Evaluation of Intra-Aneurysmal Residual Blood Flow with the iMSDE T1-Black Blood Imaging after Flow Diverter Treatment.

Objective: We aimed to evaluate the efficacy of the "improved motion-sensitized driven-equilibrium (iMSDE)"-prepared T1-weighted black blood (T1-BB) MRI for monitoring treatment effect with a flow diverter (FD) for cerebral aneurysms. Methods: Following the exclusion of concomitant coiling and retreatment cases from 60 consecutive cases of cerebral aneurysms treated with FDs at our institution, 32 with imaging data were included in the analysis. Detectability of residual blood flow within the aneurysms was validated as follows: 1) comparison of MRI sequences (iMSDE-prepared T1-BB images, T1-weighted images [ T1WI], and time-of-flight [ TOF]-MRA) in cases of incompletely occluded aneurysms and 2) comparison of angiography and MRI sequences in the same period. Results: 1) The probability of diagnosing intra-aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB (iMSDE-prepared T1-BB vs. T1WI, p <0.001; iMSDE-prepared T1-BB vs. TOF-MRA, p <0.001). 2) The diagnostic accuracy of residual aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB than that with T1WI (p = 0.032). Furthermore, in cases of incomplete occlusion, the probability of detecting intra-aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB (iMSDE-prepared T1-BB vs. T1WI, p <0.001; iMSDE-prepared T1-BB vs. TOF-MRA, p = 0.023). Conclusion: Our results demonstrated that iMSDE-prepared T1-BB could help distinguish between blood flow and thrombus within the aneurysms after FD treatment, especially in the early stages of FD treatment.

Pseudocontinuous Arterial Spin Labeling: Clinical Applications and Usefulness in Head and Neck Entities.

As functional magnetic resonance imaging, arterial spin labeling (ASL) techniques have been developed to provide quantitative tissue blood flow measurements, which can improve the performance of lesion diagnosis. ASL does not require contrast agents, thus, it can be applied to a variety of patients regardless of renal impairments and contrast agent allergic reactions. The clinical implementation of head and neck lesions is limited, although, in recent years, ASL has been increasingly utilized in brain lesions. Here, we review the development of the ASL techniques, including pseudocontinuous ASL (pCASL). We compare readout methods between three-dimensional (3D) turbo spin-echo and 2D echo planar pCASL for the clinical applications of pCASL to head and neck lesions. We demonstrate the clinical usefulness of 3D pCASL for diagnosing various entities, including inflammatory lesions, hypervascular lesions, and neoplasms; for evaluating squamous cell carcinoma (SCC) treatment responses, and for predicting SCC prognosis.

Association between early diagnosis of and inpatient mortality from invasive pulmonary aspergillosis among patients without immunocompromised host factors: a nationwide observational study.

OBJECTIVES: The incidence of invasive pulmonary aspergillosis (IPA) among patients without immunocompromised host factors (ICHF) has been described extensively. However, its diagnosis remains challenging. To date, no study has statistically confirmed the efficacy of early IPA diagnosis in patients without ICHF. METHODS: We conducted a cross-sectional study on mortality from IPA among patients without ICHF, using the Japanese Diagnosis Procedure Combination National Inpatient Database (April 2014-March 2018). The early diagnosis group was defined according to antifungal therapy initiation within 7 days of hospital admission. The delayed diagnosis group was defined according to antifungal therapy initiation between 8 and 28 days of the hospitalization. Associations were estimated using multivariate logistic regression. RESULTS: A total of 423 patients were registered (early diagnosis group, n = 262, 62%). The early diagnosis group had a lower mortality rate (30%) than the delayed diagnosis group (42%). The early diagnosis group that was treated with voriconazole was associated with lower odds of mortality (odds ratio 0.55, 95% confidence interval 0.31-0.99, P = 0.047). An age of ≥65 years and mechanical ventilation were associated with a higher mortality rate. CONCLUSION: Early diagnosis along with optimal antifungal treatment are crucial for achieving favorable outcomes among patients with IPA without ICHF.

