Stephen J. Golding

Serum Levels of Retinol-Binding Protein 4 and Adiponectin in Women with Polycystic Ovary Syndrome: Associations with Visceral Fat But No Evidence for Fat Mass-Independent Effects on Pathogenesis in This Condition

CONTEXT Insulin resistance, which associates with levels of retinol-binding protein 4 (RBP4) and adiponectin, is implicated in the development of polycystic ovary syndrome (PCOS). OBJECTIVE The objective of the study was to explore the potential contribution of RBP4 and adiponectin in the etiology of PCOS and their relationships with specific fat depot measurements. DESIGN This was a cross-sectional study. SETTING AND PARTICIPANTS Serum RBP4 and adiponectin levels were compared between 50 PCOS cases and 28 female controls (including 22 body mass index/fat mass-matched pairs) and correlated with specific fat depot (including visceral) axial magnetic resonance imaging cross-sectional area measurements. All subjects were of U.K. British/Irish origin. MAIN OUTCOME MEASURE(S) Serum levels of RBP4 (automated immunonephelometric assay) and adiponectin [immunoassay: total and high molecular weight (HMW)]. Data are reported as geometric mean (sd, range) and optionally adjusted for fat mass and age. RESULTS Between the 50 PCOS cases and 28 controls, serum RBP4 levels were indistinguishable [39.0 microg/ml (31.0, 49.0) vs. 41.6 microg/ml (32.7, 52.9), respectively, unadjusted P = 0.24; adjusted P = 0.55]. Total (and HMW) adiponectin levels were lower in PCOS cases [total adiponectin 19.9 microg/ml (14.2, 27.8) vs. 25.8 microg/ml (17.7, 37.7), respectively, unadjusted P = 2.4 x 10(-3); adjusted P = 0.10]. For the paired-sample analyzes, there were no differences in RBP4 (P = 0.09), total adiponectin (P = 0.06), HMW adiponectin (P =0.19), or HMW to total adiponectin ratio (P = 0.98). In PCOS cases, L4-visceral fat area was associated positively with RBP4 (r(2) = 0.34, P = 0.01) and negatively with HMW to total adiponectin ratio (r(2) = -0.44, P = 1.3 x 10(-3)). Controls showed similar relationships. CONCLUSIONS Although associated with visceral fat, serum RBP4 and adiponectin levels do not play important, fat-mass-independent primary roles in the development of PCOS.

Longitudinally and circumferentially directed movements of the left ventricle studied by cardiovascular magnetic resonance phase contrast velocity mapping

ObjectiveUsing high resolution cardiovascular magnetic resonance (CMR), we aimed to detect new details of left ventricular (LV) systolic and diastolic function, to explain the twisting and longitudinal movements of the left ventricle.MethodsUsing CMR phase contrast velocity mapping (also called Tissue Phase Mapping) regional wall motion patterns and longitudinally and circumferentially directed movements of the left ventricle were studied using a high temporal resolution technique in healthy male subjects (n = 14, age 23 ± 3 years).ResultsPreviously undescribed systolic and diastolic motion patterns were obtained for left ventricular segments (based on the AHA segmental) and for basal, mid and apical segments. The summation of segmental motion results in a complex pattern of ventricular twisting and longitudinal motion in the normal human heart which underlies systolic and diastolic function. As viewed from the apex, the entire LV initially rotates in a counter-clockwise direction at the beginning of ventricular systole, followed by opposing clockwise rotation of the base and counter-clockwise rotation at the apex, resulting in ventricular torsion. Simultaneously, as the entire LV moves in an apical direction during systole, the base and apex move towards each other, with little net apical displacement. The reverse of these motion patterns occur in diastole.ConclusionLeft ventricular function may be a consequence of the relative orientations and moments of torque of the sub-epicardial relative to the sub-endocardial myocyte layers, with influence from tethering of the heart to adjacent structures and the directional forces associated with blood flow. Understanding the complex mechanics of the left ventricle is vital to enable these techniques to be used for the evaluation of cardiac pathology.

