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Objective:Utilizing functional magnetic resonance imaging (fMRI) to investigate changes in brain structure and function in patients with alcohol dependence (AD) complicated by major depressive disorder (MDD), and assessing the clinical significance of fMRI in diagnosing alcohol dependence complicated by MDD.Methods:From August 2019 to October 2022, 90 patients with AD complicated by MDD and 90 healthy subjects who concurrently received physical examination in our hospital were included in the study. All participants underwent magnetic resonance imaging (MRI) and fMRI to observe the brain tissue structure of patients with AD complicated by MDD and to assess differences in N-acetylaspartic acid/creatine (NAA/Cr) and factional anisotropy (FA) values across different brain tissue regions.Results:The widths of the left and right ventricular temporal angles in the AD complicated by MDD group [(2.67 ± 0.24) mm, (2.63 ± 0.25) mm] were significantly higher than those observed in the healthy control group [(2.29 ± 0.21) mm, (2.31 ± 0.23) mm, t = 22.48, 20.64, both P < 0.001]. Additionally, the volumes of the left and right hippocampus and nucleus accumbens in the AD complicated by MDD group [(2 673.46 ± 155.74) mm 3, (2 692.29 ± 154.61) mm 3, (682.04 ± 65.37) mm 3, (729.65 ± 68.49) mm 3] were significantly lower compared with those in the healthy control group [(2 826.53 ± 158.95) mm 3, (2 849.17 ± 157.23) mm 3, (766.28 ± 69.51) mm 3, and (805.43 ± 71.36) mm 3, t = -9.53, -8.44, -15.62, -13.92, all P < 0.001]. Moreover, the NAA/Cr values in the left and right frontal lobes, temporal lobes, hippocampi, and nucleus accumbens in the AD complicated by MDD group were significantly lower than those in the healthy control group ( t = -11.36, -7.19, -9.96, -7.84, -14.59, -8.25, -7.64, -6.84, all P < 0.001). Similarly, the FA values of the left and right frontal lobes, temporal lobes, hippocampi, and right nucleus accumbens in the AD complicated by MDD group were significantly lower compared with those in the healthy control group ( t = -9.48, -11.74, -9.22, -10.36, -16.85, -14.67, -5.28, all P < 0.001). Conclusion:Patients with AD accompanied by MDD exhibit alterations in brain tissue structure, neuronal metabolic function, and the integrity of white matter nerve fibers. fMRI is effective in identifying changes in brain neuron metabolism and the integrity of white matter nerve fibers, making it invaluable for the diagnosis and assessment of AD accompanied by MDD.
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Objective To observe the value of apparent diffusion coefficient(ADC)for evaluating short-term efficacy of TACE for treating colorectal cancer liver metastases(CRLM).Methods Data of 60 liver metastases in 28 CRLM patients who underwent TACE were retrospectively analyzed.Based on MRI after the first TACE,according to the response evaluation criteria of solid tumors,the liver metastases were divided into response group(n=38)and non-response group(n=22).ADC parameters obtained with diffusion weighted imaging(DWI)before and after TACE,including ADC before TACE(ADCpre),after the first TACE(ADCpost1)and after the second TACE(ADCpost2)were compared between groups,while ADC change value(ΔADC)and the percentage of ΔADC were calculated.The maximum diameter of the target foci were measured,and the correlation between ΔADCpost1 and the change of the maximum diameter of target foci were analyzed.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to observe the efficacy of ΔADCpost1 for evaluating short-term efficacy of TACE for CRLM.Results No significant difference of ADCpre was found between groups(P=0.484).After the first TACE,ADCpost1,ΔADCpost1 and percentage of ΔADCpost1 in response group were all higher than those in non-response group(all P＜0.05).After the second TACE,no significant difference of ADCpost2,ΔADCpost2 nor percentage of ΔADCpost2 was found between groups(all P＞0.05).The maximum diameter change of the target foci after the first TACE was(-0.48±0.93)cm,which was negatively correlated with ΔADCpost1(rs=-0.347,P=0.007).AUC of ΔADCpost1 for evaluating short-term efficacy of TACE for CRLM was 0.717.Conclusion ADC had good efficacy for evaluating short-term efficacy of TACE for treating CRLM.
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ABSTRACT Purpose: This study aimed to analyze the association between magnetic resonance imaging apparent diffusion coefficient map value and histopathological differentiation in patients who underwent eye enucleation due to retinoblastomas. Methods: An observational chart review study of patients with retinoblastoma that had histopathology of the lesion and orbit magnetic resonance imaging with apparent diffusion coefficient analysis at Hospital de Clínicas de Porto Alegre between November 2013 and November 2016 was performed. The histopathology was reviewed after enucleation. To analyze the difference in apparent diffusion coefficient values between the two major histopathological prognostic groups, Student's t-test was used for the two groups. All statistical analyses were performed using SPSS version 19.0 for Microsoft Windows (SPSS, Inc., Chicago, IL, USA). Our institutional review board approved this retrospective study without obtaining informed consent. Results: Thirteen children were evaluated, and only eight underwent eye enucleation and were included in the analysis. The others were treated with photocoagulation, embolization, radiotherapy, and chemotherapy and were excluded due to the lack of histopathological results. When compared with histopathology, magnetic resonance imaging demonstrated 100% accuracy in retinoblastoma diagnosis. Optic nerve invasion detection on magnetic resonance imaging showed a 66.6% sensitivity and 80.0% specificity. Positive and negative predictive values were 66.6% and 80.0%, respectively, with an accuracy of 75%. In addition, the mean apparent diffusion coefficient of the eight eyes was 0.615 × 103 mm2/s. The mean apparent diffusion coefficient value of poorly or undifferentiated retinoblastoma and differentiated tumors were 0.520 × 103 mm2/s and 0.774 × 103 mm2/s, respectively. Conclusion: This study revealed that magnetic resonance imaging is useful in the diagnosis of retinoblastoma and detection of optic nerve infiltration, with a sensitivity of 66.6% and specificity of 80%. Our results also showed lower apparent diffusion coefficient values in poorly differentiated retinoblastomas with a mean of 0.520 × 103 mm2/s, whereas in well and moderately differentiated, the mean was 0.774 × 103 mm2/s.
