Prevalence and Clinical Significance of Immunoglobulin A Antibodies against Tissue Transglutaminase in Patients with Diverse Chronic Liver Diseases

The prevalence of celiac disease (CD) and the prevalence and clinical significance of anti-tissue transglutaminase (tTG) antibodies (tTGAbs) in a large series of patients with chronic liver diseases were assessed. We studied 738 patients (462 with chronic viral hepatitis, 117 with autoimmune liver diseases, 113 with alcoholic or nonalcoholic fatty liver disease, and 46 with other liver disorders) and 1,350 healthy controls (HC). Immunoglobulin A (IgA) tTGAbs were measured by enzyme-linked immunosorbent assay and a microsphere-based flow cytometric assay. Positive sera were investigated for IgA antiendomysial antibodies (EmA). IgA tTGAb-positive subjects were invited to undergo a small-intestinal biopsy and HLA-DQ allele typing. Four of 1,350 HC (0.3%) tested tTGAb(+) EmA(+) and underwent a biopsy (CD confirmation in all). Four of 738 liver disease patients tested tTGAbs(+) EmA(+) (0.54%; not statistically significant). Two were HCV infected (1.24%; not statistically significant), and two had transaminasemia of unknown origin. Forty-three patients tested tTGAbs(+) EmA(−) (5.8%; P < 0.001 compared to HC). Inhibition experiments verified the existence of specific IgA anti-tTG reactivity. Twenty-six of 43 patients underwent a biopsy (all negative for CD). Binary logistic regression analysis revealed age (P = 0.008), cirrhosis (P = 0.004), alkaline phosphatase (P = 0.026), and antinuclear antibodies (P = 0.012) as independent risk factors for tTGAb reactivity among the patients. It was concluded that CD prevalence is the same in HC and patients with chronic liver diseases. The prevalence of tTGAbs is higher in hepatic patients compared to HC, but their specificity for CD diagnosis in this group of patients is low. tTGAbs in patients appear to be associated with the presence of autoimmunity, cirrhosis, and cholestasis, irrespective of the origin of the liver disease

Reduction of motion, truncation and flow artifacts using BLADE sequences in cervical spine MR imaging

Purpose To assess the efficacy of the BLADE technique (MR imaging with ‘rotating blade-like k-space covering’) to significantly reduce motion, truncation, flow and other artifacts in cervical spine compared to the conventional technique. Materials and methods In eighty consecutive subjects, who had been routinely scanned for cervical spine examination, the following pairs of sequences were compared: a) T2 TSE SAG vs. T2 TSE SAG BLADE and b) T2 TIRM SAG vs. T2 TIRM SAG BLADE. A quantitative analysis was performed using the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measures. A qualitative analysis was also performed by two radiologists, who graded seven image characteristics on a 5-point scale (0: non-visualization; 1: poor; 2: average; 3: good; 4: excellent). The observers also evaluated the presence of image artifacts (motion, truncation, flow, indentation). Results In quantitative analysis, the CNR values of the CSF/SC between TIRM SAG and TIRM SAG BLADE were found to present statistically significant differences (p < 0.001). Regarding motion and truncation artifacts, the T2 TSE BLADE SAG was superior compared to the T2 TSE SAG, and the T2 TIRM BLADE SAG was superior compared to the T2 TIRM SAG. Regarding flow artifacts, T2 TIRM BLADE SAG eliminated more artifacts than T2 TIRM SAG. Conclusions In cervical spine MRI, BLADE sequences appear to significantly reduce motion, truncation and flow artifacts and improve image quality. BLADE sequences are proposed to be used for uncooperative subjects. Nevertheless, more research needs to be done by testing additional specific pathologies

The Effect of Prolonged Intradialytic Exercise in Hemodialysis Efficiency Indices

Optimal hemodialysis (HD) dose is very important to patients' health and survival, and various indices of adequacy have been incorporated into the current clinical practice to monitor HD efficiency. Exercise during HD could facilitate solute removal; however, it is still unknown whether prolonged intradialytic exercise could further improve HD efficiency. Ten stable "high-functioning" HD patients volunteered to participate. The patients were studied under two scenarios during HD: 1) supine exercise (cycling) for 3 hours at 40% of maximum exercise capacity and 2) no exercise as usual. Blood sampling was acquired pre- and post-HD in both scenarios to calculate the HD efficiency indices. All patients completed the exercise regime with no adverse effects. Rather, all efficiency indices significantly improved in the prolonged exercise scenario, compared with the no-exercise one. In particular Kt/V, urea reduction ratio, and creatinine reduction ratio significantly improved by 20%, 11%, and 26%, respectively, while potassium plasma levels were reduced by 77.5% (p < 0.05). In conclusion, prolonged low-intensity intradialytic exercise improved HD efficiency, with no adverse effects. HD patients should be encouraged to participate in exercise regimes not only for the known long-term benefits regarding their cardiovascular health but also for the acute effect of exercise in the HD adequacy. ASAIO Journal 2011; 57: 213-218

How reliable is MRCP with an SS-FSE sequence at 3.0 T: comparison between SS-FSE BH and 3D-FSE BH ASSET sequences

Purpose: The purpose of the present study was to evaluate the visibility and the image quality of the biliary and pancreatic duct system on magnetic resonance cholangiopancreatography (MRCP) images based on two breath-hold (BH) methods using array spatial sensitivity technique: a single-shot fast spin-echo (SS-FSE) sequence and a three-dimensional single slab fast spin-echo (3D-FSE) sequence. Materials and methods: In the present prospective comparative study, 47 patients (22 male and 25 female, mean age=50 years, age range=22-82 years) that were referred for MRCP during a 12-month period are included. All of them were referred with suspected pancreaticobiliary disease. All patients underwent MRCP with both a SS-FSE BH sequence and a 3D-FSE BH sequence. Qualitative evaluation regarding the depiction of three segments of the pancreaticobiliary tree and the frequency of artifacts was performed. Two radiologists graded each sequence of the obtained studies in a blinded fashion. Quantitative evaluation including calculation of relative signal intensity (rSI) and relative contrast (RC) ratios at seven segments of the pancreaticobiliary tree between fluid-filled ductal structures and organ parenchyma at the same ductal segments was performed. In order to evaluate the parameters' differences of the two sequences, either in qualitative or in quantitative analysis, the Wilcoxon paired signed-rank test was performed. Results: On quantitative evaluation, both rSI and RC ratios of all segments of the pancreaticobiliary tree at SS-FSE BH sequence were higher than those at 3D-FSE BH sequences. This finding was statistically significant (P0.60) between the two radiologists. Conclusion: The SS-FSE sequence is performed faster and significantly improves image quality; thus, it should be included into the routine MRCP sequence protocol at 3.0 T. Furthermore, we recommended SS-FSE BH MRCP examination to be applied to uncooperative patients or patients in emergency because of its short acquisition time (1 s). (c) 2013 Elsevier Inc. All rights reserved