Abstract P5-03-09: Breast cancer promotion by IL-6-mediated cross-talk between human preadipocyte and breast dutal carcinoma in situ

While the role of adipocyte, one of the major components of the breast microenvironment, has been well documented in breast cancer progression, the preadipocytes function to favor early-stage breast cancer progression at the molecular level is not fully elucidated. To delineate the role of human preadipocyte (hPreAd) on breast cancer progression, we investigated a cross-talk between human breast dutal carcinoma in situ (DCIS) and hPreAd in in vivo culture and in vivo tumor model. On Co-culture system with DCIS cell line MCF10DCIS.com and primary hPreAd, proliferation, migration and invasion of MCF10DCIS.com was promoted by hPreAd. Conditioned medium (CM) of hPreAd activated signaling molecules (AKT1, ERK1/2, mTOR, FAK and STAT3) in MCF10DCIS.com. hPreAd expressed fibroblast specific protein 1 (FSP1) and alpha-smooth muscle actin (α-SMC), and increased IL-6 secretion by co-culture or MCF10DCIS.com CM, whereas adipocyte differentiation of hPreAd was suppressed by co-culture. A neutralizing antibody (NAb) of IL-6 or IL-6 receptor suppressed the MCF10DCIS.com proliferation and migration enhanced by co-culture of hPreAd. In xenograft tumor model, tumor growth of MCF10DCIS.com was enhanced by co-injection with hPreAd. IL-6 NAb had minimal effect in xenografts with MCF10DCIS.com alone; however, in models co-administered with hPreAd, IL-6 NAb had more potent effects on tumor inhibition. Taken together, our study suggests that IL-6-mediated cross-talk between preadipocyte and breast DCIS can exert the breast cancer progression at early-stage. Deciphering the cellular and molecular mechanisms behind the preadipocyte-breast DCIS crosstalk might provide new targets for improving diagnosis/prognosis and for the design of innovative therapeutic strategies.

Citation Format: Kim HS, Jung M, Choi SK, Moon WK. Breast cancer promotion by IL-6-mediated cross-talk between human preadipocyte and breast dutal carcinoma in situ [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-03-09.

Comparison of contrast-enhanced CT angiography and gadolinium-enhanced MR angiography in the detection of subsegmental-sized pulmonary embolism: An experimental study in a pig model

Purpose: To compare contrast-enhanced CT angiography (CTA) and gadolinium-enhanced MR angiography (MRA) for the detection of subsegmental-sized pulmonary emboli in a pig model.

Material and Methods: In 5 anesthetized pigs, 3-mm diameter embolic materials made of Konjac, a semisolid food, were introduced through the internal jugular vein into pulmonary arteries. After embolization, CTA and MRA images were obtained. Respiration was suspended during CTA and MRA image acquisition. Two readers reviewed the CTA and MRA images to detect emboli. The pigs were sacrificed, and sliced specimens of inflated lung served as the gold standard.

Results: Thirty-six emboli were detected within peripheral arteries. The sensitivity (and 95% confidence intervals) of CTA for the two readers were 57% (39–74%) and 66% (48–81%), and 88% (69–98%) and 92% (74–94%) for MRA. The specificity of CTA was 95% (91–97%) and 98% (96–99%), and that of MRA was 85% (74–93%) and 90% (80–96%). Interobserver agreement was higher for MRA (kappa 0.898) than CTA (kappa 0.574).

Conclusion: For the detection of subsegmental pulmonary emboli, MRA was superior to CTA, with a higher sensitivity and interobserver agreement by demonstrating perfusion deficits.

Abstract P4-01-06: Microcalcifications as imaging biomarker in breast cancer: High-throughput radiogenomic analysis using microarrya data

Purpose: To investigate relationships between microcalcifications and gene expression pattern using microarray analysis in breast cancer.

Materials and methods: The institutional review board approved this retrospective study and waived the informed consent. Clinicopathologic finding, mammographic features, and gene expression data were evaluated in 133 women (mean age, 50.1 years; range, 21-79 years) with stage I-III breast cancer. Women with microcalcifications (n=33) and without microcalcifications (n=100) were compared. Immunohistochemical analysis of estrogen receptor, progesterone receptor, HER-2, and Ki-67 expression was performed. Differentially expressed genes (DEGs) using Affymetrix GeneChip® Human Gene 2.0 ST arrays (53,427 probes) were identified in tissue with microcalcifications versus without microcalcifications. In addition, genes included in the prediction analysis of PAM50, MammaPrint® and OncotypeDX® were also compared between two groups (microcalcifications versus no calcification). To further investigate the functions and underlying biology of DEGs, we performed enrichment analysis using the Gene Ontology database and pathway anlyais using the Kyoto Encyclopedia of Genes and Genomes database and Ingenuity Pathway Analysis.

Results: Among clinicopathologic varibales, HER2 positivity (p<0.001) and presence of comedo necrosis (p=0.024) are significantly higher in the calcification group. About 128 genes had differential expression (> 1.5 fold difference, adjusted p value<0.05). Among known gene signatures, GRB7 (fold change=2.26, p=0.006) and ERBB2 (fold change=2.13, p=0.001) which are known as associated with recurrence, cell invasion and poor survival were highly expressed. In contrast, ZNF385B which is associated with p53-mediated apoptosis and good prognosis was underexpressed (fold change=0.39, p=0.001) in calcification group. Significant gene ontology terms included response to wounding, coagulation, wound healing, and response to hypoxia. Network and canonical pathway analysis indicated that increased cellular movement, cellular growth and proliferation, cellular develoment, coagulation and atherosclerosis signaling in breast cancer with microcalcifications, suggesting biological aggressiveness.

Conclusion: Gene expression patterns are different according to microcalcifications status in breast cancer. Breast cancers with mammographic microcalcifications are associated with metabolic aggressiveness and poor prognosis.

Citation Format: Shin SU, Kim W, Song SE, Chu A, Han W, Moon WK. Microcalcifications as imaging biomarker in breast cancer: High-throughput radiogenomic analysis using microarrya data. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-01-06.

Role of second-look ultrasound examinations for MR-detected lesions in patients with breast cancer

PURPOSE

To assess the clinical value of second-look ultrasound (US) examination for the evaluation of additional enhancing lesions detected on magnetic resonance (MR) imaging.

MATERIALS AND METHODS

Between May 2008 and February 2011, 794 consecutive patients with histologically confirmed breast cancer underwent breast MR imaging. We included 101 patients with 132 additional enhancing breast lesions detected on MR imaging who underwent second-look US.  The imaging features and lesion category according to the Breast Imaging and Reporting and Data System (BI-RADS) were assessed with MR and US imaging, respectively.

RESULTS

According to the BI-RADS system, 67 lesions (50.8 %) were classified as category 0, 33 lesions (25.0 %) as category 3, and 32 lesions (24.2 %) as category 4. Of the 67 indeterminate lesions on MR imaging, 34 (50.7 %) were demonstrated on second-look US. 11 of these 34 lesions showed suspicious sonographic features, including 1 lesion that showed malignancy (9.1 %, 1/11). Most of the suspicious lesions on MR imaging (26 of 32 BI-RADS category 4 lesions, 81.3 %) were demonstrated on second-look US, and 17 were malignant (65.4 %, 17/26). Of the 6 BI-RADS category 4 lesions without sonographic correlation, 1 was malignant (16.7 %, 1/6).

CONCLUSION

Second-look US examination was useful for evaluating MR-detected lesions in patients with breast cancer.

Inhibitory effects of Acorus calamus extracts on mast cell-dependent anaphylactic reactions using mast cell and mouse model

ETHNOPHARMACOLOGICAL RELEVANCE

Acorus calamus Linn. (Araceae) is a traditional herbal plant used for centuries to treat various allergic symptoms including asthma and bronchitis.

AIM OF THE STUDY

The present study was focused to provide a pharmacological basis for the traditional use of Acorus calamus in allergic symptoms using the mast cell-dependent anaphylactic reactions in in vitro and in vivo models.

MATERIALS AND METHODS

Cell viabilities were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. Dinitrophenyl-human serum albumin (DNP-HSA) induced β-hexosaminidase and interleukin (IL)-4 productions in IgE-sensitized rat basophilic leukaemia (RBL-2H3) cells were measured by enzymatic assay and enzyme-linked immunosorbent assay (ELISA). Passive cutaneous anaphylaxis (PCA) reaction mouse model was implemented for in vivo studies.

