Apolipoprotein B and ischemic stroke / 国际脑血管病杂志

Studies have shown that plasma apolipoprotein B (ApoB) has a good predictive value for ischemic stroke and plays an important role in the prevention and treatment of ischemic stroke. More and more guidelines and consensus opinions began to recommend ApoB as a routine intervention target. This article reviews the biological characteristics, clinical detection advantages, and role and treatment prospect of ApoB in the prevention and treatment of ischemic stroke.

Combination of 3.0T magnetic resonance imaging T mapping with texture analysis for evaluating the degeneration of lumbar facet joints / 中南大学学报(医学版)

OBJECTIVES@#Quantitative magnetic resonance imaging has been successfully applied to assess the status of cartilage biochemical components. This study aimed to investigate the performance of 3.0T magnetic resonance imaging T mapping combined with texture analysis for evaluating the early degeneration of lumbar facet joints.@*METHODS@#A total of 38 patients (20 in the asymptomatic group and 18 in the symptomatic group) were enrolled. All patients underwent 3.0T magnetic resonance imaging conventional sequences, water excitation three-dimensional spoiled gradient echo sequence (3D-WATSc), and T mapping scans. The bilateral L and L/S lumbar facet joints were morphological graded using the Weishaupt criteria, T values, and texture parameters derived from T mapping of cartilage. The Kruskal-Wallis test was used to compare the differences of parameters among different groups. Multivariate logistic regression analysis was used to obtain the independent predictive factors for evaluating the early degeneration of lumbar facet joints. Receiver operating characteristic (ROC) curve was performed and the area under curve (AUC) was calculated. Spearman correlation analysis was used to evaluate the correlation of the independent predictors of cartilage T value and texture parameters with the subjects' Japanese Orthopedic Association (JOA) score or Visual Analogue Scale (VAS) score.@*RESULTS@#A total of 148 facet joints were selected, including 70 in Weishaupt 0 (normal) group, 58 in Weishaupt 1 group, and 20 in Weishaupt 2-3 group. T value, entropy, and contrast increased significantly as the exacerbation of facet joint degeneration (all <0.05), while the inverse difference moment, energy, and correlation decreased (all <0.05). Entropy among different groups was significantly different (all <0.05), and the differences of T value, contrast, inverse difference moment, and energy between Weishaupt 0 and Weishaupt 1 groups, or Weishaupt 0 and Weishaupt 2-3 groups were statistically significant (all <0.05). Multivariate logistic regression analysis suggested that T value and inverse difference moment were the independent predictors for evaluating early degeneration of facet joints. The combination of T value with inverse difference moment achieved the best performance in distinguishing Weishaupt 0 from Weishaupt 1 (AUC=0.85), with sensitivity and specificity at 92.7% and 76.5%, respectively. In the symptom group, the cartilage T value combined inverse difference moment was positively correlated with JOA score (=0.475, <0.05) and VAS score (=0.452, <0.05).@*CONCLUSIONS@#3.0T magnetic resonance imaging T mapping combined with texture analysis is helpful to quantitatively evaluate the early degeneration of lumbar facet joints, in which the T value and inverse difference moment show an indicative significance．.

Visualization analysis for radiomics research based on knowledge mapping / 中南大学学报(医学版)

To illustrate the literature distribution, research power distribution, and research hotspots in the radiomics research by using knowledge mapping analysis, and to provide reference for relevant researchers.
 Methods: Bibliographies from literature regarding radiomics in Web of Science database were downloaded. BICOM 2.0.1 and SATI 3.2 were used to clean and caculate the frequency of publication year, journal, author, key word, and research institution. CiteSpace V4.4.R1 was used to build the knowledge map of scientific research collaboration network between countries/regions.Ucinet 6 was used to build the knowledge map of scientific research collaboration network between core authors and institutions. gCLUTO 1.0 was applied to construct high-frequency keywords bi-clustering map.
 Results: A total of 700 literature was screened. Since 2012 the number of publications has been growing rapidly year by year. The United States, China, and Netherlands were leaders in this field. There were 5 major scientific research institution cooperative groups and 10 major author cooperative groups. Eight research hotspots were clustered by using high-frequency key word bi-clustering analysis.
 Conclusion: Radiomics is a new field and develops very fast. More and more countries, research institutions, and researchers with multidisciplinary background are going to participate in this filed. New terminology and new methods are going to appear in the field.

