Nermin Tuncbilek

Dynamic MRI in indirect estimation of microvessel density, histologic grade, and prognosis in colorectal adenocarcinomas

Abstract The relations of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters to microvessel density (MVD), histologic grade, and presence of metastasis were evaluated to establish new prognostic indicators in colorectal cancer (CRC). Fast-low angle shot DCE-MRI parameters (time-intensity curves, TICs; maximal relative enhancement within the first minute, Emax/1; maximal relative enhancement of the entire study, Emax; steepest slope of the contrast enhancement curve; and time to peak enhancement) of 21 CRCs (seven Duke stage B, 12 Duke stage C, and two Duke stage D) were retrospectively evaluated and correlated with corresponding postoperative MVD measurements, histologic grades, and presence of metastasis at 2 years. TICs were classified as type A in nine (43%), type B in seven (33%), and type C in five cases (24%). There was a significant difference between TIC types with regard to MVD (p < 0.05–0.001). Time to peak enhancement, steepest slope of TIC, and Emax/1 were strongly correlated with MVD (r = −0.765, p < 0.01; r = 0.681, p < 0.01; r = 0.634, p < 0.01; respectively). MVD, steepest slope of the enhancement curve, Emax/1, and Emax strongly correlated with histologic grade (r = 0.475, p < 0.05; r = 0.683, p < 0.01; r = 0.687, p < 0.01; r = 0.791, p < 0.01; respectively). There was a significant difference between groups of patients with and without metastasis with regard to histologic grade (p < 0.05) and two of the DCE-MRI parameters (p < 0.005 for Emax/1 and p < 0.05 for time to peak enhancement). Discriminant analysis correctly predicted the metastatic occurrence at 2 years in 90.5% of cases using Emax/1 (p < 0.001). Histologic grade resulted in lower rates of discrimination (66.7%; p < 0.05). DCE-MRI parameters may help in the prediction of MVD and histologic grade in CRC and may be used to predict therapeutic outcome.

Value of Dynamic Contrast-Enhanced MRI and Correlation with Tumor Angiogenesis in Bladder Cancer

OBJECTIVE The aim of this study was to investigate dynamic contrast-enhanced MRI (DCE-MRI) for the noninvasive measurement of bladder cancer angiogenesis by correlation with microvessel density, histologic grade, and tumor staging, and to predict the outcome of local recurrence. MATERIALS AND METHODS Twenty-four patients with bladder cancer were examined using DCE-MRI. Hemodynamic parameters obtained by DCE-MRI included peak time enhancement in the first minute (E(max/1)) after contrast administration, second minute (E(max/2)), third minute (E(max/3)), fourth minute (E(max/4)), and fifth minute (E(max/5)), and the steepest slope. Microvessel density was identified by immunostaining of endothelial cells using FVIII-related antigen. The Mann-Whitney U test, multivariate discriminant analysis, Spearmans correlation coefficient, and analysis of variance were used for statistical analysis. RESULTS Correlation was seen between DCE-MRI parameters (E(max/1) and steepest slope) and microvessel density (p < 0.05). E(max/1) and steepest slope were found to have a statistically significant correlation with histologic grade (p < 0.05 and p < 0.01, respectively). A significant difference was seen between groups of patients with and without local recurrence with regard to two of the DCE-MRI parameters (p < 0.05 for E(max/1) and E(max/2)). CONCLUSION The contrast enhancement patterns on DCE-MRI are influenced by tumor angiogenesis, as reflected by elevated microvessel density expression. Therefore, they are valuable indicators for assessing tumor angiogenic activity and tumor neovascularization in bladder cancers.

Evaluation of Tumor Angiogenesis with Contrast-Enhanced Dynamic Magnetic Resonance Mammography

Abstract:  The goal of this research was to correlate dynamic magnetic resonance (MR) mammographic contrast enhancement and microvessel densities in breast masses. Forty‐six female patients with breast masses detected by mammography and/or ultrasonography were included in the study. MR contrast enhancements of the lesions were investigated dynamically using axial three‐dimensional fast low‐angle shot sequences. After excisional biopsy or mastectomy, immunohistochemical staining with factor VIII‐RA was performed, followed by microvessel density measurements. Contrast enhancement patterns in dynamic MR mammography were compared with microvessel density measurements using Students t‐test, Pearsons moment correlation coefficients, and one‐way analysis of variance (ANOVA). Malignant lesions exhibited three different enhancement patterns: 1) a peak enhancement within 120 seconds (early phase), followed by a decrease in the delayed phase (25 cases); 2) an increase in the early phase, followed by a plateau in the delayed phase (9 cases); and 3) an increase throughout the examination without any peak (5 cases). In benign lesions, signal intensity did not exhibited a peak in five cases, whereas in two cases enhancement was increased in the early phase and made a plateau in the delayed phase. A significant correlation was found between microvessel density and the percentage of maximal signal increase following paramagnetic contrast administration (r = 0.322, p < 0.05). Dynamic enhancement patterns and rates of maximal signal increase predict microvessel density in breast malignancies and may possibly be used as prognostic indicators.