RESULTS

Hot water (HW), butylene glycol (BG), hexane (HE) and steam distilled (SD) extracts of Acorus calamus showed different cytoxicity levels evaluated in RBL-2H3 cells. Sub-toxic doses of HW extract suppressed the β-hexosaminidase secretion and IL-4 production significantly and dose dependently in DNP-HSA induced IgE-sensitized RBL-2H3 cells compared to other extracts of Acorus calamus. Further, in vivo studies also revealed that the HW extract significantly inhibited the PCA reaction in mouse compared to the normal control group.

CONCLUSION

HW extract of Acorus calamus most effectively inhibited degranulation and IL-4 secretion in DNP-HSA-stimulated RBL-2H3 cells and also reduced the mast cell-mediated PCA reaction in mouse, providing a therapeutic evidence for its traditional use in ameliorating allergic reactions.

P2-09-13: The Value of FDG PET/CT in Screening Detected Breast Cancer Patients

Background. To evaluate the diagnostic value of FDG PET/CT for initial staging of screening detected breast cancer.

Methods. Between January 2008 and June 2010, a total of 77 women (mean age 54 years, range 31–77 years) with screening detected primary breast cancer (mean invasive tumor size 1.65cm, range 1–70mm) underwent whole body fluorine-18 fluorodeoxyglucose (FDG) PET/CT for initial staging and were included in this retrospective study. Two patients had bilateral breast cancer. The sensitivity of FDG PET/CT for the detection of primary tumor and the sensitivity, specificity, PPV and NPV for the detection of axillary lymph node metastases were determined. Systemic staging with whole body FDG PET/CT was also performed. For analysis of diagnostic performance of FDG PET/CT, quantitative measurement of the maximum standardized uptake value (SUVmax) criteria 1.0 was used. The final histopathology following surgery served as the gold standard.

Results. The primary tumor was FDG PET/CT positive in 65 of 79 lesions (82%). Depending on the tumor size, there was a variation in diagnostic sensitivity (63% in ≤ 1cm tumor, n=19 vs. 88% in > 1cm tumor, n=60) and the uptake of FDG was significantly higher in > 1cm tumor than in ≤ 1cm tumor (mean SUVmax 2.85 vs. 1.11, p<0.05). The uptake of FDG was significantly higher in ductal carcinomas compared to lobular carcinomas (median SUVmax 2.0, n=72 vs. 1.3, n=7, p<0.05). Of the 77 patients included in this study, 16 patients were found to have axillary node metastasis. The sensitivity, specificity, PPV and NPV of FDG PET/CT for detection of LN metastasis were 63% (10/16), 89% (54/61), 59% (10/17) and 90% (54/60), respectively. FDG PET/CT showed distant uptake in 9 patients and 8 of 9 were false positive results. 4 lesions were confirmed histopathologically as benign and 4 lesions were evaluated with radiologic methods. One of nine was true positive result. Distant involvement was skeletal and visible on the conventional bone scintigraphy. The patient staged as cT1N3M1.

Conclusion. FDG PET/CT has limited value for the initial staging of screening detected breast cancer patients. Considering high costs, radiation exposure and false positivity, FDG PET-CT is not recommended for the preoperative evaluation of screening detected breast cancer patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-09-13.

Abstract P2-09-36: Role of ABCB1 Polymorphisms as Predictive Markers in Patients with HER-2 FISH Positive Metastatic Breast Cancer Who Were Treated with Taxane Plus Trastuzumab First Line Chemotherapy

Background: ABCB1 polymorphisms could predict treatment results of taxane therapy in several malignancies. FCGR2A and FCGR3A polymorphisms were associated with clinical outcomes in several diseases after treatment with monoclonal antibody drugs which had antibody-dependent cell-mediated cytotoxicity activity. These polymorphisms could be possible predictive markers after taxane plus trastuzumab (TH) chemotherapy in patients with HER-2-positive metastatic breast cancer (MBC).

Methods: Fifty-seven patients with HER-2 FISH positive MBC who received TH chemotherapy as the 1st-line treatment were enrolled. We analyzed 5 polymorphisms using DNA from peripheral blood mononuclear cells: ABCB1 1236C>T (rs1128503), ABCB1 2677G>T/A (rs2032582), ABCB1 3435C>T (rs1045642), FCGR2A 131H/R (rs1801274), and FCGR3A 158V/F (rs396991), then correlated them to treatment results of patients.

Results: Among 57 patients, 22 patients (38.6%) received weekly paclitaxel plus trastuzumab, 26 patients (45.6%) tri-weekly paclitaxel plus trastuzumab, and 9 patients (15.8%) tri-weekly docetaxel plus trastuzumab. After a median follow-up of 30.6 (range, 0.6-75.9) months, median progression-free survival (PFS) was 15.1 (95% confidence interval (CI), 10.3-19.8) months. ABCB1 2677T allele carriers had longer PFS than the others (42.1 (95% CI, 12.7-71.4) months vs. 13.0 (95% CI, 10.6-15.4) months; p=0.037) along with a tendency toward higher response rate (RR) (86.4% vs. 76.0%; p=0.470) and longer overall survival (OS) (54.7 (95% CI, 43.0-66.4) months vs. 38.9 (95% CI, 18.1-59.7) months; p=0.057). In addition, ABCB1 3435CC genotype carriers had shorter PFS than the others (13.0 (95% CI, 10.8-15.2) months vs. 19.1 (95% CI, 0.0-38.5) months; p=0.039) along with a tendency toward lower RR (78.6% vs. 100%; p=0.567) and shorter OS (38.9 (95% CI, 19.7-58.1) months vs. 54.7 (95% CI, 43.0-66.4) months; p=0.093). ABCB1 1236C>T, FCGR2A 131H/R, and FCGR3A 158V/F were not significantly associated with RR, PFS, and OS. None of these polymorphisms were associated with any grades of hematologic or cardiac toxicities.

Conclusions: Our results support that ABCB1 2677G>T/A and 3435C>T may have predictive roles after the 1st-line TH chemotherapy in patients with HER-2-positive MBC. In contrast, ABCB1 1236C>T, FCGR2A 131H/R, and FCGR3A 158V/F could not predict response after TH treatment.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-09-36.

Computer-aided diagnosis using morphological features for classifying breast lesions on ultrasound

OBJECTIVES

To develop and evaluate a computer-aided diagnosis (CAD) system with automatic contouring and morphological analysis to aid in the classification of breast tumors using ultrasound.

METHODS

We evaluated 118 breast lesions (34 malignant and 84 benign tumors). Each tumor contour was automatically extracted from the digitized ultrasound image. Nineteen practical morphological features from the extracted contour were calculated and principal component analysis (PCA) was applied to find independent features. A support vector machine (SVM) classifier utilized the selected principal vectors to identify the breast tumor as benign or malignant. In this study, all the cases were sampled with k-fold cross-validation (k = 10) to evaluate the performance by receiver-operating characteristics (ROC) curve analysis.

RESULTS

The areas under the ROC curves for the proposed CAD systems using all morphological features and the lower-dimensional principal vector were 0.91 and 0.90, respectively. The classification ability for breast tumors using morphological information was good.

CONCLUSIONS

This system differentiates benign from malignant breast tumors well and therefore provides a clinically useful second opinion. Moreover, the morphological features are nearly setting-independent and thus available to various ultrasound machines.

Optimal clustering of kinetic patterns on malignant breast lesions: comparison between K-means clustering and three-time-points method in dynamic contrast-enhanced MRI

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is useful for breast cancer diagnosis and treatment planning. Nevertheless, due to the multi-temporal nature of DCE-MRI data, the assessment of early stage breast cancer is a challenging task. In this study, we applied an unsupervised clustering approach and cluster validation technique to the analysis of malignant intral-tumoral kinetic curves in DCE-MRI. K-means cluster analysis was performed from real world malignant tumor cases and the data were transformed into an optimal number of reference patterns representative each cluster. The optimal number of clusters was estimated by a cluster validation index, which was calculated with the ratio of inter-class scatter to intra-class scatter. This technique then classifies tumor specific patterns from a given MRI data by measuring the vector distances from the reference pattern set, and compared the result from the k-means clustering with that from three-time-points (3TP) method, which represents a clinical standard protocol for analysis of tumor kinetics. The evaluation of twenty five cases indicates that optimal k-means clustering reflects partitioning intra-tumoral kinetic patterns better than the 3TP technique. This method will greatly enhance the capability of radiologists to identify and characterize internal kinetic heterogeneity and vascular change of a tumor in breast DCE-MRI.

