Tsyh-Jyi Hsieh

Altered gray matter density and disrupted functional connectivity of the amygdala in adults with Internet gaming disorder.

OBJECTIVES The aim of this study was to evaluate the altered brain structure and functional connectivity (FC) among subjects with Internet gaming disorder (IGD). METHODS We recruited 30 males with IGD and 30 controls and evaluated their gray matter density (GMD) and FC using resting fMRI. The severities of IGD, gaming urge, and impulsivity were also assessed. RESULTS The results demonstrated that the subjects with IGD had a higher impulsivity and a greater severity of IGD. The subjects with IGD had a lower GMD over the bilateral amygdala than the controls. Further, the subjects with IGD had lower FC with the left amygdala over the left dorsolateral prefrontal lobe (DLPFC) and with the right amygdala over the left DLPFC and orbital frontal lobe (OFL). They also had higher FC with the bilateral amygdala over the contralateral insula than the controls. The FC between the left amygdala and DLPFC was negatively correlated with impulsivity. The FC of the right amygdala to the left DLPFC and orbital frontal lobe was also negatively correlated with impulsivity. Our results indicated that the altered GMD over the amygdala might represent vulnerability to IGD, such as impulsivity. Further analysis of the amygdala demonstrated impaired FC to the frontal lobe, which represents impulsivity. CONCLUSION The results of this study suggested that the amygdala plays a very influential role in the mechanism of IGD. Its detailed role should be further evaluated in future study and should be considered in the treatment of IGD.

End-Stage Renal Disease: In Vivo Diffusion-Tensor Imaging of Silent White Matter Damage

PURPOSE To characterize and compare regional differences in anisotropy in patients with end-stage renal disease (ESRD) and in control subjects to understand the effect of ESRD and hemodialysis on the microstructures of white matter. MATERIALS AND METHODS This study was approved by an institutional review board; written informed consent was obtained. From March 2007 to December 2007, 34 patients (16 men, 18 women; mean age, 40.0 years; range, 26-50 years) with ESRD who were undergoing dialysis and 35 control subjects (16 men, 19 women; mean age, 38.3 years; range, 25-49 years) were enrolled. There was no significant sex or age difference between the ESRD and control groups. By using a 1.5-T imager, fractional anisotropy (FA) data obtained at diffusion-tensor magnetic resonance (MR) imaging (echo-planar imaging, 33 directions; b value, 1000 sec/mm(2)) and at T2-weighted fluid-attenuated inversion recovery (FLAIR) MR imaging of the bilateral parietal, frontal, occipital, and temporal lobe white matter, as well as the genu and splenium of the corpus callosum, were compared. The Cognitive Abilities Screening Instrument (CASI) was administered to all participants at imaging. RESULTS The ESRD group had significantly lower FA values in all regions than the control group. FA values were generally lower in older patients and in those who had been undergoing dialysis for a longer duration. Duration of dialysis was more often than age found to be correlated with differences in FA values. In areas in which there was a significant correlation between age, duration, and FA values, the regression coefficients were greater for those who had been undergoing dialysis longer than for those who were older. Patients with ESRD had significantly lower CASI scores than control subjects (P = .03). There were no significant group differences in FLAIR values (P = .25-.89). CONCLUSION Changes in FA values may be used to follow-up white matter changes in patients with ESRD who are undergoing maintenance dialysis. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/2523080484/DC1.

Muscle metabolism in Duchenne muscular dystrophy assessed by in vivo proton magnetic resonance spectroscopy.

To investigate the correlation between muscle function and metabolism in muscle tissue of Duchenne muscular dystrophy (DMD) patients by in vivo proton magnetic resonance spectroscopy. Materials and Methods: In this prospective study, we enrolled 8 boys with DMD and 8 healthy volunteers. In vivo proton magnetic resonance spectroscopy of the soleus muscles was performed using a whole-body 3.0-Tesla imaging unit and a knee coil. The levels of trimethyl ammonium (TMA) and total creatine (tCr) were measured. We compared TMA/water, tCr/water, and TMA/tCr ratios, and scores for muscle function in the legs by using a t test. Results: Fat infiltrated the leg muscles in all patients but no volunteers. All patients had elevated creatine kinase levels. Magnetic resonance spectra of patients and volunteers showed TMA and tCr peaks. Ratios of TMA/water (P = 0.0015), tCr/water (P = 0.0167), and TMA/tCr (P = 0.0017), and muscle function scores (P = 0.0028) were significantly lower in patients than in volunteers. All patients had impaired muscle function, whereas all volunteers had normal function. Muscle function in the legs was negatively correlated with the TMA/tCr ratio (r2 = 0.878). Conclusions: Metabolite ratios and muscle function scores were significantly decreased in patients with DMD when compared with normal control subjects. A statistically significant decrease in TMA/tCr ratio in patients with DMD as compared with control subjects was found to correlate with decreased muscle function.

