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Objective:To investigate the efficacy of a machine learning model based on radiomics of brain lesions on T 2WI in differentiating multiple sclerosis (MS) from neuromyelitis optica spectrum disorders (NMOSD). Methods:Totally 223 MS and NMOSD patients who were treated from January 2009 to September 2018 in Beijing Tiantan Hospital Affiliated to Capital Medical University, Donghu Branch of the First Affiliated Hospital of Nanchang University, Tianjin Medical University General Hospital, and Xuanwu Hospital of Capital Medical University were analyzed retrospectively, and according to the proportion of 7∶3, 223 patients were completely randomly divided into training set (156 cases) and test set (67 cases). A total of 74 patients with MS and NMOSD who were treated in Huashan Hospital Affiliated to Fudan University and China-Japan Friendship Hospital of Jilin University from January 2009 to September 2018 and in Xianghu Branch of the First Affiliated Hospital of Nanchang University from March 2020 to September 2021 were collected as an independent external validation set. All patients underwent brain cross-sectional MR T 2WI, radiomics features were extracted from T 2WI, and features were selected by max-relevance and min-redundancy and least absolute shrinkage and selection operator algorithms. Then various machine learning classifier models (logistic regression, decision tree, AdaBoost, random forest or support vector machine) were constructed to differentiate MS from NMOSD. The area under curve (AUC) of receiver operating characteristics was used to evaluate the performance of each classifier model in the training set, test set and external validation set. Results:Based on multi-center T 2WI, a total of 11 radiomics features related to the discrimination between MS and NMOSD were extracted and classifier models were constructed. Among them, the random forest model had the best efficiency in distinguishing MS from NMOSD, and its AUC values for distinguishing MS from NMOSD in the training set, test set and external validation set were 1.000, 0.944 and 0.902, with specificity of 100%, 76.9% and 86.0%, and sensitivity of 100%, 92.1% and 79.7%, respectively. Conclusion:The random forest model based on the radiomic features of T 2WI of brain lesions can effectively distinguish MS from NMOSD.
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Objective:To investigate the alterations of cerebellar and cerebral functional connectivity (FC) in patients with relapsing-remitting multiple sclerosis (RRMS) and associations with clinical parameters.Methods:Eighteen acute RRMS patients, 25 remitting RRMS patients and 20 healthy controls (HC) who underwent 3.0 T brain MRI using resting-state functional protocols were collected retrospectively from September 2012 to June 2019 at the First Hospital of Nanchang University. After data preprocessing, the functional connectivity coefficients were calculated between each seed of the cerebellum and every other voxel in the cerebrum for comparison of the inter-groups difference and correlation analysis with clinical variables.Results:Compared with HC, the acute RRMS patients showed significant decreased FC of left cerebellar lobule Ⅵ, the right cerebellar lobule Ⅵ and the left vermis ( P<0.001, Gaussian Random Field theory correction at cluster level P<0.05), the remitting RRMS patients showed the decreased FC of the right cerebellar Crus I, the left cerebellar Crus Ⅰ, the left cerebellar lobule Ⅴ and right cerebellar lobule Ⅴ ( P<0.001, Gaussian Random Field theory correction at cluster level P<0.05). In the acute RRMS patients, FC between the left cerebellar lobule Ⅵ and the right precentral/postcentral gyrus was negatively correlated with illness duration ( r=-0.492, P=0.038). FC between the right cerebellar lobule Ⅵ and the right postcentral gyrus/right superior parietal gyrus was negatively correlated with the expanded disability status scale scores ( r=-0.611, P=0.007). FC between the left vermis and the left calcarine gyrus was negatively correlated with illness duration ( r=-0.534, P=0.02). In the remitting RRMS patients, FC between the right Crus Ⅰ and the left anterior insula was negatively correlated with normalized total white matter lesion load ( r=-0.453, P=0.023). FC between the right Crus Ⅰ and the right anterior insula was negatively correlated with modified fatigue impact scale ( r=-0.450, P=0.024). Conclusions:The cerebello-cerebral connection of cognitive related networks is decreased in both acute attack and remission stages of RRMS patients. In addition, the cerebello-cerebral connection in sensorimotor network can also be significantly impacted in acute attack stage, while the cerebello-cerebral connection of emotional network may be decreased in remission stage.
