Sensitivity to gains during risky decision-making differentiates chronic cocaine users from stimulant-naïve controls.

BACKGROUND: Chronic cocaine use has been consistently associated with decision-making impairments that contribute to the development and maintenance of drug-taking. However, the underlying cognitive processes of risk-seeking behaviours observed in chronic cocaine users (CU) have so far remained unclear. Here we therefore tested whether CU differ from stimulant-naïve controls in their sensitivity to gain, loss, and probability of loss information when making decisions under risk. METHOD: A sample of 96 participants (56 CU and 40 controls) performed the no-feedback version of the Columbia Card Task, designed to assess risk-taking in relation to gain, loss, and probability of loss information. Additionally, cognitive performance and impulsivity were determined. Current and recent substance use was objectively assessed by toxicological urine and hair analysis. RESULTS: Compared to controls, CU showed increased risk-seeking in unfavourable decision scenarios in which the loss probability was high and the returns were low, and a tendency for increased risk aversion in more favourable decision scenarios. In comparison to controls, CU were less sensitive to gain, but similarly sensitive to loss and probability of loss information. Further analysis revealed that individual differences in sensitivity to loss and probability of loss information were related to cognitive performance and impulsivity. CONCLUSION: Reduced sensitivity to gains in people with CU may contribute to their propensity for making risky decisions. While these alterations in gain sensitivity might directly relate to cocaine use per se, the individual psychopathological profile of CU might moderate sensitivity to loss information.

Mean diffusivity discriminates between prostate cancer with grade group 1&2 and grade groups equal to or greater than 3.

PURPOSE: To test the potential ability of mean diffusivity (MD) and fractional anisotropy (FA) in discriminating between PCa of grade group (GG) 1&2, and GGs≥3. MATERIAL AND METHODS: Diffusion Tensor Imaging (DTI) experiments at 3T in a cohort of 38 patients with PCa (fifty lesions in total) were performed, by using different diffusion weights (b values) up to 2500s/mm(2). Gleason score (GS) and GG data were correlated with DTI parameters (MD and FA) estimated in PCa. The relation between DTI measures and GS was tested by the linear correlation analysis (Pearson's coefficient). One-way analysis of variance to check the statistical significance of the difference between GG 1&2 and GGs 3, 4, 5, ≥3 was used. Results were reported for each of the three b-values ranges: 0-800s/mm(2), 0-1500s/mm(2), 0-2500s/mm(2). RESULTS: A negative correlation was found between MD and GS. The highest linear correlation was observed when the fit was performed with data acquired in the b-values range 0-2500s/mm(2). MD values were significantly different between GG 1&2 and GG=3 and between GG 1&2 and GG ≥3. Moreover this difference is better defined when high b values (higher than b=800s/mm(2)) are used. The specificity, sensitivity and accuracy in the discrimination between GG 1&2 and GG=3 were: 90%, 66.7% and 82.4%, respectively when MD was estimated in the b-values range 0-2500s/mm(2) while these values were 85%, 58.3% and 78.4% when MD was estimated in the b-values range 0-800s/mm(2). Conversely FA did not discriminate between GG 1&2 and GG ≥3, at any investigated b-values range. CONCLUSION: This study suggests that MD estimation in PCa, obtained from DTI acquired at high b-values, can contribute to the diagnosis and grading of prostate cancer while FA is not a useful parameter for this purpose.

Real-time ultrasound elastography for assessment of response to brentuximab vedotin treatment in relapsed and refractory Hodgkin lymphoma.

OBJECTIVE: To evaluate the application of ultrasound elastography (ES) in monitoring treatment response to brentuximab vedotin (Seattle Genetics, Seattle, WA, USA). PATIENTS AND METHODS: Patients were selected when suffering from relapsed and refractory Hodgkin Lymphoma (HL). Our research investigated if the interim of ultrasound ES is a predictive value for treatment outcome in patients treated with brentuximab vedotin. RESULTS: 30 patients with refractory HL were enrolled. After treatment with brentuximab vedotin, 14 patients were classified as responders and 16 were classified as non-responders. At baseline, there was no difference between the groups both in the strain ratio (z = 1.1, p = 0.3) and in the volume (z = -0.3, p = 0.8). While after treatment there was a difference between the groups both in the strain ratio (z = -2.09, p < 0.05) and in the volume (z = 4.1, p < 0.001). CONCLUSIONS: Real-time elastosonography could be a reliable tool for the assessment of refractory Hodgkin lymphoma response to brentuximab vedotin treatment and help to identify patient with improved clinical outcome early during treatment. Results indicate that changes in ultrasound elastosonography parameters are correlated with the clinical and pathologic response of patients. These findings could pave the way for establishing protocols for the clinical applications of ultrasound elastography techniques in therapy response monitoring.

