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Objective:To comprehensively evaluate the ability of common resting state functional magnetic resonance imaging (rs-fMRI) indices to detect abnormal brain activity in childhood absence epilepsy (CAE).Methods:Simultaneous electroencephalography-functional magnetic resonance imaging (fMRI) data of 20 patients with CAE who were treated in the Jinling Hospital, Nanjing University School of Medicine from February 2010 to September 2021 were retrospectively collected. After excluding 2 patients with CAE with greater head movement, 44 fMRI data containing discharges from 18 patients were obtained finally. The generalized spike and slow-wave discharges (GSWD) related fMRI activation mappings were obtained by using the generalized linear model. At the same time, 94 age- and sex-matched healthy controls underwent rs-fMRI scanning. Meanwhile, 12 indices of rs-fMRI were calculated respectively [amplitude of low frequency fluctuation (ALFF), fractional amplitude of low frequency fluctuation (fALFF), regional homogeneity (ReHo), functional connectivity density (FCD), long FCD, local FCD, granger causality density (GCD)-in, GCD-out, GCD-int, resting state functional magnetic resonance imaging lag analysis (RSLA), Hurst index and brain entropy]. Two-sample t-tests were employed to detect significant differences in 12 indices of rs-fMRI. The Dice coefficient was used to evaluate the overlap between different brain maps of 12 indices of rs-fMRI and the GSWD-related blood oxygenation level dependent (BOLD) activation. Results:Positive activation of GSWD-related BOLD in CAE was mainly in the bilateral thalamus, and negative activation was mainly in default mode network (DMN) related brain regions. There was a significant overlap between the abnormal brain regions detected by various resting-state indicators: compared with normal controls, ALFF, fALFF, ReHo, GCD-in, GCD-out and local FCD were elevated in the bilateral thalamus, while FCD, long FCD, GCD-int and RSLA were decreased in CAE; ALFF, fALFF, ReHo, local FCD, GCD-out, RSLA and brain entropy were decreased in the DMN, while FCD, long FCD, GCD-in and GCD-int were increased in CAE. The Dice coefficient of long FCD was the highest (0.365),FCD was 0.362, while the Hurst index showed the lowest (0.142).Conclusions:Rs-fMRI indices variously revealed abnormal brain activity in CAE, in which the FCD is better for detection of epileptic activity. Rs-fMRI could be helpful to understand the pathophysiological mechanism of CAE, and to find reliable imaging markers.
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Brain glioma invariably relapses since the tumor is difficult to remove completely. Accurate identification of tumor subtypes and tracing of tumor boundaries intraoperatively are the key clinical issues. Raman spectroscopy has a good application prospect in the intraoperative diagnosis of brain glioma due to its advantages of nondestructive, label-free, histology imaging and high specificity. In this article, the research and application of Raman spectroscopy in the in vitro diagnosis and intraoperative navigation-related diagnosis and treatment of brain glioma are reviewed.
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Objective:To investigate the effects and significance of acute and chronic trauma on brain degree centrality (DC) in patients with post-traumatic stress disorder (PTSD) who lost their only child at resting state.Methods:Retrospectively, the study enrolled a total of 51 parents with PTSD, including 35 PTSD parents whose children was lost in emergencies (acute bereaved PTSD group) and 16 PTSD parents whose children was lost of chronic causes such as diseases (chronic bereaved PTSD group). Fifty local adults were also included as healthy controls (HC group). The clinical administered PTSD scale(CAPS) was used to evaluate the severity of the subjects' clinical symptoms.Resting-state functional magnetic resonance imaging(fMRI) data of all subjects were collected and DC values were calculated.SPSS 22.0 software was used for statistical analysis.Covariance analysis was performed among three groups, while post hoc was performed between any two groups.What's more, correlation analyses were utilized between abnormal brain regions and the scores of CAPS.Results:Significant group effects were found in multiple regions, including the right inferior temporal gyrus (MNI: x, y, z=66, -27, -21), right temporal pole (MNI: x, y, z=54, 15, -9), right orbital inferior frontal gyrus (MNI: x, y, z=42, 21, -15), bilateral medial superior frontal gyri (MNI: right x, y, z=6, 63, 12; left x, y, z=-3, 60, 18), left inferior parietal angular gyrus (MNI: x, y, z=-45, -36, 51) and left postcentral gyrus (MNI: x, y, z=-45, -33, 51). Compared with HC group, the DC of two patient groups increased in the right inferior temporal gyrus (MNI: acute x, y, z=63, -27, -21; chronic x, y, z=63, -21, -27); the DC of acute bereaved PTSD group decreased in the right temporal pole (MNI: x, y, z=45, 21, -15) and the right orbital inferior frontal gyrus (MNI: x, y, z=48, 24, -12), while the DC of chronic bereaved PTSD group decreased in the left inferior parietal angular gyrus (MNI: x, y, z=-45, -36, 51) and left postcentral gyrus (MNI: x, y, z=-45, -33, 51). Compared with chronic bereaved PTSD group, the DC of acute bereaved PTSD group increased in the left inferior parietal angular gyrus (MNI: x, y, z=-33, -39, 42) and left postcentral gyrus (MNI: x, y, z=-45, -33, 51), while decreased in the right temporal pole (MNI: x, y, z=51, 12, -9), right orbital inferior frontal gyrus (MNI: x, y, z=42, 21, -15) and bilateral medial superior frontal gyri (MNI: left x, y, z=0, 57, 15; right x, y, z=3, 57, 15). In chronic bereaved PTSD group, the DC of the left postcentral gyrus was negatively correlated with C1 (avoid trauma-related thoughts, feelings) score in CAPS ( r=-0.606, P=0.028). In acute bereaved PTSD group, the DC of the left medial superior frontal gyrus was negatively correlated with D4 (high vigilance) score ( r=-0.416, P=0.020). Conclusion:There exist functional abnormalities of multiple brain regions in acute and chronic bereaved parents with PTSD.The high arousal symptoms of the former may be related with the abnormalities of prefrontal-amygdala neural circuit, while the latter show higher avoidance which may be associated with the dysfunction of somatosensory brain regions such as postcentral gyrus.