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Objective:To investigate the effect of insular involvement on the outcomes of patients with acute anterior circulation ischemic stroke.Methods:Patients with acute anterior circulation ischemic stroke admitted to the Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2015 to December 2020 were retrospectively included. Demographic data, vascular risk factors, clinical and laboratory data, as well as treatment and outcomes were collected. Firstly, the correlation between the insular involvement and the outcomes was investigated, and then the bootstrap method was used to clarify the mediating role of infarct volume between the insular involvement and the poor outcomes.Results:A total of 450 patients with acute anterior circulation ischemic stroke were enrolled, among whom 79 cases (17.6%) had insular involvement and 41 (9.1%) had left insular involvement. There were 111 (24.7%) with poor outcomes, including 5 (1.1%) died. Compared to the non-insular involvement group, the insular involvement group had a higher proportion of patients with atrial fibrillation, shorter onset to door time, higher neutrophil-to-lymphocyte ratio (NLR), higher National Institutes of Health Stroke Scale (NIHSS) score at admission, larger infarct volume, and higher proportion of patients with poor outcomes (all P<0.05). In addition, patients with left insular involvement were younger than those with right insular involvement, had a higher baseline NIHSS score, a lower proportion of patients with minor stroke (NIHSS score ≤8), and had a longer onset to door time (all P<0.05). Compared to the good outcome group, the poor outcome group was older, with a higher proportion of female patients, higher systolic blood pressure, blood glucose, NLR, and NIHSS scores at admission, larger infarct volume, and a higher proportion of patients with insular involvement (all P<0.05). Mediation analysis suggested that the mediating effect of infarct volume between the insular involvement and the poor outcomes was significant (95% confidence interval 0.033-0.230; P=0.008). Conclusions:insular involvement in patients with acute anterior circulation ischemic stroke is associated with the poor outcomes, and this association may be mediated by infarct volume. Patients with left insular involvement may have more severe symptoms than those with right insular involvement, but there is no significant difference in the outcomes.
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Cerebral small vessel disease (CSVD) is a group of pathological, imaging and clinical syndromes involving small cerebral vessels with different causes. The incidence rate of CSVD increases with age and is the most important cause of vascular cognitive impairment. Different diffusion imaging techniques can quantify white matter microstructure damage by revealing the diffusion movement of water molecules in specific brain tissues, explore the basis and biophysical mechanisms of tissue change, and have important value for the mechanism research, early diagnosis, progression risk, and therapeutic evaluation of cognitive impairment related to CSVD. This article reviews the research progress of diffusion magnetic resonance imaging in CSVD related cognitive impairment.
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Objective:To explore the clinical application value of dynamic contrast-enhanced MRI (DCE) time-signal intensity curve (TIC) combined with diffusion weighted imaging (DWI) in the diagnosis of benign and malignant breast lesions.Methods:This study was a retrospective study. 95 patients with suspected breast cancer who were diagnosed and treated in the Beijing Huairou Hospital from October 2018 to October 2021 were taken as the study subjects. All patients received DCE-TIC and DCE-DWI examinations, and then underwent needle biopsy after imaging examination. We evaluated the diagnostic efficacy of DCE-TIC and DCE-DWI alone and in combination in benign and malignant breast lesions by collecting general clinical data and apparent diffusion coefficient (ADC) values of patients, using pathological examination results as the " gold standard" .Results:A total of 95 patients with suspected breast cancer were diagnosed as benign lesions in 25 cases and malignant lesions in 70 cases after biopsy. Compared with benign lesions, the tumor diameter and ADC value of malignant lesions were significantly different (all P<0.05). The eceiver operating characteristic (ROC) curve of subjects was drawn, and the area under the curve (AUC) of DCE-DWI diagnosis of breast cancer was 0.826. 95 suspected breast cancer patients were diagnosed by DCE-TIC in 28 cases of type Ⅰ, 27 cases of type Ⅱ, and 40 cases of type Ⅲ. With the pathological diagnosis results as the " gold standard", the accuracy, sensitivity, and negative predictive value of DCE-TIC combined with DCE-DWI in the diagnosis of breast cancer were higher than those of a single diagnosis, with a statistically significant difference (all P<0.05); The specificity and positive predictive value of combined diagnosis were not statistically significant compared to single diagnosis (all P>0.05). Conclusions:Both DCE-TIC and DCE-DWI can differentiate benign and malignant breast lesions, and the accuracy, sensitivity, and positive predictive value of combined diagnosis are higher than those of single diagnosis. The combination of DCE-TIC and DCE-DWI can help improve the differential efficiency of breast lesion properties.