Semiautomated Segmentation and Volume Measurements of Cervical Carotid High-Signal Plaques Using 3D Turbo Spin-Echo T1-Weighted Black-Blood Vessel Wall Imaging: A Preliminary Study.

Unstable carotid plaques are visualized as high-signal plaques (HSPs) on 3D turbo spin-echo T1-weighted black-blood vessel wall imaging (3D TSE T1-BB VWI). The purpose of this study was to compare manual segmentation and semiautomated segmentation for the quantification of carotid HSPs using 3D TSE T1-BB VWI. Twenty cervical carotid plaque lesions in 19 patients with a plaque contrast ratio of > 1.3 compared to adjacent muscle were studied. Using the mean voxel value for the adjacent muscle multiplied by 1.3 as a threshold value, the semiautomated software exclusively segmented and measured the HSP volume. Manual and semiautomated HSP volumes were well correlated (r = 0.965). Regarding reproducibility, the inter-rater ICC was 0.959 (bias: 24.63, 95% limit of agreement: −96.07, 146.35) for the manual method and 0.998 (bias: 15.2, 95% limit of agreement: −17.83, 48.23) for the semiautomated method, indicating improved reproducibility by the semiautomated method compared to the manual method. The time required for semiautomated segmentation was significantly shorter than that of manual segmentation times (81.7 ± 7.8 s versus 189.5 ± 49.6 s; p < 0.01). The results obtained in this study demonstrate that the semiautomated segmentation method allows for reliable assessment of the HSP volume in patients with carotid plaque lesions, with reduced time and effort for the analysis.

Tumor blood flow and apparent diffusion coefficient histogram analysis for differentiating malignant salivary tumors from pleomorphic adenomas and Warthin's tumors.

We aimed to assess the combined diagnostic value of apparent diffusion coefficient (ADC) and tumor blood flow (TBF) obtained by pseudocontinuous arterial spin labeling (pCASL) for differentiating malignant tumors (MTs) in salivary glands from pleomorphic adenomas (PAs) and Warthin's tumors (WTs). We used pCASL imaging and ADC map to evaluate 65 patients, including 16 with MT, 30 with PA, and 19 with WT. We evaluated all tumors by histogram analyses and compared various characteristics by one-way analysis of variance followed by Tukey post-hoc tests. Diagnostic performance was evaluated by receiver operating characteristic (ROC) curve analysis. There were significant differences in the mean, 50th, 75th, and 90th percentiles of TBF among the tumor types, in the mean TBFs (mL/100 g/min) between MTs (57.47 ± 35.14) and PAs (29.88 ± 22.53, p = 0.039) and between MTs and WTs (119.31 ± 50.11, p < 0.001), as well as in the mean ADCs (× 10-3 mm2/s) between MTs (1.08 ± 0.28) and PAs (1.60 ± 0.34, p < 0.001), but not in the mean ADCs between MTs and WTs (0.87 ± 0.23, p = 0.117). In the ROC curve analysis, the highest areas under the curves (AUCs) were achieved by the 10th and 25th percentiles of ADC (AUC = 0.885) for differentiating MTs from PAs and the 50th percentile of TBF (AUC = 0.855) for differentiating MTs from WTs. The AUCs of TBF, ADC, and combination of TBF and ADC were 0.850, 0.885, and 0.950 for MTs and PAs differentiation and 0.855, 0.814, and 0.905 for MTs and WTs differentiation, respectively. The combination of TBF and ADC evaluated by histogram analysis may help differentiate salivary gland MTs from PAs and WTs.

A Rare Case of Pulmonary Tumor Thrombotic Microangiopathy Associated with Micropapillary Urothelial Carcinoma of the Urinary Bladder: An Autopsy Case.