Radiological and clinical difficulties in the management of chronic maxillary sinusitis in ß Thalassemic paediatric patients.

INTRODUCTION: Beta thalassemia is a blood dyscrasia that caused a marked expansion of active marrow spaces and extramedullary haematopoiesis results. In these patients various alterations and abnormalities affects different body areas, including increased risk of sinusitis. The marrow expansion in the facial bones results in delay in pneumatisation of the sinuses, overgrowth of the maxillae, and forward displacement of the upper incisors with skeletal deformities. In current literature, maxillary sinuses are not deeply evaluated by CT scan studies in these kind of patients. The aim of our study was to investigate the presence of maxillary sinuses abnormalities by the use of CT in patients with beta-thalassemia major and to compare these findings with a control group free from this disease. MATERIALS AND METHODS: A retrospective analysis of 22 paediatric patients with beta-thalassemia major and 22 control subjects without sinonasal diseases was performed. CT was done using a 64-multidetector-row CT scanner without contrast injection, obtained in axial plane using thin-slice technique. Evaluated parameters were: bone thickness of the lateral and anterior wall, density and volume of the maxillary sinuses. RESULTS: Significant difference was found between the study group and control group in the evaluation of all the parameters examined. The maxillary sinus of ß thalassemic patients was smaller respect of controls, the bone was more dense and thick in the side and anterior wall. Beta-thalassemic patients have a relative risk of 2.87 to develop a maxillary sinusitis. DISCUSSION: In these patients there is an increased incidence of sinonasal infections due to the abnormal development of cranio facial skeleton. These bone alterations might confuse the physicians and lead to an increased rate of sinusitis diagnoses.

Osteoporosis detection by 3T diffusion tensor imaging and MRI spectroscopy in women older than 60 years.

Aim of this study was to evaluate the cancellous bone quality of postmenopausal women (age >60 years) by diffusion tensor imaging (DTI) using mean diffusivity (MD) and fractional anisotropy (FA) in combination with proton magnetic resonance spectroscopy (1H-MRS). 20 postmenopausal women older than 60 years were introduced to dual-energy X-ray absorptiometry (DXA) examination in femoral neck and to an MRI spectroscopy and DTI evaluation at 3T. We observed that fat fraction (FF) can discriminate healthy and osteoporotic patients. Water mean diffusivity (MD) and FA can discriminate the healthy group from osteopenic and osteoporotic group. MD/FF vs FA/FF graph extracted from the femoral neck identifies all healthy individuals, according to DXA results. DTI and spectroscopy protocol performed in the femoral neck could be highly sensitive and specific in identifying healthy subjects.

Genetic linkage analysis identifies Pas1 as the common locus modulating lung tumorigenesis and acute inflammatory response in mice.

Selective breeding for the acute inflammatory response (AIR) generated two mouse lines characterized by maximum (AIRmax) and minimum (AIRmin) responses, explained by the additive effect of alleles differentially fixed in quantitative trait loci (QTLs). These mice also differ in their susceptibility to lung tumorigenesis, raising the possibility that the same loci are involved in the control of both phenotypes. To map the QTLs responsible for the different phenotypes, we carried out a genome-wide linkage analysis using single-nucleotide polymorphism arrays in a pedigree consisting of 802 mice, including 693 (AIRmax × AIRmin)F2 intercross mice treated with urethane and phenotyped for AIR and lung tumor multiplicity. We mapped five loci on chromosomes 4, 6, 7, 11 and 13 linked to AIR (logarithm of odds (LOD)=3.56, 3.52, 15.74, 7.74 and 3.34, respectively) and two loci linked to lung tumor multiplicity, on chromosomes 6 and 18 (LOD=12.18 and 4.69, respectively). The known pulmonary adenoma susceptibility 1 (Pas1) locus on chromosome 6 was the only locus linked to both phenotypes, suggesting that alleles of this locus were differentially fixed during breeding and selection of AIR mice. These results represent a step toward understanding the link between inflammation and cancer.

A Case of Primary T-Cell Central Nervous System Lymphoma: MR Imaging and MR Spectroscopy Assessment.