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Objective:To explore the changes of brain activity in drug-resistant or drug-controlled medial temporal lobe epilepsy patients by the method of functional connectivity density (FCD), and to analyze their correlation with the course of the disease.Methods:According to the definition of drug-resistant epilepsy by the International League Against Epilepsy in 2010, 146 patients with medial temporal lobe epilepsy who were clearly diagnosed as unilateral hippocampal sclerosis in Jinling Hospital, Nanjing University School of Medicine from July 2009 to February 2019 were divided into drug control group ( n=73) and drug-resistant group ( n=73). The 3.0 T resting state functional magnetic resonance scan was performed on all subjects to compare the difference in FCD between the two groups, and calculate the correlation between the FCD value of the brain area and the course of the disease between the two groups of patients. Results:There was significant difference between the two groups in FCD. Compared with the drug control group, the drug-resistant group had significantly lower FCD values in the insula, lenticular nucleus, thalamus, hippocampus and precentral gyrus on the side of the epileptogenic focus. The FCD value of the precuneus on the side of the epileptogenic focus in the drug-resistant group was negatively correlated with the duration ( r=-0.30, P=0.01). Conclusions:The FCD of patients with drug-resistant medial temporal lobe epilepsy was lower than that of the drug control group. In addition, there may be progressive damage to the brain. The difference is helpful for exploring the pathophysiological mechanisms related to drug resistance in patients with medial temporal lobe epilepsy, and finding reliable neuroimaging markers related to drug resistance.
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OBJECTIVES@#Major depressive disorder (MDD) patients with anhedonia tend to have a poor prognosis. The underlying imaging basis for anhedonia in MDD remains largely unknown. The relationship between nodal properties and anhedonia in MDD patients need to be further investigated. Herein, this study aims to explore differences of cerebral functional node characteristics in MDD patients with severe anhedonia (MDD-SA) and MDD patients with mild anhedonia (MDD-MA) before and after the antidepressant treatment.@*METHODS@#Ninety participants with current MDD were recruited in this study. 24-Item Hamilton Depression Scale (HAMD-24) and Snaith-Hamilton Pleasure Scale (SHAPS) were used to assess the severity of depression and anhedonia at baseline and the end of 6-months treatment. The MDD patients who scored above the 25th percentile on the SHAPS were assigned to an MDD-SA group (n=19), while those who scored below the 25th percentile were assigned to an MDD-MA group (n=18). All patients in the 2 groups received antidepressant treatment. Functional magnetic resonance imaging (fMRI) images of all the patients were collected at baseline and the end of 6-months treatment. Graph theory was applied to analyze the patients' cerebral functional nodal characteristics, which were measured by efficiency (ei) and degree (ki).@*RESULTS@#Repeated measures 2-factor ANCOVA showed significant main effects on group on the ei and ki values of left superior frontal gyrus (LSFG) (P=0.003 and P=0.008, respectively), and on the ei and ki values of left medial orbital-frontal gyrus (LMOFG) (P=0.004 and P=0.008, respectively). Compared with the MDD-MA group, the significantly higher ei and ki values of the LSFG (P=0.015 and P=0.021, respectively), and the significantly higher ei and ki values of the LMOFG (P=0.015 and P=0.037, respectively) were observed in the MDD-SA group at baseline. Meanwhile, higher SHAPS scores could result in higher ei and ki values of LSFG (P=0.019 and P=0.026, respectively), and higher ei value of LMOFG (P=0.040) at baseline; higher SHAPS scores could result in higher ei values of LSFG (P=0.049) at the end of 6-months treatment. The multiple linear regression analysis revealed that sex were negatively correlated with the ei and ki values of LSFG (r= -0.014, P=0.004; r=-1.153, P=0.001, respectively). The onset age of MDD was negatively correlated with the ki value of LSFG (r=-0.420, P=0.034) at the end of 6-months treatment. We also found that SHAPS scores at baseline were positively correlated with the HAMD-24 scores (r=0.387, P=0.022) at the end of 6-months treatment.@*CONCLUSIONS@#There are obvious differences in nodal properties between the MDD-SA and the MDD-MA patients, such as the high ei of LSFG in the MDD-SA patients, which may be associated with the severity of anhedonia. These nodal properties could be potential biomarkers for the prognosis of MDD. The increased ei and ki values in the LSFG of MDD-SA patients may underlie a compensatory mechanism or protective mechanism. The mechanism may be an important component of the pathological mechanism of MDD-SA. The poor prognosis in the MDD-SA patients suggests that anhedonia may predict a worse prognosis in MDD patients. Sex and onset age of MDD may affect the nodal properties of LSFG at baseline and the end of 6-months treatment.
