancements Thu, 13 Mar 2014 09:48:00 +0000 During the past decade, medical imaging has made the transition from anatomical imaging to functional and even molecular imaging. Such transition provides a great opportunity to begin the integration of imaging data and various levels of biological data. In particular, the integration of imaging data and multiomics data such as genomics, metabolomics, proteomics, and pharmacogenomics may open new avenues for predictive, preventive, and personalized medicine. However, to promote imaging-omics integration, the practical challenge of imaging techniques should be addressed. In this paper, we describe key challenges in two imaging techniques: computed tomography (CT) and magnetic resonance imaging (MRI) and then review existing technological advancements. Despite the fact that CT and MRI have different principles of image formation, both imaging techniques can provide high-resolution anatomical images while playing a more and more important role in providing molecular information. Such imaging techniques that enable single modality to image both the detailed anatomy and function of tissues and organs of the body will be beneficial in the imaging-omics field. Hsuan-Ming Huang and Yi-Yu Shih Copyright © 2014 Hsuan-Ming Huang and Yi-Yu Shih. All rights reserved. Automatic Detection and Quantification of Acute Cerebral Infarct by Fuzzy Clustering and Histographic Characterization on Diffusion Weighted MR Imaging and Apparent Diffusion Coefficient Map Wed, 12 Mar 2014 16:58:04 +0000 Determination of the volumes of acute cerebral infarct in the magnetic resonance imaging harbors prognostic values. However, semiautomatic method of segmentation is time-consuming and with high interrater variability. Using diffusion weighted imaging and apparent diffusion coefficient map from patients with acute infarction in 10 days, we aimed to develop a fully automatic algorithm to measure infarct volume. It includes an unsupervised classification with fuzzy C-means clustering determination of the histographic distribution, defining self-adjusted intensity thresholds. The proposed method attained high agreement with the semiautomatic method, with similarity index 89.9 ± 6.5%, in detecting cerebral infarct lesions from 22 acute stroke patients. We demonstrated the accuracy of the proposed computer-assisted prompt segmentation method, which appeared promising to replace the laborious, time-consuming, and operator-dependent semiautomatic segmentation. Jang-Zern Tsai, Syu-Jyun Peng, Yu-Wei Chen, Kuo-Wei Wang, Hsiao-Kuang Wu, Yun-Yu Lin, Ying-Ying Lee, Chi-Jen Chen, Huey-Juan Lin, Eric Edward Smith, Poh-Shiow Yeh, and Yue-Loong Hsin Copyright © 2014 Jang-Zern Tsai et al. All rights reserved. Current Opportunities and Challenges of Magnetic Resonance Spectroscopy, Positron Emission Tomography, and Mass Spectrometry Imaging for Mapping Cancer Metabolism In Vivo Mon, 03 Mar 2014 00:00:00 +0000 Cancer is known to have unique metabolic features such as Warburg effect. Current cancer therapy has moved forward from cytotoxic treatment to personalized, targeted therapies, with some that could lead to specific metabolic changes, potentially monitored by imaging methods. In this paper we addressed the important aspects to study cancer metabolism by using image techniques, focusing on opportunities and challenges of magnetic resonance spectroscopy (MRS), dynamic nuclear polarization (DNP)-MRS, positron emission tomography (PET), and mass spectrometry imaging (MSI) for mapping cancer metabolism. Finally, we highlighted the future possibilities of an integrated in vivo PET/MR imaging systems, together with an in situ MSI tissue analytical platform, may become the ultimate technologies for unraveling and understanding the molecular complexities in some aspects of cancer metabolism. Such comprehensive imaging investigations might provide information on pharmacometabolomics, biomarker discovery, and disease diagnosis, prognosis, and treatment response monitoring for clinical medicine. Gigin Lin and Yuen-Li Chung Copyright © 2014 Gigin Lin and Yuen-Li Chung. All rights reserved. Establishment of a Swine Model for Validation of Perfusion Measurement by Dynamic