Primary central nervous system lymphomas (PCNSLs) are mainly B-cells lymphomas. A risk factor for the development of PCNSL is immunodeficiency, which includes congenital disorders, iatrogenic immunosuppression, and HIV. The clinical course is rapidly fatal; these patients usually present signs of increased intracranial pressure, nausea, papilledema, vomiting, and neurological and neuropsychiatric symptoms. PCNSL may have a characteristic appearance on CT and MR imaging. DWI sequences and MR spectroscopy may help to differentiate CNS lymphomas from other brain lesions. In this paper, we report a case of a 23-year-old man with T-primary central nervous system lymphoma presenting with a mass in the right frontotemporal lobe. We describe clinical, CT, and MRI findings. Diagnosis was confirmed by stereotactic biopsy of the lesion.

Percutaneous ablative treatment of metastatic bone tumours: visual analogue scale scores in a short-term series.

INTRODUCTION: The aim of this study was to examine the role of palliative percutaneous secondary lesions bone treatment by comparing the visual analogue scale (VAS) scores of cryoablation plus vertebroplasty versus radiofrequency (RF) plus vertebroplasty so as to determine their feasibility, reliability and efficacy in a short-term series. METHODS: Combined RF thermal ablation plus osteoplasty or cryoablation plus osteoplasty was performed in osteolytic secondary bone localisations in 30 consecutive patients who were suffering from pain refractory to conservative therapies. We evaluated pain with the VAS during the preoperative period and at four hours, 24 hours, one week, one month, three months and six months post procedure. RESULTS: There were no statistically significant differences in the VAS score between patients treated with cryoablation plus osteoplasty and those treated with RF ablation plus osteoplasty at one week (p-value is 0.34), one month (p-value is 1), three months (p-value is 0.68) and six months (p-value is 0.65) post procedure. Patients treated with cryoablation plus vertebroplasty have less pain at four hours (p-value less than 0.001) and 24 hours (p-value less than 0.001) than patients treated with RF ablation plus vertebroplasty. CONCLUSION: Both RF ablation and cryoablation are optimal techniques in the treatment of painful bone metastatic cancer. Cryoablation achieves less treatment-related pain during the early period of follow-up and better volume control by real-time depiction of ablation margins.

Role of interventional radiology in pudendal neuralgia: a description of techniques and review of the literature.

PURPOSE: The authors sought to evaluate indications, technical feasibility and clinical efficacy of computed tomography (CT)-guided pudendal nerve infiltration in patients with chronic anoperineal pain by reviewing the role of the CT technique in their personal experience and in the recent interventional literature. MATERIALS AND METHODS: Twenty-eight women, mean age 50 years, and with a diagnosis of pudendal neuralgia on the basis of clinical and electromyographic criteria were enrolled in the study. CT-guided pudendal nerve injections were performed during three consecutive sessions held 2 weeks apart. In each session, patients received two percutaneous injections: one in the ischial spine, and the other in the pudendal (Alcock's) canal. RESULTS: One patient dropped out of the study after the first session. At clinical assessment, 24h h after treatment, 21/27 patients reported significant pain relief. At follow-up at 3, 6, 9 and 12 months, 24/27 patients reported a>or=20% improvement in the Quality of Life (QOL) index. CONCLUSIONS: In pudendal nerve entrapment, CT-guided perineural injection in the anatomical sites of nerve impingement is a safe and reproducible treatment with a clinical efficacy of 92% at 12 months.

Cryptogenic stroke in hanging. A case report.

This paper reports the unique neuroimaging findings of a 37-year-old woman who attempted suicide by hanging. To our knowledge, this is the first reported case describing neuroimaging findings of unilateral lesions instead of the well-documented bilateral lesions after a hanging event. Computed tomography demonstrated a low density area in the right thalamus and no hemorrhage. 3.0 T Magnetic resonance revealed a hyperintense area on both T2-weighted and FLAIR images on the right thalamus. Diffusion weighted images demonstrated no area of diffusivity restriction. Another smaller lesion with the same signal characteristics was found in the left cerebellum. A second relevant point of this report is the observation that the most probable cause of the documented unilateral lesions was an ischemic-arterial event.

Cis-acting genomic elements of the Pas1 locus control Kras mutability in lung tumors.

The Pas1 locus is the major tumor modifier of lung tumorigenesis in mouse inbred strains. Of six genes contained in a conserved haplotype, three (Casc1, Kras and Ifltd1) have been proposed as Pas1 candidates, but mechanistic evidence is sparse. Herein, we examined urethane-induced lung tumorigenesis in a new mouse model developed by replacing the Kras gene with an Hras gene in the susceptible A/J-type Pas1 locus and crossing these mice with either C57BL/6J or A/J mice. Heterozygous mice carrying the Hras-replacement gene were more susceptible than wild-type mice to lung carcinogenesis, indicating that Hras replacement not only compensates for Kras functions, but is more active. Indeed, most lung tumors carried a Gln61Leu mutation in the Hras-replacement gene, whereas no mutations were observed in the endogenous Hras gene. Thus, the context of the Kras locus determined mutability of ras genes. In mice carrying the Hras-replacement gene, the mutation frequency affecting the wild-type Kras gene was much higher when this gene was located in the A/J type than in the C57BL/6J-type Pas1 locus (12 versus 0%, -log P=5.0). These findings identify cis-acting elements in the Pas1 locus as the functional components controlling genetic susceptibility to lung tumorigenesis by modulating mutability of the Kras gene.