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Humans , Infant , Infant, Newborn , Anhedonia , Antidepressive Agents/therapeutic use , Depressive Disorder, Major/drug therapy , Magnetic Resonance Imaging , Prefrontal CortexABSTRACT
Erythropoietin-producing hepatocellular A2 receptor (EphA2) is the most common subtype in the largest subfamily of the receptor tyrosine kinase superfamily, and is considered as a key factor in the regulation of malignant tumor progression. EphA2 is highly expressed in glioma, which plays an important role in the development and progression of glioma. This article reviews the structure, function, expression of EphA2 in glioma, and its role in glioma cell migration, maintenance of glioma stem cells, angiogenesis and targeted therapy.
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Objective:To construct a multi-label learning MRI model for assisting diagnosis of sports injury in knee.Methods:A total of 1 391 knee MRI cases from 1 343 young adults with sports injury in Affiliated Jinling Hospital Nanjing University School of Medicine were retrospectively enrolled. The image cases were randomly divided into training set ( n=973), validation set ( n=139) and test set ( n=279) with ratio of 7∶1∶2. The knee injuries were divided into six categories: meniscus injury, tendon injury, ligament injury, osteochondral injury, synovial bursa disorder and soft tissue injury. Using PyTorch V1.1.0 algorithm package, the Yolo model of deep learning was used to construct the MRI knee joint sports injury detection model. The model was validated on the test set, and the sensitivity, specificity and mean average precision of lesion detection were evaluated. Results:Among the 279 patients in test set, the mean average precision of meniscus injury, tendon injury, ligament injury, osteochondral injury, synovial bursa disorder and soft tissue injury were 83.1%, 89.0%, 88.0%, 85.8%, 85.5% and 83.2%, respectively, and the overall mean average precision was 85.8%. The model was most effective in detecting tendon injury. The sensitivity and specificity of the model for tendon injury were 91.2% and 87.1% respectively.Conclusions:The multi-label MRI knee joint exercise-related injury detection model based on deep learning can effectively assist in detecting the exercise-related injury of knee joint in each tissue structure, and is expected to improve the efficiency of diagnosis and treatment in orthopedics.
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Objective@#To investigate whether a deep learning-based model using unenhanced computed tomography (CT) at baseline could predict the malignancy of pulmonary nodules.@*Methods@#A deep learning model was trained and applied for the discrimination of pulmonary nodule in Dr. Wise Lung Analyzer. This study retrospectively recruited 130 consecutive participants with pulmonary nodules detected on CT who undergoing biopsy or surgery from May 2009 to June 2017 in Jinling hospital. A total of 136 pulmonary nodules were included in this study, including 86 malignant nodules and 50 benign ones. All patients underwent CT scans 2 times at least, the first scan was defined as baseline and the last scan before the pathological results was defined as final scan. The ROC curve of deep learning model was plotted and the AUCs were calculated. Delong test was used to examine the difference of AUCs baseline and final scan. The nodules were further divided into subsolid nodule group (pure ground-glass nodule and part solid nodule) (n=87) and solid nodule group (n=49). The difference of AUCs at baseline and final scans was evaluated intra two groups.@*Results@#The AUCs of the deep learning model at final and baseline scans were 0.876 and 0.819, respectively. There was no significant difference between them (P=0.075). The result indicated that the model could predict the consequences of pulmonary nodules well at baseline. In small nodules (longest diameter ≤10mm), the AUC at final scan (0.847) was better than it at baseline scan (0.734), but there was no significant difference between them (P=0.058). In solid nodule group, The AUC at final scan (0.932) was better than it at baseline scan (0.835), but there was no significant difference between them (P=0.066). In subsolid nodule group, the deep learning model exhibited consistent performance at final scan (AUC, 0.759) with the baseline scan (AUC, 0.728, P=0.580).@*Conclusions@#The deep learning model could predict the malignancy of pulmonary nodules including small ones at baseline, and the model exhibited consistent performance between baseline and final scans in subsolid nodules.
