Prediction of Cognitive Progression in Individuals with Mild Cognitive Impairment Using Radiomics as an Improvement of the ATN System: A Five-Year Follow-Up Study

Objective@#To improve the N biomarker in the amyloid/taueurodegeneration system by radiomics and study its value for predicting cognitive progression in individuals with mild cognitive impairment (MCI). @*Materials and Methods@#A group of 147 healthy controls (HCs) (72 male; mean age ± standard deviation, 73.7 ± 6.3 years), 197 patients with MCI (114 male; 72.2 ± 7.1 years), and 128 patients with Alzheimer’s disease (AD) (74 male; 73.7 ± 8.4 years) were included. Optimal A, T, and N biomarkers for discriminating HC and AD were selected using receiver operating characteristic (ROC) curve analysis. A radiomics model containing comprehensive information of the whole cerebral cortex and deep nuclei was established to create a new N biomarker. Cerebrospinal fluid (CSF) biomarkers were evaluated to determine the optimal A or T biomarkers. All MCI patients were followed up until AD conversion or for at least 60 months. The predictive value of A, T, and the radiomics-based N biomarker for cognitive progression of MCI to AD were analyzed using Kaplan-Meier estimates and the log-rank test. @*Results@#The radiomics-based N biomarker showed an ROC curve area of 0.998 for discriminating between AD and HC. CSF Aβ42 and p-tau proteins were identified as the optimal A and T biomarkers, respectively. For MCI patients on the Alzheimer’s continuum, isolated A+ was an indicator of cognitive stability, while abnormalities of T and N, separately or simultaneously, indicated a high risk of progression. For MCI patients with suspected non-Alzheimer’s disease pathophysiology, isolated T+ indicated cognitive stability, while the appearance of the radiomics-based N+ indicated a high risk of progression to AD. @*Conclusion@#We proposed a new radiomics-based improved N biomarker that could help identify patients with MCI who are at a higher risk for cognitive progression. In addition, we clarified the value of a single A/T/N biomarker for predicting the cognitive progression of MCI.

Atrophy of entorhinal cortex in evaluation of cognitive performance in patients with diabetes mellitus / 中国医学影像技术

Objective To evaluate the potential cerebral cortical volume alterations in type 2 diabetes mellitus (T2DM) patients with mild cognitive impairment (MCI) compared with T2DM patients and healthy controls,and to observe the correlations with the scores of neuropsychological scales.Methods Cortical volume based on high-resolution MR T1WI data from 30 healthy controls (HC),30 T2DM patients and 30 T2DM with MCI patients were evaluated with FreeSurfer software and compared with variance analysis.The correlations between cerebral cortical volume which had statistical difference and the scores of neuropsychological scales were analyzed.Results There were significant differences in auditory verbal learning test (AVLT) scores,complex figure test-delayed recall (20 min) scores,digit symbol-coding subtest scores,MoCA scores and higher trail-making test-A scores,as well as trail-making test-B scores between T2DM and T2DM with MCI patients (all P＜0.05).Compared with T2DM patients,cortical volume of left entorhinal cortex,left lateral orbitofrontal gyrus,left posterior cingulate gyrus and the right lateral orbitofrontal gyrus,right pars orbitalis,right insula reduced in T2DM with MCI patients (all P＜0.05).In T2DM with MCI patients,AVLT scores were positively correlated with volume of the left entorhinal cortex (r=0.452,P=0.018).Conclusion Several cortical volume reductions are exhibited in T2DM patients with MCI.The volume of the left entorhinal cortex may be a potential biomarker to diagnose and evaluate MCI in T2DM.

CT characteristics of primary pulmonary lymphoma and misdiagnosis analysis / 实用放射学杂志

Objective To explore CT performance of primary pulmonary lymphoma(PPL)and analyze the cause of misdiagnosis. Methods CT data of 42 cases with PPL which confirmed by pathology and clinical were analyzed.All cases met the diagnostic criteria of Kim et al[1] and CT analysis of lesions included the location,shape,border,enhanced degree and internal characteristic,etc.CT images of 29 preoperative misdiagnosis cases were also analyzed and summarized.Results 34 cases underwent both pre-contrast and post-contrast scan and 8 cases only had plain CT scan.The cases included mass or nodular type(21 cases),pneumonic-alveolar type(11 cases), bronchovascular-lymphatic type(4 cases),and mixed pattern(6 cases).Meanwhile,CT features contained air-bronchus sign (32 cases),angiogram sign(20 cases),airway dilatation(4 cases)and cross lobe growing(4 cases).29 cases were misdiagnosed as other lung diseases,thus misdiagnosis rate accounted for 69%.Conclusion PPLs mainly present with intrapulmonary nodules, masses and patches.In the lesions,air-bronchus sign or angiogram sign can be seen,and the density of solid portion is homogeneous with mildly to moderately homogeneous enhancement.The coexistence of multiple-type lesions and trans-lobes distribution have certain characteristics.

