Effects of moderate dose rosuvastatin on carotid plaque in patients with diabetes mellitus evaluated by magnetic resonance imaging / 中华心血管病杂志

Objective: To observe the effect of lipid regulating therapy on carotid atherosclerotic plaque in diabetic patients. Methods: The REACH study, conducted between March 2009 and February 2012, enrolled asymptomatic patients with magnetic resonance imaging (MRI) confirmed carotid atherosclerotic plaque, who had never taken lipid-lowering drugs. Patients were treated with a moderate dose of rosuvastatin for 24 months. Blood lipid levels were measured and carotid MRI was performed at baseline, 3 and 24 months after treatment. The volume of carotid wall and lipid-rich necrotic core (LRNC) were measured by image analysis software. This study retrospectively analyzed patients in the REACH study. Patients were divided into diabetes group and non-diabetic group. The changes of blood lipid level and MRI parameters of carotid atherosclerotic plaque were compared between the two groups and their correlation was analyzed. Results: A total of 38 patients with carotid atherosclerotic plaque were included in this study, including 13 patients (34.2%) in the diabetic group and 25 patients (65.8%) in the non-diabetic group. Baseline parameters were comparable between the two groups, except higher HbA1c level in diabetes group (P<0.05). Compared with baseline, the total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels were significantly decreased at 3 and 24 months in both two groups (P<0.05). The change of high-density lipoprotein cholesterol (HDL-C) in diabetes group was not obvious, while it was significantly increased in non-diabetic group at 24 months ((1.38±0.33) mmol/l vs. (1.26±0.26) mmol/l, P<0.05). MRI results showed that the volume and percentage of LRNC remained unchanged at 3 months, slightly decreased at 24 months (64.86 (45.37, 134.56) mm3 vs. 75.76 (48.20, 115.64) mm3, P>0.05) and (15.84% (11.47%, 24.85%) vs. 16.95% (11.64%, 22.91%), P>0.05) in diabetic group. In non-diabetic group, the volume and percentage of LRNC were significantly decreased at 3 months (63.01 (44.25, 188.64) mm3 vs. 72.49 (51.91, 199.59) mm3, P<0.05) and (13.76% (8.81%, 27.64%) vs. 16.04% (11.18%, 27.05%), P<0.05) respectively. Both parameters further decreased to (55.63 (27.18, 179.40) mm3) and (12.71% (8.39%, 24.41%)) at 24 months (both P<0.05). Wall volume, lumen volume and percent wall volume (PWV) were not affected post therapy in both two groups(P>0.05). There were no correlations between the changes of plaque parameters including volume and percentage of LRNC, wall volume, lumen volume, PWV and the changes of blood lipid parameters (TC, LDL-C, HDL-C and TG) in 3 and 24 months (P>0.05). Conclusion: Lipid-lowering therapy possesses different effects on carotid atherosclerotic plaque in diabetic and non-diabetic patients, and the LRNC improvement is more significant in non-diabetic patients as compared to diabetic patients.

Application of Magnetic Resonance Mapping in Progressive Intervertebral Disc Degeneration in Rabbits / 中国康复理论与实践

Objective:To apply magnetic resonance T2 mapping and T1 mapping in diagnosing progressive intervertebral disc degeneration. Methods:Seven New Zealand rabbits modeled with intervertebral disc degeneration underwent sagittal T1WI, T2WI, T2 mapping and T1 mapping before, and one and three months after modeling. Pfirrmann grade of six intervertebral discs (L1-S1) in each rabbit was obtained based on T2WI and values of T2 and T1 based on T2 mapping and T1 mapping. They were observed pathologically as progressive or non-progressive intervertebral disc degeneration. The diagnostic efficacy of these imaging markers was compared with receiver operating characteristic (ROC) curve according to pathological results. Results:T2 values of intervertebral discs decreased after degeneration (F = 24.224, P < 0.001), while T1 values varied little (F = 2.191, P = 0.116). The diagnostic efficacy from more to less ranked as T2 mapping+T1 mapping = T2 mapping > T1 mapping > Pfirrmann grade. Conclusion:T2 mapping may differentiate progressive intervertebral disc degeneration from non-progressive for clinic.

