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INTRODUCTION: The discussion on the mechanism(s) underlying mental fatigue is still ongoing. We want to reconfirm a performance-impairing effect of executing a lengthy cognitive task on the subsequent task, and determine how this effect is subtended by neurophysiological variations and subjective experience. METHODS: Twenty participants (12 females; age: 23 ± 1 y) performed an experimental (EXP) and a control trial (CON) in a randomized counter-balanced order. In both trials a 90-min cognitive task had to be performed (EXP, Stroop task; CON, documentary), that was preceded and followed up by a 10-min flanker task that was completed in the MRI scanner. Throughout the protocol, subjective self-evaluation, peripheral autonomic activation and metabolic measures, cognitive performance and functional brain imagery were recorded. Due to equipment issues, only 11 participants could be included in the analysis of the peripheral autonomic activation. RESULTS: Flanker performance dropped both in EXP and CON (p = .010). Heart rate variability increased in time, both in EXP and CON (p ≤ .047). A time-on-task related drop in Stroop performance (p = .007) and higher subjective mental fatigue was observed in EXP compared to CON (p < .001). Moreover, the BOLD signal of response inhibition-associated brain activity in corpus callosum, somatosensory association cortex and anterior cingulate cortex was reduced during the post-flanker task in EXP compared to CON (p < .001). Discussion Our results indicate two different processes: 1) A time-on-task effect as a peripheral physiological deactivation that coincided with the observed post-flanker performance drop both in EXP and CON; and 2) An increase in the level of subjective mental fatigue with prolonged performance on a 90-min Stroop task that is associated with a decrease in response inhibition-associated brain activity in both grey and white matter, specifically in the EXP-condition. CONCLUSION: Our results highlight the multifactoriality of carryover effects, in the present study increased parasympathetic activity was linked with the drop in performance.

PURPOSE: To determine the normal thickness and MRI appearance of the Tibialis Posterior Tendon near the navicular insertion in normal volunteers. MATERIALS AND METHODS: By using a 3T MRI system 41 ankles were imaged, and PD weighted images with fat saturation were acquired in the three orthogonal planes. Symptoms of tendon pathology and history of trauma or surgery of the tendon were used as volunteer exclusion criteria. Two different measurement points were determined to evaluate hyperintensity and thickness. Two radiologists assessed the internal signal of the Tibialis Posterior Tendon independently by using axial and coronal images. Tendon hyperintensity was classified from homogenously dark to different degrees of hyperintense signal, where 0 means no internal hyperintensity, 1 - minimal hyperintensity, 2 - moderate and 3 - marked. Correlations between the two observers were obtained by Cohen's kappa. Descriptive statistics were also obtained. RESULTS: Eight men and 13 women (total 21) volunteers, age range 19-43(average 24.7)years were included in the study. At measurement point-1 on the coronal images, observer-1 and observer-2 evaluated hyperintensity (mostly minimal) respectively in 90.5% and 95.3% of tendons with a Cohen's kappa coefficient of 0.701 (moderate agreement) for the right foot and in 60% and 70% of tendons with a Cohen's kappa coefficient of 0.624 (moderate agreement) for the left foot. On axial images both observers assessed hyperintensity (mostly marked) in 100% of the tendons with a coefficient of 0.763 (moderate agreement) for the right foot, and in 95% of tendons with a coefficient of 0.839 (strong agreement) for the left foot. At measurement point-2 on coronal images, both observers rated any degree of hyperintensity in 33.3% of tendons with a coefficient of 1.00 (perfect agreement) for the right foot, in 38.9% of tendons with a coefficient of 0.766 (moderate agreement) for the left foot. On axial images both observers evaluated hyperintensity (mostly minimal) in 100% of tendons with a kappa coefficient of 0.702 (moderate agreement) for the right foot, in 95% of tendons with a coefficient of 0.790 (moderate- to strong agreement) for the left foot. CONCLUSION: The Tibialis Posterior Tendon, near the navicular insertion (navicular tendon and tarsometatarsal tendon), exhibits an apparent thickening and most importantly hyperintensity which should be regarded as a normal finding, and not lead to an erroneous diagnosis of tendinopathy. This observation was almost always the case for the navicular insertion and less so for the tarsometatarsal tendon.

Graph-theoretical analysis is a novel tool to understand the organisation of the brain.We assessed whether altered graph theoretical parameters, as observed in multiple sclerosis (MS), reflect pathology-induced restructuring of the brain's functioning or result from a reduced signal quality in functional MRI (fMRI). In a cohort of 49 people with MS and a matched group of 25 healthy subjects (HS), we performed a cognitive evaluation and acquired fMRI. From the fMRI measurement, Pearson correlation-based networks were calculated and graph theoretical parameters reflecting global and local brain organisation were obtained. Additionally, we assessed metrics of scanning quality (signal to noise ratio (SNR)) and fMRI signal quality (temporal SNR and contrast to noise ratio (CNR)). In accordance with the literature, we found that the network parameters were altered in MS compared to HS. However, no significant link was found with cognition. Scanning quality (SNR) did not differ between both cohorts. In contrast, measures of fMRI signal quality were significantly different and explained the observed differences in GTA parameters. Our results suggest that differences in network parameters between MS and HS in fMRI do not reflect a functional reorganisation of the brain, but rather occur due to reduced fMRI signal quality.

PURPOSE: To investigate the contrast media iodine dose dependency of radiation-induced DNA double-strand breaks (DSBs) during a coronary computed tomography angiography (CCTA) scan. METHODS: This prospective patient study was approved by the ethical committee. Between November 2018 and July 2019, 50 patients (31 males and 19 females, mean age 64 years) were included in the study, 45 CCTA and five noncontrast-enhanced (NCE) cardiac computed tomography (CT) patients. A single-heartbeat scan protocol with a patient-tailored contrast media injection protocol was used, administering a patient-specific iodine dose. DNA double-strand breaks were quantified using a γH2AX foci assay on peripheral blood lymphocytes. The net amount of γH2AX/cell was normalized to the individual patient CT dose by the size-specific dose estimate (SSDE). Correlation between the administered and blood-iodine dose and the SSDE normalized amount of DNA DSBs was investigated using a Pearson correlation test. RESULTS: CCTA patients were scanned with a mean CTDIvol of 10.6 ± 5.6 mGy, corresponding to a mean SSDE of 11.3 ± 5.3 mGy while the NCE cardiac CT patients were scanned with a mean CTDIvol of 6.00 ± 1.8 mGy, corresponding to a mean SSDE of 6.6 ± 2.7 mGy. The administered iodine dose ranged from 16.5 to 34.0 gI in the CCTA patients, resulting in a blood-iodine dose range from 5.1 to 15.0 gI in the exposed blood volume. A significant linear relationship (r = 0.79, p-value < 0.001) was observed between the blood iodine dose and SSDE normalized radiation-induced DNA DSBs. A similar significant linear relationship (r = 0.62, p-value < 0.001) was observed between the administered iodine dose and SSDE normalized radiation-induced DNA DSBs. CONCLUSIONS: This study shows that contrast media iodine dose increases the level of radiation-induced DNA DSBs in peripheral blood lymphocytes in a linear dose-dependent manner with CCTA. Importantly, the level of DNA DSBs can be reduced by lowering the administered iodine dose.

PURPOSE: To assess normal distribution of fluid in the tendon sheaths of the ankle. METHODS: 21 healthy volunteers were evaluated. Bilateral ankle MRI was performed on a 3T unit with PD-weighted images with fat saturation. The images were interpreted by two radiologists separately, and the short-axis dimension of fluid amount was measured. Bland-Altman plots and correlation plots were used to assess consistency between readers. RESULTS: There were 13 men and 8 women. The mean age was 24.7 years. Fluid in the retromalleolar part of the peroneus longus was seen in three ankles of three volunteers and in the inframalleolar part in three ankles of three volunteers. Fluid in the retromalleolar part of the peroneus brevis was seen in four ankles of three volunteers and in the inframalleolar part in three ankles of two volunteers. Fluid in the retromalleolar part of the tibialis posterior was seen in 37 ankles of 20 volunteers and in the inframalleolar part in 38 ankles of 21 volunteers Fluid in the retromalleolarpart of the flexor digitorum was seen in 14 ankles of eight volunteers and in the inframalleolar part in 11 ankles of eight volunteers Fluid in the retromalleolar part of the flexor hallucis longus was seen in 23 ankles of 16 volunteers and in the inframalleolar part in 17 ankles of 11 volunteers. CONCLUSION: Fluid is common in the retro- and inframalleolar parts of the medial tendons. Fluid is virtually absent in the peroneal tendons and anterior tendon sheaths in normal volunteers.

