Nawele Boublay

Impact of diffusion-weighted MR imaging on the characterization of small hepatocellular carcinoma in the cirrhotic liver.

PURPOSE The purpose of this study was to determine whether or not adding diffusion-weighted magnetic resonance imaging (DWI) to conventional magnetic resonance (MR) imaging sequences improves the characterization of small hepatocellular carcinoma (HCC) (≤2 cm) in the setting of cirrhotic liver compared to conventional sequences alone. MATERIALS AND METHODS A total of 62 cirrhotic liver patients with 82 nodules smaller than 2 cm in diameter were enrolled, and all lesions were pathologically confirmed. For the first reading session, which included precontrast T1- and T2-weighted images and T1 dynamic contrast-enhanced images, preindicated lesions by a study coordinator were characterized by two radiologists. They determined the confidence levels in consensus for the presence of small HCC into four grades. In another session, respiratory-triggered diffusion-weighted MR images (b factor=50, 400 and 800 s/mm(2)) were added to the previously reviewed images, and the same two radiologists again determined the confidence levels. The diagnostic performance of the combined DWI-conventional sequences set and the conventional sequences alone set was evaluated using receiver operating characteristic curves. Sensitivity and specificity values for characterizing small HCCs were also calculated. RESULTS The area under the receiver operating characteristic curve for the second interpretation session (0.86) was significantly higher (P=.038) than that of the first session (0.76). The sensitivity was significantly increased from 75.7% to 87.8% by adding DWI to the conventional sequences (P=.015). No significant differences were observed for specificity values. CONCLUSION Adding DWI to conventional imaging modalities improves the diagnosis of small HCCs in the cirrhotic liver in terms of diagnostic performance and sensitivity by increasing reader confidence.

Neuroanatomical Correlates of Recognizing Face Expressions in Mild Stages of Alzheimer's Disease.

Early Alzheimer’s disease can involve social disinvestment, possibly as a consequence of impairment of nonverbal communication skills. This study explores whether patients with Alzheimer’s disease at the mild cognitive impairment or mild dementia stage have impaired recognition of emotions in facial expressions, and describes neuroanatomical correlates of emotion processing impairment. As part of the ongoing PACO study (personality, Alzheimer’s disease and behaviour), 39 patients with Alzheimer’s disease at the mild cognitive impairment or mild dementia stage and 39 matched controls completed tests involving discrimination of four basic emotions—happiness, fear, anger, and disgust—on photographs of faces. In patients, automatic volumetry of 83 brain regions was performed on structural magnetic resonance images using MAPER (multi-atlas propagation with enhanced registration). From the literature, we identified for each of the four basic emotions one brain region thought to be primarily associated with the function of recognizing that emotion. We hypothesized that the volume of each of these regions would be correlated with subjects’ performance in recognizing the associated emotion. Patients showed deficits of basic emotion recognition, and these impairments were correlated with the volumes of the expected regions of interest. Unexpectedly, most of these correlations were negative: better emotional facial recognition was associated with lower brain volume. In particular, recognition of fear was negatively correlated with the volume of amygdala, disgust with pallidum, and happiness with fusiform gyrus. Recognition impairment in mild stages of Alzheimer’s disease for a given emotion was thus associated with less visible atrophy of functionally responsible brain structures within the patient group. Possible explanations for this counterintuitive result include neuroinflammation, regional β-amyloid deposition, or transient overcompensation during early stages of Alzheimer’s disease.

Contrast-enhanced ultrasound: a new method for TIPS follow-up

PurposeTo determine the diagnostic value of contrast-enhanced ultrasound (CEUS) for the detection of TIPS (transjugular intrahepatic portosystemic shunt) complications.Materials and method67 cirrhotic patients who underwent TIPS between 2001 and 2008 were retrospectively reviewed. Sixty-two vascular examinations in 37 patients for suspicion of TIPS dysfunction based on the clinical or radiological criteria were analyzed and compared with the 62 related Doppler and CEUS examinations obtained previously. Abnormal CEUS was defined as poor opacification of the prosthesis compared to the native portal vein, stent stenosis, hepatic vein stenosis, and occlusion of the stent.ResultsAmong the 62 vascular examinations, 56 were considered as pathologic, including: 20 occlusions, 25 stent stenoses, 9 hepatic vein stenoses, 1 arterial-TIPS fistula, and 1 strong flow stealing through a voluminous paraumbilical vein associated with a patent shunt. 50 were exactly correlated with a previous CEUS examination, including 20/20 occlusions (100%), 23/25 stent stenoses (91%), 5/9 hepatic vein stenoses (56%), 1/1 fistula (100%), and 1/1 strong flow stealing (100%). Two CEUS and 14 Doppler examinations were false negative.ConclusionCEUS allows direct visualization of intra-prosthetic flow, with a qualitative and anatomic study, in addition to the Doppler examination. This is a new, simple, and effective technique for TIPS follow-up.

