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Objective:To explore the value of the Wilcoxon-Mann-Whitney generalized dominance ratio (T max-weighted ratio) based on residual tissue time to peak (T max) delayed severity weighting in predicting the moderate to severe edema after acute anterior circulation ischemic stroke. Methods:The clinical and imaging features of patients with acute anterior circulation ischemic stroke from January 2019 to April 2022 in Yidu Central Hospital of Weifang were retrospectively analyzed. A total of 85 patients were enrolled, including 60 males and 25 females, with the age from 34 to 93 (67±11) years old. Patients underwent non-contrast CT, CT angiography of the head and neck, and CT perfusion imaging of the head, and ischemic core volume and the ratio of T max 4-6 s volume, T max 6-8 s volume, T max 8-10 s volume, and T max >10 s volume relative to the entire hypo-perfused area (T max>4 s volume) was measured, and the T max-weighted ratio was calculated, the collateral circulation were assessed. Patients were divided into mild edema group and moderate to severe edema group according to whether local swelling exceeded 1/3 of the unilateral cerebral hemisphere on non-contrast CT at 24-48 h. The indicators were compared between the two groups by independant t test, Mann-Whitney U and χ 2 test. The performance to predict moderate to severe edema was assessed using the receiver operating characteristic (ROC) curve. The univariate and multivariate logistic regression was used to analyze the risk factors for the moderate to severe edema. Differences in baseline National Institutes of Health Stroke Scale (NIHSS) score and infarct core volume were equalized by 1∶1 propensity score matching (PSM) and the differences of T max-weighted ratio between the two groups were further compared. Results:There were 52 cases in the mild edema group and 33 cases in the moderate to severe edema group. Baseline NIHSS score, T max>10 s volume, ischemic core volume, T max-weighted ratio and proportion of poor collateral circulation were higher in the moderate-severe edema group than those in the mild edema group ( P<0.001), T max 4-6 s volume was lower than in the mild edema group ( P<0.001). ROC analysis showed that the area under the curve (AUC) of T max-weighted ratio for predicting the incidence of moderate to severe edema was 0.885 (95%CI 0.798-0.944), with an optimal cut-off value of 1.17, sensitivity of 84.85% and specificity of 82.69% before PSM. The predictive ability based on T max-weighted ratio was similar to ischemic core volume( Z=0.64, P=0.520), T max 4-6 s volume ( Z=1.48, P=0.140) and superior to T max 6-8 s volume( Z=5.65, P<0.001), T max 8-10 s volume( Z=4.46, P<0.001), T max >10 s volume ( Z=2.91, P=0.004). Multivariate logistic regression analysis showed that T max-weighted ratio>1.17 was an independent predictor of the development of moderate to severe edema (OR=10.40,95%CI 2.65-40.83, P=0.001) through adjusted for baseline NIHSS score and ischemic core volume. After PSM, 14 patients in each group were included; the T max-weighted ratio was higher in the moderate-to-severe edema group than that in the mild edema group ( P<0.001), and the differences in other factors were not statistically significant (all P>0.05); ROC analysis showed that the AUC of T max-weighted ratio to predict the occurrence of moderate-to-severe edema was 0.852 (95%CI 0.667-0.957). Conclusion:The T max-weighted ratio can predict the occurrence of moderate-to-severe edema in brain tissue after acute anterior circulation ischemic stroke.
