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Objective To investigate the microstructural changes of temporal lobe epilepsy(TLE)in patients with sleep disorders based on diffusion kurtosis imaging(DKI).Methods This research prospectively included 38 TLE patients(case group)and 20 healthy controls(HC)(HC group).Participants used sleep questionnaires to evaluate their sleep status.All TLE patients were divided into groups with and without sleep disorders according to the diagnostic criteria and scale scores of sleep disorders.The mean kurtosis(MK),mean diffusivity(MD),and fractional anisotropy(FA)of the relevant region of interest(ROI)were measured by DKI sequence.The differences of sleep quality scores and DKI parameters between groups were further compared via independent samples t-test and one-way analysis of variance.Results The Epworth sleepiness scale(ESS),Athens insomnia scale(AIS),and Pittsburgh sleep qual-ity index(PSQI)scores of TLE patients with sleep disorders were significantly higher than those of HC group(P＜0.05).The FA and MK values in TLE patients were significantly lower than those in HC group,while the MD value of TLE patients were substan-tially higher than that of HC group(P＜0.05).The values of MK and FA in left TLE patients with sleep disorders were significantly lower than those of without sleep disorders(P＜0.05),while there was no significant difference in MD value between the two groups(P＞0.05).MK value of right TLE patients with sleep disor-ders was significantly lower than that of without sleep disorders(P＜0.05),however,there were no significant differences in MD and FA values between the two groups(P＞0.05).Conclusion Quantitative DKI analysis revealed differences in DKI parameters in TLE patients combined with sleep disorders,inferring a specific white matter fiber damage in this group and providing imaging data to support the personalized treatment and prognostic assessment of these patients.
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Objective:To explore the predictive value of a regression model based on diffusion kurtosis imaging (DKI) parameters for prediction of the recurrence risk in patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER-2)-negative early invasive breast cancer.Methods:A retrospective cross-sectional study was designed. The clinicopathological (age, histological grade, Ki-67 level, etc.) and imaging data of 50 patients (50 lesions) with ER-positive, HER-2 negative early invasive breast cancer who underwent treatment at Wuxi People′s Hospital from January 2016 to December 2018 were retrospectively analyzed. All patients were female, aged 29 to 81 years, and underwent pre-operation conventional MRI and DKI examinations. The volume of breast fibroglandular tissue (FGT), background parenchymal enhancement (BPE), and internal enhancement features were recorded; the peak enhancement (PH), peak enhancement rate, time to peak, mean kurtosis (MK), and mean diffusivity (MD) were calculated. Based on the 21-gene recurrence risk scores, patients were divided into low recurrence risk group and medium-high recurrence risk group. Independent sample t test, Mann-Whitney U test, χ2 test were used to compare the differences of various indicators between the two groups. Two logistic models were constructed with age, PH, MD, and MK as independent variables (Pre1), and with Ki-67, age, PH, MD, and MK as independent variables (Pre2), respectively. The efficacy of the models in predicting low recurrence risk in patients was assessed using receiver operating characteristic curve and area under the curve (AUC). Results:There were 25 cases in the low recurrence risk group and 25 cases in the medium-high recurrence risk group. The differences in age, FGT, PH, MD, MK, and Ki-67 between the low recurrence risk group and the medium-high recurrence risk group were statistically significant (all P<0.05), while other indexes showed no statistically significant differences (all P>0.05). The AUC of Pre1 in predicting low recurrence risk of ER-positive, HER-2 negative early invasive breast cancer was 0.87, with a sensitivity of 0.76 and specificity of 0.88. The AUC of Pre2 for predicting the low recurrence risk of ER-positive, HER-2 negative early invasive breast cancer was 0.92, with a sensitivity of 0.84, and specificity of 0.92. Conclusions:A multi-parameter model based on DKI can effectively predict the recurrence risk of ER-positive and HER-2 negative breast cancer. The model with combination of Ki-67 can further improve the predictive efficacy, and help effectively identify patients at low recurrence risk.
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Objective:To analyze the prognostic value of nomogram model for cervical cancer based on the imaging features of diffusion kurtosis imaging (DKI) histogram.Methods:The DKI and clinical data of 272 patients with cervical cancer who were admitted to Affiliated Hospital of Guangdong Medical University from March 2015 to February 2022 were collected and retrospectively analyzed. All patients were randomly divided into the training group ( n=190) and validation group ( n=82) at a ratio of 7 vs. 3. The parameters of DKI histogram were obtained by GE AW 4.2 MRI software. The best prognostic imaging features were screened by LASSO regression. The DKI radiomics score was calculated by linear combination. The independent risk factors of prognosis were identified by univariate and multivariate regression analyses, and a nomogram model was constructed. The model discrimination was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). The internal consistency of the model was evaluated by the calibration map. Results:Adenocarcinoma ( HR=2.496, 95% CI=1.312-4.749, P=0.005), DKI score ( HR=24.087, 95% CI=6.062-95.711, P<0.001), depth of invasion ≥ 1/2 muscular layer ( HR=2.277, 95% CI=1.156-4.487, P=0.017) and neutrophil to lymphocyte ratio (NLR) ( HR=1.800, 95% CI=1.313-2.468, P<0.001) were the independent risk factors for prognosis of cervical cancer. The AUC of the nomogram model in the training and validation groups were 0.860 and 0.757, respectively. The calibration curve was well fitted with the 45° diagonal. The prediction results of long-term prognosis of this model were in good agreement with the actual situation. Conclusions:Adenocarcinoma, NLR, DKI score and depth of invasion ≥ 1/2 muscular layer are the independent risk factors for the prognosis of patients with cervical cancer. The constructed nomogram model could reliably predict the 3-year survival rate of patients with cervical cancer.