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Objective:To investigate the value of a nomogram predicting the outcome of intracerebral hemorrhage (ICH) based on clinical characteristics and diffusion-weighted imaging (DWI) of hyperintense lesions.Methods:A case-control study. Consecutive patients, aged 30-88(59±13) years old, with ICH were recruited at the Stroke Center of Zhengzhou People′s Hospital from January 2018 to August 2021. Patients were divided into a group with DWI lesions and a group without DWI lesions depending on whether there were DWI hyperintense lesions distant from the hematoma. Prognosis was evaluated at 90 days via the modified Rankin Scale (mRS). Univariate and multivariable logistic regression models were used to identify independent predictors of a poor ICH outcome (mRS score≥4), and a nomogram model was developed. The performance of the nomogram was validated via the area under the receiver operating characteristic curve (AUC) and a calibration chart.Results:Of the 303 patients included in the study, 24.8% presented with DWI lesions; 17.5% with asymptomatic DWI lesions and 7.3% with symptomatic DWI lesions. Poor outcomes were significantly more frequent in the group with DWI lesions than in the group without DWI lesions ( χ2=21.32, P<0.001). In multivariable regression analysis, age [odds ratio ( OR)=1.032, 95% confidence interval ( CI) 1.002-1.063, P=0.035], hematoma volume ( OR=1.050, 95% CI 1.011-1.090, P=0.012), hematoma location ( OR=3.839, 95% CI 1.248-11.805, P=0.019), DWI lesions ( OR=3.955, 95% CI 1.906-8.206, P<0.001), and baseline NIHSS scores ( OR=1.102, 95% CI 1.038-1.170, P=0.001) were independent predictors of a poor outcome. In subgroup analysis patients with asymptomatic DWI lesions had a 3-fold greater risk of a poor outcome compared to those without DWI lesions ( OR=3.135, 95% CI 1.382-7.112, P=0.006), and patients with symptomatic DWI lesions had a 7-fold greater risk of a poor outcome compared to those without DWI lesions ( OR=7.126, 95% CI 2.279-22.277, P=0.001). A nomogram model was established based on the independent predictors for a poor outcome. The AUC of the nomogram was 0.846 (95% CI 0.795-0.898), and a calibration chart indicated good consistency between values predicted by the nomogram and actual observed values. Conclusions:DWI lesions are an independent risk factor for a poor outcome in patients with ICH-particularly symptomatic DWI lesions. A nomogram model based on clinical characteristics and DWI lesions exhibited good efficacy when predicting the outcome of ICH.
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Objective:To investigate the intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in the differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus (T2DM).Methods:A diagnostic test. In this prospective study, patients with T2DM who underwent both IVIM-DWI and renal biopsy at the First Medical Center of Chinese PLA General Hospital between October 2017 and September 2021 were consecutively enrolled. IVIM-DWI parameters including perfusion fraction (f), pure diffusion coefficient (D), and pseudo-diffusion coefficient (D*) were measured in the renal cortex, medulla, and parenchyma. Patients were divided into the DN group and NDRD group based on the renal biopsy results. IVIM-DWI parameters, clinical information, and diabetes-related biochemical indicators between the two groups were compared using Student′s t-test or Mann-Whitney U test. The correlation of IVIM-DWI parameters with diabetic nephropathy histological scores were analyzed using Spearman′s correlation analyzes. The diagnostic efficiency of IVIM-DWI parameters for distinguishing between DN and NDRD were assessed using the receiver operating characteristic (ROC) curves. Results:A total of 27 DN patients and 23 NDRD patients were included in this study. The DN group comprised 19 male and 8 female patients, with an average age of 52±9 years. The NDRD group comprised 16 male and 7 female patients, with an average age of 49±10 years. The DN group had a higher D* value in the renal cortex and a lower f value in the renal medulla than the NDRD group (9.84×10 -3 mm 2/s vs. 7.35×10 -3 mm 2/s, Z=-3.65; 41.01% vs. 46.74%, Z=-2.29; all P<0.05). The renal medulla D* value was negatively correlated with DN grades, interstitial lesion score, and interstitial fibrosis and tubular atrophy (IFTA) score ( r=-0.571, -0.409, -0.409; all P<0.05) while the renal cortex f value was positively correlated with vascular sclerosis score ( r=0.413, P=0.032). The renal cortex D* value had the highest area under the curve (AUC) for discriminating between the DN and NDRD groups (AUC=0.802, sensitivity 91.3%, specificity 55.6%). Conclusion:IVIM-derived renal cortex D* value can be used non-invasively to differentiate DN from NDRD in patients with T2DM that can potentially facilitate individualized treatment planning for diabetic patients.
