Magnetic Resonance (MR) Patterns of Brain Metastasis in Lung Cancer Patients: Correlation of Imaging Findings with Symptom

IntroductionAsymptomatic brain metastasis in lung cancer patients, if detected early have been reported to show survival benefit with treatment. These asymptomatic metastasis have been found to be smaller and less in number than those with symptoms. We however observed that many lung cancer patients bear a significant metastatic load in the brain irrespective of the stage or neurologic symptoms at the time of initial presentation.Material and MethodsA retrospective study was conducted on 175 patients of proven non-small cell lung cancer to assess the patterns of brain metastasis in the two groups of patients, with and without neurologic symptoms. All patients had undergone screening magnetic resonance imaging for brain metastasis as an initial staging protocol. The patients with brain metastasis were divided into two groups: asymptomatic (group I) and symptomatic (group II). The lesions were studied with regards to the number, size, site, nature (solid with and without necrosis), and presence of perilesional edema and intralesional hemorrhage in both the groups in various stages of disease.ResultsBrain metastasis was seen in 62 (31.3%) patients of whom 46.7% were neurologically asymptomatic. Patients (90.3%) with brain metastasis were in stage IV at the time of presentation. No statistically significant correlation was found between the two groups regarding the number of lesions (p = 0.554), size of lesion (p = 0.282), site of lesion (p = 0.344), nature of lesion (p = 0.280), presence of perilesional edema (p = 0.404), and presence or absence of intralesional hemorrhage (p = 0.09). In our study, brain metastases were present only in stages III and IV disease with no statistically significant difference in the lesion patterns.ConclusionThe study reveals almost equal number of patients with brain metastasis in the symptomatic and asymptomatic groups with no significant difference in lesion patterns. We therefore conclude that although imaging surveillance of the brain for metastasis will detect asymptomatic metastasis early for early institution of appropriate therapy the prognosis in these patients would not solely depend on the presence or absence of symptoms and the pattern of lesion may have an influence on the patients’ response to therapy and survival benefit specially for those asymptomatic patients with equally large metastatic load

MRI Appearance of Florid Cystic Endosalpingiosis of the Uterus: a Case Report

Endosalpingiosis is a non-neoplastic proliferation of ectopic tubal epithelium. It may be found incidentally or the patients may present with chronic pelvic pain. It may resemble a gynecologic malignancy on imaging findings and clinicians and radiologists should be aware of this benign entity to render a correct diagnosis and to avoid over-treatment. We report here the MR imaging appearance of a case of florid cystic endosalpingiosis

Long-term trends of direct nitrous oxide emission from fuel combustion in South Asia

An increasing concentration of nitrous oxide (N2O) in the global atmosphere can perturb the ecological balance, affecting the climate and human life. South Asia, one of the world's most populous regions, is a hotspot for N2O emission. Although agriculture traditionally dominated the region, economic activities are rapidly shifting towards industry and energy services. These activites may become the largest emitters of N2O in future. Yet, few attempts have been made to estimate long-term direct N2O emission from fuel combustion for the different energy-consuming sectors in the South Asian region. Therefore, the present study developed a comprehensive sectoral N2O emission inventory for South Asian countries for the time period of 1990–2017, with projections till 2041. It revealed that the average N2O emission from fuel combustion in the South Asia region is about 40.96 Gg yr−1 with a possible uncertainty of ±12 Gg yr−1, showing an increase of more than 100% from 1990 to 2017. Although India is the major contributor, with an average of 34 Gg yr−1 of N2O emissions, in terms of growth, small countries like Bhutan and Maldives are dominating other South Asian countries. Sector-wise, the residential sector contributed a maximum emission of 14.52 Gg yr−1 of N2O but this is projected to reduce by more than 50% by 2041. This is because of the successful promotion of cleaner fuels like liquefied petroleum gas over more polluting fuelwood. Power generation contributed 9.43 Gg yr−1of N2O emissions, exhibiting a maximum growth of 395%, followed by road transport (289%) and industry (231%). Future N2O emissions from transport, power and industry are projected to rise by 2.8, 3.3, and 23.9 times their 2017 estimates, respectively, due to the incapability of current policies to combat rising fossil fuel consumption. Mitigation options, such as replacing diesel and compressed natural gas vehicles with electricity-driven vehicles, can decelerate N2O emissions to 45% by 2041 for road transport. A 41% reduction is possible by displacing coal with renewables in the power and industry sectors. Overall, the South Asian contribution to global N2O emissions has enlarged from 2.7% in 1990 to 5.7% in 2007–2016, meaning there is an urgent need for N2O emission mitigation in the region

Prevalence, Distribution and Functional Significance of the −237C to T Polymorphism in the IL-12Rβ2 Promoter in Indian Tuberculosis Patients