Contrast-Enhanced Magnetic Resonance Imaging Thu, 27 Feb 2014 06:39:47 +0000 The aim of the study was to develop a suitable animal model for validating dynamic contrast-enhanced magnetic resonance imaging perfusion measurements. A total of 8 pigs were investigated by DCE-MRI. Perfusion was determined on the hind leg musculature. An ultrasound flow probe placed around the femoral artery provided flow measurements independent of MRI and served as the standard of reference. Images were acquired on a 1.5 T MRI scanner using a 3D T1-weighted gradient-echo sequence. An arterial catheter for local injection was implanted in the femoral artery. Continuous injection of adenosine for vasodilation resulted in steady blood flow levels up to four times the baseline level. In this way, three different stable perfusion levels were induced and measured. A central venous catheter was used for injection of two different types of contrast media. A low-molecular weight contrast medium and a blood pool contrast medium were used. A total of 6 perfusion measurements were performed with a time interval of about 20–25 min without significant differences in the arterial input functions. In conclusion the accuracy of DCE-MRI-based perfusion measurement can be validated by comparison of the integrated perfusion signal of the hind leg musculature with the blood flow values measured with the ultrasound flow probe around the femoral artery. Anika Sauerbrey, Stefan Hindel, Marc Maaß, Christine Krüger, Andreas Wissmann, Martin Kramer, Benno Nafz, and Lutz Lüdemann Copyright © 2014 Anika Sauerbrey et al. All rights reserved. Performance Enhancement of a Web-Based Picture Archiving and Communication System Using Commercial Off-the-Shelf Server Clusters Thu, 20 Feb 2014 16:42:29 +0000 The rapid development of picture archiving and communication systems (PACSs) thoroughly changes the way of medical informatics communication and management. However, as the scale of a hospital’s operations increases, the large amount of digital images transferred in the network inevitably decreases system efficiency. In this study, a server cluster consisting of two server nodes was constructed. Network load balancing (NLB), distributed file system (DFS), and structured query language (SQL) duplication services were installed. A total of 1 to 16 workstations were used to transfer computed radiography (CR), computed tomography (CT), and magnetic resonance (MR) images simultaneously to simulate the clinical situation. The average transmission rate (ATR) was analyzed between the cluster and noncluster servers. In the download scenario, the ATRs of CR, CT, and MR images increased by 44.3%, 56.6%, and 100.9%, respectively, when using the server cluster, whereas the ATRs increased by 23.0%, 39.2%, and 24.9% in the upload scenario. In the mix scenario, the transmission performance increased by 45.2% when using eight computer units. The fault tolerance mechanisms of the server cluster maintained the system availability and image integrity. The server cluster can improve the transmission efficiency while maintaining high reliability and continuous availability in a healthcare environment. Yan-Lin Liu, Cheng-Ting Shih, Yuan-Jen Chang, Shu-Jun Chang, and Jay Wu Copyright © 2014 Yan-Lin Liu et al. All rights reserved. Respiratory-Gated MRgHIFU in Upper Abdomen Using an MR-Compatible In-Bore Digital Camera Wed, 29 Jan 2014 13:31:41 +0000 Objective. To demonstrate the technical feasibility and the potential interest of using a digital optical camera inside the MR magnet bore for monitoring the breathing cycle and subsequently gating the PRFS MR thermometry, MR-ARFI measurement, and MRgHIFU sonication in the upper abdomen. Materials and Methods. A digital camera was reengineered to remove its magnetic parts and was further equipped with a 7 m long USB cable. The system was electromagnetically shielded and operated inside the bore of a closed 3T clinical scanner. Suitable triggers were generated based on real-time motion analysis of the images produced by the camera (resolution pixels, 30 fps). Respiratory-gated MR-ARFI prepared MRgHIFU ablation was performed in the kidney and liver of two sheep in vivo, under general anaesthesia