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Objective:To explore the correlation of apparent diffusion coefficient (ADC) of magnetic resonance diffusion weighted imaging (DWI) examination before radiotherapy in patients with advanced cervical squamous cell carcinoma with clinicopathological characteristics and radiotherapy efficacy.Methods:The clinical data of 80 patients with advanced cervical cancer who were admitted to the Second Hospital of Nanjing from September 2019 to March 2022 were retrospectively analyzed. All patients underwent magnetic resonance imaging (MRI) DWI examination. The differences in ADC values among cervical squamous cell carcinoma patients with different clinicopathological characteristics were analyzed. The patients were divided into the effective group (complete remission+partial remission) and the ineffective group (stable disease+progressive disease) based on the radiotherapy effect, and the differences in ADC values between the two groups were compared. The logistic regression model was used to analyze the factors affecting the radiotherapy efficacy of patients with advanced cervical squamous cell carcinoma.Results:Among 80 patients with advanced cervical squamous cell carcinoma, 21 achieved complete remission, 31 achieved partial remission, 25 achieved stable disease, and 3 achieved progressive disease after radiotherapy; there were 52 cases in the effective group and 28 cases in the ineffective group. The ADC value of the effective group before radiotherapy was higher than that of the ineffective group [(0.99±0.14)×10 -3mm 2/s vs. (0.76±0.20)×10 -3mm 2/s], and the difference was statistically significant ( t = 6.01, P < 0.001); after radiotherapy, the ADC value of the effective group was also higher than that of the ineffective group [(1.43±0.25)×10 -3mm 2/s vs. (1.11±0.23)×10 -3mm 2/s), and the difference was statistically significant ( t = 5.61, P < 0.001); the ADC values of both the effective and ineffective groups increased after radiotherapy compared to before radiotherapy (both P < 0.05). The ADC values of patients with different International Federation of Obstetrics and Gynecology (FIGO) stage, degree of pathological differentiation, depth of lesion infiltration, Ki-67 expression, lymph node metastasis, and distant metastasis were statistically significant (all P < 0.05). The results of multivariate logistic regression analysis showed that ≥FIGO stage Ⅲ, low differentiation, lymph node metastasis, lymphatic vessel infiltration, distant metastasis, and low ADC value before radiotherapy were independent risk factors for efficacy of radiotherapy in patients with advanced cervical squamous cell carcinoma (all P < 0.05). Conclusions:The ADC value before radiotherapy is a factor that affects the radiotherapy effect of patients with advanced cervical squamous cell carcinoma. The lower the ADC value before radiotherapy is, the worse the radiotherapy effect of patients will be.
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ABSTRACT Optic neuritis is an important cause of decreased vision due to inflammation of the optic nerve. In view of its complex etiology, a thorough clinical evaluation is essential. Autoimmune optic neuropathy, a rare form of optic neuritis, is associated with progressive, painless, and severe visual loss. Severity depends on the inflammatory and ischemic components of the condition. Autoimmune optic neuropathy is ideally diagnosed with autoimmune disease markers (usually elevated levels of antinuclear antibodies). The treatment is immunosuppression with high doses of corticosteroids. Corticoid dependence is a characteristic of autoimmune optic neuropathy. In this report, we describe a patient with autoimmune optic neuropathy and discuss the importance of laboratory parameters and magnetic resonance imaging findings in the diagnosis of the disease.
RESUMO A Neurite óptica é uma importante causa de diminuição da visão devido à inflamação do nervo óptico. Por apresentar diversas etiologias faz-se necessário ampla investigação. A neuropatia óptica autoimune corresponde a uma doença rara que se manifesta com perda visual aguda, indolor e grave. A gravidade está associada a sua fisiopatogenia com componentes inflamatório e isquêmico. A positividade para marcadores de doenças autoimunes, mais comumente a elevação da titulação de anticorpos antinucleares, são fatores determinantes para o diagnóstico da neuropatia óptica autoimune. O tratamento é feito através de imunossupressão, com necessidade de altas doses de corticoide. Neste relato iremos descrever um paciente com neuropatia óptica autoimune. Discutiremos sobre a importância dos parâmetros laboratoriais e os achados de imagem da ressonância magnética para o diagnóstico.
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ABSTRACT Bladder cancer (BCa) is one of the most common cancers worldwide and is also considered to be one of the most relapsing and aggressive neoplasms. About 30% of patients will present with muscle invasive disease, which is associated with a higher risk for metastatic disease. The aim of this article is to review the state of art imaging in Radiology, while providing a complete guide to urologists, with case examples, for the rationale of the development of the Vesical Imaging Reporting and Data System (VI-RADS), a scoring system emphasizing a standardized approach to multiparametric Magnetic Resonance Imaging (mpMRI) acquisition, interpretation, and reporting for BCa. Also, we examine relevant external validation studies and the consolidated literature of mpMRI for bladder cancer. In addition, this article discusses some of the potential clinical implications of this scoring system for disease management and follow-up.
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ABSTRACT Background: the diagnosis of Parkinson's disease (PD) can be challenging, especially in the early stages, albeit its updated and validated clinical criteria. Recent developments on neuroimaging in PD, altogether with its consolidated role of excluding secondary and other neurodegenerative causes of parkinsonism, provide more confidence in the diagnosis across the different stages of the disease. This review highlights current knowledge and major recent advances in magnetic resonance and dopamine transporter imaging in aiding PD diagnosis. Objective: This study aims to review current knowledge about the role of magnetic resonance imaging and neuroimaging of the dopamine transporter in diagnosing Parkinson's disease. Methods: We performed a non-systematic literature review through the PubMed database, using the keywords "Parkinson", "magnetic resonance imaging", "diffusion tensor", "diffusion-weighted", "neuromelanin", "nigrosome-1", "single-photon emission computed tomography", "dopamine transporter imaging". The search was restricted to articles written in English, published between January 2010 and February 2022. Results: The diagnosis of Parkinson's disease remains a clinical diagnosis. However, new neuroimaging biomarkers hold promise for increased diagnostic accuracy, especially in earlier stages of the disease. Conclusion: Future validation of new imaging biomarkers bring the expectation of an increased neuroimaging role in the diagnosis of PD in the following years.