Parvalbumin immunoreactivity and protein content alter in the hippocampus after adrenalectomy in seizure sensitive gerbils

OBJECTIVES

Neurons containing parvalbumin (PV), a calcium-binding protein, in the hippocampus, play an important role in hippocampal excitability in epilepsy. In this study, we examined temporal and spatial changes of PV immunoreactivity and protein content in the hippocampus after adrenalectomy (ADX) in seizure sensitive (SS) gerbils, which are hereditarily seizure-prone.

METHODS

PV distribution and change in SS gerbils after ADX were examined in the hippocampal CA1 region and in the dentate gyrus (DG) using immunohistochemistry and Western blot analysis.

RESULTS

PV immunoreactivity in sham-operated SS gerbils was detected in many CA1 pyramidal cells. Three hours after ADX, PV immunoreactivity significantly decreased in CA1 pyramidal cells and thereafter PV immunoreactivity began to increase by 4 days after ADX. Four days after ADX, PV immunoreactivity was significantly higher than that in the sham-operated SS gerbils. In the DG of sham-operated SS gerbils, PV immunoreactivity was mainly detected in polymorphic cells. Three hours after ADX, PV immunoreactivity in the DG significantly decreased in the polymorphic layer. Thereafter, PV-immunoreactive neurons decreased with time after ADX. Western blot analysis showed that change in PV protein content was similar to immunohistochemical data after ADX in SS gerbils.

CONCLUSION

Our results indicate that PV is changed in hippocampus after ADX and PV may be associated with the regulation of seizure activity.

Microcalcification detection in 3-d breast ultrasound

The appearance of cluster of microcalcifications in mammography or sonography is an important indicator for malignancy. Microcalcifications are calcium deposits, which can be identified as tiny areas that are slightly brighter than surrounding tissue. Detection of mammographic microcalcification has been proposed in many studies. Since a microcalcification cluster is a three-dimensional (3-D) entity, its projection onto a two-dimensional (2-D) image results in a loss of spatial information and may also cause superimposition of individual calcifications within the cluster. This paper aims to use the 3-D ultrasound to determine microcalcifications. In each slice, the proposed method adopts the top-hat filter to find bright spots, and employs four 2-D criteria to select the spots as candidate microcalcifications. Finally, spots appearing in sequent slices at the same position are considered as a microcalcification. We suggest using a computer automatically to detect the microcalcification being feasible and microcalcifications being a very important criterion of malignancy on future developing the computer-aided diagnosis for ultrasound. In the future, this technique can be adopted in a computer-aided diagnosis system combined with other diagnosis features for improving the diagnosis performance.

Coenzyme Q_{10} effects on manganese superoxide dismutase and glutathione peroxidase in the hairless mouse skin induced by ultraviolet B irradiation

Coenzyme Q_{10} (CoQ_{10}) is a naturally occurring antioxidant and a prominent component of mitochondrial electron transport chain. In the present study, we investigated the effect of CoQ_{10} nanoparticle against photoaging using immunohistochemistry and Western blot analysis in the hairless mouse skin induced by ultraviolet B (UVB) irradiation (300 mJ/cm;{2}, 3 min/day for 21 days). In the UVB-irradiated distilled water (DW)-treated group, manganese superoxide dismutase (SOD2) and glutathione peroxidase (GPx) immunoreactivity and their protein levels in the skin were significantly lower than those in the control group. However, SOD2 and GPx immunoreactivity and their protein levels in the skin of the UVB-irradiated CoQ_{10}-treated group were higher than those in the UVB-irradiated DW-treated group. GPx activity in the skin in the UVB-irradiated DW-treated group significantly decreased compared to that in the control group; whereas GPx activity in the UVB-irradiated CoQ_{10}-treated group was similar to that in the control group. These results suggest that CoQ_{10} strongly inhibits oxidative stress in the skin induced by UVB via increasing SOD2 and GPx.

Neuroprotective effects of roasted licorice, not raw form, on neuronal injury in gerbil hippocampus after transient forebrain ischemia

AIM

To observe neuroprotective effects of raw and roasted licorice against hypoxia and ischemic damage.

METHODS

When elucidating the protective effects of raw and roasted licorice, we analyzed the lactate dehydrogenase (LDH) release using PC12 cells after hypoxia in an in vitro study and after transient forebrain ischemia in an in vivo study on Mongolian gerbils.

RESULTS

Raw and roasted licorice significantly reduced LDH release from PC12 cells exposed to an hypoxic chamber for 1 h. In the roasted licorice-treated group, the decrease of LDH release was more pronounced compared to that of the raw licorice-treated group. In roasted licorice-treated animals, approximately 66%-71% of CA1 pyramidal cells in the ischemic hippocampus were stained with cresyl violet compared to the control group. However, in the raw licorice-treated animals, no significant neuroprotection against ischemic damage was shown. In addition, ischemic animals in roasted licorice-treated group maintained the Cu, Zn-superoxide dismutase (SOD1) activity and protein levels compared to the control group, while in raw licorice-treated group SOD1 activity and protein levels were reduced significantly. High pressure liquid chromatography analysis showed that non-polar compounds containing glycyrrhizin-degraded products, such as glycyrrhetinic acid (GA) and glycyrrhetinic acid monoglucuronide (GM), were increased in roasted licorice.

CONCLUSION

Roasted licorice had neuroprotective effects against ischemic damage by maintaining the SOD1 levels. In addition, the difference in protective ability between raw and roasted licorice may be associated with non-polar compounds, such as GA and GM.

Effects of supplementation of β-glucans on growth performance, nutrient digestibility, and immunity in weanling pigs

Two experiments were conducted to evaluate the efficacy of beta-glucan on growth performance, nutrient digestibility, and immunity in weanling pigs. In Exp. 1, 210 weanling pigs (6.38 +/- 0.92 kg of BW) were fed dietary beta-glucan (0, 0.01, 0.02, 0.03, or 0.04%) for 5 wk. In Exp. 2, 168 pigs (6.18 +/- 1.31 kg of BW) were fed no beta-glucan or antibiotics (T1), 0.02% beta-glucan (T2), only antibiotics (T3), or 0.02% beta-glucan with antibiotics (T4) for 8 wk. In Exp. 2, the antibiotics fed were apramycin and carbadox in phase I (0 to 2 wk) and carbadox and chlortetracycline in phase II (3 to 8 wk). During Exp. 2, the performance study was conducted for 5 wk, and the immune response was tested until 8 wk. In Exp. 1, there was a trend for a linear increase (P = 0.068) in ADG as the dietary beta-glucan concentration increased in the diet. The digestibilities of DM, GE, CP, ether extract, Ca, and P increased linearly (P < 0.05) in the beta-glucan-supplemented pigs. In Exp. 2, the overall ADG was greater (P < 0.05) in treatment T4 compared with the control group (T1). Also, except for P, this group showed greater (P < 0.05) nutrient digestibilities than the control group. In Exp. 2, at d 15, 24, and 46 antibody titers were measured by ELISA against Pasteurella multocida type A and D after vaccination with atrophic rhinitis, and they differed significantly (P < 0.05) with no particular trend. Flow cytometry was used to determine porcine lymphocyte subpopulations at 4 and 8 wk of Exp. 2. There was an increase in CD4 cells (P < 0.05) and a trend for an increase in CD8 cells (P < 0.10) at 8 wk in pigs fed the T2 diet compared with the other groups. Overall, increasing the dietary concentrations of beta-glucan did not improve ADG without antibiotic, and in weanling pigs antibiotics seem to be more effective in improving nutrient digestibilities and growth performance than beta-glucan.

Image retrieval with principal component analysis for breast cancer diagnosis on various ultrasonic systems

OBJECTIVES

We present a computer-aided diagnostic (CAD) system with textural features and image retrieval strategies for classifying benign and malignant breast tumors on various ultrasonic systems. Effective applications of CAD have used different types of texture analysis. Nevertheless, most approaches performed in a specific ultrasonic machine do not indicate whether the technique functions satisfactorily for other ultrasonic systems. This study evaluated a series of pathologically proven breast tumors using various ultrasonic systems.

