Assessment of breast lesions by the Kaiser score for differential diagnosis on MRI: the added value of ADC and machine learning modeling.

OBJECTIVES: To evaluate the diagnostic performance of Kaiser score (KS) adjusted with the apparent diffusion coefficient (ADC) (KS+) and machine learning (ML) modeling. METHODS: A dataset of 402 malignant and 257 benign lesions was identified. Two radiologists assigned the KS. If a lesion with KS > 4 had ADC > 1.4 × 10-3 mm2/s, the KS was reduced by 4 to become KS+. In order to consider the full spectrum of ADC as a continuous variable, the KS and ADC values were used to train diagnostic models using 5 ML algorithms. The performance was evaluated using the ROC analysis, compared by the DeLong test. The sensitivity, specificity, and accuracy achieved using the threshold of KS > 4, KS+ > 4, and ADC ≤ 1.4 × 10-3 mm2/s were obtained and compared by the McNemar test. RESULTS: The ROC curves of KS, KS+, and all ML models had comparable AUC in the range of 0.883-0.921, significantly higher than that of ADC (0.837, p < 0.0001). The KS had sensitivity = 97.3% and specificity = 59.1%; and the KS+ had sensitivity = 95.5% with significantly improved specificity to 68.5% (p < 0.0001). However, when setting at the same sensitivity of 97.3%, KS+ could not improve specificity. In ML analysis, the logistic regression model had the best performance. At sensitivity = 97.3% and specificity = 65.3%, i.e., compared to KS, 16 false-positives may be avoided without affecting true cancer diagnosis (p = 0.0015). CONCLUSION: Using dichotomized ADC to modify KS to KS+ can improve specificity, but at the price of lowered sensitivity. Machine learning algorithms may be applied to consider the ADC as a continuous variable to build more accurate diagnostic models. KEY POINTS: • When using ADC to modify the Kaiser score to KS+, the diagnostic specificity according to the results of two independent readers was improved by 9.4-9.7%, at the price of slightly degraded sensitivity by 1.5-1.8%, and overall had improved accuracy by 2.6-2.9%. • When the KS and the continuous ADC values were combined to train models by machine learning algorithms, the diagnostic specificity achieved by the logistic regression model could be significantly improved from 59.1 to 65.3% (p = 0.0015), while maintaining at the high sensitivity of KS = 97.3%, and thus, the results demonstrated the potential of ML modeling to further evaluate the contribution of ADC. • When setting the sensitivity at the same levels, the modified KS+ and the original KS have comparable specificity; therefore, KS+ with consideration of ADC may not offer much practical help, and the original KS without ADC remains as an excellent robust diagnostic method.

Non-joint effusion is associated with osteoarthritis in temporomandibular joints with disk displacement.

PURPOSE: The aim of this study was to examine the possible association between different grades of joint effusion (JE) and osteoarthritis (OA) in temporomandibular joint (TMJ) anterior disk displacement without reduction (ADDwoR). MATERIAL AND METHODS: A sample of 101 female patients 20-40 years of age with unilateral TMJ ADDwoR were retrospectively reviewed. JE and OA were diagnosed with magnetic resonance imaging (MRI). JE was subdivided into three different grades: grade 0, no or minimal effusion; grade 1, moderate effusion; and grade 2, extensive effusion. