Local gyrification index in patients with major depressive disorder and its association with tryptophan hydroxylase-2 (TPH2) polymorphism.

The tryptophan hydroxylase-2 (TPH2) gene is considered a promising genetic candidate regarding its association with a predisposition to major depressive disorder (MDD). Local gyrification reflects the early neural development of cortical connectivity, and is regarded as a potential neural endophenotype in psychiatric disorders. They aimed to investigate the alterations in the cortical gyrification of the prefrontal cortex and anterior cingulate cortex and their association with the TPH2 rs4570625 polymorphism in patients with MDD. One hundred and thirteen patients with MDD and eighty-six healthy controls underwent T1-weighted structural magnetic resonance imaging and genotyping for TPH2 rs4570625. The local gyrification index of 22 cortical regions in the prefrontal cortex and anterior cingulate cortex was analyzed using the FreeSurfer. The patients with MDD showed significant hypergyria in the right rostral anterior cingulate cortex (P = 0.001), medial orbitofrontal cortex (P = 0.003), and frontal pole (P = 0.001). There was a significant genotype-by-diagnosis interaction for the local gyrification index in the right rostral anterior cingulate cortex (P = 0.003). Their study revealed significant hypergyria of the anterior cingulate cortex and prefrontal cortex and an interactive effect between the diagnosis of MDD and the genotype in the anterior cingulate cortex. This might be associated with the dysfunction of neural circuits mediating emotion processing, which could contribute to pathophysiology of MDD. Hum Brain Mapp 38:1299-1310, 2017. © 2016 Wiley Periodicals, Inc.

Predicting Extrathyroidal Extension in Patients With Papillary Thyroid Microcarcinoma According to a BRAF Mutation.

OBJECTIVES: The aim of this study was to evaluate the association between preoperative parameters and extrathyroidal extension (ETE) of papillary thyroid microcarcinoma (PTMC) according to the BRAF mutation and to evaluate the preoperative predictability of ETE. METHODS: We analyzed the medical records of 332 patients with PTMC (140 in the BRAF- group and 192 in the BRAF+ group). The presence of ETE was subjected to a correlation analysis with age, sex, tumor size, clinical nodal status, and ultrasonography (US) findings. Among the US findings, the correlation between tumors and the thyroid capsule was categorized into four groups; US group A, intraparechymal; US group B, tumor abutting the capsule <50% of diameter; US group C, tumor abutting >50% of diameter; and US group D, tumor destroyed the capsule. The predictive value of ETE, including sensitivity, specificity, and positive and negative predictive values were evaluated. RESULTS: Tumor size and US group were significantly correlated with gross ETE in the BRAF- and BRAF+ groups. Tumor size of 0.5 cm and US groups B and C in the BRAF- group were cutoff values for gross ETE, with a negative predictive value of 100%, whereas tumor size of 0.7 cm and US groups A and B in the BRAF+ group had negative predictive values of 92.4% and 100%, respectively. CONCLUSION: Excluding of ETE by US was categorized according to tumor size and US findings. A different categorization to exclude ETE is needed according to the BRAF mutation.

Effects of a Polymorphism of the Neuronal Amino Acid Transporter SLC6A15 Gene on Structural Integrity of White Matter Tracts in Major Depressive Disorder.

BACKGROUND: The SLC6A15 gene has been identified as a novel candidate gene for major depressive disorder (MDD). It is presumed to be involved in the pathophysiology of MDD through regulation of glutamate transmission in the brain. However, the involvement of this gene in microstructural changes in white matter (WM) tracts remains unclear. We aimed to investigate the influence of a polymorphism of this gene (rs1545853) on the structural integrity of WM tracts in the cortico-limbic network. METHODS: Eighty-six patients with MDD and 64 healthy controls underwent T1-weighted structural magnetic resonance imaging, including diffusion tensor imaging (DTI), and genotype analysis. We selected the genu of the corpus callosum, the uncinate fasciculus, cingulum, and fornix as regions of interest, and extracted fractional anisotropy (FA) values using the FMRIB Diffusion Toolbox software. RESULTS: FA values for the left parahippocampal cingulum (PHC) was significantly reduced in the patients with MDD compared to healthy control participants (p = 0.004). We also found that MDD patients with the A allele showed reduced FA values for the left PHC than did healthy controls with the A allele (p = 0.012). There was no significant difference in the FA value of left PHC for the comparison between the G homozygotes of MDD and healthy control group. CONCLUSIONS: We observed an association between the risk allele of the SLC6A15 gene rs1545843 and the WM integrity of the PHC in MDD patients, which is known to play an important role in the neural circuit involved in emotion processing.

