Diabetes mellitus and tuberculosis in Korean adults: impact on tuberculosis incidence, recurrence and mortality

<sec id="st1"> <title>SETTING</title> The prevalence of diabetes mellitus (DM) worldwide is increasing markedly, and many countries with rising rates also have a high incidence rate of tuberculosis (TB). </sec> <sec id="st2"> <title>OBJECTIVE</title> To investigate the relationships of fasting serum glucose (FSG) and DM with TB incidence, recurrence and mortality risk in a prospective cohort study in South Korea. </sec> <sec id="st3"> <title>DESIGN</title> Our study comprised 1 267 564 Koreans who received health insurance from the National Health Insurance System, had an initial medical evaluation between 1997 and 2000 and were prospectively followed biennially. </sec> <sec id="st4"> <title>RESULTS</title> Participants with DM had a higher risk for incident TB (hazard ratio [HR] 1.81, 95%CI 1.71-1.91 in males, HR 1.33; 95%CI 1.20-1.47 in females) than those without DM. There was a strong positive trend for TB risk with rising FSG among males. The risk for recurrent TB among those with previous TB was significantly higher in males (HR 1.58, 95%CI 1.43-1.75) and in females with DM (HR 1.38, 95%CI 1.08-1.76). The increased risk of death from TB during follow-up was also significant in men (HR 1.91, 95%CI 1.87-1.95) and in women (HR 1.71, 95%CI 1.65-1.77). </sec> <sec id="st5"> <title>CONCLUSIONS</title> A diagnosis of DM is a risk factor for TB, TB recurrence and death from TB. Screening for TB should be considered among people living with DM in Korea, particularly those with severe DM. </sec>.

Risk of malignancy in patients with psoriasis: a 15-year nationwide population-based prospective cohort study in Korea

BACKGROUND

The association between psoriasis and risk of malignancy has not been thoroughly evaluated in a large longitudinal cohort of Asian population.

OBJECTIVE

To determine the long-term risk of malignancy in Korean adult patients with psoriasis.

METHODS

We conducted a nationwide population-based prospective cohort study with a 15-year observational period. During the baseline period (1997-2000), total 1 773 786 Korean subjects who received health insurance from the National Health Insurance System were enrolled and 5788 subjects were defined as a psoriasis group. The number of new-onset malignancy was collected during the observational period (2001-2015).

RESULTS

Patients with psoriasis had a higher adjusted hazard ratio (aHR) for development of overall malignancy [aHR 1.08, 95% confidence interval (CI) 1.00-1.18] and gastric cancer (aHR 1.31, 95% CI 1.08-1.58) compared to controls. The risks of non-Hodgkin lymphoma and non-melanoma skin cancer were significantly increased only in patients with psoriasis who received systemic treatments (aHR 2.86, 95% CI 1.07-7.61 and aHR 3.93, 95% CI 1.47-10.47, respectively).

CONCLUSION

Psoriasis is associated with long-term risk for overall malignancy in Koreans, which was primarily driven by the increased risk of gastric cancer.

Differential expression of 11β-hydroxysteroid dehydrogenase type 1 and 2 in mild and moderate/severe persistent allergic nasal mucosa and regulation of their expression by Th2 cytokines: asthma and rhinitis

BACKGROUND

Glucocorticoids are used to treat allergic rhinitis, but the mechanisms by which they induce disease remission are unclear. 11β-hydroxysteroid dehydrogenase (11β-HSD) is a tissue-specific regulator of glucocorticoid responses, inducing the interconversion of inactive and active glucocorticoids.

OBJECTIVE

We analysed the expression and distribution patterns of 11β-HSD1, 11β-HSD2, and steroidogenic enzymes in normal and allergic nasal mucosa, and cytokine-driven regulation of their expression. The production levels of cortisol in normal, allergic nasal mucosa and in cultured epithelial cells stimulated with cytokines were also determined.

METHODS

The expression levels of 11β-HSD1, 11β-HSD2, steroidogenic enzymes (CYP11B1, CYP11A1), and cortisol in normal, mild, and moderate/severe persistent allergic nasal mucosa were assessed by real-time PCR, Western blot, immunohistochemistry, and ELISA. The expression levels of 11β-HSD1, 11β-HSD2, CYP11B1, CYP11A1, and cortisol were also determined in cultured nasal epithelial cell treated with IL-4, IL-5, IL-13, IL-17A, and IFN-γ. Conversion ratio of cortisone to cortisol was evaluated using siRNA technique, 11β-HSD1 inhibitor, and the measurement of 11β-HSD1 activity.