Combination of prostate imaging reporting and data system with the apparent diffusion coefficient map for the diagnosis of peripheral zone prostate cancer / 中南大学学报(医学版)

To explore the value of prostate imaging reporting and data system version 2 (PI-RADS V2) combined with quantitative parameters derived from apparent diffusion coefficient (ADC) map in the diagnosis of peripheral zone prostate cancer.
 Methods: A total of 50 patients who underwent prostate multiparametric MRI (mpMRI) with suspicious peripheral nodules were retrospectively enrolled, and all patients were biopsy-proven histologically. Two radiologists analyzed the position and category of peripheral zone lesions based on PI-RADS V2. Then 12 ADC quantitative parameters were calculated regarding each lesion on the ADC map by post-processing software. The lesions were divided into malignant group and benign group according to histopathological findings. The ADC quantitative parameters between groups were compared, and stepwise logistic regression analysis was used to build a discriminative model. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were performed to evaluate the diagnostic power and clinical benefit.
 Results: Twenty-eight peripheral zone prostate malignant lesions and 25 benign lesions were obtained finally. The area under the ROC curve, sensitivity and specificity to differentiate peripheral zone prostate malignant from benign lesions were as follows: 0.803, 60.71%, 92.00% (PI-RADS V2 score), 0.857, 89.29%, 76.00% (ADC model), and 0.891, 71.43%, 92.00% (combined model), respectively. The discriminative power of the combined model was significantly improved compared with PI-RADS V2 score (P=0.012). The combined model had relatively optimal overall net benefit, which outperformed the PI-RADS V2 score when threshold probability varied in the range of 0.05-0.27 and 0.46-0.81.
 Conclusion: PI-RADS V2 combined with quantitative analysis of ADC map improve the power in discriminating peripheral zone prostate cancer from benign lesions, and the clinical benefit as well.

Radiomics strategy based on cardiac magnetic resonance imaging cine sequence for assessing the severity of mitral value regurgitation / 中南大学学报(医学版)

To assess the performance of radiomics model based on cardiac magnetic resonance imaging (CMR) cine sequence for assessing the severity of mitral regurgitation.
 Methods: A total of 80 patients who underwent CMR and echocardiography examination were retrospectively enrolled, including 67 patients with no or slight mitral regurgitation and 13 patients with moderate or severe mitral regurgitation. The relative difference in average filtered gradient (RDAFG) of CMR cine sequence were generated, which were combined with minimum output sum of squared error tracker (MOSSE) to extract 25 radiomics features. After reducing feature dimensionality by principal component analysis (PCA) and oversampling the minority samples, the radiomics model was established using support vector machine (SVM). The performance of the model was assessed by receiver operating characteristic (ROC) curve.
 Results: There were significant differences (both P<0.01) of the 2-dimension radiomics features between the two groups. The best performance (area under the ROC curve) of the established radiomics model was 0.971, with sensitivity and specificity at 85.7% and 94.1%, respectively.
 Conclusion: The performance of the machine learning-based radiomics model derived from CMR cine sequence for assessing the severity of mitral regurgitation was excellent, which can facilitate the computer-aided diagnosis and treatment in the era of artificial intelligence.

CT-based estimation of liver function using arterial enhancement fraction in liver cirrhosis patients / 中南大学学报(医学版)

To explore the feasibility and clinical value of CT-based arterial enhancement fraction (AEF) for evaluating liver function in liver cirrhosis patients.
 Methods: Fifty-two patients with liver cirrhosis (Child-Pugh A, B, and C group included 13, 20, and 19 patients, respectively) and 17 patients without liver diseases as control were prospectively enrolled, respectively. All individuals underwent three-phase hepatic CT, and the color mapping of AEF were obtained in CT kinetics software, as well as the corresponding parameters, i.e., hepatic AEF (HAEF) and the ratio of HAEF to spleen AEF (H/S). The AEF parameters were compared among different groups, and the area under the receiver operating characteristic curve (AUROC) was calculated. The Spearman correlation analysis was performed between the AEF parameters and model for end-stage liver disease (MELD) score in liver cirrhosis patients.
 Results: The interobserver agreement of HAEF and H/S were perfect, and the intraclass correlation coefficient (ICC) were 0.918 (95% CI 0.871 to 0.949), 0.946 (95% CI 0.915 to 0.966), respectively. The HAEF and H/S among those groups were significant different (both P<0.001), and they elevated with the increase of Child-Pugh classification in liver cirrhosis patients (all P<0.05, except the H/S between Child-Pugh A and B). In all patients with liver cirrhosis, the AUROC of HAEF and H/S were 0.933 and 0.821 for Child-Pugh A, and were 0.925 and 0.915 for Child-Pugh C, respectively. The HAEF and H/S of patients with liver cirrhosis were significantly correlated with the MELD score (HAEF: r=0.752, P<0.001; H/S: r=0.676, P<0.001).
 Conclusion: CT-based AEF parameters including HAEF and H/S are closely associated with the severity and prognosis of patients with liver cirrhosis, which have the potential to estimate the liver function in liver cirrhosis patients quantitatively and effectively.