A 70-year-old woman was hospitalized with dyspnea. A transthoracic echocardiogram indicated an elevated systolic pulmonary artery pressure, and the cytology specimens obtained using a pulmonary artery catheter confirmed adenocarcinoma metastasis. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) detected high-signal-intensity lesions in the urinary bladder. The patient died of respiratory failure and a postmortem examination was performed. Tumor cells in the bladder were immunohistochemically positive for GATA3, indicating micropapillary urothelial carcinoma, which is a rare variant of urothelial carcinoma and considered an adenocarcinoma subtype. This case is the first autopsy case of pulmonary tumor thrombotic microangiopathy (PTTM) associated with micropapillary urothelial carcinoma of the urinary bladder.

Tumor Embolism as a Cause of Renal Artery Occlusion and Acute Kidney Injury Diagnosed and Treated with Endovascular Intervention in a Patient with Mediastinal Undifferentiated Sarcoma.

A 72-year-old man presented with back pain due to a mass in the left posterior mediastinum that had surrounded and partly infiltrated the descending aorta. Mediastinal undifferentiated sarcoma was diagnosed. After the diagnosis, sudden anuria was observed. Contrast-enhanced computed tomography revealed an enhancement defect at the origins of the bilateral renal arteries. He received catheter-directed thrombolysis and was weaned off dialysis. The aspirated artery thrombus contained tumor cells, proving our diagnosis of acute kidney injury secondary to bilateral renal artery tumor embolism. In cancer patients, endovascular intervention may be a useful diagnostic and therapeutic option in cases of acute kidney injury secondary caused by peripheral thromboembolic complications.

A case of allergic bronchopulmonary aspergillosis with marked peripheral blood eosinophilia successfully treated with benralizumab.

We herein report a case of allergic bronchopulmonary aspergillosis (ABPA) with marked eosinophilia and high attenuation mucus (HAM) on chest computed tomography (CT), which demonstrated a rapid and remarkable improvement with benralizumab treatment. A 67-year-old Japanese woman, who was diagnosed with asthma at the age of 64 years, was admitted with dyspnea. Her blood test results showed marked eosinophilia (peripheral blood eosinophil count 24403/µL) and elevated serum IgE levels. Chest CT also revealed ground-glass opacity. Sputum cytology detected filamentous fungi, suggesting an infection with Aspergillus spp. Based on these findings, ABPA was diagnosed. Following systemic corticosteroid treatment, her respiratory symptoms and chest radiography findings showed improvements. However, with the gradual tapering and eventual discontinuance of the corticosteroid therapy, a concomitant increase in the peripheral blood eosinophils and a recurrence of the clinical symptoms, was observed. In addition, her pulmonary function decreased and chest CT revealed worsened bronchial mucus plugs. To control the asthma with ABPA exacerbation, benralizumab was administered. Following treatment with benralizumab, the patient's asthmatic symptoms improved, together with a decrease in her peripheral eosinophil count. Mucus plugs were no longer visible on chest CT. Pulmonary function test result also showed a remarkable improvement. There was no relapse of dyspnea and no reappearance of the mucus plugs. This case suggests that benralizumab may be a suitable treatment option for patients with ABPA with marked eosinophilia and HAM on chest CT.

The seamless integration of three-dimensional rotational angiography images into electroanatomical mapping systems to guide catheter ablation of atrial fibrillation.