RESULTS

The expression levels of 11β-HSD1, CYP11B1, and cortisol were up-regulated in mild and moderate/severe persistent allergic nasal mucosa. By contrast, 11β-HSD2 expression was decreased in allergic nasal mucosa. In cultured epithelial cells treated with IL-4, IL-5, IL-13, and IL-17A, 11β-HSD1 expression and activity increased in parallel with the expression levels of CYP11B1 and cortisol, but the production of 11β-HSD2 decreased. CYP11A1 expression level was not changed in allergic nasal mucosa or in response to stimulation with cytokines. SiRNA technique or the measurement of 11β-HSD1 activity showed that nasal epithelium activates cortisone to cortisol in a 11β-HSD-dependent manner.

CONCLUSIONS AND CLINICAL RELEVANCE

These results indicate that the localized anti-inflammatory effects of glucocorticoids are regulated by inflammatory cytokines, which can modulate the expression of 11β-HSD1, 11β-HSD2, and CYP11B1, and by the intracellular concentrations of bioactive glucocorticoids.

Transient expression of iron transport proteins in the capillary of the developing rat brain

Iron is essential for normal brain function and its uptake in the developing rat brain peaks during the first two weeks after birth, prior to the formation of the blood–brain barrier (BBB). The first step of iron transport from the blood to the brain is transferrin receptor (TfR)-mediated endocytosis in the capillary endothelial cells. However, the subsequent step from the endothelium into interstitium has not been fully described. The goal of this study was to examine the expression of iron transport proteins by immunodetection and RT–PCR in the developing rat brain. Tf and TfR are transiently expressed in perivascular NG2+ cells of the capillary wall during the early postnatal weeks in the rat brain. However, MTP-1 and hephaestin were expressed in endothelial cells, but not in the NG2+ perivascular cells. Immunoblot analysis for these iron transfer proteins in the developing brain generally confirmed the immunochemical findings. Furthermore, the expression of Tf and TfR in the blood vessels precedes its expression in oligodendrocytes, the main iron-storing cells in the vertebrate brain. RT–PCR analysis for the primary culture of endothelial cells and pericytes revealed that Tf and TfR were highly expressed in the pericytes while MTP-1 and hephaestin were expressed in the endothelial cells. The specific expression of Tf and TfR in brain perivascular cells and MTP-1 and hephaestin in endothelial cells suggest the possibility that trafficking of elemental iron through perivascular cells may be instrumental in the distribution of iron in the developing central nervous system.

Effect of short term calorie restriction on pro-inflammatory NF-kB and AP-1 in aged rat kidney

OBJECTIVE

To compare the effect of short-term calorie restriction (CR) on aging with that of already known long-term CR, the anti-inflammatory efficacy of 10-day CR was explored in aged rat kidney.

TREATMENT

Two different age groups, 6 months (young) and 24 months (old) were used. In the old group, one sub-group was control, fed ad libitum (AL) and the other was fed CR for 10 days with 40 % of the food intake of the AL subgroup (n = 5).

METHODS

Reactive species (RS), lipid peroxides and COX-2 activity were measured. The activities of proinflammatory transcription factors NF-kB and AP-1 were measured by electro-mobility shift assay (EMSA). Upstream signaling cascades of NF-kB and AP-1 as well as proinflammatory gene expression were detected by Western blot.

RESULTS

10-day CR suppressed RS, lipid peroxides, and COX-2 activity in aged rat kidney. CR also inhibited upstream signaling cascades and DNA binding activity of NF-kB and AP-1, and thioredoxin/Ref-1 pathway. CR blocked expression of NF-kB-and AP-1-responsive gene COX-2, iNOS, VCAM-1 and ICAM-1.

CONCLUSIONS

We report for the first time that 10-day CR can attenuate the altered signaling transduction for inflammatory processes which is mediated through RS-induced NF-kB and AP-1 in aged kidney.