Proton magnetic resonance spectroscopy of late-life major depressive disorder

The primary goal of this study was to examine the biochemical abnormalities of late-life major depression by using 3-tesla (3-T) proton magnetic resonance spectroscopy ((1)H-MRS). The antidepressant effects on the biochemical abnormalities were investigated as well. Study participants were 27 elderly patients with major depressive disorders (among which 9 were on antidepressant medication) and 19 comparison elderly subjects. (1)H-MRS spectra were acquired from voxels that were placed in the left frontal white matter, left periventricular white matter, and left basal ganglia. Ratios of N-acetylaspartate (NAA), choline (Cho) and myo-inositol to creatine were calculated. Patients with late-life major depressive disorder had a significantly lower NAA/creatine ratio in the left frontal white matter, and higher Cho/creatine and myo-inositol/creatine ratios in the left basal ganglia when compared with the control subjects. The myo-inositol correlated with global cognitive function among the patients. The biochemical abnormalities in late-life major depressive disorder were found on the left side of the frontal white matter and the basal ganglia. Neuron degeneration in the frontal white matter and second messenger system dysfunction or glial dysfunction in the basal ganglia are suggested to be associated with late-life depression.

Differentiation between Malignant and Benign Gastric Ulcers: CT Virtual Gastroscopy versus Optical Gastroendoscopy

PURPOSE To retrospectively compare computed tomographic virtual gastroscopy (VG) and conventional optical gastroendoscopy for the differentiation of malignant and benign gastric ulcers. MATERIALS AND METHODS The institutional review board approved this study and confirmed that informed consent was not required. Gastric ulcers in 115 patients (mean age, 64.7 years; range, 31-86 years; 61 men, 54 women) were evaluated by using endoscopy and VG. Ulcer shape, base, and margin and periulcer folds were evaluated by two independent reviewers. Malignant gastric ulcers were identified by irregular, angulated, or geographic shape; uneven base; irregular or asymmetric edges; and disrupted or moth-eaten appearance of periulcer folds near the crater edge and/or clubbed or fused folds. Benign gastric ulcers were identified by smooth and regular shapes, even bases, clearly demarcated and regular edges, and folds that tapered and converged toward the ulcer. The performance of VG and endoscopy for the diagnosis of benign and malignant gastric ulcers was evaluated by using histopathologic results as the reference standard. The McNemar test was used to compare VG and endoscopic data. A P value less than .05 was considered to indicate a significant difference. RESULTS At histopathologic examination, 39 gastric ulcers were benign, while 76 were malignant. VG and endoscopy had sensitivities of 92.1% (70 of 76) and 88.2% (67 of 76), respectively, for overall diagnosis of malignant gastric ulcers, and specificities of 91.9% (34 of 37) and 89.5% (34 of 38), respectively, for overall diagnosis of malignant gastric ulcers. Endoscopy was more sensitive in depicting malignancy according to ulcer base (85.5% [65 of 76] vs 68.4% [52 of 76]) (P = .034), and VG was more specific in depicting malignancy according to ulcer margin (78.4% [29 of 37] vs 63.2% [24 of 38]) (P = .034). CONCLUSION VG and endoscopy were almost equally useful in distinguishing between malignant and benign gastric ulcers. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/2522081249/DC1.

Duodenal Metastasis of Malignant Pleural Mesothelioma

Metastatic malignant mesothelioma of the pleura is uncommon at the time of initial diagnosis. The gastrointestinal lumen is rarely found at autopsy in patients with widespread disease. Here, we describe an extremely rare case of isolated duodenal metastasis of sarcomatoid mesothelioma of the pleura in a 73-year-old man, without memory of any direct exposure to asbestos. The possibility of gastrointestinal tract metastasis should be considered in the presence of anemia or positive occult blood test in patients with malignant pleural mesothelioma.

Follow-up for covered stent treatment of carotid blow-out syndrome in patients with head and neck cancer

