Laboratory Imaging (Czechia)

Abstract Background Exercise has benefits on glycemic control, increasing exercise capacity, and muscle strength in patients with type 2 diabetes mellitus (T2DM). In the progression of T2DM, proprioceptive deficits may develop, which can cause inadequate muscle strength and neuropathy. Preventive strategies are needed for T2DM patients without neuropathy even in the early stage of disease. Proprioceptive exercises has a potential to improve dynamic balance through an increase in peripheral sensitivity, and prevent from neuropathy and reduction in falls associated with sensory deficits. Purpose To compare the effects of proprioceptive exercise training or resistive exercise training on glycemic control, functional capacity, dynamic balance, sensation and muscle strength in patients with good-controlled T2DM. Methods Thirty patients with good-controlled T2DM were randomized into Proprioceptive Training Group (PG) (n=15, mean %glycated hemoglobin (HbA1c)=6.85±0.58, mean age=51.6±8.09/years, 12 F, 3 M) and Resistive Training Group (RG) (n=15, mean %HbA1c= 6.8±1.1, mean age= 50.86±7.51/years, 12 F, 3 M). Fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were analyzed. Functional capacity assessed with six-minute walking test (6MWT) and dynamic balance was evaluated using a dynamic balance system (Prokin PK200 platform). Proprioception sense measured with angle reproduction test in direction of dorsiflexion and plantar flexion and deviation. Cortical sensation was evaluated with two-point discrimination test. Quadriceps and Ankle muscle strength were assessed with a digital hand-held dynamometer (JTech PowerTrack II Commander). All subjects were performed moderate intensity of aerobic exercise 3 times/week for 6 weeks. In addition, patients in PG continued the proprioceptive training for the lower extremities while RG performed moderate intensity lower extremity resistive training 2 times/week. Results Significant but not clinically important decrease in HbA1c and FBG were obtained in the groups. Functional capacity, and lower extremity proprioception, cortical sensation and muscle strength showed in-group improvements in both groups. PG also showed significant intragroup improvements in dynamic balance. The groups were similar in terms of obtained changes in all parameters after training (Table 1 and Table 2). Conclusion The proprioceptive training leads similar benefits with resistance training on functional capacity and lower extremity sensation, and muscle strength in patients with good-controlled T2DM. Besides, proprioceptive training can be considered to improve dynamic balance.

Caseous mitral annulus calcification mimicking a cardiac tumor Henda Nèji a,b,c, Emna Bennour b,d, , Ines Baccouche a,c, Salma Kechaou a,c, Ikram Kammoun b,d, Meriem Affes a,b,cSaoussen Hantous-Zannad a,b,ca: Imaging Department, Abderrahmen Mami Hospital, Ariana – Tunisiab: Faculty of Medicine of Tunis, University Tunis El Manar, Tunisiac: Cardio-thoracic imaging Research Laboratoryd: Cardiology Department

The wrist and ankle are complex and injury-prone anatomical regions that can be overlooked when evaluated with conventional radiography. Delayed treatment of an occult lesion impacts the quality of life of the patient and the resources of the health system. Objective: The objective of the study was to determine the prevalence of occult traumatic injuries to the wrist and ankle using simple radiography in the general population. Materials and methods: A systematic search was carried out in the Medline, CINAHL, Scopus, Cochrane library, Embase, Google Scholar, OpenGray, and Proquest databases. A meta-analysis of proportions was performed to estimate the prevalence of occult bone lesions. Results: In the wrist, the global prevalence of occult traumatic injuries was 36% (95% confidence interval [95% CI]: 24.0-49.0), and in adults, it was 31% (95% CI: 20.0-43.0). In the ankle, the overall prevalence of occult traumatic injuries was 34% (95% CI: 19.0-51.0) and 47% in adults (95% CI: 38.0-56.0). Conclusion: The results of the meta-analysis show a significant global prevalence of occult traumatic injuries for the wrist of 36% and for the ankle of 34%, for which it is important to take into account a systematic approach for the interpretation of radiographic images of the wrist and ankle to mitigate diagnostic errors.