Influence of BclI C/G (rs41423247) on hippocampal shape and white matter integrity of the parahippocampal cingulum in major depressive disorder.

We investigated the interactive effects of BclI C/G (rs41423247) allelic variants and the diagnosis of major depressive disorder (MDD) on hippocampal shape and integrity of the left parahippocampal subdivision of the cingulum. Fifty-two patients with MDD and 52 healthy controls (HCs) underwent T1-weighted structural magnetic resonance imaging and BclI C/G (rs41423247) genotyping. We analyzed hippocampal shape using the FIRST module of FSL and analyzed white matter (WM) integrity using diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS). Significant alterations in left hippocampal shape and decreased fractional anisotropy (FA) values of the left parahippocampal cingulum were observed in MDD patients, compared to HCs. In addition, MDD patients of the BclI minor (G-) allele carrier group showed significant alterations in left hippocampal shape and decreased FA values of the left parahippocampal cingulum compared to BclI minor (G-) allele carrier HCs. No significant differences between diagnostic subgroups of the C/C homozygotes were observed. Our study provides evidence for alterations in hippocampal shape and decreased integrity of the WM region associated with the hippocampus in MDD, and for the possible influence of BclI C/G polymorphism (rs41423247) on hippocampal shape and integrity of the parahippocampal subdivision of the cingulum in depression.

Feasibility Study of a Contrast-Enhanced Multi-Detector CT (64 Channels) Protocol for Papillary Thyroid Carcinoma: The Influence of Different Scan Delays on Tumor Conspicuity.

BACKGROUND: Recently, a number of studies have advocated the diagnostic benefit of contrast-enhanced computed tomography (CECT) in the current ultrasound (US)-based preoperative evaluation of thyroid cancer. However, no study has been conducted to optimize a CECT protocol focusing on tumor conspicuity using a multi-detector CT scanner. This study aimed at determining the optimal scan delay for increased CT attenuation differences between thyroid cancer and parenchymal background using a biphasic CECT examination. METHODS: This study retrospectively enrolled 84 patients (M:F = 7:77; Mage = 44.8 ± 10.9 years) with 87 papillary thyroid carcinomas (Msize = 14.1 mm) who consecutively underwent US and CECT examination prior to surgery. In each patient, CT scanning was taken twice-once with a 40-second delay and once with a 70-second delay-using a 64-channel multi-detector scanner. After obtaining the mean attenuation value (MAV) of the thyroid cancer and the ipsilateral parenchyma by drawing regions of interest on the CECT images based on their cytopathologic results and US findings, the parenchyma-cancer differences (PCD) between the early and delayed scans were simply compared using a paired t-test. Then, the mean differences in the MAVs of the thyroid cancer and ipsilateral parenchyma (hereafter abbreviated as Group) between the early and delayed scans (abbreviated as Time) were compared after adjusting for the other factors that significantly affected MAVs, such as concentration of iodinated contrast medium (abbreviated as CCM) and size of thyroid cancer (abbreviated as Size) using a repeated-measures general linear model. RESULTS: Because the ipsilateral parenchyma exhibited significantly higher attenuation on the early scan and further decline on the delayed scan compared with thyroid cancer (p < 0.001), the PCD for thyroid cancer was significantly better with a 40-second scan delay than a 70-second delay (58.8 ± 36.6 Hounsfield units [HU] vs. 40.4 ± 25.6 HU; p < 0.001). Similar results were obtained from the repeated-measures general linear model that considered the effects of CCM, Size, Group, and Time, and the interaction of Group and Time. CONCLUSION: Based on this CECT study that adjusted for the effects of CCM and size on MAV, early scans (e.g., 40-second scan delay) are helpful for improving the tumor conspicuity of thyroid cancer on CECT images.