METHODS

Altogether, 600 ultrasound images of solid breast nodules comprising 230 malignant and 370 benign tumors were investigated. All ultrasound images were acquired from four diverse ultrasonic systems. The suspicious tumor area in the ultrasound image was manually chosen as the region-of-interest (ROI) subimage. Textural features extracted from the ROI subimage are supported in classifying the breast tumor as benign or malignant. However, the textural feature always behaves as a high-dimensional vector. In practice, high-dimensional vectors are unsatisfactory at differentiating breast tumors. This study applied the principal component analysis (PCA) to project the original textural features into a lower dimensional principal vector that summarized the original textural information. The image retrieval techniques were employed to differentiate breast tumors, according to the similarities of the principal vectors. The query ROI subimages were identified as malignant or benign tumors according to characteristics of retrieved images from the ultrasound image database.

RESULTS

Using the proposed CAD system, historical cases could be directly added into the database without a retraining program. The area under the receiver-operating characteristics curve for the system was 0.970+/-0.006.

CONCLUSION

The CAD system identified solid breast nodules with comparatively high accuracy in the different ultrasound systems investigated.

Effects of supplementation of beta-glucan on the growth performance and immunity in broilers

Two experiments were conducted to evaluate the efficacy of beta-glucan on commercial broilers. In experiment 1, one hundred and forty-four broiler chicks were employed in a 2x3 factorial design with cage and open floor housing with three levels of beta-glucan viz. 0%, 0.02% and 0.04%. In experiment 2, ninety-six broilers were used with 4 treatments: No beta-glucan and antibiotic (T1), beta-glucan 0.03% (T2), antibiotic (T3), and beta-glucan 0.03% + antibiotic (T4) for 34 d with 3 replicates of 8 chicks each in both studies. During experiment 1 there was no significant effect of the feeding system or the beta-glucan levels on the performance from 0 to 17 d but during 18-34 days birds housed on the open floor had significantly (p<0.0001) higher weight gain compared with those in cages. In experiment 2, no significant effect was noticed on the weight gains when the effect of beta-glucan, antibiotic or their interaction were tested. The retention of dry matter increased in both experiments with beta-glucan supplementation. The CD8 and TCR 1 cells were significantly higher in the 0.04% beta-glucan group at 42 days as compared with the control. It could be concluded that beta-glucan supplementation was beneficial for broilers.

Seizure-induced changes of mineralocorticoid and glucocorticoid receptors in the hippocampus in seizure sensitive gerbils

Abnormal corticosteroid hormone levels during stress and resultant mineralocorticoid receptor (MR)/glucocorticoid receptor (GR) imbalance enhance the vulnerability of specific hippocampal neurons. In the present study, we investigated the distribution of MR and GR in seizure resistant (SR) and seizure sensitive (SS) gerbils, and observed the seizure-induced changes of MR and GR in the hippocampus of SS gerbils using immunohistochemistry and western blot analysis. MR and GR immunoreactivities were higher in the SS pre-seizure gerbils than that in SR gerbils. In the SR gerbils, the immunodensity of GR was high compared to that of MR. The changes of MR and GR immunoreactivities were significant in the stratum pyramidale of the hippocampal CA1 region and the infrablade of the dentate gyrus after seizure on-set. MR immunoreactivity in the CA1 region was significantly increased at 12h after seizure on-set, thereafter MR immunoreactivity was decreased. MR immunoreactivity in the dentate gyrus was decreased time-dependently after seizure on-set. GR immunoreactivity was decreased in the CA1 region and dentate gyrus time-dependently after seizure on-set. At 12h after seizure on-set, differences in MR and GR immunodensity diminished in the CA1 region and dentate gyrus. This imbalance of MR and GR immunoreactivity in these regions may be associated with seizure generation in the Mongolian gerbil, which is a hereditary seizure model.

Antiviral effect of Saccharomyces cerevisiae beta-glucan to swine influenza virus by increased production of interferon-gamma and nitric oxide

The aim of these experiments was to investigate the potential antiviral effect of Saccharomyces cerevisiae beta-glucan on the pneumonia induced by swine influenza virus (SIV). Forty colostrum-deprived 5-day-old piglets were randomly divided into four groups of 10. The 20 pigs in groups 1 and 2 were administered Saccharomyces cerevisiae beta-glucan orally (50 mg/day/pig; En-Bio Technology Co., Ltd) for 3 days before SIV infection and those in groups 3 and 4 were given culture medium/diluent alone. Groups 1 and 3 were inoculated intranasally with 3 ml of tissue culture fluid containing 2 x 10(6) tissue culture infective doses 50% (TCID(50))/ml of SIV and those in groups 2 and 4 were exposed in the same manner to uninfected cell culture supernatant. The microscopic lung lesions induced by SIV infection (group 1 pigs) were significantly more severe than those induced by infection in animals pre-administered beta-glucan (group 3) (P < 0.05). Significantly more SIV nucleic acid was detected in the lungs of pigs experimentally infected with SIV only (group 1) at 5, 7 and 10 days post-inoculation (dpi) compared with lungs from pigs pre-administered beta-glucan and infected with SIV (group 3) (P < 0.05). The concentrations of interferon-gamma (IFN-gamma) and nitric oxide (NO) in bronchoalveolar lavage fluid from pigs pre-administered beta-glucan and infected with SIV (group 3) were significantly higher than for any other group at 7 and 10 dpi for IFN-gamma, and at 5, 7 and 10 dpi for NO (P < 0.05). Saccharomyces cerevisiae beta-glucan reduced the pulmonary lesion score and viral replication rate in SIV-infected pigs. These findings support the potential application of beta-glucan as prophylactic/treatment agent in influenza virus infection.

Comparison of contrast-enhanced ct angiography and gadolinium-enhanced MR angiography in the detection of subsegmental-sized pulmonary embolism. An experimental study in a pig model

PURPOSE

To compare contrast-enhanced CT angiography (CTA) and gadolinium-enhanced MR angiography (MRA) for the detection of subsegmental-sized pulmonary emboli in a pig model.

MATERIAL AND METHODS

In 5 anesthetized pigs, 3-mm diameter embolic materials made of Konjac, a semisolid food, were introduced through the internal jugular vein into pulmonary arteries. After embolization, CTA and MRA images were obtained. Respiration was suspended during CTA and MRA image acquisition. Two readers reviewed the CTA and MRA images to detect emboli. The pigs were sacrificed, and sliced specimens of inflated lung served as the gold standard.

RESULTS

Thirty-six emboli were detected within peripheral arteries. The sensitivity (and 95% confidence intervals) of CTA for the two readers were 57% (39-74%) and 66% (48-81%), and 88% (69-98%) and 92% (74-94%) for MRA. The specificity of CTA was 95% (91-97%) and 98% (96-99%), and that of MRA was 85% (74-93%) and 90% (80-96%). Interobserver agreement was higher for MRA (kappa 0.898) than CTA (kappa 0.574).

CONCLUSION

For the detection of subsegmental pulmonary emboli, MRA was superior to CTA, with a higher sensitivity and interobserver agreement by demonstrating perfusion deficits.

Fluorodeoxyglucose positron emission tomography for detection of recurrent or metastatic breast cancer

Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a noninvasive imaging technique capable of identifying primary tumors and metastases with high sensitivity and accuracy. The aim of this study was to evaluate the diagnostic accuracy of whole-body FDG-PET imaging for the detection of recurrent or metastatic breast cancer after surgery. Whole-body FDG-PET imaging was performed on 27 patients with suspected recurrent breast carcinoma. PET images were evaluated qualitatively for each patient and lesion. FDG-PET scans showed that there were 61 reference sites of malignant or benign lesions in 27 patients. In a patient-based analysis, FDG-PET scans correctly identified 16 of 17 patients with recurrent or metastatic disease and 8 of 10 without recurrence, resulting in a sensitivity, specificity, and accuracy of 94%, 80%, and 89%, respectively. In a lesion-based analysis, FDG-PET scans correctly identified 46 of 48 lesion sites with recurrent or metastatic disease and 11 of 13 without recurrence. The overall sensitivity, specificity, and accuracy for all lesion sites were 96%, 85%, and 93%, respectively. FDG-PET scans revealed unsuspected recurrent or metastatic diseases in 8 of 27 (30%) of patients and 11 of 20 (55%) distant metastatic lesions. In 13 patients treatment was altered by the outcome of the PET scan. We concluded that whole-body FDG-PET scan is a useful diagnostic imaging modality for detecting recurrent or metastatic breast carcinoma in patients suspected of having recurrent disease after primary surgery.

