Imbalanced Gamma-band Functional Brain Networks of Autism Spectrum Disorders.

Resting gamma-band brain networks are known as an inhibitory component in functional brain networks. Although autism spectrum disorder (ASD) is considered as with imbalanced brain networks, the inhibitory component remains not fully explored. The study reported 10 children with ASD and 10 typically-developing (TD) controls. The power spectral density analysis of the gamma-band signal in the cerebral cortex was performed at the source level. The normalized phase transfer entropy values (nPTEs) were calculated to construct brain connectivity. Gamma-band activity of the ASD group was lower than the TD children. The significantly inhibited brain regions were mainly distributed in the bilateral frontal and temporal lobes. Connectivity analysis showed alterations in the connections from key nodes of the social brain network. The behavior assessments in the ASD group revealed a significantly positive correlation between the total score of Childhood Autism Rating Scale and the regional nPTEs of the right transverse temporal gyrus. Our results provide strong evidence that the gamma-band brain networks of ASD children have a lower level of brain activities and different distribution of information flows. Clinical meanings of such imbalances of both activity and connectivity were also worthy of further explorations.

Imaging findings of radiologically misdiagnosed nodular fasciitis.

BACKGROUND: Nodular fasciitis rarely occurs in young adults and children; it usually resembles other tumors, even malignancy. PURPOSE: To review the imaging findings of six cases of nodular fasciitis misdiagnosed radiologically. MATERIAL AND METHODS: The clinical and radiologic features of six cases of histologically proven but radiologically misdiagnosed nodular fasciitis were reviewed retrospectively. Two cases underwent both plain and enhanced computed tomography (CT) scans and the other four had both regular and enhanced magnetic resonance (MR) scans. RESULTS: All six patients were young (five children and one young adult). A rapid growing mass, pain or painless, was the most frequent presentation. Most masses were oval, well-defined, and homogeneous, with an average diameter of 2.2 cm. Five were found in superficial fascia with a broad base. Two cyst-like masses showed hypodensity relative to muscle on plain CT and without enhancement. Compared to muscle, these masses showed isointensity (n = 3) or slight hyperintensity (n = 1) on T1-weighted imaging, hyperintensity on T2-weighted imaging (n = 4), with homogeneous notable enhancement (n = 3) or mild enhancement (n = 1). Five (83.3%) were found with a "fascial tail" sign characterized as thickening of adjacent fascial layer with notable enhancement. One mass showed an "inverted target" sign. CONCLUSION: Nodular fasciitis in young adults and children is usually superficial, rapid growing, well-defined, and homogeneous, frequently with a "fascial tail" sign. Radiologically, it can resemble a benign cyst and might be easily misdiagnosed. Therefore, nodular fasciitis should be remembered in the differential diagnosis for superficial soft tissue tumor found in young adult and children.

Clinical and imaging features of Kaposiform Hemangioendothelioma.

OBJECTIVE: Kaposiform hemangioendothelioma (KHE) is a unique locally aggressive vascular tumor with poor prognosis. The aim of this study is to assess the clinical and imaging features of KHE, and to compare the differences between solitary and diffusive infiltrative subtype further. METHODS: The clinical and radiological findings of a cohort of 25 cases with histologically proven KHE, between June 2011 and June 2016, were reviewed retrospectively. 7 solitary and 18 diffusive infiltrative subtypes KHE were included. The differences of clinical and imaging features between these two subtypes were compared statistically by Wilcoxon rank sum test and Fisher exact test. RESULTS: The median age was 4 months old. 20 cases (80%) were accompanied by Kasabach-Merritt phenomenon (KMP). Most KHE located in trunk and/or extremity. The masses showed inhomogeneous echogenicity and were rich in vascularity on ultrasound; showed isoattenuation relative to muscle on unenhanced CT, isointense (n = 15) or slightly hyperintense (n = 7) T1 weighted imaging (T1WI) signal relative to muscle, mainly heterogeneous hyperintense or slightly hyperintense with speckled hypointense (n = 17) T2WI signal (77%) relative to muscle, and notable (n = 15) and moderate (n = 3) enhancement. Feeding and draining vessels were revealed in 15 cases. Five masses with DWI showed slightly restricted diffusivity, with average apparent diffusion coefficient value of (1.28 ± 0.09) × 10-3 mm2 s-1. Necrosis and hemorrhage were also found. Compared with solitary ones, diffusive infiltrative KHE were larger, more commonly accompanied by KMP and reticular lymphedema, and more frequently located in trunk and/or extremity. CONCLUSION: Five masses with DWI showed slightly restricted diffusivity. A hypervascular mass accompanied by KMP and reticular lymphedema, with speckled hypointense signal T2WI signal, especially in pediatric patients, is highly suggestive of the diagnosis of KHE. Advances in knowledge: Speckled hypointense signal T2WI signal, and notable enhancement were unique features of KHE. KHE showed slightly restricted diffusivity on DWI, commonly accompanied by KMP and reticular lymphedema.