Induction of endothelial iNOS by 4-hydroxyhexenal through NF-kappaB activation

Lipid peroxidation and its end-product, 4-hydroxyhexenal (HHE), are known to affect redox balance during aging, which causes various degenerative processes including vascular alterations from endothelial cell deterioration. To better understand the molecular action of HHE in the development of vascular abnormalities during the aging process, we investigated whether the upregulation of inducible endothelial nitric oxide synthase (iNOS) by HHE is mediated through nuclear factor kappaB (NF-kappaB) activation. Results indicate that HHE stimulates iNOS by the transcriptional regulation of NF-kappaB activation through cytosolic kappaB degradation inhibitors (IkappaB). Pretreatment with NF-kappaB inhibitors Bay 11-7082 and N-acetyl cysteine (NAC) suppressed the upregulation of iNOS by blunting IkappaB degradation and NF-kappaB binding activity. Because inflammatory stimuli induce iNOS to generate large amounts of nitric oxide (NO), intracellular NO levels in the presence of Bay 11-7082, NAC, and caffeic acid methyl ester were estimated. These inhibitors significantly suppressed the HHE-induced NO levels to a basal level. These findings strongly suggest that in endothelial cells, HHE induces iNOS gene expression through NF-kappaB activation, which can lead to vascular dysfunction by the activation of various proinflammatory genes.

Predictors for benign solitary pulmonary nodule in tuberculosis-endemic area

BACKGROUND

Solitary pulmonary nodule (SPN) may show different presentation in tuberculosis (TB)-endemic countries. The aim of this study was to identify clinical and radiological predictors favoring benign or malignant SPN in TB-endemic region.

METHODS

Two hundred one SPNs in 201 consecutive Korean patients were included (< 3 cm in diameter, all confirmed by pathology or bacteriology, 93 benign and 108 malignant diseases). For clinical parameters, age, sex, smoking status and amount, and past history of pulmonary tuberculosis and diabetes mellitus were investigated retrospectively. For radiological parameters, size, location, margin characteristics, presence of calcification, pleural tag, surrounding satellite nodule, cavitation, internal low attenuation, open bronchus sign, surrounding ground-glass opacity, enhancement pattern of the SPNs and mediastinal lymph node (LN) enlargement were analyzed on chest CT scans.

RESULTS

Patients with a older age (60.7 +/- 9.6 vs 56.2 +/- 13.1, p = 0.008) and more than 40-pack years smoking (27.8% vs 14.0%, p = 0.017) were more frequently related with malignant than benign SPN. On chest CT scans, spiculated margin, contrast enhancement more than 20 Hounsfield unit and presence of pleural tag and mediastinal LN enlargement were more frequently observed in malignant than benign SPNs. In contrast to previous studies, satellite lesions (21.5% vs 1.9%, p < 0.001) and cavitation (20.4% vs 5.6%, p = 0.001) were more frequently seen in benign than malignant SPN. Positive predictive values of benignity were 90.9% and 76.0%, respectively, when satellite lesions and cavitation were found in cases of SPN.

CONCLUSION

Satellite lesions and cavitation on chest CT scan could be useful predictors for benign SPN in TB-endemic areas.

Large cell neuroendocrine carcinoma of the lung: clinical, CT, and pathologic findings in 11 patients

The purpose of this study was to describe the clinical, computed tomographic (CT), and pathologic findings of large cell neuroendocrine carcinoma (LCNEC) of the lung. CT and pathologic findings as well as clinical features of surgically proven LCNEC of the lung were reviewed retrospectively in 11 consecutive patients (eight men and three women; mean age, 63 years; range, 44-77 years). Chest CT showed peripheral mass or nodule (n = 8) and central mass with distal atelectasis (n = 3). Six tumors were accompanied by mediastinal (n = 3) and hilar (n = 3) lymph node enlargement at CT. On pathologic examination, all resected tumors showed necrosis of variable extent (mean: 38%, range; 10-70%). The areas of intrinsic lipoid pneumonia and tumor emboli in two patients appeared at CT as areas of ground-glass opacity surrounding the tumor. Mediastinal nodal metastases were seen in three (27%) patients. Pathologic staging of 11 patients was IB in six, IIA in one, IIB in one, IIIA in two, and IIIB in one. Follow-up data showed extrathoracic metastases in four patients at mean follow-up period of 15 months. One patient died of distant metastasis 5 months after the surgery. CT findings of LCNEC of the lung are nonspecific and similar to those of other non-small cell lung cancers and extrathoracic metastasis is seen in approximately one third of the patients with follow-up study.

Mediastinal interfaces and lines in children: radiographic-CT correlation

BACKGROUND

Various mediastinal interfaces and lines are well known in adults, but not fully understood in children.