Construction of three-dimensional finite element model and biomechanical study on patient with with cervical spondylotic myelopathy / 中南大学学报(医学版)

To establish a three-dimensional finite element model (FEM) of the neck, to analyze the differences in neck biomechanics between patient with cervical spondylotic myelopathy (CSM) and healthy subject and to provide biomechanics basis for the pathogenesis of CSM.
 Methods: A patient with CSM was enrolled in a mechanical simulation experiment. Three-dimensional CT scan was performed, and three-dimensional FEM of the neck was constructed. A heathy subject was selected as a control according to the patient's age, gender, height, and weight. Three-dimensional FEM was used to compare the stress differences in the vertebral body, intervertebral disc, ligament and spinal cord under the normal stress of the cervical spine and the maximum stress of the posterior reclining motion.
 Results: Successfully constructed FEM model of CSM patient and control, and performed mechanical analysis, the most obvious difference in cervical vertebral body force was at C5-C6 segment in CSM patients. The maximum stress site of control and patient was at the anterior edge of the vertebral body. The maximum stress of the vertebral body in the CSM patient was less than that of the control. The stress distribution of the intervertebral disc was irregular in the CSM patient, and the maximum stress was concentrated on both sides of the posterior edge of the intervertebral disc. The stress distribution of the ligaments of the CSM patient was uneven. The maximum stress was in the posterior longitudinal ligament. The range of neck movement in extension of the CSM patient was restricted.
 Conclusion: Compared with the healthy subject, the balance of the vertebral body, intervertebral disc, ligament and limited range of motion of the CSM patient has been changed, which may be related to the mechanical pathogenesis of cervical spondylotic myelopathy.

Radiomics in predicting tumor molecular marker P63 for non-small cell lung cancer / 中南大学学报(医学版)

Objective:To establish a radiomics signature based on CT images of non-small cell lung cancer (NSCLC) to predict the expression of molecular marker P63.Methods:A total of 245 NSCLC patients who underwent CT scans were retrospectively included.All patients were confirmed by histopathological examinations and P63 expression were examined within 2 weeks after CT examination.Radiomics features were extracted by MaZda software and subjective image features were defined from original non-enhanced CT images.The Lasso-logistic regression model was used to select features and develop radiomics signature,subjective image features model,and combined diagnostic model.The predictive performance of each model was evaluated by the receiver operating characteristic (ROC) curve,and compared with Delong test.Results:Of the 245 patients,96 were P63 positive and 149 were P63 negative.The subjective image feature model consisted of 6 image features.Through feature selection,the radiomics signature consisted of 8 radiomics features.The area under the ROC curves of the subjective image feature model and the radiomics signature in predicting P63 expression statue were 0.700 and 0.755,respectively,without a significant difference (P＞0.05).The combined diagnostic model showed the best predictive power (AUC=0.817,P＜0.01).Conclusion:The radiomics-based CT scan images can predict the expression status of NSCLC molecular marker P63.The combination of the radiomics features and subjective image features can significantly improve the predictive performance of the predictive model,which may be helpful to provide a non-invasive way for understanding the molecular information for lung cancer cells.

Radiomics and its advances in hepatocellular carcinoma / 中南大学学报(医学版)

Liver cancer is the second leading cause of cancer-related death worldwide,so early detection and prediction for response to treatment is of great benefit to hepatocellular carcinoma (HCC) patients.Currently,needle biopsy and conventional medical imaging play a significant and basic role in HCC patients' management,while those two approaches are limited in sample error and observerdependence.Radiomics can make up for this deficiency because it is an emerging non-invasive technic that is capable of getting comprehensive information relevant to tumor situation across spatial-temporal limitation.The basic procedure for radiomics includes image acquisition,region of interest segmentation and reconstruction,feature extraction,selection and classification,and model building and performance evaluation.The current advances and potential prospect of radiomics in HCC studies are involved in diagnosis,prediction for response to treatment,prognosis evaluation and radiogenomics.