and ventilator-driven forced breathing. Results. The optical device demonstrated very good MR compatibility. The current setup permitted the acquisition of motion artefact-free and high resolution MR 2D ARFI and multiplanar interleaved PRFS thermometry (average SNR 30 in liver and 56 in kidney). Microscopic histology indicated precise focal lesions with sharply delineated margins following the respiratory-gated HIFU sonications. Conclusion. The proof-of-concept for respiratory motion management in MRgHIFU using an in-bore digital camera has been validated in vivo. Vincent Auboiroux, Lorena Petrusca, Magalie Viallon, Arnaud Muller, Sylvain Terraz, Romain Breguet, Xavier Montet, Christoph D. Becker, and Rares Salomir Copyright © 2014 Vincent Auboiroux et al. All rights reserved. Differential Regulation of Ferritin Subunits and Iron Transport Proteins: An Effect of Targeted Hepatic X-Irradiation Thu, 12 Dec 2013 08:57:05 +0000 The current study aimed to investigate radiation-induced regulation of iron proteins including ferritin subunits in rats. Rat livers were selectively irradiated in vivo at 25 Gy. This dose can be used to model radiation effects to the liver without inducing overt radiation-induced liver disease. Sham-irradiated rats served as controls. Isolated hepatocytes were irradiated at 8 Gy. Ferritin light polypeptide (FTL) was detectable in the serum of sham-irradiated rats with an increase after irradiation. Liver irradiation increased hepatic protein expression of both ferritin subunits. A rather early increase (3 h) was observed for hepatic TfR1 and Fpn-1 followed by a decrease at 12 h. The increase in TfR2 persisted over the observed time. Parallel to the elevation of AST levels, a significant increase (24 h) in hepatic iron content was measured. Complete blood count analysis showed a significant decrease in leukocyte number with an early increase in neutrophil granulocytes and a decrease in lymphocytes. In vitro, a significant increase in ferritin subunits at mRNA level was detected after irradiation which was further induced with a combination treatment of irradiation and acute phase cytokine. Irradiation can directly alter the expression of ferritin subunits and this response can be strongly influenced by radiation-induced proinflammatory cytokines. FTL can be used as a serum marker for early phase radiation-induced liver damage. Naila Naz, Shakil Ahmad, Silke Cameron, Federico Moriconi, Margret Rave-Fränk, Hans Christiansen, Clemens Friedrich Hess, Giuliano Ramadori, and Ihtzaz A. Malik Copyright © 2013 Naila Naz et al. All rights reserved. The Importance and Perspective of Magnetic Resonance Imaging in the Evaluation of Endometriosis Wed, 20 Nov 2013 15:00:32 +0000 MR imaging is becoming increasingly important in the assessment of patients with endometriosis. Its multiplanar capabilities and superior soft tissue contrast are particularly useful in the detection of deep infiltrating endometriotic implants. Endometriosis, defined as the presence of endometrial glands and stroma outside the endometrium, is among the most common gynaecological disorders affecting women in their reproductive age. The diagnosis and evaluation of the extension of endometriosis are difficult only with physical examination and laparoscopy. According to the authors’ personal experience, a special MRI technique and some imaging guidelines regarding different anatomical localizations of endometriosis are discussed. This review is a brief presentation of current evidence on the diagnostic accuracy of MRI in the evaluation of endometriosis concerning other diagnostic methods, the limitations of MRI and its essential usefulness for preoperative diagnosis of deep pelvic endometriosis, and future perspectives in monitoring this disease. Agnieszka Bianek-Bodzak, Edyta Szurowska, Sambor Sawicki, and Marcin Liro Copyright © 2013 Agnieszka Bianek-Bodzak et al. All rights reserved. Cone Beam Computed Tomographic Analysis of the Shape, Height, and Location of the Mandibular Lingula in a Population of Children Wed, 20 Nov 2013 15:00:28 +0000  Objectives. This is the first study to identify and classify the different morphological shapes of the mandibular lingula (ML) in children