Jesse Wei

Angiomyolipoma with Minimal Fat: Can It Be Differentiated from Clear Cell Renal Cell Carcinoma by Using Standard MR Techniques?

PURPOSE To retrospectively assess whether magnetic resonance (MR) imaging with opposed-phase and in-phase gradient-echo (GRE) sequences and MR feature analysis can differentiate angiomyolipomas (AMLs) that contain minimal fat from clear cell renal cell carcinomas (RCCs), with particular emphasis on small (<3-cm) masses. MATERIALS AND METHODS Institutional review board approval and a waiver of informed consent were obtained for this HIPAA-compliant study. MR images from 108 pathologically proved renal masses (88 clear cell RCCs and 20 minimal fat AMLs from 64 men and 44 women) at two academic institutions were evaluated. The signal intensity (SI) of each renal mass and spleen on opposed-phase and in-phase GRE images was used to calculate an SI index and tumor-to-spleen SI ratio. Two radiologists who were blinded to the pathologic results independently assessed the subjective presence of intravoxel fat (ie, decreased SI on opposed-phase images compared with that on in-phase images), SI on T1-weighted and T2-weighted images, cystic degeneration, necrosis, hemorrhage, retroperitoneal collaterals, and renal vein thrombosis. Results were analyzed by using the Wilcoxon rank sum test, two-tailed Fisher exact test, and multivariate logistic regression analysis for all renal masses and for small masses. A P value of less than .05 was considered to indicate a statistically significant difference. RESULTS There were no differences between minimal fat AMLs and clear cell RCCs for the SI index (8.05%±14.46 vs 14.99%±19.9; P=.146) or tumor-to-spleen ratio (-8.96%±16.6 and -15.8%±22.4; P=.227) when all masses or small masses were analyzed. Diagnostic accuracy (area under receiver operating characteristic curve) for the SI index and tumor-to-spleen ratio was 0.59. Intratumoral necrosis and larger size were predictive of clear cell RCC (P<.001) for all lesions, whereas low SI (relative to renal parenchyma SI) on T2-weighted images, smaller size, and female sex correlated with minimal fat AML (P<.001) for all lesions. CONCLUSION The diagnostic accuracy of opposed-phase and in-phase GRE MR imaging for the differentiation of minimal fat AML and clear cell RCC is poor. In this cohort, low SI on T2-weighted images relative to renal parenchyma and small size suggested minimal fat AML, whereas intratumoral necrosis and large size argued against this diagnosis.

Static material properties of the tectorial membrane: a summary

The tectorial membrane (TM) is a polyelectrolyte gel. Hence, its chemical, electrical, mechanical, and osmotic properties are inextricably linked. We review, integrate, and interpret recent findings on these properties in isolated TM preparations. The dimensions of the TM in alligator lizard, chick, and mouse are sensitive to bath ion concentrations of constituents normally present in the cochlear fluids - an increase in calcium concentration shrinks the TM, and an increase in sodium concentration swells the TM in a manner that depends competitively on the calcium concentration. The sodium-induced swelling is specific; it does not occur with other alkali metal cations. We interpret these findings as due to competitive binding of sodium and calcium to TM macromolecules which causes a change in their conformation that leads to a change in mechanical properties. In mouse TM, decreasing the bath pH below 6 or increasing it above 7 results in swelling of the TM. Electric potential measurements are consistent with the notion that the swelling is caused by a pH-driven increase in positive fixed charge at low pH and an increase in the magnitude of the negative fixed charge at high pH which is consistent with the known protonation pattern of TM macromolecules. Increasing the osmotic pressure of the bathing solution with polyethylene glycol shrinks the TM and decreasing the ionic strength of the bathing solution swells the TM. Both results are qualitatively consistent with predictions of a polyelectrolyte gel model of the TM.

Tumor Necrosis on Magnetic Resonance Imaging Correlates With Aggressive Histology and Disease Progression in Clear Cell Renal Cell Carcinoma

