Prognostic Role of Lymphovascular Invasion in Patients with Early Breast Cancer.

In this study, our aim was to evaluate the role of lymphovascular invasion (LVI) in the prognosis of patients with early stage breast cancer. The medical records of more than 7000 patients who suffered from invasive breast cancer and had undergone surgical treatment since December 1994 till December 2019, retrospectively. Patient's history, physical examination and the clinicopathological features, histopathology characteristics, immunohistochemical findings, adjuvant systemic therapy, recurrence rate, metastasis-free survival (MFS), disease-free survival (DFS), and overall survival (OS) were reviewed. A total of 5425 eligible patients were categorized into two groups based on the presence of LVI; 3031 (55.9%) patients had no LVI (group 1) and LVI was present in 2394 (44.1%) patients (group 2), then divided into LN-positive and -negative groups. Presence of LVI was significantly associated with patient age ≤ 40 years (p = 0.048), high histological grade (grades II and III, p < 0.001), tumor size between 2-5 cm and > 5 cm (p < 0.001), number of involved LN ≥ 4 (p < 0.001), and negative ER (p = 0.042) tumors. Five-year OS, MFS, and DFS were 93%, 88.9%, and 76.1% and 85.2%, 84.7%, and 73.6 in groups 1 and 2, respectively (P < 0.001). On multivariate analysis, LVI was an independent prognostic factor for DFS in all patients. Furthermore, histological grade II, histological grade III, and a higher number of involved LNs (≥ 4) were independent predictors in all patients. Thus, the presence of LVI can be considered as an independent prognostic factor for patients with operable breast cancer, irrespective of the LN status.

Combined low-dose contrast-enhanced MR angiography and perfusion for acute ischemic stroke at 3T: A more efficient stroke protocol.

BACKGROUND AND PURPOSE: There is need to improve image acquisition speed for MR imaging in evaluation of patients with acute ischemic stroke. The purpose of this study was to evaluate the feasibility of a 3T MR stroke protocol that combines low-dose contrast-enhanced MRA and dynamic susceptibility contrast perfusion, without additional contrast. METHODS: Thirty patients with acute stroke who underwent 3T MR imaging followed by DSA were retrospectively enrolled. TOF-MRA of the neck and brain and 3D contrast-enhanced MRA of the craniocervical arteries were obtained. A total of 0.1 mmol/kg of gadolinium was used for both contrast-enhanced MRA (0.05 mmol/kg) and dynamic susceptibility contrast perfusion (0.05 mmol/kg) (referred to as half-dose). An age-matched control stroke population underwent TOF-MRA and full-dose (0.1 mmol/kg) dynamic susceptibility contrast perfusion. The cervicocranial arteries were divided into 25 segments. Degree of arterial stenosis on contrast-enhanced MRA and TOF-MRA was compared with DSA. Time-to-maximum maps (>6 seconds) were evaluated for image quality and hypoperfusion. Quantitative analysis of arterial input function curves, SNR, and maximum T2* effects were compared between half- and full-dose groups. RESULTS: The intermodality agreements (k) for arterial stenosis were 0.89 for DSA/contrast-enhanced MRA and 0.63 for DSA/TOF-MRA. Detection specificity of >50% arterial stenosis was lower for TOF-MRA (89%) versus contrast-enhanced MRA (97%) as the result of overestimation of 10% (39/410) of segments by TOF-MRA. The DWI-perfusion mismatch was identified in both groups with high interobserver agreement (r = 1). There was no significant difference between full width at half maximum of the arterial input function curves (P = .14) or the SNR values (0.6) between the half-dose and full-dose groups. CONCLUSIONS: In patients with acute stroke, combined low-dose contrast-enhanced MRA and dynamic susceptibility contrast perfusion at 3T is feasible and results in significant scan time and contrast dose reductions.

Role of EPI-FLAIR in patients with acute stroke: a comparative analysis with FLAIR.

