Photon-counting CT of degenerative changes and rupture of silicone breast implants: a pilot study.

BACKGROUND: Accurate assessment of breast implants is important for appropriate clinical management. We evaluated silicone properties and diagnostic accuracy for characterizing silicone implants and detecting degenerative changes including rupture in photon-counting computed tomography (PCCT). METHODS: Over 16 months, we prospectively included patients with silicone implants and available breast magnetic resonance imaging (MRI) who received thoracic PCCT performed in prone position. Consensus reading of all available imaging studies including MRI served as reference standard. Two readers evaluated all implants in PCCT reconstructions for degenerative changes. In a subgroup of implants, mean density of silicone, adjacent muscle, and fat were measured on PCCT reconstructions. Contrast-to-noise ratios (CNRs) were calculated for implant-to-muscle and implant-to-fat. RESULTS: Among 21 subjects, aged 60 ± 13.1 years (mean ± standard deviation) with 29 implants PCCT showed the following: high accuracy for linguine sign, intraimplant fluid (all > 0.99), peri-implant silicone (0.95), keyhole sign (0.90), and folds of the membrane (0.81); high specificity for linguine sign, intraimplant fluid, keyhole sign, folds of the membrane (all > 0.99), and peri-implant silicone (0.98); and high sensitivity for linguine sign and intraimplant fluid (all > 0.99). In a subgroup of 12 implants, the highest CNR for implant-to-muscle was observed on virtual unenhanced reconstructions (20.9) and iodine maps (22.9), for implant-to-fat on iodine maps (27.7) and monoenergetic reconstructions (31.8). CONCLUSIONS: Our findings demonstrate that silicone breast implants exhibit distinct contrast properties at PCCT, which may provide incremental information for detection of degenerative changes and rupture of implants. RELEVANCE STATEMENT: Thoracic photon-counting computed tomography is a promising modality for the diagnostic assessment of silicone breast implants. KEY POINTS: • Thoracic photon-counting computed tomography demonstrates unique contrast properties of silicone breast implants. • Iodine map reconstructions reveal strong contrast-to-noise ratios for implant-to-muscle and implant-to-fat. • Thoracic photon-counting computed tomography shows high diagnostic accuracy in detecting implant degeneration and rupture. TRIAL REGISTRATION: German Clinical Trials Register number DRKS00028997, date of registration 2022-08-08, retrospectively registered.

Diagnostic Accuracy of Contrast-Enhanced Thoracic Photon-Counting Computed Tomography for Opportunistic Locoregional Staging of Breast Cancer Compared With Digital Mammography: A Prospective Trial.

OBJECTIVE: Accurate locoregional staging is crucial for effective breast cancer treatment. Photon-counting computed tomography (PC-CT) is an emerging technology with high spatial resolution and the ability to depict uptake of contrast agents in tissues, making it a promising tool for breast cancer imaging. The aim of this study was to establish the feasibility of locoregional staging of breast cancer through contrast-enhanced thoracic PC-CT, assess its diagnostic performance, and compare it with that of digital mammography (DM). MATERIALS AND METHODS: Patients with newly diagnosed breast cancer, DM, and indication of thoracic CT staging were prospectively enrolled in this clinical cohort study over a period of 6 months. Participants underwent contrast-enhanced thoracic PC-CT and breast magnetic resonance imaging in prone position. After blinding to patient data, 2 radiologists independently rated PC-CT and DM regarding the following 6 characteristics: (1) diameter of the largest mass lesion, (2) infiltration of cutis/pectoral muscle/thoracic wall, (3) number of mass lesions, (4) presence/absence of adjacent ductal carcinoma in situ (DCIS), (5) tumor conspicuity, and (6) diagnostic confidence. Reference standard was generated from consensus reading of magnetic resonance imaging combined with all histopathological/clinical data by an independent adjudication committee applying TNM eighth edition. RESULTS: Among 32 enrolled female subjects (mean ± SD age, 59 ± 13.0 years), diagnostic accuracy for T-classification was higher for PC-CT compared with DM (0.94 vs 0.50, P < 0.01). Moreover, the correlation of the number of detected tumor masses with the reference standard was stronger for PC-CT than for DM (0.72 vs 0.50, P < 0.01). We observed that PC-CT significantly (P < 0.04) outperformed DM regarding not only sensitivity (0.83 and 0.25, respectively) but also specificity (0.99 and 0.80, respectively) for adjacent DCIS. The κ values for interreader reliability were higher for PC-CT compared with DM (mean 0.88 vs 0.54, respectively; P = 0.01). CONCLUSIONS: Photon-counting computed tomography outperformed DM in T-classification and provided higher diagnostic accuracy for the detection of adjacent DCIS. Therefore, opportunistic locoregional staging of breast cancer in contrast-enhanced thoracic PC-CT is feasible and could overcome limitations of DM with the potential to improve patient management.

