Guang-xian Wang

Wall enhancement ratio and partial wall enhancement on MRI associated with the rupture of intracranial aneurysms

Objectives To evaluate the risk factors for rupture of intracranial aneurysms (IAs) using high resolution MRI (HRMRI). Methods 91 consecutive patients with 106 IAs were reviewed from February 2016 to April 2017. Patients and IAs were divided into ruptured and unruptured groups. In addition to the clinical characteristics of the patients, the features of IAs (eg, shape) were evaluated by CT angiography, whereas wall thickness, enhanced patterns, and enhancement ratio (ER) were evaluated by MRI. Multiple logistic regression analysis was used to identify independent risk factors associated with the rupture of IAs. Receiver operating characteristic curve analysis was performed on the final model, and the optimal thresholds were obtained. Results ER (OR 6.638) and partial wall enhancement (PWE) (OR 6.710) were not markers of aneurysms more prone to rupture, but simply were more commonly found in the ruptured aneurysm cohort. The threshold value for ER was 61.5%. Conclusions ER (≥61.5%) and IAs with PWE are better predictors of rupture. Increased attentions should be paid to these factors during assessment of IA rupture.

Risk Factors for the Rupture of Middle Cerebral Artery Bifurcation Aneurysms Using CT Angiography.

Background and Purpose To investigate the clinical and morphological characteristics associated with risk factors for the rupture of bifurcation-type middle cerebral artery aneurysms (MCAAs). Methods A total of 169 consecutive patients with 177 bifurcation-type MCAAs were reviewed from August 2011 to January 2016. Based on the clinical and morphologic characteristics findings, the risk factors of aneurysm rupture were assessed using statistical methods. Results Age, cerebral atherosclerosis, no hypertension, hypertension grade 2 and coronary artery disease (CAD) were negatively correlated with aneurysm rupture. The mean diameter (MD) of the parent and two daughter arteries was negatively correlated with rupture. Aneurysms with irregularity, depth, width, maximum size, aspect ratio, depth-to-width ratio, bottleneck factor, and size ratio were positively correlated with rupture. The multivariate logistic regression model revealed that irregular shape (odds ratio (OR) 2.697) and aspect ratio (OR 3.723) were significantly and positively correlated with rupture, while cerebral atherosclerosis (OR 0.033), CAD (OR 0.080), and MD (OR 0.201) were negatively correlated with rupture. Receiver operating characteristic analysis revealed that the threshold value of the aspect ratio and MD were 0.96 and 2.43 mm, respectively. Conclusions Cerebral atherosclerosis and CAD are protective factors against rupture. Morphological characteristics such as an aneurysm with an irregular shape, a high aspect ratio (>0.96) and a small MD (<2.43 mm) are likely better predictors of rupture.

MR molecular imaging of tumours using ferritin heavy chain reporter gene expression mediated by the hTERT promoter

AbstractObjectivesUsing the human telomerase reverse transcriptase (hTERT) promoter and the modified ferritin heavy chain (Fth) reporter gene, reporter gene expression for MRI was examined in telomerase positive and negative tumour cells and xenografts.MethodsActivity of the reporter gene expression vector Lenti-hTERT-Fth1-3FLAG-Puro was compared to constitutive CMV-driven expression and to the untransfected parental control in five tumour cell lines: A549, SKOV3, 293T, U2OS and HPDLF. In vitro, transfected cells were evaluated for FLAG-tagged protein expression, iron accumulation and transverse relaxation. In vivo, tumours transduced by lentiviral vector injection were imaged using T2*WI. Changes in tumour signal intensity were validated by histology.ResultsOnly telomerase positive tumour cells expressed FLAG-tagged Fth and displayed an increase in R2* above the parental control, with a corresponding change in T2*WI. In addition, only telomerase positive tumours, transduced by injection of the reporter gene expression construct, exhibited a change in signal intensity on T2*WI. Tumour histology verified the expression of FLAG-tagged Fth and iron accumulation in telomerase positive tissue.ConclusionReporter gene expression for MRI, using the Fth reporter and the hTERT promoter, may be a useful strategy for the non-invasive diagnosis of many types of cancer.Key points• Modified heavy chain of ferritin can serve as an MR reporter gene • hTERT promoter can direct the expression of reporter gene in cancer cells • MR reporter imaging mediated by hTERT promoter can be used for cancer diagnosis

Risk Factors for the Rupture of Intracranial Aneurysms Using Computed Tomography Angiography

