MRI of the lung (3/3)-current applications and future perspectives

BACKGROUND: MRI of the lung is recommended in a number of clinical indications. Having a non-radiation alternative is particularly attractive in children and young subjects, or pregnant women. METHODS: Provided there is sufficient expertise, magnetic resonance imaging (MRI) may be considered as the preferential modality in specific clinical conditions such as cystic fibrosis and acute pulmonary embolism, since additional functional information on respiratory mechanics and regional lung perfusion is provided. In other cases, such as tumours and pneumonia in children, lung MRI may be considered an alternative or adjunct to other modalities with at least similar diagnostic value. RESULTS: In interstitial lung disease, the clinical utility of MRI remains to be proven, but it could provide additional information that will be beneficial in research, or at some stage in clinical practice. Customised protocols for chest imaging combine fast breath-hold acquisitions from a "buffet" of sequences. Having introduced details of imaging protocols in previous articles, the aim of this manuscript is to discuss the advantages and limitations of lung MRI in current clinical practice. CONCLUSION: New developments and future perspectives such as motion-compensated imaging with self-navigated sequences or fast Fourier decomposition MRI for non-contrast enhanced ventilation- and perfusion-weighted imaging of the lung are discussed. Main Messages • MRI evolves as a third lung imaging modality, combining morphological and functional information. • It may be considered first choice in cystic fibrosis and pulmonary embolism of young and pregnant patients. • In other cases (tumours, pneumonia in children), it is an alternative or adjunct to X-ray and CT. • In interstitial lung disease, it serves for research, but the clinical value remains to be proven. • New users are advised to make themselves familiar with the particular advantages and limitations

Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging

Pediatric chest MRI is challenging. High-resolution scans of the lungs and airways are compromised by long imaging times, low lung proton density and motion. Low signal is a problem of normal lung. Lung abnormalities commonly cause increased signal intenstities. Among the most important factors for a successful MRI is patient cooperation, so the long acquisition times make patient preparation crucial. Children usually have problems with long breath-holds and with the concept of quiet breathing. Young children are even more challenging because of higher cardiac and respiratory rates giving motion blurring. For these reasons, CT has often been preferred over MRI for chest pediatric imaging. Despite its drawbacks, MRI also has advantages over CT, which justifies its further development and clinical use. The most important advantage is the absence of ionizing radiation, which allows frequent scanning for short- and long-term follow-up studie

Evolutionary Sequence Modeling for Discovery of Peptide Hormones

There are currently a large number of “orphan” G-protein-coupled receptors (GPCRs) whose endogenous ligands (peptide hormones) are unknown. Identification of these peptide hormones is a difficult and important problem. We describe a computational framework that models spatial structure along the genomic sequence simultaneously with the temporal evolutionary path structure across species and show how such models can be used to discover new functional molecules, in particular peptide hormones, via cross-genomic sequence comparisons. The computational framework incorporates a priori high-level knowledge of structural and evolutionary constraints into a hierarchical grammar of evolutionary probabilistic models. This computational method was used for identifying novel prohormones and the processed peptide sites by producing sequence alignments across many species at the functional-element level. Experimental results with an initial implementation of the algorithm were used to identify potential prohormones by comparing the human and non-human proteins in the Swiss-Prot database of known annotated proteins. In this proof of concept, we identified 45 out of 54 prohormones with only 44 false positives. The comparison of known and hypothetical human and mouse proteins resulted in the identification of a novel putative prohormone with at least four potential neuropeptides. Finally, in order to validate the computational methodology, we present the basic molecular biological characterization of the novel putative peptide hormone, including its identification and regional localization in the brain. This species comparison, HMM-based computational approach succeeded in identifying a previously undiscovered neuropeptide from whole genome protein sequences. This novel putative peptide hormone is found in discreet brain regions as well as other organs. The success of this approach will have a great impact on our understanding of GPCRs and associated pathways and help to identify new targets for drug development

Global navigation satellite systems performance analysis and augmentation strategies in aviation