99mTc-labeled RBC-equilibrium radionuclide angiocardiography (ERNA) is done in transfusion-dependent beta-thalassemia major (β-TM) patients routinely for cardiac dysfunction. This prospective study aimed at evaluating the potential of ERNA in demonstrating the bone marrow hyperplasia as an adjunct biomarker for monitoring the adequacy of blood transfusions in transfusion-dependent β-TM patients. One hundred and twenty-six patients of β-TM (study group) and 30 nonthalassemic patients (control) underwent ERNA study with an additional whole-body imaging. We quantitated the normalized bone marrow tracer uptake (due to marrow hyperplasia) and hepatic tracer uptake (indicator of hepatic perfusion) in both the groups on whole-body imaging. Liver and myocardial iron deposition were evaluated with T2* MRI in the thalassemic group. β-TM group showed significantly increased mean normalized marrow count (MN) compared to the control group (P < 0.001) reflecting peripheral marrow hyperplasia (indirect marker for blood transfusion inadequacy). The hematological parameters in the study group showed a negative correlation with MN, without such correlation in the control group. The study group showed greater derangement in hepatic perfusion with significantly less mean normalized hepatic tracer uptake (HN) compared to the control group. Hepatic iron deposition (evaluated with T2* MRI) also showed a negative correlation with hepatic perfusion parameter (HN) assessed by ERNA, though myocardial iron deposition did not show any significant correlation with cardiac systolic/diastolic parameters evaluated by ERNA in the study group. ERNA study with these novel parameters (MN and HN) may have the potential to assess peripheral marrow hyperplasia and derangement in hepatic perfusion in transfusion-dependent β-TM.

The aim of the study was to assess the diagnostic performance of fluciclovine positron emission tomography (PET)/computerized tomography (CT) in post-radical prostatectomy prostate cancer patients with rising prostate-specific antigen (PSA) ≤0.5 ng/mL, and identify the associated predictive factors of positive studies. From 30 June 2017 to 9 August 2019, patients with post-radical prostatectomy prostate cancer who underwent F-18 fluciclovine PET/CT and had PSA level within 2-week interval (PSAPET) ≤0.5 ng/mL were enrolled into this single-institution retrospective study. Data on tumor characteristics, including Gleason scores, extra-prostatic extension, seminal vesicle invasion, surgical margin and nodal metastasis, PSA after radical prostatectomy, previous hormonal therapy, PSA doubling time (PSADT), scanner type, PSAPET and site of recurrence were collected. Comparison of these factors between groups of positive and negative fluciclovine PET/CT was done by using Mann-Whitney U-test and Fisher's exact test. Of 94 eligible patients with post-radical prostatectomy prostate cancer, 10 patients had positive studies (10.6%). Detection rate at PSAPET 0.1, 0.2, 0.3, 0.4 and 0.5 ng/mL were 0% (0/11), 0% (0/15), 20% (6/30), 4% (1/25) and 23.1% (3/13), respectively. Upon multivariate analysis of clinical factors, only a PSADT <3 months (P = 0.023) was shown to have a statistically significant correlation with a positive study. In post-radical prostatectomy prostate cancer patients with rising PSA 0.1-0.5 ng/mL, the sensitivity of F-18 fluciclovine PET/CT for identifying tumor recurrence/metastases is poor with an overall detection rate of 10.6%. Larger prospective studies are required to validate these findings.