The objective of the current study was to explore the potential of dynamic computed tomography to detect kinematic changes, induced by sequential sectioning of the lateral collateral ligaments of the ankle, during full motion sequence of the talocrural joint. A custom-made device was used to induce cyclic controlled ankle inversion movement in one fresh frozen cadaver leg. A 256-slice CT scanner was used to investigate four different scenarios. Scenario 1 with all ligaments intact was first investigated followed by sequential section of the anterior talo-fibular ligament (Scenario 2), the calcaneo-fibular ligament (Scenario 3) and posterior talo-fibular ligament (Scenario 4). Off-line image processing based on semi-automatic segmentation and bone rigid registration was performed. Motion parameters such as translation, rotational angles and orientation and position of the axis of rotation were calculated. Differences between scenarios were calculated. Progressive increase of cranio-caudal displacement up to 3.9 mm and flexion up to 10° compared to Scenario 1 were reported. Progressive changes in orientation (up to 20.6°) and position (up to 4.1 mm) of the axis of rotation were also shown. Estimated effective dose of 0.005 mSv (1.9 mGy CTDIvol) was reported. This study demonstrated that kinematic changes due to the absence of ligament integrity can be detected with 4DCT with minimal radiation exposure. Identifying abnormal kinematic patterns could have future application in helping clinicians to choose patients’ optimal treatment. Therefore, further studies with bigger in vitro sample sizes and consequent investigations in vivo are recommended to confirm the current findings.

Purpose: Tendon pathology around the hip is a common entity. The aim of this study was to detect tendon abnormalities around the hip in a population of asymptomatic volunteers. Materials and methods: Fifty volunteers (100 hips) referred for non-musculoskeletal conditions were evaluated with an additional coronal STIR-weighted MRI imaging on a 1.5 MR unit. This group was composed of 27 women and 23 men with a mean age of 52 (19-91 years). The images were interpreted independently by 2 musculoskeletal radiologists. All tendons around the hip were given a score from 0 to 4, with a score 0 corresponding to no abnormality, score 1 to signal alteration around the tendon, score 2 to minimal signal abnormality in the tendon, score 3 partial tear and score 4 complete rupture. The trochanteric bursa was also evaluated and its size was measured. It was also given a score from 0 to 3 (0: no abnormality, 1: slight hypersignal, 2: bursitis < 10 mm, 3: bursitis ≥ 10 mm). Results: High intratendinous signal was commonly found at the joined insertion of biceps femoris and semitendinosus (18% L, 20% R), the semimembranosus (24% L, 20% R), gluteus minimus (6% L, 11% R) and rectus femoris (9% L, 3% R). A small trochanteric bursa was seen in 33% of the volunteers on the left side and 32% on the right side. The interobserver correlation was very good with an intraclass correlation coefficient of 0.79 (CI: 0.74-0.85). Conclusion: Slight signal alterations might be found in the insertions of the rectus femoris, hamstrings and gluteus minimus tendons. A small to moderate trochanteric bursitis might also be seen. This suggests that care should be taken when interpreting MR scans to attribute symptoms to these findings.

Objective To explore the effects of low-frequency repetitive transcranial magnetic stimulation (LF rTMS) on cortico-striatal-cerebellar resting state functional connectivity in Parkinson’s disease (PD), with and without dyskinesias. Methods Because there is increasing evidence of an involvement of the pre-supplementary motor area (pre-SMA) in the pathophysiology of levodopa induced dyskinesias, we targeted the right pre-SMA with LF rTMS in 17 PD patients. We explored the effects of one sham-controlled LF rTMS session on resting state functional connectivity of interconnected brain regions by using functional MRI, and how it is modified by levodopa. The clinical effect on motor function and dyskinesias was documented. Results As expected, one LF rTMS session did not alleviate dyskinesias. However, real, and not sham LF rTMS significantly increased the functional connectivity with the right putamen in patients with dyskinesias. In patients without dyskinesias, the real LF rTMS session significantly decreased functional connectivity in the right putamen and the cerebellum. We found no effects on functional connectivity after levodopa ingestion. Conclusion One session of 1 Hz rTMS has opposing effects on pre-SMA functional connectivity depending on the PD patients' dyskinesia state. Significance Patients dyskinesias state determines the way LF rTMS affects functional connectivity in late stage PD.

Recent EACVI recommendations described the importance of limiting cardiovascular imaging during the COVID-19 pandemic in order to reduce virus transmission, protect healthcare professionals from contamination, and reduce consumption of personal protective equipment. However, an elevated troponin remains a frequent request for cardiac imaging in COVID-19 patients, partly because it signifies cardiac injury due to a variety of causes and partly because it is known to convey a worse prognosis. The present paper aims to provide guidance to clinicians regarding the appropriateness of cardiac imaging in the context of troponin elevation and myocardial injury, how best to decipher the mechanism of myocardial injury, and how to guide patient management.

Aims: Fractional flow reserve (FFR) pullback allows to assess the distribution of pressure loss along the coronary vessels. FFR derived from CT (FFR CT) provides a virtual pullback curve that may also aid in the assessment of the distribution of epicardial coronary resistance in the non-invasive setting. The present study aims to determine the accuracy of the virtual FFR CT pullback curve using a motorized invasive FFR pullback as reference in patients with stable coronary artery disease. Methods and results: FFR values were extracted from coronary vessels at approximately 1 mm to generate pullback curves. Invasive motorized FFR pullbacks were acquired using a dedicated device at a speed of 1 mm/s. A total of 3172 matched FFR CT and FFR values were obtained in 24 vessels. The correlation coefficient between FFR CT and FFR was 0.76 (95%CI 0.75 to 0.78; p < 0.001). The area under the pullback curve was similar between FFR CT and invasive FFR (79.0 ± 16.1 vs. 85.3 ± 16.4, p = 0.097). The mean difference in lesion gradient between FFR CT and FFR was −0.07 (LOA -0.26 to 0.13) whereas in non-obstructive segments was −0.01 (LOA -0.06 to 0.05). Conclusion: The evaluation of epicardial coronary resistance using coronary CT angiography with FFR CT was feasible. FFR CT virtual pullback appears to be accurate for the evaluation of pressure gradients. FFR CT has the potential to identify the pathophysiological pattern of coronary artery disease in the non-invasive setting.

Objective: To study the effect of Low Frequency repetitive Transcranial Magnetic Stimulation (LF rTMS) on brain metabolites in late stage Parkinson's disease (PD) patients (disease duration at least 4 years and Hoehn and Yahr (1969) score at least 2 in OFF). Several neuroimaging data support a role for preSupplementary Motor Area (pre-SMA) involvement in the pathogenesis of Parkinson's disease. Proton magnetic resonance spectroscopy (H-1-MRS) measures in vivo metabolites, but results in PD brain remain conflicting and little is known of the effect of LF rTMS thereupon.Methods: We investigate the neurochemical profile of the right pre-SMA in 17 late stage PD patients (11 male and 6 female, mean age of 71 years) before and after one session of sham controlled 1 Hz rTMS (1000 pulses, 16 minutes), focusing on the tNAA/tCr and tCho/tCr ratios.Results: The tNAA/tCr ratio was unaffected by one session of LF rTMS. We did observe a significant effect of real LF rTMS on the tCho/tCr ratio, inversely correlated with disease duration, and not related to the presence of dyskinesias. As expected, one session of LF rTMS did not affect clinical outcome.Conclusions: LF rTMS at the right pre-SMA in late stage Parkinson's disease patients does not alter tNAA/tCr, but influences tCho/tCr ratio, in particular in patients with shorter disease duration.Significance: Pre-SMA LF rTMS seems to influence membrane turnover, more importantly in patients with shorter disease duration. Larger LF rTMS treatment studies applying multiple sessions are needed. (C) 2019 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

OBJECTIVE: To assess CT features of the sternoclavicular joint (SCJ) and first costochondral junction in asymptomatic patients. MATERIALS AND METHODS: In 66 patients transverse and coronal oblique high-resolution multiple detector CT images of the SCJ and first costochondral junction were obtained. Images were reviewed by consensus of two radiologists. Joint space width was measured at three levels, and osteophytes, geodes, and erosions were evaluated. Variants and degree of ossification were noted. Statistical analysis consisted of Shapiro-Wilk test, Pearson's test, and paired sample t test. RESULTS: There were 34 men and 32 women with a mean age of 60 years (age range, 17-98 years). The width of the joint spaces showed a normal distribution. There was no significant difference between the left and right sides. On coronal images the joint space was wider superiorly and on transverse images posteriorly. There was a trend toward decreasing joint space with age, although it did not reach significance (p > 0.05). Clavicular osteophytes were seen in 16 out of 66 patients (24 %) and sternal osteophytes in 16 out of 66 patients. Clavicular geodes were seen in 10 out of 66 patients (15 %) and sternal geodes in 14 out of 66 patients (14 %). No erosions were seen. Clefts of the first costochondral junction were seen in 31 out of 66 patients (47 %). CONCLUSION: In asymptomatic patients, there is no significant asymmetry of the SCJ. The joint spaces did not significantly decrease with age, although such a trend could be observed. Pronounced joint space narrowing with large geodes and osteophytes was not seen. Clefts of the first costochondral junction are common and not significant.