In an era of significant air traffic expansion characterized by a rising congestion of the radiofrequency spectrum and a widespread introduction of Unmanned Aircraft Systems (UAS), Global Navigation Satellite Systems (GNSS) are being exposed to a variety of threats including signal interferences, adverse propagation effects and challenging platform-satellite relative dynamics. Thus, there is a need to characterize GNSS signal degradations and assess the effects of interfering sources on the performance of avionics GNSS receivers and augmentation systems used for an increasing number of mission-essential and safety-critical aviation tasks (e.g., experimental flight testing, flight inspection/certification of ground-based radio navigation aids, wide area navigation and precision approach). GNSS signal deteriorations typically occur due to antenna obscuration caused by natural and man-made obstructions present in the environment (e.g., elevated terrain and tall buildings when flying at low altitude) or by the aircraft itself during manoeuvring (e.g., aircraft wings and empennage masking the on-board GNSS antenna), ionospheric scintillation, Doppler shift, multipath, jamming and spurious satellite transmissions. Anyone of these phenomena can result in partial to total loss of tracking and possible tracking errors, depending on the severity of the effect and the receiver characteristics. After designing GNSS performance threats, the various augmentation strategies adopted in the Communication, Navigation, Surveillance/Air Traffic Management and Avionics (CNS + A) context are addressed in detail. GNSS augmentation can take many forms but all strategies share the same fundamental principle of providing supplementary information whose objective is improving the performance and/or trustworthiness of the system. Hence it is of paramount importance to consider the synergies offered by different augmentation strategies including Space Based Augmentation System (SBAS), Ground Based Augmentation System (GBAS), Aircraft Based Augmentation System (ABAS) and Receiver Autonomous Integrity Monitoring (RAIM). Furthermore, by employing multi-GNSS constellations and multi-sensor data fusion techniques, improvements in availability and continuity can be obtained. SBAS is designed to improve GNSS system integrity and accuracy for aircraft navigation and landing, while an alternative approach to GNSS augmentation is to transmit integrity and differential correction messages from ground-based augmentation systems (GBAS). In addition to existing space and ground based augmentation systems, GNSS augmentation may take the form of additional information being provided by other on-board avionics systems, such as in ABAS. As these on-board systems normally operate via separate principles than GNSS, they are not subject to the same sources of error or interference. Using suitable data link and data processing technologies on the ground, a certified ABAS capability could be a core element of a future GNSS Space-Ground-Aircraft Augmentation Network (SGAAN). Although current augmentation systems can provide significant improvement of GNSS navigation performance, a properly designed and flight-certified SGAAN could play a key role in trusted autonomous system and cyber-physical system applications such as UAS Sense-and-Avoid (SAA)

Phaeochromocytoma and functioning paraganglioma in childhood and adolescence: role of iodine 131 metaiodobenzylguanidine

Phaeochromocytomas and functioning paragangliomas are rare tumours in childhood and adolescence. We review our experience of 43 cases (24 men, 19 women) who were first diagnosed at the age of ⩽ 18 years. All patients were evaluated at some point in their illness with iodine 131 metaiodobenzylguanidine ( 131 I-mIBG) scintigraphy. Eight patients (19%) had bilateral adrenal tumours, 12 (28%) had solitary extra-adrenal tumours, and 8 (19%) had multiple tumours. In 10 patients (23%), the tumours were associated with a familial neurocristopathic syndrome. Thirteen of 24 (54%) unifocal tumours which were initially considered to be benign ultimately proved to be multi-focal and/or malignant. The final prevalence of malignancy was 60% − 26 patients, of whom only 15 (57%) had obviously malignant tumours at the time of diagnosis. Primary tumour size ⋝5 cm was more commonly associated with a malignant course in adrenal but not extra-adrenal tumours. No other clinical, biochemical or morphological characteristic was significantly associated with malignancy. Although the high prevalence of malignancy in this series at least partly reflects referral bias, the need for lifelong follow-up of these patients is underscored. 131 I-mIBG scintigraphy was positive in 36 patients (84%), with a somewhat lower false-negative rate (12%) than X-ray computed tomography (20%). Eight patients with malignant tumours received therapeutic doses of 131 I-mIBG, with partial tumour responses in 3. Thus, 131 I-mIBG is an efficacious, non-invasive, localising agent and may be considered as a palliative therapeutic agent when alternatives have failed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46831/1/259_2005_Article_BF02262730.pd