Accelerated Diffusion-Weighted Imaging in 3 T Breast MRI Using a Deep Learning Reconstruction Algorithm With Superresolution Processing: A Prospective Comparative Study.

OBJECTIVES: Diffusion-weighted imaging (DWI) enhances specificity in multiparametric breast MRI but is associated with longer acquisition time. Deep learning (DL) reconstruction may significantly shorten acquisition time and improve spatial resolution. In this prospective study, we evaluated acquisition time and image quality of a DL-accelerated DWI sequence with superresolution processing (DWI DL ) in comparison to standard imaging including analysis of lesion conspicuity and contrast of invasive breast cancers (IBCs), benign lesions (BEs), and cysts. MATERIALS AND METHODS: This institutional review board-approved prospective monocentric study enrolled participants who underwent 3 T breast MRI between August and December 2022. Standard DWI (DWI STD ; single-shot echo-planar DWI combined with reduced field-of-view excitation; b-values: 50 and 800 s/mm 2 ) was followed by DWI DL with similar acquisition parameters and reduced averages. Quantitative image quality was analyzed for region of interest-based signal-to-noise ratio (SNR) on breast tissue. Apparent diffusion coefficient (ADC), SNR, contrast-to-noise ratio, and contrast (C) values were calculated for biopsy-proven IBCs, BEs, and for cysts. Two radiologists independently assessed image quality, artifacts, and lesion conspicuity in a blinded independent manner. Univariate analysis was performed to test differences and interrater reliability. RESULTS: Among 65 participants (54 ± 13 years, 64 women) enrolled in the study, the prevalence of breast cancer was 23%. Average acquisition time was 5:02 minutes for DWI STD and 2:44 minutes for DWI DL ( P < 0.001). Signal-to-noise ratio measured in breast tissue was higher for DWI STD ( P < 0.001). The mean ADC values for IBC were 0.77 × 10 -3 ± 0.13 mm 2 /s in DWI STD and 0.75 × 10 -3 ± 0.12 mm 2 /s in DWI DL without significant difference when sequences were compared ( P = 0.32). Benign lesions presented with mean ADC values of 1.32 × 10 -3 ± 0.48 mm 2 /s in DWI STD and 1.39 × 10 -3 ± 0.54 mm 2 /s in DWI DL ( P = 0.12), and cysts presented with 2.18 × 10 -3 ± 0.49 mm 2 /s in DWI STD and 2.31 × 10 -3 ± 0.43 mm 2 /s in DWI DL . All lesions presented with significantly higher contrast in the DWI DL ( P < 0.001), whereas SNR and contrast-to-noise ratio did not differ significantly between DWI STD and DWI DL regardless of lesion type. Both sequences demonstrated a high subjective image quality (29/65 for DWI STD vs 20/65 for DWI DL ; P < 0.001). The highest lesion conspicuity score was observed more often for DWI DL ( P < 0.001) for all lesion types. Artifacts were scored higher for DWI DL ( P < 0.001). In general, no additional artifacts were noted in DWI DL . Interrater reliability was substantial to excellent (k = 0.68 to 1.0). CONCLUSIONS: DWI DL in breast MRI significantly reduced scan time by nearly one half while improving lesion conspicuity and maintaining overall image quality in a prospective clinical cohort.

Accuracy of cone-beam computed tomography, digital mammography and digital breast tomosynthesis for microcalcifications and margins to microcalcifications in breast specimens.