Aims Coronary computed tomography angiography (CTA) has emerged as a non-invasive diagnostic method for patients with suspected coronary artery disease, but its usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the agreement between separate heart teams on treatment decision-making based on either coronary CTA or conventional angiography. Methods and results Separate heart teams composed of an interventional cardiologist, a cardiac surgeon, and a radiologist were randomized to assess the coronary artery disease with either coronary CTA or conventional angiography in patients with de novo left main or three-vessel coronary artery disease. Each heart team, blinded for the other imaging modality, quantified the anatomical complexity using the SYNTAX score and integrated clinical information using the SYNTAX Score II to provide a treatment recommendations based on mortality prediction at 4 years: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or equipoise between CABG and PCI. The primary endpoint was the agreement between heart teams on the revascularization strategy. The secondary endpoint was the impact of fractional flow reserve derived from coronary CTA (FFRCT) on treatment decision and procedural planning. Overall, 223 patients were included. A treatment recommendation of CABG was made in 28% of the cases with coronary CTA and in 26% with conventional angiography. The agreement concerning treatment decision between coronary CTA and conventional angiography was high (Cohen’s kappa 0.82, 95% confidence interval 0.74–0.91). The heart teams agreed on the coronary segments to be revascularized in 80% of the cases. FFRCT was available for 869/1108 lesions (196/223 patients). Fractional flow reserve derived from coronary CTA changed the treatment decision in 7% of the patients. Conclusion In patients with left main or three-vessel coronary artery disease, a heart team treatment decision-making based on coronary CTA showed high agreement with the decision derived from conventional coronary angiography suggesting the potential feasibility of a treatment decision-making and planning based solely on this non-invasive imaging modality and clinical information. Trial registration number NCT02813473.

The application of repetitive transcranial magnetic stimulation (rTMS) to prevent relapse in alcohol addiction is currently being evaluated. However, how rTMS may influence the related brain processes is far from clear. Here we wanted to investigate whether baseline grey matter volume (GMV) can predict relapse and whether 15 accelerated high-frequency (HF)- rTMS sessions may influence GMV in areas related to relapse. Voxel-based morphometric (VBM) measurements were used to compare baseline GMV of 22 detoxified, hospitalized, alcohol-dependent patients with 22 age and gender matched healthy control subjects. Only patients received 15 accelerated HF-rTMS sessions at the right dorsolateral prefrontal cortex (DLPFC) followed by VBM measurements. Relapse rates were assessed four weeks after the end of the stimulation protocol. At baseline, alcohol-dependent patients overall showed less GMV in diffuse brain areas compared to healthy controls. Relapsers compared to abstainers displayed larger GMV decreases, especially in brain midline structures, insular, hippocampal, and amygdalar areas. Accelerated HF-rTMS treatment had no significant effect on GMV in alcohol-dependent patients, regardless of the relapse state. Although an accelerated HF-rTMS treatment protocol did not influence GMV in alcohol-dependent patients, baseline GMV predicted future relapse.

RATIONALE: Type 1 diabetes (T1D), a chronic autoimmune disease, can result in cognitive dysfunction and is associated with vascular dysfunction. Cocoa flavanols (CFs) can stimulate nitric oxide-dependent vasodilation, resulting in enhanced hemodynamic responses and better cognitive function. OBJECTIVES: To investigate whether acute CF supplementation can improve cognitive function and hemodynamic responses in T1D. METHODS: In this randomized, double-blinded, cross-over pilot study, 11 patients with T1D and their healthy matched controls consumed CF (900 mg CF) and placebo (15 mg CF) 2 h before a flanker test. fMRI was used to measure blood oxygen level-dependent (BOLD) response during the cognitive test. Repeated measure ANOVAs were used to test the effects of CF and T1D on BOLD response and cognitive performance. RESULTS: CF improved reaction time on the flanker test and increased the BOLD response in the supramarginal gyrus parietal lobe and inferior frontal gyrus, compared to placebo, in both groups. Inpatients with T1D, cognitive performance was not deteriorated while the BOLD response was smaller in T1D compared to healthy controls in the subgyral temporal lobe and the cerebellum. CONCLUSIONS: Acute CF intake improved reaction time on the flanker test and increased the BOLD response in the activated brain areas in patients with T1D and their matched controls.

BACKGROUND: Smoking is a common phenomenon and kills over 6 million people every year. Many smokers try to quit smoking by using nicotine replacement therapy (NRT). Most of the time, relapse occurs in less than six months after finishing the program of NRT. We performed a single blinded study in which our aim was to figure out what the effect of the nicotine patch is on craving in the brain of smokers deprived from smoking. METHODS: Five heavy smokers (Fagerström Test for Nicotine Dependence ≥4) underwent a functional magnetic resonance imaging (fMRI) in 4 random conditions: smoking (S); smoking deprivation (SD); SD combined with a NP (SD + NP); SD combined with a placebo patch (SD + PP). Visual stimulation provoked craving in block design by randomly displaying images of smoking related scenes. After image preprocessing, a fixed-effect analysis was performed to compare average group activations. The Questionnaire for Smoking Urges (QSU) was obtained before and after each scan. RESULTS: The fMRI results showed higher activation in areas involved in craving in S compared with SD + NP, SD + PP, and SD. In the SD + NP, limbic circuit and attention area were higher activated compared with SD and SD + PP. The SD + PP and SD showed higher activation in the frontal cortex and limbic system compared with S and SD + NP. Nonsmokers showed higher limbic activation compared with SD.The QSU increased significantly after the fMRI experiment in S (P = .036).The SD had higher QSU scores compared with the S before (P = .002), and also after (P = .022) the fMRI experiment. The NP showed lower scores than the SD before the experiment (P = .046). CONCLUSION: The fMRI experiment revealed lower activity in areas associated with attention when subjects were nicotine deprived (SD + PP and SD). Areas involved with craving showed less activity when nicotine is present (S and SD + NP). The QSU showed a significant difference between SD and when nicotine is present (S and SD + NP).

PURPOSE: To assess the predictive value for local tumor progression (LTP) of geometrical tumor coverage using the contrast-enhanced (ce-)CT images acquired before and within 24 h after radiofrequency (RF) ablation. METHODS: Twenty patients (6 male and 14 female, median age 62 years) with 45 focal hypovascular liver metastases (16 colorectal carcinoma, 3 melanoma and 1 breast carcinoma) underwent RF ablation under CT-guidance and received a ce-PET/CT scan within 24 h post-procedure. Pre- and post-ablation ce-CT-images were aligned using an interactive procedure and used to verify the tumor coverage of the RF ablation. Results were correlated to LTP as recorded during follow-up performed every 2-3 months after the intervention (mean follow-up of 110 weeks) and compared to standard reading performed by three readers of the ce-CT images. RESULTS: Eleven tumors (25%) showed LTP during the follow-up period. One lesion, which did not show LTP, was excluded from analysis due to the poor quality of the alignment. For the remaining, 29 (66%) tumors were completely covered by the ablation zone, 9 (20%) were not, and for 6 (14%) tumors the edges coincided with the edge of the ablation zone. The sensitivity, specificity, PPV and NPV for LTP of having incomplete tumor coverage or no apparent ablative margin versus standard reading of ce-CT were 100, 88, 73 and 100% versus 42, 88, 58 and 82%, respectively. CONCLUSIONS: Verifying the tumor coverage of liver metastases by an ablation zone through alignment of pre- and early post-ablation ce-CT images has a high predictive value for LTP.