RESUMO Antecedentes: O diagnóstico da doença de Parkinson (DP) pode ser desafiador, principalmente nas fases iniciais da doença, embora tenha critérios clínicos atualizados e validados. Os avanços recentes em neuroimagem na DP, além do seu papel já consolidado de excluir causas secundárias e outras causas neurodegenerativas de parkinsonismo, tem contribuído para uma maior confiabilidade no diagnóstico em diferentes estágios da doença. Nesta revisão, nós destacamos os principais avanços de ressonância magnética e imagem do transportador de dopamina em auxiliar o diagnóstico de DP. Objetivo: realizar uma revisão acerca do conhecimento atual sobre o papel da ressonância magnética e imagem do transportador de dopamina no diagnóstico de doença de Parkinson. Método: Realizamos uma revisão não sistemática da literatura através da base de dados PubMed, utilizando as palavras-chave "Parkinson", "magnetic resonance imaging", "diffusion tensor", "diffusion-weighted", "neuromelanin", "nigrosome-1", "single-photon emission computed tomography", "dopamine transporter imaging". A busca foi restrita a artigos escritos em inglês, publicados entre janeiro de 2010 e fevereiro de 2022. Resultados: O diagnóstico de doença de Parkinson continua sendo um diagnóstico clínico, contudo, novos biomarcadores de neuroimagem são promissores para o aumento da acurácia diagnóstica, especialmente em fases mais precoces da doença. Conclusão: A validação futura de novos biomarcadores de imagem traz a expectativa de um maior papel da neuroimagem no diagnóstico de doença de Parkinson nos próximos anos.
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Abstract Background: Topographic patterns may correlate with causes of ischemic stroke. Objective: To investigate the association between diffusion-weighted imaging (DWI) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Methods: We included 1019 ischemic stroke patients. DWI were classified as: i) negative; ii) DWI single lesion (cortico-subcortical, cortical, subcortical ≥20 mm, or subcortical <20 mm); iii) scattered lesions in one territory (small scattered lesions or confluent with additional lesions); and iv) multiple lesions (multiple unilateral anterior circulation [MAC], multiple posterior circulation [MPC], multiple bilateral anterior circulation [MBAC], and multiple anterior and posterior circulations [MAP]). Results: There was a relationship between DWI patterns and TOAST classification (p<0.001). Large artery atherosclerosis was associated with small, scattered lesions in one vascular territory (Odds Ratio [OR] 4.22, 95% confidence interval [95%CI] 2.61-6.8), MPC (OR 3.52; 95%CI 1.54-8.03), and subcortical lesions <20 mm (OR 3.47; 95%CI 1.76-6.85). Cardioembolic strokes correlated with MAP (OR 4.3; 95%CI 1.64-11.2), cortico-subcortical lesions (OR 3.24; 95%CI 1.9-5.5) and negative DWI (OR 2.46; 95%CI 1.1-5.49). Cryptogenic strokes correlated with negative DWI (OR 4.1; 95%CI 1,84-8.69), cortical strokes (OR 3.3; 95%CI 1.25-8.8), MAP (OR 3.33; 95%CI 1.25-8.81) and subcortical lesion ≥20 mm (OR 2.44; 95%CI 1,04-5.73). Lacunar strokes correlated with subcortical lesions diameter <20 mm (OR 42.9; 95%CI 22.7-81.1) and negative DWI (OR 8.87; 95%CI 4.03-19.5). Finally, MBAC (OR 9.25; 95%CI 1.12-76.2), MAP (OR 5.54; 95%CI 1.94-15.1), and MPC (OR 3.61; 95%CI 1.5-8.7) correlated with stroke of other etiologies. Conclusions: A relationship exists between DWI and stroke subtype.
RESUMEN Antecedentes: Los patrones topográficos pueden correlacionarse con las causas del accidente cerebrovascular isquémico. Objetivo: Investigar la asociación entre imágenes ponderadas por difusión por resonancia nuclear magnética (dRNM) y el ensayo de Org 10172 en la clasificación de tratamiento agudo de accidentes cerebrovasculares (TOAST). Métodos: Fueron incluidos 1.019 pacientes con accidente cerebrovascular isquémico. Las dRNM fueron clasificadas como: i) negativa; ii) dRNM lesión única (cortico-subcortical, cortical, subcortical ≥20 mm, o subcortical <20 mm); iii) lesiones disgregadas un territorio vascular (pequeñas lesiones dispersas o confluentes con lesiones adicionales); y iv) lesiones múltiples (unilaterales de circulación anterior [MAC], de circulación posterior [MPC], bilaterales de circulación anterior [MBAC] y de circulación anterior y posterior [MAP]). Resultados: Existió relación entre los patrones de dRNM y la clasificación TOAST (p<0,001). La aterosclerosis de las arterias grandes se asoció con lesiones pequeñas y disgregadas en un territorio vascular (Odds Ratio [OR] 4,22, intervalo de confianza del 95% [IC95%] 2,61-6,8), MPC (OR 3,52; IC95% 1,54-8,03), y lesiones subcorticales <20 mm (OR 3,47; IC95% 1,76-6,85). Cardioembolias se relacionaron con MAP (OR 4,3; IC95% 1,64-11,2), lesiones cortico-subcorticales (OR 3,24; IC95% 1,9-5,5) y dRNM negativas (OR 2,46; IC95% 1,1-5,49). Los accidentes cerebrovasculares criptogénicos se relacionaron con dRNM negativas (OR 4,1; IC95% 1,84-8,69), accidentes cerebrovasculares corticales (OR 3,3; IC95% 1,25-8,8), MAP (OR 3,33; IC95% 1,25-8,81) y lesiones subcorticales ≥20 mm (OR 2,44; IC95% 1,04-5,73). Los accidentes cerebrovasculares lacunares se correlacionaron con lesiones subcorticales de diámetro <20 mm (OR 42,9; IC95% 22,7-81,1) y dRNM negativas (OR 8,87; IC95% 4,03-19,5). Finalmente, MBAC (OR 9,25; IC95% 1,12-76,2), MAP (OR 5,54; IC95% 1,94-15,1) y MPC (OR 3,61; IC95% 1,5-8,7) se relacionaron con accidentes cerebrovasculares de otras etiologías. Conclusiones: Existe relación entre dRNM y subtipo de accidente cerebrovascular.