US of mammographically detected clustered microcalcifications

PURPOSE

To determine whether ultrasonography (US) can depict breast masses associated with mammographically detected clustered microcalcifications and whether the visibility at US is different between benign and malignant lesions.

MATERIALS AND METHODS

Ninety-four patients with 100 mammographically detected microcalcification clusters prospectively underwent US with a 10- or 12-MHz transducer before mammographically guided presurgical hook-wire localization. The visibility of breast masses at US was correlated with histologic and mammographic findings.

RESULTS

Surgical biopsy revealed 62 benign lesions, 30 intraductal cancers, and eight invasive cancers. At US, breast masses associated with microcalcifications were seen in 45 (45%) of 100 cases. US depicted more breast masses associated with malignant (31 [82%] of 38) than with benign (14 [23%] of 62) microcalcifications (P: <.001). In malignant microcalcification clusters larger than 10 mm, US depicted associated breast masses in all 25 cases. There was no statistically significant difference in shape and distribution of calcific particles, as well as in breast composition, at mammography between US visible and invisible groups.

CONCLUSION

Given a known mammographic location, US with a high-frequency transducer can depict breast masses associated with malignant microcalcifications, particularly clusters larger than 10 mm. US can be used to visualize large clusters of microcalcifications that have a very high suspicion of malignancy.

Nonpalpable breast lesions: evaluation with power Doppler US and a microbubble contrast agent-initial experience

PURPOSE

To evaluate power Doppler ultrasonography (US) performed with a microbubble US contrast agent in the differentiation of nonpalpable breast lesions.

MATERIALS AND METHODS

Fifty nonpalpable breast lesions in 50 patients were prospectively evaluated with power Doppler US before and after injection of the contrast agent SH U 508A. Lesion vascularity and the morphology of vessels on US scans were analyzed and were correlated with histologic results.

RESULTS

Surgical excision revealed 22 cancers and 28 benign lesions. At nonenhanced power Doppler US, eight (36%) of 22 cancers and four (14%) of 28 benign lesions were vascular. At contrast agent-enhanced power Doppler US, 21 (95%) cancers and six (21%) benign lesions were vascular (P <.001). Irregular vessels were seen in three cancers and one benign lesion at nonenhanced power Doppler US and in 11 cancers and one benign lesion at contrast-enhanced power Doppler US. By using the presence of vascularity in the mass as the diagnostic criterion for malignancy, the sensitivity, specificity, and positive and negative predictive values of power Doppler US changed from 36%, 86%, 67%, and 63%, respectively, to 95%, 79%, 78%, and 96% after contrast agent injection.

CONCLUSION

Contrast-enhanced power Doppler US was superior to nonenhanced power Doppler US in the demonstration and characterization of tumor vascularity in nonpalpable breast lesions. Contrast-enhanced power Doppler US may be useful for the differentiation between nonpalpable breast cancers and benign tumors.

Dynamic contrast-enhanced MR imaging of bacterial abscess and VX2 carcinoma in rabbits: comparison of gadopentetate dimeglumine and a macromolecular contrast agent

OBJECTIVE

The objective of this study was to compare enhancement patterns of a blood-pool contrast agent, Gadomer-17, with those of gadopentetate dimeglumine in bacterial abscesses and VX2 carcinoma in rabbits.

MATERIALS AND METHODS

Fourteen rabbits with experimentally induced bacterial abscesses and VX2 carcinoma in both thighs underwent dynamic contrast-enhanced MR imaging with Gadomer-17 and gadopentetate dimeglumine at a 24-hr interval. The enhancement ratios (postcontrast to precontrast signal intensities) of lesions in the same animal were assessed and correlated with microvessel density.

RESULTS

For Gadomer-17, the enhancement ratio of the abscesses (1.66 +/- 0.39) peaked 15 min after the injection, while that of the carcinoma (2.05 +/- 0.16) peaked at 10 min. The enhancement ratios of the carcinoma were consistently higher than those of the abscesses up to 30 min. For gadopentetate dimeglumine, peak enhancement ratio of the abscesses (2.30 +/- 0.75) was seen 5 min after the injection, while that of the carcinoma (2.32 +/- 0.51) was seen at 3 min. The enhancement ratios of the carcinomas were significantly higher at 1 min, but significantly lower at 20-30 min, compared with those of the abscesses, as a result of rapid decrease of enhancement ratios in the carcinomas. The microvessel density was 9.8 +/- 5.2 vessels per field of view for the abscesses and 36.3 +/- 9.5 vessels per field of view for the carcinoma (p < 0.001).

CONCLUSION

Delayed peak enhancement and slow decay were found in both bacterial abscess and VX2 carcinoma with Gadomer-17, whereas early peak enhancement and rapid decay were found especially in VX2 carcinoma with gadopentetate dimeglumine. Enhancement ratios on MR imaging with a blood-pool contrast agent correlated well with the microvessel density in bacterial abscess and VX2 carcinoma.

Metaplastic carcinoma of the breast: mammographic and sonographic findings

PURPOSE

We investigated the mammographic, sonographic, and pathologic findings in metaplastic carcinoma of the breast.

METHODS

The mammographic (n = 16) and sonographic (n = 11) findings in 16 patients with metaplastic carcinoma of the breast were analyzed retrospectively along with pathologic findings. Whenever possible, results of preoperative fine-needle aspiration biopsy and immunohistochemical studies were obtained.

RESULTS

All patients presented with a palpable breast mass. The mean size of the lesions at pathologic examination was 4.2 cm. On mammography, 15 patients had a mass (1 patient had 2 masses), and 1 patient had only clustered microcalcifications without an associated mass. The mean longest diameter of the 16 masses on mammography was 4.6 cm. Eleven lesions (69%) were round to ovoid in shape, 13 lesions (81%) showed ill-defined or obscured margins, and 10 lesions (63%) showed associated architectural distortion. On sonography, 6 (55%) of 11 lesions were round to ovoid, 9 lesions (82%) had well-defined margins, and 6 lesions (55%) showed complex echogenicity with solid and cystic components. At pathologic examination, 4 of these 6 lesions showed hemorrhagic or cystic necrosis. Axillary lymph nodes were positive in 6 (40%) of 15 patients in whom axillary node dissection was performed.

CONCLUSIONS

Metaplastic carcinoma of the breast manifests as a rapidly growing, mammographically ill-defined round mass with associated architectural distortion on mammograms. Complex echogenicity with solid and cystic components may be seen sonographically and is related to hemorrhagic or cystic necrosis seen pathologically.

Metastatic tumors to the breast: mammographic and ultrasonographic findings

We evaluated the mammographic (n = 16) and ultrasonographic (n = 15) findings of 18 patients with metastatic breast carcinoma. Fifteen patients showed multiple or diffuse lesions and three patients showed single lesions. Ten patients (55.6%) had bilateral lesions. Mammography revealed high density (15 cases, 93.8%), round to oval (11 cases, 68.8%) lesions with poorly defined or obscured margins (12 cases, 75.0%). No associated calcification was found in any lesion. Ultrasonographically, poorly defined (8 cases, 53.3%), irregularly shaped (8 cases, 53.3%), hypoechoic (14 cases, 93.3%), heterogeneous (8 cases, 53.3%) lesions were predominantly distributed superficially (11 cases, 73.3%). Axillary lymphadenopathy was detected in six patients (33.3%). The longest diameter of most of the lesions was less than 2.0 cm (13 cases, 81.3%). We conclude that metastatic tumors to the breast appear as relatively small, superficially located, poorly defined, irregular nodules without calcification on mammography and ultrasonography. However, when the metastatic lesion is diffuse, the appearance is indistinguishable from that of inflammatory breast carcinoma.

Metallic punctate densities in the breast after Chinese herbal treatment: mammographic findings

PURPOSE

To describe the mammographic features of metallic punctate densities seen in women who were treated with the herb go-yak for breast abscess and to explain the cause of these findings.

MATERIALS AND METHODS

Mammograms showing metallic punctate densities that appeared to be microcalcifications in 34 women were analyzed retrospectively with attention to the location, shape, distribution, and depth of the lesions. In all patients, go-yak was applied into the open wound after abscess drainage 6-42 years before mammography. In six patients, histopathologic specimens were obtained after needle localization.

RESULTS

Metallic densities were in the subareolar or central breast in 24 (71%) of 34 patients. The shape was predominantly round or punctate in all patients, but rod-shaped or linear lesions were found in seven patients. The distribution and depth of lesions were variable, but they extended to the subcutaneous fat in 29 patients (85%). A high concentration of lead was found in the histopathologic specimens and herb samples.

