Efficacy of inhaled corticosteroids for patients with asthma: a descriptive review of randomized controlled trials

Objective: To evaluate the efficacy of inhaled corticosteroids (ICS) in patients with asthma based on changes in sputum eosinophil counts, through a review of relevant randomized controlled trials (RCTs). Methods: Studies were retrieved from MEDLINE, EMBASE, the SYSTEM FOR INFORMATION ON GREY LITERATURE, and the INSTITUTE FOR SCIENTIFIC INFORMATION from February 1, 2003 to February 1, 2013 based on a comprehensive search strategy. Articles were screened through two stages: title and abstract; and full-text screening. RCTs enrolling patients with asthma, testing an ICS intervention, and reporting outcomes on changes in sputum eosinophil counts pre- and post-intervention were included. Following screening, data extraction, and quality appraisal, a descriptive synthesis of trials was conducted. Results: The search strategy retrieved 447 articles, of which 66 articles underwent full-text screening, resulting in 37 RCTs that met the inclusion criteria for this review. The articles were stratified according to the type of ICS: budesonide, fluticasone propionate, ciclesonide, beclomethasone dipropionate, and mometasone.  Across trials, 9 of 16 budesonide, 5 of 14 fluticasone propionate, 4 of 9 of nine ciclesonide, 2 of 4 beclomethasone dipropionate, and 1 of 2 mometasone interventions demonstrated a statistically significant (p < 0.05) reduction in sputum eosinophil counts. Conclusion: This study detected differences between ICS treatments however the clinical relevance is uncertain. There is insufficient evidence to suggest the superiority of one ICS treatment over another. Further research needs to be conducted to evaluate the relative impact of ICS products upon eosinophil counts, as well as in clarifying what quantitative level of change in baseline eosinophil counts is required to observe a change in symptom improvement and disease control

Cross-Sectional Imaging of Nontraumatic Peritoneal and Mesenteric Emergencies

Multiple nontraumatic peritoneal and mesenteric emergencies are encountered at imaging of patients in the emergency department. Peritoneal and mesenteric emergencies are usually detected in patients in the emergency department during evaluation of nonspecific abdominal pain. A high index of suspicion is required for the establishment of early diagnosis and aversion of life-threatening complications in cases of peritoneal carcinomatosis, nontraumatic hemoperitoneum, and peritonitis. A correct diagnosis of omental infarction, mesenteric adenitis, and mesenteric panniculitis helps patients primarily by avoiding unnecessary surgery. In this review article, we illustrate the cross-sectional imaging appearance of various nontraumatic peritoneal and mesenteric emergencies by emphasizing the role of the emergency radiologist in detecting and managing these entities

Evaluation of adipose tissue volume quantification with IDEAL fat-water separation

Purpose: To validate iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) for adipose tissue volume quantification. IDEAL allows MRI images to be produced only from adipose-containing tissues; hence, quantifying adipose tissue should be simpler and more accurate than with current methods. Materials and Methods: Ten healthy controls were imaged with 1.5 Tesla (T) Spin Echo (SE), 3.0T T1-weighted spoiled gradient echo (SPGR), and 3.0T IDEAL-SPGR. Images were acquired from the abdomen, pelvis, mid-thigh, and mid-calf. Mean subcutaneous and visceral adipose tissue volumes were compared between the three acquisitions for each subject. Results: There were no significant differences (P \u3e 0.05) between the three acquisitions for subcutaneous adipose tissue volumes. However, there was a significant difference (P = 0.0002) for visceral adipose tissue volumes in the abdomen. Post hoc analysis showed significantly lower visceral adipose tissue volumes measured by IDEAL versus 1.5T (P \u3c 0.0001) and 3.0T SPGR (P \u3c 0.002). The lower volumes given by IDEAL are due to its ability to differentiate true visceral adipose tissue from other bright structures like blood vessels and bowel content that are mistaken for adipose tissue in non-fat suppressed images. Conclusion: IDEAL measurements of adipose tissue are equivalent to established 1.5T measurement techniques for subcutaneous depots and have improved accuracy for visceral depots, which are more metabolically relevant. © 2011 Wiley-Liss, Inc

Validation of volumetric and single-slice MRI adipose analysis using a novel fully automated segmentation method.