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Resumen Introducción: La imagen ponderada en difusión es una técnica de imagen funcional que aporta información complementaria a las secuencias convencionales de resonancia magnética. El coeficiente de difusión aparente (CDA) se valora junto con la secuencia de difusión, calculando el logaritmo negativo de la proporción de intensidades de dos conjuntos de imágenes, lo que permite el análisis cuantitativo de la restricción a la difusión. Objetivo: Determinar si existe una diferencia significativa entre los valores de CDA de las lesiones musculoesqueléticas benignas y malignas, correlacionando los resultados con los hallazgos histológicos. Método: Estudio prospectivo, observacional y descriptivo. Se incluyeron en el trabajo pacientes con sospecha de lesiones tumorales del sistema musculoesquelético de cualquier edad y sexo, sin antecedentes de radioterapia previa o cirugía, evaluados con resonancia magnética y con posterior biopsia o cirugía. Resultados: Se incluyeron 170 pacientes, de los cuales 80 (44 benignos) eran hombres y 90 (43 benignos) eran mujeres. El total fue de 87 lesiones benignas y 83 lesiones malignas, con una media de CDA de 1,44 ± 0,55 × 10−3 mm2/s y de 0,96 ± 0,4 × 10−3 mm2/s, respectivamente, con una diferencia estadísticamente significativa (p < 0,001; 6,335; 168). Conclusiones: Los valores de difusión, y particularmente el CDA, han aportado información adicional en la caracterización de los tumores benignos y malignos, con diferencia significativa, estableciendo valores altos de CDA para los tumores benignos.
Abstract Introduction: Diffusion-weighted imaging is a functional imaging technique that provides complementary information to conventional magnetic resonance imaging sequences. The apparent diffusion coefficient (ADC) is evaluated together with the diffusion sequence, calculating the negative logarithm of the intensity ratio of two image sets, allowing the quantitative analysis of the diffusion. Objective: To determine if there is a statistical significance between the ADC values of benign and malignant musculoskeletal lesions, correlating the results with the histological findings. Method: Prospective, observational and descriptive study. Patients with suspected tumoral lesions of the musculoskeletal system of any age and sex, with no history of prior radiation therapy or surgery, evaluated with resonance with subsequent biopsy or surgery. Results: This study included 170 patients. Male patients were 80 (44 benign), and female patients were 90 (43 benign). The total was 87 benign lesions and 83 malignant lesions, with a mean ADC of 1.44 ± 0.55 × 10−3 mm2/s and 0.96 ± 0.4 × 10−3 mm2/s respectively, with a statistical significance (p < 0.001; 6.335; 168). Conclusions: Diffusion and, in particular, ADC values have provided additional information in the characterization of benign and malignant tumors, with a statistical significance, establishing high ADC values for benign tumors.
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Abstract Introduction: Posterior fossa tumors are common in the pediatric population and require adequate characterization by means of structural magnetic resonance imaging (MRI) and advanced MRI techniques to achieve an appropriate therapeutic approach. Objectives: To determine the usefulness of apparent diffusion coefficient (ADC) values for the differential diagnosis of posterior fossa tumors in the pediatric population treated at a reference hospital in Bogotá D.C., Colombia. Materials and methods: Diagnostic accuracy study carried out in 28 pediatric patients diagnosed with posterior fossa tumor between 2017 and 2019 at the Fundación Hospital de la Misericordia, a quaternary care institution. ADC values were measured and compared with histopathological diagnosis as gold standard, obtaining sensitivity, specificity, and positive and negative predictive values. Differences between medians were determined using the Kruskall-Wallis test. The p value between the quantitative ADC value and the gold standard was calculated using Pearson's chi-squared test, with a significance level of p<0.05. Results: The mean age of the participants was 83.9 months (SD=57 months), and 64.28% of them were boys. Medulloblastoma was the most frequent tumor (39.29%). For the diagnosis of medulloblastoma, an ADC value of 0.6210x10-3mm2/s was established, obtaining a sensitivity and specificity of 81.82% and 76.47%, respectively. For the diagnosis of pilocytic astrocytoma, an ADC of 1.03x10-3mm2/s was determined, with a sensitivity of 66.67% and a specificity of 89.40%. Conclusions: ADC value is useful to classify and differentiate posterior fossa tumors in the Colombian pediatric population, showing an inversely proportional relationship with the tumor grade.