CONCLUSION

Lead deposits associated with go-yak treatment should be included in the differential diagnosis when the suspected microcalcifications are of unusually high density, are central in location, and extend into the subcutaneous fat in Asian women with a history of breast abscess.

An application of polarized domains in ferroelectric thin films using scanning probe microscope

The feasibility of utilizing PZT films as future data storage media was investigated using a modified AFM. Applying voltages between a conductive AFM tip and the PZT films causes the switching of ferroelectric domains. The domains are observed using an EFM imaging technique. The experimental results and calculations revealed that the electrostatic force generated between the polarized area and the tip is a main contributor for the imaging of the polarized domains. The written features on ferroelectric films were less than 100 nm in diameter, implying the possibility of realizing data storage devices with ultra-high area density. The disappearance of the polarized images without any applied voltage was observed, which is a drawback in this application of PZT thin films.

Detection of cancer in augmented breasts by positron emission tomography

OBJECTIVE

To assess the diagnostic efficiency of positron emission tomography with 18-fluorine fluorodeoxyglucose in detecting breast cancer in augmented breasts.

DESIGN

Retrospective study.

SETTING

University hospital, Korea.

SUBJECT

9 cases or 8 patients with breasts augmented with paraffin or silicone.

INTERVENTION

FDG-PET, mammography, and ultrasonography

RESULTS

The mammogram detected the breast cancer in only 1 of 3 patients, and ultrasonography gave a false positive result in 1 patient with an augmented breast. In contrast, PET predicted all the cancers and 5/6 benign lesions. 2/3 breast cancers had axillary FDG uptake interpreted as showing metastatic involvement, and in 1 case with cancer with no axillary lymph node involvement there was no FDG uptake in the axilla, which correlated with the pathological finding.

CONCLUSIONS

Although the high cost of PET makes its use as a screening test for all patients with augmented breasts unrealistic, it would be the best diagnostic choice if other methods failed.

Granulomatous mastitis: mammographic and sonographic appearances

OBJECTIVE

The objective of our study is to describe the mammographic and sonographic appearances of granulomatous mastitis.

CONCLUSION

Granulomatous mastitis can mimic breast carcinoma clinically and mammographically, but the sonographic appearance of multiple clustered, often contiguous tubular hypoechoic lesions that are sometimes associated with a large hypoechoic mass should suggest the possibility of granulomatous mastitis.

Right paratracheal air cysts in the thoracic inlet: clinical and radiologic significance

OBJECTIVE

The purpose of our study was to determine the CT appearance and clinical significance of a right paratracheal air cyst at the level of the thoracic inlet.

MATERIALS AND METHODS

Sixty-five consecutive patients with paratracheal air cysts were included in this study. The location, level, size, and shape of the paratracheal air cysts on CT were analyzed. The spirometric data, tracheal indexes, and CT-determined emphysema scores of these patients were compared with those of 60 consecutive patients in a control group.

RESULTS

The air cysts were located at the right posterolateral aspect of the trachea in 64 (98%) of 65 patients and at T1-T2 vertebral levels in 57 (88%) of 65 patients. The mean diameter of the right paratracheal cysts was 10 mm in the axial plane and 14 mm in the vertical plane. CT showed a communicating channel with the trachea in five patients. The ratio of forced expiratory volume obtained in 1 sec to forced vital capacity, and forced expiratory flow between 25% and 75% of vital capacity in patients with paratracheal air cysts, were significantly lower than those of the control group (p < .05). Differences in the tracheal indexes and CT-determined emphysema scores between the study group and the control group were found to be statistically significant (p = .001).

CONCLUSION

The most probable nature of a right paratracheal cyst in the thoracic inlet is tracheal diverticulum with a narrow stalk. The presence of a right paratracheal air cyst on CT could be a sign of obstructive lung disease clinically and of the presence of emphysema radiologically.

Complicated pleural tuberculosis in children: CT evaluation

PURPOSE

To describe the CT features of complicated pleural tuberculosis in children and to define the use of CT in children with pleural tuberculosis.

MATERIALS AND METHODS

The CT findings in 11 children with complicated pleural tuberculosis were retrospectively analysed. CT was performed to evaluate persistent pleural thickening (n = 6) or a mass-like lesion (n = 5) detected on plain radiographs. Chest radiographs and medical records were reviewed to determine whether additional information provided by CT had altered clinical management.

RESULTS

On CT, more than one location was involved in five patients (45%) and in two patients (18%) the entire pleural spaces were involved. Pleural thickening was seen in all 11 patients and enhancement after administration of contrast medium occurred in ten patients (91%). Low-density fluid collections were seen in nine patients (82%) and in two, CT revealed fluid collections within calcified pleural lesions. In five patients with mass-like lesions on plain radiographs, CT showed a low-density pleural mass with peripheral enhancement in four and a calcified pleural mass with fluid collection in one. CT demonstrated parenchymal abnormalities on the same side as pleural lesions in all 11 patients and hilar or mediastinal adenopathy in four. Four patients (36%) underwent surgery because of fluid within a calcified fibrothorax (n = 3) and chest wall tuberculosis (n = 1) that were seen only on CT.

CONCLUSIONS

The CT features of complicated pleural tuberculosis in children were pleural thickening, enhancement and fluid collection with associated parenchymal abnormalities and lymphadenopathy. In the evaluation of children with pleural tuberculosis, CT can be useful for demonstrating fluid within a calcified fibrothorax or chest wall involvement, which usually requires surgical intervention.

Intracranial germinomas: correlation of imaging findings with tumor response to radiation therapy

OBJECTIVE

The purpose of this study was to correlate imaging characteristics of intracranial germinomas with response to radiation therapy.

MATERIALS AND METHODS

Using tumor size at the completion of irradiation, we classified 23 patients with histologically proven germinomas in the pineal gland (n = 6), the suprasellar region (n = 7), and the basal ganglia (n = 10) into two groups: excellent response group (n = 14) and good response group (n = 9). Excellent response was defined as complete resolution or residual tumor less than 1.0 cm in diameter, and good response was defined as residual tumor of 1.0-3.0 cm in diameter. CT (n = 53) and MR (n = 32) images obtained before, during, and after radiation therapy were retrospectively analyzed with particular attention to the location, size, presence of cystic change, and CSF seeding of the tumors.

RESULTS

In all 23 patients, the tumors decreased 85-100% in size at the completion of irradiation with 40-56 Gy. A significant factor in the different responses to irradiation between patients in the excellent and good response groups was cystic change of the tumor. Tumors with cystic components responded more slowly and had larger residual lesions than did tumors without cystic components (p < .01). In eight of 12 cystic tumors, the cystic portion of the tumor responded more slowly than did the solid portion and remained visible on imaging 6-12 months after irradiation. We found no significant differences between the two groups in location, size, and CSF seeding of tumors. In 12 patients with residual lesions at the completion of irradiation, the tumors proceeded to resolve after completion of treatment.

CONCLUSION

In our study, tumor response to radiation therapy correlated negatively with the presence of a cystic region.

Mediastinal tuberculous lymphadenitis: CT findings of active and inactive disease

OBJECTIVE

The purpose of this study was to analyze CT findings of active and inactive disease in patients with mediastinal tuberculous lymphadenitis.

MATERIALS AND METHODS

Using biopsy and culture results, we categorized 49 consecutive patients with mediastinal tuberculous lymphadenitis studied with CT scans as patients with active disease (n = 37) or patients with inactive disease (n = 12). Follow-up CT scans were obtained after antituberculous therapy in 25 patients with active disease and three patients with inactive disease. In 10 patients (seven with active disease and three with inactive disease), CT findings were analyzed and correlated with pathologic findings.

RESULTS

In all 37 patients with active disease, the nodes (n = 151) varied in size (1.5-6.7 cm; mean, 2.8 +/- 1.0 cm) and had central low attenuation and peripheral rim enhancement. Calcifications within the nodes were seen in seven patients (19%). In the 12 patients with inactive disease, the nodes (n = 34) varied in size (1.0-4.7 cm; mean, 2.1 +/- 1.0 cm) but were usually smaller than nodes in patients with active disease. In the patients with inactive disease, the diseased nodes were homogeneous and without low-attenuation areas. Calcifications within the nodes were seen in 10 (83%) of the 12 patients with inactive disease. Low-attenuation areas within the nodes corresponded pathologically to areas of caseation necrosis in seven patients with active disease and in no patients with inactive disease. After treatment, enlarged mediastinal nodes in patients with active disease shrunk and low-attenuation areas within the nodes disappeared in all 25 patients. However, the findings of calcified nodes in the three patients with inactive disease did not change after 6 months of follow-up.