using cone-beam computed tomography (CBCT). Material and Methods. A retrospective study was performed to evaluate the shape, height, and location of the ML in relation to the surrounding structures using CBCT images of mandibles obtained from 269 children. The shape of the ML was classified into triangular, truncated, nodular, or assimilated types. The location was determined by five distances. The height of the lingula was also measured from the lingular tip to the mandibular foramen. Results. A nodular shape of the ML was most commonly found (48.3%, ) followed by truncated (23.4%, ), assimilated (14.4%, ), and triangular (13.7%, ). The mean distance of ML from the anterior and posterior borders of mandibular ramus was  mm and  mm, respectively. In the majority of the mandibles studied, the ML was located above the occlusal plane. Conclusion. The present study provides new information to the literature concerning the shape, height, and location of the lingula in a Turkish pediatric population. This finding may assist clinicians to localize the lingula and avoid intraoperative complications. Ahmet Ercan Sekerci, Kenan Cantekin, and Mustafa Aydinbelge Copyright © 2013 Ahmet Ercan Sekerci et al. All rights reserved. Similar-Case-Based Optimization of Beam Arrangements in Stereotactic Body Radiotherapy for Assisting Treatment Planners Sat, 02 Nov 2013 14:30:18 +0000 Objective. To develop a similar-case-based optimization method for beam arrangements in lung stereotactic body radiotherapy (SBRT) to assist treatment planners. Methods. First, cases that are similar to an objective case were automatically selected based on geometrical features related to a planning target volume (PTV) location, PTV shape, lung size, and spinal cord position. Second, initial beam arrangements were determined by registration of similar cases with the objective case using a linear registration technique. Finally, beam directions of the objective case were locally optimized based on the cost function, which takes into account the radiation absorption in normal tissues and organs at risk. The proposed method was evaluated with 10 test cases and a treatment planning database including 81 cases, by using 11 planning evaluation indices such as tumor control probability and normal tissue complication probability (NTCP). Results. The procedure for the local optimization of beam arrangements improved the quality of treatment plans with significant differences () in the homogeneity index and conformity index for the PTV, V10, V20, mean dose, and NTCP for the lung. Conclusion. The proposed method could be usable as a computer-aided treatment planning tool for the determination of beam arrangements in SBRT. Taiki Magome, Hidetaka Arimura, Yoshiyuki Shioyama, Katsumasa Nakamura, Hiroshi Honda, and Hideki Hirata Copyright © 2013 Taiki Magome et al. All rights reserved. Effect of Alcohol on Diffuse Axonal Injury in Rat Brainstem: Diffusion Tensor Imaging and Aquaporin-4 Expression Study Sun, 27 Oct 2013 11:10:27 +0000 The aim of this study is to assess the effects of alcohol on traumatic brain injury by using diffusion tensor imaging (DTI) and evaluate aquaporin-4(AQP4) expression changes in rat brainstems following acute alcohol intoxication with diffuse axonal injury (DAI). We further investigated the correlation between the AQP4 expression and DTI in the brain edema. Eighty-five rats were imaged before and after injury at various stages. DTI was used to measure brainstem apparent diffusion coefficient (ADC) and fractional anisotropy (FA), with immunostaining being used to determine AQP4 expression. After acute alcoholism with DAI, ADC values of the brainstem first decreased within 6 h and then elevated. FA values began to decline by 1 h, reaching a minimum at 24 h after trauma. There was a negative correlation between ADC values and brainstem AQP4 expression at 6 h and positive correlation at 6 h to 24 h. Changes of ADC and FA values in DAI with acute alcoholism indicate the effects of ethanol on brain edema and the severity of axonal injury. The correlations between ADC values and the brainstem AQP4 expression at different time points suggest that AQP4 expression follows an adaptative profile