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Objective ToanalyzetheCTimagingfeaturesofatypicalpulmonaryhamartomas,soastounderstandthecausesof misdiagnosisandimprovetheaccuracyofdiagnosis.Methods 18caseswithatypicalpulmonaryhamartomasconfirmedbypathology inourhospitalwerecollectedretrospectively,including9 malesand9females.18caseswereexaminedbychestCTscans,among which,2caseswithplainscans,and16caseswithenhancedscans.TheresultsofCTimagingwereanalyzedbytwoassociatechief radiologistswithdoubleblindmethod,observingthelesionlocation,size,edge,border,density,enhancementfeatures,theremaining lungtissue,theageofonset,history,andclinicalmanifestations.Results Inall18cases,3caseswereendotracheallesion,ofwhich1 casewasinleftmainbronchus,theothertwowereinrightmiddleandupperbronchusrespectively,showingcalcificationdensityand subsequentatelectasis;15caseswereperipherallesions,including7casespresentingrightpulmonarynodulesand8casespresenting leftpulmonarynodules.Allperipheralcasesweresolitarypulmonarynoduleswithoutcalcificationandfatdensity.Thediameterof nodulesrangedfrom0.3cmto2.1cm.5casesshowedsmoothroundisolatednodulesand10casesshowedshallowlobulatednodules. In16casesofenhancedscan,1lesionshowedremarkableenhancement,6lesionsshowedslightlyenhancement,and9lesionsshowed nosignificantenhancement.Conclusion PulmonaryhamartomaislackofcharacteristicofCTimaging,whichisthemainreasonof misdiagnosis.Recognizingitsdiverseimageperformancesincludingshallowlobulation,roughedge,remarkableenhancementandetc. helpsusavoidmisdiagnosis.
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Objective To analyze the topological characteristics of the brain structural network in primary angle-closure glaucoma (PACG) patients by applying graph theoretical approaches.Methods From October 2015 to April 2017, nineteen PACG patients and nineteen gender-and age-matched healthy controls (HCs) were enrolled to undergo MRI scan. The whole brain was parceled into 90 regions by automated anatomical labeling template, and the brain structural network was constructed by the fiber distribution of continuous tracking method.Both the weighted and unweighted network analyses were performed.The global and regional properties were computed by graph theoretical analysis.To compare the brain network regional properties between two groups, two-sample t-test was utilized.The correlations between the brain structural network properties and clinical parameters were further analysed. Results Both two groups were found to follow the efficient small-world characteristics. Compared to HCs, the brain structural network in PACG patients showed no statistical significance in the small-worldness, average shortest path, clustering coefficient, global efficiency and local efficiency(P＞0.05). Compared to the HCs, the PACG patients showed decreased nodal efficiency in the right superior frontal gyrus, right inferior frontal gyrus, left median cingulate and paracingulate gyri, left amygdala and left cuneus(P＜0.05). Compared to HCs, the PACG patients showed decreased node degree in left superior frontal gyrus, medial orbital, right inferior frontal gyrus, left amygdala, left cuneus and left lingual gyrus(P＜0.05). Compared with the hub regions in healthy controls'network, we found that two hub regions disappeared.Those hubs were right inferior parietal lobule and left middle temporal gyrus. Node degree in left amygdala showed negatively correlated with visual ability (r=-0.679, P=0.001). Node degree in left lingual gyrus showed negatively correlated with vertical CDR(r=-0.791, P=0.001),which showed positively correlated with visual acuity(r=0.538, P=0.018).Conclusions The brain structural network in PACG patients showed small-worldness properties as HCs group. The alterations of local properties in visual, emotion-cognition brain regions were observed, manifesting that PACG can affect the topology properties of the structural brain network.