OBJECTIVE

To review the mediastinal interfaces and lines on plain radiographs in the paediatric age group with CT correlation.

MATERIALS AND METHODS

Soft copies of 195 sets of CT examinations and concurrent chest radiographs in 180 paediatric patients (age 1 month to 15 years) were retrospectively reviewed. The frequency of visualisation and the anatomical basis of the mediastinal interfaces and lines were assessed. The evaluated mediastinal interfaces and lines were superior vena cava interface, descending aorta interface, left paraspinal interface, azygoesophageal recess interface, right paratracheal stripe, anterior junction line and posterior junction line.

RESULTS

Chest radiographs showed the SVC interface in 161, the descending aorta interface in 155, the left paraspinal interface in 98, the azygoesophageal recess in 94, the right paratracheal stripe in 53, the anterior junction line in 15 and the posterior junction line in 10. Non-visualisation of mediastinal interfaces and lines on plain radiographs was explained by normal anatomical difference compared with the adult and underlying intrathoracic abnormalities when they were correlated with CT. The frequency of visualisation of the SVC interface, descending aortic interface, left paraspinal interface and azygoesophageal recess fluctuated with age, while the frequency of the right paratracheal stripe, anterior junction line and posterior junction line increased with age.

CONCLUSIONS

Awareness of the frequency of visualisation and the anatomical basis of the mediastinal interfaces and lines in paediatric patients may be helpful for interpretation of chest radiographs.

Crescent sign in invasive pulmonary aspergillosis: frequency and related CT and clinical factors

PURPOSE

The aim of our study was to evaluate the frequency of the crescent sign on follow-up radiographs in patients with invasive pulmonary aspergillosis, correlated with initial CT and clinical findings.

METHOD

Retrospective analysis of serial chest radiographs was performed to see the frequency of the crescent sign in 21 consecutive patients with pathologically proved invasive pulmonary aspergillosis. The appearance of the crescent sign was correlated with the pattern of parenchymal lesions on initial CT scans, the presence and duration of neutropenia, and underlying diseases.

RESULTS

The crescent sign was seen in 10 of 21 patients (48%) on follow-up radiographic examinations. It was seen in patients with initially large [consolidation or mass; 9/11 (82%) patients] rather than small [nodule(s); 1/10 (10%) patients] parenchymal lesions (p = 0.002) on CT. The sign appeared in 7 of 17 (41%) patients with neutropenia 1-10 days after recovery from neutropenia. It appeared in three of four patients (75%) without neutropenia 4--8 days after treatment with amphotericin B. The appearance was not related to the duration (32 days in patients with crescent sign and 17 days without sign) of the neutropenic period (p > 0.05). The sign was seen in 8 of 15 (53%) patients with acute myelogenous leukemia and 2 of 6 (33%) patients with other diseases (p > 0.05).

CONCLUSION

The crescent sign appears in about half of patients with invasive pulmonary aspergillosis with recovery from neutropenia, especially when the initial lesion is a consolidation or mass on CT scans.

Malignant thymic epithelial tumors: CT-pathologic correlation

OBJECTIVE

The purpose of our study was to describe and compare the CT and pathologic findings of atypical thymoma and thymic carcinoma.

MATERIALS AND METHODS

Twenty-seven consecutive patients (14 men, 13 women ranging in age from 22 to 77 years [mean age, 52 years]) with pathologically proven atypical thymoma (n = 9) and thymic carcinoma (n = 18) constituted the study population. The chest CT findings in each of the 27 patients were reviewed retrospectively in consensus by two chest radiologists. These findings were correlated with pathologic findings.

RESULTS

The tumors were located in the anterior mediastinum, and most tumors had a lobulated margin (24/27, 89%). Atypical thymomas were significantly smaller (mean, 4.7 cm) than thymic carcinomas (mean, 7.2 cm) (p = 0.041) on CT. The findings of invasion of the great vessels, lymph node enlargement, extrathymic metastases, and phrenic nerve palsy were seen only in patients with thymic carcinoma. The frequencies of necrosis, intratumoral calcification, pleural effusion, pleural implants, pericardial effusion, and obliteration of the mediastinal fat plane were not significantly different between atypical thymomas and thymic carcinomas (p > 0.05). Various histologic subtypes were included in thymic carcinoma. The tumor necrosis and calcification seen on CT were confirmed at pathologic examination.