Sarcopenia is prevalent in adults pre-liver transplantation (LTx) and post-LTx contributing to adverse outcomes. Little is known regarding the prevalence of sarcopenia in pediatric LTx recipients. This novel study examined sarcopenia prevalence and associations with post-LTx growth and healthcare utilization in pediatric LTx recipients. We prospectively assessed body composition at annual clinical appointments in children (0.5-17 years; n = 58) by Dual-energy-X-ray absorptiometry (absolute/regional/percent fat mass [FM], fat-free mass [FFM], skeletal muscle mass [SMM]). Sarcopenia was defined as SMM z scores ≤2. Additional variables measured included age, gender, PELD, immunosuppressive therapies (dose/type), weight, weight-z, height, height-z, serum aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, albumin, total/conjugated bilirubin, prothrombin time, international normalized ratio, albumin, creatinine clearance, urea and creatinine at LTx assessment, LTx and annual clinic appointments. Healthcare variables studied included rejection (number/type/severity), length of in-patient stay (total, intensive care unit [ICU], emergency, readmission) and ventilator dependency. Sarcopenia occurred in 41% (n = 17) at 7.6 (± 3.1) years; with a mean time post-LTx of 1.1 ± 1.9 (1-8) years. Female children ≤9.8 years had a higher sarcopenia prevalence than children >9.8 years (83.1% vs 17.1%; p = 0.004). Sarcopenia was associated with lower weight velocity standard deviation scores, lower weight-z/height-z scores at 2-10 years post LTx, increased hospitalization (total, ICU, emergency and readmission) and ventilator dependency (p < 0.05), but not to rejection and/or corticosteroid therapy (p > 0.05). This is the first study demonstrating persistent sarcopenia associated with poorer growth and recurrent hospitalization in children post-LTx.

Although retropharyngeal infection (RPI) may present with voice change, drooling, fever, and a toxic appearance, diagnosis based on symptoms alone is unreliable. As incidence is increasing in children and drug-resistant bacterial strains such as methicillin-resistant Staphylococcus aureus are becoming more common, we decided to assess the clinical utility of lateral neck radiography. The aim of this study was to review the experience of a large tertiary care pediatric emergency department (ED) in using lateral soft tissue neck radiographs in the diagnosis of suspected RPI. A retrospective analysis of all lateral soft tissue neck radiograph reports from 2011 to 2015 in conjunction with a review of patients' charts to describe clinical and laboratory findings, disposition, and final diagnosis was performed. Patients aged 31 days to 18 years who presented to the ED with suspicion of RPI were included. Review of 366 radiographic reports revealed that 46 were positive for RPI, 286 were negative, and 34 indeterminate. A final discharge diagnosis of RPI was made in 38 patients. Lateral neck radiographs had a sensitivity of 84.3% and a specificity of 93.7% for diagnosing RPI. In triage, most patients had no fever (264, 72.1%), stridor (356, 97%), drooling (348, 95%), or voice change (342, 93%). Surgical intervention occurred in 15 patients (39.5%) with a final diagnosis of RPI. Lateral neck radiography is useful for diagnosis of RPI in the ED with good sensitivity and specificity. Additional imaging is to be considered at the behest of physician's clinical judgment.

The high ion signals produced by many lipids in mass spectrometry imaging (MSI) make them an ideal molecular class to study compositional changes throughout tissue sections and their relationship with disease. However, the large extent of structural diversity observed in the lipidome means optimal ion signal for different lipid classes is often obtained in opposite polarities. In this work we demonstrate how new high speed MALDI-MSI technologies combined with precise laser position control enables the acquisition of positive and negative ion mode lipid data from the same tissue section much faster than is possible with other MSI instruments. Critically, using this approach we explicitly demonstrate how such dual polarity acquisitions provide more information regarding molecular composition and spatial distributions throughout biological tissues. For example, in applying this approach to the zebra finch songbird brain we reveal the high abundance of DHA containing phospholipids (PC in positive mode and PE, PS in negative ion mode) in the nuclei that control song learning behaviour. To make the most of dual polarity data from single tissues we have also developed a pLSA-based multivariate analysis technique that includes both positive and negative ion data in the classification approach. In doing so the correlation amongst different lipid classes that ionise best in opposite polarities and contribute to certain spatial patterns within the tissue can be directly revealed. To demonstrate we apply this approach to studying the lipidomic changes throughout the tumor microenvironment within xenografts from a lung cancer model.