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Objective:To investigate the diagnostic value of diffusion kurtosis imaging (DKI) quantitative parameters in lymph node metastasis of rectal cancer.Methods:The clinicopathological data of 79 patients with rectal cancers in Shanxi Province Cancer Hospital from November 2016 to March 2017 were retrospectively analyzed. All patients underwent routine magnetic resonance image (MRI) sequence and DKI sequence examinations before the operation. The tumor region of interest (ROI) was delineated by two radiologists. Matlab software was applied to calculate DKI quantitative parameters including apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) in two groups, respectively; and the consistency analysis was performed by using the interclass correlation coefficients (ICC). According to the results of postoperative pathology, all patients were divided into lymph node metastasis group and lymph node non-metastasis group; ADC, MD, MK of both groups were compared. The pathological diagnosis results were taken as the gold standard, receiver operating characteristic (ROC) curves of DKI quantitative parameters in the diagnosis of lymph node metastasis of rectal cancer were plotted, the area under the curve (AUC) was calculated, the optimal diagnostic threshold was determined based on the Yoden index, and the sensitivity and specificity were calculated.Results:The ICC of ADC, MD and MK calculated by two physicians were 0.934 (0.833-0.975), 0.963 (0.905-0.981) and 0.971 (0.949-0.991), respectively, showing a good inter-observer consistency. Among the 79 patients with rectal adenocarcinoma, 36 cases were in lymph node metastasis group and 43 cases were in lymph node non-metastasis group. MK value in lymph node metastasis group was higher than that in lymph node non-metastasis group, and the difference was statistically significant (0.97±0.08 vs. 0.89±0.09; t = -4.07, P < 0.001), while the ADC and MD values in lymph node metastasis group were lower than those in lymph node non-metastasis group, and the differences were not statistically significant (all P > 0.05). The AUC of MK value in the diagnosis of lymph node metastasis of rectal cancer was 0.735, and the corresponding sensitivity and specificity were 55.56% and 88.37%, respectively. Conclusions:DKI quantitative parameter MK has a certain diagnostic value in predicting lymph node metastasis of rectal cancer.
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Objective:To investigate the changes in structural brain network topology and microstructural damage in patients with multiple sclerosis (MS), and to analyze its correlation with cognitive function.Methods:Clinical and imaging data of 114 patients with MS (MS group) diagnosed in the First Affiliated Hospital of Chongqing Medical University from May 2021 to September 2022 were analyzed retrospectively. In addition, 71 volunteers were recruited as a healthy control group (HC group) during the same period. All subjects were performed on cognitive assessment and 3D-T 1 magnetization-prepared rapid gradient echo, 3D-fluid-attenuated inversion recovery, and diffusion kurtosis imaging (DKI) scans. GRETNA software was used to obtain network topology attributes, and global attributes included global efficiency, local efficiency, and small-world attributes [clustering coefficient(Cp), shortest path length(Lp), normalized Cp(γ), normalized Lp, and small-world index (σ)]. Local attributes included betweenness centrality (BC), degree centrality (DC), nodal clustering coefficient (NCp), nodal efficiency, nodal local efficiency (NLe) and nodal shortest path length. The DKI parameter map generated by the post-processing software was used to extract the DKI parameter values of the brain region with abnormal local topology of the brain structure network. The differences of global attributes, local attributes and DKI parameter values [kurtosis fractional anisotropy (KFA), mean kurtosis (MK), radial kurtosis (RK) and axial kurtosis (AK) values] were analyzed by independent sample t-test or Mann-Whitney U test, and corrected by false discovery rate (FDR). Spearman or Pearson correlation analysis was used to evaluate the correlation between abnormal brain structure network topology attributes and cognitive scale scores in the MS group. Results:Both the MS group and the HC group structure network showed small-world attributes, and the γ and σ values of the MS group were significantly lower than those in the HC group (FDR correction, P<0.05). Compared with the HC group, BC, DC, NCp and NLe broadly reduced in the MS group, mainly involving in bilateral frontal, temporal, precuneus, amygdala, and thalamus (FDR correction, P<0.05). After FDR correction, compared with the HC group, the KFA, MK, RK and AK values of 23 brain regions with abnormal local attributes of the network in the MS group were significantly changed in several brain regions (FDR correction, P<0.05). The correlation analysis showed, after FDR correction, the DC value of the right putamen in MS patients was positively correlated with the digit span test (DST) scores ( r=0.318 ,P=0.001). Conclusion:There are extensive changes in the structural brain network of MS patients, accompanied by varying degrees of microstructural damage, and the reduction of degree centrality in the basal ganglia putamen region is associated with cognitive impairment.