Comparative proteomic analysis of rats subjected to water immersion and restraint stress as an insight into gastric ulcers.

In the present study, comparative proteomic analysis was performed in rats subjected to water immersion­restraint stress (WRS). A total of 26 proteins were differentially expressed and identified using matrix­assisted laser desorption/ionization time of flight mass spectrometry. Among the 26 differentially expressed protein spots identified, 13 proteins were significantly upregulated under WRS, including pyruvate kinase and calreticulin, which may be closely associated with energy metabolism. In addition, 12 proteins were downregulated under WRS, including hemoglobin subunit ß­2 and keratin type II cytoskeletal 8, which may be important in protein metabolism and cell death. Gene Ontology analysis revealed the cellular distribution, molecular function and biological processes of the identified proteins. The mRNA levels of certain differentially expressed proteins were analyzed using fluorescence quantitative polymerase chain reaction analysis. The results of the present study aimed to offer insights into proteins, which are differentially expressed in gastric ulcers in stress, and provide theoretical evidence of a radical cure for gastric ulcers in humans.

Long-term Brain Tissue Monitoring after Semi-brain Irradiation in Rats Using Proton Magnetic Resonance Spectroscopy: A Preliminary Study In vivo.

BACKGROUND: In head and neck neoplasm survivors treated with brain irradiation, metabolic alterations would occur in the radiation-induced injury area. The mechanism of these metabolic alterations has not been fully understood, while the alternations could be sensitively detected by proton (1H) nuclear magnetic resonance spectroscopy (MRS). In this study, we investigated the metabolic characteristics of radiation-induced brain injury through a long-term follow-up after radiation treatment using MRS in vivo. METHODS: A total of 12 adult Sprague-Dawley rats received a single dose of 30 Gy radiation treatment to semi-brain (field size: 1.0 cm × 2.0 cm; anterior limit: binocular posterior inner canthus connection; posterior limit: external acoustic meatus connection; internal limit: sagittal suture). Conventional magnetic resonance imaging and single-voxel 1H-MRS were performed at different time points (in month 0 before irradiation as well as in the 1st, 3rd, 5th, 7th, and 9th months after irradiation) to investigate the alternations in irradiation field. N-acetylaspartate/choline (NAA/Cho), NAA/creatinine (Cr), and Cho/Cr ratios were measured in the bilateral hippocampus and quantitatively analyzed with a repeated-measures mixed-effects model and multiple comparison test. RESULTS: Significant changes in the ratios of NAA/Cho (F = 57.37, P_{g < 0.001), NAA/Cr (F = 54.49, Pg < 0.001), and Cho/Cr (F = 9.78, Pg = 0.005) between the hippocampus region of the irradiated semi-brain and the contralateral semi-brain were observed. There were significant differences in NAA/Cho (F = 9.17, Pt < 0.001) and NAA/Cr (F = 13.04, Pt < 0.001) ratios over time. The tendency of NAA/Cr to change with time showed no significant difference between the irradiated and contralateral sides. Nevertheless, there were significant differences in the Cho/Cr ratio between these two sides. CONCLUSIONS: MRS can sensitively detect metabolic alternations. Significant changes of metabolites ratio in the first few months after radiation treatment reflect the metabolic disturbance in the acute and early-delayed stages of radiation-induced brain injuries.}

Treatment of cerebral radiation necrosis with nerve growth factor: A prospective, randomized, controlled phase II study.