to the severity of brain edema. Lingmei Kong, Gengpeng Lian, Wenbin Zheng, Huimin Liu, Haidu Zhang, and Ruowei Chen Copyright © 2013 Lingmei Kong et al. All rights reserved. Design and Validation of an Augmented Reality System for Laparoscopic Surgery in a Real Environment Wed, 23 Oct 2013 09:09:42 +0000 Purpose. This work presents the protocol carried out in the development and validation of an augmented reality system which was installed in an operating theatre to help surgeons with trocar placement during laparoscopic surgery. The purpose of this validation is to demonstrate the improvements that this system can provide to the field of medicine, particularly surgery. Method. Two experiments that were noninvasive for both the patient and the surgeon were designed. In one of these experiments the augmented reality system was used, the other one was the control experiment, and the system was not used. The type of operation selected for all cases was a cholecystectomy due to the low degree of complexity and complications before, during, and after the surgery. The technique used in the placement of trocars was the French technique, but the results can be extrapolated to any other technique and operation. Results and Conclusion. Four clinicians and ninety-six measurements obtained of twenty-four patients (randomly assigned in each experiment) were involved in these experiments. The final results show an improvement in accuracy and variability of 33% and 63%, respectively, in comparison to traditional methods, demonstrating that the use of an augmented reality system offers advantages for trocar placement in laparoscopic surgery. F. López-Mir, V. Naranjo, J. J. Fuertes, M. Alcañiz, J. Bueno, and E. Pareja Copyright © 2013 F. López-Mir et al. All rights reserved. Glutamine/Glutamate Metabolism Studied with Magnetic Resonance Spectroscopic Imaging for the Characterization of Adrenal Nodules and Masses Wed, 02 Oct 2013 17:53:36 +0000 Purpose. To assess glutamine/glutamate (Glx) and lactate (Lac) metabolism using proton magnetic resonance spectroscopic imaging (1H-MRS) in order to differentiate between adrenal gland nodules and masses (adenomas, pheochromocytomas, carcinomas, and metastases). Materials and Methods. Institutional review board approval and informed consent were obtained. A total of 130 patients (47 men) with 132 adrenal nodules/masses were prospectively assessed ( years). A multivoxel system was used with a two-dimensional point-resolved spectroscopy/chemical-shift imaging sequence. Spectroscopic data were interpreted by visual inspection and peak amplitudes of lipids (Lip), choline (Cho), creatine (Cr), Lac, and Glx. Lac/Cr and Glx/Cr were calculated. Glx/Cr was assessed in relation to lesion size. Results. Statistically significant differences were observed in Glx/Cr results between adenomas and pheochromocytomas (), however, with a low positive predictive value (PPV). Glx levels were directly proportional to lesion size in carcinomas. A cutoff point of 1.44 was established for the differentiation between carcinomas larger versus smaller than 4 cm, with 75% sensitivity, 100% specificity, 100% PPV, and 80% accuracy. Lac/Cr results showed no differences across lesions. A cutoff point of −6.5 for Lac/Cr was established for carcinoma diagnosis. Conclusion. Glx levels are directly proportional to lesion size in carcinomas. A cutoff point of −6.5 Lac/Cr differentiates carcinomas from noncarcinomas. Suzan M. Goldman, Thiago F. Nunes, Homero J. F. Melo, Claudio Dalavia, Denis Szejnfeld, Claudio Kater, Cassio Andreoni, Jacob Szejnfeld, and Sergio A. Ajzen Copyright © 2013 Suzan M. Goldman et al. All rights reserved. Risk Management in Magnetic Resonance: Failure Mode, Effects, and Criticality Analysis Thu, 19 Sep 2013 08:26:32 +0000 The aim of the study was to perform a risk management procedure in “Magnetic Resonance Examination” process in order to identify the critical phases and sources of radiological errors and to identify potential improvement projects including procedures, tests, and checks to reduce the error occurrence risk. In this study we used the proactive analysis “Failure Mode Effects Criticality Analysis,” a qualitative and quantitative risk