Shambhu Kumar Sah

Iron deposition in the gray matter in patients with relapse-remitting multiple sclerosis: A longitudinal study using three-dimensional (3D)-enhanced T2*-weighted angiography (ESWAN)

PURPOSE To investigate the relationship between the iron content by magnetic resonance imaging (MRI) and clinic correlation in patients with relapse-remitting multiple sclerosis (RRMS) over a two-year period. METHODS Thirty RRMS patients and 30 healthy control subjects were examined twice, two years apart, by undergoing brain conventional MRI and three-dimensional (3D)-enhanced T2*-weighted angiography (ESWAN) sequences at 3.0T. Quantitative differences in iron content in deep gray matter (GM) nuclei and precentral gyrus GM between patients and control subjects with repeated-measures the mean phase values (MPVs) for ESWAN-filtered phase images. Spearmans rank correlation coefficient analysis was used to evaluate correlations of the MPVs, both 2-year-difference and single-time measurements, to disease duration, expanded disability status scale (EDSS) and times of recurrence. RESULTS The RRMS patients had higher GM iron concentration than that of the healthy control subjects in both single-time measurements, but only the substantia nigra (SN), and the precentral gyrus GM (PGM) showed a significant statistical difference (p<0.05). Using the paired samples t test, we found that there were significant differences in two-year-difference measurements of the MPVs in the putamen (PUT), the globus pallidus (GP), the head of the caudate nucleus (HCN), the thalamus (THA), SN, the red nucleus (RN), the dentate nucleus (DN) and PGM, especially in SN (t=2.92, p=0.007) in RRMS patients. The MPVs of the PUT, GP, HCN, THA, SN, RN, DN and PGM for the subgroup with RRMS patients in times of recurrence less than twice were similar to the healthy controls. There was no significant difference in all regions of interests (ROIs). However, there were significant differences in all ROIs except THA and GP for the other subgroup with RRMS patients in times of recurrence more than and equal to twice. Spearmans rank correlation coefficient analysis showed there were significant negative correlations between disease duration and the MPVs in the HCN (r=-0.516, p=0.004), DN (r=-0.468, p=0.009) and PGM (r=-0.84, p=0). However, no correlations were found between the EDSS scores and the MPVs. CONCLUSIONS Iron content in the GM can be measurable using MRI and our results confirmed that iron concentration was increasing in the GM of MS patients during two-year period compared to healthy controls. Furthermore, this study had also shown significant and substantial correlation of iron concentration with disease severity.

Amplitude of low-frequency fluctuation (ALFF) and fractional ALFF in migraine patients: a resting-state functional MRI study

AIM To evaluate the amplitude of low-frequency oscillations (LFOs) of the brain in migraine patients using amplitude of low-frequency fluctuation (ALFF) and fractional ALFF in the interictal period, in comparison to healthy controls (HCs). MATERIALS AND METHODS A total of 54 subjects, including 30 migraineurs and 24 gender- and age-matched HCs completed the fMRI. All the data and ALFF, fALFF analyses were preprocessed with the Data Processing Assistant for Resting-State fMRI (DPARSF). All of the statistical analyses were performed using the REST software to explore the differences in ALFF and fALFF between migraine patients and HCs. RESULTS In contrast to HCs, migraine patients showed significant ALFF increase in the left medulla and pons, the bilateral cerebellum posterior lobe and right insula. The regions showing decreased ALFF in migraine patients included the bilateral cerebellum posterior lobe, left cerebellum anterior lobe, bilateral orbital cortex, right middle frontal gyrus, bilateral occipital lobe, right fusiform gyrus, and bilateral postcentral gyrus. The fALFFs in migraine patients were significantly increased in the bilateral insular and left orbital cortex, but were decreased in the left occipital lobe and bilateral cerebellum posterior lobe. CONCLUSION These ALFF and fALFF alterations in the brain regions of migraineurs are in keeping with the domains associated with pain and cognition. Such brain functional alteration may contribute to further understanding of migraine-related network imbalances demonstrated in previous studies.