OBJECTIVE The study objective was to correlate the magnetic resonance imaging (MRI) features of clear cell renal cell carcinoma (ccRCC) with the histopathologic features and disease progression. METHODS Institutional review board approval for this retrospective study was obtained; patient consent was not required. The initial staging MRI scans of 75 patients with histologically confirmed ccRCC were retrospectively reviewed. The imaging was assessed by 2 radiologists for the presence of tumor necrosis, cystic degeneration, intracellular fat, hemorrhage, retroperitoneal collaterals, and renal vein thrombosis. Quantitative analysis for the MRI presence of intracellular lipid within tumors was performed. MRI findings were correlated with histopathologic findings of clear cell percentage, alveolar and tubular growth pattern, and disease progression. Statistical associations were evaluated with nonparametric univariable analyses and multivariable logistic regression models. RESULTS Correlation between MRI and histopathologic features was performed in 75 patients, whereas follow-up data were available for progression analysis in 68 patients. The presence of tumor necrosis, retroperitoneal collaterals, and renal vein thrombosis on MRI was significantly associated with a low percentage of tumor cells with clear cytoplasm (P < .01) and metastatic disease at presentation or disease progression (P < .01). At multivariable analysis, necrosis remained the only feature statistically associated with disease progression (P = .03; adjusted odds ratio, 27.7; 95% confidence interval, 1.4-554.7 for reader 1 and P = .02; adjusted odds ratio, 29.3; 95% confidence interval, 1.7-520.8 for reader 2). CONCLUSIONS Necrosis in ccRCC on MRI correlates with the histopathologic finding of lower percentage of tumor cells with clear cytoplasm and is a poor prognostic indicator irrespective of tumor size.

High-resolution proton density weighted three-dimensional fast spin echo (3D-FSE) of the knee with IDEAL at 1.5 tesla: Comparison with 3D-FSE and 2D-FSE—initial experience

To assess the feasibility of combining three‐dimensional fast spin echo (3D‐FSE) and Iterative‐decomposition‐of water‐and‐fat‐with‐echo asymmetry‐and‐least‐squares‐estimation (IDEAL) at 1.5 Tesla (T), generating a high‐resolution 3D isotropic proton density‐weighted image set with and without “fat‐suppression” (FS) in a single acquisition, and to compare with 2D‐FSE and 3D‐FSE (without IDEAL).

High Throughput Tools to Access Images from Clinical Archives for Research

Historically, medical images collected in the course of clinical care have been difficult to access for secondary research studies. While there is a tremendous potential value in the large volume of studies contained in clinical image archives, Picture Archiving and Communication Systems (PACS) are designed to optimize clinical operations and workflow. Search capabilities in PACS are basic, limiting their use for population studies, and duplication of archives for research is costly. To address this need, we augment the Informatics for Integrating Biology and the Bedside (i2b2) open source software, providing investigators with the tools necessary to query and integrate medical record and clinical research data. Over 100 healthcare institutions have installed this suite of software tools that allows investigators to search medical record metadata including images for specific types of patients. In this report, we describe a new Medical Imaging Informatics Bench to Bedside (mi2b2) module (www.mi2b2.org), available now as an open source addition to the i2b2 software platform that allows medical imaging examinations collected during routine clinical care to be made available to translational investigators directly from their institution’s clinical PACS for research and educational use in compliance with the Health Insurance Portability and Accountability Act (HIPAA) Omnibus Rule. Access governance within the mi2b2 module is customizable per institution and PACS minimizing impact on clinical systems. Currently in active use at our institutions, this new technology has already been used to facilitate access to thousands of clinical MRI brain studies representing specific patient phenotypes for use in research.

Dynamic half-Fourier single-shot turbo spin echo for assessment of deep venous thrombosis: initial observations

OBJECTIVE The objective of this study was to retrospectively analyze the value of dynamic half-Fourier single-shot turbo spin echo (HASTE) imaging in patients with suspected deep venous thrombosis (DVT). MATERIALS AND METHODS Fifty-five veins in 24 patients were interrogated using a HASTE sequence with the patients relaxed and in various degrees of Valsalva. Veins were analyzed for changes in caliber (+CAL) and signal intensity (+SI) or in their absence (-CAL and -SI, respectively) and compared with the presence of thrombus on gadolinium-enhanced magnetic resonance imaging. RESULTS There was no thrombus in veins with the +CAL, +SI pattern (n=40) (P<.01). Five of seven veins (71.4%) with the -CAL, -SI pattern had thrombus (P<.01). A qualitative change in CAL had a sensitivity of 100% and a specificity of 91% for the presence of thrombus. An increase of 1.5 mm in CAL had a sensitivity of 100% and a specificity of 93% for this diagnosis. CONCLUSION Dynamic HASTE imaging offers a physiological method to evaluate veins for deep venous thrombosis.

MRI guided needle localization in a patient with recurrence pleomorphic sarcoma and post-operative scarring

MRI-guided wire localization is commonly used for surgical localization of breast lesions. Here we introduce an alternative use of this technique to help with surgical resection of a recurrent pleomorphic sarcoma embedded in extensive post-treatment scar tissue. We describe a case of recurrent pleomorphic soft tissue sarcoma in the thigh after treatment with neoadjuvant therapy, surgery, and radiation. Due to the distortion of the normal tissue architecture and formation of extensive scar tissue from prior treatment, wire localization under MRI was successfully used to assist the surgeon in identifying the recurrent tumor for removal.