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Objective To investigate the alterations of regional spontaneous activity in patients with classical trigeminal neuralgia (CTN) during resting state.Methods Twenty-seven patients with CTN (CTN group) and 27 healthy subjects (control group) were recruited and underwent a rest-state functional MRI.The regional homogeneity (ReHo) analysis was used to compare the differences of regional synchronization of spontaneous brain activity.And correlation tests were performed between ReHo values in the abnormal brain areas and clinical metrics (visual analogue scale and disease duration) of the disease.Results Compared with control group (P＜0.05,Gaussian random field correction),ReHo increased in bilateral primary somatosensory cortex (S1) and primary motor cortex (M1),right supplementary motor area (SMA),inferotemporal cortex and cerebellum,left thalamus,limbic lobe,parahippocampa gyrus,middle and superior temporal gyrus in CTN group;ReHo decreased in bilateral insula,prefrontal cortex and orbitofrontal cortex,right frontal medial cortex and superior temporal gyrus,left anterior cingulate area,supramarginal gyrus and cerebellum in CTN group.ReHo values in right frontal medial cortex was negatively correlated with the course of disease (r=-0.45,P=0.03).The ReHo values of left primary sensorimotor cortex were positively correlated with the visual analogue scale scores (r=0.46,P=0.02).Conclusion CTN patients has abnormal functional homogeneity of spontaneous brain activity in regions involved in the pain processing,which can help understanding mechanism of CTN.
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Purpose To investigate the diagnostic value of magnetic resonance spectroscopy (MRS) and diffusion weighted imaging (DWI) in diagnosing prostate cancer among Chinese patients.Materials and Methods A Meta-analysis was performed on papers relating to diagnostic value of MRS and DWI in Chinese patients with prostate cancer for the recently ten years using Review Manager 5.2 and Meta-Disc software.QUADAS was employed to assess the quality of qualified articles based on the calculated sensitivity,specificity,diagnostic odds ratio and area under the receiver operating characteristic (ROC) curve of MRS and DWI.Results Ten relevant literatures were enrolled.Heterogeneity of sensitivity and specificity was excluded in accordance to results of Meta-analysis,and hence the combination was feasible.The combination results indicated that AUC of ROC for DWI and MRS were 0.8979 and 0.9302,respectively;sensitivity was 0.83 and 0.87,respectively;specificity was 0.84 and 0.86,respectively;DOR was 22.71 and 41.31,respectively.Conclusion MRS is higher than DWI in terms of diagnostic value of prostate cancer as well as its sensitivity and specificity.When prostate cancer is untypical in DWI findings or not clear in its diagnosis,MRI results can be further consulted.This paper investigated the value of DWI and MRS in diagnosing prostate cancer through quantitative system evaluation,providing evidence-based medicine reference for using imaging methods to diagnose prostate cancer.
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Objective To quantitative analyze the injury degree of cervical cord in cervical spondylotic myelopathy (CSM) patients using fractional anisotropy (FA) entropy of diffusion tensor imaging (DTI).Methods Twenty-four CSM patients and well-match healthy volunteers underwent cervical cord DTI scanning.FA value was measured at each segment of spinal cord (including grey matter and white matter) of spinal cord level and intervertebral disc level.Further Shannon entropy of FA value was calculated in each segment to observe the disorder degree of cervical cord structure in CSM patients.After the analysis of homogeneity of variance,two samples t test analysis was used to identify FC's differences of FA and Shannon entropy of FA value between the two groups.Result In CSM group,the average FA value of whole cervical cord was 0.644 ± 0.056,while it was 0.672 ± 0.035 in the healthy control group.There was significant difference of FA values between the two groups (t=-2.049,P=0.046).The FA entropy of CSM patients' cervical cord was 0.687±0.043,while it was 0.854±0.027 in the healthy control group.The FA entropy of CSM patients' cervical cord was lower than that of control group.There was significant difference of FA entropy between the two groups (t=-12.100,P＜0.001).The significant difference between the two groups was only found at C6 level for each level's FA value.The FA entropy of CSM patients' cervical cord was significantly lower than that of control group for every level.Conclusion This decreased FA entropy of cervical cord in CSM patients indicates that FA entropy can be used to detect the disorder of cervical cord structure in CSM patients.