Chemoembolization for hepatocellular carcinoma supplied by a lumbar artery.

PURPOSE: To describe the radiologic findings and imaging response of hepatocellular carcinoma (HCC) supplied by the lumbar artery. METHODS: Between April 2004 and December 2012, we encountered HCC supplied by a lumbar artery in 21 patients. Two investigators retrospectively reviewed clinical and radiological findings of HCC supplied by the lumbar artery using computed tomography (CT) scans and digital subtraction angiograms. RESULTS: Patients had received 1-27 sessions of previous chemoembolization procedures (mean 7.7 sessions, median 4 sessions). Mean tumor size was 5.3 cm. The locations of HCC supplied by lumbar artery were the bare area (n = 14, 67 %) and segment VI (n = 7, 33 %). Tumor-feeding arteries arose from the main lumbar artery (n = 7), proximal anterior division (n = 4), and distal anterior division (n = 14). In 20 patients, selective chemoembolization through the tumor-feeding arteries of the lumbar artery was achieved. In 1 patient, nonselective embolization at the main lumbar artery was performed. There was no complication such as skin necrosis or paralysis. On the first follow-up enhanced CT scan, target tumors fed by the lumbar artery showed complete response (n = 6), partial response (n = 4), stable disease (n = 3), and progressive disease (n = 8), but overall tumor response was partial response (n = 1) and progressive disease (n = 20). CONCLUSION: When HCC is located in the inferior tip or bare area of the liver, a lumbar artery may supply the tumor. Although selective chemoembolization via the tumor-feeding vessel of the lumbar artery can be achieved in most cases, overall tumor response is commonly unfavorable.

Disconnection of the rubber tip of arrow-trerotola percutaneous thrombolytic device.

A rubber tip disconnection of Arrow-Trerotola percutaneous thrombolytic device (PTD) may occur occasionally. We experienced 5 cases of a rubber tip disconnection among 453 mechanical thrombectomy sessions with the use of PTD. We present a report about these five cases and suggest possible causes for the occurrences.

Serial MR analysis of early permanent and transient ischemia in rats: diffusion tensor imaging and high b value diffusion weighted imaging.

OBJECTIVE: To evaluate the temporal evolution and diagnostic values of the diffusion tensor imaging (DTI) and the high b value diffusion weighted imaging (DWI) in the early permanent and transient cerebral ischemia. MATERIALS AND METHODS: For permanent or 30-minute transient-ischemia induced 30 rats, DTI and DWIs at both high b (b = 3000 s/mm(2)) and standard b value (b = 1000 s/mm(2)) were obtained at the following conditions: at 15, 30, 45, 60 minutes after the occlusion of what for hyperacute permanent ischemia; at 1, 3, 5, 7, 9 hours after the occlusion for acute permanent ischemia; and at 15 minutes before reperfusion, 0.5, 2.5, and 24 hours after reperfusion for transient ischemia. The diffusion parameters and their ratios were obtained and compared between different b values, and among different time points and groups, respectively. RESULTS: For both b values, the apparent diffusion coefficient (ADC) ratio decreased for first three hours, and then slightly increased until 9 hours after the occlusion during a gradual continuous increase of DWI signal intensity (SI) ratio, with excellent correlation between ADC ratios and DWI SI ratios. The DWI showed a higher contrast ratio, but the ADC map showed a lower contrast ratio for permanent ischemia at high b value than at standard b value. Fractional anisotropy (FA) increased for 1 hour, then gradually decreased until 9 hours after the occlusion in permanent ischemia and showed transient normalization and secondary decay along with change in ADC in transient ischemia. CONCLUSION: This study presents characteristic initial elevation and secondary decay of FA, higher contrast ratio of DWI, and lower contrast ratio of ADC map at high b value, in addition to the time evolutions of diffusion parameters in early permanent and transient ischemia.

Sprague-Dawley rats bearing McA-RH7777 cells for study of hepatoma and transarterial chemoembolization.