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Mood disorders/psychosis have been associated with dysfunctions in the default mode network (DMN). However, the relative contributions of DMN regions to state and trait disturbances in pediatric bipolar disorder (PBD) remain unclear. The aim of this study was to investigate the possible mechanisms of PBD through brain imaging and explore the influence of psychotic symptoms on functional alterations in PBD patients. Twenty-nine psychotic and 26 non-psychotic PBD patients, as well as 19 age- and sex-matched healthy controls underwent a resting-state functional MRI scan and the data were analyzed by independent component analysis. The DMN component from the fMRI data was extracted for each participant. Spearman's rank correlation analysis was performed between aberrant connectivity and clinical measurements. The results demonstrated that psychotic PBD was characterized by aberrant DMN connectivity in the anterior cingulate cortex/medial prefrontal cortex, bilateral caudate nucleus, bilateral angular gyri, and left middle temporal gyrus, while non-psychotic PBD was not, suggesting further impairment with the development of psychosis. In summary, we demonstrated unique impairment in DMN functional connectivity in the psychotic PBD group. These specific neuroanatomical abnormalities may shed light on the underlying pathophysiology and presentation of PBD.
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Objective To investigate the biodistribution of 18F-Alfatide II in patients with breast diseases and to compare its uptake with 18F-fluorodeoxyglucose(FDG)uptake.Methods A total of 44 female patients(age:(50.7±8.0)years)with clinically suspected breast cancer from December 2015 to May 2017 were prospectively enrolled and underwent 18 F-Alfatide II and 18F-FDG PET/CT prior to treatment.By drawing regions of interest in normal organs and breast lesions,differences between 18F-Alfatide II uptake and l8F-FDG uptake were evaluated in all patients.Paired t test,two-sample t test and Wilcoxon rank sum test were used for data analysis.Results There were 53 breast lesions confirmed by histopathology in 44 patients.Among them,42 lesions were malignant and the others were benign.The uptake of 18F-Alfatide II was very low in the brain,vocal cords,lungs,blood pool and muscle.But the renal cortex and bladder had high 18F-Alfatide II accumulation.Different levels of 18F-Alfatide II uptake were found in other normal organs including normal breast tissue.There were differences(t values:2.04-41.65,all P<0.05)between 18F-Alfatide II and 18F-FDG maximum standardized uptake value(SUVmax)and mean standardized uptake value(SUVmean)in many normal organs except for the choroid plexus,salivary glands,liver,colon and normal breast tissue.The uptake of 18F-Alfatide II was significantly lower than 18F-FDG in breast cancer lesions(SUVmax:3.77±1.78 vs 7.37±4.48,SUVmean:2.25±0.98 vs 4.54±2,82;t values:4.89,4.82,both P< 0.05),but it was still higher in benign breast lesions(SUVmax:2.37±1.62,SUVmean:1.50±0.92;t val-ues:2.35,2.29,both P<0.05).Also,target/non-target(T/NT)of 18F-Alfatide II in breast cancer lesions was higher than that in benign breast lesions(5.32±3.08 vs 2.60±2.37;t = 2.72,P<0.05).Condusion The biodistribution of 18F-Alfatide II in patients is favorable and 18F-Alfatide II can be clinically used for breast cancer imaging.
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Objective To investigate the clinical value of endovascular embolization in treating severe acute pancreatitis (SAP) associated with hemorrhage. Methods The clinical data of 71 patients with SAP, who were admitted to authors' hospital during the period from 2010 to 2016, were collected. DSA was performed in all patients. Of the 71 patients, 27 (38.0％) received endovascular embolization treatment. The angiographic findings and the endovascular embolization results of the 27 patients were analyzed. Results Angiography demonstrated that 20 patients (28.2％, 20/71) had hemorrhage due to arterial rupture and 7 patients (9.9％, 7/71) had pseudoaneurysm formation. A total of 32 responsible arteries were detected, and the spleen artery was the main bleeding artery (34.4％, 11/32) . A total of 32 endovascular embolization procedures were carried out, the technical success rate was 93.8％ (30/32) . Post-embolization complication was seen in 4 patients, including infarction of spleen (n =2), which was improved after symptomatic treatment, liver abscess (n=1) and splenic abscess (n=1), which were improved after anti-infection therapy and tube drainage. Three patients died of hemorrhagic shock (n=2) or brain stem infarction (n=1), the causes of death were not related to the intervention operation. Five patients developed recurrent hemorrhage, in 4 of them the new bleeding point was different from the primary bleeding point, and successful hemostasis was achieved after second embolization treatment. Conclusion In treating SAP associated with hemorrhage, angiography together with endovascular embolization can quickly detect the hemorrhagic responsible arteries, thus, rapid hemostasis can be reliably achieved.