Malignant renal neoplasms: correlation between ADC values and cellularity in diffusion weighted magnetic resonance imaging at 3 T.

PURPOSE: This study aimed at exploring the feasibility of high-field diffusion-weighted magnetic resonance imaging (DW-MRI) (3 T) and to correlate apparent diffusion coefficient (ADC) values with tumour cellularity in renal malignancies. MATERIALS AND METHODS: Thirty-seven patients (ten healthy volunteers and 27 patients with suspected renal malignancy) underwent T1-, T2-weighted and T1-weighted contrast-enhanced magnetic resonance imaging (MRI). Diffusion-weighted images were obtained with a single-shot spin-echo echo-planar imaging (SE-EPI) sequence with a b value of 500 s/mm(2). All lesions were surgically resected, and mean tumour cellularity was calculated. Comparison between tumour cellularity and mean ADC value was performed using simple linear regression analysis. RESULTS: The mean ADC value in normal renal parenchyma was 2.35+/-0.31 x 10(-3) mm(2)/s, whereas mean ADC value in renal malignancies was 1.72+/-0.21 x 10(-3) mm(2)/s. In our population, there were no statistically significant differences between ADC values of different histological types. The analysis of mean ADC values showed an inverse linear correlation with cellularity in renal malignancies (r=-0.73, p<0.01). CONCLUSIONS: DW-MRI is able to differentiate between normal and neoplastic renal parenchyma on the basis of tissue cellularity.

FEM analysis of RF breast ablation: multiprobe versus cool-tip electrode.

BACKGROUND: Radio-frequency ablation (RFA) has recently received much attention as an effective minimally invasive strategy for the local treatment of tumors. The purpose of this study was to evaluate the efficacy of single-needle cool-tip RF breast ablation in terms of temperature distribution and duration of the procedure as compared to multiprobe RF breast ablation. MATERIALS AND METHODS: Two different commercially available radiofrequency ablation needle electrodes were compared. Finite-element method (FEM) models were developed to simulate the thermoablation procedures. A series of ex vivo radiofrequency thermal lesions were induced to check the response of the FEM calculations. RESULTS: Data obtained from FEM models and from ex vivo procedures showed that cool-tip RF breast ablation assures better performances than multiprobe RF breast ablation in terms of temperature distribution and duration of the procedure. Histopathological analysis of the cool-tip RF thermoablated specimens showed successful induction of coagulation necrosis in the thermoablated specimens. CONCLUSION: Data obtained from FEM models and from ex vivo procedures suggest that the proposed cool-tip RF breast ablation may kill more tumor cells in vivo with a single application than the multiprobe RF breast ablation.

Multiparameter characterisation of vertebral osteoporosis with 3-T MR.

PURPOSE: This study was undertaken to evaluate the diagnostic capabilities of 3-Tesla (T) magnetic resonance (MR) in vertebral osteoporosis. MATERIALS AND METHODS: Thirty subjects (ten healthy controls, ten with osteoporosis but no fracture, ten with osteoporotic vertebral fractures) underwent MR of the lumbar spine. Turbo spin echo (TSE) T1-, T2- and T2- spectral selection attenuated inversion recovery (SPAIR) weighted imaging and spectroscopy for the selective evaluation of water and fat content were performed. The apparent diffusion coefficient (ADC) was calculated, and diffusion tensor imaging (DTI) was performed to create a map of the spatial arrangement of the tissue structures. RESULTS: Morphological imaging detected recent vertebral fractures. In osteoporotic patients, spectroscopic imaging demonstrated an increase in the saturated fats and a decrease in the ADC, whereas the data provided by DTI demonstrated a bone structure with medium-degree anisotropy. DISCUSSION: Osteoporosis is characterised by trabecular thinning, with an increase in the intertrabecular spaces, which are filled with fats. The anisotropic study and the subsequent assessment of colour and vector maps can provide a noninvasive tool for assessing the risk of fracture due to osteoporosis.

In vivo measurement of the apparent diffusion coefficient in normal and malignant prostatic tissue using thin-slice echo-planar imaging.