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Objective To assess the altered regional homogeneity (ReHo) of local intrinsic cerebral activity within sensorimotor network(SMN) in patients with cervical spondylotic myelopathy (CSM) before or after spinal cord decompression using functional MRI (fMRI). Methods Twenty-one CSM patients who would decompress spinal canal, and 21 healthy volunteers (age, gender and level of education matched) were enrolled from June 2013 to April 2014. All the patients underwent rs-fMRI examination before and 3 months after spinal cord decompression. ReHo measurement was performed statistically within a SMN mask. A second-level random-effect 2-tailed Student's t test was applied to compare the ReHo results between pre-and post-operation CSM patients and healthy volunteers. A second-level paired 2-tailed Student's t test was applied to compare the ReHo results between pre-and post-operation CSM patients. Pearson correlation analysis was performed to assess the correlations between the altered ReHo and clinical evaluation. Results Compared with healthy volunteers, pre-operation patients showed significantly lower ReHo in the left postcentral gyrus/precentral gyrus, together with enhanced ReHo in the right superior parietal lobule (GRF correction, P0.05) between pre-operation and post-operation. Conclusions Myelopathy in cervical cord may affect intrinsic cerebral activity, as patients with CSM show disrupted regional homogeneity within sensorimotor network. The change of ReHo following decompression suggests that central plasticity may influence functional recovery.
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Objective To investigate the small-world property of default mode network in relapsingremitting multiple sclerosis (RRMS) compared with the (matched) healthy control subjects,using a graph theory for resting-state functional network analysis.Methods Twenty four patients with RRMS and 24 age-,and sexmatched healthy controls were exanined with resting-state functional MRI (R-fMRI) and 3D-T1WI on Trio 3.0 Tesla.The R-fMRI data were preprocessed,then 20 regions of interest (ROIs) was defined and extracted from the default mode network.The functional connectivity between a pair of regions was defined as the Pearson's correlation coefficient in the time courses.Graph theoretical analysis was implemented and compared with the property of binary functional network.Further,the relationships were examined between the topological property of functional networks and the clinical parameters.Results In this study,functional network in the default mode network was conducted,and the small-world characteristics were observed in both RRMS and healthy control group.In the range of densities (Dmin:0.01∶0.48 ;Dmin =0.42),compared with healthy control group,RRMS groups had a slightly smaller normalized clustering coefficient (P＞0.05),a slightly larger normalized path length (P＞0.05),and a slightly decrease small-world index (P＞0.05).The left posterior cingulated cortex showed a significantly larger clustering coefficient in RRMS group (P=0.031) on the network threshold at Dmin.The area under a curve (AUC) for clustering coefficient measure curves of the left posterior cingulated cortex (density range of 0.42:0.01:0.48) between two groups were compared.The AUC result was similar to the Dmin result (P=0.031).Negative correlation was observed between the clustering coefficient of left posterior cingulated cortex and the Paced Auditory Serial Addition Test (PASAT) in both the Dmin(P=0.023) and the AUC (P=0.020).Conclusion The default mode network has small-world property in RRMS group.The significantly increased clustering coefficience is observed in the left posterior cingulated cortex,which may be a side effect.
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Objective To investigate the difference of cerebral inter-hemispheric functional connectivity between the patients with amyotrophic lateral sclerosis ( ALS) and healthy controls ( HC) by a newly developed voxel-mirrored homotopic connectivity ( VMHC) method based on resting-state functional MRI ( rs-fMRI) , as well as its correlation to the structural imaging indices and clinical neurological scales .Methods Twenty patients with ALS ( ALS group ) and 20 age-, and sex-matched healthy controls ( HC group) were examined by rs-fMRI and diffusion tensor imaging ( DTI ) on 3.0 T MR imaging system ( Siemens Trio Tim ).The rs-fMRI data preprocessing were performed using data processing assistant for rs-fMRI ( DPARSF) based on Matlab 2009a, and the rs-fMRI data analysis toolkit ( REST) with an automated VMHC approach was utilized to calculate and compare the VMHC correlation coefficients between the ALS group and the HC group[P0.05).Conclusions Abnormal VMHC coefficients were detected in ALS patients.The decreased VMHC in ACC and M1 are associated with the reduced micro-structure integrity of CC, meanwhile, and they may be related to disease severity.