CONCLUSION

When a large thymic tumor appears with invasion of the great vessels, lymph node enlargement, phrenic nerve palsy, or extrathymic metastases on CT, thymic carcinoma rather than atypical thymoma should be considered.

Development and characterization of a flavoring agent from oyster cooker effluent

The general composition of concentrated oyster cooker effluent (OCE) was 80% moisture, 6.7% total nitrogen, 2.4% glycogen, and 8.5% ash. Optimum conditions for enzymatic hydrolysis of OCE were 50 degrees C, 2 h of reaction time, 0.1% amylase mixture (alpha-amylase plus glucoamylase), and 0.2% protease NP. Hydrolysis of OCE led to an increase in free amino acids, with taurine comprising approximately 20% of the total. Inosine monophosphate was predominant (456 mg/100 g) among nucleotides and related compounds. Enzyme hydrolysis increased extractable nitrogen by approximately 2-fold. Trimethylamine, trimethylamine oxide, and total creatinine levels were not affected by enzyme treatment. Predominant aroma-active components of enzyme-hydrolyzed OCE included 2-acetyl-1-pyrroline and 3-(methylthio)propanal. Results of this study may help alleviate the wastewater disposal problem currently caused by OCE.

Pulmonary tuberculosis: CT and pathologic correlation

Typical CT findings of active postprimary pulmonary tuberculosis include centrilobular nodules and branching linear structures (tree-in-bud appearance), lobular consolidation, cavitation, and bronchial wall thickening. The CT findings of inactive pulmonary tuberculosis include calcified nodules or consolidation, irregular linear opacity, parenchymal bands, and pericicatricial emphysema. The typical appearance of primary tuberculosis on CT scans is homogeneous, dense, well-defined segmental or lobar consolidation with enlargement of lymph nodes in the hilum or the mediastinum. Miliary nodules may be seen in primary and postprimary tuberculosis. On CT, tuberculomas appear as a nodule with surrounding satellite nodules and internal cavitation on CT. Atypical radiologic manifestations of tuberculosis, encountered in as many as one third of the cases of adult-onset tuberculosis, are single or multiple nodules or masses, basilar infiltrates, miliary tuberculosis with diffuse bilateral areas of ground-glass opacity, and reversible multiple cysts. Underlying histopathologic findings of typical and atypical CT findings of tuberculosis are caseating granulomas or pneumonia in the active phase and fibrosis and dystrophic calcification in the inactive phase.

Low-dose, volumetric helical CT: image quality, radiation dose, and usefulness for evaluation of bronchiectasis

RATIONALE AND OBJECTIVES

The aim of our study was to assess the image quality, radiation dose, and clinical applicability of low-dose, volumetric helical CT in the evaluation of bronchiectasis.

METHODS

Volumetric helical CT scans (120 kVp, 3-mm collimation, pitch of 2, and reconstruction interval of 2 mm) were obtained through the thorax at four levels of tube current: 150, 100, 70, and 40 mA. There were a total of 12 patients who underwent CT scan either for suspected bronchiectasis or for lung cancer screening, with three patients allocated to each current level. Five radiologists assessed and compared image quality of the helical CT scans obtained at the various exposure levels. Radiation doses of helical CT performed with four different current settings and of high-resolution CT (120 kVp, 170 mA, 1-mm collimation, and 10-mm intervals) were measured. The diagnostic usefulness of the 40-mA helical CT images was compared with that of high-resolution CT by two observers in 52 patients with known or suspected airway diseases.

RESULTS

With helical CT, there was no significant difference in image quality among the four different levels of current (P > 0.05). Radiation doses associated with the 40-, 70-, 100-, and 150-mA helical techniques were 3.21 mGy (range, 3.02-3.57), 4.81 mGy (range, 3.89-5.93), 6.46 mGy (range, 6.01-7.31), and 10.4 mGy (range, 8.93-12.1), respectively, whereas that of high-resolution CT was 2.17 mGy (range, 1.90-2.67). Of 52 patients, 44.5 and 47 patients (the mean of positive interpretations by the five observers) were diagnosed with bronchiectasis at high-resolution and low-dose helical CT, respectively. Of 928 segments, bronchiectasis was seen in 152.5 segments on high-resolution CT and in 193.5 segments on helical CT. The interobserver agreement (k-values) was acceptable for both techniques.