PURPOSE: Besides chiasmal hemidecussation, interhemispheric connections are likely important in human binocularity. The corpus callosum (CC) is the major fiber bundle in the mammalian brain which mostly connects homologous cortical areas in the two hemispheres. Visual interhemispheric connections were found abnormal in strabismic cats. No studies have investigated these pathways in humans with infantile strabismus. METHODS: Diffusion tensor imaging was used in four subjects with infantile esotropia (IE) and nine control subjects with normal binocularity, in order to study interhemispheric fibers in the CC connecting the right and left primary visual cortical areas. RESULTS: The number of callosal fibers linking both visual cortical areas between the hemispheres was found to be higher in subjects with IE. Also in IE, the amount of visual callosal fibers found after analysis from the primary visual cortical areas on one side appeared significantly different from the amount starting from the contralateral primary visual areas. The distribution area on one side is wider. CONCLUSION: We show callosal visual fibers to be abnormal in human IE. Subjects with IE showed abnormal numbers of transcallosal fibers connecting the visual cortical areas on both sides which likely results from an abnormal elimination process during development. Pruning of these fibers in IE favors the side of the visual cortex ipsilateral to the dominant eye. This study underlines the likely role of the CC in the development of human binocularity.

OBJECTIVE: To retrospectively compare image quality of a lowered dose CT protocol to a standard CT protocol in children with suspicion of craniosynostosis. METHODS: Forty-eight patients (age 0- 35 months), who presented with a cranial deformity underwent cranial 3D CT to assess sutural patency: between 2009 - 2010, 24 patients were imaged with a standard protocol (CTDIvol 32.18 mGy), from 2011-2012, 24 underwent a low dose protocol (0.94 mGy) combined with iterative reconstruction. Image quality was evaluated by both expert reading and objective analysis. Differences were assessed by independent t-test and Mann-Whitney U test, interreader agreement by Cohen's Kappa test. RESULTS: Effective dose of the low dose protocol was 0.08 mSv, corresponding to a reduction of 97 %. Image quality was similar in both groups in terms of overall diagnostic acceptability, objective noise measurements, subjective cranial bone edge sharpness and presence of artefacts. For objective sharpness of cranial bone-brain interface and subjective perception of noise, the images of the low dose protocol were superior. For all evaluated structures, interreader agreement was moderate to almost perfect. CONCLUSION: In the diagnosis of craniosynostosis in children with cranial deformities, a dedicated sub 0.1 mSv cranial 3DCT protocol can be used without loss in image quality. KEY POINTS: • 3DCT is used for the diagnosis of craniosynostosis. • Imaging protocols should be optimized to minimize radiation exposure to children. • Combining 80 kVp with iterative reconstruction can help to reduce dose. • A sub 0.1 mSv cranial 3DCT protocol can be used without loss of diagnostic quality.

OBJECTIVE: To evaluate the involvement of the iliotibial band (ITB), the anterolateral ligament (ALL), and the anterior arm of the biceps femoris in MRI-diagnosed Segond fracture and to evaluate other associated findings of Segond fracture. MATERIALS AND METHODS: We retrospectively reviewed the MRI of 13 cases of Segond fracture. The studies included proton density-weighted, T2-weighted, and proton density-weighted with fat saturation images in the three planes. We studied 2 cadaveric specimens with emphasis on the ALL. One cadaveric specimen was dissected while the other was sectioned in the sagittal plane. RESULTS: The mean age of the patients was 36 years (range, 17-52). There were 7 men and 6 women. The mean size of the Segond bone fragment was 8?×?10?×?2 mm. The distance from the tibia varied from 2 to 6 mm. Associated findings included anterior cruciate ligament (ACL) tear (n?=?13), medial collateral ligament (MCL) tear (n?=?8), meniscocapsular tear of the posterior horn of the medial meniscus(n?=?5), and posterolateral corner involvement (n?=?4). Bone marrow edema involved the mid-lateral femoral condyle and the posterior tibial plateau on both the medial and the lateral side. Edema at the Segond area was seen, but was limited. Fibular head edema was also seen. The ITB (11 out of 13) and ALL (10 out of 13) inserted on the Segond bone fragment. The anterior arm of the biceps tendon did not insert on the Segond fracture. CONCLUSION: Associated findings of Segond fracture include ACL tear, MCL tear, medial meniscus tear, and posterolateral corner injury. Both the ITB and the ALL may be involved in the Segond avulsion. The anterior arm of the biceps femoris tendon is not involved.

Recently, we published a first anatomical Diffusion Tensor Imaging (DTI) atlas regarding white matter tracts in the canine brain. The purpose of this study was to show the significance of DTI in the revelation of the white matter fibres in the feline brain (i.e. to obtain an anatomical DTI atlas of images) and to descriptively compare these to previously obtained white matter fibre images of the canine brain. DTI MR Images of 4 cats euthanised for reasons other than neurological disorders were obtained with a 3 T system. Combined fractional anisotropic (FA) and directional maps were obtained within the hour after death. An experienced anatomist tracked white matter tracts of clinical relevance using the scanner software. After validation of these tracts, we compared relevant neurological connections between the cat and the dog. Comparison of cerebral structures between different species is easier when the three dimensional anatomy is visualized by using DTI. 3D rendered DTI images clearly show major differences in neurological architecture between cats and dogs e.g. the more important space occupying role of the limbic system, and the less diffuse, less nodular, less pronounced and thinner fibre bundles in the feline brain compared to the canine brain (except for the cerebellum different parts connecting fibres passing through the brainstem which are pronouncedly developed). This article is protected by copyright. All rights reserved.

PURPOSE: The purpose of this study is to assess the amount of fluid in the joints of the ankle and midfoot on MR imaging in asymptomatic volunteers. MATERIALS AND METHODS: Twenty-one healthy asymptomatic volunteers (42 ankles) were evaluated with MRI imaging. There were 13 men and 8 women. The mean age was 24.7 years (19-42 years). MR imaging was performed on a 3T MR system using proton density weighted images with fat saturation (TR 2969, TE 30 ms, NA 2, slice thickness 2.5 mm). Images were obtained in three orthogonal planes. The images were interpreted by two radiologists in two sessions. The maximum size of the joint effusion was measured in one plane. Descriptive statistics and variation between interpretation sessions were calculated. RESULTS: Fluid in the anterior tibiotalar joint had a mean size of 2.0 mm (0.0-5.5 mm), in the posterior tibiotalar joint 3.1 mm (0.0-6.3 mm), in the talonavicular joint 0.7 mm (0.0-2.9 mm), and in the anterolateral recess 2.0 mm (0.0-4.3 mm). Fluid in the posterior aspect of the posterior subtalar joint had a mean size of 2.6 mm (0.0-9.4 mm), in the anterior aspect of the posterior subtalar joint 1.9 mm (0.0-6.6 mm), at the middle subtalar joint 0.1 mm (0.0-1.7 mm), and at the anterior subtalar joint 1.6 mm (0.0-6.0 mm). Fluid in the tibiofibular joint had a mean height of 8.1 mm (0.0-16.4 mm). CONCLUSION: In asymptomatic volunteers, moderate to large amounts of fluid were common in all joint recesses of ankle and midfoot, and most pronounced in the anterior and posterior tibiotalar joint, anterolateral recess, and posterior subtalar joint. This should not be mistaken for evidence of a pathological condition.

BACKGROUND AND AIMS: 18F-fluoro-ethyl-tyrosine (FET) is a radiopharmaceutical used in positron emission tomography (PET)-computed tomography in patients with glioma. We propose an original approach combining a radiotracer-pharmacokinetic exploration performed at the voxel level (three-dimensional pixel) and voxel classification to identify tumor tissue. Our methodology was validated using the standard FET-PET approach and magnetic resonance imaging (MRI) data acquired according to the current clinical practices. METHODS: FET-PET and MRI data were retrospectively analyzed in ten patients presenting with progressive high-grade glioma. For FET-PET exploration, radioactivity acquisition started 15 min after radiotracer injection, and was measured each 5 min during 40 min. The tissue segmentation relies on population pharmacokinetic modeling with dependent individuals (voxels). This model can be approximated by a linear mixed-effects model. The tumor volumes estimated by our approach were compared with those determined with the current clinical techniques, FET-PET standard approach (i.e., a cumulated value of FET signal is computed during a time interval) and MRI sequences (T1 and T2/fluid-attenuated inversion recovery [FLAIR]), used as references. The T1 sequence is useful to identify highly vascular tumor and necrotic tissues, while the T2/FLAIR sequence is useful to isolate infiltration and edema tissue located around the tumor. RESULTS: With our kinetic approach, the volumes of tumor tissue were larger than the tissues identified by the standard FET-PET and MRI T1, while they were smaller than those determined with MRI T2/FLAIR. CONCLUSION: Our results revealed the presence of suspected tumor voxels not identified by the standard PET approach.