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@#Objective To investigate the microstructure changes of brain regions of interest in patients with Parkinson disease with dysosmia using diffusion kurtosis imaging.Methods DKI scanning was performed in 16 patients with dysosmia and 21 patients without dysosmia.Supramarginal gyrus,postcentral gyrus,heschl gyrus and inferior temporal gyrus were selected as regions of interest.Results The values of FA,KFA,AK and RK in the region of interest in the Parkinson disease group with dysosmia were significantly lower than those without dysosmia (P<0.05);the values of AD,MD and RD in the region of interest in the Parkinson disease group with dysosmia were significantly higher than those without dysosmia (P<0.05);There was a close correlation between the olfactory score and the right supramarginal gyrus,postcentral gyrus,inferior temporal gyrus,bilateral heschl gyrus in the Parkinson disease group with dysosmia (P<0.05).Conclusion DKI parameters can be used as biomarkers for early diagnosis of dysosmia in Parkinson disease.
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Magnetic resonance imaging (MRI) is a very important imaging method for diagnosis and treatment of prostate cancer (PCa) in clinical practice. As functional MRI is growing and maturing, its quantitative parameters are expected to enhance the clinical value of MRI furtherly. Intravoxel incoherent motion diffusion imaging, diffusion tensor imaging, and diffusion kurtosis imaging, which were derived from diffusion weighted imaging, have provided richer and more accurate parameters. The newly-developed magnetic resonance elastography can complement the mechanical characteristics of PCa.
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Humans , Male , Diffusion Magnetic Resonance Imaging , Diffusion Tensor Imaging , Magnetic Resonance Imaging , Motion , Prostatic Neoplasms/diagnostic imagingABSTRACT
Objective:To observe the changes of cognitive function, subcortical nuclei volumes, and diffusion kurtosis imaging (DKI) parameters (values of fractional anisotropy [FA], mean diffusivity [MD] and mean kurtosis [MK]) after surgery in patients with aneurysmal subarachnoid hemorrhage (aSAH), and analyze the correlations of cognitive dysfunction with subcortical nuclei volumes and DKI parameters.Methods:A prospective sutdy was conducted;17 patients with aSAH confirmed by surgery in our hospital from September 2019 to June 2020 were selected as patient group, and 16 healthy volunteers whose age, gender, and education level were matched with the patient group were recruited as control group. Neuropsychological tests and MR imaging were performed in the patients 3 months after surgery and the controls right after enrollment. The structural image data of all subjects were post-processed. Bilateral subcortical nuclei volumes and DKI parameters were analyzed. The differences of general clinical data, subcortical nuclei volumes and DKI parameters were compared between the two groups. The correlations of mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scores with subcortical nuclei volumes and DKI parameters were analyzed.Results:As compared with the control group, the patient group had significantly lower MMSE and MoCA scores, and statistically decreased volumes of ipsilateral hippocampus, ipsilateral thalamus and ipsilateral lentiform nucleus ( P<0.05). The FA values of the contralateral caudate nucleus, bilateral thalamus and bilateral lentiform nucleus and MK values of the ipsilateral hippocampus in the patient group were significantly decreased as compared with those in the control group ( P<0.05); while the MD values of the ipsilateral caudate nucleus in the patient group were significantly increased as compared with those in the control group ( P<0.05). The volume of ipsilateral hippocampus was positively with MoCA scores ( r=0.604, P=0.038); the FA values of contralateral caudate nucleus were negatively correlated with MMSE scores ( r=-0.579, P=0.049). Conclusions:Cognitive dysfunction, atrophy of ipsilateral hippocampus, thalamus and lenticular nucleus, and changes of DKI parameters exist in patients with aSAH after surgery. The changes in ipsilateral hippocampus volume and FA values of caudate nucleus may be related to the postoperative cognitive dysfunction in these patients.