OBJECTIVE To study the clinical and morphologic characteristics associated with risk factors for the rupture of intracranial aneurysms (IAs). METHODS A total of 1115 consecutive patients with 1282 IAs were reviewed from August 2011 to February 2016. The patients and IAs were divided into ruptured and unruptured groups. Based on the clinical and morphologic findings, the risk factors for IA rupture were assessed using statistical methods. RESULTS Age, hypertension, diabetes mellitus, and cerebral atherosclerosis were associated with ruptured IAs. IAs located in the anterior cerebral artery, the anterior communicating artery, the posterior communicating artery, and the internal carotid artery were associated with ruptured IAs. Ruptures were also associated with arterial bifurcations, irregular aneurysm shapes, and all continuous data, except neck width. Binary logistic regression showed that IAs located at bifurcations (odds ratio [OR], 1.804), with irregular shapes (OR, 4.677), with high aspect ratios (ARs) (OR, 5.037) or with small mean diameters (MDs) (OR, 0.495) are more prone to rupture. Receiver operating characteristic analysis showed that the threshold values of the AR and MD were 1 and 3.70 mm, respectively. CONCLUSIONS Morphologic characteristics, such as being located at bifurcations, being irregularly shaped, having a high AR (>1), and having a small MD (<3.70 mm), were better predictors of rupture.

Clear cell tumor of the lung: a case report and literature review.

Clear cell tumor of the lung is a rare and benign pulmonary tumor; only sporadic cases have been reported. Here, we report the case of a 38-year-old man with recurrent cough, blood-streaked sputum and left chest pain. A chest computed tomography scan showed a round, homogeneous pulmonary mass in the left lower lobe, which exhibited intense heterogeneous enhancement in the arterial phase and homogeneous in the delay phase after injecting a contrast agent. The patient underwent a fine-needle aspiration biopsy and was diagnosed as having a benign clear cell tumor of the lung. The clinical presentation and radiographic investigation of this tumor are summarized in this paper to recognize this rare disease. Interestingly, we found some differences with previously reported cases.

Abnormal amplitude of low-frequency fluctuations associated with rapid-eye movement in chronic primary insomnia patients

Purpose Chronic primary insomnia (CPI) is the most prevalent sleep disorder worldwide. CPI manifests as difficulties in sleep onset, maintaining sleep, prolonged sleep latency, and daytime impairment and is often accompanied by cognitive problems such as poor academic performance, poor attention, and decreased memory. The most popular explanation of insomnia is hyperarousal or increased activities of neurons. Rapid eye movement (REM) sleep detected by polysomnography (PSG) exhibits a positive relationship with brain homeostasis and can be helpful for optimally preparing an organism for emotional and social function. Limited work has been performed to explore brain function of insomnia patients in combination with PSG analysis. Results We observed increased ALFF within areas related to hyperarousal such as the midbrain and bilateral extra-nucleus, whereas decreased ALFF was observed within areas associated with memory and attention involving the parietal and occipital lobule and others. Furthermore, the altered ALFF was associated with the duration of insomnia, sleep efficiency, duration of REM, latency of RME and ratio of REM. Materials and Methods In this study, we recruited twenty-five CPI patients and twenty-five normal sleep (NS) volunteers as a control group to investigate the amplitude of low-frequency fluctuations (ALFF) and the correlation between those altered ALFF regions through resting-state fMRI and PSG data. Conclusions These findings suggest that hyperarousal reflected by ALFF abnormality within brain areas related to cognition and emotion in insomnia associated with REM sleep.PURPOSE Chronic primary insomnia (CPI) is the most prevalent sleep disorder worldwide. CPI manifests as difficulties in sleep onset, maintaining sleep, prolonged sleep latency, and daytime impairment and is often accompanied by cognitive problems such as poor academic performance, poor attention, and decreased memory. The most popular explanation of insomnia is hyperarousal or increased activities of neurons. Rapid eye movement (REM) sleep detected by polysomnography (PSG) exhibits a positive relationship with brain homeostasis and can be helpful for optimally preparing an organism for emotional and social function. Limited work has been performed to explore brain function of insomnia patients in combination with PSG analysis. RESULTS We observed increased ALFF within areas related to hyperarousal such as the midbrain and bilateral extra-nucleus, whereas decreased ALFF was observed within areas associated with memory and attention involving the parietal and occipital lobule and others. Furthermore, the altered ALFF was associated with the duration of insomnia, sleep efficiency, duration of REM, latency of RME and ratio of REM. MATERIALS AND METHODS In this study, we recruited twenty-five CPI patients and twenty-five normal sleep (NS) volunteers as a control group to investigate the amplitude of low-frequency fluctuations (ALFF) and the correlation between those altered ALFF regions through resting-state fMRI and PSG data. CONCLUSIONS These findings suggest that hyperarousal reflected by ALFF abnormality within brain areas related to cognition and emotion in insomnia associated with REM sleep.