Endobronchial ultrasound and bronchial artery embolization for Dieulafoy's disease of the bronchus in a teenager: A case report

Dieulafoys disease of the bronchus is a relatively rare cause of hemoptysis. It can be completely asymptomatic and diagnosed as an incidental finding on bronchoscopy. At the other end of the spectrum, it can present with potentially fatal hemorrhage. We present a case of a 13-year old boy who suffered from massive hemoptysis. Endobronchial ultrasound (EBUS) and bronchial artery embolization (BAE) proved useful in the initial management. This case may support the role of EBUS in the diagnosis of Dieulafoys disease as well as other intrapulmonary vascular lesions.

Transanal endoscopic microsurgery is an oncologically safe alternative to total mesorectal excision for stage I rectal cancer: results of a meta-analysis of randomized controlled trials.

Dear Editor: Total mesorectal excision (TME) is the gold standard for stage I rectal cancer. The National Comprehensive Cancer Network (NCCN) 2015 guidelines recommend transabdominal resection using the principles of TME for cT1-2N0M0 tumors. Local excision (LE) is deemed appropriate for small T1 cancers without any high-risk features. While TME has reduced local recurrence rate and improved survival rate considerably, it is not without harm. This radical operation is associated with a high postoperative morbidity. Perioperative mortality is approximately 4 %. The quality of life of patients is impaired. Sexual, urinary, or defaecatory dysfunctions are reported in up to 50 % of patients. The last decade has been marked by an exponentially growing interest in more conservative treatment modalities with curative intent. The aim is to preserve the rectum and anal sphincter, decrease morbidity and mortality, and improve quality of life. LE is now established for treatment of selected cases of rectal cancer. It has been used as a single modality for low-risk T1 or in combination with neoadjuvant chemoradiotherapy (CRT) for more advanced tumors. However, a high recurrence rate of 15–20 % has been reported with LE. Various techniques of LE have been described (Parks and Stuart 1973, Buess et al. 1985, Atallah et al. 2010). With conventional LE, a full thickness excision is performed. Lymph nodes in the mesorectum are not removed and may contain tumor foci. Endoscopic posterior mesorectal excision has been proposed to reduce locoregional recurrence. Previous reviews did not focus on the role of LE in stage I rectal cancer and analyzed observational studies at high risk of bias. One meta-analysis published by Sajid et al. on early rectal cancer had somemethodological limitations: it included diverse studies with different stages of rectal cancer and outcomes with different effect measures were pooled. Despite a comprehensive search, no systematic review of randomized controlled trials (RCTs) was found on this topic. While LE reduces morbidity and mortality, it remains unclear whether it compromises recurrence and survival. These factors, as well as the production of new evidence, provided the impetus for this meta-analysis. The objective of this review was to investigate how LE compares with TME in terms of oncological outcomes and short-term operative outcomes in patients with stage I rectal cancer. We searched Pubmed, Biosis Previews, ScienceDirect, Ovid, and the Cochrane Central Register of Controlled trials using the following search strategy: (Brectal cancer^ AND (Blocal excision^ OR Btransanal excision^ OR Btransanal endoscopic microsurgery^ OR Btransanal minimally invasive surgery^) AND (Btotal mesorectal excision^ OR Banterior resection^ OR Babdominoperineal resection^)) for papers up to 30 November 2015. The lists of references of relevant trials were also hand searched. Studies were included if (1) they were RCTs, (2) compared LE to TME, (3) the subjects were patients with clinical stage I rectal cancer, and (4) oncological * Manu Chiniah manu_chiniah@hotmail.com

Measurement of the permeability, perfusion, and histogram characteristics in relapsing-remitting multiple sclerosis using dynamic contrast-enhanced MRI with extended Tofts linear model