OBJECTIVE Carotid blow-out syndrome (CBS) is a life-threatening complication of head and neck cancer (HNC). One of the various methods used for emergency management of CBS is covered stent placement (CSP). Our initial experience in CSP is evaluated and compared with reports in the literature. METHODS This study analysed 17 patients with HNC who had received CSP for CBS at Kaohsiung Medical University Chung-Ho Memorial Hospital from May 2005 to December 2013. The medical records and images for these patients were retrospectively reviewed to evaluate the causes of CBS, treatment success rates and complications. RESULTS The initial angiography success rate was 100%. Procedural or periprocedural complications were noted in two (12%) cases, both suffering from cerebral vascular accident (CVA). Short-term complications were noted in eight (47%) cases, including four rebleeding cases and four CVA cases. Medium- to long-term complications were noted in nine cases, which included two asymptomatic in-stent thrombosis cases, one symptomatic CVA case, two abscess formation cases and four rebleeding cases. Overall, eight (47%) cases of rebleeding occurred during follow-up. Three of the eight cases were fatal, accounting for 27% of the all-cause mortality. CONCLUSION Although CSP is considered effective for achieving haemostasis in patients with HNC with CBS, the medium- to long-term outcomes are unfavourable owing to high risks of rebleeding, CVA and other complications. Therefore, CSP should be considered a temporary life-saving technique rather than a definitive treatment. ADVANCES IN KNOWLEDGE Analysis of the relatively large series of patients with HNC in this study suggests that CSP is a useful temporary treatment for CBS.

Ileoileal intussusception due to ileal ectopic pancreas with abundant fat tissue mimicking lipoma.

A 26-year-old woman presented with symptoms of bowel obstruction. An emergent computed tomography (CT) scan was performed which showed ileoileal intussusceptions due to a fatty nodule. Exploratory laparotomy and removal of the involved small bowel was performed. The pathology showed the leading point of the intussusception to be ectopic pancreas with abundant fatty infiltration.

Intramuscular low-grade fibromyxoid sarcoma: a case report.

Low‐grade fibromyxoid sarcoma (LGFMS) is a rare neoplasm that commonly arises in the deep soft tissues of the lower extremities, particularly in the thigh. LGFMS occurs preferentially in young male adults. The microscopic appearance of LGFMS exhibits bland fibroblastic spindle cells with a whorled or linear arrangement in fibrous and myxoid areas. Although LGFMS has a deceptively benign histologic appearance, local recurrence and late metastases have frequently been reported. Diagnosis of LGFMS is still difficult because of its characteristic bland‐looking histologic features that can be confused with other benign or low‐grade fibromyxoid lesions. Although immunohistochemical staining can offer an overview of the differential diagnosis of myxoid tumors of soft tissue, it is sometimes limited for diagnosis of LGFMS. However, recent cytogenetic and molecular analyses have provided significant improvements in the diagnosis of LGFMS. Such analyses have demonstrated that most cases of LGFMS have a characteristic t (7,16) (q33;p11) translocation, resulting in the FUS‐CREB3L2 fusion gene. We report a 29‐year‐old female who presented with a LGFMS located in the soleus muscle of her left lower leg. Preoperative imaging suggested the possibility of an intramuscular histiocytoma of the left soleus muscle. In conclusion, diagnosis of LGFMS can be challenging in routine practice in surgical pathology because of its bland‐looking features. The immunohistochemical and ultrastructural findings were consistent with the fibroblastic properties of LGFMS. Cytogenetic and/or molecular genetic analyses can be used as ancillary diagnostic tools for LGFMS.

A proton magnetic resonance spectroscopy study of the chronic lead effect on the Basal ganglion and frontal and occipital lobes in middle-age adults.

Background Lead is known to be a health hazard to the human brain and nervous system based on data from epidemiologic studies. However, few studies have examined the mechanism or biochemical changes caused by lead in the human brain, although recently some have used magnetic resonance spectroscopy (MRS) to test brain metabolism in vivo. Objectives In this study, we used 3-T MRS to investigate brain metabolism in workers chronically exposed to lead and matched nonexposed controls. Materials Methods: Twenty-two workers at a lead paint factory served as chronically exposed subjects of this study. These workers did not have any clinical syndromes. Eighteen age- and sex-matched nonexposed healthy volunteers served as controls. We measured blood and bone lead and used a 3-T MRS to measure their levels of brain N-acetyl aspartate (NAA), choline (Cho), and total creatine (tCr). A structural questionnaire was used to collect demographic, work, and health histories and information about their life habits. Results All the MRS measures were lower in the lead-exposed group. Increased blood and bone lead levels correlated with declines in Cho:tCr ratios, especially in the occipital lobe, where changes in all gray, subcortical, and white matter were significant. Increases in blood and patella lead in every layer of the frontal lobe correlated with significant decreases in NAA:tCr ratios. One of the strongest regression coefficients was −0.023 (SE = 0.005, p < 0.001), which was found in the NAA:tCr ratio of frontal gray matter. Discussion We conclude that chronic exposure to lead might upset brain metabolism, especially NAA:tCr and Cho:tCr ratios. Brain NAA and Cho are negatively correlated to blood and bone lead levels, suggesting that lead induces neuronal and axonal damage or loss. The most significant changes occurred in frontal and occipital lobes, areas in which previous neurobehavioral studies have shown memory and visual performance to be adversely affected by lead toxicity.