management procedure; has calculated Priority Risk Index (PRI) for each activity of the process; have identified, on the PRI basis, the most critical activities and, for them, have defined improvement projects; and have recalculated the PRI after implementation of improvement projects for each activity. Time stop and audits are performed in order to control the new procedures. The results showed that the most critical tasks of “Magnetic Resonance Examination” process were the reception of the patient, the patient schedule drafting, the closing examination, and the organization of activities. Four improvement projects have been defined and executed. PRI evaluation after improvement projects implementation has shown that the risk decreased significantly following the implementation of procedures and controls defined in improvement projects, resulting in a reduction of the PRI between 43% and 100%. Antonella Petrillo, Roberta Fusco, Vincenza Granata, Salvatore Filice, Nicola Raiano, Daniela Maria Amato, Maria Zirpoli, Alessandro di Finizio, Mario Sansone, Anna Russo, Eugenio Maria Covelli, Tonino Pedicini, and Maria Triassi Copyright © 2013 Antonella Petrillo et al. All rights reserved. Estimation of the Lateral Ventricles Volumes from a 2D Image and Its Relationship with Cerebrospinal Fluid Flow Mon, 16 Sep 2013 13:35:16 +0000 Purpose. This work suggests a fast estimation method of the lateral ventricles volume from a 2D image and then determines if this volume is correlated with the cerebrospinal fluid flow at the aqueductal and cerebral levels in neurodegenerative diseases. Materials and Methods. FForty-five elderly patients suffering from Alzheimer’s disease (19), normal pressure hydrocephalus (13), and vascular dementia (13) were involved and underwent anatomical and phase contrast MRI scans. Lateral ventricles and stroke volumes were assessed on anatomical and phase contrast scans, respectively. A common reference plane was used to calculate the lateral ventricles’ area on 2D images. Results. The largest volumes were observed in hydrocephalus patients. The linear regression between volumes and areas was computed, and a strong positive correlation was detected (). A derived equation was determined to represent the volumes for any given area. On the other hand, no significant correlations were detected between ventricles and stroke volumes (). Conclusion. Lateral ventricles volumes are significantly proportional to the 2D reference section area and could be used for patients’ follow-up even if 3D images are unavailable. The cerebrospinal fluid fluctuations in brain disorders may depend on many physiological parameters other than the ventricular morphology. Chaarani Bader, Capel Cyrille, Zmudka Jadwiga, Daouk Joel, Anthony Fichten, Gondry-Jouet Catherine, Bouzerar Roger, and Balédent Olivier Copyright © 2013 Chaarani Bader et al. All rights reserved. Postmortem Computed Tomography Imaging in the Investigation of Nontraumatic Death in Infants and Children Wed, 04 Sep 2013 13:31:05 +0000 Objective. To determine the accuracy of postmortem computed tomography (PMCT) for the assessment of causes in nontraumatic deaths in children. Study Design. We enrolled cases of nontraumatic deaths of infants and children who underwent PMCT at a single center. The presumed cause of death determined by PMCT was prospectively compared with the clinical and pathological diagnoses of deaths. Results. Thirty-eight cases were enrolled for analysis. Among them, seven cases also underwent conventional medical autopsy. PMCT revealed an identifiable cause of death in accordance with the clinical diagnosis of death in 16 cases of the 38 cases (the concordance rate was 42%) and in accordance with the autopsy cause of death in four of the seven autopsy cases (the concordance rate was 57%). Among eight cases with unknown cause of death by clinical diagnosis, four cases (50%) were identified with cardiac tamponade as a cause of death (one case) and intracranial hemorrhage suggesting abuse (3 cases). Conclusions. PMCT seems to be a promising technique that might serve as a substitute for conventional medical autopsy and give us the complementary information to clinical diagnoses particularly