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Objective To investigate the value of quantitative evaluation in white matter damage caused by delayed neuropsychiatric sequelae (DNS) after carbon monoxide poisoning (CO) with diffuse kurtosis imaging (DKI).Methods A prospective study was conducted from November 2016 to February 2019 in 28 patients diagnosed as having DNS after CO poisoning and 30 healthy controls in our hospital.DKI scans were performed within 7 d of onset and DKI-derived parameters (9 regions of interest),including mean kurtosis (MK),axial kurtosis (AK),and radial kurtosis (RK),were obtained.Mini Mental State Examination Scale (MMSE),Barthel Index,Verbal Fluency Test (VFT),and Digital Breadth Test (DST) were performed on both subjects to conduct neurocognitive assessment;multivariate regression analysis was performed to determine the statistical relations of scores of above neurocognitive scales with AK values of ROIs.Results As compared with those in the control group,the MK,AK and RK values in all ROIs showed an increased trend in DNS group;among which,the anterior semioval center,posterior semioval center and frontal lobe enjoyed the most obvious increase,with significant differences (P＜0.05).In the genu of corpus callosum,body of corpus callosum and parietal lobe,the AK value of DNS group was significantly higher than that in the controls (P＜0.05).Except for temporal lobe and occipital lobe,area under the curve (AUC) of AK value of other ROIs in diagnosing DNS was larger than that of RK and MK values of other ROIs;AK value of anterior semioval center (AUC=0.802,P=0.000),posterior semioval center (AUC=0.785,P=0.000),frontal lobe (AUC=0.749,P=0.001),genu of corpus callosum,(AUC=0.730,P=0.003),parietal lobe (AUC=0.699,P=0.009) and body of corpus callosum (AUC=0.654,P=0.045) had better performance than RK and MK in diagnosing DNS,with statistically significant differences (P＜0.05).Multivariate regression analysis results show that the DST value (reverse) is the independent influencing factors of AK values of anterior semioval center,genu of corpus callosum,and frontal lobe;VET (vegetable) is the independent influencing factors of AK values of body of corpus callosum,age is the independent influencing factors of AK values of posterior semioval center,splenium of corpus callosum,and frontal,temporal and occipital lobes;and education is the independent influencing factors of AK values of temporal lobe.Conclusion DKI can quantitatively evaluate the microstructural damage of white matter caused by DNS,and the increase of AK is related to the decrease of neurological function in patients with DNS.
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Objective To investigate the application value of diffusion kurtosis imaging (DKI) in the changes of prefrontal cortex microstructures in patients with mild cognitive impairment (MCI). Methods A total of 79 consecutive patients with cerebral small vascular disease admitted to the Department of Neurology, Chaoyang Hospital, Capital Medical University between January 2018 and December 2018 were enrolled retrospectively. They were confirmed by head MRI and MR angiography and Montreal cognitive assessment scale (MoCA) was used to assess the overall cognitive function. According to the presence or absence of MCI,79 patients were divided into MCI group (n = 46) and non-MCI group (rc = 33). The general clinical data of the two groups of patients were recorded and analyzed; neuropsychological assessment results, including MoCA scale, Hamilton depression rating scale (HAMD) , Hamilton anxiety rating scale (HAMA); conventional MR morphology, and DKI scan results. The prefrontal cortex of the patients was selected as the region of interest, i. e. , bilateral dorsolateral superior gyrus, medial superior frontal gyrus,anterior cingulate,and paracingulate gyrus; the DKI related parameters of the region of interest were measured, including mean diffusivity (MD) , fractional anisotropy (FA), axial kurtosis (AK),mean kurtosis (MK) ,and radial kurtosis (RK). The Bonferroni method was used to adjust P values for multiple comparisons of multiple regions of interest The P value was adjusted with P 0.05). (2) In the right anterior cingulate and paracingulate gyrus,the FA,AK and MK values of the MCI group were lower than those of the non-MCI group. The differences were statistically significant between groups (0. 16 ±0.03 us. 0. 18 ±0.03, 0. 64 ± 0.08 vs. 0.70 ± 0.06, and 0. 67 ± 0. 09 vs. 0. 73 ± 0. 06, all P 0. 008). In the left anterior cingulate and paracingulate gyrus,there were no significant differences in MD,FA, AK,MK and RK between the two groups (all P>0.008). (3) There were no significant differences in the MD,FA,AK,MK and RK values between the bilateral dorsolateral superior frontal gyrus and bilateral medial superior frontal gyrus (all P > 0. 008). Conclusions DKI technique can be used to observe the microstructural change of prefrontal cortex matter in patients with MCI. The parameters related to DKI have certain value in clinical imaging evaluation of patients with MCI.
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Objective To compare the value of diffusion kurtosis imaging (DKI) mode and mono-exponential mode in predicting the response to neoadjuvant chemotherapy (NAC) for locally advanced breast carcinoma using DWI.Methods From January 1,2013 to December 31,2016,eighty patients with locally advanced breast carcinoma were enrolled into this prospective clinical study.The diagnosis was confirmed on the basis of histopathological results.The clinical stage stayed at Ⅱ or Ⅲ.The patients would receive breast-conserving surgery after NAC.All the patients underwent DWI examination by using both mono-exponential mode and DKI mode before chemotherapy was initiated.The parameters included ADC,mean diffusivity (MD) and mean kurtosis (MK).Within 1 to 3 days before or after MRI examination,the patients underwent aspiration biopsy,received 4 to 8 cycles of NAC and followed by surgery.According to histologic grading before NAC,the patients were classified into well-differentiated and poor-differentiated group.According to the comparison between pathological results acquired from biopsy before NAC and specimen acquired after surgery,the patients were classified into pathologic complete response (pCR) and pathologic non-complete response (non-pCR) according to treatment effect.The imaging parameters were compared between the pCR and the non-pCR group using t test.The predicting ability of two imaging modes was compared and analyzed with ROC analysis.The relationships between multiple imaging parameters,pathologic,clinical characteristics of tumor and treatment effect were analyzed using logistic multi-variate regression analysis,and further analyzed using Wald test.Results There were 30 cases of pCR and 50 cases of non-pCR.The ADC and MD values were lower in the pCR group than in the non-pCR group (P＜0.05).MK value was higher in the pCR group than in the non-pCR group (P＜0.05).ROC analysis showed that the area under ROC curve of ADC,MD and MK in predicting treatment effect were 0.732,0.866 and 0.683 respectively.Logistic regression analysis showed that,according to predicting ability,MD,ADC and MK successively were the independent predictors for the early response to chemotherapy.Conclusion Compared with mono-exponential mode,DKI mode can reflect the real micro-environment and water diffusion restriction within the tumor area more reliably and accurately,and is more suitable to serve as an imaging technique for predicting the response to NAC for locally advanced breast carcinoma.