Development of a radiomics signature to predict Ki-67 expression level in non-small cell lung cancer / 中南大学学报(医学版)

To develop a radiomics signature based on CT image features to estimate the expression level of Ki-67 in non-small cell lung cancer (NSCLC).
 Methods: A total of 108 NSCLC patients, who underwent non-enhanced and contrast-enhanced CT scan in our hospital from January 2014 to November 2017, were retrospectively analyzed. They were confirmed by histopathological examination and undergone Ki-67 expression level test within 2 weeks after CT examination. The non-enhanced and contrast-enhanced CT three-dimensional structural images of the lesions were manually delineated by MaZda software, and the texture features of the region of interest were extracted. Combination of feature selection and classification methods were used to build radiomics signatures, and the classification were assessed using misclassification rates. The MaZda software provides texture feature selection methods including mutual information (MI), Fisher coefficients (Fisher), classification error probability combined with average correlation coefficients (POE+ACC), and Fisher+POE+ACC+MI (FPM), and texture feature analysis including raw data analysis (RDA), principal component analysis (PCA), linear classification analysis (LDA) and nonlinear classification analysis (NDA).
 Results: Among the 108 patients, 50 cases were at high levels of Ki-67 expression and 58 cases were at low levels of Ki-67 expression, respectively. The differences of gender, age and pathological type between the two groups were statistically significant (P<0.05). The radiomics signature built by FPM feature selection combined with NDA feature analysis based on non-enhanced CT images achieved the best performance for predicting the level of Ki-67 with a misclassification rate of 14.81%. However, radiomics signature based on contrast-enhanced CT images did not reduce the misclassification rate.
 Conclusion: The radiomics signature based on conventional CT image texture features is helpful to predict the expression of Ki-67 in NSCLC lesions, which can provide a non-invasive technique for assessing the invasiveness and prognosis for NSCLC.

Transhepatic arterial embolization with superparamagnetic iron oxide and lipiodol for the treatment of VX2 tumor in rabbits / 中南大学学报(医学版)

Objective:To evaluate the feasibility and therapeutic efficacy of transhepatic arterial embolization with superparamagnetic iron oxide (SPIO) and lipiodol (LIP) for the treatment of VX2 tumor in rabbits.Methods:Twenty-four rabbits with hepatic VX2 tumors by surgical implantation were randomly divided into 4 groups and treated with transhepatic arterial embolization of 4 different agents as follows (n=6 each):doxorubicin (DOX) group,DOX-LIP group,SPIO-DOX group,and SPIO-DOX-LIP group.Liver function (AST and ALT) was measured at 0,1,3,5 and 7 d after transhepatic arterial embolization.The serum DOX level was measured at 0,5,15,30,60,and 120 minutes after transhepatic arterial embolization.MRI was performed at 7 d after the treatment to assess the distribution of SPIO in the SPIO-DOX group and SPIO-DOX-LIP group,while CT was performed to assess the distribution of LIP in the DOX-LIP group and SPIO-DOX-LIP group.All the rabbits were sacrificed and their livers were removed at 7 d after treatment for the detection of tissue DOX level.The histopathologic examinations were performed including HE staining,Prussian blue staining and TUNEL assay,and then the tumor necrosis percentage and apoptosis index were calculated.Results:Compared to the DOX group,the levels of AST and ALT in other 3 groups were significantly elevated at 1 and 3 d after embolization (P＜0.05).The levels of ALT and AST in the DOX group,DOX-LIP group or SPIO-DOX-LIP group returned to the baseline at day 7,there were no significant differences (P＞0.05).The SPIO-DOX-LIP group exhibited the lowest serum DOX level at all time points up to 120 minutes after embolization (P＜0.05).However,the tissue DOX level in the SPIO-DOX-LIP group was the highest among all groups at day 7 (P＜0.05).The SPIO-DOX group and SPIO-DOX-LIP group showed significantly lower MRI signal intensity of tumors in T2 weighted imaging (T2WI) at day 7.Meanwhile DOX-LIP group and SPIO-DOX-LIP group showed that high-density lipiodol was deposited in the tumors in CT images.Histopathologic findings showed an almost complete central necrosis coagulation of tumors in the SPIO-DOX-LIP group,and the tumor necrosis percentage and tumor apoptosis index were significantly increased in the SPIO-DOX-LIP group compared to those in other 3 groups (P＜0.05).Conclusion:This novel drug-delivery system of SPIO nano-drug carrier together with LIP is safe and feasible when it is used for transhepatic arterial embolization for liver tumor.It provides an excellent MR and CT visualization and improves the therapeutic efficacy for the treatment of rabbit VX2 liver tumor.