PURPOSE: A prospective, placebo controlled phase II trial was conducted to test the efficacy of Nerve Growth Factor (NGF) for the treatment of symptomatic temporal lobe necrosis (TLN). MATERIALS AND METHODS: Patients with progressive TLN were randomly assigned to either the control or the study group in a 1:1 ratio. The control group received corticosteroids with gradually reduced dosage. The study group received NGF with corticosteroids. NGF was dissolved in 2mL normal saline and injected intramuscularly at 18µg/time, once a day for 2months. The efficacy was evaluated by both the objective and subjective methods every 3-4months after treatment. The objective method compared volumes of the necrotic masses on MRI before and after treatment. The subjective method compared the neurocognitive score as evaluated by the mini-mental status examination (MMSE). RESULTS: Twenty-eight cases were enrolled into this study. The objective evaluation showed that the response rate (RR) in the study group was higher than the control group. The ratio was 10 versus 2 (p=0.006), and 12 versus 3 (p=0.002) at 3-4months and 6-8months after intervention, respectively. The subjective evaluation demonstrated both groups were effective in controlling the necrosis related symptoms in the first 6months after treatment. But NGF was more effective than corticosteroids at 9months (13 versus 4, p=0.001). The only observed side effect was mild pain at the injection site in 3 patients in the study group. CONCLUSIONS: Our results demonstrated that the process of TLN is not irreversible. NGF is more effective in recovering TLN than corticosteroids with little side effect. NGF has a longer duration in controlling the necrosis related symptoms than corticosteroids.

Study of the medial group retropharyngeal node metastasis from nasopharyngeal carcinoma based on 3100 newly diagnosed cases.

PURPOSE: Patterns of metastases to the medial retropharyngeal lymph nodes (RPLN) from nasopharyngeal carcinoma (NPC) have gain little attention. Since the incidence of dysphagia was closely related to whether the medial RPLN was irradiated, we carried out a prospective study to explore the patterns of the medial RPLN involvement. METHODS AND MATERIALS: Previously untreated NPC patients were required to receive MRI scan. MRI scanning sequences included pre-contrast T1WI, T2WI, and post-contrast T1WI with fat suppression. All images were evaluated by the multi-disciplinary treatment group of NPC. RESULTS: 3100 cases of NPC entered this study. 2679 (86.4%) cases had involved lymph nodes. The detailed distribution were: 2341 (87.4%) in level IIb, 1798 (67.1%) in level IIa, 1184 (44.2%) in level III, 350 (14.1%) in level IV, 995 (37.1%) in level V, 115(4.3%) in level Ib, 2012 (75.1%) in the retropharyngeal area. But only 6 (0.2%) were located at the medial group, accompanied with the lateral RPLN and other node metastasis. Only one medial RPLN can be identified in a patient, whereas the number of the lateral RPLNs per affected side varied between one and four. The average size of the medial and lateral RPLNs was 8±4 mm (range, 4-17 mm) and 16±9 mm (range, 5-53 mm), respectively. CONCLUSIONS: ① Involvement of the retropharyngeal nodes were mainly located at the lateral group, the medial RPLN was rarely seen. ② Metastasis to the medial RPLN was always accompanied with other node metastasis. ③ Only one medial RPLN can be identified in a patient, whereas the enlarged lateral RPLNs per affected side could be multiple. ④ The average size of the medial RPLN was smaller than the lateral RPLNs.

Age-associated changes in gene expression of goat oocytes.

Oocyte aging severely decreases the quality of oocytes, which hampers fertilization and subsequent embryo development. In the present study, age-dependent molecular changes in goat oocytes were investigated. First, the quality of goat oocytes with various in vitro culture times (24, 30, 36, 48, and 60 hours) was evaluated on the basis of developmental rates of parthenogenetically activated embryos and apoptosis of cumulus cells (CCs). Second, relative gene expression of six genes (mitochondrial genes: PGC-1α and NRF-1; epigenetic modification genes: SNRPN and HAT1; mitotic spindle checkpoint protein: SMAD2; and hyaluronan synthase gene: HAS3) were analyzed during oocyte aging. Third, we further studied the changes of seven genes (PGC-1α and NRF-1; apoptotic-related genes: BAX and BCL2; hyaluronan synthase gene: HAS2; metabolism-related gene: STAR; and superoxide dismutase gene: SOD1) in CCs during oocyte aging. In these studies, the blastocyst rate gradually decreased and the number of apoptotic cells significantly increased as the culture time increased (P < 0.05). Moreover, relative gene expressions of PGC-1α, NRF-1 and SMAD2 significantly decreased from 24 to 36 hours (P < 0.05), whereas the levels of HAT1 and HAS3 slowly increased as culture was prolonged. Furthermore, the levels of PGC-1α, BCL2, HAS2 and SOD1 quickly reduced, and BAX significantly increased from 24 to 36 hours in aged CCs (P < 0.05). In conclusion, goat oocytes started to age at 30 hours in vitro culture, and gene expression patterns of oocytes and CCs significantly changed as the oocytes aged. Gene expression pattern changes in CCs may provide a convenient and effective way to detect oocyte aging without compromising oocyte integrity.