In adult patients with cystic fibrosis (CF), the lung clearance index (LCI) derived from the multiple breath washout relates to both acinar and conductive ventilation heterogeneity. The latter component predicts an association between LCI and the number of bronchial segments affected by bronchiectasis. Here, we experimentally demonstrated this association in patients with CF, and also examined an ancillary group of patients with non-CF bronchiectasis. We conclude that lung disease severity in terms of number of bronchial segments results in an associated LCI increase, likely constituting a portion of LCI that cannot be reversed by treatment in patients with CF lung disease.

OBJECTIVES: Intensified repetitive transcranial magnetic stimulation (rTMS) applied to the left dorsolateral prefrontal cortex (DLPFC) may result in fast clinical responses in treatment resistant depression (TRD). In these kinds of patients, subgenual anterior cingulate cortex (sgACC) functional connectivity (FC) seems to be consistently disturbed. So far, no de novo data on the relationship between sgACC FC changes and clinical efficacy of accelerated rTMS were available. METHODS: Twenty unipolar TRD patients, all at least stage III treatment resistant, were recruited in a randomized sham-controlled crossover high-frequency (HF)-rTMS treatment study. Resting-state (rs) functional MRI scans were collected at baseline and at the end of treatment. RESULTS: HF-rTMS responders showed significantly stronger resting-state functional connectivity (rsFC) anti-correlation between the sgACC and parts of the left superior medial prefrontal cortex. After successful treatment an inverted relative strength of the anti-correlations was observed in the perigenual prefrontal cortex (pgPFC). No effects on sgACC rsFC were observed in non-responders. CONCLUSIONS: Strong rsFC anti-correlation between the sgACC and parts of the left prefrontal cortex could be indicative of a beneficial outcome. Accelerated HF-rTMS treatment designs have the potential to acutely adjust deregulated sgACC neuronal networks in TRD patients.

Background: While it is generally accepted that inertial impaction will lead to particle loss as aerosol is being carried into the pulmonary airways, most predictive aerosol deposition models adopt the hypothesis that the inhaled particles that remain airborne will distribute according to the gas flow distribution between airways downstream. Methods: Using a 3D printed cast of human airways, we quantified particle deposition and distribution and visualized their inhaled trajectory in the human lung. The human airway cast was exposed to 6 μm monodisperse, radiolabeled aerosol particles at distinct inhaled flow rates and imaged by scintigraphy in two perpendicular planes. In addition, we also imaged the distribution of aerosol beyond the airways into the five lung lobes. The experimental aerosol deposition patterns could be mimicked by computational fluid dynamic (CFD) simulation in the same 3D airway geometry. Results: It was shown that for particles with a diameter of 6 μm inhaled at flows up to 60 L/min, the aerosol distribution over both lungs and the individual five lung lobes roughly followed the corresponding distributions of gas flow. While aerosol deposition was greater in the main bronchi of the left versus right lung, distribution of deposited and suspended particles toward the right lung exceeded that of the left lung. The CFD simulations also predict that for both 3 and 6 μm particles, aerosol distribution between lung units subtending from airways in generation 5 did not match gas distribution between these units and that this effect was driven by inertial impaction. Conclusions: We showed combined imaging experiments and CFD simulations to systematically study aerosol deposition patterns in human airways down to generation 5, where particle deposition could be spatially linked to the airway geometry. As particles are negotiating an increasing number of airways in subsequent branching generations, CFD predicts marked deviations of aerosol distribution with respect to ventilation distribution, even in the normal human lung.

Purpose: Run-off Computed Tomography Angiography (run-off CTA) of the lower extremities has become the method of choice for the diagnostic imaging of patients suffering from peripheral arterial disease (PAD). However, it remains a challenging radiological examination with a considerable risk of non-diagnostic image quality for the assessment of below-the-knee arteries. In this study, we investigate the diagnostic benefit of adding time-resolved CT scan series to the standard run-off CTA by performing repeated axial acquisitions over the calves of the patient during a second bolus of iodinated contrast injection. Materials and Methods: This prospective study included 20 patients (9 male, 11 female; mean age 66.1 ± 14.9 years) who received a standard run-off CTA and an additional time-resolved CT scan series after a 10 min delay. The time-resolved series consisted of 18 repeated axial acquisitions over the calves directly below the knee with a 2 s interphase delay. For both series, two observers independently assessed the anterior tibial, posterior tibial and peroneal arteries of both legs for following criteria: arterial enhancement, presence and degree of stenosis, the confidence of grading, degree of stenosis and venous overlay. Quantitative assessment of arterial enhancement was performed by measuring the mean CT values (HU) in all arteries. Radiation exposure was quantified by the effective dose. Results: A total of 118 arteries were assessed. The observer study showed that the additional time-resolved series improved both arterial enhancement (64% considered optimal enhanced versus 44%) and diagnostic confidence (59% considered as certain versus 33%) for the assessment of arterial stenosis (all p < 0.05). Venous overlay reduced from 15% to 6%. In all three arteries, the measured contrast enhancement by CT values (HU) was considerably higher (average 48%, p < 0.05) with the time-resolved series. The time-resolved series had an effect on stenosis classification (p = 0.03): a higher number of arteries were graded as having a non-significant stenosis (78.8% versus 71.2%). The interobserver variability in stenosis classification improved from κ = 0.39 to κ = 0.61. The mean effective dose was 5.1 ± 1.3 mSv for the run-off CTA and 0.2 ± 0.07 mSv for the time-resolved series. Per patient, a total volume of 140 mL contrast agent was injected. Conclusion: A dynamic CT scan protocol with repeated axial series can be added to a standard helical run-off CTA sequence for the lower extremities within the same CT examination, and it increases image quality and diagnostic confidence for the assessment of presence and degree of arterial stenosis in below-the-knee arteries.

OBJECTIVE: Since dual energy X-ray absorptiometry (DXA) cannot distinguish between different adipose tissue (AT) deposits, it remains unclear how DXA-derived body composition variables relate to anatomical tissue (sub)compartments. The aim of the present study was to compare and relate regional DXA variables with absolute tissue masses obtained by computer tomography (CT) scanning of the lower limbs in elderly persons. METHODS: Eleven well-preserved white Caucasian adults (seven male and four female cadavers) with a median age of 79.0 years (ranging from 68 to 96 years) were fully scanned with DXA and CT. Separate densities of skin tissue, AT, muscle tissue and bone were obtained by hydrostatic weighing. RESULTS: The leg DXA-variables were significantly related (rho-values between 0.60 and 0.98, P

Concerns are raising about the large variability in reported correlations between gray matter morphology and affective personality traits as 'Harm Avoidance' (HA). A recent review study (Mincic 2015) stipulated that this variability could come from methodological differences between studies. In order to achieve more robust results by standardizing the data processing procedure, as a first step, we repeatedly analyzed data from healthy females while changing the processing settings (voxel-based morphology (VBM) or region-of-interest (ROI) labeling, smoothing filter width, nuisance parameters included in the regression model, brain atlas and multiple comparisons correction method). The heterogeneity in the obtained results clearly illustrate the dependency of the study outcome to the opted analysis settings. Based on our results and the existing literature, we recommended the use of VBM over ROI labeling for whole brain analyses with a small or intermediate smoothing filter (5-8mm) and a model variable selection step included in the processing procedure. Additionally, it is recommended that ROI labeling should only be used in combination with a clear hypothesis and that authors are encouraged to report their results uncorrected for multiple comparisons as supplementary material to aid review studies.

Recently, we published a first anatomical diffusion tensor imaging (DTI) atlas regarding white matter tracts in the canine brain. The purpose of this study was to show the significance of DTI in the revelation of the white matter fibres in the feline brain (i.e., to obtain an anatomical DTI atlas of images) and to descriptively compare these to previously obtained white matter fibre images of the canine brain. DTI MR Images of four cats euthanized for reasons other than neurological disorders were obtained with a 3 T system. Combined fractional anisotropic (FA) and directional maps were obtained within the hour after death. An experienced anatomist tracked white matter tracts of clinical relevance using the scanner software. After validation of these tracts, we compared relevant neurological connections between the cat and the dog. Comparison of cerebral structures between different species is easier when the three dimensional anatomy is visualized by using DTI. 3D rendered DTI images clearly show major differences in neurological architecture between cats and dogs for example, the more important space occupying role of the limbic system, and the less diffuse, less nodular, less pronounced and thinner fibre bundles in the feline brain compared to the canine brain (except for the cerebellum different parts connecting fibres passing through the brainstem which are pronouncedly developed). Anat Rec, 300:1270-1289, 2017. © 2017 Wiley Periodicals, Inc.