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Objective To compare the difference in the microstructure of gray matter nucleus in basal ganglia of different movement subtypes of Parkinson's disease (PD) by diffusion kurtosis imaging (DKI) technique,and to analyze its clinical significance in the process of disease occurrence and development.Methods A total of 44 PD patients and 20 healthy controls (HC) admitted to the First Hospital of Shanxi Medical University from July 2017 to October 2018 were recruited into the study.The PD patients were classified into tremor dominant (TD) and non-tremor dominant (NTD) subtypes according to motor symptoms.All participants were scanned for DKI sequence.Fractional anisotropy (FA),mean kurtosis (MK),and mean diffusivity (MD) were obtained from bilateral red nucleus,substantia nigra,caudate nucleus,globus pallidus,putamen,and thalamus.The DKI of the deep brain nucleus in TD,NTD,HC groups was compared,and relationships between DKI and clinical measures were tested.Results Comparing the two substypes of PD with the HC group,the TD group had lower FA value (0.346±0.006 vs 0.389±0.009,U=-3.052,P=0.007),higher MK value (1.101±0.008 vs 0.981±0.006,U=-5.577,P=0.000) and higher MD value (1.005(0.919,1.082) vs 0.934 (0.899,0.970),U=2.493,P=0.038) in the substantia nigra ipsilateral to the more affected side than the HC group.The NTD group had higher MK value in the bilateral substantia nigra than the HC group (less affected side:1.090±0.022 vs 0.990±0.008,U=-4.102,P=0.000;more affected side:1.071±0.020 vs 0.981±0.006,U=-3.728,P=0.001).In the PD patients,the MK value in the substantia nigra ipsilateral to the more affected side showed a negative correlation with the Hoehn-Yahr (H-Y) grade,Unified Parkinson's Disease Rating Scale (UPDRS) Ⅲ scores,and non-tremor scores (r=-0.299,P=0.048;r=-0.366,P=0.015;r=-0.402,P=0.007).The FA values of the bilateral putamen of the TD group and the NTD group were lower than those of the HC group.The FA value in putamen contralateral to the more affected side was positively correlated with H-Y grade,UPDRS Ⅲ scores,and non-tremor scores (r=0.331,P=0.028;r=0.403,P=0.007;r=0.376,P=0.012).Compared with the HC group,the FA value of the bilateral globus pallidus was lower in the TD group.Comparing different subtypes of PD,only the FA and MK values of the bilateral thalamus were different.The tremor scores of PD patients were negatively correlated with the FA value of bilateral thalamus (less affected side:r=-0.371,P=0.013;more affected side:r=-0.402,P=0.007),and positively correlated with MK value (less affected side:r=0.547,P＜0.01;more affected side:r=0.532,P＜0.01).Conclusions The microstructure of the deep brain nucleus of PD is changed,while the TD and NTD patients have only differences in the microstructure changes of the thalamus.The changes in the microstructure of the thalamus are related to the severity of tremor in PD patients.
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Objective To explore the value of diffusion kurtosis imaging (DKI) in predicting radiotherapy sensitivity of esophageal cancer from the animal model level.Methods BALB/c nude mice were subcutaneously injected with Eca-109 cell lines to form xenograft tumors.The tumors received a single dose of 15 Gy (6 MV X-rays) in the experimental group or had no any treatment as control.The volume of transplanted tumor,the change of ADC,MK and MD values,and the tumor cell density and necrosis ratio of these two groups were observed at the corresponding time points.Results The growth of xenograft volume in the experimental group was suppressed and it was significantly smaller than that in the control group (t=3.206-6.149,P＜0.05) at the 7th day after radiotherapy.From the 3rd day after radiotherapy,the ADC and MD values of the experimental group were significantly higher than those of the control group,and the MK values was lower than those in the control group (tADC =-11.018--2.049,tMD =-6.609--2.052,tMK =2.492-9.323,P＜0.05).Meanwhile,the tumor cell density of the control group was higher than that of the experimental group,and the proportion of necrosis in the experimental group was higher than that in the control group (tdensity =-8.387--2.239,t is =2.980-17.430,P＜0.05).Conclusions A single large dose radiation could inhibit the growth of xenograft.ADC,MK,MD values changed at the early stage prior to morphological changes of tumor in consistent with the change of cell density and necrosis ratio.DKI has the potential value in predicting radiotherapy sensitivity of esophageal carcinoma.