“Black Bone” MRI: a potential alternative to CT with three-dimensional reconstruction of the craniofacial skeleton in the diagnosis of craniosynostosis

AbstractObjectivesTo determine the potential of novel gradient echo parameters, “Black Bone” MRI as an alternative to CT in the identification of normal and prematurely fused cranial sutures both in 2D and 3D imaging.MethodsThirteen children with a clinical diagnosis of craniosynostosis underwent “Black Bone” MRI in addition to routine cranial CT. “Black Bone” datasets were compared to CT and clinical findings. “Black Bone” imaging was subsequently used to develop 3D reformats of the craniofacial skeleton to enhance further visualisation of the cranial sutures.ResultsPatent cranial sutures were consistently identified on “Black Bone” MRI as areas of increased signal intensity. In children with craniosynostosis the affected suture was absent, whilst the remaining patent sutures could be visualised, consistent with CT and clinical findings. Segmentation of the “Black Bone” MRI datasets was successful with both threshold and volume rendering techniques. The cranial sutures, where patent, could be visualised throughout their path.ConclusionsPatent cranial sutures appear as areas of increased signal intensity on “Black Bone” MRI distinct from the cranial bone, demonstrating considerable clinical potential as a non-ionising alternative to CT in the diagnosis of craniosynostosis.Key Points• Patent cranial sutures appear hyperintense on “Black Bone” MRI • Prematurely fused cranial sutures are distinct from patent sutures • Minimal soft tissue contrast permits 3D-rendered imaging of the craniofacial skeleton

Angioleiomyoma of the hard palate: report of a case and review of the literature and magnetic resonance imaging findings of this rare entity.

Angioleiomyomas are benign solitary smooth muscle tumors originating in the tunica media of vessels. They are rarely encountered within the oral cavity, and the number of reported cases specifically involving the hard palate remains small. A 39-year-old man presented with a 2-cm painless swelling on the left anterior hard palate. The mass had been present for ≈ 5 years before presentation, during which time it had slowly enlarged. Magnetic resonance imaging (MRI) showed a uniform signal pattern with T1 signal intensity slightly higher than surrounding soft tissues and marked hyperintensity on T2-weighted sequences. Although the MRI characteristics of angioleiomyomas affecting the extremities have previously been reported, this is the first reported case describing the MRI features of an oral-cavity angioleiomyoma. In view of the inability to differentiate angioleiomyoma from other pathologies with similar MRI features, simple local excision for definitive histopathologic diagnosis remains recommended.

The in vivo relationship between cross-sectional area and CT dose index in abdominal multidetector CT with automatic exposure control

The relationship between patient cross-sectional area and both volume CT dose index (CTDI) and dose length product was explored for abdominal CT in vivo, using a 16 multidetector row CT (MDCT) scanner with automatic exposure control. During a year-long retrospective survey of patients with MDCT for symptoms of abdominal sepsis, cross-sectional areas were estimated using customised ellipses at the level of the middle of vertebra L3. The relationship between cross-sectional area and the exposure parameters was explored. Scans were performed using a LightSpeed 16 (GE Healthcare Medical Systems, Milwaukee, WI) operated with tube current modulation. From a survey of 94 patients it was found that the CTDI increased with the increase in patient cross-sectional area. The relationship was logarithmic rather than linear, with a least-squares fit to the data (R(2) = 0.80). For abdominal CT the cross-sectional area gave a measure of patient size based on the region of the body to be exposed. Exposure parameters increased with increasing cross-sectional area and the greater radiation exposure of larger patients was partly a consequence of their size. Given increasing obesity levels we believe that cross-sectional area and scan length should be added to future dose surveys, allowing patient size to be considered as a factor of relevance when examining population doses.

Justifying multidetector CT in abdominal sepsis: time for review?

The further development of multidetector row CT (MDCT) has led to changes in the application and examination technique, leading to a need to justify the level and frequency of radiation exposure associated with MDCT. A literature review of how the use of modern scanners has affected diagnosis was undertaken, followed by a year-long retrospective study of MDCT scans of patients presenting with symptoms of abdominal sepsis. The diagnostic accuracy of detecting causes of abdominal sepsis using this technology was sought. Scans were performed using a LightSpeed 16 system (GE Healthcare Medical Systems, Slough, UK and Milwaukee, WI). Clinical diagnoses were based upon surgical and histopathological findings, treatment outcome and follow-up scans. System dose parameters recorded were the dose-length product (DLP) and volume CT dose index. The literature on investigating suspected abdominal sepsis has not been updated significantly since the time of conventional CT. 94 patients were included in the study; causes of abdominal sepsis could be detected with a sensitivity of 0.95 and a specificity of 0.91. Repeat examination and cumulative exposure was a key finding. Patients with abscesses and acute pancreatitis had the highest number of scanner visits; patients with diverticular disease had the lowest number of visits, lowest cumulative DLP and shortest stay in hospital. Cumulative DLP was affected by scan length, number of scans and patient size. In conclusion, diagnostic accuracy data for MDCT scans using 16 slices confirm that CT remains a suitable modality for imaging abdominal sepsis but scope for dose constraint exists.