In case of a ruptured bladder with urine leakage into the peritoneal cavity 'reversed autodialysis' can occur, in which urea and creatinine diffuse back into the bloodstream via the peritoneum. This causes clinical signs of pseudorenal failure, with raised concentrations of creatinine and urea. The urea/creatinine ratio does not change.A 34-year-old female patient experienced increasing abdominal pain 3 days after laparoscopic myomectomy. Acute renal failure was suspected because of increased serum concentrations of creatinine and urea, but no cause could be found. There was a build-up of fluid in the abdominal cavity, which proved to be urine originating from an iatrogenic rupture of the bladder. Serum levels normalised following repair of the rupture.If serum creatinine levels rise rapidly following abdominal surgery or blunt abdominal trauma the bladder should be examined for possible perforation, particularly if the abdominal dimension increases. A ruptured bladder leading to pseudorenal failure is an indication for rapid surgical intervention.

The Corpus Callosum (CC) is an important structure connecting the two brain hemispheres. As several neurodegenerative diseases are known to alter its shape, it is an interesting structure to assess as biomarker. Yet, currently, the CC-segmentation is often performed manually and is consequently an error prone and time-demanding procedure. In this paper, we present an accurate and automated method for corpus callosum segmentation based on T1-weighted MRI images. After the initial construction of a CC atlas based on healthy controls, a new image is subjected to a mid-sagittal plane (MSP) detection algorithm and a 3D affine registration in order to initialise the CC within the extracted MSP. Next, an active shape model is run to extract the CC. We calculated the reliability of most popular CC features (area, circularity, corpus callosum index and thickness profile) in healthy controls, Alzheimer's Disease patients and Multiple Sclerosis patients. Importantly, we also provide inter-scanner reliability estimates. We obtained an intra-class correlation coefficient (ICC) of over 0.95 for most features and most datasets. The inter-scanner reliability assessed on the MS patients was remarkably well and ranged from 0.77 to 0.97. In summary, we have constructed an algorithm that reliably detects the CC in 3D T1 images in a fully automated way in healthy controls and different neurodegenerative diseases. Although the CC area and the circularity are the most reliable features (ICC > 0.97); the reliability of the thickness profile (ICC > 0.90; excluding the tip) is sufficient to warrant its inclusion in future clinical studies., Highlights • A completely automated segmentation of the Corpus Callosum • Both traditional features and the thickness profile using Laplace's equation are calculated. • Excellent reproducibility and accuracy in healthy controls • Excellent reproducibility and accuracy in Alzheimer's Dementia and Multiple Sclerosis patients • Excellent inter-scanner reliability enabling the pooling of multi-center data

Purpose: To optimize the local control of stereotactic body radiotherapy (SBRT) using the Vero-SBRT system and respiratory motion management in patients with oligometastatic cancer. Materials and methods: Patients with five or less metastases were eligible. In metastases with significant motion, a fiducial was implanted for Vero dynamic tracking. For other metastases an internal target volume (ITV) was defined to encompass the respiratory tumor trajectory. A dose of 50 Gy in 10 fractions was prescribed on the 80% isodose line. Results: We treated 87 metastases in 44 patients, with colorectal cancer as the most common primary origin (65.9%). Metastatic sites were mainly lung (n = 62) and liver (n = 17). Twenty-seven metastases were treated with dynamic tracking, the remaining 60 using the ITV-concept. Three patients (7%) experienced grade >= 3 toxicity. After a median follow-up of 12 months, the overall one-year local control (LC) amounted to 89% (95% CI 77-95%), with corresponding values of 90% and 88% for the metastases irradiated with the ITV-approach and dynamic tracking, respectively. Median progression-free survival reached 6.5 months, one-year overall survival 95%. Conclusions: SBRT with proper respiratory motion management resulted in a high LC and an acceptable toxicity profile in oligometastatic cancer patients. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Objectives: Recently, T1-weighted DCE-MRI was proposed as an alternative to T2*-weighted DSC-MRI for the quantification of perfusion and permeability in brain tumors. The aim of the present feasibility study was to explore the clinical potential of the technique in different tumor types using a case-based review of initial results. Patients and methods: The method for data analysis was adapted from cerebral perfusion CT and applied in this study to a small group of patients with grade IV glioma and other brain tumors. The possible use of the proposed methodology was also explored for characterizing, following-up and planning the therapy of brain tumors. Results: Parametric maps clearly differentiated tumor from the surrounding brain tissue, and also distinguished areas within the tumor presenting with different characteristics, thereby allowing identification of significant target areas for biopsy and/or treatment. Differences in cerebral blood flow (CBF) and lower extraction fractions (E) were observed in various tumors. Progression from a grade II to grade IV glioma over the course of a year was characterized by an increase in CBF and a decrease in E. Conclusion: DCE-MRI-based quantitative perfusion and permeability may be helpful for tumor-grade characterization, biopsy guidance, radiotherapy planning, radiotherapy monitoring and clinical follow-up, thereby improving the non-invasive characterization of brain tumors. (C) 2011 Elsevier Masson SAS. All rights reserved.

Purpose To determine the changes in temperature within the gravid miniature pig uterus during magnetic resonance (MR) imaging at 3 T. Materials and Methods The study received ethics committee approval for animal experimentation. Fiber-optic temperature sensors were inserted into the fetal brain, abdomen, bladder, and amniotic fluid of miniature pigs (second trimester, n = 2; third trimester, n = 2). In the first trimester (n = 2), the sensors were inserted only into the amniotic fluid (three sacs per miniature pig, for a total of six sacs). Imaging was performed with a 3-T MR imager by using different imaging protocols in a random order for animal, each lasting approximately 15 minutes. The first regimen consisted of common sequences used for human fetal MR examination, including normal specific absorption rate (SAR). The second regimen consisted of five low-SAR sequences, for which three gradient-echo sequences were interspersed with two diffusion-weighted imaging series. Finally, a high-SAR regimen maximized the radiofrequency energy deposition (constrained by the 2-W per kilogram of body weight SAR limitations) by using five single-shot turbo spin-echo sequences. Differences in temperature increases between the three regimens and between the three trimesters were evaluated by using one-way analysis of variance. The maximum cumulative temperature increase over 1 hour was also evaluated. Results Low-SAR regimens resulted in the lowest temperature increase (mean ± standard deviation, -0.03°C ± 0.20), normal regimens resulted in an intermediate increase (0.31°C ± 0.21), and high-SAR regimens resulted in the highest increase (0.56°C ± 0.20) (P < .0001). Mean temperature increase in the third trimester was 0.38°C ± 0.27, with no significant differences compared with the first (0.23°C ± 0.27) and second (0.25°C ± 0.32) trimesters (P = .07). The cumulative temperature increase over 1-hour imaging time with high SAR can reach 2.5°C. Conclusion In pregnant miniature pigs, the use of 3-T magnets for diagnostic MR imaging with normal SAR regimens does not lead to temperature increases above 1°C if imaging time is kept below 30 minutes. Longer imaging time, especially with high-SAR regimens, can lead to an increase of 2.5°C. (©) RSNA, 2015 Online supplemental material is available for this article.

Objectives Postmastectomy lymphoedema remains a disabling complication caused by treatment for breast cancer. The increased thickness of the dermal layer and the increased volume of the subcutis represent the most important contributions to the total swelling of the arm. Ultrasound imaging of the subcutaneous layer results in different patterns of reflected ultrasound waves depending on the morphological alternations that occurred due to impaired lymphatic drainage. The aim of this study was to compare these echographic images with those obtained using magnetic resonance imaging to explain the nature of the morphological changes. Design Observational study. Setting Patients were recruited from the Breast Clinic at the University Hospital Brussels. Participants Seven women (mean age 60 years) with unilateral breast cancer who subsequently developed lymphoedema. Main outcome measures The water displacement technique was applied to determine arm volumes, and echographic and magnetic resonance images were used to evaluate changes in tissue structures. Results Volumetric measurements of the arm (mean affected arm 3241ml vs unaffected arm 2538ml) showed a significant increase in total arm volume of 703ml (95% confidence interval 324 to 1084ml). Using echography, the thickness of the dermal and subcutaneous layers showed an average increase of 0.2 to 0.8mm and 3.9 to 7.2mm, respectively. The differences between the affected arm and the unaffected arm for all upper and lower arm measurements (i.e. volumetry, dermal and subcutaneous thickness) were significant, but no significant differences were registered for hand measurements. On echography, the dermis showed uniform changes, with a homogenous hypo-echogenic appearance compared with the contralateral side due to water influx. Different patterns of structural changes could be visualised within the subcutis: (1) uniformly hypo-echogenic due to the diffuse spread of water through the subcutis; (2) hyperechogenic areas surrounded by hypo-echogenic streaks visualised on magnetic resonance imaging as adipose tissue surrounded by fluid embedded in fibrous tissue; and (3) homogenously hyperechogenic due to the overgrowth of adipose tissue with a minimal amount of water. Conclusions Echographic images can help to determine the likelihood that complex physical therapy will reduce lymphoedema, and evaluate treatment results by measuring tissue thickness and evaluating tissue consistency.