Role of SUV(max) obtained by 18F-FDG PET/CT in patients with a solitary pancreatic lesion: predicting malignant potential and proliferation.

OBJECTIVES: Maximum standardized uptake value (SUV(max)) is a marker of tumor glucose metabolism detected by [(18)F]-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography (PET/CT) and reflects tumor aggressiveness. The aim of the study was to evaluate the value of SUV(max) in differentiating benign from malignant solitary pancreatic lesions and explore the correlation between SUV(max) and tumor proliferative activity. MATERIALS AND METHODS: F-FDG PET/CT scans were performed in 80 patients with solitary pancreatic lesions who were scheduled for resective surgery. The relationships between SUV(max) and postoperative pathologic diagnosis, histologic grade, and Ki-67 proliferation index (PI) were analyzed. RESULTS: Of these 80 patients, 54 had malignant lesions. The SUV(max) of malignant tumors (6.3 ± 2.4) was significantly greater than that of benign lesions (2.9 ± 2.0) (P<0.001). Receiver-operating characteristic curve analysis showed that the SUV(max) cutoff value of 3.5 had a high sensitivity (92.6%) and specificity (76.9%) for the diagnosis of malignancies. Among pancreatic cancers with low (Ki-67<5%), moderate (5% ≤ Ki-67<50%), and high (Ki-67 ≥ 50%) PI, SUV(max) increased significantly from 4.2 ± 1.2, through 6.0 ± 1.7, to 8.6 ± 2.5 (P<0.001). The SUV(max) had a positive correlation with Ki-67 PI (P<0.001, r=0.60). CONCLUSION: The SUV(max) of F-FDG PET/CT can be used in the differential diagnosis of solitary pancreatic lesions and can also aid in the prediction of proliferative activity of pancreatic cancer.

Production of myostatin-targeted goat by nuclear transfer from cultured adult somatic cells.

Myostatin, a member of the transforming growth factor-ß family, acts as a negative regulator of skeletal muscle mass. In this study, myostatin-targeted caprine fibroblasts were obtained and subjected to SCNT to determine whether myostatin-knockout goats could be created. Fibroblasts from a 2-mo-old goat were transfected with a myostatin-targeted vector to prepare transgenic donor cells for nuclear transfer. After serum-starvation (for synchronization of the cell cycle), the percentage of transgenic fibroblasts in the G(0)/G(1) phase increased (66.2% vs. 82.9%; P < 0.05) compared with that in the control group, whereas the apoptosis rate and mitochondrial membrane potential were unaffected (P > 0.05). There were no significant differences between in vivo- and in vitro-matured oocytes as recipient cytoplasts for rates of fusion (86.5% vs. 78.4%), pregnancy (21.6% vs. 16.7%), or kidding (2.7% vs. 0%). One female kid from an in vivo-matured oocyte was born, but died a few hours later. Microsatellite analysis and polymerase chain reaction identification confirmed that this kid was genetically identical to the donor cells. Based on Western blot analysis, myostatin of the cloned kid was not expressed compared with that of nontransgenic kids. In conclusion, SCNT using myostatin-targeted 2-mo-old goat fibroblasts as donors has potential as a method for producing myostatin-targeted goats.

Efficiency of donor cell preparation and recipient oocyte source for production of transgenic cloned dairy goats harboring human lactoferrin.

