Correction to: Consensus-based technical recommendations for clinical translation of renal diffusion-weighted MRI.

The article Consensus-based technical recommendations for clinical translation of renal diffusion-weighted MRI.

Consensus-based technical recommendations for clinical translation of renal diffusion-weighted MRI.

OBJECTIVES: Standardization is an important milestone in the validation of DWI-based parameters as imaging biomarkers for renal disease. Here, we propose technical recommendations on three variants of renal DWI, monoexponential DWI, IVIM and DTI, as well as associated MRI biomarkers (ADC, D, D*, f, FA and MD) to aid ongoing international efforts on methodological harmonization. MATERIALS AND METHODS: Reported DWI biomarkers from 194 prior renal DWI studies were extracted and Pearson correlations between diffusion biomarkers and protocol parameters were computed. Based on the literature review, surveys were designed for the consensus building. Survey data were collected via Delphi consensus process on renal DWI preparation, acquisition, analysis, and reporting. Consensus was defined as ≥ 75% agreement. RESULTS: Correlations were observed between reported diffusion biomarkers and protocol parameters. Out of 87 survey questions, 57 achieved consensus resolution, while many of the remaining questions were resolved by preference (65-74% agreement). Summary of the literature and survey data as well as recommendations for the preparation, acquisition, processing and reporting of renal DWI were provided. DISCUSSION: The consensus-based technical recommendations for renal DWI aim to facilitate inter-site harmonization and increase clinical impact of the technique on a larger scale by setting a framework for acquisition protocols for future renal DWI studies. We anticipate an iterative process with continuous updating of the recommendations according to progress in the field.

Multistationarity in the Space of Total Concentrations for Systems that Admit a Monomial Parametrization.

We apply tools from real algebraic geometry to the problem of multistationarity of chemical reaction networks. A particular focus is on the case of reaction networks whose steady states admit a monomial parametrization. For such systems, we show that in the space of total concentrations multistationarity is scale invariant: If there is multistationarity for some value of the total concentrations, then there is multistationarity on the entire ray containing this value (possibly for different rate constants)-and vice versa. Moreover, for these networks it is possible to decide about multistationarity independent of the rate constants by formulating semi-algebraic conditions that involve only concentration variables. These conditions can easily be extended to include total concentrations. Hence, quantifier elimination may give new insights into multistationarity regions in the space of total concentrations. To demonstrate this, we show that for the distributive phosphorylation of a protein at two binding sites multistationarity is only possible if the total concentration of the substrate is larger than either the total concentration of the kinase or the total concentration of the phosphatase. This result is enabled by the chamber decomposition of the space of total concentrations from polyhedral geometry. Together with the corresponding sufficiency result of Bihan et al., this yields a characterization of multistationarity up to lower-dimensional regions.

Heparin-induced thrombocytopaenia presenting as acute aortic mural thrombosis.

Heparin-induced thrombocytopaenia (HIT) is a life and limb-threatening acquired autoimmune complication of heparin-based treatment, characterised by thrombocytopaenia and thrombosis. We present a case of a 77-year-old female with concomitant metastatic ovarian and breast cancer who presented to our institution with worsening shortness of breath. She had been diagnosed with acute pulmonary embolism 1 month earlier that was treated with therapeutic low molecular weight heparin (LMWH). In view of her worsening symptoms, CT imaging was performed. This demonstrated significant progression of the bilateral pulmonary emboli and new mural thrombosis of the thoracic aorta, despite being compliant with therapeutic anticoagulation. She had also developed thrombocytopaenia since commencing LMWH, which raised the clinical suspicion of HIT syndrome. The HIT pre-test probability score was intermediate and LMWH was immediately discontinued pending further investigation. She was commenced on rivaroxaban, a direct oral anticoagulant, and her platelet count soon recovered. Laboratory testing was strongly positive on both immunological and functional assays, thus confirming a diagnosis of HIT syndrome. A repeat CT scan 3 weeks later showed a reduction in the overall thrombus load. Whilst venous thrombosis is observed in as many as half of patients with HIT, arterial thrombosis is a far less common event. Furthermore, arterial involvement usually affects the distal vessels with significant atherosclerotic burden and typically presents as acute limb ischaemia or ischaemic stroke. Aortic thrombosis, as in this case, is a rare complication of HIT syndrome.

Improvement of MRI-functional measurement with automatic movement correction in native and transplanted kidneys.

PURPOSE: To improve 2D software for motion correction of renal dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and to evaluate its effect using the Patlak-Rutland model. MATERIALS AND METHODS: A subpixel-accurate method to correct for kidney motion during DCE-MRI was evaluated on native and transplanted kidneys using data from two different institutions with different magnets and protocols. The Patlak-Rutland model was used to calculate glomerular filtration rate (GFR) on a voxel-by-voxel basis providing mean (Kp) and uncertainty (sigma(K(p))) values for GFR. RESULTS: In transplanted kidneys, average absolute variation of Kp was 6.4% +/- 4.8% (max = 16.6%). In native kidneys average absolute variation of Kp was 12.11% +/- 6.88% (max = 25.6%) for the right and 11.6% +/- 6% (max = 20.8%) for the left. Movement correction showed an average reduction of sigma(K(p)) of 6.9% +/- 6.6% (max = 21.4%) in transplanted kidneys, 30.9% +/- 17.6% (max = 60.8%) for the right native kidney, and 31.8% +/- 14% (max = 55.3%) for the left kidney. CONCLUSION: The movement correction algorithm showed improved uncertainty on GFR computation for both native and transplanted kidneys despite different spatial resolution from the different MRI systems and different levels of signal-to-noise ratios on DCE-MRI.

Silicone rubber mould cast polyethylmethacrylate-hydroxyapatite plate used for repairing a large skull defect.

INTRODUCTION: Reconstruction of the cranial vault is performed for various reasons and precise repair of the defect is important. A modified method of cranioplasty is presented using three-dimensional (3D) models and polyethylmethacrylate mixed with hydroxyapatite, cast in a silicone rubber mould. PATIENT AND METHOD: A large custom made cranial implant was produced using data acquired from 3D computer tomography, rapid prototyping and cast in a silicone rubber mould. This plate was then applied to a 53 year-old man who had undergone a decompressive fronto-parieto-temporo-occipital craniotomy. The bone flap had been lost due to infection. The cranioplasty was performed at 1 year after the initial operation. RESULTS: The cranial plate fitted precisely into the defect and needed no correction at the time of surgery. The stability of the reconstruction plate was increased by the presence of thin margins allowed by silicone rubber elasticity. No complications occurred and the final functional and aesthetic results were good. CONCLUSION: The use of 3D imaging and rapid prototyping allow precise repair of large skull defects, with good aesthetic and functional results. At the same time, silicone rubber moulds permit the production of very thin details needed not only for cosmetic reasons but for reconstruction plate stability as well.