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Objective:To explore whether there were changes in midbrain morphology related to motor function in patients with cerebral small vessel disease (CSVD).Methods:The study was conducted on a subset of patients with CSVD registered at the Department of Neurology of Peking Union Medical College Hospital from 2010 to 2018. All magnetic resonance imaging images were taken with a 3.0 T nuclear magnetic resonance imager. The measurement of anteroposterior diameter of the mesencephalon and the tegmentum of mesencephalon was performed on a personal computer with the image processing software RadiAnt DICOM Viewer. Several clinical manifestations of dyspraxia, dysphagia, dysarthria and dysuria were evaluated by interviewing the patient and family members living with the patient. Kinect depth camera combined with self-developed software platform was used to conduct quantitative evaluation of patients′ motor function. Three parameters, namely walking speed, walking time of three meters and time of standing up and sitting down, were selected from the obtained parameters. SPSS 17.0 software was used for statistical analysis.Results:A total of 176 patients were included, aged 30-88 (64.16±11.57) years. One hundred and fifteen patients were males, accounting for 65.34%. In patients with CSVD, anteroposterior diameter of the mesencephalon and the tegmentum of mesencephalon were negatively correlated with age ( B=-0.032, P<0.001; B=-0.020, P=0.006). The anteroposterior diameter of the mesencephalon was negatively correlated with symptoms of dyskinesia ( OR=0.006, 95% CI 0-0.135, P=0.001), even when the age and gender were adjusted ( OR=0.014,95% CI 0-0.416, P=0.013). The anteroposterior diameter of the mesencephalon was negatively correlated with symptoms of dysuria ( OR=0.046,95% CI 0.002-0.936, P=0.045), but no longer correlated when the age and gender were adjusted. The anteroposterior diameter of tegmentum of mesencephalo was also negatively correlated with symptoms of dyskinesia ( OR=0.035,95% CI 0.002-0.684, P=0.027), but no longer correlated after adjusting for age and gender. Video recording and evaluation of motor function were performed on 87 patients. Spearman correlation analysis showed that none of the three motor function scores was correlated with age or gender. The anteroposteric diameter of the midbrain was positively correlated with walking speed ( r=0.231 ,P=0.040) and negatively correlated with walking time of three meters ( r=-0.304, P=0.005), but not with standing up and sitting down time, while the anteroposteric diameter of tegmentum of mesencephalo was not correlated with all of them. Conclusion:There are changes in mesencephalon morphology in patients with CSVD, structural parameters of mesencephalon are related to motor function and urination function, and mesencephalon atrophy may be an independent related factor for symptoms of dyskinesia in patients with CSVD.
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Objective To study the dynamic changes of anatomy and the dosimeter distribution those changes influenced. Methods Initially simplified intensity modulated radiation therapy (sIMRT)were performed to twenty-nine patients with phase Ⅲ - Ⅳa esophageal carcinoma from January 2007 to March 2009. The target volumes and involving organs were contoured on the primary spiral CT pictures.After sIMRT planning being finished, secondary CT scan was acquired to rectify the treatment center. For eleven patients at every other week and eighteen patients at the fourth week, spiral CT images were acquired according to the same treatment center, and thereafter fused with the first CT images. Firstly, the law of change and the best time of replanning were searched:the changed gross tumor volume (GTV), gross node volume (GTVnd), plan target volume (PTV) and normal organs (lung, spinal cord, heart and outline) on the fusion interface were modified by a single physician, the changes for each structure throughout treatment were measured by system software. Secondly, dose distributions were computed and evaluated for replanning CT using the same beams arrangement as the initial plan. Cumulative dose was estimated using weighted average and compared with the original plan. Results For eleven patients, The law of change:the volume of outlines and GTV gradually decreased, and the change come to peak in the fourth week. The conformal index for PTV gradually decreased, whereas the heterogeneous index gradually increased. For twenty-nine patients on the fourth week, the dose of GTV were more than 60 Gy. The dose of PTV-D95 and CTV-D99 decreased ( t = 1.49, P = 0. 147 and t = 2. 07, P = 0. 048 respectively). The dose of CTV-D99 in two patients deceased to 54 Gy or less. The cord-Dmax and lung V30 increased significantly ( t = - 2. 42, P = 0. 022 and t = -2. 26,P =0. 032). Conclusions During the course of sIMRT for esophageal cancer, the volume of GTV decreased and the change come to peak in the fourth week. It is the best time for evaluating the change of dose of target volume using CT-CT fusion. For some patients, revise of the treatment plan is needed to ensure adequate target volume dosage and safety of normal tissues.