CONCLUSION

In these 49 patients with mediastinal tuberculous lymphadenitis, CT findings of nodes with central low attenuation and peripheral rim enhancement suggested active disease, and findings of homogeneous and calcified nodes suggested inactive disease. Low-attenuation areas within the nodes had pathologic correspondence to areas of caseation necrosis and may be a reliable indicator for disease activity.

Tuberculosis of the central airways: CT findings of active and fibrotic disease

OBJECTIVE

Management of patients with central airways tuberculosis differs according to the activity of the disease. The purpose of this study was to analyze CT findings of active and fibrotic disease in patients with central airways tuberculosis.

MATERIALS AND METHODS

According to bronchoscopic findings and biopsy results, 41 patients with tuberculosis of the trachea and main bronchi were categorized as having active disease (n = 30) or fibrotic disease (n = 11). Follow-up CT scans were obtained after antituberculous therapy in 11 patients with active disease and two patients with fibrotic disease. All CT scans were retrospectively analyzed with particular attention to the locations of airway lesions, patterns of luminal narrowing, wall thickening of diseased airways, and presence of abnormal adjacent lymph nodes.

RESULTS

Active disease in 30 patients involved the trachea (n = 20), the right main bronchus (n = 14), or the left main bronchus (n = 13). Seventeen patients had multiple lesions. On CT scans, these airways showed irregular (n = 24) or smooth (n = 4) narrowing in 28 patients: minimal (n = 5) or marked (n = 18) wall thickening with contrast enhancement in 23 patients: and obstruction with peribronchial cuffing in nine patients. Enlarged mediastinal lymph nodes were seen in 26 patients. Fibrotic disease in 11 patients involved the trachea (n = 6), the right main bronchus (n = 2), or the left main bronchus (n = 9). Six patients had multiple lesions. On CT scans, the airways showed smooth (n = 7) or irregular (n = 2) narrowing without (n = 5) or with minimal (n = 4) wall thickening in nine patients and obstruction without peribronchial cuffing in four patients. On follow-up CT scans, the findings for the airway lesions were almost normal in nine patients who had had initial active disease. However, the findings for airway narrowing did not change in two patients with fibrotic disease after 6 months of follow-up.

CONCLUSION

Principal CT findings in our patients depended on disease stage. Central airways narrowing was seen in both active and fibrotic stages. However, in patients with active disease, CT scans showed irregular and thick-walled airways, a pattern that was reversible, whereas patients with fibrotic disease generally had smooth narrowing of airways and minimal wall thickening, a pattern that was not reversible during the follow-up period.

Chronic mesenteric ischemia: use of in vivo MR imaging measurements of blood oxygen saturation in the superior mesenteric vein for diagnosis

PURPOSE

To determine if dogs and humans with chronic mesenteric ischemia demonstrate a decrease in the percentage of oxygenated hemoglobin (%HbO2) in the superior mesenteric vein (SMV) after a meal.

MATERIALS AND METHODS

In 10 dogs, ameroid rings were surgically implanted around the superior mesenteric arteries to create gradual stenosis. Pre- and postoperative angiograms and pre- and postprandial magnetic resonance (MR) oximetry measurements of the SMV %HbO2, with flow-independent T2 measurements of venous blood, were obtained at different times. In 10 patients with atherosclerotic disease and six patients with symptomatic chronic mesenteric ischemia, the same measurements were obtained after at least 6 hours of fasting and at 15, 35, and 45 minutes after ingestion of a liquid nutritional supplement.

RESULTS

In seven dogs, the postprandial SMV %HbO2 increased an average of 2.5% +/- 0.8 before surgery and decreased an average of 6.3% +/- 2.1 when hemodynamically significant (>70%) stenosis of the superior mesenteric artery developed 7-14 days after surgery. In the 10 patients without ischemia, the SMV %HbO2 increased by 4.6% +/- 0.6, whereas in the symptomatic patients a postprandial decrease of 8.8% +/- 0.7 occurred (P < .0001).

CONCLUSION

Measurement of the SMV %HbO2 with MR oximetry is a promising test for diagnosis of chronic mesenteric ischemia.

Pulmonary tuberculosis in children: evaluation with CT

OBJECTIVE

The purpose of our study was to describe the CT findings of pulmonary tuberculosis in children and to define indications for the use of CT.

MATERIALS AND METHODS

CT findings in 41 consecutive children with confirmed tuberculosis were retrospectively analyzed by two radiologists. Chest radiographs and medical records were also reviewed to determine whether additional information provided by CT scans had altered clinical management of the disease.

RESULTS

Mediastinal and hilar lymphadenopathy was seen in 34 patients (83%). In 29 of these patients, enlarged nodes had low-attenuation centers and enhancing rims. In the five other patients, enlarged nodes had calcification. Segmental (n = 12) or lobar (n = 8) air space consolidation was seen in 20 patients (49%), nodules of bronchogenic spread were seen in 12 patients (29%), and miliary nodules were seen in seven patients (17%). Bronchial (n = 15), pleural (n = 7), pericardiac (n = 1), or chest wall (n = 1) complications of tuberculosis were seen in 22 patients (54%). In eight (20%) of 41 patients, a diagnosis of tuberculosis was suggested only on CT scans, which revealed low-attenuation nodes with rim enhancement, calcifications, and nodules of bronchogenic spread or miliary nodules. These findings were not seen on chest radiographs. In 15 patients (37%), CT scans provided information that altered clinical management. Also two of these patients underwent surgery because of pleural and chest wall complications that were seen only on CT scans.

CONCLUSION

Mediastinal or hilar lymphadenopathy revealed as low-attenuation nodes with rim enhancement or calcification was the most characteristic CT finding of pulmonary tuberculosis in children. CT can be useful when tuberculosis or its complications are suspected in children and the radiographic findings are normal or inconclusive.

CT and MR imaging of head and neck tuberculosis

Tuberculosis of the head and neck can involve the cervical lymph nodes, larynx, temporal bone, sinonasal cavity, eye, pharynx, thyroid gland, and skull base. Although computed tomography (CT) and magnetic resonance (MR) imaging can accurately demonstrate the sites, pattern, and extent of the disease, both modalities have limitations in the evaluation of head and neck tuberculosis. Imaging and clinical features of head and neck tuberculosis are often varied and nonspecific and frequently mistaken for those of carcinoma. However, tuberculous lymphadenitis is often characterized by areas of low attenuation or low signal intensity with rim enhancement or calcification, and laryngeal tuberculosis usually manifests as a diffuse bilateral lesion with or without a focal mass. A thorough knowledge of head and neck tuberculosis is important because early diagnosis and therapy may prevent a permanent loss of function or needless surgery.

Diminished postprandial hyperemia in patients with aortic and mesenteric arterial occlusive disease. Quantification by magnetic resonance flow imaging

BACKGROUND

Superior mesenteric blood flow in the fasting and postprandial state in humans can be measured accurately by cine phase-contrast (CPC) magnetic resonance (MR) imaging. Postprandial flow changes associated with mesenteric arterial occlusive disease (MAOD) are unknown.

METHODS AND RESULTS

We used CPC MR imaging to measure fasting and postprandial blood flow in the superior mesenteric artery (SMA) and vein (SMV) in 22 patients (mean age, 69 years) with aortic occlusive disease and MAOD and compared the results with similar measurements in 8 younger, asymptomatic volunteers (mean age, 34 years). All 22 patients had stenosis or occlusion of the splanchnic or pelvic arteries demonstrated by contrast aortography; 19 were asymptomatic and 3 had symptoms of chronic mesenteric ischemia. Mean fasting blood flow was higher in patients (4.5 mL.kg-1.min-1) than in volunteers (2.3 mL.kg-1.min-1; P < .01). However, postprandial hyperemia (mean percentage change in SMV blood flow) was less in the asymptomatic (70%; P < .001) and symptomatic patients (29%; P < .01) than in the volunteers. Postprandial SMV flow was similar to SMA flow in the patients but was significantly greater than SMA flow in the volunteers (P < .005).