It is important to visually confirm radiofrequency ablation lesions during atrial fibrillation (AF) ablation for procedural efficiency, which requires the integration of a three-dimensional (3D) left atrial image reconstructed from computed tomography (CT) or a magnetic resonance imaging. However, an EP Navigator allows seamless integration of 3D anatomy obtained through 3D rotational angiography (3D-ATG) into an electroanatomical mapping system. We hypothesized that 3D-ATG can be used during AF ablation while significantly reducing the effective dose (ED) and without compromising image morphology compared to a 3D-CT image. Organ dose was measured at 37 points with a radiophotoluminescence glass dosimeter inserted in an anthropomorphic Rando Phantom. The ED was calculated by multiplying the organ dose by the tissue weighting factor. The dose-area product (DAP)-to-ED conversion factor was calculated by measuring the DAP during radiation exposure. The ED for the CT examination was estimated from the dose-length product with a conversion factor of 0.014. ED was calculated from DAP measurements in 114 patients undergoing AF ablation using 3D-ATG. The DAP-to-ED conversion factor for 3D-ATG was 2.4 × 10-4 mSv/mGy cm2 in our hospital. The mean DAP for all patients was 7777 ± 1488 mGy cm2 for the 3D-ATG of the left atrium. The corresponding ED for 3D-ATG was 1.9 ± 0.4 mSv. The ED for CT examinations was 13.6 ± 4.2 mSv (P < 0.001). 3D-ATG can be used during AF ablation while significantly reducing the ED and without compromising image morphology.

Cervical carotid plaque evaluation using 3D T1-weighted black-blood magnetic resonance imaging: Comparison of turbo field-echo and turbo spin-echo sequences.

PURPOSE: To compare the capability of three-dimensional (3D) T1-weighted turbo field-echo (TFE) black-blood (BB) magnetic resonance imaging (MRI) and turbo-spin echo (TSE) BB MRI for discerning carotid plaques and the difference of signal intensities of the plaques from that of adjacent muscle in patients with cervical carotid stenosis. METHODS: Cervical carotid stenosis was evaluated by 3.0-T MR in 43 patients (38 men and 5 women; age, 36-83 years; mean age, 70 years) during 8 months. The carotid BB MRI comprised 3D T1-weighted TSE BB (T1-TSEBB) and 3D T1-weighted TFE BB (T1-TFEBB) sequences. The delineation of the carotid plaque border was evaluated in comparison with digital subtraction angiography (DSA). The border between the plaque and vessel lumen was rated visually (4-point analysis) and quantitatively (contrast-to-noise ratio). The signal-intensity ratio (SIR) of the plaque to the adjacent muscle was also measured. Data of 3D T1-TSEBB and 3D T1-TFEBB were compared statistically using the Wilcoxon signed-rank test. RESULTS: Visual and quantitative analyses revealed that the border between the plaque and vessel lumen was better delineated on 3D T1-TSEBB MRI than on 3D T1-TFEBB MRI (p<0.01, respectively). SIR of the plaque-to-adjacent muscle was higher on 3D T1- TFEBB MRI than on 3D T1-TSEBB MRI (p<0.05). High signal plaques with a SIR of >1.5 were underestimated on 3D T1-TSEBB MRI. CONCLUSIONS: 3D T1-TSEBB MRI was superior to 3D T1-TFEBB MRI for delineating carotid plaques; however, high signal plaques were underestimated on 3D T1-TSEBB MRI.

Alternation of gene expression in trigeminal ganglion neurons following complete Freund's adjuvant or capsaicin injection into the rat face.

The hyperexcitability of trigeminal ganglion (TG) neurons following inflammation or C-fiber stimulation is known to be involved in a variety of changes in gene expression in TG neurons, resulting in pain abnormalities in orofacial regions. We analyzed nocifensive behavior following complete Freund's adjuvant (CFA) or capsaicin injection into the maxillary whisker pad, and gene expression in the TG neurons using microarray analysis. The head-withdrawal latency to capsaicin injection or the head-withdrawal threshold to mechanical stimulation of the whisker pad skin in CFA-treated rats was significantly decreased compared to vehicle-treated rats. Many up-regulated and down-regulated genes in the TG neurons of each model were reported. Genes which have not been linked to peripheral inflammation or C-fiber activation were detected. Moreover, microarray chip containing a number of non-coding sequences was also up-regulated by C-fiber activation. These findings suggest that the diverse gene expressions in TG neurons are differentially involved in the inflammatory chronic pain and the acute pain induced by C-fiber activation, and the hyperexcitation of C-fibers are associated with the activation of certain non-coding RNAs.