Cytokine/cytokine receptor gene polymorphisms related to structure/expression could impact immune response. Hence, the −237 polymorphic site in the 5′ promoter region of the IL-12Rβ2 (SNP ID: rs11810249) gene associated with the AP-4 transcription motif GAGCTG, was examined. Amplicons encompassing the polymorphism were generated from 46 pulmonary tuberculosis patients, 35 family contacts and 28 miscellaneous volunteers and sequenced. The C allele predominated among patients, (93.4%, 43/46), and in all volunteers and contacts screened, but the T allele was exclusively limited to patients, (6.5%, 3/46). The functional impact of this polymorphism on transcriptional activity was assessed by Luciferase-reporter and electrophoretic mobility shift assays (EMSA). Luciferase-reporter assays showed a significant reduction in transcriptional efficiency with T compared to C allele. The reduction in transcriptional efficiency with the T allele construct (pGIL-12Rb2-T), in U-87MG, THP-1 and Jurkat cell lines, were 53, 37.6, and 49.8% respectively, compared to the C allele construct (pGIL-12Rb2-C). Similarly, densitometric analysis of the EMSA assay showed reduced binding of the AP-4 transcription factor, to T compared to the C nucleotide probe. Reduced mRNA expression in all patients (3/3) harboring the T allele was seen, whereas individuals with the C allele exhibited high mRNA expression (17/25; 68%, p = 0.05). These observations were in agreement with the in vitro assessment of the promoter activity by Luciferase-reporter and EMSA assays. The reduced expression of IL-12Rβ2 transcripts in 8 patients despite having the C allele was attributed to the predominant over expression of the suppressors (IL-4 and GATA-3) and reduced expression of enhancers (IFN-α) of IL-12Rβ2 transcripts. The 17 high IL-12Rβ2 mRNA expressers had significantly elevated IFN-α mRNA levels compared to low expressers and volunteers. Notwithstanding the presence of high levels of IL-12Rβ2 mRNA in these patients elevated IFN-α expression could modulate their immune responses to Mycobacterium tuberculosis

Simultaneous PET/MRI: Impact on cancer management-A comprehensive review of cases

The metabolic mapping of malignancy in whole body in a single examination by PET/CT has gained widespread acceptance where the CT provides an anatomical correlate for the PET. MRI offers advantage over CT in providing better anatomical information owing to its high soft tissue resolution especially in brain, liver, neck, pelvis and bone marrow. Simultaneous PET/MRI is a new multimodal imaging modality that is expected to improve the diagnostic performance of imaging wherein better anatomical and metabolic information can be acquired at the same time and space during a single examination time. Also, MR attributes like diffusion, perfusion and spectroscopy may further add to its diagnostic potential. In this article, we present our initial experience in illustrated cases done with simultaneous PET/MRI and outline its potential for several clinical applications in oncology

Role of quantitative pharmacokinetic parameter (transfer constant: Ktrans ) in the characterization of breast lesions on MRI

Background: The semi-quantitative analysis of the time-intensity curves in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has a limited specificity due to overlapping enhancement patterns after gadolinium administration. With the advances in technology and faster sequences, imaging of the entire breast can be done in a few seconds, which allows measuring the transit of contrast (transfer constant: K trans ) through the vascular bed at capillary level that reflects quantitative measure of porosity/permeability of tumor vessels. Aim: Our study aims to evaluate the pharmacokinetic parameter K trans for enhancing breast lesions and correlate it with histopathology, and assess accuracy, sensitivity, and specificity of this parameter in discriminating benign and malignant breast lesions. Materials and Methods: One hundred and fifty-one women with 216 histologically proved enhancing breast lesions underwent high temporal resolution DCE-MRI for the early dynamic analysis for calculation of pharmacokinetic parameters (K trans ) using standard two compartment model. The calculated values of K trans were correlated with histopathology to calculate the sensitivity, specificity, and accuracy. Results: Receiver operating characteristic (ROC) curve analysis revealed a mean K trans value of 0.56, which reliably distinguished benign and malignant breast lesions with a sensitivity of 91.1% and specificity of 90.3% with an overall accuracy of 89.3%. The area under curve (AUC) was 0.907. Conclusion: K trans is a reliable quantitative parameter for characterizing benign and malignant lesions in routine DCE-MRI of breasts

Technical Note: MRI-guided breast biopsy - our preliminary experience

The diagnostic potential of breast MRI can be fully utilized only when it is possible to biopsy lesions detected on MRI, especially when they are not visible on mammography or USG. We would like to describe our experience with MRI-guided wire localization and biopsy

MRI evaluation of the contralateral breast in patients with recently diagnosed breast cancer

Introduction: Contralateral breast cancer can be synchronous and/or metachronous in patients with cancer of one breast. Detection of a synchronous breast cancer may affect patient management. Dynamic contrast-enhanced MRI of the breast (DCE-MRI) is a sensitive technique for detecting contralateral lesions occult on the other imaging modalities in women already diagnosed with cancer of one breast. Aim: The aim was to assess the incidence of mammographically occult synchronous contralateral breast cancer in patients undergoing MRI mammography for the evaluation of a malignant breast lesion. Materials and Methods: A total of 294 patients with recently diagnosed breast cancer who underwent MRI of the breast were evaluated for lesions in the opposite breast. Results: The incidence of synchronous contralateral malignancy detected by preoperative MRI mammography done for evaluation of extent of disease was 4.1%. Conclusion: Preoperative breast MRI may detect clinically and mammographically occult synchronous contralateral cancer, and can help the patient avoid an additional second surgery or a second course of chemotherapy later; also, as theoretically these lesions are smaller, there may be a survival benefit as well

Integrated 18F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging (18F-FDG PET/MRI), a multimodality approach for comprehensive evaluation of dementia patients: A pictorial essay

Dementia, caused by irreversible neurodegenerative disorders such as Alzheimer's disease or reversible non-degenerative conditions, is rapidly becoming one of the most alarming health problems in our aging society. This cognitive disorder associated with a multitude of clinical differentials with overlapping clinical, pathological, and imaging features is difficult to diagnose and treat, as it often presents late after significant neuronal damage has already occurred. Novel disease-modifying treatments being developed will have to be corroborated with innovative imaging biomarkers so that earlier reliable diagnosis can be made and treatment initiated upon. Along with new specific PET radiotracers, integrated PET/MRI with combined methodological advantage and simultaneously acquired structural-cum-functional information may help achieve this goal. The present pictorial essay details our experiences with PET/MRI in dementing disorders, along with reviewing recent advances and future scope