Relapse of acute lymphoblastic leukemia in the pancreas after bone marrow transplant

BackgroundRelapse of acute lymphoblastic leukemia (ALL) in the pancreas is rare. We report a case of a 12-yearold boy who experienced a relapse of ALL in the pancreas after a bone marrow transplant.MethodsClinical data, including course of illness, laboratory results, and imaging studies are included. The patient presented with acute pancreatitis, suspected to be secondary to gallstones, with ampullary obstruction. Ultrasound and magnetic resonance imaging demonstrated a distended gallbladder and intra- and extra-hepatic biliary dilatation with a cutoff at the pancreatic head, but with no evidence of gallstones.ResultsUltrasound-guided biopsy of the pancreas revealed ALL in the pancreas. Systematic chemotherapy was recommended, but was declined by the parents. The patient died one week later.ConclusionRelapse of ALL in the pancreas is rare, but when a history of ALL is present, it should be considered in patients with pancreatic enlargement, obstructive jaundice, and pancreatitis.

Computed Tomography Angiography Evaluation of Risk Factors for Unstable Intracranial Aneurysms

OBJECTIVE To evaluate risk factors for instability in intracranial aneurysms (IAs) using computed tomography angiography (CTA). METHODS A total of 614 consecutive patients diagnosed with 661 IAs between August 2011 and February 2016 were reviewed. Patients and IAs were divided into stable and unstable groups. Along with clinical characteristics, IA characteristics were evaluated by CTA. Multiple logistic regression analysis was used to identify the independent risk factors associated with unstable IAs. Receiver operating characteristic (ROC) curve analysis was performed on the final model, and optimal thresholds were obtained. RESULTS Patient age (odds ratio [OR], 0.946), cerebral atherosclerosis (CA; OR, 0.525), and IAs located at the middle cerebral artery (OR, 0.473) or internal carotid artery (OR, 0.512) were negatively correlated with instability, whereas IAs with irregular shape (OR, 2.157), deep depth (OR, 1.557), or large flow angle (FA; OR, 1.015) were more likely to be unstable. ROC analysis revealed threshold values of age, depth, and FA of 59.5 years, 4.25 mm, and 87.8°, respectively. CONCLUSIONS The stability of IAs is significantly affected by several factors, including patient age and the presence of CA. IA shape and location also have an impact on the stability of IAs. Growth into an irregular shape, with a deep depth, and a large FA are risk factors for a change in IAs from stable to unstable.

Morphological characteristics associated with the rupture risk of mirror posterior communicating artery aneurysms

Objective Patient related clinical factors and intracranial aneurysms (IAs) at different locations may lead to statistical bias when investigating the rupture risk of IAs. Thus the purpose of this study was to identify the morphological parameters that are related to the rupture of mirror posterior communicating artery aneurysms (PComAAs). Methods Between August 2011 and July 2017, 68 patients with mirror PComAAs and aneurysmal subarachnoid hemorrhage were diagnosed by CT angiography at three medical centers. Morphological characteristics for PComAAs included bifurcation, shape, neck width, width, depth, maximum size, flow angle, parent vessel diameter, aspect ratio (AR), depth/width ratio, bottleneck factor, and size ratio (SR). Multiple logistic regression analysis was performed to determine the independent risk factors for rupture. Receiver operating characteristic curve analysis was performed to obtain the optimal thresholds. Results AR (OR 5.623) and SR (OR 5.570) were more commonly observed in the ruptured cohort. The threshold values of AR and SR were 0.98 and 1.21, respectively. Conclusions Mirror PComAAs are a useful model to investigate the rupture risk of PComAAs. AR (≥0.98) and SR (≥1.21) are better predictors of ruptured PComAAs.

Risk factors for ruptured intracranial aneurysms

Background & objectives: The treatment of unruptured intracranial aneurysms (IAs) remains controversial; the ability to predict the risk of rupture for an aneurysm would be of clinical value. The aim of this study was to determine and evaluate the predictive value of the risk factors of IA rupture. Methods: This retrospective study involved 379 consecutive patients with 441 aneurysms between August 2011 and July 2014. Based on clinical data and computed tomography angiography findings, the potential of risk factors to predict the aneurysmal rupture was assessed using statistical methods. Results: Age, hypertension, heart disease, diabetes mellitus, cerebral atherosclerosis, aneurysms located at the internal carotid artery (ICA) and neck width (N) correlated negatively with rupture risk. Aneurysms located at the anterior communicating artery, bifurcation, irregularity, with a daughter sac, aneurysm height, maximum size, aspect ratio (AR), height-to-width ratio and bottleneck factor were significantly and positively correlated with rupture risk. The multivariate logistic regression model revealed that bifurcation aneurysm, irregular aneurysm and high AR increased the rupture risk, while cerebral atherosclerosis, aneurysm located on the ICA and greater N decreased the risk. Receiver operating characteristic analysis of AR curve values differed according to circumstances. Interpretation & conclusions: Cerebral atherosclerosis, location in the ICA and larger N were the protective factors against aneurysm rupture, and IAs located at bifurcations, irregular shape and increased AR indicated a greater rupture risk.