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Objective To evaluate the role of non?invasive fractional flow reserve (FFR) derived from coronary CT angiography (CCTA) in assessing the hemodynamic relevance of myocardial bridging (MB). Methods A total of 60 patients without obstructive coronary artery disease but with CCTA?confirmed MB of the left anterior descending coronary artery and 30 patients with negative CCTA findings as control group were retrospectively included in this study. The 60 patients with MB were divided into 2 groups (superficial and deep MB group) according to the depth of MB. Age and sex were matched among three groups. The location, length, depth, and degree of systolic compression of the MB were measured. The FFRCT values (including systolic and diastolic phases) were measured at three points (segments 1 to 2 cm proximal to a MB, mid?tunneled segment and segments 1 to 2 cm distal to the MB) by cFFR software. Patients with FFRCT<0.75 were deemed to have hemodynamic relevance (abnormal group). χ2 test, ANOVA test, Mann?Whitney U test, Kruskal?Wallis H test and logistic regression model were used for statistical analysis. Results The FFRCT values decreased from diastolic phase to systolic phase in deep MB group [0.90 (0.81-0.94) vs. 0.93 (0.91-0.97), Z=-2.172, P=0.03]. Compared to control group, the FFRCT values decreased in both diastolic phase and systolic phase in superficial MB group as well as deep MB group [systole 0.92 (0.90-0.94) control vs. 0.84 (0.77-0.88) superficial vs. 0.67 (0.50-0.88) deep, H=37.193, P<0.001; diastole 0.93 (0.89-0.94) control vs. 0.85 (0.73-0.92) superficial vs. 0.81 (0.65-0.87) deep, H=26.508, P<0.001]. Abnormal FFRCT values (<0.75) were found in 28 (47.7%) MB patients (9 superficial vs. 19 deep). The length (OR=1.067, 95% CI: 1.016-1.122, P=0.010) and depth (OR=2.028, 95%CI: 1.129-3.644, P=0.018) of MB were associated with the abnormal FFRCT values.Conclusions The FFRCT values of coronary artery distal to MB were lower than that without MB. Abnormal FFRCT values are more prevalent in deep MB. MB length and depth demonstrate moderate predictive value for an abnormal FFRCT value.
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Objective To explore the aberrance of brain activity in healthy young adults with apolipoprotein E (APOE) ε2, ε3 and ε4 allele by the method of functional connectivity density(FCD). Method Two hundred and thirteen young healthy adults underwent the 3 T resting-state functional MRI, the neuropsychological tests and genotype testing for ε2, ε3 and ε4 allele. Age-and gender-matched individuals,including 14 subjects with APOE ε2,31 subjects with APOE ε4 and 31 subjects with APOE ε3 were enrolled for final analysis.FCD mapping was used to compare the brain functional connective networks among the three groups.All results were corrected with a Gaussian random field(GRF)(voxel-level of P<0.01 and joint cluster-level of P<0.05). Correlation analysis was performed between abnormal short-and long-range FCD values and neuropsychological scores. Results Compared with APOE ε3 carriers, the short-and long-range FCD values of APOE ε2 carriers were increased in the frontal lobe,particularly in the medial prefrontal lobe(37 voxels,t=3.54),anterior cingulate cortex(36 voxels,t=3.19)and orbital frontal cortex(41 voxels, t=3.72), while APOE ε4 carriers showed decreased short-range FCD in the bilateral cuneus(38 voxels, t=-3.68). Moreover, the long-range FCD values of APOE ε4 group were decreased in right orbital frontal cortex(46 voxels,t=-4.56)and increased in the right inferior parietal lobe(31 voxels,t=3.49)compared with that of APOE ε2 group. No significant correlation was detected with Bonferroni correction. Conclusions The opposite FCD alteration in cuneus and inferior parietal lobe might be the early existence of inhibitory and compensatory mechanism modulated by the ε4 allele in the young age, while the increased FCD in frontal lobe might be the underlying protective mechanism of delaying the onset of Alzheimer's disease.