Identification of normal cranial sutures in infants on routine magnetic resonance imaging.

Abstract There are increasing concerns relating to the ionizing effects of computed tomography imaging in infants with benign conditions. Magnetic resonance imaging (MRI) is a potential alternative to ionizing radiation when determining patency of the cranial sutures; however, there is no documentation in the literature on the appearance of normal cranial sutures in infants on MRI. This study reviews the appearance of the cranial sutures, their widths, and accuracy of identification in the first year of life on MRI. The coronal, sagittal, and lambdoid sutures were evaluated by 5 assessors on 100 anonymized MRI scans in infants aged 1 to 361 days. The sutures were scored on a 3-point scale. The MRI sequences investigated were axial T1, axial T2, coronal fluid attenuated inversion recovery, axial short tau inversion recovery, and sagittal T1. The suture widths were measured in those cases where they were clearly identifiable, and agreement was obtained in the first aspect of the study (n = 38). A &kgr; score of 0.6 was obtained for interrater agreement. An increasing total score for all sutures with advancing age was found (P < 0.05). The mean suture widths for the coronal, sagittal, and lambdoid sutures were 1.2 (SD, 0.4), 1.4 (SD, 0.4), and 1.3 (SD, 0.3) mm, respectively. There was no significant difference in suture width with age. The appearance of cranial sutures on MRI is as an area of signal void, which may be difficult to clearly define, thus making it unreliable as a standard investigation in the diagnosis of craniosynostosis.

Evaluating lingual carcinoma for surgical management: what does volumetric measurement with MRI offer?

MRI plays a crucial but under utilized role in the surgical management of lingual squamous cell carcinoma (SCC). Measurement of three-dimensional tumour volume (TV) has the potential to guide management of clinically negative cervical lymph nodes and address deficiencies in current TNM staging criteria This work studied the value of MRI-measured TV as a predictor of 2 year disease-related survival (DRS) and disease-free survival (DFS), as well as occult cervical lymph node metastasis (OM) in lingual cancer. TV was determined by manually segmenting the tumour contour in each image slice and using the resulting pixel value to calculate the three-dimensional extent of disease. TV was also compared with the more established measure of tumour thickness (TT) Significant differences in DRS (χ²(1) = 7.7, Hazard ratio (HR) = 7.3, p = 0.005) and DFS (χ²(1) = 5.6, HR = 4.3, p = 0.02) at two years were found using a cut-off of 8 cm³. Similarly, a significant relationship between TV and occult cervical lymph node metastasis was discovered using a 3 cm³ cut-off (OR = 6.7, p = 0.02, Fishers Exact Test).

Automatic upstaging of tongue squamous cell carcinoma with lateral extrinsic muscle involvement is not justified

The TNM classification for oral malignancies has been criticized for its upstaging to T4a when tumour involves styloglossus, hyoglossus, palatoglossus and genioglossus. The aims of this study were to (1) create an anatomical computer atlas of extrinsic tongue musculature, and (2) reassess the original staging of pre-treatment archived magnetic resonance images (MRI) of tongue carcinomas using the strict extrinsic muscle criteria. The anatomy of the extrinsic tongue muscles was mapped using images from the Visible Human Project (VHP) to create a computer model of the extrinsic tongue muscles. This was co-registered with 87 archived pre-staging MRI scans of tongue carcinomas to assess tumour ingress of the extrinsic tongue muscles. Of the 87 image sets reviewed, 16 were of superficial tumours not visible on MRI. In the remaining 71 cases that showed positive extrinsic muscle tumour ingress, 52% were upstaged from T1/2/3 tumours to cT4a based upon this finding. Extrinsic lateral and genioglossus muscle invasion did not predict occult cervical lymph node invasion or disease-related survival. In conclusion, tumour invasion of styloglossus or hyoglossus would result in the majority of lateral tongue tumours being staged T4a. Such stratification is of little clinical relevance, and an alternative more reliable method is required.

Polycystic Parotid Disease in a Male Child: Report of a Case and Review of the Literature

Non-neoplastic cysts account for approximately 6% of all lesions causing salivary gland enlargement. Polycystic parotid disease (PPD) is a rare cause of parotid gland swelling, with only 10 investigating groups identified within the literature accounting for 13 reported cases. The clinical features of PPD were first reported by Mihalyka in 1962, but it was not until 981 that Seifert and Donath provided histologic confirmation and the condition termed bilateral dysgenetic polycystic parotid glands. We present the second reported male case of PPD presenting to the Department of Oral and Maxillofacial Surgery, Oxford Radcliffe Hospitals NHS Trust (Oxford, UK).