Resumen Introducción. Los tumores de la fosa posterior son frecuentes en población pediátrica y requieren de una adecuada caracterización mediante resonancia magnética (RM) estructural y técnicas avanzadas de RM para lograr un enfoque terapéutico apropiado. Objetivo. Determinar la utilidad de los valores del coeficiente de difusión aparente (ADC cuantitativo) en el diagnóstico diferencial de los tumores de la fosa posterior en población pediátrica de un hospital de referencia en Bogotá D.C., Colombia. Materiales y métodos. Estudio de validez de prueba diagnóstica realizado en 28 pacientes pediátricos diagnosticados con tumor de fosa posterior entre 2017 y 2019 en la Fundación Hospital Pediátrico de la Misericordia, hospital de IV nivel de complejidad. Se midieron los valores del ADC cuantitativo, los cuales fueron comparados con el diagnóstico histopatológico como estándar de oro, obteniendo datos de sensibilidad, especificidad, valores predictivos positivos y negativos. Las diferencias entre medianas fueron determinadas mediante la prueba de Kruskall-Wallis. El valor p entre el valor del ADC cuantitativo y el estándar de oro se calculó con la prueba X2 de Pearson, con un nivel de significancia de p<0.05. Resultados. La edad media fue 83.9 meses (DE=57 meses) y 64.28% fueron niños. El tumor más frecuente fue el meduloblastoma (39.29%). Para el diagnóstico de meduloblastoma se estableció un valor ADC cuantitativo de 0.6210x10-3mm2/s, obteniéndose una sensibilidad y especificidad de 81.82% y 76.47%, respectivamente, y para el diagnóstico de astrocitoma pilocítico, un ADC cuantitativo de 1.03x10-3mm2/s, con una sensibilidad de 66.67% y una especificidad de 89.40%. Conclusiones. El valor del ADC cuantitativo es útil para clasificar y diferenciar los tumores de la fosa posterior en población pediátrica colombiana, mostrando una relación inversamente proporcional con el grado tumoral.
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Objective:To investigate the clinical manifestations, risk factors and outcomes of patients with acute cingulate cortex (CC) infarction.Methods:Patients with acute CC infarction admitted to the Department of Neurology, the First Affiliated Hospital of Nanjing Medical University from December 2019 to April 2022 were enrolled retrospectively. According to the location of infarction, they were divided into anterior cingulate cortex (ACC) infarction group and posterior cingulate cortex (PCC) infarction group. The clinical manifestations, stroke risk factors, imaging examination and National Institutes of Health Stroke Scale (NIHSS) score of the patients were analyzed. At one month after onset, the modified Rankin Scale was used to evaluate the short-term outcome.Results:A total of 21 patients with acute CC infarction were enrolled, including 12 males (57.14%), aged 67.14±12.36 years (range, 45-89 years). There were 16 patients (76.19%) with ACC infarction, including 13 (81.25%) unilateral CC infarction. The clinical manifestations were mainly apathy, decreased concentration, and executive dysfunction. There were 5 patients (23.81%) with PCC infarction, all with unilateral onset, mainly manifested as memory loss and visual space disorder. Among the 21 patients, 18 (85.71%) had ≥2 vascular risk factors, and 13 patients (61.90%) had ≥3 vascular risk factors, of which hypertension was most common (90.48%); 19 (90.48%) were caused by atherosclerosis, and 2 (9.52%) were caused by cardiogenic embolism. After treatment, the symptoms of both groups were improved significantly, and there was statistical difference in the NIHSS score before and after treatment ( Z=4.07, P<0.01). During the follow-up, 16 patients (76.19%) had a good outcome, 5 (23.81%) had a poor outcome and no death occurred. Conclusions:ACC and PCC infarction mainly showed different forms of cognitive impairment. If the diagnosis and treatment are timely, the overall outcome of CC infarction is good.
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Objective:To evaluate the value of time-signal intensity curve (TIC) combined with apparent diffusion coefficient (ADC) obtained with 1.5T magnetic resonance imaging in the evaluation of anal fistula activity.Methods:The clinical, imaging, and pathological data of 71 patients with pathologically confirmed anal fistula who received treatment in Ningbo Yinzhou No.2 Hospital from June 2018 to February 2020 were retrospectively analyzed. These patients were divided into active phase group ( n = 42) and remission phase group ( n = 29) according to surgical findings and pathological tissue composition. Pearson's chi-square test was used to analyze TIC types. The ADC value was compared between the two groups. Results:TIC types: In the active phase group, the percentage of patients with type I curve (rising enhancement pattern) and type III curve (washout pattern) was 47.6% (20/42) and 35.7% (15/42) respectively, which were significantly higher than that of patients with type III curve [plateau pattern; 16.7% (7/42)], χ2 = 9.22, 3.94, both P < 0.05). In the remission phase group, the percentage of patients with type I and II curves was 34.5% (10/29) and 55.2% (16/29) respectively, which were significantly higher than that of patients with type III curve [10.3% (3/29), χ2 = 4.86, 13.23, both P < 0.05]. ADC value: ADC value in the active phase group was significantly lower than that in the remission phase group [(0.932 ± 0.074) × 10 -3 mm 2/s vs. (1.164 ± 0.061) × 10 -3 mm 2/s, t = -13.87, P < 0.001). Conclusion:TIC combined with ADC value can effectively evaluate anal fistula activity. It can be used as a routine method for preoperative evaluation and postoperative follow-up for patients with anal fistula.
