Hippocampus-associated causal network of structural covariance measuring structural damage progression in temporal lobe epilepsy.

In mesial temporal lobe epilepsy (mTLE), the causal relationship of morphometric alterations between hippocampus and the other regions, that is, how the hippocampal atrophy leads to progressive morphometric alterations in the epileptic network regions remains largely unclear. In this study, a causal network of structural covariance (CaSCN) was proposed to map the causal effects of hippocampal atrophy on the network-based morphometric alterations in mTLE. It was hypothesized that if cross-sectional morphometric MRI data could be attributed temporal information, for example, by sequencing the data according to disease progression information, GCA would be a feasible approach for constructing a CaSCN. Based on a large cohort of mTLE patients (n = 108), the hippocampus-associated CaSCN revealed that the hippocampus and the thalamus were prominent nodes exerting causal effects (i.e., GM reduction) on other regions and that the prefrontal cortex and cerebellum were prominent nodes being subject to causal effects. Intriguingly, compensatory increased gray matter volume in the contralateral temporal region and post cingulate cortex were also detected. The method unraveled richer information for mapping network atrophy in mTLE relative to the traditional methods of stage-specific comparisons and structured covariance network. This study provided new evidence on the network spread mechanism in terms of the causal influence of hippocampal atrophy on progressive brain structural alterations in mTLE. Hum Brain Mapp 38:753-766, 2017. © 2016 Wiley Periodicals, Inc.

Application of intraoperative magnetic resonance imaging in large invasive pituitary adenoma surgery.

OBJECTIVE: To investigate the clinical application value of intraoperative magnetic resonance imaging (iMRI) in large invasive pituitary adenoma surgery. METHODS: A total of 30 patients with large pituitary adenoma underwent microscopic tumor resection under the assistance of an iMRI system; 26 cases received surgery through the nasal-transsphenoidal approach, and the remaining four cases received surgery through the pterion approach. iMRI was performed one or two times depending on the need of the surgeon. If a residual tumor was found, further resection was conducted under iMRI guidance. RESULTS: iMRI revealed residual tumors in 12 cases, among which nine cases received further resection. Of these nine cases, iMRI rescanning confirmed complete resection in six cases, and subtotal resection in the remaining three. Overall, 24 cases of tumor were totally resected, and six cases were subtotally resected. The total resection rate of tumors increased from 60% to 80%. CONCLUSION: iMRI can effectively determine the resection extent of pituitary adenomas. In addition, it provides an objective basis for real-time judgment of surgical outcome, subsequently improving surgical accuracy and safety, and increasing the total tumor resection rate.

Liver virtual non-enhanced CT with dual-source, dual-energy CT: a preliminary study.

PURPOSE: To compare virtual non-enhanced liver CT (VNCT) from dual-energy CT (DECT) with true non-enhanced liver CT (TNCT) in patients. METHODS: A total of 102 patients underwent multi-phase abdominal CT. Liver arterial VNCT (VNCT(A)) and portovenous VNCT (VNCT(V)) images were derived from the arterial and portovenous DECT data. The mean CT number, signal to noise ratio (SNR), image quality, contrast to noise (CNR) of liver lesions, lesion detectability and radiation dose were compared. RESULTS: There was no difference in mean CT numbers of all organs (all P>0.05). SNR on VNCT images was higher than that of TNCT (all P<0.001). Image quality of VNCT was diagnostic but lower than that of TNCT (P<0.001). VNCT(A) images were superior to VNCT(V) (P<0.001). VNCT(A) and VNCT(V) detected 78 (91%) and 70 (81%) of 86 hepatic focal lesions visualised on TNCT. There was no difference in the size, attenuation and CNR of focal hepatic lesions (all P>0.05), but SNR of the lesions on VNCT was higher than that on TNCT (P<0.001). Radiation dose of biphase DECT was lower than that of routine triphase CT (P<0.001). CONCLUSION: VNCT(A) may potentially replace TNCT as part of a multi-phase liver imaging protocol with consequent saving in radiation dose.