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Objective:To explore the effect of dynamic changes of cerebral oxygen saturation before and after treatment on the progression of infarction in patients with acute ischemic stroke (AIS).Methods:Totally 39 patients with first onset AIS within 24 hours in Tianjin First Central Hospital and Shanghai Fourth People′s Hospital Affiliated to Tongji University from May 2018 to July 2020 were enrolled retrospectively. All patients underwent multi-modal MR at admission (baseline) and within 2 weeks after standardized treatment, including diffusion weighted imaging (DWI), susceptibility weighted imaging (SWI), and dynamic magnetic sensitive contrast-enhanced magnetic resonance perfusion imaging (DSC-PWI). The degree of asymmetrically prominent cortical vein (APCV) at admission was observed on SWI, and the venous oxygen saturation (SvO 2) of APCV on the infarcted cerebral hemisphere was calculated in all patients before and after treatment. The original DWI and DSC-PWI images obtained from two MR scans were imported into the software to obtain the delayed perfusion volume [peak time (T max)>6 s] and the infarct core volume (apparent diffusion coeffivient value<620×10 -6 mm 2/s). According to the comparison of baseline infarct core (DWI-ASPECT) score and follow-up (FUP-ASPECT) score, all patients were divided into infarct progression group (27 cases) and non-infarct progression group (12 cases). Two independent sample t-test or Mann Whitney U-test were used to compare the differences of baseline infarct core volume, baseline SvO 2, SvO 2 change, baseline hypoperfusion volume and hypoperfusion volume change between the two groups. Univariate analysis and multivariate logistic regression analysis were used to obtain independent predictors of infarct progression. Pearson correlation analysis was used to evaluate the correlation between SvO 2 change, hypoperfusion volume change and infarct change score respectively. Results:Difference in baseline infarct core volume, baseline SvO 2, hypoperfusion volume and hypoperfusion volume change between infarct progression group and non-progression group had no statistical significance ( P>0.05). There was significant difference in the change of SvO 2 between the infarct progression group and non-infarct progression group after treatment [(27±11)%, (35±6)% respectively, t=-2.56, P=0.015]. Univariate logistic regression analysis showed that the change value of SvO 2 was the influencing factor of infarction progression of AIS (OR=0.872, 95%CI 0.773-0.984, P=0.026). Multivariate logistic regression analysis showed that the baseline NIHSS score (OR=1.248, 95%CI 1.042-1.494, P=0.016) was an independent predictor of infarction progression in AIS, and the change value of SvO 2 (OR=0.814, 95%CI 0.688-0.964, P=0.017) was an independent protective factor. The change of SvO 2 was positively correlated with the score of infarct change ( r=0.425, P=0.007). Conclusions:The change of SvO 2 after AIS treatment can independently predict the progress of acute infarction. Improvement of SvO 2 after treatment is conducive to delay the progress of infarction.
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Objective:To investigate the feasibility of predicting lateral cervical lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC) based on the nomogram constructed by dual-energy CT data.Methods:In total 417 patients with PTC confirmed by pathology in Tianjin First Central Hospital from January 2015 to December 2018 were retrospectively analyzed as a training group. Internal validation was conducted, including 139 patients in the LLNM group and 278 patients in the non-LLNM group. A total of 169 PTC patients from January 2019 to June 2020 were included as an external validation group, including 58 patients in the LLNM group and 111 patients in the non-LLNM group. The morphological characteristics of the primary thyroid lesions on dual-energy CT iodine maps were analyzed, including tumor location, maximum diameter, calcification, and extrathyroidal extension (ETE). Iodine concentration (IC) of the PTC parenchyma and the internal carotid artery on the same level in the arterial and venous phases were measured, and normalized iodine concentration (NIC) was calculated. The independent risk factors for LLNM were obtained by univariate and multivariate logistic regression analysis. Base on the results, a prediction model was constructed and expressed in the form of a nomogram. The internal and external validation of the model was carried out using ROC curve.Results:Multivariate binary logistic regression analysis showed that the lesion location in the upper polar of the thyroid, the presence of ETE, IC in arterial phase>2.9 mg/ml, IC in the venous phase>3.2 mg/ml, and NIC in the arterial phase>0.21 were independent risk factors for LLNM prediction. The nomogram based on the above factors was constructed with an area under the ROC curve (AUC) of 0.895 (95%CI 0.862-0.923). With a cut-off value of 0.79, the sensitivity and specificity were 86.3% and 75.2%, respectively. As for the external validation group, the AUC of the model was 0.887 (95%CI 0.830-0.931), with the sensitivity of 82.8%, and the specificity of 81.1%.Conclusion:The application values of the nomogram model based on dual-energy CT data in preoperative evaluation of the possibility of LLNM of PTC patients has been verified. The model constructed in this study might be helpful with the individualized treatment in a certain degree.