The objective was to investigate the effects of the transgenic donor cell synchronization method, oocyte sources, and other factors, on production of hLF-gene nucleus transfer dairy goats. Three transfected cell lines from ear biopsies from three 3-mo-old Saanen dairy goats (designated Number 1, Number 2, and Number 3, respectively) were selected as karyoplast donors for somatic cell nuclear transfer (SCNT) after detailed identification (including PCR and sequencing of PCR products). In donor cell cycle synchronization studies, the apoptosis rate of hLF transgenic fibroblasts was not different (P > 0.05) after 3 days of serum starvation or 2 days of contact inhibition. Additionally, there was no effect (P > 0.05) on developmental capacity of reconstructed embryos; however, the kidding rate of recipients in the serum starvation group was higher than that in the contact inhibition group (18 vs. 0%, respectively). The production efficiency of the transgenic cloned goats using donor cells from the Number 1 dairy goat cell line was higher than those using the Number 2 and the Number 3 cell lines (kidding rates were 18, 2, and 0%, respectively, P < 0.05). The oocyte source did not significantly affect the pregnancy rate of hLF-transgenic cloned dairy goats, but more fetuses were aborted when using in vitro matured oocytes compared to in vivo matured oocytes. In summary, utilizing transfected 3-mo-old dairy goat fibroblasts as donor cells, seven live offspring were produced, and the hLF gene was successfully integrated. This study provided additional insights into preparation of donor cells and recipient oocytes for producing transgenic cloned goats through SCNT.

[Neuroendocrine carcinoma of the breast: mammographic features correlated with sonography and histopathological findings].

OBJECTIVE: The purpose of this study was to describe the X-ray features of the neuroendocrine carcinoma (NEC) of breast to raise the awareness for the disease. METHODS: The mammography, sonography and clinicopathologic features in a total of 16 cases of pathologically proven breast neuroendocrine carcinoma in Fudan University Cancer Hospital were analyzed retrospectively. RESULTS: All the 16 patients were women with a mean age of 67.3 years old (ranged from 45 to 75 years old). Twelve patients had palpable masses and the other four patients had outflow from the nipple. Pathological diagnosis included endocrine ductal carcinoma in situ (E-DCIS) in 4 cases, E-DCIS with microinvasion in 5, and invasive solid neuroendocrine carcinoma in 7. On mammography, 9 of 16 cases exhibited round or slightly lobulated masses. Five of the 16 cases exhibited irregular or asymmetric opacities. Two of the 16 cases had negative findings. The borders of the 14 masses detected on mammography were vague in 7, partly unclear in 3 and clear-cut in 4 cases. Malignant microcalcification was not found in all cases. The accuracy rates of preoperative qualitative diagnosis for NEC with mammography and sonography were 68.8% (11/16) and 81.3% (13/16), respectively. Given the application of combined mammography and sonography, the accuracy rates could be improved to 87.5% (14/16). CONCLUSIONS: A round mass and irregular or asymmetric opacities without malignant calcification are the most frequent appearances of mammography in neuroendocrine carcinoma of the breast. Combination of mammography and sonography may be useful to improve the accuracy of diagnosis and early detection of neuroendocrine carcinoma of the breast.

Calcified metastases from ovarian carcinoma highlighted by F-18 FDG PET/CT: report of two cases.

Two cases of postoperative female patients with ovarian serous papillary carcinoma were referred for F-18 Fluorodeoxyglucose (F-18 FDG) PET/CT to evaluate suspicious recurrence and/or metastasis. One patient presented with multiple extensive calcified lesions with increased FDG uptake in the abdominopelvic cavity and the series of PET/CT scans showed progression of disease after chemotherapy. The other patient presented with three calcified masses with intensive uptake of FDG located in the left pelvis, the right subphrenic region, and the right supradiaphragmatic area, respectively. These suggest that F-18 FDG PET/CT can be useful in identifying malignant calcification and assessing therapeutic response of calcified malignancy.

The role of technetium-99m methoxyisobutyl isonitrile scintigraphy in predicting the therapeutic effect of chemotherapy against nasopharyngeal carcinoma.