Facial soft tissue thickness in Japanese children.

Facial reconstruction techniques used in forensic anthropology are based on mean soft tissue thickness measurements. Numerous studies of facial tissue thickness in adults have been published on a range of subjects from different ancestral backgrounds. Data on facial thickness in children derive primarily from Caucasoid, African-American, and Hispanic subjects. There are limited data from the few studies of Japanese children (male: skeletal class I only; female: all skeletal classes). The author has previously reported facial tissue thickness data for Japanese girls and boys with skeletal class I and for all three skeletal classes in Japanese girls. The present study reports facial soft tissue thickness data in Japanese children of all skeletal classes, within age subsets. With parental informed consent, diagnostic lateral cephalometric X-ray images were obtained from 339 Japanese children aged 7-18 years (male: 162; female: 177) who attended the Matsumoto Dental University Department of Orthodontics to undergo orthodontic treatment. Soft tissue and skeletal features were traced onto acetate sheets from the X-ray images, and 10 anthropological landmarks on the midsagittal line were measured. Means, SDs, and ranges were then calculated. Differences between male and female measurements in six age groups were compared using t-tests. Significant differences were observed at some landmarks in each age group. The findings were compared with data from other juvenile populations.

Pilot study of facial soft tissue thickness differences among three skeletal classes in Japanese females.

Facial reconstruction is a technique used in forensic anthropology to estimate the appearance of the antemortem face from unknown human skeletal remains. This requires accurate skull assessment (for variables such as age, sex, and race) and soft tissue thickness data. However, the skull can provide only limited information, and further data are needed to reconstruct the face. The authors herein obtained further information from the skull in order to reconstruct the face more accurately. Skulls can be classified into three facial types on the basis of orthodontic skeletal classes (namely, straight facial profile, type I, convex facial profile, type II, and concave facial profile, type III). This concept was applied to facial tissue measurement and soft tissue depth was compared in each skeletal class in a Japanese female population. Differences of soft tissue depth between skeletal classes were observed, and this information may enable more accurate reconstruction than sex-specific depth alone.

Distribution of epithelial cells and their relationship to immunocompetent cells in rat molars: a confocal and transmission electron microscope study.

This study sought to investigate the distribution of cytokeratin (CK)-immunopositive cells and their relationship to immunocompetent ED1- and OX6-immunopositive cells in rat periodontium by immunohistochemistry and electron microscopy. CK-immunopositive cells were generally distributed along the surface of the tooth root. They could also be found between root dentin and cementum, in the perivascular space, and close to or in the alveolar bone lacunae. ED1-immunopositive cells exhibited a compact shape with small processes and were widely distributed in the periodontium. Few sections demonstrated an intimate relationship between the CK- and ED1-immunopositive cells close to the cementum, in the perivascular space, and close to or in the alveolar bone. Numerous OX6-immunopositive cells with long branching processes were widely distributed in the periodontal ligament, surrounding and holding CK-immunopositive cells in the cell clusters, close to the cementum. Transmission electron microscopy revealed OX6-immunopositive cells that extended their cytoplasmic processes, which contained vesicles and occasionally lysosomes in between the epithelial cells. This study demonstrates the close relationship between the epithelial cells and the immunocompetent cells in a rat periodontium, indicating a functional interrelationship. It is possible that in a non-inflammatory periodontium, the epithelial cells act not independently, but through interaction with immunocompetent cells.

Epithelial cell rests of Malassez and OX6-immunopositive cells in the periodontal ligament of rat molars: a light and transmission electron microscope study.