BACKGROUND AND PURPOSE: Further improvement in acquisition speed is needed, if MR imaging is to compete with CT for evaluation of patients with acute ischemic stroke. The purpose of this study was to evaluate the feasibility of implementing an echo-planar fluid-attenuated inversion recovery (EPI-FLAIR) sequence into an acute MR stroke protocol with potential reduction in scan time and to compare the results with conventional FLAIR images. MATERIALS AND METHODS: Fifty-two patients (28 men and 24 women; age range, 32-96 years) with acute ischemic stroke were prospectively evaluated with an acute stroke MR protocol, which included both conventional FLAIR and EPI-FLAIR imaging with integration of parallel acquisition. The image acquisition time was 52 seconds for EPI-FLAIR and 3 minutes for conventional FLAIR. FLAIR and EPI-FLAIR studies were assessed by 2 observers independently for image quality and conspicuity of hyperintensity in correlation with DWI and were rated as concordant or discordant. Coregistered FLAIR and EPI-FLAIR images were evaluated for signal intensity ratio of the DWI-positive lesion to contralateral normal white matter. RESULTS: An estimated 96% of all FLAIR and EPI-FLAIR studies were rated of diagnostic image quality by both observers, with interobserver agreements of κ = 0.82 and κ = 0.63 for FLAIR and EPI-FLAIR, respectively. In 36 (95%) of 38 patients with acute infarction, FLAIR and EPI-FLAIR were rated concordant regarding DWI lesion. The mean ± standard deviation of the signal intensity ratio values on EPI-FLAIR and FLAIR for DWI-positive lesions were 1.28 ± 0.16 and 1.25 ± 0.17, respectively (P = .47), and demonstrated significant correlation (r = 0.899, z value = 8.677, P < .0001). CONCLUSIONS: In patients with acute stroke, EPI-FLAIR is feasible with comparable qualitative and quantitative results to conventional FLAIR and results in reduced acquisition time.

The healing effect of arnebia euchroma in second degree burn wounds in rat as an animal model.

BACKGROUND: Finding more efficient agents with fewer side effects for treatment of burns has always been a concern for researchers. Silver sulfadiazine (SSD), apparently due to its antimicrobial effect, is still one of the most common prescribed agents. Previous studies suggested that Arnebia euchroma (AE) has shown antimicrobial and anti-inflammatory activities. This study investigates the healing effect of AE extract in comparison with SSD in second degree burn wounds. METHODS: Fort eight female Wistar rats (220±20 g) were divided into four groups. Standard second degree burn wounds were induced on the back of their necks. One group was treated with SSD; two groups were treated with AE cream at concentrations of 10% (AE10) and 20% (AE20) and the control group which received no treatment. The duration of treatment was 28 days. RESULTS: This study revealed that AE and SSD noticeably improved re-epithelization, fibroblasts proliferation, and collagen bundle synthesis and had a noticeable anti-inflammatory effect compared with the control group. CONCLUSION: Results of the present study revealed that Arnebia euchroma herbal extract was an effective treatment for second degree burn wounds when compared with SSD.

Methanol poisoning: acute MR and CT findings in nine patients.

INTRODUCTION: Methanol poisoning is an uncommon but potent central nervous system toxin. We describe here the CT and MR findings in nine patients following an outbreak of methanol poisoning. METHODS: Five patients with a typical clinical presentation and elevated anion and osmolar gaps underwent conventional brain MRI with a 1.5-T Gyroscan Interna scanner. In addition nonenhanced CT was performed in another three patients with more severe toxicity. RESULTS: Bilateral hemorrhagic or nonhemorrhagic necrosis of the putamina, diffuse white matter necrosis, and subarachnoid hemorrhage were among the radiological findings. Various patterns of enhancement of basal ganglial lesions were found including no enhancement, strong enhancement and rim enhancement. CONCLUSION: A good knowledge of the radiological findings in methanol poisoning seems to be necessary for radiologists. The present study is unique in that it enables us to include in a single report most of the radiological findings that have been reported previously.