AIM: To evaluate the feasibility of the McA-RH7777 tumor model in Sprague-Dawley (SD) rats, for study of hepatoma and transarterial chemoembolization. MATERIALS AND METHODS: McA-RH7777 rat hepatoma cells (1×10(7)) were inoculated into the left hepatic lobe of SD rats (n=38). Chemoembolization with left common carotid artery access was performed using an emulsion of iodized oil and doxorubicin, and polyvinyl alcohol particles. Tumor induction rate and response to chemoembolization were assessed by magnetic resonance imaging and histology. RESULTS: Tumor induction rate of McA-RH7777 in SD rat livers was 73.3% (11/15). Hematoxylin-and-eosin staining revealed hypercellular tumor with a trabecular pattern that mimics human hepatocellular carcinoma. Chemoembolization was successfully conducted in all rats. There was a significant difference in tumor growth rates between the chemoembolization-treated and control groups (p<0.0001). CONCLUSION: A rat tumor model of McA-RH7777 cells in SD rats is feasible and has the potential to be a good model for hepatoma and chemoembolization studies.

Remote cerebral and cerebellar hemorrhage after massive cerebrospinal fluid leakage.

Dural tears can occur during spinal surgery and may lead to cerebrospinal fluid (CSF) leakage which is rarely involved in remote cerebellar hemorrhage. Only a few of cases of simultaneous cerebral and cerebellar hemorrhage have been reported in the English literature. We experienced a case of multiple remote cerebral and cerebellar hemorrhages in a 63-year-old man who exhibited no significant neurologic deficits after spinal surgery. Magnetic resonance imaging (MRI) performed 4 days after the surgery showed a large amount of CSF leakage in the lumbosacral space. The patient underwent the second surgery for primary repair of the dural defect, but complained of headache after dural repair surgery. Brain MRI taken 6 days after the dural repair surgery revealed multifocal remote intracerebral and cerebellar hemorrhages in the right temporal lobe and both cerebellar hemispheres. We recommend diagnostic imaging to secure early identification and treatment of this complication in order to prevent serious neurologic deficits.

Lymph node metastases from gastric cancer: gadofluorine M and gadopentetate dimeglumine MR imaging in a rabbit model.

PURPOSE: To compare the diagnostic performance of gadofluorine M with that of gadopentetate dimeglumine in the diagnosis of lymph node metastases with magnetic resonance (MR) imaging in a rabbit model of gastric cancer. MATERIALS AND METHODS: The study protocol was approved by the institutional animal care committee. VX2 carcinomas were inoculated into the wall of the stomach in 20 rabbits. Gadopentetate dimeglumine-enhanced MR imaging was performed 4-6 weeks after inoculation, and gadofluorine M-enhanced MR imaging was performed approximately 24 hours later. Both MR imaging sets were analyzed separately and independently by four radiologists with respect to confidence level regarding the presence of metastases in lymph nodes and lymph node conspicuity. Statistical analysis was performed by using multiple-reader multiple-case (MRMC) receiver operating characteristic curve analysis and the Wilcoxon signed rank test. RESULTS: Metastases were confirmed at pathologic analysis in 32 of 104 lymph nodes from 16 rabbits. The area under the receiver operating characteristic curve (AUC) for confidence regarding the presence of metastases in lymph nodes was significantly greater for gadofluorine M than for gadopentetate dimeglumine (AUC, 0.947 vs 0.894; P = .009). However, most (81%, 25 of 32) metastatic nodes were necrotic, and no significant difference was obtained in nonnecrotic nodes. For lymph node conspicuity, the gadofluorine M MR imaging set was assigned a significantly higher score than was the gadopentetate dimeglumine MR imaging set by all readers (P < .001). CONCLUSION: Gadofluorine M showed significantly higher accuracy and better conspicuity than gadopentetate dimeglumine in the diagnosis of metastatic nodes, most of which were necrotic, in this animal model of gastric cancer.

Demonstration of decreased gray matter concentration in the midbrain encompassing the dorsal raphe nucleus and the limbic subcortical regions in major depressive disorder: an optimized voxel-based morphometry study.