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Objective To investigate the difference in the microstructure of gray matter nucleus in different movement subtypes of Parkinson’s disease (PD) by diffusion kurtosis imaging ( DKI) technique, and to analyze the correlation with clinical manifestations. Methods Ninety-seven patients with PD and 83 healthy controls performed conventional MRI sequence and DKI sequence scan. The PD patients were classi-fied into gait disorder subtype (PIGD,n=57) and tremor dominant subtype (TD,n=40)subtypes according to motor symptoms. Fractional anisotropy (FA),mean diffusivity (MD),axial diffusivity (Da),radial diffu-sivity(Dr),mean kurtosis (MK),axial kurtosis (Ka) and radial kurtosis (Dr) maps and data were genera-ted by software after processing. DKI was performed for all subjects and data was collected from different brain regions in both hemispheres,including red nucleus(RN),substantia nigra pars reticulate( SNr),sub-stantia nigra pars compacta(SNc),putamen(PUT),globus pallidus(GP),head of caudate nucleus (CN)and thalamus(THA). Results TD showed a higher MMSE score(P=0. 019),but lower modified Hoehn-Yahr score than that in PIGD (P<0. 001),there was no significant difference of age of onset,sex,limbs of onset or disease duration between two PD subgroups. Compared with healthy controls, both TD and PIGD showed down-regulated MD,Da and Dr and up-regulated Ka values(P<0. 001); MK(0. 83±0. 26,0. 80±0. 18) was increased in SNr both in TD and PIGD,while SNc,PUT and GP (0. 84± 0. 20,0. 75± 0. 07,0. 81± 0. 14) were decreased only in TD (P=0. 017,P=0. 010,P=0. 020,P<0. 001,P=0. 002). The Kr values of PUT and CN(0. 71±0. 17,0. 72±0. 14) were reduced in PIGD,while CN(0. 70±0. 14) were reduced in TD re-spectively (P=0. 002,P=0. 031,P=0. 007). The MK was lower in TD than that in PIGD (t=-2. 214,P=0. 029),and no significant difference was found in other grey matter nuclei between TD and PIGD ( P>0. 05). Moreover,there was no significant correlation between DKI value and disease duration,MMSE score or Hoehn-Yahr scale (P>0. 05) in TD and PIGD. Conclusion There is heterogeneity of clinical symptoms between these two subgroups of PD. DKI can quantify the microstructural changes of grey matter nucleus in different type PD patient.
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Objective To explore the value of diffusion kurtosis imaging (DKI) histogram analysis for differential diagnosis of prostate cancer and noncancerous foci and the correlation between histogram parameters and Gleason score. Methods Twenty?one patients were retrospectively enrolled in Beijing Hospital from May 2017 to May 2018. All subjects underwent Philips 3.0 T MR scanning. The pathologies were confirmed by in?bore MR?guided biopsy. Finally, 31 lesions were collected (two lesions each from 10 patients), including 15 prostate cancer and 16 noncancerous foci (benign prostatic hyperplasia and prostatitis). ROI was drawn manually by two experienced radiologists. All the lesions were measured mean apparent diffusion coefficient (Dapp), mean apparent kurtosis coefficient (Kapp) and their histogram parameters, the averages of two measurements were used to be calculated. The values of these parameters in cancer and noncancerous foci were compared using independent?samples t test. The Spearman test was used to evaluate the correlation of these parameters and Gleason scores of prostate cancer. Results Mean Dapp, 10th Dapp, 25th Dapp, 50th Dapp, 75th Dapp, 90th Dapp, minimum Dapp, maximum Dapp, mean Kapp, 50th Kapp, 75th Kapp, 90th Kapp, maximum Kapp between prostate cancer and noncancerous foci were statistically significant (P<0.05). 90th Kapp (r=0.630, P<0.05) and maximum Kapp (r=0.565, P<0.05) increased with the Gleason scores increasing. Conclusion Histogram analysis of DKI model is valuable for diagnosing and assessing aggressiveness of prostate cancer.