Objective The aim of this study was to use ultrasound to examine the dorsal hood in nine patients with a clinical suspicion of dorsal hood injuries. Material and methods Clinical and imaging files from interesting case logbooks of nine patients were reviewed. Ultrasound was performed by one of the three radiologists experienced in musculoskeletal ultrasound. The examinations were also performed in flexion and in flexion with resistance. MR correlation was obtained in six patients. One patient underwent surgery. To obtain anatomical correlation of the normal dorsal hood 2 embalmed hand specimens were dissected. Results The sagittal bands were easily depicted in the transverse plane on ultrasound images and presented as hypoechoic bands on both sides of the extensor communis tendons. Injuries of the sagittal bands were seen on ultrasound as hypoechoic thickening of the sagittal bands at the side of the extensor tendons. The normal shape of the sagittal bands was also no longer recognizable. Subluxations or dislocations of the extensor tendons were also seen. When the injuries were located in the fibrous slips between the extensor indicis and the extensor communis of the second finger, subluxations with an increased distance between these 2 tendons were seen, especially in flexion, or in flexion with resistance. Conclusion Ultrasound is a valuable tool for the assessment of the injuries of the dorsal hood and is an easily available method for the diagnosis of the fine soft tissue components of the dorsal hood region.

Transcranial magnetic stimulation (TMS) is currently used as a non-invasive treatment for depression. In most clinical trials, the left dorsolateral prefrontal cortex (DLPFC) has been selected as the target site for TMS treatment and this region is commonly determined by a "standard procedure", using a fixed position with respect to the motor cortex. In this study, to evaluate the relevance of using individual anatomical data during coil positioning, we used a more individualized localization method, based on three-dimensional magnetic resonance imaging of the head (3D-MRI). We wanted to examine the intra-individual variability of the localization of the stimulation area using a method taking into account individual brain anatomy by 3D-MRI, by comparing this method to the "standard procedure". As expected, even in a gender-controlled sample, our results demonstrate that the difference between the anatomical localization and the standard procedure of a well-defined part of the prefrontal cortex varies within subjects. Therefore, our results confirm the need for a TMS-coil positioning method which incorporates individual anatomical information.

Background The application of accelerated high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) could be a potential treatment option for alcohol-dependent patients and may result in a faster clinical response. In this open-label HF-rTMS feasibility study, we wanted to replicate previous findings of baseline brain activation as a predictor of relapse, and to evaluate how this intervention influences the relapse neurocircuit of “treatment-seeking” alcohol-dependent patients, by means of functional magnetic resonance imaging (fMRI) cue-exposure paradigms. Because relapsing patients have a diminished resilience of the emotion regulation/cognitive control system, before HF-rTMS treatment, we expected lower neuronal activation of especially the ventromedial prefrontal cortex and anterior cingulate cortex (ACC) during the presentation of alcohol-related cues in these patients. The relapse neurocircuit should be modified after accelerated HF-rTMS treatment, only in those patients who did not relapse. Methods After being administered a single sham-controlled HF-rTMS session (20 Hz to 110% motor threshold), 19 alcohol-dependent patients received an accelerated HF-rTMS protocol, consisting of 14 right dorsolateral prefrontal cortical sessions spread over 3 days. Before and after stimulation, during fMRI patients were confronted with a block and an event-related alcoholic cue-exposure paradigm. Relapse was defined as the consumption of any amount of alcohol within 4 weeks after the stimulation. A region of interest analysis was performed to evaluate how HF-rTMS exerts its effect. Results After 4 weeks, 13 of 19 patients had already consumed alcohol. When abstainers were compared to patients who had relapsed, we found higher dorsal ACC (dACC) activation at baseline, but only during the blocked cue-exposure paradigm. The effects of HF-rTMS on dACC blood oxygen level-dependent response were negatively correlated with the baseline dACC activation. Due to susceptibility artifacts located at the ventral cortical aspects in 6 of our participants, reliable data were only obtained for the ACC. Conclusions Our data indicate that higher baseline dACC activation may serve as a protective mechanism regarding relapse. For the first time, it is demonstrated that accelerated HF-rTMS treatment influences dACC activation in a rate-dependent manner: the lower the baseline dACC activation, the more dACC activity was increased after HF-rTMS treatment.

In alcohol-dependent patients craving is a difficult-to-treat phenomenon. It has been suggested that high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) may have beneficial effects. However, exactly how this application exerts its effect on the underlying craving neurocircuit is currently unclear. In an effort to induce alcohol craving and to maximize detection of HF-rTMS effects to cue-induced alcohol craving, patients were exposed to a block and event-related alcohol cue-reactivity paradigm while being scanned with fMRI. Hence, we assessed the effect of right dorsolateral prefrontal cortex (DLPFC) stimulation on cue-induced and general alcohol craving, and the related craving neurocircuit. Twenty-six recently detoxified alcohol-dependent patients were included. First, we evaluated the impact of one sham-controlled stimulation session. Second, we examined the effect of accelerated right DLPFC HF-rTMS treatment: here patients received 15 sessions in an open label accelerated design, spread over 4 consecutive days. General craving significantly decreased after 15 active HF-rTMS sessions. However, cue-induced alcohol craving was not altered. Our brain imaging results did not show that the cue-exposure affected the underlying craving neurocircuit after both one and fifteen active HF-rTMS sessions. Yet, brain activation changes after one and 15 HF-rTMS sessions, respectively, were observed in regions associated with the extended reward system and the default mode network, but only during the presentation of the event-related paradigm. Our findings indicate that accelerated HF-rTMS applied to the right DLPFC does not manifestly affect the craving neurocircuit during an alcohol-related cue-exposure, but instead it may influence the attentional network.

PURPOSE: To investigate a computed tomographic (CT) protocol with iterative reconstruction at conventional radiography dose levels for the assessment of structural lung abnormalities in patients with cystic fibrosis ( CF cystic fibrosis ). MATERIALS AND METHODS: In this institutional review board-approved study, 38 patients with CF cystic fibrosis (age range, 6-58 years; 21 patients 18 years) underwent investigative CT (at minimal exposure settings combined with iterative reconstruction) as a replacement of yearly follow-up posteroanterior chest radiography. Verbal informed consent was obtained from all patients or their parents. CT images were randomized and rated independently by two radiologists with use of the Bhalla scoring system. In addition, mosaic perfusion was evaluated. As reference, the previous available conventional chest CT scan was used. Differences in Bhalla scores were assessed with the χ(2) test and intraclass correlation coefficients ( ICC intraclass correlationcoefficient s). Radiation doses for CT and radiography were assessed for adults (>18 years) and children (

As CT scanners are more routinely used as a guidance tool for various types of interventional radiological procedures, concern has grown for high patient and staff doses. CT fluoroscopy provides the physician immediate feedback and can be a valuable tool to dynamically assist various types of percutaneous interventions. However, the fixed position of the scanning plane in combination with high exposure factors may lead to high cumulative patient skin doses that can reach deterministic threshold limits. The staff is also exposed to a considerable amount of scatter radiation while standing next to the patient during the procedures. Although some studies have been published dealing with this subject, data of patient skin doses determined by direct in vivo dosimetry remains scarce. The purpose of this study is to quantify and to evaluate both patient and staff doses by direct thermoluminescent dosimetry during various clinical CT fluoroscopy guided procedures. Patient doses were quantified by determining the entrance skin dose with direct thermoluminescent dosimetry and by estimating the effective dose (E). Staff doses were quantified by determining the entrance skin dose at the level of the eyes, thyroid, and both the hands with direct thermoluminescent dosimetry. For a group of 82 consecutive patients, the following median values were determined (data per procedure): patient E (19.7 mSv), patient entrance skin dose (374 mSv), staff entrance skin dose at eye level (0.21 mSv), thyroid (0.24 mSv), at the left hand (0.18 mSv), and at the right hand (0.76 mSv). The maximum recorded patient entrance skin dose stayed well below the deterministic threshold level of 2 Gy. Poor correlation between both patient/staff doses and integrated procedure mAs emphasizes the need for in vivo measurements. CT fluoroscopy doses are markedly higher than classic CT-scan doses and are comparable to doses from other interventional radiological procedures. They consequently require adequate radiation protection management. An important potential for dose reduction exists by limiting the fluoroscopic screening time and by reducing the tube current (mA) to a level sufficient to provide adequate image quality.