Regional homogeneity of primary insomnia with cognitive impairment：a blood oxygenation level dependent functional MRI study / 中华放射学杂志

Objective To investigate the regional homogeneity (ReHo) changes of primary insomnia (PI) with cognitive impairment using resting?state fMRI. Methods Twenty-one patients with primary insomnia and cognitive impairment and 25 healthy volunteers matched with age, gender and education level were collected from Southwest Hospital of China from November 2014 to June 2015. Pittsburgh sleep quality index (PSQI), Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE), Activity of Daily Living Scale (ADL), Hamilton depression scale (HAMD), and Hamilton Anxiety Scale (HAMA) were conducted to evaluate the sleep and cognitive conditions of all subjects. Independent sample t?test was performed to evaluate the significant difference of neuropsychology scores of two groups. ReHo of rs?fMRI were evaluated and compared between two groups using independent sample T?test, meanwhile, the partial correlation analysis was conducted in ReHo values of different brain regions and neuropsychology scores (age, gender and education level were regarded as covariates). Results Compared with normal controls, patients with primary insomnia and cognitive impairment showed significant higher PSQI score and lower MoCA and MMSE scores(P<0.05). The patient group also showed significant increased ReHo in the left medial temporal gyrus(54 voxels, t=3.14), left inferior temporal gyrus(76 voxels, t=4.80), right inferior temporal gyrus(84 voxels, t=4.30) and left parahippocampal gyrus(301 voxels, t=4.44) (P<0.05) and decreased ReHo in the left superior temporal lobe(79 voxels, t=-3.38), right fusiform gyrus(50 voxels, t=-3.17), right superior temporal gyrus(283 voxels, t=-5.34), right inferior frontal gyrus(56 voxels, t=-3.98), right anterior cingulate(233 voxels, t=-3.91), left parietal lobe angular gyrus(67 voxels, t=-3.27) and superior parietal lobule(65 voxels, t=-3.45) (P<0.05). The partial correlation analysis showed positive correlations between the ReHo values and PSQI scores of the left parahippocampal gyrus (R=0.771,P<0.01), negative correlations between the ReHo values and PSQI scores of the right anterior cingulate gyrus (R=-0.649,P<0.01) and positive correlations between the ReHo values and MoCA scores of the right anterior cingulate gyrus(R=0.555,P<0.05). Conclusions Patients with primary insomnia and cognitive impairment have ReHo alterations in various brain regions. The decreasing ReHo in the right anterior cingulate gyrus can reflect the level of sleep disorder and cognitive impairment, and increasing ReHo in the left parahippocampal gyrus can reflect the compensation of sleep disorders of PI.

Influence of contrast injection methods in interstitial magnetic resonance lymphography of breast cancer / 局解手术学杂志

Objective To study the influence of different contrast injection skills in interstitial magnetic resonance lymphography( IMRL) of breast cancer, and standardize the IMRL contrast injection process. Methods A total of 36 patients with invasive breast cancer were ran-domly divided into four groups. The imaging time of different contrast agent dose and local massage time on sentinel lymph node ( SLN) were analyzed. According to the results, the best contrast injection methods technology program was choosed. Results For the same massage time, different contrast agent doses showed no significant difference in the SLN imaging time (P>0. 05);For same contrast agent dose, dif-ferent massage time showed significant statistically different SLN imaging time(P<0. 05). Conclusion In clinical work, IMRL with a con-trast agent injection dose of 0. 5 mL/person, local massage 1 min after injection can successfully achieve the lymphatic system image of breast cancer.

Activity of attentional and executive cortex and its relationship with cognitive impairment in subcortical ischemic vascular dementia / 中华神经科杂志

Objective To investigate the activity of attentional and executive cortex and its relationship with cognitive impairment in subcortical ischemic vascular dementia (SIVD).MethodsTwenty patients with SIVD and twenty normal control subjects who were matched by age,sex and education were enrolled.All of them underwent fMRI using SEMENTS 3.0T MR during Stroop task performance. The correlation between cognitive impairment and cortex activation in fMRI was analyzed.Results Cortical activation of bilateral dorsolateral prefrontal cortex,Nentrolateral prefrontal cortex,inferior parietal lobe have closed correlation with total score,visual trabecular spaces and execution,attention,verbalization,delayed memory and orientation score in MoCA test ( r =0.447-0.837,P ＜ 0.05 ).ConclusionsCortex activation in fMRI can reflex the cognitive impairment of SIVD.