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Objective:To observe and analyze the atypical magnetic resonance imaging (MRI) findings and misdiagnosis reasons of primary central nervous system lymphoma (PCNSL), and to explore the value of conventional MRI signs combined with minimum apparent diffusion coefficient value (ADCmin) and imaging features of magnetic resonance spectroscopy (MRS) in the diagnosis and differentiation of atypical PCNSL.Methods:The clinical and imaging data of 15 patients with atypical PCNSL confirmed by clinical and pathological findings from Lianyungang Second People′s Hospital and the Affiliated Hospital of Xuzhou Medical University from January 2015 to December 2020 was collected. All cases were examined by plain MRI, enhanced and diffusion weighted imaging (DWI), and 3 cases were examined by MRS. The conventional MRI features, DWI signal features and MRS imaging features of 15 cases of atypical PCNSL were observed and analyzed, and the MRI findings of atypical PCNSL and the causes of misdiagnosis were summarized and analyzed. The ADCmin of tumor parenchyma, the mean ADC values of proximal peritumor, distal peritumor and contralateral white matter were detected and compared to explore the variation rules of ADC values in different regions.Results:Of the 15 cases of PCNSL, 14 cases were single and 1 case was multiple, with a total of 21 lesions. (1) Single lesions in rare sites: 4 cases in the superficial part of the brain, 1 case in the bridge arm, 1 case in the cerebellar hemisphere, 1 case in the suprasellar saddle, and 1 case in the third ventricle. (2) Atypical MRI findings: cystic degeneration or necrosis in 5 lesions (5/21), accompanied by hemorrhage in 1 lesion (1/21); There were 3 isosensitive lesions on DWI, and isosensitive lesions on ADC false color images. There were 5 ring enhancement lesions and 3 sheet enhancement lesions. (3) Multi-center growth pattern: 1 case with a total of 7 lesions, located in the right thalamus, basal ganglia and corona radiata, showing multiple nodules and ring enhancement. 1H-MRS examination showed that choline (Cho) peak increased, creatine (Cr) peak decreased, N-acetyl aspartate (NAA) peak decreased, and obvious Lip peak appeared in all the 3 cases with single lesions. 2 cases showed high Lip peak as the first peak. The ADCmin values of tumor parenchyma, proximal peritumor, distal peritumor and contralateral white matter showed a parabola pattern of first rise and then decline, as follows: (0.54±0.06)×10 -3 mm 2/s, (1.55±0.10)×10 -3 mm 2/s, (1.45±0.09)×10 -3 mm 2/s, (0.85±0.03)×10 -3 mm 2/s, overall difference was statistically significant ( F=630.570, P<0.001). The pairwise comparison was statistically significant (all P<0.05). Conclusions:Atypical PCNSL is easy to be misdiagnosed. Conventional MRI feature analysis combined with DWI and MRS imaging features and comparison of ADC values in different tumor areas are helpful for the diagnosis and differentiation of PCNSL and are expected to improve diagnostic accuracy.
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Objective:To investigate the differential diagnostic value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) combined with serum indicators for prostate cancer.Methods:We recruited 97 patients with prostate diseases who received treatment in Zhuji People's Hospital from March 2018 to September 2020 for this study. Patients with prostate cancer were included in the study group ( n = 46) and patients with benign prostatic hyperplasia in the control group ( n = 51). All patients were subject to IVIM-DWI and serum early prostate cancer antigen-2 level detection alone or in combination. The sensitivity, specificity, accuracy, and diagnostic efficacy of IVIM-DWI and serum early prostate cancer antigen-2 level detection alone or in combination were compared between the two groups. Results:D and f values in the study group were (0.50 ± 0.14) × 10 -3 mm 2/s and (0.35 ± 0.11), respectively, which were significantly lower than those in the control group [(0.71 ± 0.12) × 10 -3 mm 2/s, (0.59 ± 0.08), t = 7.95, 12.37, both P < 0.001]. D* value and serum early prostate cancer antigen-2 level in the study group were (6.24 ± 1.90) × 10 -3 mm 2/s and (62.5 ± 18.3) μg/L, which were significantly higher than those in the control group [(4.08 ± 1.34) × 10 -3 mm 2/s, (17.3 ± 6.8) μg/L, t = -6.52, -16.43, both P < 0.001]. The overall detection rate, sensitivity, specificity, and accuracy of IVIM-DWI combined with serum early prostate cancer antigen-2 level detection for prostate cancer were 53.6% (52/97), 97.8% (45/46), 74.5% (38/51), and 85.6% (83/97), respectively. A receiver operating characteristic curve analysis showed that the sensitivity of IVIM-DWI combined with serum indicators in the diagnosis of prostate cancer and the area under the curve were greater than those produced by IVIM-DWI and serum early prostate cancer antigen-2 level detection alone (both P < 0.05). Conclusion:IVIM-DWI combined with serum early prostate cancer antigen-2 level detection has a higher sensitivity in the diagnosis of prostate cancer than monotherapy. The combined therapy provides a new perspective for the differential diagnosis of prostate cancer and has a certain clinical value.
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Constrained spherical deconvolution can quantify white matter fiber orientation distribution information from diffusion magnetic resonance imaging data. But this method is only applicable to single shell diffusion magnetic resonance imaging data and will provide wrong fiber orientation information in white matter tissue which contains isotropic diffusion signals. To solve these problems, this paper proposes a constrained spherical deconvolution method based on multi-model response function. Multi-shell data can improve the stability of fiber orientation, and multi-model response function can attenuate isotropic diffusion signals in white matter, providing more accurate fiber orientation information. Synthetic data and real brain data from public database were used to verify the effectiveness of this algorithm. The results demonstrate that the proposed algorithm can attenuate isotropic diffusion signals in white matter and overcome the influence of partial volume effect on fiber direction estimation, thus estimate fiber direction more accurately. The reconstructed fiber direction distribution is stable, the false peaks are less, and the recognition ability of cross fiber is stronger, which lays a foundation for the further research of fiber bundle tracking technology.