in cases of child abuse. Larger multicenter trials are worthwhile to validate the general feasibility of PMCT. Yukihiro Noda, Ken Yoshimura, Shoji Tsuji, Atsushi Ohashi, Hirohide Kawasaki, Kazunari Kaneko, Shigeki Ikeda, Hiroaki Kurokawa, and Noboru Tanigawa Copyright © 2013 Yukihiro Noda et al. All rights reserved. Congenital and Acquired Abnormalities of the Corpus Callosum: A Pictorial Essay Tue, 06 Aug 2013 09:17:49 +0000 The purpose of this review is to illustrate the wide spectrum of lesions in the corpus callosum, both congenital and acquired: developmental abnormalities, phakomatoses, neurometabolic disorders, demyelinating diseases, infection and inflammation, vascular lesions, neoplasms, traumatic and iatrogenic injury, and others. Cases include fetuses, children, and adults with rich iconography from the authors’ own archive. Katarzyna Krupa and Monika Bekiesinska-Figatowska Copyright © 2013 Katarzyna Krupa and Monika Bekiesinska-Figatowska. All rights reserved. Qualitative and Quantitative Hippocampal MRI Assessments in Intractable Epilepsy Mon, 29 Jul 2013 08:32:39 +0000 Aims. To acquire normative data of hippocampal volumes and T2 relaxation times, to evaluate and compare qualitative and quantitative assessments in evaluating hippocampi in patients with different durations of intractable epilepsy, and to propose an imaging protocol based on performance of these techniques. Methods. MRI analysis was done in 50 nonepileptic controls and 30 patients with intractable epilepsy on 1.5T scanner. Visual assessment and hippocampal volumetry were done on oblique coronal IR/T2W and T1W MP-RAGE images, respectively. T2 relaxation times were measured using 16-echo Carr-Purcell-Meiboom-Gill sequence. Volumetric data was normalized for variation in head size between individuals. Patients were divided into temporal () and extratemporal () groups based on clinical and EEG localization. Results. In controls, right hippocampal volume was slightly more than the left with no effect of age or gender. In TLE patients, hippocampal volumetry provided maximum concordance with EEG. Visual assessment of unilateral pathology concurred well with measured quantitative values but poorly in cases with bilateral pathologies. There were no significant differences of mean values between extratemporal group and controls group. Quantitative techniques detected mild abnormalities, undetected on visual assessment. Conclusions. Quantitative techniques are more sensitive to diagnose bilateral and mild unilateral hippocampal abnormalities. Paramdeep Singh, Rupinderjeet Kaur, Kavita Saggar, Gagandeep Singh, and Amarpreet Kaur Copyright © 2013 Paramdeep Singh et al. All rights reserved. Magnetic Resonance Sialography Findings of Submandibular Ducts Imaging Thu, 25 Jul 2013 10:13:38 +0000 Purpose. We aimed to assess the problem solving capability of magnetic resonance sialography (MR sialography), a noninvasive method for imaging submandibular gland ducts and determining duct-related pathologies, by comparing diseased and healthy cases. Materials and Methods. We conducted radiological assessment on a total of 60 submandibular glands (mean age 44.7) in 20 cases and 10 volunteers. MR sialography examinations were conducted with single-shot fast spin-echo sequence by using a surface coil placed on the submandibular gland. Each gland was evaluated in terms of the length, width and stricture of the main duct, as well as the difference between the intraparenchymal duct width, and the main duct width. Statistical analysis was performed. Results. In the MR sialography the primary duct mean length was determined as 51 mm (40–57 mm) in all submandibular glands. On the MR sialography imaging, the visualization ratio of the ductal system of submandibular gland was evaluated in the cases and volunteers. Conclusion. MR sialography is an effective and a noninvasive method in imaging submandibular gland ducts, demonstrating the presence, location and degree of stricture/dilatation, and elucidating the disease etiology. Nezahat Karaca Erdoğan, Canan Altay, Nesibe Özenler, Tuğba Bozkurt, Engin Uluç, Berna Dirim Mete, and İsmail Özdemir Copyright © 2013 Nezahat Karaca Erdoğan et al. All rights reserved.