ABSTRACT
PURPOSE: To compare three magnetic resonance imaging (MRI) protocols containing diffusion-weighted imaging with background suppression (DWIBS) and one traditional protocol for detecting extrahepatic colorectal cancer metastases. MATERIALS AND METHODS: Thirty patients with extrahepatic colorectal cancer metastases were scanned in three stations from the skull base to the upper thighs using a 1.5T MRI system with six different MRI sequences; transverse and coronal T2 -weighted (T2 W) turbo spin-echo (TSE), coronal short tau inversion recovery (STIR), 3D T1 W TSE, DWIBS, and a contrast-enhanced T1 W 3D gradient echo (GRE) sequence. The six sequences were used to build four hypothetical MRI interpretive sets which were read by two readers in consensus, blinded to prior imaging. Lesions were categorized into 13 anatomic regions. Fluorodeoxyglucose / positron emission tomography / computed tomography (FDG-PET/CT) read with full access to prior imaging and clinical records was used as the reference standard. Sensitivity, specificity, and false discovery rate (FDR) were calculated as appropriate and receiver operating characteristic (ROC) curves were constructed. RESULTS: In all, 177 malignant lesions were detected by FDG-PET/CT and distributed in 92 out of 390 scanned anatomic regions. The sensitivity was statistically higher in two out of three sets incorporating DWIBS on a per-lesion basis (66.7%, 63.3%, and 66.7% vs. 57.6%) (P = 0.01, P = 0.11, and P = 0.01, respectively) and in all sets incorporating DWIBS on a per-region basis (75.0%, 75.0%, and 77.2 vs. 66.3%) (P = 0.04, P = 0.04, and P = 0.01, respectively). There was no difference in specificity, FDR, or AUCROC . There was no difference between sets containing DWIBS irrespective of the use of a contrast-enhanced sequence. CONCLUSION: MRI sets containing DWIBS had superior sensitivity. This sensitivity was retained when omitting a contrast-enhanced sequence. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1619-1630.
Subject(s)
Colorectal Neoplasms/pathology , Magnetic Resonance Imaging/methods , Neoplasm Metastasis/diagnostic imaging , Whole Body Imaging/methods , Aged , Aged, 80 and over , Contrast Media , Diffusion Magnetic Resonance Imaging/methods , Female , Humans , Image Enhancement/methods , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Group G streptococci (GGS) are beta-haemolytic, and can be found as commensal on skin and mucous membranes. Several articles describe an increased incidence of invasive GGS infections, in majority among older men with co-morbidities. We describe a rare case of invasive post-partum infection, most likely nosocomial transmission since the infected patient shared bath and toilet facilities with the index patient for one day during admission. Subtype stG643 was found in both cases.
Subject(s)
Cross Infection/microbiology , Puerperal Infection/microbiology , Streptococcal Infections/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Cross Infection/epidemiology , Cross Infection/transmission , Denmark/epidemiology , Female , Humans , Male , Postpartum Period , Puerperal Infection/drug therapy , Puerperal Infection/epidemiology , Streptococcal Infections/drug therapy , Streptococcal Infections/epidemiology , Streptococcal Infections/transmission , Streptococcus/isolation & purification , Streptococcus/pathogenicityABSTRACT
Actinobaculum schaalii is a small, Gram-positive, facultative anaerobic, CO2-requiring rod. It is now an acknowledged uropathogen, but often overlooked because of its slow growth. It is part of the normal bacterial flora in the urogenital area, but can be the cause of both local and invasive infections. We present a case of A. schaalii urosepsis in a 68-year-old male with phimosis caused by a severe lichen sclerosus et atrophicus. The only bacteria found in blood and urine was A. schaalii.