Progress and challenges of reference standards and their new form: digital reference standards (DRS) / 中国药学杂志

The number and quantities of reference standards (RS) needed for the quality control of drugs are increasing, bringing great pressure to the companies that calibrate and use RS. This manuscript summarized the four generations of RS including physical RS, paper atlas, substitute RS, and electronic databases. The advantages and disadvantages of each generation were summarized. The concept of digital RS (DRS) was proposed based on this, and the definition, advantages, and technical architecture of DRS were summed up. The 10 characteristics of the five aspects of the DRS were discussed including digital, multi-dimensional, big data, cloud computing, internet, internet of things, sharing, multi-terminal, intelligence, and compliance certification. Then, the necessity of the formation and application of DRS in the holistic quality control of drugs in the era of internet plus is discussed.

Evaluation of atherosclerotic carotid plaque composition with magnetic resonance imaging using different sequences / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the capability of magnetic resonance imaging (MRI) using different sequences in displaying atherosclerotic carotid plaque composition.</p><p><b>METHODS</b>Thirty-five patients received pre- and post-contrast carotid MRI examination on a 3.0T scanner. TOF, T(1)W, T(2)W, PDW and CE-T(1)W were used for identifying the positive and negative cases for the plaque composition (lipid-rich necrotic core, intraplaque hemorrhage and calcification), and their respective sensitivity, specificity and Cohens κ with 95% CI for displaying the components of the plaques were calculated.</p><p><b>RESULTS</b>A total of 74 plaques were found in the 35 patients, and after exclusion of 6 plaques for a thickness below 3 mm, 68 plaques were included for the analysis. Lipid-rich necrotic core were found in 57 plaques, intraplaque hemorrhage in 30 plaques, and alcification in 43 plaques. CE-T(1)W was the optimal sequence for displaying lipid-rich necrotic core with a sensitivity of 100%, specificity of 90.9%, and κ value of 0.944. Both T(1)W and TOF reliably showed the intraplaque hemorrhage, but the former had a greater sensitivity (100%), specificity (92.1%), and κ value (0.911). Of all the 5 sequences, TOF was the best to show calcification with high sensitivity (100%), specificity (92%), and κ value (0.936).</p><p><b>CONCLUSION</b>CE-T(1)W is the best sequence to show lipid-rich necrotic core with high sensitivity and specificity. T(1)W and TOF show a high level of agreement with the standard to show the intraplaque hemorrhage. TOF is more sensitive and accurate than the other sequences in displaying calcification. The combination of T(1)W, TOF and CE-T(1)W allows accurate evaluation of each component of the plaque.</p>

Oblique-sagittal black-blood contrast-enhanced magnetic resonance imaging in preoperative evaluation for carotid endarterectomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the value of oblique-sagittal black-blood contrast-enhanced magnetic resonance imaging (OB-CEMRI) in atherosclerotic carotid artery (CA) assessment before carotid endarterectomy (CEA).</p><p><b>METHODS</b>Twenty-five patients with symptomatic atherosclerotic stenosis in the carotid artery (involving 26 arteries) were scheduled for CEA. OB-CEMRI and digital subtraction angiography (DSA) were conducted within 1 week prior to CEA, and two radiologists independently assessed the location of maximal lumen stenosis, plaque rupture, degree of maximal lumen stenosis and plaque involvement on DSA and OB-CEMRI images. The differences of DSA and the OB-CEMRI in analyzing the plaque conditions were assessed in comparison with matched histological sections of the excised specimens.</p><p><b>RESULTS</b>Compared with the corresponding histological specimens, both DSA (κ=0.807) and OB-CEMRI (κ=0.812) showed a good consistency in defining the location of the maximal lumen stenosis. OB-CEMRI showed a better performance in detecting plaque rupture with higher sensitivity (90.0%) and specificity (83.3%) than DSA (40.0% and 66.7%, respectively). No significant difference was found between DSA and the OB-CEMRI in evaluating the degree of maximal lumen stenosis [(77.33∓3.79)% vs (76.02∓3.95)%, P=0.648]. Compared with the histological examination, OB-CEMRI appeared to underestimate the stenosis. The plaque extent on OB-CEMRI was larger than that on DSA (18.96∓4.96 mm vs 14.80∓3.78 mm, P=0.004), and similar to that by histological examination (18.13∓4.57 mm, P=0.506).</p><p><b>CONCLUSIONS</b>OB-CEMRI allows noninvasive and objective detection of the location of the maximal lumen stenosis, plaque rupture, and plaque extent, though with a lower accuracy than DSA in the assessment of the maximal lumen stenosis. OB-CEMRI combined with DSA offers a more reliable means for preoperative evaluation of the carotid artery plaques for CEA.</p>