It has been shown that human and cat epithelial cell rests of Malassez (ERM) consist of heterogeneous cell populations. Immunohistochemical and immunoelectron microscopic analyses have verified the presence of neuroendocrine and Merkel-like cells in both of these epithelia. During experimental orthodontic tooth movement, immunocompetent cells have also been found in the vicinity of ERM in rat periodontal ligament (PDL), but have not been characterized in normal rat PDL. The aim of this study was to investigate the presence and distribution of MHC class II antigen presenting cells by using OX6 antibody in ERM of rat molars by light and transmission electron microscopy. Immunohistochemical and immunoelectron microscopic observations of rat maxillary molars confirmed the presence of OX6-positive cells in contact with ERM. Some immunopositive cytoplasmic processes containing vesicles interdigitated with cells of the Malassez epithelial clusters. Based on these findings it can be concluded that immunocompetent cells are localized close to Malassez epithelial clusters in normal rat PDL. Furthermore, the ultrastructural evidences indicate a possible interaction between the epithelial and immunocompent cells and suggest morphological and functional properties for ERM.

A case of a divided maxillary artery in the infratemporal fossa.

A divided maxillary artery was found in the left infratemporal fossa of a 63-year-old male cadaver during a student dissection practice. The maxillary artery, which arose from the external carotid artery at the posterior border of the ramus of the mandible, was divided into two branches in the infratemporal fossa. The deep branch of the maxillary artery was deep to the lateral pterygoid muscle and the inferior alveolar, buccal and lingual nerves, giving off the anterior tympanic, middle meningeal, anterior deep temporal, buccal, and posterior superior alveolar arteries. The deep branch passed through the pterygomaxillary fissure. On the other hand, the superficial branch of the maxillary artery, which was superficial to the lateral pterygoid muscle, gave off the inferior alveolar artery and other branches. The maxillary artery on the right side displayed a normal branching pattern within the infratemporal fossa. These findings indicate that the deep and superficial branches of the maxillary artery remained without disappearing during the development of the maxillary artery originated from the stapedial artery.

Dopamine beta-hydroxylase like immunoreactive cells in the frog taste disc.

We immunohistochemically examined the existence of dopamine beta-hydroxylase (DBH), a noradrenalin (NA)-synthesizing enzyme from dopamine, in the taste disc of frog, Rana catesbeiana. DBH-like immunoreactive cells were located in the intermediate layer in the taste disc; the cells showed an apical process reaching the surface of the disc and one or several basal processes. Cells with a thick apical process and those with a thin apical process were both immunoreactive: these cells corresponded to type II and III receptor cells of the frog taste disc. Immunoreactive granules were observed in the cytoplasm of those cells. In the frog taste disc, only type III cells are reported to have afferent synapses with the nerve via basal processes but those basal processes have not been reported in type II cells. In the present study, we found that type II-like cells possessed a long basal process extending toward the basal lamina. Mucous (type Ia) cells, wing (type Ib) cells, and glia-like sustentacular (type Ic) cells were all immunohistochemically unreactive. The present observations support the argument that NA (or adrenalin) may work as a chemical transmitter in the frog taste organ.

Facial soft tissue thickness in skeletal type I Japanese children.

Facial reconstruction techniques used in forensic anthropology require knowledge of the facial soft tissue thickness of each race if facial features are to be reconstructed correctly. If this is inaccurate, so also will be the reconstructed face. Knowledge of differences by age and sex are also required. Therefore, when unknown human skeletal remains are found, the forensic anthropologist investigates for race, sex, and age, and for other variables of relevance. Cephalometric X-ray images of living persons can help to provide this information. They give an approximately 10% enlargement from true size and can demonstrate the relationship between soft and hard tissue. In the present study, facial soft tissue thickness in Japanese children was measured at 12 anthropological points using X-ray cephalometry in order to establish a database for facial soft tissue thickness. This study of both boys and girls, aged from 6 to 18 years, follows a previous study of Japanese female children only, and focuses on facial soft tissue thickness in only one skeletal type. Sex differences in thickness of tissue were found from 12 years of age upwards. The study provides more detailed and accurate measurements than past reports of facial soft tissue thickness, and reveals the uniqueness of the Japanese child's facial profile.