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Objective To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters in diagnosing prostate cancer(PCa) in transition zone (TZ) and stratifying pathologic Gleason grade of prostate cancer. Methods A total of 55 patients who were undergoing preoperative muti?parameters MRI of T2WI, DWI, IVIM and DKI model for the exploration of prostate cancer (January 2015 to June 2017) with pathologically confirmed by MRI?transrectal ultrasound (TRUS) targeted fusion biopsy were retrospectively included. Parameters were postprocessed by IVIM models including quantitation of perfusion fraction (f), diffusivity (D) and pseudo?diffusivity (D*) and DKI models including the mean diffusivity (MD), mean kurtosis (MK) and fractional anisotropy (FA) by outlining the 3D VOI. Independent sample t?test was used to compare the differences in lesion parameters between prostate cancer and BPH, low?risk (BPH+Gleason score 6 points) and medium?high?risk lesions (Gleason score ≥7 points). Correlation between ADC values, IVIM and DKI parameters and Gleason scores were assessed with Spearman analysis.Receiver operating characteristic curve analysis was used to evaluate the efficacy of various parameters in the differential diagnosis of prostate cancer and BPH with low?risk or high?risk. Results 27 (36 focus) cases of PCa and 28 (40 focus) cases of benign prostatic hyperplasia(BPH) in PZ were included, meanwhile, the cases of GS≥7 and and BPH+(GS=6) were 33,43,respectively. There were significant differences in ADC, D, MD, MK, and FA between patients in PCa?BHP group and high?low risk group in TZ (P<0.05), D*and f had no significant differences (P>0.05). ADC and MD showed relatively higher negativity correlations (r were－0.585 and－0.489, P<0.05) with GS of PCa in TZ. ADC exhibited a higher area under the curve (AUC 0.864) compared with D with area under the curve (AUC 0.853), however, the difference is not significant (P>0.05). Of model DKI in diagnose of PCa and BPH, the highest classification accuracy was MD(AUC 0.796). The AUC derived from multiple model parameters in different combination of ADC+D value, ADC+MD value, and ADC+MD+D value were 0.892, 0.884, and 0.897, respectively. ADC and D of IVIM model showed a significance difference between GS≥7 and BPH+(GS=6) with a higher AUC of 0.826 and 0.743. The AUC was 0.851 of the combination of mean ADC and D, 0.846 of combination of mean ADC and MD, the AUC (0.856) of the combination of ADC, D and MD significant higher than any two combined parameters (P>0.05). Conclusions IVIM and DKI models may help to discriminate prostate cancer from BPH, and predict mid?higher GS PCa in TZ. But there is no significant advantage compared with ADC values. It is feasible to stratify the pathological grade of prostate cancer in TZ by mean ADC and MD.
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Objective@#To explore the value of diffusion kurtosis imaging (DKI) histogram analysis for differential diagnosis of prostate cancer and noncancerous foci and the correlation between histogram parameters and Gleason score.@*Methods@#Twenty-one patients were retrospectively enrolled in Beijing Hospital from May 2017 to May 2018. All subjects underwent Philips 3.0 T MR scanning. The pathologies were confirmed by in-bore MR-guided biopsy. Finally, 31 lesions were collected (two lesions each from 10 patients), including 15 prostate cancer and 16 noncancerous foci (benign prostatic hyperplasia and prostatitis). ROI was drawn manually by two experienced radiologists. All the lesions were measured mean apparent diffusion coefficient (Dapp), mean apparent kurtosis coefficient (Kapp) and their histogram parameters, the averages of two measurements were used to be calculated. The values of these parameters in cancer and noncancerous foci were compared using independent-samples t test. The Spearman test was used to evaluate the correlation of these parameters and Gleason scores of prostate cancer.@*Results@#Mean Dapp, 10th Dapp, 25th Dapp, 50th Dapp, 75th Dapp, 90th Dapp, minimum Dapp, maximum Dapp, mean Kapp, 50th Kapp, 75th Kapp, 90th Kapp, maximum Kapp between prostate cancer and noncancerous foci were statistically significant (P<0.05). 90th Kapp (r=0.630, P<0.05) and maximum Kapp (r=0.565, P<0.05) increased with the Gleason scores increasing.@*Conclusion@#Histogram analysis of DKI model is valuable for diagnosing and assessing aggressiveness of prostate cancer.