Measuring the volume of the fourth ventricle in healthy Chinese adults of the Han nationality on the high-resolution MRI / 中华放射学杂志

Objective To explore the normal range of the fourth ventricle volume of Chinese adults of the Han nationality and provide morphological data for the construction of database for Chinese Standard Brain.Methods This is a clinical multi-center study.One thousand Chinese healthy volunteers (age range= 18 to 70) recruited from 15 hospitals were divided into 5 groups, i.e., Group A (age range = 18 to 30),B (age range =31 to 40), C (age range =41 to 50), D (age range =51 to 60), and E (age range =61 to 70).Each group contained 100 males and 100 females.All of the volunteers were scanned by MR using T1 weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence.After three dimension data reconstruction, the volumes of the fourth ventricle were measured at sagittal view by automatic trace of Midobl.2 combined with manual outlining.The difference of volumes of the fourth ventricle between male and female were analyzed by independent sample t test, and among age groups by ANOVA.Pearson's correlation coeffcient was used to characterize the relationship between volumes of the fourth ventricle and age.Results The fourth ventricle volumes of Group A-E were (2.1±0.9), (2.1±0.8), (2.2±0.8), (2.1±1.0) and (2.4±0.8) ml respectively for male; those for female were(2.0±0.7), (1.9±0.6), (18±0.6), (1.9±0.7) and (2.0±0.6) ml respectively.The fourth ventricle volumes of males were significantly larger than those of females ( t = 5.573, P =0.000 ) ; there were no significant differences among the female groups ( F = 1.788, P = 0.130 ) ; there were significant differences among the male groups ( F = 2.639, P = 0.033 ) and multiple comparison found that the 60 years old was the watershed with significant difference ( P < 0.05 ).Correlation between the change of males' volumes and the ages was not strong (r = 0.119, P = 0.008 ), and the females' volumes did not correlated with their ages ( r = 0.041,P = 0.360 ).Conclusion There are gender differences in the fourth ventricle volumes of normal Chinese adults, and changes of the fourth ventricle volume with aging are different between males and females.

A magnetic resonance imaging study of the gray matter configuration in amnestic mild cognitive impairment patients / 中华神经科杂志

Objective To investigate the cortex gray matter configuration in amnestic mild cognitive impairment(aMCI)patients using MRI technology, FMRIB software library(FSL)and Freesurfer software.Methods Twenty aMCI patients and 20 normal control subjects were recruited and studied. They were matched by age, sex and education. All the patients and healthy volunteers underwent MRI scan using SEMENTS trio 3.0 T MRI. The subtile three-dimensional brain images were obtained using high resolution scanning technique. The imaging data was processed and analyzed with FSL and Freesurfer software. The cortex gray matter density and thickness in different brain areas of aMCI patients and normal control subjects were calculated and compared using statistic analysis. Results Compared to that in the controls, cortex gray matter density in the aMCI patients showed remarkable decreases in left frontal lobe, temporal lobe,parietal lobe, and slight decrease in right thalamus, temporal lobe and island lobe; For cortex thickness,aMCI patients showed significant decreases in left anterior cingulate gyrus((2. 19 ±0. 24)mm), inferior parietal lobe((2. 27 ± 0. 15)mm), bilateral parahippocampal gyrus((2. 03 ± 0. 15),(2. 04 ±0. 17)mm), precentral gyrus((2. 20 ± 0. 11),(2. 31 ± 0. 19)mm), postcentral gyrus((1.88 ± 0. 11),(1.82 ± 0. 09)mm), superior frontal gyrus((2. 42 ± 0. 34),(2. 40 ± 0. 28)mm), middle frontal gyrus ((2.31±0.31),(2.33 ±0.29)mm), supramarginal gyrus((2.53 ±0.33),(2.55 ±0.23)mm),temporal pole((3.41 ±0.68),(3.30 ±0.56)mm)and transverse temporal gyrus((2.04 ±0. 12),(2. 01 ± 0. 11)mm; t = 2. 13-3.75, P ＜ 0. 05), no significant changes in the other areas(t = 0. 09-1.88, P ＞ 0. 05). Conclusions Our results suggest that there are significant changes in gray matter configuration in cortex of aMCl patients. The changes of cortical thickness is earlier than the changes of gray matter density.