Value of multi-slice spiral CT image texture analysis in diagnosing lymphatic metastasis of rectal cancer / 中华放射学杂志

Objective To investigate the value of multi-slice spiral CT image texture analysis in differentiating metastatic (MLN) from non-metastatic lymph nodes (NLN) in patients with rectal cancer.Methods Thirty five patiets with rectal cancer who were pathologically confirmed by total mesorectum excision were included retrospectively,with regional lymph nodes (short-axis diameter of larger than 3 mm)found in preoperative CT images.All the patients underwent preoperative abdominal and pelvic dynamic contrast-enhanced CT scan.Regional lymph nodes were identified according to pathological findings,and were divided into MLN and NLN groups.The short-axis diameter,short-to long-axis diameter ratio of lymph nodes were manually measured and calculated,and the texture features,including skewness,kurtosis,variance,entropy and inverse difference moment,were analyzed.The above parameters between MLN and NLN groups were compared using independent sample t test or Mann-Whitney U test.ROC curve analysis was performed regarding the statistically significant parameters and the areas under curve (AUC) were calculated.Multivariate Logistic regression analysis was accomplished to obtain the independent predictive factor of diagnosing regional lymph nodes.Results A total of 68 regional lymph nodes were obtained and consisted of 31 MLNs and 37 NLNs.The short-axis diameter,kurtosis,and entropy of the MLN group were significantly higher than those of the NLN group (all P＜0.05).Whereas,the short-to long-axis diameter ratio,skewness,variance,and inverse difference moment did not differ significantly between the two groups (all P＞0.05).The AUC for distinguishing MLN from NLN of the short-axis diameter,kurtosis and entropy were 0.79,0.67,and 0.85,respectively.Multivariate logistic regression analysis showed that only entropy (odds ratio=8.48,95％ confidence interval was 3.01 to 23.92,P＜0.01) was screened out as the independent variable,which suggested that the entropy was the unique predictor for characterizing regional lymph nodes of rectal cancer.Conclusion Multi-slice spiral CT images texture analysis can facilitate the accurate differentiation between MLN and NLN in patients with rectal cancer,and especially the entropy has the optimal reference significance.

Perfusion computed tomography imaging and its clinical applications in chronic liver diseases / 中国医师杂志

Perfusion computed tomography (CT) imaging is a kind of functional imaging technique to evaluate and determine the hepatic and portal blood flow noninvasively.It offers the significant clinical advantages in the early diagnosis,evaluation of treatment response,and prognosis assessment in chronic liver diseases.In this article,we reviewed the principle,scanning protocol,clinical applications,and advances in chronic liver diseases of hepatic perfusion CT imaging.

Multi-slice spiral CT (MSCT) : value of evaluating intestinal ischemia and therapeutic strategy for patients with intestinal obstruction / 中国医师杂志

Objective To explore early signs of strangulated bowel with multi-slice spiral CT (MSCT),and the ability of this diagnostic modality to indicate when surgical management is required for intestinal obstruction with ischemia.Methods A total of 746 patients of intestinal obstruction were investigated with MSCT scan.The final diagnosis was confirmed by surgery and/or angiography.According to the final diagnosis,those cases were divided into ischemia groups (n =70) and no ischemia group (n =676).According to surgical findings,the cases in ischemia group was divided into necrosis group (n =31) and no-necrosis group (n =39).The clinical manifestations,CT signs,and surgical/angiography findings were retrospectively evaluated in this study.Results Among the typical MSCT signs for evaluating intestinal ischemia of intestinal obstruction,no enhancement,thickening,and reduced unenhanced attenuation of bowel wall had relatively high sensitivity and specificity.However,intestinal expansion,pneumatosis and effusion was absence of high specificity,and gas in bowel wall or mesenteric vascular was absence of high sensitivity.Mesenteric congestion was another important sign for intestinal ischemia.Filling defect in mesenteric vascular was highly specific to diagnosis intestinal ischemia.The MSCT signs to assess intestinal necrosis in moderate-high risk intestinal obstruction included no enhancement of bowel wall (sensitivity 0.93,specificity 0.69),mesenteric congestion (sensitivity 0.97,specificity 0.64),filling defect in mesenteric vascular (sensitivity 0.78,specificity 0.92),and ascites (sensitivity 0.77,specificity 0.92).Conclusions MSCT is an important non-invasive examination in diagnosing intestinal blood perfusion disorder and intestinal necrosis.It is much more valuable to bowel obstruction assessment than the value of symptom and physical examinations of the patient.It can provide valuable guidance to treatment strategy of bowel obstruction patient.