BACKGROUND: Previous neuroimaging studies in patients with major depressive disorder (MDD) have reported changes in several brain areas, such as the medial and dorsolateral orbital cortex, amygdala, hippocampus, and basal ganglia. However, the results of these studies are inconsistent, and relatively few studies have been conducted using voxel-based morphometry (VBM) to detect gray matter concentration (GMC) abnormalities in patients with MDD. METHODS: We examined 47 MDD patients and 51 healthy controls to investigate structural abnormalities using a 1.5 T magnetic resonance imaging system, which was normalized to a customized T1 template and segmented with optimized VBM. Analysis of covariance with age and gender as covariates was adopted for the VBM statistics; the level of statistical significance was set at P<0.05 for the corrected false discovery rate. RESULTS: Decreased GMC was found in MDD patients in the bilateral amygdalae, hippocampi, fusiform gyri, lingual gyri, insular gyri, middle-superior temporal gyri, thalami, cingulate gyri, the central lobule of the cerebellum, and the midbrain encompassing the dorsal raphe nuclei (DRN). LIMITATIONS: Half of our study subjects were taking antidepressants. This may have been a potential confounding factor if any of the medications affected cortical volume. CONCLUSIONS: The results suggest that the GMC of several regions associated with emotion regulation was lower in MDD patients. In particular, we found decreased GMC in the DRN. These findings may provide a better understanding of the anatomical properties of the neural mechanisms underlying the etiology of MDD.

Transarterial chemoembolization of a colic branch of the superior mesenteric artery in patients with unresectable hepatocellular carcinoma.

PURPOSE: To evaluate the technical feasibility, safety, and imaging response of transarterial chemoembolization performed through a colic branch of the superior mesenteric artery (SMA) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Between July 2000 and June 2009, we observed tumor staining supplied by a colic branch of the SMA in 61 of 5,095 patients (1.2%) with HCC. Computed tomography (CT) scans and digital subtraction angiograms of these patients were retrospectively reviewed by two investigators in consensus to evaluate the tumor location, the technical success of chemoembolization, complications, and imaging response on a follow-up CT scan according to European Association for the Study of the Liver criteria. RESULTS: Tumors supplied by a colic branch of the SMA were located in segment VI (n = 58) or were extrahepatic metastases caused by peritoneal seeding (n = 3). Vessels supplying the tumor arose from the right colic artery (n = 23), middle colic artery (n = 22), or ileocolic artery (n = 26). Selective chemoembolization via a colic branch of the SMA was performed in 24 patients (39%). No patient developed symptoms related to colon ischemia. Complete response or partial response of the tumor fed by a colic branch of the SMA as depicted on follow-up CT was achieved in eight patients (33%). CONCLUSIONS: Chemoembolization via a colic branch of the SMA can be safely performed if the microcatheter can be advanced beyond the antimesenteric border of the colon.

Novel intraarterial therapy for liver cancer using ethylbromopyruvate dissolved in an iodized oil.

RATIONALE AND OBJECTIVES: In spite of various therapies developed, hepatocellular carcinoma still shows poor prognosis. In this study, we introduced ethylbromopyruvate (EBrP), a hydrophobic derivative of 3-bromopyruvate, as an agent for intraarterial therapy of hepatocellular carcinoma. MATERIALS AND METHODS: In in vitro study, we evaluated whether EBrP induced apoptotic cell death in Huh-BAT cells. Chemical degradation products of EBrP were identified by performing proton nuclear magnetic resonance spectroscopy and thin layer chromatography. VX2 carcinoma was implanted and grown in the liver of 25 rabbits for in vivo study. By transfemoral intraarterial approach, 0.4 mL of 10 mM and 40 mM EBrP dissolved in an iodized oil (Lipiodol) was infused into the proper hepatic artery in 8 and 10 rabbits, respectively. In the remaining seven rabbits, 0.4 mL of Lipiodol alone was intraarterially injected as a control. One week later, tumor necrosis rate was calculated with histopathologic examination and hepatotoxicity was evaluated with biochemical analysis. RESULTS: EBrP induced apoptosis in human HCC cells via mitochondrial apoptotic signaling cascades. EBrP dissociated into 3-bromopyruvate and ethanol in the aqueous environment. In VX2 liver tumor models, the group of intraarterial delivery of 40 mM EBrP/Lipiodol solution showed higher tumor necrosis rates (96.1% ± 3.8) than the other groups (38.9% ± 15.9 of a control, 90.5% ± 2.9 in 10 mM) (P < .05). There was transient elevation of AST and ALT enzyme levels without any mortality. CONCLUSIONS: Intraarterial infusion of EBrP/Lipiodol solution is a feasible intraarterial therapy for liver tumors with potent antitumor effects and transient hepatotoxicity.