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Objective DSA and/or surgery was used as a control to evaluate the image quality, radiation dose and diagnostic efficacy of 70 kV combined with low contrast agent dose and 80 kV dual-source CT scanning of coronary artery. Methods Between Apr, 2012 and Apr, 2017, a total of 150 consecutive pediatrics with suspected or confirmed coronary arterial diseases underwent DSCTCA, and the patients were randomly divided into 3 groups by different scanning protocols. Group A (n=50): 80 kV with 1.5 ml/kg contrast agent;Group B (n=50): 70 kV with 1.5 ml/kg contrast agent;Group C (n=50): 70 kV with 1.0 ml/kg contrast agent. ANOVA was used to compare the differences of subjective coronary arteries image quality between the three groups; The t-test was used to compare the difference in effective radiation dose between the 70 kV group and the 80 kV group; The surgery and/or angiography results were used as gold standard to evaluate the diagnostic efficacy of the three groups. Results All patients underwent DSCTCA successfully and satisfactory diagnostic images were gained . The mean scores of subjective image quality of coronary artery were 3.5±0.7, 3.4±0.6, 3.7±0.8, respectively. There was no significant difference between the 3 groups (F=2.042, P=0.133). The diagnostic accuracy of the three groups for coronary artery disease was 100%, as the surgical and/or angiographic results were used as gold standard. The effective radiation doses in 80 kV group (A group) and the 70 kV group (B+C group) were (0.49 ± 0.04) and (0.30 ± 0.03) mSv, respectively, with a statistically significant difference (t=4.037, P=0.001). Conclusions DSCTCA can better display and diagnose pediatric coronary artery lesions with 70 kV tube voltage combined with low contrast agent, and has a high diagnostic accuracy. It is a reliable method for diagnosing pediatric coronary artery disease.
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Objective To explore crossed cerebellar diaschisis (CCD) in cerebral gliomas with three dimensional arterialspin-labeling (3D ASL) perfusion MRI.Methods The images of 31 patients with cerebral gliomas and 31 normal subjects were retrospectively analyzed.The cerebral blood flow (CBF) were measured with 3D ASL technology,and the asymmetry index (AI) of cerebellar hemispheric CBF value changes were calculated and compared in patients.And the relationship between the AI values of cerebellar hemispheric and the AI values of tumor region in cerebral hemispheric,tumor histological grade and size were investigated.Results Compared with tumor ipsilateral cerebellar hemisphere of supratentorial glioma,the CBF value of contralateral cerebellar hemisphere significantly reduced (t=5.04,P＜0.01),and the AI values of cerebellar hemispheric in patients obviously increased compared to normal subjects (t=4.13,P＜0.01).But there was no significant difference in the AI values of cerebellum between high grade and low grade gliomas (t=1.31,P＞0.05).In cerebral gliomas patients,there was no significant correlation between the AI values of cerebellar hemispheres and the AI values of cerebral hemisphere (tumor:r=-0.28;tumor parenchyma:r=-0.24;tumor plus edema:r=-0.19,all P＞0.05),and tumor size (r=0.18,P＞0.05).Conclusion Cerebral glioma can cause CCD phenomenon,and 3D ASL is able to quantitatively assess the degree of cerebellar hypoperfusion noninvasively.This phenomenon may not be associated with tumor histological grade,size and the AI values of cerebral hemispheric.
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Objective To improve diagnosis accuracy of pineocytoma (PC) by joint analysis of CT,MRI imaging features and differential diagnosis with other lesions in pineal region.Methods Totally 6 pineocytoma patients confirmed surgically and pathologically had their clinical history,CT and MRI data collected and analyzed on lesion morphology,cystic solid changes,existence of necrosis,complications of hemorrhage and or calcification,MRI and enhanced scan of solid component,complications with hydrocephalus and etc.Results Plain scan found 1 case of solid nodule and 5 cases of cystic-solid nodules,2 cases with clearly-bordered lesions and 4 one not as well as 4 cases with significant hydrocephalus and 2 ones with light hydrocephalus.Enhanced scan showed 5 cases of moderate to marked enhancement and one case with no obvious enhancement.CT examination proved there were 1 case of calcification and 1 case of hemorrhage.Conclusion Pineocytoma has the characteristics of benign tumor,and has to be differentiated with other tumors frequently occurring in this region in case of obvious clinical signs due to crushing brain parenchyma or blocking aqueduct cerebri by oversized lesions.
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Objective At present, there is no study on effect of levetiracetam(LEV) on the gray matter structure remodeling in benign epilepsy children with central temporal spikes(BECTS).The purpose of this study was to study the influence of LEV on the gray matter structure in BECTS and to evaluate the mechanism of LEV on the brain structure of BECTS through using voxel-based MRI morphological(VBM) methods.Methods From January 2014 to September 2016, twenty-four BECTS treated with LEV(LEV group), twenty-four drug-na?ve BECTS(untreated group) and twenty-four normal children(normal group) consulted in department of Neurology, Nanjing Children′s Hospital and the Nanjing Military Region, Nanjing General Hospital were continuously included to receive three-dimensional T1-weighted imaging with 3T MRI and the gray matter volume was calculated by VBM.We compared the difference of grey matter volumes of the three groups and analyzed their correlation with epilepsy duration, age of onset and medication time and other clinical index.Results Compared with the normal group, the grey matter volume of bilateral thalamus were decreased, and the volume of bilateral Rolandic areas, anterior insula/frontal operculum/frontal triangle, left supplementary motor area, paracentral lobule, precentral gyrus, superior frontal gyrus and right middle frontal gyrus were increased in the untreated group, but the grey matter volume of the bilateral Rolandic areas, frontal operculum and left supplementary motor area were decreased in the LEV group.Compared with the untreated group, the grey matter volume of bilateral supplementary motor, left paracentral lobule, precentral gyrus, bilateral anterior insula/frontal operculum/frontal triangle, left superior frontal gyrus and right middle frontal gyrus in the LEV group were decreased.The grey matter volume of left anterior insula/frontal operculum areas was negatively correlated with the medication time in LEV group(r=-0.527, P<0.01).Conclusion T The mainly representations of BECTS are thalamic gray matter damage and epileptic-related cortical area irritation structural abnormalities, but the LEV could reshape the epilepsy-related cortical area and the gray matter in the brain area associated with clinical symptoms.