Prognostic value DCE-MRI parameters in predicting factor disease free survival and overall survival for breast cancer patients

PURPOSE The aim of the study is to assess the predictive power of DCE-MRI semi-quantitative parameters during treatment of breast cancer, for disease-free (DFS) and overall survival (OS). MATERIALS AND METHODS Forty-nine women (age range, 28-84 years; mean, 50.6 years) with breast cancer underwent dynamic contrast enhancement MRI at 1.0T imaging, using 2D FLASH sequences. Time intensity curves (TICs) were obtained from the regions showing maximal enhancement in subtraction images. Semi-quantitative parameters (TICs; maximal relative enhancement within the first minute, E (max/1); maximal relative enhancement of the entire study, E(max); steepest slope of the contrast enhancement curve; and time to peak enhancement) derived from the DCE-MRI data. These parameters were then compared with presence of recurrence or metastasis, DFS and OS by using Cox regression (proportional hazards model) analysis, linear discriminant analysis. RESULTS The results from of the 49 patients enrolled into the survival analysis demonstrated that traditional prognostic parameters (tumor size and nodal metastasis) and semi-quantitative parameters (E(max/1), and steepest slope) demonstrated significant differences in survival intervals (p<0.05). Further Cox regression (proportional hazards model) survival analysis revealed that semi-quantitative parameters contributed the greatest prediction of both DFS, OS in the resulting models (for E(max/1): p=0.013, hazard ratio 1.022; for stepest slope: p=0.004, hazard ratio 1.584). CONCLUSION This study shows that DCE-MRI has utility predicting survival analysis with breast cancer patients.

Visceral fat thickness determined using ultrasonography is associated with anthropometric and clinical parameters of metabolic syndrome

The aim of this study is to find out the relation between the ultrasonographic (USG) measurements of the abdominal fat thickness and cardiovascular risk factors in metabolic syndrome. The thickness of subcutaneous fat (SF), visceral fat (VF) and preperitoneal fat (PF) was measured using USG in 75 subjects (35 women and 40 men) with metabolic syndrome. The body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressures, fasting plasma glucose, fasting insulin and lipid parameters of all participants were recorded. Insulin resistance was estimated using HOMA‐IR formula. BMI (p < 0.05), WC (p < 0.01), SBP (p < 0.001), DBP (p < 0.05), fasting insulin (p < 0.05), total cholesterol (p < 0.001) and triglyceride (p < 0.001) levels were found in correlation with VF thickness in the female group. There was a positive association between WC and SF thickness (p < 0.05) in the same group. In the male patients, BMI (p < 0.001), WC (p < 0.01), SBP (p < 0.05), DBP (p < 0.05) and triglyceride level (p = 0.01) were significantly correlated with VF thickness. SF thickness was associated with BMI (p < 0.001) and WC (p < 0.01) in this group. There was no relation between PF thickness and clinical variables in both groups (p > 0.05). It can be concluded that VF thickness may have a significant pathophysiological role in the development of the metabolic syndrome.

Diabetic Fibrous Mastopathy: Dynamic Contrast‐Enhanced Magnetic Resonance Imaging Findings

Abstract:  Diabetic fibrous mastopathy (DFM) is an uncommon lesion that may clinically mimic breast carcinoma. Routine mammographic and ultrasonographic features of this disease also mimic the those of malignant disease, making an accurate preoperative diagnosis difficult. Dynamic contrast‐enhanced magnetic resonance imaging (MRI), however, reveals a homogeneous low‐enhancement with a gradual and progressive course without a washout. A corresponding time intensity curve is related to benign lesions of low vascularity, and by being a potential criterion for making a differentiation between DFM and malignant processes, spares patients from excisional biopsy. 

Temporomandibular joint (TMJ) pain revisited with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)