CONCLUSIONS

Postprandial mesenteric hyperemia is reduced in older patients with MAOD. The role of aging alone has not been determined. Fasting and postprandial flow changes in these patients may predict the onset of chronic mesenteric ischemia.

Iodized-oil retention within hepatic hemangioma: characteristics on iodized-oil CT

OBJECTIVE

The purpose of this study was to describe the characteristic computed tomographic (CT) appearance of iodized-oil retention in hepatic hemangioma and to evaluate the duration of the retention of iodized oil on follow-up CT.

METHODS

Seventeen hepatic hemangiomas of 14 patients were studied with CT performed 1-3 weeks after injection of 2-9 ml of iodized oil (iodized-oil CT) for the characterization of focal hepatic lesions, which needed differential diagnosis with hepatocellular carcinoma in 10 patients, for therapy in two patients, and for chemoembolization therapy of accompanying hepatocellular carcinomas in two. Twelve patients had 1-7 follow-up CT scans within an interval of 1-38 months.

RESULTS

In all cases, iodized-oil CT showed iodized-oil retention within the tumor, regardless of tumor size, shape, location, and amount of injected iodized oil. The distribution was incomplete and predominantly peripheral in all cases. Central retention was also seen in seven cases, in which a relatively large amount of iodized oil was injected, but retention of iodized oil in the tumor was incomplete even in two cases in which a large amount of iodized oil was injected to relieve symptoms and in three cases in which prominent uptake of surrounding liver parenchyma was seen. Patterns of retention were predominantly spotty in five, predominantly nodular in four, and mixed in eight patients. Retention materials slowly washed out but persisted for at least 3 months and up to 38 months (mean = 18.1 months), and complete washout was not seen in any cases at follow-up CT.

CONCLUSION

In all cases of hepatic hemangiomas, iodized oil was retained, and retention persisted over several months. Distribution and patterns of retention were characteristically peripheral, spotty, and nodular at iodized-oil CT. Knowledge of the iodized-oil CT appearance of hepatic hemangioma would be helpful to interpret follow-up CT studies of patients who have undergone iodized-oil chemoembolization procedures.

Laryngeal tuberculosis: CT findings

OBJECTIVE

The purpose of this study was to evaluate the CT findings of laryngeal tuberculosis (TB).

SUBJECTS AND METHODS

CT scans, laryngoscopic examinations, and chest radiographs of 12 patients (21-63 years old) with histologically (n = 8) or bacteriologically (n = 4) confirmed laryngeal TB were retrospectively reviewed.

RESULTS

Bilateral diffuse thickening of the vocal cords and diffuse thickening and increased density of the aryepiglottic folds and paralaryngeal tissues were present in all patients. Diffuse thickening of the epiglottis was observed in seven patients. In four patients, a focal mass was noted in the anterior portions of the vocal cords (n = 3) or tip of the epiglottis (n =1). Destruction or sclerosis of cartilage was not found. Subglottic extension of the lesion was suspected in only one patient. Enlarged cervical lymph nodes were found in five patients. On laryngoscopic examinations, swelling of the vocal cords (n = 12) or epiglottis (n = 6) was present in all patients and was bilateral in nine patients. Vocal cord mobility was impaired in only one patient. Radiographic findings consistent with active pulmonary TB were present in all patients.

CONCLUSION

Although the CT appearances of laryngeal TB are not specific, the possibility of laryngeal TB should be raised when bilateral and diffuse laryngeal lesions are encountered without destruction of the laryngeal architecture in patients with pulmonary TB.

Mediastinal tuberculous lymphadenitis: MR imaging appearance with clinicopathologic correlation

OBJECTIVE

The purpose of our study was to determine the MR imaging appearance of mediastinal tuberculous lymphadenitis and to compare these findings with clinical and pathologic findings.

MATERIALS AND METHODS

MR images of 23 consecutive patients with mediastinal tuberculous lymphadenitis were retrospectively analyzed with regard to homogeneity, signal intensity, and enhancement of diseased nodes after injection of contrast material (n = 19), and the imaging findings were grouped by patterns and correlated with clinical signs or symptoms and with pathologic (n = 9) findings.

RESULTS

Three imaging patterns of mediastinal tuberculous lymphadenitis (113 nodes) were seen of MR images. In six patients, nodes (type 1, n = 25) were relatively homogeneous and hyperintense to muscle on both T1- and T2-weighted images and enhanced homogeneously after injection of contrast material. The patients had mild (n = 2) or no (n = 4) constitutional symptoms. The nodes corresponded pathologically to tuberculous granulomas without or with minimal necrosis. In 14 patients, nodes (type 2, n = 71) were inhomogeneous with a strong peripheral enhancement after injection of contrast material. Enhancing areas were of intermediate intensity on T1-weighted images and hypointense on T2-weighted images, and corresponded pathologically to peripheral granulation tissue within the nodes. Unenhanced areas were relatively hypointense on T1-weighted images and markedly hyperintense on T2-weighted images, and corresponded pathologically to central caseation or liquefaction necrosis within the nodes. All but one patient with type 2 nodes had moderate to severe clinical signs and symptoms. In the remaining three patients, nodes (type 3, n = 17) were homogeneously hypointense on both T1- and T2-weighted images and did not enhance after injection of contrast material. No patient with type 3 nodes had clinical signs or symptoms. The nodes corresponded pathologically to fibrocalcified nodes.

CONCLUSION

The most common MR imaging appearance of mediastinal tuberculous lymphadenitis was as inhomogeneous nodes with marked hyperintensity on T2-weighted images and peripheral enhancement after injection of contrast material. This typical MR imaging appearance was mostly seen in severely symptomatic patients and was due to caseation necrosis of the tuberculous nodes.

Castleman disease with renal amyloidosis: imaging findings and clinical significance

We report two cases of renal amyloidosis associated with mesenteric and mediastinal Castleman disease of plasma cell type. Computed tomographic (CT) scan revealed a mesenteric mass with multiple nodal enlargement in one patient and a right paratracheal mass with irregular central calcifications in the second patient. Renal ultrasonography (US) showed increased echogenicity of the renal parenchyma with prominent medullas. Doppler waveform obtained in the kidney associated with mesenteric disease showed complete absence of diastolic flow signal, although it was normal in the patient with mediastinal disease. Recognition of Castleman disease as the cause of renal amyloidosis and the understanding of CT and US findings of this entity are important for the management, as well as its diagnosis.

Congenital fistula from ectopic accessory parotid gland: diagnosis with CT sialography and CT fistulography

We report a case of congenital fistula from ectopic accessory parotid gland to the cheek demonstrated by CT sialography and CT fistulography. The right parotid gland was abnormally located lateral to masseter muscle. The fistula was arising from an ectopic accessory parotid gland with ectopic duct positioned anterior to masseter muscle. CT sialography and CT fistulography were very helpful in the diagnosis and surgical planning.

Complications of Klebsiella pneumonia: CT evaluation

OBJECTIVE

To evaluate the CT features of complicated Klebsiella pneumonia.

MATERIALS AND METHODS

We retrospectively reviewed 15 CT examinations from 11 consecutive patients with complicated Klebsiella pneumonia with special attention to internal architecture of pneumonic consolidation and its changes on follow-up CT. On plain radiography, abscess or cavitation was suspected in all patients. The diagnosis was established by isolation of Klebsiella pneumoniae from blood in six patients, from sputum in two, and from both in three. Five patients underwent follow-up CT due to progression (one) or incomplete resolution (four) of the disease despite antimicrobial therapy.

RESULTS

In all patients pneumonic consolidation was composed of two intermingled components: enhancing homogeneous areas and poorly marginated low-density areas with multiple small air cavities, suggesting necrotizing pneumonia. In nine patients scattered enhancing structures probably due to atelectatic lung and pulmonary vessels were noted within necrotic areas of consolidated lung. In eight patients pleural complications such as effusion (all) or diffuse pleural enhancement (five) were seen. In two patients with multilobar disease and delayed treatment, multiple small abscess cavities coalesced to form a large cavity with sloughing of lung tissue, suggesting pulmonary gangrene and lung abscess formation on 18 and 45 day follow-up CT, respectively. In three other patients necrotizing pneumonia resolved slowly from the periphery to the center with residual fibrosis on follow-up CT at 2-3 months.

CONCLUSION

The most common CT manifestation of complicated Klebsiella pneumonia was necrotizing pneumonia associated with pleural abnormalities. In extensive cases, pulmonary gangrene or lung abscess was a rare complication.