Intercostal artery supplying hepatocellular carcinoma: demonstration of a tumor feeder by C-arm CT and multidetector row CT.

This study was designed to describe tumor feeders from the intercostal artery supplying hepatocellular carcinoma (HCC) on C-arm CT and multidetector row CT. From March 2008 to May 2009, C-arm CT of the intercostal artery was prospectively performed in 24 HCC patients. Two interventional radiologists, who performed C-arm CT, evaluated tumor feeders on C-arm CT and multidetector row CT scans by consensus. In total, 35 intercostal arteries were examined by C-arm CT. All tumor feeders except one showed a sharp upward turn at or near the costochondral junction. On axial C-arm CT images, all tumor feeders were observed as an enhancing dot in the upper intercostal space along the diaphragm. On multidetector CT scans, 17 tumor feeders were observed and 18 were not. Tumor feeders from the intercostal artery are observed as an enhancing dot along the diaphragm on C-arm CT and can be seen on multidetector row CT in approximately half of patients.

MRI of magnetically labeled mesenchymal stem cells in hepatic failure model.

AIM: To track intravascularly transplanted mesenchymal stem cells (MSCs) labeled with superparamagnetic iron oxide (SPIO) by using magnetic resonance imaging (MRI) in an experimental rabbit model of hepatic failure. METHODS: Human MSCs labeled with FDA-approved SPIO particles (Feridex) were transplanted via the mesenteric vein into rabbits (n = 16) with carbon tetrachloride-induced hepatic failure. Magnetic resonance (MR) examinations were performed with a 3.0 T clinical scanner immediately before and 2 h and 1, 3, and 7 d after transplantation. Signal intensity (SI) changes on T2*-weighted MRI were measured, and correlation between MR findings and histomorphologic findings was also investigated. RESULTS: SI on T2*-weighted MRI decreased significantly in the liver 2 h after injection of human MSCs and returned gradually to the levels found before injection in 7 d. Changes in SI in the liver at 2 h, 1, 3, and 7 d were 41.87% ± 9.63%, 10.42% ± 4.3%, 5.12% ± 1.9%, 3.75% ± 1.2%, respectively (P < 0.001). Histologic analyses confirmed the presence of MSCs in the liver, localized mainly in the sinusoids in early period (2 h and 1 d) and concentrated to the border zone in late period (3 and 7 d). The number of iron-positive cells in the liver at 2 h and on 1, 3 and 7 d after transplantation was 29.2 ± 4.8, 10.1 ± 3.7, 6.7 ± 2.2, and 5.8 ± 2.1, respectively (P = 0.013). CONCLUSION: Intravascularly injected SPIO-labeled MSCs in an experimental rabbit model of hepatic failure can be detected and followed with MRI.

The effects of clinically used MRI contrast agents on the biological properties of human mesenchymal stem cells.

This study was undertaken to compare the labeling efficiencies of three iron-oxide based MRI contrast agents [Feridex, Resovist and monocrystalline iron oxide (MION)] and to evaluate their effects on the biological properties of human mesenchymal stem cells (hMSCs). The hMSCs were cultivated for 1 and 7 days after 24-h labeling with iron oxide nanoparticles (12.5 microg Fe/mL) in the presence of poly-L-lysine (0.75 microg/mL). The hMSCs were labeled more efficiently with use of Feridex, Resovist as compared to MION. No significant differences were observed in terms of viability and proliferation of labeled hMSCs. The level of Oct-4 mRNA increased in labeled hMSCs at day 1 and the cellular phenotype changed from CD45-/CD44+/CD29+ to CD45low/CD44+/CD29+ at day 7, which closely resembles the phenotype of fresh bone marrow-derived hMSCs. Our study has demonstrated that the Feridex or Resovist is the preferred labeling agent for hMSCs. There was a change in Oct-4 and CD45 expression after labeling.