Accurate determination of resection margins in breast specimens is important as complete removal of malignancy is a prerequisite for patients' outcome. Mammography (DM) as 2D-technique provides only limited value in margin assessment. Therefore, we investigated whether cone-beam computed tomography (CBCT) or digital breast tomosynthesis (DBT) has incremental value in assessing margins to microcalcifications. Three independent readers investigated breast specimens for presence of microcalcifications and the smallest distance to margins. Histopathology served as gold standard. Microcalcifications were detected in 15 out of 21 included specimens (71%). Pooled sensitivity for DM, DBT and CBCT for microcalcifications compared to preoperative DM was 0.98 (CI 0.94-0.99), 0.83 (CI 0.73-0.94) and 0.94 (CI 0.87-0.99), pooled specificity was 0.99 (CI 0.99-0.99), 0.73 (CI 0.51-0.96) and 0.60 (CI 0.35-0.85). Mean measurement error for margin determination for DM, DBT and CBCT was 10 mm, 14 mm and 6 mm (p = 0.002) with significant difference between CBCT and the other devices (p < 0.03). Mean reading time required by the readers to analyze DM, DBT and CBCT, was 36, 43 and 54 s (p < 0.001). Although DM allows reliable detection of microcalcifications, measurement of resection margin was significantly more accurate with CBCT. Thus, a combination of methods or improved CBCT might provide a more accurate determination of disease-free margins in breast specimens.

Genetic Analysis of the ATG16L1 c.898A>G (p.T300A) Variant in Acute and Chronic Pancreatitis.

OBJECTIVES: Human and animal studies suggest an important role of autophagy in the pathogenesis of pancreatitis. ATG16L1 (autophagy-related 16 like 1) is part of a protein complex that is involved in the formation of autophagosomes. The c.898A > G (p.T300A) variant of ATG16L1 is associated with Crohn disease. In this study, we analyzed ATG16L1 c.898A > G (p.T300A) for an association with pancreatitis. METHODS: We genotyped 777 patients and 551 control subjects of German origin by melting curve analysis using fluorescence resonance energy transfer probes. The patient group included 429 patients with nonalcoholic chronic pancreatitis (CP), 141 patients with alcoholic CP, and 207 patients with acute pancreatitis (AP). We classified AP by severity according to the Atlanta symposium 1992. RESULTS: Allele and genotype frequencies of ATG16L1 c.898A > G (p.T300A) did not differ significantly between patients and controls (G allele frequencies: nonalcoholic CP, 49.9%; alcoholic CP, 48.2%; AP, 49.5%; controls, 52.7%). We found no significant association with the severity of AP either. CONCLUSIONS: Our data do not support a role of ATG16L1 c.898A > G (p.T300A) in the pathogenesis of AP or CP or an influence on the severity of AP.

Comparing the diagnostic performance of radiation dose-equivalent radiography, multi-detector computed tomography and cone beam computed tomography for finger fractures - A phantom study.

PURPOSE: To compare the diagnostic performance and raters´confidence of radiography, radiography equivalent dose multi-detector computed tomography (RED-MDCT) and radiography equivalent dose cone beam computed tomography (RED-CBCT) for finger fractures. METHODS: Fractures were inflicted artificially and randomly to 10 cadaveric hands of body donors. Radiography as well as RED-MDCT and RED-CBCT imaging were performed at dose settings equivalent to radiography. Images were de-identified and analyzed by three radiologists regarding finger fractures, joint involvement and confidence with their findings. Reference standard was consensus reading by two radiologists of the fracturing protocol and high-dose multi-detector computed tomography (MDCT) images. Sensitivity and specificity were calculated and compared with Cochrane´s Q and post hoc analysis. Rater´s confidence was calculated with Friedman Test and post hoc Nemenyi Test. RESULTS: Rater´s confidence, inter-rater correlation, specificity for fractures and joint involvement were higher in RED-MDCT and RED-CBCT compared to radiography. No differences between the modalities were found regarding sensitivity. CONCLUSION: In this phantom study, radiography equivalent dose computed tomography (RED-CT) demonstrates a partly higher diagnostic accuracy than radiography. Implementing RED-CT in the diagnostic work-up of finger fractures could improve diagnostics, support correct classification and adequate treatment. Clinical studies should be performed to confirm these preliminary results.

