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Objective:To investigate the prognostic value of texture analysis of MRI diffusion weighted imaging (DWI) for neonatal hypoglycemic encephalopathy (HE).Methods:The clinical data and MRI data of 119 patients with neonatal HE admitted to Children′s Hospital of Nanjing Medical University from July 2013 to September 2020 were retrospectively analyzed. The children were followed up to 7—8 months and scored by Bayley scales of infant and toddler development. According to the overall development index, the children were divided into three groups: normal group (≥85, group A, n=42), mild developmental retardation group (70－84, group B, n=46) and developmental retardation group (≤69, group C, n= 31). The whole brain region (except sulcus and cisterna) was delineated as region of interest (ROI) by LIFEx 3.4 software in MRI apparent diffusion coefficient images. A total of 37 parameters were calculated automatically by the software, The clinical data, including gender, gestational age, age at MRI scan, birth weight, mode of delivery, history of asphyxia at birth, maternal preeclampsia or diabetes, minimum blood glucose, duration of hypoglycemia, neonatal behavioral neurological assessment (NBNA), presence or absence of polycythemia); the texture parameters, including histogram, volume, gray level co-occurrence matrix (GLCM), gray level run length matrix (GLRLM), neighborhood gray tone difference matrix (NGTDM), gray level size zone matrix (GLSZM), in the three groups were analyzed; and the diagnostic efficacy of clinical parameters and texture parameters was analyzed. Multivariate Logistic regression was used to analyze statistically significant clinical parameters and texture parameters, and receiver operating characteristic curve (ROC) was used to evaluate the prognostic efficacy of these parameter for neonatal HE. Results:There were no significant differences in gender, gestational age, age at MRI scan, delivery mode and blood glucose minimum among the three groups ( P>0.05). There were significant differences in birth weight [(3 150±130)g, (3 020±220)g, (2 880±140)g, F=-0.31, P=0.015], history of suffocation (10 cases, 18 cases, 20 cases, P=0.001), history of maternal diabetes or preeclampsia (14 cases, 29 cases, 21 cases, P=0.002), blood glucose duration [(5.0±0.2)d, (8.0±0.4)d, (14.0±1.7)d, F=-3.09, P=0.030] and NBNA scores (32.0±3.2, 28.0±2.6, 22.0±1.9, F=-4.21, P=0.010) among three groups. There were significant differences in kurtosis and entropy of histogram (2.57±1.12, 3.66±0.98, 4.23±0.37, F=3.54, P=0.010;5.89±1.09, 7.67±2.12, 8.92±1.62, F=-4.42, P=0.020); energy, contrast and dissimilarity of GLCM (0.48±0.01, 0.36±0.02, 0.23±0.01, F=-3.12, P=0.001;2 419±21, 3 354±31, 4 313±26, F=-4.16, P=0.020;126±14, 153±23, 344±43, F=-3.50, P<0.001); long run emphasis of GLRLM (0.78±0.15, 1.12±0.12, 1.76±0.31, F=-4.13, P=0.006), run length non-uniformity and run percentage (71.7±13.9, 96.6±10.7, 104.1±13.5, F=-0.98, P=0.001;0.91±0.05, 0.84±0.21, 0.72±0.17, F=2.97, P=0.010); coarseness and busyness of NGTDM [0.09±0.01, 0.13±0.03, 0.26±0.07, F=-1.95, P=0.003;0.16(0.04, 4.14), 0.32(0.05, 9.84), 0.45(0.15, 10.14), H=-3.24, P=0.030], short-zone emphasis and short-zone high gray length emphasis of GLSZM (4.74±0.45, 3.44±1.03, 1.88±0.67, F=-3.14, P=0.040; 278 963±239, 164 607±544, 111 653±618, F=-3.84, P=0.001) among three groups. Multivariate Logistic regression showed that duration of hypoglycemia, NBNA score, energy, kurtosis, run percentage and short zone effect were independent risk factors for poor prognosis of neonatal HE ( OR=7.43, 4.09, 1.10, 2.11, 1.36, 1.68, P=0.002, 0.027, 0.001, 0.006, 0.007, 0.010, respectively). ROC curve showed that for combined hypoglycemic duration, NBNA and texture parameters, the area under the curve (AUC) was the highest (AUC=0.94, P<0.001). Conclusion:Texture analysis of the MRI diffusion weighted imaging can predict the prognosis of neonatal hypoglycemic encephalopathy at an early stage, which has better prediction efficiency when combined with clinical features.