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Objective@#To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters in diagnosing prostate cancer(PCa) in transition zone (TZ) and stratifying pathologic Gleason grade of prostate cancer.@*Methods@#A total of 55 patients who were undergoing preoperative muti-parameters MRI of T2WI, DWI, IVIM and DKI model for the exploration of prostate cancer (January 2015 to June 2017) with pathologically confirmed by MRI-transrectal ultrasound (TRUS) targeted fusion biopsy were retrospectively included. Parameters were postprocessed by IVIM models including quantitation of perfusion fraction (f), diffusivity (D) and pseudo-diffusivity (D*) and DKI models including the mean diffusivity (MD), mean kurtosis (MK) and fractional anisotropy (FA) by outlining the 3D VOI. Independent sample t-test was used to compare the differences in lesion parameters between prostate cancer and BPH, low-risk (BPH+Gleason score 6 points) and medium-high-risk lesions (Gleason score ≥7 points). Correlation between ADC values, IVIM and DKI parameters and Gleason scores were assessed with Spearman analysis. Receiver operating characteristic curve analysis was used to evaluate the efficacy of various parameters in the differential diagnosis of prostate cancer and BPH with low-risk or high-risk.@*Results@#27 (36 focus) cases of PCa and 28 (40 focus) cases of benign prostatic hyperplasia (BPH) in PZ were included, meanwhile, the cases of GS ≥7 and and BPH+(GS=6) were 33,43,respectively. There were significant differences in ADC, D, MD, MK, and FA between patients in PCa-BHP group and high-low risk group in TZ (P<0.05), D* and f had no significant differences (P>0.05). ADC and MD showed relatively higher negativity correlations (r were -0.585 and -0.489, P<0.05) with GS of PCa in TZ. ADC exhibited a higher area under the curve (AUC 0.864) compared with D with area under the curve (AUC 0.853), however, the difference is not significant (P>0.05). Of model DKI in diagnose of PCa and BPH, the highest classification accuracy was MD(AUC 0.796). The AUC derived from multiple model parameters in different combination of ADC+D value, ADC+MD value, and ADC+MD+D value were 0.892, 0.884, and 0.897, respectively. ADC and D of IVIM model showed a significance difference between GS ≥7 and BPH+(GS=6) with a higher AUC of 0.826 and 0.743. The AUC was 0.851 of the combination of mean ADC and D, 0.846 of combination of mean ADC and MD, the AUC (0.856) of the combination of ADC, D and MD significant higher than any two combined parameters (P>0.05).@*Conclusions@#IVIM and DKI models may help to discriminate prostate cancer from BPH, and predict mid-higher GS PCa in TZ. But there is no significant advantage compared with ADC values. It is feasible to stratify the pathological grade of prostate cancer in TZ by mean ADC and MD.
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Objective@#To investigate the difference in the microstructure of gray matter nucleus in different movement subtypes of Parkinson’s disease (PD) by diffusion kurtosis imaging (DKI) technique, and to analyze the correlation with clinical manifestations.@*Methods@#Ninety-seven patients with PD and 83 healthy controls performed conventional MRI sequence and DKI sequence scan. The PD patients were classified into gait disorder subtype (PIGD, n=57) and tremor dominant subtype (TD, n=40)subtypes according to motor symptoms. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (Da), radial diffusivity(Dr), mean kurtosis (MK), axial kurtosis (Ka) and radial kurtosis (Dr) maps and data were generated by software after processing. DKI was performed for all subjects and data was collected from different brain regions in both hemispheres, including red nucleus(RN), substantia nigra pars reticulate(SNr), substantia nigra pars compacta(SNc), putamen(PUT), globus pallidus(GP), head of caudate nucleus (CN)and thalamus(THA).@*Results@#TD showed a higher MMSE score(P=0.019), but lower modified Hoehn-Yahr score than that in PIGD (P<0.001), there was no significant difference of age of onset, sex, limbs of onset or disease duration between two PD subgroups. Compared with healthy controls, both TD and PIGD showed down-regulated MD, Da and Dr and up-regulated Ka values(P<0.001); MK(0.83±0.26, 0.80±0.18) was increased in SNr both in TD and PIGD, while SNc, PUT and GP (0.84±0.20, 0.75±0.07, 0.81±0.14)were decreased only in TD (P=0.017, P=0.010, P=0.020, P<0.001, P=0.002). The Kr values of PUT and CN(0.71±0.17, 0.72±0.14) were reduced in PIGD, while CN(0.70±0.14) were reduced in TD respectively (P=0.002, P=0.031, P=0.007). The MK was lower in TD than that in PIGD (t=-2.214, P=0.029), and no significant difference was found in other grey matter nuclei between TD and PIGD(P>0.05). Moreover, there was no significant correlation between DKI value and disease duration, MMSE score or Hoehn-Yahr scale (P>0.05) in TD and PIGD.@*Conclusion@#There is heterogeneity of clinical symptoms between these two subgroups of PD. DKI can quantify the microstructural changes of grey matter nucleus in different type PD patient.
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Objective To compare the value of diffusion kurtosis imaging (DKI) and intravoxel incoherent motion (IVIM) in evaluation of histological classification and grading of cervical squamous cell carcinoma and cervical adenocarcinoma. Methods DKI and IVIM data of 60 patients with cervical cancer were retrospectively analyzed, and MK, MD, D, D* and f values were measured. The differences of the parameters between cervical squamous cell carcinoma group (n=38) and cervical adenocarcinoma group (n=22) were analyzed, as well as among different graded subgroups. The diagnostic efficiency of each parameter was evaluated with ROC curve, the correlations between the parameters and pathological grades were analyzed using Spearman method. Results MK of cervical squamous cell carcinoma group was higher than that of cervical adenocarcinoma group, while MD, D, D* and f were lower than those of cervical adenocarcinoma group (all P<0.05). In both groups, the differences of MK, MD and D were statistically significant among different subgroups (all P<0.05), while in cervical adenocarcinoma group, the differences of f were also statistically significant among different subgroups (all P<0.05). MK had the highest AUC in diagnosing cervical squamous cell carcinoma and adenocarcinoma.Except for D*, there was correlation between other parameters and pathological grade (all P<0.05). Conclusion Compared with IVIM, DKI can more effectively evaluate cervical squamous cell carcinoma and cervical adenocarcinoma and their pathological grading.