Multiple Angulated Mammography Reconstructions in Digital Breast Tomosynthesis for the Diagnosis of Microcalcifications - Added Value to Standard Stack Reconstructions and Synthesized Mammography.

PURPOSE: To compare ratings regarding the depiction, diagnostic accuracy and lesion characterization of conventional synthesized mammography (SM), multiple angulated mammography reconstructions (INSIGHT3D), and standard stack reconstructions in digital breast tomosynthesis for microcalcifications. MATERIALS AND METHODS: This is a retrospective, multicase, multireader study. We included patients with digital breast tomosynthesis (DBT), microcalcifications and histology over a period of four months in our institution and the same number of normal cases. Three radiologists, who were blinded to patient data, independently rated the depiction, distribution, morphology and BI-RADS score of microcalcifications in SM, INSIGHT3D and standard stack reconstructions. Deidentified images were presented in random order. Reading time was measured. Friedman and post hoc Nemenyi tests, Cochrane's Q and post hoc Wilcoxon signed rank tests, Fleiss' kappa and receiver operating characteristics were used for statistical analysis. RESULTS: We included 41 histopathologically proven and 41 normal cases. Depiction of microcalcifications was rated better in INSIGHT3D than in SM and better in stack reconstructions than in INSIGHT3D and SM (P < 0.001). The reading time was lower in SM and INSIGHT3D compared to stack reconstructions (P < 0.001). The diagnostic accuracy and inter-rater correlation were comparable between all tested modes of reconstruction. CONCLUSIONS: INSIGHT3D has higher ratings regarding the depiction of microcalcifications compared to SM while maintaining a short reading time. Our preliminary assessment suggests that INSIGHT3D provides added value to SM. KEY POINTS: · INSIGHT3D depicts microcalcifications better than synthesized mammography while maintaining a low reading time.. · The diagnostic accuracy and inter-rater correlation were comparable between INSIGHT3D and synthesized mammography.. · INSIGHT3D may be a potential successor to synthesized mammography.. CITATION FORMAT: · Neubauer J, Neubauer C, Wicklein J et al. Multiple Angulated Mammography Reconstructions in Digital Breast Tomosynthesis for the Diagnosis of Microcalcifications - Added Value to Standard Stack Reconstructions and Synthesized Mammography. Fortschr Röntgenstr 2018; DOI: 10.1055/s-0044-100726.

Coincidental cerebral venous thrombosis and subarachnoid haemorrhage related to ruptured anterior communicating artery aneurysm.

Aneurysmal subarachnoid haemorrhage (SAH) and cerebral venous thrombosis (CVT) are rare cerebrovascular pathologies. Here, we report the extremely rare coincidental presentation of both entities and discuss the likely relationship in aetiology and their optimal management. A female patient presented with headache and progressive neurological deficits. Cranial computed tomography and contrast-enhanced magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) revealed dural venous sinus thrombosis, left-sided frontal and parietal infarcts, and left middle and anterior cerebral artery stenosis. In addition, left hemispheric subarachnoid haemosiderosis was seen on MRI. Following standard anticoagulation therapy for CVT, she represented with acute SAH. Digital subtraction angiography revealed a ruptured anterior communicating artery aneurysm and left middle cerebral artery/anterior cerebral artery vasospasms that were responsive to intra-arterial nimodipine. The latter were already present on the previous MRI, and had most likely prevented the detection of the aneurysm initially. The aneurysm was successfully coil embolised, and the patient improved clinically. Despite this case being an extremely rare coincidence, a ruptured aneurysm should be excluded in the presence of CVT and non-sulcal SAH. A careful consideration of treatment of both pathologies is required, since anticoagulation may have a potentially negative impact on aneurysmal bleeding.

Comparison of Multidetector Computed Tomography and Flat-Panel Computed Tomography Regarding Visualization of Cortical Fractures, Cortical Defects, and Orthopedic Screws: A Phantom Study.