Traumatic dislocation of the extensor tendon over the metacarpophalangeal (MCP) joint is a rare problem in patients without rheumatoid disorders. The common extensor tendon is stabilized on the metacarpal head by components of the dorsal hood (DH). A tear in the sagittal bands, allows (sub)luxation of the tendon. To ensure appropriate treatment, the identification of the damaged structures is essential. Ultrasound (US) is a valuable method in the evaluation of DH injuries and in the follow-up for evaluation of healing or lack of healing of the lesions. We report three cases with partial rupture of the sagittal band of the DH: two cases in the index finger and one case in the long finger, which caused pain and swelling and was diagnosed with US. The patients were treated conservatively and the pain resolved after 9 months in case 1, 3 months in case 2 and 6 months in case 3. The follow-up at one year revealed painless full range of motion and no residual subluxation during the dynamic ultrasound.

OBJECTIVE: The purpose of this study is to investigate the distal insertions of the semimembranosus tendon with MR imaging, correlated with findings in cadavers. MATERIALS AND METHODS: Four fresh cadaveric specimens were studied with 3-T MR imaging. Sequences included proton density (PD) sequences (TE, 13; TR, 4957; FOV, 170 × 170; matrix, 424 × 413; NA, 2; slice thickness, 2.5 mm) in the axial, coronal, and sagittal planes and 3D fast field echo (FFE) sequences (TR 9.4; TE 6.9; FOV, 159 × 105; matrix, 200 × 211; NA, 2; slice thickness, 0.57 mm). One specimen was dissected and three specimens were sectioned with a bandsaw in the axial, coronal, and sagittal plane. The sections were photographed and correlated with MR images. To standardize the analysis, the semimembranosus muscle and tendon were assessed at seven levels for the axial sections, and at three levels for the coronal and sagittal sections. RESULTS: Anatomic dissection revealed six insertions of the distal semimembranosus tendon:direct arm, anterior arm, posterior oblique ligament extension, oblique popliteal ligament extension, distal tibial expansion (popliteus aponeurosis), and meniscal arm. Axial MR images showed five of six insertions: direct arm, anterior arm, oblique popliteal ligament extension, posterior oblique ligament extension, and distal tibial expansion. Sagittal MR images showed four of six insertions: direct arm, anterior arm, oblique popliteal ligament arm, and distal tibial expansion. Sagittal MR images were ideal for showing the direct arm insertion, but were less optimal than the axial images for showing the other insertions. The anterior arm was seen but volume averaging was present with the gracilis tendon. Coronal MR images optimally revealed the anterior arm, although magic angle artifact was present at its posterior aspect. The common semimembranosus tendon and meniscal arm were also well depicted. The division in anterior arm, direct arm, and oblique popliteal ligament arm was poorly seen on coronal imagesdue to volume averaging. CONCLUSIONS: Although the anatomy of the distal semimembranosus tendon is complex, six different semimembranosus insertions can be identified on routine proton density and FFE sequences at 3 T. Analysis of images at defined levels in the three imaging planes simplifies MR interpretation of the anatomy of the distal semimembranosus tendon.

Background: The left and right amygdalae are key regions distinctly involved in emotion-regulation processes. Individual differences, such as personality features, may affect the implicated neurocircuits. The lateralized amygdala affective processing linked with the temperament dimension Harm Avoidance (HA) remains poorly understood. Resting state functional connectivity imaging (rsFC) may provide more insight into these neuronal processes. Methods: In 56 drug-naive healthy female subjects, we have examined the relationship between the personality dimension HA on lateralized amygdala rsFC. Results: Across all subjects, left and right amygdalae were connected with distinct regions mainly within the ipsilateral hemisphere. Females scoring higher on HA displayed stronger left amygdala rsFC with ventromedial prefrontal cortical (vmPFC) regions involved in affective disturbances. In high HA scorers, we also observed stronger right amygdala rsFC with the dorsomedial prefrontal cortex (dmPFC), which is implicated in negative affect regulation. Conclusions: In healthy females, left and right amygdalae seem implicated in distinct mPFC brain networks related to HA and may represent a vulnerability marker for sensitivity to stress and anxiety (disorders).

Depressive brooding – a passive ruminative focus on one’s problems, negative mood and their consequences – is a thinking style that places individuals at a greater risk to develop future psychopathology. In this study, we investigated whether inter-individual differences in depressive brooding are related to neural differences underlying the inhibition of a dominant response towards negative information in favor of the concurrent (positive) response. To exclude the possibility that information processes would be confounded by sustained negative mood or enhanced stress responses, a sample of thirty never-depressed healthy individuals was selected. The Cued Emotional Control Task (CECT) was used to index the ability to enhance cognitive control when encountering a negative stimulus associated with an incompatible stimulus–response mapping. Individual brooding scores were not related to behavioral performances on the CECT. On the other hand, whole brain analyses demonstrated that trait depressive brooding scores were positively associated with activation in the posterior parts of the dorsal anterior cingulate cortex (pdACC) while successfully inhibiting a response to negative relative to positive information. These findings demonstrate that brooding minds need to recruit more pdACC activation when inhibiting a dominant response towards negative information (in favor of a response towards positive), although they are performing similarly as low brooders at the behavioral level. Future research should investigate whether and how these brooding related neural adjustments in healthy volunteers are related to future psychopathology.

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Although repetitive Transcranial Magnetic Stimulation (rTMS) is frequently used to examine emotional changes in healthy volunteers, it remains largely unknown how rTMS is able to influence emotion.We carried out a sham-controlled single-blind crossover study using fMRI, we examined in 20 right-handed healthy female volunteers whether a single high frequency (HF)-rTMS session applied to the left dorsolateral prefrontal cortex (DLPFC) could influence emotional processing while focussing on blocks of positively and negatively valenced baby faces. A single HF-rTMS session selectively influenced the processing of positively and negatively valenced baby faces. In essence, our results indicate that the effects of one left-sided HF-rTMS sessions results in improved processing of positive emotions and reduced negative emotional processing in never depressed female subjects.

The psychobiological personality model of Cloninger distinguishes four heritable temperament traits (harm avoidance (HA), novelty seeking (NS), reward dependence (RD) and persistence (P)) and three character traits (self-directedness (SD), cooperativeness (CO) and self-transcendence (ST)) which develop during lifetime. Prior research already showed that individual differences in temperament are reflected in structural variances in specific brain areas. In this study, we used voxel-based morphometry (VBM) to correlate the different temperament and character traits with local gray and white matter volumes (GMV and WMV) in young healthy female volunteers. We found correlations between the temperament traits and GMV and WMV in the frontal, temporal and limbic regions involved in controlling and generating the corresponding behavior as proposed in Cloninger's theory: anxious for HA, impulsive for NS, reward-directed for RD and goal-directed for P. The character traits correlated with GMV and WMV in the frontal, temporal and limbic regions involved in the corresponding cognitive tasks: self-reflection for SD, mentalizing and empathizing with others for CO and religious belief for ST. This study shows that individual variations in brain morphology can be related to the temperament and character dimensions, and lends support to the hypothesis of a neurobiological basis of personality traits.

A sign of injury of the sagittal bands is thickening. The normal values for the thickness of the sagittal bands has not been described before. Our purpose was to measure the thickness of the sagittal bands with ultrasound in normal volunteers and compare differences between radial and ulnar band, dominant and non-dominant hand, different fingers, and men and women. MATERIALS AND METHODS: In 21 volunteers (10 men, 11 women), high resolution ultrasound imaging of the fingers was performed by two radiologists. The index, mid finger, ring finger and little finger were analyzed. The mean values were obtained for each finger. Statistical differences were calculated with a two-tailed Student's t test. RESULTS: The thickness of the sagittal bands showed a wide range of variations. Statistically significant differences were not found between the radial and ulnar band, dominant and non-dominant hand, and different fingers. Between men and women a significant difference was found for the ulnarband of index and ring finger of the dominant hand. CONCLUSION: The measurements of the sagittal bands show a wide range of values. Statistically significant differences for the means were only found for the ulnar band of index and ring finger of the dominant hand between men and women.