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Objective To explore the clinical and imaging features of pulmonary embolism (PE)in children with mycoplasma pneumonia (MP).Methods The clinical features,imaging manifestations and laboratory data of 6 children with MP complicated by PE were reviewed retrospectively.Results 6 cases of children were admitted with chief complaints of fever and cough,the D-dimer levels were increased obviously.Consolidation was observed in 4 cases in the right lower lobe combined with pleural effusion and in 2 cases in the left lobe,which showed homogeneous enhancement.Filling defect of pulmonary artery was observed in 1 case,and other 5 cases showed sparse pulmonary vascular in consolidation area.D-dimer returned to normal level and consolidation was absorbed after anticoagulation therapy.Conclusion MP combined with PE in children is rare,and the positive detection rate of pulmonary artery angiography is low.PE should be considered when MP continues to deterioration after anti-infection treatment,even though there is no typical imaging findings of PE.
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Objective To explore the clinical and imaging features of pulmonary embolism (PE)in children with mycoplasma pneumonia (MP).Methods The clinical features,imaging manifestations and laboratory data of 6 children with MP complicated by PE were reviewed retrospectively.Results 6 cases of children were admitted with chief complaints of fever and cough,the D-dimer levels were increased obviously.Consolidation was observed in 4 cases in the right lower lobe combined with pleural effusion and in 2 cases in the left lobe,which showed homogeneous enhancement.Filling defect of pulmonary artery was observed in 1 case,and other 5 cases showed sparse pulmonary vascular in consolidation area.D-dimer returned to normal level and consolidation was absorbed after anticoagulation therapy.Conclusion MP combined with PE in children is rare,and the positive detection rate of pulmonary artery angiography is low.PE should be considered when MP continues to deterioration after anti-infection treatment,even though there is no typical imaging findings of PE.
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Objective To analyze characteristics of patients with acute left ventricular failure,to explore application of non -invasive ventilator in elderly patients with acute left ventricular failure in first aid,and to provide reference for clinical practice.Methods The 84 cases of elderly patients with acute left ventricular failure were selected,in accordance with the random number table.They were divided into control group and treatment group,both groups were given conventional drugs and methods of treatment,while the treatment group was treated by using of non-invasive ventilator -assisted therapy based on the control group.The main changes in physiological indicators of treatment,clinical efficacy and prognosis of the two groups were compared.Results After treatment,in the control group,the clinical total effective rate was 61.9%,while in the treatment group was 88.1%,there were significant differences (χ2 =3.841,P <0.05).Before treatment,RR,HR,SBP,PaO2 and SaO2 of the control group were (28.70 ± 1.01)min,(133.22 ±13.20)min,(112.87 ±14.02)mmHg,(55.60 ±10.56)mmHg and (80.25 ±3.26)%respectively,while the data after treatment were (20.04 ±1.42)min,(95.83 ±14.56)min,(96.08 ±13.84)mmHg, (79.86 ±11.69)mmHg and (90.24 ±3.45)%.Before treatment,RR,HR,SBP,PaO2 and SaO2 of the treatment group were (28.87 ±1.34)min,(135.36 ±10.98)min,(110.90 ±13.65)mmHg,(57.80 ±11.35)mmHg and (81.33 ±3.34)%,while the data after treatmen was (15.86 ±1.13 )min,(84.22 ±11.82)min,(84.26 ± 10.27)mmHg,(89.31 ±12.21)mmHg and (99.35 ±3.96)%.Arterial blood gas indicators in the two groups had improved(t≥5.523,P <0.05),but the degree of improvement in the treatment group compared with the control group was significant difference (t =14.927,4.186,4.445,3.834,11.241,all P <0.05).The turnaround time of the treatment group was (12.7 ±4.1)h,which was significantly lower than that of control group[(20.8 ±5.6)h (t =7.563,P <7.563)].The length of hospital stay in treatment group was (11.8 ±3.9)d,significantly shorter than that in the control group[(18.5 ±4.9)d (t =6.933,P <0.05)].The mortality of treatment group was 2.38%,which was significantly lower than 16.67% of control group (χ2 =2.488,P <0.05).Conclusion On the basis of conven-tional treatment,the use of non -invasive ventilator -assisted therapy in elderly patients with acute left ventricular failure,can significantly improve the main physiological indicators,the effect of improving the clinical treatment and the prognosis is good.
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Objective To assess CT diagnostic value of gastric stromal tumor (GST). Methods Clinical data and spiral CT findings of 20 patients with pathologically proven GST were analyzed retrospectively. Results Twenty lesions were solitary in plain CT scan image. The malignant lesions (n=9) were larger than 5.0 cm in diameter and cystic degenerations as well as necrosis were detected within the tumors, while the underlying malignant lesions (n=11) were smaller than 5.0 cm in diameter and most of them showed homogeneous density. Calcification was detected in 2 patients. On enhanced CT scan, the substantial part of the lesions was obviously strengthened. Multiplanar reformation displayed the relationship of tumor and stomach clearly. Conclusion The CT imaging features of gastric stromal tumor are characteristic. Plain CT scan and multiplanar reformation are helpful to determine the location and nature of gastric stromal tumors.