Efficacy of gadobenate dimeglumine vs gadopentetate dimeglumine in contrast- enhanced magnetic resonance imaging for diagnosis of solitary brain metastases / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare gadobenate dimeglumine (Gd-BOPTA) and gadopentetate dimeglumine (Gd-DTPA) for their efficacy as contrast agents in contrast-enhanced magnetic resonance imaging (MRI) for diagnosis of solitary brain metastases (SBM).</p><p><b>METHODS</b>We conducted an intra-individual study of contrast-enhanced T1-weighted MRI (T(1)WI) data from 27 Chinese patients with suspected SBM to compare the enhancement findings of two different MRI contrast agents, Gd-BOPTA and Gd-DTPA (at equivalent doses of 0.1 mmol/kg), for the detection of SBM. All the patients underwent two identical MRI examinations on a 3.0-T MRI scanner first with Gd-DTPA and then with Gd-BOPTA. Evaluation of the contrast enhancement was performed qualitatively (border delineation, extent, internal morphology, and contrast enhancement) and quantitatively (lesion-to-brain ratio, contrast-to-noise ratio, and percent enhancement) by 3 independent, fully blinded, and highly experienced neuroradiologists.</p><p><b>RESULTS</b>Qualitative assessment by readers revealed a significant overall preference (P<0.05) for Gd-BOPTA over Gd-DOTA in terms of lesion border delineation, extent, lesion internal morphology, and contrast enhancement. Quantitative assessment also revealed a significant better performance of Gd-BOPTA in light of lesion-to-brain ratio (P<0.05), contrast-to-noise ratio (P<0.05), and percent enhancement (P<0.05).</p><p><b>CONCLUSION</b>At an equivalent dose, Gd-BOPTA allows better contrast enhancement of SBM than Gd-DTPA in MRI.</p>

Atherosclerotic area measurement in the vascular wall of the carotid artery: comparison between 16-slice computed tomography angiography and high-resolution magnetic resonance imaging / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the accuracy of computed tomography angiography (CTA) in quantifying atherosclerotic area in the vascular wall of the carotid artery in comparison with high-resolution magnetic resonance imaging (MRI).</p><p><b>METHODS</b>Eighteen subjects (15 males and 3 females aged 63-/+8 years) with >or=50% stenosis in at least one carotid artery were enrolled in this study. CTA and high-resolution MRI scans (in-plane pixel size of 0.25 mmx0.25 mm for both) were conducted within 1 week on a multi-slice spiral CT scanner and a 1.5T MR scanner (Signa, GE Medical Systems), respectively. CTA images were matched with MR images with the carotid bifurcation as the mark. For each patient, multiple matched slices with carotid atherosclerotic plaques in the bilateral carotid arteries were selected to measure the outer wall boundary (OWB) area, lumen area and wall area. Bland-Altman analysis and Pearson correlation coefficients were used to analyze the correlations of the area measurements between CTA and high-resolution MRI.</p><p><b>RESULTS</b>A wide range of lesion size (vascular wall area) was found in these patients. Strong correlations were noted between CTA and high-resolution MRI with the correlation coefficients for OWB area, lumen area and wall area of 0.98, 0.98 and 0.96, respectively. The mean differences between CTA and high-resolution MRI were 0.16-/+5.71 mm(2), 4.47-/+1.44 mm(2) and -4.31-/+5.73 mm(2) for OWB area, lumen area and wall area, respectively.</p><p><b>CONCLUSION</b>Compared to high-resolution MRI, CTA is also a reliable method to measure carotid vascular wall area. CTA might become an alternative modality to high-resolution MRI for follow-up examination of patients with carotid artery atherosclerosis, especially in uncooperative patients or patients with contra-indications for MRI.</p>