Ruptured aneurysm originating from an aberrant medullary branch of the proximal posterior inferior cerebellar artery: case report.

OBJECTIVE: Aneurysms that arise from a small branch of the posterior inferior cerebellar artery (PICA) are very rare. All reported PICA branch aneurysms originated from the choroidal branches or PICA communicating branches. No aneurysms of the PICA medullary branch have been reported previously. CLINICAL PRESENTATION: A 62-year-old woman presented with a subarachnoid hemorrhage and intraventricular hemorrhage. Angiography showed a globular-shaped aneurysm arising from an aberrant branch of the anterior medullary segment of the left PICA. At the time of operation, the arterial branch was found to send some perforators into to the medulla oblongata and cervical spinal cord. INTERVENTION: Aneurysm trapping was performed. Postoperatively, the patient had a mild transient difficulty in swallowing that may have been caused by manipulation of the vagus nerve rootlets. CONCLUSION: Aneurysms can develop from a proximal medullary branch of the PICA and lead to subarachnoid hemorrhage and intraventricular hemorrhage. Trapping can be judiciously attempted to treat this precarious aneurysm.

The effects of bone turnover rate on subchondral trabecular bone structure and cartilage damage in the osteoarthritis rat model.

The effects of bone turnover rate on subchondral trabecular changes and cartilage destruction were evaluated in an iodoacetate-induced osteoarthritis rat model. Thirty female rats were randomly divided into three groups as the ovariectomized group, the no-treatment group and the bisphosphonate medication group. Arthritis was induced by a single intra-articular iodoacetate injection into the right tibiofemoral joint. Eight weeks after this injection, tibiofemoral joints on both sides were scanned with a micro-CT. Subchondral trabecular indices were measured on both sides of the tibial lateral condyle epiphysis. In the ovariectomized group, the percentage of bone volume, trabecular thickness and trabecular bone pattern factor of the arthritic sides were lower than those of the control sides, while trabecular separation and structure model index of the arthritic sides were higher than those of the control sides (p < 0.05). In the no-treatment group, only trabecular thickness of the arthritic sides was lower than in the control sides (p < 0.05). In the bisphosphonate medication group, trabecular indices were no different between the arthritic and control sides. Articular cartilage destruction and severity of arthritis increased significantly in the order: ovariectomized group < no-treatment group < bisphosphonate medication group (p < 0.05). After osteoarthritis development, severities of subchondral trabecular changes appeared to be strongly affected by bone turnover rate. Furthermore, a correlation was found between cartilage destruction severity and subchondral trabecular change in the intra-articular iodoacetate-injected osteoarthritis rat model.

Detection of metastatic cervical lymph nodes in recurrent papillary thyroid carcinoma: computed tomography versus positron emission tomography-computed tomography.

OBJECTIVE: We sought to determine whether positron emission tomography-computed tomography (PET-CT) is more accurate than CT for detecting metastatic cervical lymph nodes in recurrent papillary thyroid carcinoma (PTC) and to determine the relationship between the CT features and PET-CT findings of metastatic nodes. METHODS: Eleven consecutive patients with recurrent PTC underwent contrast-enhanced CT (CECT) and PET-CT before surgery. We retrospectively evaluated CECT and PET-CT images to determine the presence of metastatic nodes by level-by-level analysis. The CT findings of the PET-CT results that were positive and negative for metastatic nodes were compared. RESULTS: Metastatic nodes were found at 28 (78%) of 36 neck levels surgically explored. The sensitivity, specificity, and accuracy of CECT for the detection of metastatic nodes were 75.0%, 87.5%, and 77.8%, respectively, and those of PET-CT were 35.7%, 87.5%, and 48.6%, respectively, by level-by-level analysis. No significant difference in the CT features was found between the PET-CT findings positive and negative for metastatic nodes (P > 0.05). CONCLUSIONS: Computed tomography is more sensitive and accurate than PET-CT for detecting metastatic lymph nodes in recurrent PTC. No significant relationship was found between the CT features and the PET-CT findings of the metastatic nodes.