To compare the visualization of cortical fractures, cortical defects, and orthopedic screws in a dedicated extremity flat-panel computed tomography (FPCT) scanner and a multidetector computed tomography (MDCT) scanner.We used feet of European roe deer as phantoms for cortical fractures, cortical defects, and implanted orthopedic screws. FPCT and MDCT scans were performed with equivalent dose settings. Six observers rated the scans according to number of fragments, size of defects, size of defects opposite orthopedic screws, and the length of different screws. The image quality regarding depiction of the cortical bone was assessed. The gold standard (real number of fragments) was evaluated by autopsy.The correlation of reader assessment of fragments, cortical defects, and screws with the gold standard was similar for FPCT and MDCT. Three readers rated the subjective image quality of the MDCT to be higher, whereas the others showed no preferences.Although the image quality was rated higher in the MDCT than in the FPCT by 3 out of 6 observers, both modalities proved to be comparable regarding the visualization of cortical fractures, cortical defects, and orthopedic screws and of use to musculoskeletal radiology regarding fracture detection and postsurgical evaluation in our experimental setting.

Fast word reading in pure alexia: "fast, yet serial".

Pure alexia is a severe impairment of word reading in which individuals process letters serially with a pronounced length effect. Yet, there is considerable variation in the performance of alexic readers with generally very slow, but also occasionally fast responses, an observation addressed rarely in previous reports. It has been suggested that "fast" responses in pure alexia reflect residual parallel letter processing or that they may even be subserved by an independent reading system. Four experiments assessed fast and slow reading in a participant (DN) with pure alexia. Two behavioral experiments investigated frequency, neighborhood, and length effects in forced fast reading. Two further experiments measured eye movements when DN was forced to read quickly, or could respond faster because words were easier to process. Taken together, there was little support for the proposal that "qualitatively different" mechanisms or reading strategies underlie both types of responses in DN. Instead, fast responses are argued to be generated by the same serial-reading strategy.

Targeting of syndecan-1 by microRNA miR-10b promotes breast cancer cell motility and invasiveness via a Rho-GTPase- and E-cadherin-dependent mechanism.

microRNAs are small endogenous noncoding RNAs, which post-transcriptionally regulate gene expression. In breast cancer, overexpression of the transmembrane heparan sulfate proteoglycan syndecan-1, a predicted target of the oncomiR miR-10b, correlates with poor clinical outcome. To investigate the potential functional relationship of miR-10b and syndecan-1, MDA-MB-231 and MCF-7 breast cancer cells were transiently transfected with pre-miR-10b, syndecan-1 siRNA or control reagents, respectively. Altered cell behavior was monitored by proliferation, migration and invasion chamber assays, and time-lapse video microscopy. miR-10b overexpression induced post-transcriptional downregulation of syndecan-1, as demonstrated by quantitative real-time PCR (qPCR), flow cytometry, and 3'UTR luciferase assays, resulting in increased cancer cell migration and matrigel invasiveness. Syndecan-1 silencing generated a copy of this phenotype. Adhesion to fibronectin and laminin and basal cell proliferation was increased. Syndecan-1 coimmunoprecipitated with focal adhesion kinase, which showed increased activation upon syndecan-1 depletion. Affymetrix screening and confirmatory qPCR and Western blotting analysis of syndecan-1-deficient cells revealed upregulation of ATF-2, COX-2, cadherin-11, vinculin, actin γ 2, MYL9, transgelin-1, RhoA/C, matrix metalloproteinase 2 (MMP2) and heparanase, and downregulation of AML1/RUNX1, E-cadherin, CLDN1, p21WAF/CIP, cyclin-dependent kinase 6, TLR-4, PAI1/2, Collagen1alpha1, JHDM1D, Mpp4, MMP9, matrilin-2 and ANXA3/A10. Video microscopy demonstrated massively increased Rho kinase-dependent motility of syndecan-1-depleted cells, which displayed increased filopodia formation. We conclude that syndecan-1 is a novel target of the oncomiR miR-10b. Rho-GTPase-dependent modulation of cytoskeletal function and downregulation of E-cadherin expression are identified as relevant effectors of the miR-10b-syndecan-1 axis, which emerges as a promising target for the development of new therapeutic approaches for breast cancer.