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BACKGROUND:Bone marrow mesenchymal stem cel s (BMSCs) are the focus of research on the proliferation and metastasis of hepatocel ular carcinoma cel s. By genetic engineering techniques, the hepatocel ular carcinoma cel s can be induced to reduce the expression of bioactive factors, thereby seeking suitable intervention targets for improving the interventional effect of BMSCs. OBJECTIVE:To silence the expression of transforming growth factor beta1 (TGFβ1) and osteopontin (OPN) in high metastatic potential hepatocel ular carcinoma cel s (MHCC97-H) fol owed by co-culture with BMSCs and then to observe the change of MHCC97-H cel invasion ability as wel as the interventional effect of BMSCs on the animal model of hepatocel ular carcinoma tissue MHCC97-H by fluorescence imaging in vivo. METHODS:MHCC97-H cel s were divided into four groups:MHCC97-H group was set as a blank control group, and MHCC97-H NC siRNA as negative control group, and MHCC97-H siRNA TGFβ1 and siRNA OPN were experimental groups. Transwel s assay was carried out for co-culture experiments. After 48 hours of co-culture, crystal violet staining was performed for cel counting in three randomly selected fields of vision. Combined with the red fluorescence protein gene, MHCC97-H cel lines in each group were inoculated via the right subaxil ary subcutaneous transplantation to make a tumor model in nude mice. When the tumor volume was up to about 50 mm3, BMSCs were injected into the tumor in the nude mice, and 4 weeks later, fluorescence images were analyzed using software for fluorescence intensity. Frozen hepatocel ular carcinoma tissue sections were taken for 4’,6-diamidino-2-phenylindole staining and fluorescence microscope observation. RESULTS AND CONCLUSION:Cel counting results showed that BMSCs significantly decreased MHCC97-H cel s after gene silencing, and crystal violet staining showed that the migration ability of MHCC97-H cel s was significantly decreased. Tumor volume shown by the fluorescence imaging was significantly reduced after the OPN gene transfection, the fluorescence intensity was lower than that in the other groups, and quantitative results showed that the absorbance value of OPN shRNA cel s decreased significantly compared with other groups, indicating the BMSCs exhibit best interventional effectiveness in OPN-silenced MHCC97-H cel s. Pathological sections showed that BMSCs were mainly distributed in the tumor necrosis area, and the fluorescence expression in the OPN siRNA group was more than that in the TGFβ1 siRNA group and the blank control group, indicating that after OPN gene silencing of MHCC97-H cel s, the distribution of BMSCs in the tumor was increased. To conclude, it is able to reduce the invasive ability of hepatocel ular carcinoma cel s by inhibiting the expression of OPN and TGFβ1 factors, and OPN silencing may be more conductive to BMSCs biotherapy.