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Objective To examine brain regions with a functional connection to posterior cingulate cortex (PCC) in a relapsing-remitting multiple sclerosis (RRMS) group compared with matched control subjects,and to employ resting-state functional MRI (rs-fMRI) to PCC connectivity gathered by investigating synchronic low frequency fMRI signal fluctuations of default mode network with seed-based correlation analysis (SCA).Methods Twenty-seven patients with RRMS (RRMS group) and 27 age-,and sexmatched healthy controls (HC group) were examined by resting-state fMRI,DTI and 3D-T1 on Siemens Trio Tim 3.0T.The fMRI data preprocessing and processing was performed using Data Processing Assistant for Resting-State fMRI Advanced Edition (DPARSFA) based on Matlab 2012a,and PCC (-5,-49,40)was selected as seed.An SCA approach was used to analyze the rs-fMRI data.We examined the differences in SCA-derived connectivity metrics in patients with RRMS and healthy controls,and analyzed correlations between connectivity correlation coefficient of the differences regions and MRI-derived metrics (brain parenchymal fraction,T2 lesion load),as well as clinical metrics (expanded disability status scale,paced auditory serial addition test,and disease duration) of the disease.Results The SCA via functional connectivity of PCC showed that the temporal correlation between the blood-oxygen-level-dependent signals of the default mode network was reliable spatial patterns of activation in patients with RRMS.The lower connectivity in right superior frontal gyrus within default mode network,and higher connectivity in right posterior lobe of cerebellum,right crus of cerebellum,right medial frontal gyrus,right medial occipital gyrus,left precuneus/cingulate gyrus,right angular gyrus and right cingulate gyrus were found in our study.Significant negative-related was observed between the paced auditory serial addition test and functional connectivity in right middle temporal gyrus (0.387 ± 0.216) of RRMS patients (r =-0.59,P =0.001).Significant negative correlation also was observed between the course of disease and functional connectivity in right superior frontal gyrus (0.039 ± 0.293) in patients (r =-0.39,P =0.041).There was no significant correlations between other regions with different functional connectivity and expanded disability status scale,disease duration,or brain atrophy.The connectivity in right superior frontal gyrus,left medial occipital gyrus,left precentral gyrus was decreased; and connectivity in right cerebellum anterior lobe (dentate),right frontal lobe white matter was significantly increased.Significant positive correlation was observed between the course of disease and functional connectivity in left precentral gyrus (-0.924 ± 0.253),right cerebellum anterior lobe (dentate ;0.217 ± 0.208) of RRMS patients (r =0.650,P =0.000;r =0.436,P =0.023),respectively.Conclusion These findings reveal the compensatory mechanism of the brain in response to structural damage,by means of increased activation or synchronization of default mode network,which seems to be finite.
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Objective To investigate the functional and structural changes of connectivity of default mode network (DMN) in relapsing-remitting multiple sclerosis (RRMS) by functional MRI (fMRI) and diffusion tensor imaging (DTI) and to study the relationship between them.Methods Twenty-seven RRMS patients(clinically diagnosed as RRMS)and 27 healthy volunteers (matched to the patients in age and gender) were selected to participate in this study.All the subjects underwent 3.0 T MR scanning.Softwares such as DPARSF,MICA,TrackVis were used for data post-processing.Medial prefrontal cortex (mPFC) and posterior cingulate cortex(PCC) of DMN were chosen as ROIs,and functional and structural changes of DMN and the relationship between them were analyzed.Values of r reflecting the functional connectivity and fractional anisotropy(FA) of two groups were obtained.Then statistical analysis was performed by using student t test and Pearson correlation analysis.Results The DMN space pattern of the RRMS patients was mostly identical to that of controls,but with specific difference in the connectivity strength with respect to that of controls.Particularly,the patient group showed increased DMN connectivity in the mPFC,but decreased connectivity in the inferior parietal lobule (IPL) and PCC.Compared with controls,the r value (0.695 ±0.151 vs.0.796±0.085),FA value(0.261 ±0.012 vs.0.285 ±0.017) between mPFC and PCC in RRMS patients were decreased (t =-3.020,-6.206,P ＜ 0.05).In addition,functional connectivity (r value) was found to correlate with structural connectivity(FA value) between the PCC and mPFC (r =0.704,0.735,P ＜ 0.01).The number of MS lesion,had no correlation with r value or FA value (P ＞ 0.05).Conclusions The functional connectivity and structural connectivity of DMN change in RRMS patients.The functional connectivity and structural connectivity between mPFC and PCC are both decreased in RRMS patients compared with the controls.The injury of structural connectivity may be the structural basis of the decrease of functional connectivity.