CONCLUSIONS

With acceptable images and similar radiation dose, low-dose volumetric helical CT at 40 mA may offer more information than does high-resolution CT in the evaluation of bronchiectasis.

T1 lung cancer on CT: frequency of extrathoracic metastases

PURPOSE

To determine the frequency of extrathoracic metastases in T1 non-small-cell lung cancer.

METHOD

Ninety patients with T1 lung cancer identified on CT were included. Extrathoracic metastases were evaluated at the time of initial diagnosis and during a 1-year follow-up study. The frequency of metastases was compared in terms of cell type (squamous or nonsquamous), size (<2 cm or >2 cm), and the initial CT findings of the tumor.

RESULTS

Extrathoracic metastases were identified in 12 (13%) of 90 patients at the time of diagnosis and in 10 patients at the 1-year follow-up study (total, 22 of 90 [24%] patients). Tumors with ground-glass opacity on CT were associated with a significantly lower prevalence of metastases (p = 0.042). The area of ground-glass opacity was seen in 1 of 13 (85%) patients with bronchioloalveolar carcinoma and in 12 of 53 (23%) patients with adenocarcinoma other than bronchioloalveolar carcinoma (p < 0.001). There was no significant difference in the prevalence of metastases between squamous and nonsquamous cell carcinoma, between tumors smaller than 2 cm (n = 17) and larger than 2 cm in diameter (n = 73) and between tumors with or without mediastinal nodal metastases (p>0.05).

CONCLUSION

Extrathoracic metastases were apparent at the initial examination in 13% of patients and at the 1-year follow-up examination in 11% of patients. The prevalence is significantly lower in tumors with ground-glass opacity.

Cytomegalovirus pneumonia: high-resolution CT findings in ten non-AIDS immunocompromised patients

OBJECTIVE

To describe the HRCT findings of cytomegalovirus (CMV) pneumonia in non-AIDS immunocompromised patients

MATERIALS AND METHODS

This retrospective study involved the ten all non-AIDS immunocompromised patients with biopsy-proven CMV pneumonia and without other pulmonary infection encountered at our Medical Center between January 1997 and May 1999. HRCT scans were retrospectively analysed by two chest radiologists and decisions regarding the findings were reached by consensus.

RESULTS

The most frequent CT pattern was ground-glass opacity, seen in all patients, with bilateral patchy (n = 8) and diffuse (n = 2) distribution. Other findings included poorly-defined small nodules (n = 9) and consolidation (n = 7). There was no zonal predominance. The small nodules, bilateral in eight cases and unilateral in one, were all located in the centrilobular region. Consolidation (n = 7), with patchy distribution, was bilateral in five of seven patients (71%). Pleural effusion and bilateral areas of thickened interlobular septa were seen in six patients (60%).

CONCLUSION

CMV pneumonia in non-AIDS immunocompromised patients appears on HRCT scans as bilateral mixed areas of ground-glass opacity, poorly defined centrilobular small nodules, and consolidation. Interlobular septal thickening and pleural effusion are frequently associated.

Primary tumors and mediastinal lymph nodes after neoadjuvant concurrent chemoradiotherapy of lung cancer: serial CT findings with pathologic correlation

PURPOSE

The purpose of this work was to describe the changes of primary tumor and mediastinal lymph nodes on CT after neoadjuvant concurrent chemoradiotherapy and to correlate the CT findings with pathology.

METHOD

Twenty-one consecutive patients [N2 disease (n = 19) or resectable T4 and N2 disease (n = 2)] with non-small cell lung cancer underwent neoadjuvant concurrent chemoradiotherapy. Changes of primary tumor and mediastinal nodes before and after the therapy were assessed using CT. The CT findings were correlated with pathologic findings.

RESULTS

With neoadjuvant therapy, decrease in T stage was achieved in 9 of 21 (43%) patients on CT. On pathology, the remaining tumor consisted mostly of fibrosis and necrosis with little proportion of viable tumor cells (mean volume 17%, range 0-55%). Decrease in nodal stage was achieved in 14 of 21 (67%) patients on pathologic examination. Seven patients had cancer cells in mediastinal lymph nodes: in 6 of 9 (67%) patients with adenocarcinoma and 1 of 12 (8%) patients with squamous cell carcinoma (p = 0.016).