BACKGROUND: The authors prospectively evaluated the correlation between technetium-99m methoxyisobutyl isonitrile ((99m) Tc-MIBI) accumulation in tumors and response to induction chemotherapy in patients with nasopharyngeal carcinoma (NPC). METHODS: Eighty-six patients with locally advanced NPC underwent single-photon emission computed tomography 15 minutes after an intravenous injection of 740 megabecquerels (20 mCi) (99m) Tc-MIBI before chemotherapy. The tumor uptake ratio (TUR) was calculated. Two weeks after the second cycle of combined chemotherapy with 5-fluorouracil (5-FU) and cisplatin (DDP), the tumor response rate was evaluated. The correlation between (99m) Tc-MIBI accumulation in tumors and response to chemotherapy with 5-FU/DDP was examined. RESULTS: Positive accumulation of (99m) Tc-MIBI in tumors was observed in 76 patients (88.4%). The tumor response was a complete response (CR) in 8 patients, a partial response (PR) in 68 patients, stable disease (SD) in 9 patients, and progressive disease (PD) in 1 patient. The response rate (CR and PR) to 5-FU/DDP chemotherapy in patients who had positive (99m) Tc-MIBI accumulation (tumor uptake ratio [TUR] >1.1) was higher than that in patients who had negative (99m) Tc-MIBI accumulation (TUR ≤ 1.1; 98.7% vs 10%; P < .001). CONCLUSIONS: Patients with negative (99m) Tc-MIBI accumulation were resistant to 5-FU/DDP chemotherapy. (99m) Tc-MIBI imaging in patients with NPC was capable of predicting tumor response to chemotherapy with 5-FU/DDP and can help in the selection of patients for induction chemotherapy.

Cell cycle distribution, cellular viability and mRNA expression of hGCase-gene-transfected cells in dairy goat.

Nuclear transfer using transgenic donor cells is an efficient way of generating transgenic goats, wherein the preparation of competent transgenic donor cells is the pivotal upstream step. We have measured the efficiency of transfection with a plasmid containing hGCase (human lysosomal acid beta-glucosidase) gene into goat FFC (fetal-derived fibroblast cells), MEC (mammary epithelial cells) and AEFC (adult ear skin-derived fibroblast cells), and the characteristics of cell cycle, apoptosis and chromosome abnormalities after transfection. The expression of genes involved in imprinting [IGF2 (insulin-like growth factor 2), IGF2R (IGF2 receptor)], apoptosis (Bax), stress (heat-shock protein, Hsp70.1), cellular connections [Cx43 (connexin 43)] and DNA methylation [DNMT1 (DNA methyltransferase 1)] in transgenic fetal cells has been investigated. The hGCase transgene was successfully detected in the transfected cell lines, and chromosomal stability remained similar in FFC and transgenic FFC (70.9 compared with 66.8%), whereas a smaller percentage (P<0.05) of cells at G(0)/G(1) in the transgenic FFC, MEC and AEFC (T-FFC, T-MEC and T-AEFC), and higher percentage (P<0.05) of apoptotic cells in T-FFC than the non-transfected controls were detected by flow cytometric analysis. Among the genes tested, the relative expressions of IGF2, IGF2R and transcripts of Cx43 were significantly higher (P<0.05) in T-FFC compared with non-transfected FFC. These novel findings on gene expression in transgenic fetal cells may have certain implications in the biopharming industry and in our understanding the low efficiency of transgenic cloning.

Patterns of retropharyngeal node metastasis in nasopharyngeal carcinoma.

PURPOSE: To explore the pattern of metastasis to retropharyngeal lymph nodes (RLN) and its relationship with tumor range in nasopharyngeal carcinoma (NPC) patients by using magnetic resonance imaging. METHODS AND MATERIALS: Magnetic resonance images of 618 NPC patients were reviewed. Nodes were classified as metastatic on the basis of size criteria, the presence of nodal necrosis, and extracapsular spread. RESULTS: A total of 597 involved RLN were detected in 392 patients (63.4%). The sites of RLN metastasis included occipital bone, 37 (6.2%); first cervical vertebra (C1), 453 (75.9%); second cervical vertebra (C2), 104 (17.4%); and third cervical vertebra (C3), 3 (0.5%). The incidence of RLN involvement was less than that of Level IIb node involvement (72.2% vs. 86.5%) in 543 patients with lymphadenopathy. The incidence of RLN metastasis was significantly higher in cases of parapharyngeal space invasion or involvement of Level II, Level III, Level IV, and/or Level V nodes and significantly lower in N0 and Stage I disease. Conversely, the incidence of RLN metastasis did not differ significantly among T1, 2, 3, and 4 disease or among Stage II, III, and IV disease. CONCLUSIONS: Level IIb nodes, rather than RLN, seem to be the first-echelon nodes in NPC. The incidence of RLN metastasis decreases steadily from level C1 to level C3. Retropharyngeal lymph node metastasis correlates well with involvement of the parapharyngeal space and metastases to Level II, III, IV, and/or V nodes but not with T stage.