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Objective To explore the diagnostic value of DTI for prostate cancer.Methods From October 2009 to December 2010,44 patients suspected of prostate cancer received MRI and DTI.The data of MRI and DTI were analyzed retrospectively.By histopathology,prostate cancer was proved in 16 patients,and benign prostatic hyperplasia ( BPH ) was proved in 28 patients.Differences in ADC and FA values between prostate cancer and BPH were compared by independent samples t test.Diagnostic accuracy of FA value and ADC value for prostate cancer was analyzed by using ROC curve,and the diagnostic threshold of FA value and ADC value for prostate cancer was determined.Results The mean FA value of the tumor regions and BPH were 0.308 +0.084 and 0.203 ±0.029,respectively.The mean ADC value of the tumor regions and BPH were (0.883 +0.192) × 10 -3 mm2/s and ( 1.408 ±0.130) × 10-3 mm2/s,respectively.There were statistically significant differences in ADC and FA values between tumor regions and BPH (t values were 4.833 and 10.779 respectively,P＜0.01).The ADC value area under curve of ROC was 0.996 (95％ CI was 0.984 to 1.007) ; the FA value area under curve of ROC was 0.904(95％ CI was 0.812 to 0.996) ; Combined the FA and ADC value area under curve of ROC is 0.996(95％ CI was 0.984to 1.007) ; Using the ADC value of 0.725 × 10 3 mm2/s as the ROC cut off point,the diagnostic sensitivity and specificity were 100.0％ and 96.0％,respectively; Using the FA value of 0.311as the ROC cut off point,the diagnostic sensitivity and specificity was 100.0％ and 68.7％,respectively.Conclusion DTI imaging can provide valuable information for prostate cancer diagnosis and differential diagnosis,and improve the diagnosis ability of prostate cancer.
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Objective To assess the changes in normal-appearing white matter fiber tracts of the brainstem in patients with relapsing-remitting multiple sclerosis (RRMS) quantitatively with diffusion tensor imaging (DTI). Methods Fifty patients with RRMS were recruited, and twenty five healthy volunteers with the same gender and age were selected as controls. Conventional magnetic resonance imaging and DTI was performed. Quantitative indexes as fractional anisotropy (FA) and mean diffusivity (MD) values in the brainstem fiber tracts, including corticopontine tract/corticospinal tract (cpt/cst), superior cerebellar peduncle (scp), middle cerebellar peduncle (mcp), inferior cerebellar peduncle (icp), and medial lemniscus (ml) were measured and analyzed. Results In comparison with controls, decreasing FA values in cpt/cst (L:P=0.030; R:P=0.020), icp (L:P=0.030; R:P=0.037), scp (L:P=0.036; R:P=0.041) and ml (L:P=0.014; R:P=0.035), as well as increasing MD values in cpt/cst (L:P=0.004; R:P=0.046), icp (L:P=0.047; R:P=0.011), scp (L:P=0.021; R:P=0.011) and ml (L:P=0.002; R:P=0.044) were found in patients with RRMS. No significant difference of FA and MD values was found in mcp between patients with RRMS and controls (P＞0.05). None of the MD or FA values in fiber tracts of the brainstem in patients with RRMS was correlated with brain parenchymal fraction (BPF) or T2 lesion volume. Conclusion The relevant abnormalities which were found in normal-appearing white matter fiber tracts of the brainstem in RRMS patients by DTI scanning suggested pathological changes. It is presumed that the changes may be due to demyelination caused by hiding lesions.
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Objective To investigate the effect of expectant management on the maternal and/or infant out-comes of early onset severe preeclamp sia in different gestafional weeks. Methods A retrospective study was carried out on 158 patients with early onset severe preeclampsia. They were divided into three groups according to their onset gestation ago:group A( <28weeks,n=28) ,group B(≥28、<32weeks,n=51) and group C(≥32、< 34weeks,n =79). Results The rates of complications declined along with the postponement of the onset gestation age, but there was no statistical significant difference among these three groups. The neonatal asphyxia rate and perinatal infant mor-tality of these three groups declined along with the postponement of gestation age, and there were statistical significant differences among these three groups ( P<0.05 ). Expectant treatment time of group B was significantly longer than that of the other two groups ( P<0.05 ), and cesarean section was a main method of pregnancy termination for the groups B and C. Conclusion The smaller the gestational ages in the early onset severe preeelampsia,the higher the maternal and/ or infant complication rates, neonatal morbidity and mortality.