CONCLUSION

With neoadjuvant concurrent chemoradiotherapy, the remaining tumor consists mostly of fibrosis or necrosis. Decreased nodal stage on pathology is achieved especially in patients with N2 disease of squamous cell carcinoma. The CT findings of the tumor and mediastinal nodes are not helpful in predicting the pathology after the therapy.

Halo sign on high resolution CT: findings in spectrum of pulmonary diseases with pathologic correlation

The halo sign in a pulmonary nodule refers to the condition in which soft tissue attenuation of a pulmonary nodule is surrounded by peripheral ground glass attenuation on high resolution CT. The halo sign can be caused by several pathologic processes: hemorrhagic pulmonary nodules, tumor cell infiltration, and nonhemorrhagic inflammatory lesions. Hemorrhagic pulmonary nodules may occur in infectious diseases including invasive pulmonary aspergillosis, mucormycosis, and candidiasis and noninfectious diseases including Wegener granulomatosis and primary and metastatic hemorrhagic tumors. Tumor cell infiltration in bronchioloalveolar carcinoma, pulmonary lymphoma, and pulmonary metastatic neoplasm may appear with the halo sign. Eosinophilic lung disease and organizing pneumonia are representative of inflammatory lesions showing the sign.

Simultaneous acquisition of quadrupolar order and double-quantum 23Na signals

Na+ with both residual quadrupolar coupling and biexponential relaxation contributes to the signal acquired from DQF-4, while only Na+ with residual quadrupolar coupling contributes to the signal acquired with the Jeener-Broekaert sequence. Since RF phases and flip angles for DQF-4 and Jeener-Broekaert sequences are identical, these different types of signals can be generated simultaneously. A phase-cycling scheme is developed to differentiate the signals corresponding to residual quadrupolar coupling and biexponential relaxation after the signals are acquired by use of the same RF sequences. This technique can maximize the attainable information from Na+ in biological tissues in a given acquisition time. Copyright 1997 Academic Press. Copyright 1997Academic Press

Superconducting receiver coils for sodium magnetic resonance imaging

We present the results from sodium magnetic resonance imaging (MRI) experiments using high-temperature superconducting (HTS) receiver coils. Sodium imaging has been shown to have great potential for the assessment of cell integrity but suffers from a substantially lower signal-to-noise ratio (SNR) than that of a hydrogen imaging. The use of an HTS receiver coil was found to significantly increase the SNR relative to an equivalent copper receiver coil at room temperature. The SNR gains afforded by HTS coils can also be used to decrease the imaging time.

Chemical-Shift-Selective Acquisition of Multiple-Quantum-Filtered 23Na Signal

Equations describing the multiple-quantum (MQ) signal produced by an MQ pulse sequence are systematically derived in both absence and presence of refocusing RF pulses. When the RF pulses in an MQ pulse sequence satisfy certain conditions, these equations may be arranged in a factorized form. The off-resonance effects on the MQ signal due to chemical shift can then be analyzed separately during the preparation and evolution times. Using the reformulated equations, the dependence of the amplitude of an MQ signal on the phase shift induced by the resonance offset during the preparation and evolution times is demonstrated. By use of the new equations, it is shown that the off-resonance effects, occurring during both the preparation and evolution times, may be described in terms of the same physical process, i.e., interference between echo and antiecho. In applying the off-resonance effects for the elimination of the MQ signal in the presence of chemical shift, it is possible to suppress the MQ signal over a wider off-resonance bandwidth by use of the nonrefocused preparation and evolution times than by use of a single time. Furthermore, by taking an alternative approach in deriving the equations, the interference between echo and antiecho due to the resonance offset is shown to be insensitive to the flip angle of the creation RF pulse (usually the second pi/2 RF pulse). The theoretical findings were experimentally verified by use of a phantom containing sodium in agarose.