Axenization and optimization of in vitro growth of clonal cultures of Tetratrichomonas gallinarum and Trichomonas gallinae.

A rapid and simple procedure was established to obtain clonal axenic cultures of Tetratrichomonas gallinarum and Trichomonas gallinae and to optimize their in vitro growth conditions. Medium 199 was used for axenization of two genetically different clones of T. gallinarum and T. gallinae. Six different media were used to optimize the growth behaviour of axenically grown parasites: Medium 199, TYM, TYI-S-33, Hollander fluid (HF), Trichomonas vaginalis (TV) and modified TV media. The highest cell yields for both axenic clones of T. gallinarum were obtained in modified TV medium without antibiotics. The maximum numbers of trophozoites of T. gallinae were obtained in an optimized HF medium. This study demonstrated that axenic cultures for T. gallinarum and T. gallinae could be obtained avoiding the migration technique through a V-tube. Following axenization and optimization, both clones of T. gallinarum and T. gallinae could be propagated both aerobically and anaerobically.

Comparative studies on [Pasteurella] testudinis and [P.] testudinis-like bacteria and proposal of Chelonobacter oris gen. nov., sp. nov. as a new member of the family Pasteurellaceae.

A collection of 12 strains, isolated from diseased tortoises and tentatively identified as [Pasteurella] testudinis-like based on phenotypic characters, was compared with three reference strains of [P.] testudinis. All strains could be separated from the reference strains with respect to 16S rRNA gene sequences, partial sequences of the rpoB housekeeping gene and by phenotypic characters. Based upon differences in 16S rRNA and rpoB gene sequences, the new isolates are suggested to represent a novel species in a new genus of the family Pasteurellaceae Pohl 1981, for which the name Chelonobacter oris gen. nov., sp. nov. is proposed. The type strain is 1662(T) (=CCUG 55632(T)=DSM 21392(T)). beta-Haemolysis and acid production from (+)-l-arabinose, dulcitol, (-)-d-mannitol, (+)-d-mannose, trehalose and salicin separated the new strains from members of existing genera of the family Pasteurellaceae, in addition to the beta-galactosidase, urease and alpha-glucosidase reactions. Differences in indole production, phosphatase, beta-glucosidase and production of acid from dulcitol and trehalose separated C. oris from [P.] testudinis. Several phenotypic characters separated C. oris from Bisgaard's taxa 14 and 32.

Tissue tropism of Helicobacter pullorum in specific pathogen-free chickens determined by culture and nucleic acid detection.

Three-day-old specific pathogen-free chickens (n = 24) located in isolators were inoculated orally with Helicobacter pullorum. One group (n = 12) was infected with a H. pullorum field isolate from human origin, another one (n = 12) with the American Type Culture Collection H. pullorum reference isolate 51801 originating from chickens. Both isolates were positive for cytolethal distending toxin, investigated using a polymerase chain reaction (PCR). A third group (n = 4) was kept as a negative control. Starting on day 7 of life, birds from each group were euthanatized at different time points up to 35 days. Various organ samples were taken aseptically and processed by culture and a H. pullorum-specific PCR. In the group infected with the human isolate the nucleic acid of H. pullorum was detected in the caecal tonsils and caeca of 12 and 11 birds, respectively. Live bacteria were cultivated from the caecal tonsils and caeca of five birds 24 and 31 days postinfection. Live bacteria were also isolated from the heart of one bird, whereas PCR had to be used to detect the nucleic acid of H. pullorum in the gallbladder of four birds. No live bacteria were reisolated at any time from birds infected with the avian isolate, but bacterial nucleic acid was detected in the caeca of five birds and in the gallbladder of one. In both groups neither live H. pullorum nor its nucleic acid were detected in the liver, spleen, and duodenum. Compared to the avian H. pullorum isolate the human isolate proved to be more invasive. No obvious clinical symptoms or disease was seen in the chickens during the entire experiment. The reisolation of live bacteria at the end of the experiments indicates that H. pullorum could enter the food chain even after early infection in birds. Furthermore, PCR was demonstrated to be helpful in tracing these fastidious bacteria.