PURPOSE: To validate a fully automated adipose segmentation method with magnetic resonance imaging (MRI) fat fraction abdominal imaging. We hypothesized that this method is suitable for segmentation of subcutaneous adipose tissue (SAT) and intra-abdominal adipose tissue (IAAT) in a wide population range, easy to use, works with a variety of hardware setups, and is highly repeatable. MATERIALS AND METHODS: Analysis was performed comparing precision and analysis time of manual and automated segmentation of single-slice imaging, and volumetric imaging (78-88 slices). Volumetric and single-slice data were acquired in a variety of cohorts (body mass index [BMI] 15.6-41.76) including healthy adult volunteers, adolescent volunteers, and subjects with nonalcoholic fatty liver disease and lipodystrophies. A subset of healthy volunteers was analyzed for repeatability in the measurements. RESULTS: The fully automated segmentation was found to have excellent agreement with manual segmentation with no substantial bias across all study cohorts. Repeatability tests showed a mean coefficient of variation of 1.2 ± 0.6% for SAT, and 2.7 ± 2.2% for IAAT. Analysis with automated segmentation was rapid, requiring 2 seconds per slice compared with 8 minutes per slice with manual segmentation. CONCLUSION: We demonstrate the ability to accurately and rapidly segment regional adipose tissue using fat fraction maps across a wide population range, with varying hardware setups and acquisition methods. J. Magn. Reson. Imaging 2015;41:233-241. © 2014 Wiley Periodicals, Inc

Added value of diffusion-weighted images and dynamic contrast enhancement in multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer in the PICTURE trial

Objective To determine the additional diagnostic value of diffusion‐weighted imaging (DWI) and dynamic contrast‐enhanced (DCE) imaging in men requiring a repeat biopsy within the PICTURE study. Patients and Methods PICTURE was a paired‐cohort confirmatory study in which 249 men who required further risk stratification following a previous non‐MRI guided TRUS biopsy underwent a 3‐Tesla mpMRI consisting of T2W, DWI and DCE followed by transperineal template prostate mapping (TPM) biopsy. Each mpMRI was reported using a LIKERT score in a sequential blinded manner to generate scores for T2W, T2W+DWI and T2W+DWI+DCE. Area under the receiver operating characteristic (AUROC) fanalysis was performed to compare the diagnostic accuracy of each combination. The threshold for a positive mpMRI was set as a LIKERT score >/=3. Clinically significant prostate cancer was analysed across a range of definitions including UCL/Ahmed Definition 1 (primary definition), UCL/Ahmed Definition 2, any Gleason >/=3+4 and any Gleason >/=4+3. Results Of 249, sequential MRI reporting was available for 246. There was a higher rate of equivocal lesions (44.6%) using T2W alone compared to the addition of DWI (23.9%) and DCE (19.8%). Using the primary definition of clinically significant disease, there was no significant difference in the overall accuracy between T2W at AUROC 0.74 (95% CI 0.68‐0.80), T2W+DWI at 0.76 (95% CI 0.71‐0.82) and T2W+DWI+DCE at 0.77 (95% CI 0.71‐0.82) (p=0.55). The AUROCs remained comparable using other definitions of clinically significant disease including UCL/Ahmed 2 (p=0.79), Gleason >/=3+4 (p=0.53) and Gleason >/=4+3 (p=0.53). Conclusions Using a 3T MRI, a high level of diagnostic accuracy can be achieved using T2W as a single parameter in men with a prior biopsy. However, such a strategy can lead to a higher rate of equivocal lesions