PURPOSE We aimed to assess the contrast enhancement patterns of the retrodiscal tissue with dynamic contrast-enhanced MR imaging (DCE-MRI) with respect to different temporomandibular joint disc pathologies. Additionally, we questioned the relationship between the temporomandibular joint (TMJ) pain and the contrast enhancement pattern of the retrodiscal tissue regardless of the TMJ disc position. MATERIALS AND METHODS 52 joints of 26 patients (4 males and 22 females) who have pain in at least at one of their TMJ were included in this study. For the qualitative analysis, the joints were divided into four groups in terms of their disc positions: normal (1), partially displaced with or without reduction (2), totally dislocated with reduction (3) and totally dislocated without reduction (4). Besides, two different joint groups were constituted, namely the painful group and painless group according to the clinical findings without taking the TMJ disc positions into account. Quantitative analyses were made by means of measuring signal intensity ratios (SI) ratio at the retrodiscal tissue (from internal side and external side of the each joint) using DCE-MRI and these measurements were analyzed with paired samples t test to define the difference between the measurements. At the second stage, the time-dependent arithmetical mean values of the SI ratios were calculated for each joint group and significant differences between the groups were questioned using analysis of variance (ANOVA) test. Besides, painful and painless groups which were classified on the basis of the clinical data were compared according to the mean SI ratios found for each joint and the significant differences between these two groups were assessed by means of Students T test. The results were assessed in 95% confidence interval where the significance level was p<0.05. RESULTS A significant difference was observed between the internal and external contrast enhancement of the joints with partial displacement. Another significant difference was found between the average time versus SI ratio curves of the four groups. In consequence of the comparison made between the joints classified as painful and painless on the basis of the clinical data, one more significant difference was observed according to the mean SI ratios of the groups without taking the TMJ disc position into account. CONCLUSION The contrast enhancement patterns in the retrodiscal tissues of the painful joints showed significant differences in comparison with the painless joints. This result supports the hypothesis defending that inflammation and increased vascularity are responsible from the TMJ pain. Besides, the measurements from the retrodiscal tissues of the joints with partial displacement show significant difference between the signals of the displaced and non-displaced parts of the joints. Dynamic contrast-enhanced imaging revealed that different disc malpositions create different contrast enhancement patterns. On this basis, it is assessed that the types of the disc malpositions, which are believed to be acquired pathologies, are correlated with the retrodiscal inflammation degrees.

MRI in multiple myeloma with orbital and dural invasion.

The case of a 42-year-old woman with aleukemic Bence Jones-type multiple myeloma who developed ocular abnormalities is described. Extramedullary plasmocytomas, either as solitary lesions or as manifestations of multiple myeloma, rarely involve the orbit and durai structures. Early detection of such lesions indicates an aggressive clinical course. In this paper we describe the magnetic resonance imaging findings of ocular and dural myelomatous involvement.

The effects of fat distribution and some adipokines on insulin resistance.

INTRODUCTION The risk of developing insulin resistance and metabolic syndrome is particularly high in central obesity. In this study we evaluated the effects of fat distribution and some adipokines on insulin resistance in prediabetic patients. MATERIAL AND METHODS Eighty-seven age- and sex-matched patients were divided into three groups according to their 75-gram oral glucose tolerance test results as follows: impaired fasting glucose group, impaired glucose tolerance group, and normal glucose tolerance group. Fasting insulin levels were measured. Homeostatic model assessment of insulin resistance was calculated. Body fat mass measurements were assessed by bioelectric impedance analyser and abdominal fat thicknesses (subcutaneous, visceral, and preperitoneal) by ultrasonography. The fasting serum levels of several adipokines [adiponectin, leptin, resistin, vaspin, visfatin, retinol-binding protein-4 (RBP-4), tumour necrosis factor-alpha (TNF-alpha)] were measured by ELISA method. RESULTS The mean body mass index, fat mass measurements, and abdominal fat thicknesses of the groups were similar. There were no differences between groups in terms of the mean fasting insulin, vaspin, RBP-4, leptin, resistin, and TNF-alpha. In comparison of the prediabetic and normal groups, the levels of adiponectin (p < 0.001) and visfatin (p < 0.001) were lower in the prediabetic group. Furthermore, we found that high body mass index (p < 0.01) and fat mass (p < 0.01) and low adiponectin (p < 0.05) levels have roles in the development of insulin resistance in the prediabetic group. CONCLUSIONS We suggested that in the prediabetic period not only obesity but also decreased adiponectin levels play some role in the pathogenesis of insulin resistance. (Endokrynol Pol 2016; 67 (3): 277-282).

Extramedullar plasmacytoma: clinicopathology, immunohistochemistry and therapeutic approach to a case with a tonsillar site

Hematol Oncol Stem Cell Ther 1(4) October 2008 hemoncstem.edmgr.com 241 Monoclonal extramedullary plasmacytoma (EMP) is a rare plasma cell tumor. The dia agnosis is based on a mass of clonal plasma cells separate from bone or bone marrow without evia dence of occult disease elsewhere. It occurs in the upper aerodigestive tract in more than 80% of patients, most often in the nasal cavity, paranasal sinuses, nasopharynx, oropharynx and larynx.1,2 Regional nodes are invaded in less than 10% of patients.1 The disease is more coma mon in males with a peak incidence in the sixth decade. Primary EMP often presents with a mass and produces local compressive symptoms. The differential diagnosis includes benign reactive processes, carcinoma and lyma phoma. Radiotherapy (RT) is an effective modality of treatment for EMP with high local control rates (85% to 100%).1,3a6 Currently moderate dose RT (40a50 Gy) using involved fields is recommended.