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Objective To explore the underlying anatomy of iliac vein compression syndrome (IVCS) using CT, and discuss the imageological index for subtype diagnosis and potential clinical significance. Methods We retrospectively analyzed the imageological data of 69 IVCS patients from July, 2009 to June, 2014. According to CT findings, patients were categorized to simple IVCS (sIVCS, the iliac vein is compressed by only the anterior iliac artery, n=22), lumbar degeneration?related IVCS ( dIVCS, besides the iliac artery, the lower lumbar degenerative changes including osteophyte, protruded disc, etc. pressed the iliac vein from the back, n=33) and other IVCS causes (oIVCS, including tuberculosis, inflammation and fracture hematoma of the lumbar spine, n=14); meanwhile, 69 age? and sex?matched subjects was set as a control group. Evaluated indexes were onset age, course of lower limb swelling and pain, size of the iliac vein tunnel ahead lumbar (IVTAL), lower lumbar spine forward curvature angle (LLSCA), iliac vein?pressed signs by lower lumbar degeneration, compression sites, scope of deep venous thrombosis and interventional therapeutic effect. The differences of those indexes of various groups were compared. Data as onset age, course of disease, sizes of IVTAL and LLSCA were evaluated using variance analysis of the general linear model, with Bofferroni test correction for multiple comparisons. Data as iliac vein?pressed site, scope of venous embolism and therapeutic effect were assessed by crossing table χ2 test. All statistical analyses were performed using SPSS17.0 software (SPSS company, Chicago, USA). Bilateral P≤0.05 were considered to be significant. Results The onset mean age was (61.5 ± 10.6) yr. in dIVCS, (42.3 ± 6.5)yr in sIVCS. and(53.1 ± 16.8)yr. in oIVCS with a significant difference ( F=11.030, P<0.01). Mean sagittal diameter of the IVTAL and LLSCA were(2.3±0.5)mm and(121.8±5.4)° in dIVCS and(2.5± 0.5)mm and(124.4 ± 3.9)° in sIVCS, respectively; which were smaller than those of control group [(6.4 ± 1.6)mm and(127.5 ± 7.3)° , respectively ] and oIVCS [(5.9 ± 2.3)mm and(129.5 ± 5.9)° , respectively ](F=125.275,P<0.01 for sigittal diameter and F=7.95,P<0.01 for LLSCA). The degenerative changes compressing the iliac vein of dIVCS had 41 sites of 33 patients which were respectively the discal forward protrusion or bulge (51%, 17/33), vertebral anterior osteophyte (50%, 16/33)and lower lumbar vertebrae slippage (19%,8/33). The compression sites of dIVCS located exactly anterior to the fifth lumbar(18/33, 56%), the intervertebral disk between the fourth and fifth lumbar(9/33, 26%), the right front (3/33, 9%) and left front (3/33, 9%) of the fifth lumbar, however, that of sIVCS sited the right front(14/22, 64%), exactly the front(4/22, 18%)of the fifth lumbar and exactly anterior(4/22, 18%)to the intervertebral disk between the fourth and fifth lumbar, with a significant difference of location distribution(χ2=19.305, P<0.01). In sIVCSs, deep vein thrombosis of all exceeded the iliac vein length and implicated the femoral vein by 27%(6/22)and the popliteal vein by 73%(16/22), while in dIVCSs 18%(6/33)patients had deep vein thrombosis in the iliac vein, 30%(10/33)in the femoral vein and 52%(17/33)in the popliteal vein, and in oIVCSs, 30%(4/14)patients had deep vein thrombosis in the iliac vein, 40%(6/14)in the femoral vein and 30%(4/14)in the popliteal vein, with a significant difference of thrombosis scope(χ2=9.28, P<0.01). 86%sIVCSs needed intravenous stent?implanted operation to obtain effective treatment, only 52%dIVCSs were performed stent?implanted operation for effective therapy, none of oIVCSs had stent?implanted operation before the iliac vein recanalization. Conclusion CT can precisely display the pathological anatomy features of different IVCS patients, which can potentially help clinicians plan accurate treatment strategy.
ABSTRACT
Objective To establish the animal model of chronic thromboembolic pulmonary hypertension(CTEPH) and to compare the accuracy of dual-energy CT (DECT) pulmonary angiography and histopathology for detecting CTEPH. Methods Eighteen canines were included in the study. All canines underwent paracentesis, embolization, CT scanning, pressure measurement and tranexamic acid feeding. The procedures were repeated every two weeks, until systolic/diastolic pressure in canines was≥30/15 mmHg or mean pulmonary artery pressure ≥ 20 mmHg.And then canines were sacrificed for histopathology examination. For CT pulmonary angiography (CTPA)in DE mode and DECT lung perfused blood volume (Lung PBV) images, the presence or absence of PE or perfusion defects were recorded on a per-canineand aper-lobe basis. With histopathological results as reference standard, the sensitivity, specificity of CTPA and lung PBV to detect PE were computed for two readers. The pairedχ2 test (McNemar test) was used to analyze the difference in diagnostic accuracy between CTPA and Lung PBV. Inter-reader agreement was also calculated with kappa test. Results CTEPH was demonstrated in 13 canines. On a per-canine basis, both readers found uneven and peripheral perfusion defects with DECT in 11 canines (84.6%, 11/13); while 5 canines (38.5%, 5/13) had cutoff or sudden stenosis of pulmonary arteries with CTPA;on a per-lobe basis, both readers had sensitivities of 14.3%(5/35), 83.3%(30/36), specificities of 100.0%(30/30), 100.0%(29/29), accuracies of 53.8%(35/65), 90.8%(59/65)for CTPA and DECT, respectively. DECT had a higher sensitivity(χ2=-4.690,P<0.01)and accuracy(χ2=8.284,P<0.01) in detecting CTEPH. Excellent and moderate inter-reader agreements were observed with CTPA and DECT (Kappa=0.938, 0.572, both P<0.001). Conclusions It is feasible to make a CTEPH animal model with autologous thrombus. DECT shows a higher accuracy than CTPA to detect CTEPH in this canine model study.