A two dimensional locally regularized strain estimation technique: preliminary clinical results for the assessment of benign and malignant breast lesions

We previously developed a 2D locally regularized strain estimation technique that was already validated with ex vivo tissues. In this study, our technique is assessed with in vivo data, by examining breast abnormalities in clinical conditions. Method reliability is analyzed as well as tissue strain fields according to the benign or malignant character of the lesion. Ultrasound RF data were acquired in two centers on ten lesions, five being classified as fibroadenomas, the other five being classified as malignant tumors, mainly ductal carcinomas from grades I to III. The estimation procedure we developed involves maximizing a similarity criterion (the normalized correlation coefficient or NCC) between pre- and post-compression images, the deformation effects being considered. The probability of correct strain estimation is higher if this coefficient is closer to 1. Results demonstrated the ability of our technique to provide good-quality strain images with clinical data. For all lesions, movies of tissue strain during compression were obtained, with strains that can reach 15%. The NCC averaged over each movie was computed, leading for the ten cases to a mean value of 0.93, a minimum value of 0.87 and a maximum value of 0.98. These high NCC values confirm the reliability of the strain estimation. Moreover, lesions were clearly identified for the ten cases investigated. Finally, we have observed with malignant lesions that compared to ultrasound data, strain images can put in relief a more important lesion size, and can help in evaluating the lesion invasive character.

PERSONALITY AND BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA: RESULTS FROM THE PACO STUDY

may present with neuropsychiatric symptoms. This case report describes a patient with anti-NMDA receptor encephalitis who presented with a clinical syndrome resembling catatonia. Methods: A 52-year-old woman was admitted to hospital with a 5-month history of progressive deterioration of verbal output, ambulation and urinary incontinence. She was diagnosed with bipolar disease in 2010 and started on lithium treatment. She had an episode of catatonic depression in 2010, a manic episode in 2012 and an episode of psychotic depression in 2014. She received electroconvulsive therapy (ECT) after depressive episodes in 2010 and 2014. She did not fully recover to baseline psychiatric status after these episodes. Five months prior to admission, she started developing apathy and ataxia and then became increasingly more apathetic. On admission, her neurologic examination revealed severe apathy and decreased responsiveness, her verbal output was limited to a few words. She was unable to stand and walk. She had bilateral increased muscle tone with waxy flexibility. Psychiatric consultation resulted in a suspected diagnosis of catatonic psychosis. MRI showed frontoparietal cortical atrophy. Electroencephalography (EEG) depicted irregular theta waves on both hemispheres. Cerebrospinal fluid (CSF) protein level was elevated (70.8 mg/dL), and anti-NMDA receptor antibodies were positive in the CSF. Detailed screening for malignancies remained negative. Results: Intravenous methylprednisolone (1 gr/kg for 5 days) and intravenous immunoglobulin (0.4 g/kg) treatments were started. After immunosuppressive treatment, her mental status improved and verbal output increased. After 7 days of treatment she was able to sit and walk with assistance, her EEG became normalized. Conclusions: In patients with a clinical presentation resembling catatonic psychosis, the possibility of anti-NMDA encephalitis should be considered.

REGIONAL FRONTAL CORTEX VOLUME PREDICTS APATHY IN ALZHEIMER’S DISEASE

CDR 0.024 0 265(71.0%) 158(62.5%) 0.5 108(29.0%) 95(37.5%) CDR SOB 0.19460.33 0.2560.35 0.033 B-ADL 19.9060.61 19.8660.61 0.468 BNT 0.3560.68 0.2960.66 0.277 Digit_BD 0.2761.13 0.0760.97 0.022 SVLT delayed 0.63 60.64 -0.1860.50 0.000 SVLT recognition 0.3660.81 -0.0060.77 0.000 RCFT delayed 0.3860.78 0.1960.75 0.004 RCFT recognition 0.0660.96 -0.01 60.84 0.337 COWAT total 0.2360.99 0.0361.01 0.102 Stroop 0.2060.98 0.1460.89 0.031 MMSE 0.1960.87 0.0960.92 0.178

BRAIN VOLUME PREDICTS BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS IN ALZHEIMER’S DISEASE

(FTD), rather than the purely memory and cognitive deficit presentation of typical AD. Methods:Case study methods included analysis of seven patients’ cases with a confirmed mutation on the PSEN-2 gene. The history of illness and disease progression of each patient was reviewed and examined to further identify common symptoms associated with PSEN-2 mutations such as behavioral changes, psychiatric symptoms and memory loss. Results: The participants consisted of six females and one male. Six out of seven patients had a clinical diagnosis of AD between the ages of 51-57 years old, while they presented the first symptom in an age range between 48-56 years. In six out of seven patients, initial symptoms included changes in behavior and personality followed by memory deficits as the disease progressed. Four out of seven patients were diagnosed with depressive/affective disorder and three patients had visual hallucinations. Three patients had previous brain imaging studies in which two of them presented frontal lobe atrophy. All patients had a rapid progression leading to early incapacity on most cases. Conclusions: For the first time, we describe the clinical presentation of a PSEN-2 mutation in seven Puerto Rican patients. Coupled with recent literature, this report suggests that PSEN-2 mutations can present with a mixed AD and FTD clinical criteria, with behavioral changes and psychiatric symptoms being the earliest prominent signs. These findings can guide physicians to recognize that patients with the aforementioned symptoms may have an underlying PSEN-2mutation and may need further evaluation of their families. We believe these results can raise awareness for future studies on PSEN-2 mutation prevalence in the Puerto Rican population.