PURPOSE: Diffusion is a physical process based on the random movement of water molecules, known as Brownian movement. Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique that provides information on such biophysical properties of tissues as density, cell organisation and microstructure, which influence the diffusion of water molecules. The aim of this study was to evaluate the ability of MRI to obtain information on the diffusion of water molecules in normal and malignant prostate tissues. MATERIALS AND METHODS: Ten volunteers and 19 patients with prostate lesions diagnosed by transrectal ultrasound (TRUS) were enrolled in our study. Morphological imaging was obtained with T2-weighted turbo spin-echo (TSE) sequences with and without fat suppression [spectral presaturation with inversion recovery (SPIR)] and an axial dynamic T1-weighted SPIR fast-field echo (FFE) sequence during intravenous administration of contrast material. DWI was obtained with a high-spatial-resolution single-shot spin-echo echo planar imaging (EPI) inversion recovery (IR) sequence. The apparent diffusion coefficient (ADC) maps were analysed by positioning an 8-pixel region of interest (ROI) over different zones of the prostate, and the focal lesion when present. The tumour was confirmed by a TRUS-guided needle biopsy taken within 1 month of the MRI examination. RESULTS: The mean ADC value of the central zones (1,512.07+/-124.85x10(-3) mm2/s) was significantly lower than the mean ADC of the peripheral zones (1,984.11+/-226.23x10(-3) mm2/s) (p<0.01). The mean ADC value of tumours (958.97+/-168.98x10(-3) mm2/s) was significantly lower than the mean values of normal peripheral zones (p<0.01). CONCLUSIONS: Our preliminary results indicate that DWI is useful for characterising tissue in the different regions of the prostate gland and in distinguishing normal from cancerous tissues, given its ability to detect early changes in the structural organisation of prostate tissue.

Magnetic resonance imaging of the prostate with spectroscopic imaging using a surface coil. Initial clinical experience.

PURPOSE: The purpose of this study was to evaluate the diagnostic ability of proton magnetic resonance spectroscopic imaging (MRSI) in the detection and localisation of prostate cancer, prospectively compared with histopathologic findings. MATERIALS AND METHODS: Magnetic resonance imaging (MRI) and MRSI were performed on 39 patients with prostate-specific antigen (PSA) levels greater than 4 ng/ml and suspicious findings at trans-rectal ultrasound (TRUS). All patients underwent a TRUS ten-core biopsy within 30 days according to a subdivision of the prostate into octants. All studies were interpreted by a dedicated radiologist who reported the areas of interest as normal, equivocal or suspicious on MRI. At MRSI, cancer was defined as possible if the ratio of choline plus creatine to citrate exceeded mean normal peripheral zone values by two standard deviations (SD) or as definite if that ratio exceeded the normal value by three SD. MRI and MRSI findings were spatially correlated with findings obtained from individual biopsy sites. RESULTS: MRI and MRSI alone had sensitivity, specificity, positive and negative predictive values and diagnostic accuracy in the detection of prostate cancer equal to 85%, 75%; 53%, 89%; 65%, 88%; 77%, 74%; and 69%, 79%, respectively. These values were 70%, 89%, 88%, 74% and 79% when MRI and MRSI were combined. Site-by-site analysis of MRI and MRSI findings and biopsy results yielded no significant correlation. CONCLUSIONS: The combination of MRSI and MRI provides a significantly higher specificity in the detection of tumours as compared with MRI alone and can be recommended as a problem-solving modality before biopsy in patients with high PSA levels and suspicious TRUS.

Specific gene expression profiles distinguish among functional allelic variants of the mouse Pthlh gene in transfected human cancer cells.

The mouse parathyroid hormone-like hormone (Pthlh) gene encodes three allelic variants characterized by amino acid substitutions that are associated with susceptibility (Pthlh(Pro)) or resistance (Pthlh(Thr) and Pthlh(SerAspTyr)) to two-stage skin carcinogenesis and to modulation of cell migration in vitro in transfected human cancer cells. cDNA microarray hybridization analysis of 8473 transcript clones revealed a similar gene expression profile for the Pthlh(Thr) and Pthlh(SerAspTyr) alleles but a distinct pattern for the Pthlh(Pro) allele, suggesting an association between a specific gene expression profile and biological function of the Pthlh alleles. Some of the genes modulated by the Pthlh alleles, e.g., ANXA1, CCL2, FN1 and TFF3, play a role in cell migration and may represent candidate targets for this Pthlh function. Our study demonstrates the potential usefulness of gene expression profiling of genetic variants for the functional characterization of candidate cancer modifier genes.