[Evaluation of MRI in nasopharyngeal carcinoma with cavernous sinus infiltration].

OBJECTIVE: To investigate the incidence, MRI characteristics and invasion route of nasopharyngeal carcinoma (NPC) infiltrating the cavernous sinus. METHODS: The data of 141 patients with histologically proven NPC collected from May 2003 to June 2004 were reviewed. All patients were examined by 1.5-tesla superconducting MR unit to evaluate the tumor extent. MR FSE technique was used for T1 WI and T2WI images in the axial plane, followed by FSPGR fat-suppressed gadolinium-enhancement for T1WI images in the axial and coronal sections. All MR images were interpreted and evaluated by two diagnostic radiologists, paying particular attention to the nasopharynx and cavernous sinus infiltration. RESULTS: MR imaging showed infiltration of 49 cavernous sinuses in 39 patients (27.7%). The most common MRI features were enlargement of cavernous sinus with unconventional enhancement (22/49, 44.9%), even with formation of mass inside the sinus (9/49, 18.4%). The other MRI image features were local or diffuse dura mater thickening of cavernous sinus and presence of obscure structure as intra-sinus blurs and hazies inside. The most common infiltration route is through the foramen ovale (18/49, 36.7%), or through both the foramen ovale and foramen lacerum (6/49, 12.2%). CONCLUSION: In NPC patients, MRI invasion is characteristically and clearly shown as changes in the cavernous sinus. Possession of this information is crucial for giving correct treatment. The main infiltrtion route is through foramen ovale.

Diagnostic value of contrast-enhanced fluid-attenuated inversion-recovery MRI for intracranial tumors in comparison with post-contrast T1W spin-echo MRI.

BACKGROUND: Contrast-enhanced fluid-attenuated inversion-recovery (FLAIR) magnetic resonance imaging (MRI) has been reported to have higher sensitivity for detecting leptomeningeal disease compared with contrast-enhanced T1-weighted MRI (CE T1WI). However, currently there are no studies showing the potential value of clinical applications of contrast-enhanced FLAIR (CE FLAIR) sequence in diagnosing intracranial tumors in a larger group of patients. The purpose of this study was to evaluate the diagnostic value of CE FLAIR in comparison with CE T1WI for intracranial tumors and to provide more information for clinical diagnosis and therapy. METHODS: One hundred and four consecutive cases of intracranial tumors referred for CE brain MRI were analyzed with regard to FLAIR and T1WI pre- and post-administration of Gd-DTPA. The CE FLAIR and CE T1WI were evaluated independently by two radiologists for the number of examinations with one or more enhanced lesions, the number and location of enhanced lesions per examination, signal-to-noise ratio (SNR) and contrast-enhancement ratio (CER) of lesions, as well as the size and extent of the enhanced lesions. RESULTS: In 98 of 104 cases, enhanced lesions were seen both on the FLAIR and T1W images. More lesions were seen on CE T1WI (n = 120) than those on CE FLAIR sequence (n = 117), but no differences of statistical significance were found between the two sequences (P > 0.05). Four lesions were revealed only on the CE FLAIR images whereas 7 lesions were only found on CE T1WI. Enhanced lesions located in the cerebral hemisphere or the forth ventricle were revealed much more on CE T1WI than on CE FLAIR images. However, CE FLAIR images may be useful in showing superficial abnormalities and those located in the sulcus or lateral ventricle. The CER and contrast-to-noise ratio (CNR) on CE T1WI was significantly higher (t = 7.10, P = 0.00; t = 9.67, P = 0.00, respectively), but grey matter/white matter contrast was lower (t = 2.46, P = 0.02) than those on CE FLAIR images. The SNR did not show any statistically significant difference between the two sequences (t = 1.1, P = 0.27). The size and extent of lesions on the CE FLAIR images were significantly larger than those on CE T1WI (t = 4.13, P = 0.00). CONCLUSIONS: CE FLAIR and CE T1WI may complement each other in showing intracranial tumors and the CE FLAIR sequence should be selected as a routine MRI sequence.