Objective: To investigate the application value of using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with extended Tofts linear model for relapsing-remitting multiple sclerosis (RRMS) and its correlation with expanded disability status scale (EDSS) scores and disease duration. Materials and Methods: Thirty patients with multiple sclerosis (MS) underwent conventional magnetic resonance imaging (MRI) and DCE-MRI with a 3.0 Tesla MR scanner. An extended Tofts linear model was used to quantitatively measure MR imaging biomarkers. The histogram parameters and correlation among imaging biomarkers, EDSS scores, and disease duration were also analyzed. Results: The MR imaging biomarkers volume transfer constant (Ktrans), volume of the extravascular extracellular space per unit volume of tissue (Ve), fractional plasma volume (Vp), cerebral blood flow (CBF), and cerebral blood volume (CBV) of contrast-enhancing (CE) lesions were significantly higher (P < 0.05) than those of nonenhancing (NE) lesions and normal-appearing white matter (NAWM) regions. The skewness of Ve value in CE lesions was more close to normal distribution. There was no significant correlation among the biomarkers with the EDSS scores and disease duration (P > 0.05). Conclusions: Our study demonstrates that the DCE-MRI with the extended Tofts linear model can measure the permeability and perfusion characteristic in MS lesions and in NAWM regions. The Ktrans, Ve, Vp, CBF, and CBV of CE lesions were significantly higher than that of NE lesions. The skewness of Ve value in CE lesions was more close to normal distribution, indicating that the histogram can be helpful to distinguish the pathology of MS lesions.

Structural abnormalities and altered regional brain activity in multiple sclerosis with simple spinal cord involvement

OBJECTIVE To assess the changes of the structural and functional abnormalities in multiple sclerosis with simple spinal cord involvement (MS-SSCI) by using resting-state functional MRI (RS-fMRI), voxel based morphology (VBM) and diffusion tensor tractography. METHODS The amplitude of low-frequency fluctuation (ALFF) of 22 patients with MS-SSCI and 22 healthy controls (HCs) matched for age, gender and education were compared by using RS-fMRI. We also compared the volume, fractional anisotropy (FA) and apparent diffusion coefficient of the brain regions in baseline brain activity by using VBM and diffusion tensor imaging. The relationships between the expanded disability states scale (EDSS) scores, changed parameters of structure and function were further explored. RESULTS (1) Compared with HCs, the ALFF of the bilateral hippocampus and right middle temporal gyrus in MS-SSCI decreased significantly. However, patients exhibited increased ALFF in the left middle frontal gyrus, left posterior cingulate gyrus and right middle occipital gyrus ( two-sample t-test, after AlphaSim correction, p < 0.01, voxel size > 40). The volume of right middle frontal gyrus reduced significantly (p < 0.01). The FA and ADC of right hippocampus, the FA of left hippocampus and right middle temporal gyrus were significantly different. (2) A significant correlation between EDSS scores and ALFF was noted only in the left posterior cingulate gyrus. CONCLUSION Our results detected structural and functional abnormalities in MS-SSCI and functional parameters were associated with clinical abnormalities. Multimodal imaging plays an important role in detecting structural and functional abnormalities in MS-SSCI. Advances in knowledge: This is the first time to apply RS-fMRI, VBM and diffusion tensor tractography to study the structural and functional abnormalities in MS-SSCI, and to explore its correlation with EDSS score.

CT features and analysis for misdiagnosis of parotid tuberculosis

PURPOSE To analyze the computed tomography (CT) features and the reasons for misdiagnosis of parotid tuberculosis (TB). METHODS CT features of 13 cases of parotid TB identified more than a 10-year period (2005-2015) were retrospectively analyzed. The CT features were analyzed for nature, range, and extent of the various pathological patterns. RESULTS Because of the nonspecific CT features, 10 of 13 cases were misdiagnosed as benign and malignant tumors of parotid gland and received surgery. Ten cases of lymph nodal TB, one case of parenchymal TB, and two cases of mixed (concurrence of lymph nodal and parenchymal types) TB were found in the parotid gland. On contrast-enhanced CT scan, two cases showed homogeneous enhancement and eight cases showed ring enhancement (including five cases with thin-walled ring enhancement, two cases with flower-ring enhancement, and one case with thick-walled and eccentric ring enhancement); diffuse enhancement was seen in the one case of parenchymal type; the two cases of mixed type showed diffuse enhancement of parotid gland and ring enhancement of lymph node. Thickened skin around the parotid gland was seen in eight cases, including sinus tract between the lesion and skin in two cases. Ipsilateral cervical lymphadenopathy was found in 10 patients and bilateral was found in 3 patients. CONCLUSIONS Nonspecific CT features of parotid TB closely relate with pathological changes. Recognition and understanding the spectrum of CT features of parotid TB is helpful for differential diagnosis, but the definitive diagnosis still depends on laboratory and pathological examination.