New double-quantum filtering schemes

New double-quantum filtering (DQF) schemes are theoretically developed by reformulating the equations describing the double-quantum (DQ) signal. The equations describing the second- and third-rank DQ signals are simplified by restricting the RF phases as required for DQF. The equations are then factorized into two terms representing the separate contribution to the DQ signal from the RF pulses involved in the preparation and evolution times. This allows analysis of the DQ signal of a particular DQF scheme separately for each of these times in a concise manner. By use of the reformulated equations, the conventional DQF scheme is shown to be only one of four possible DQF schemes. The three new DQF schemes offer some desirable properties over the conventional DQF scheme. In the conventional DQF scheme, the third-rank DQ signal declines rapidly to null as the flip angles of the creation and readout RF pulses deviate from 90 degrees to 54.7 degrees or 125.3 degrees. In addition, the second- and third-rank DQ signals in the conventional DQF scheme are opposite in their polarities, resulting in attenuation of the total DQ signal due to destructive interference between them. In one of three new DQF schemes, the DQ signal does not vanish at 54.7 degrees and 125.3 degrees, but varies smoothly with the same functional dependence on the RF flip angles as the second-rank DQ and triple-quantum signals. Furthermore, in two of the three new DQF schemes, the second- and third-rank DQ signals have the same polarity so that the total DQ signal may be enhanced through constructive interference between them. These features of new DQF schemes have been confirmed experimentally.

Breakthrough of single-quantum coherence and its elimination in double-quantum filtering

Breakthrough of single-quantum coherence is shown to occur after application of a double-quantum filter with the conventional four-step phase-cycling scheme. This single-quantum breakthrough is due to the intersequence stimulated echo which has been generated by the radiofrequency pulses in the preceding pulse sequence and appears at the same time as the double-quantum coherence signal in the current pulse sequence. Moreover, the phase of the intersequence stimulated echo is the same as the phase of the double-quantum coherence signal; i.e., the phase of the intersequence stimulated echo is twice the phase change of the radiofrequency pulses in the creation period when their phase is rotated in accordance with the conventional four-step phase-cycling scheme. Consequently, the intersequence stimulated echo passes through the double-quantum filtration in the conventional four-step phase-cycling scheme and gradient pulses. A new phase-cycling scheme which can filter out the single-quantum breakthrough signal is proposed here and its effectiveness is verified experimentally and by computer simulations.

Self-correction of proton spectroscopic images for gradient eddy current distortions and static field inhomogeneities

A postprocessing method of correcting for gradient eddy current distortions and inter-voxel static field inhomogeneity in spectroscopic imaging is presented. Data is acquired normally and all spatial processing is performed. The FID in each voxel is then digitally filtered to extract the signal from a single reference line. Phase multiplying the original FID by the phase of this reference signal corrects for gradient eddy currents and static field offsets. Computer simulations show that the method is robust with respect to noise, filter bandwidth and the presence of small lines close to the reference line. The method is demonstrated on proton spectroscopic images of phantoms.

Reduction of flow artifacts in NMR diffusion imaging using view-angle tilted line-integral projection reconstruction

Most of the diffusion imaging techniques employ strong diffusion gradient pulses of long duration in order to achieve appreciable signal attenuation through the diffusion effect. However, these strong and long gradient pulses make the resultant images extremely sensitive to the motion or flow of the object. Fourier imaging, with which most of the current NMR imaging is performed, is especially sensitive to the fluctuating flow and the images are usually obscured by severe flow artifacts smeared in the phase-encoding direction. In this paper, we have proposed a diffusion imaging technique which reduces the flow artifacts by use of the line-integral projection reconstruction (LPR) imaging method. Furthermore, the inhomogeneity artifacts expected to occur in LPR imaging have been corrected by application of the view-angle tilting technique. The pulse sequence of the view-angle tilted LPR diffusion imaging is designed in such a way that it works for both isotropic and anisotropic diffusion. Experimental results are presented along with the experimental procedures.

MR Fourier transform arteriography using spectral decomposition

Reliable separation of arteries from other stationary tissues is accomplished through spectral decomposition by exploiting the pulsatile nature of the blood flow in the arteries. Fourier transformation of a series of projection images in the temporal direction along the cardiac cycle results in spectral images where the arteries are a part of the harmonic component images while stationary tissues and veins are represented as a de component image. From the magnitude of the spectral images an arteriogram can be obtained by summation of the harmonic component images excluding the de component image. This principle is applied to Fourier imaging in a cine mode data acquisition as well as line scan imaging. Since there is no need for the encoding of the flow-sensitive gradient, this technique is free from eddy current artifacts which have been one of the major obstacles to projection angiography using the flow-encoding gradient.

Further improvement of high-speed NMR flow-velocity measurement using a differential phase-encoding technique

An NMR imaging technique applicable to high-velocity flow imaging is described. By subtraction of two phase images obtained by varying the flow-encoding gradient, it is possible to extract much larger ranges of velocity components. This differential phase-encoding technique is tested by experiments in a phantom as well as a human volunteer.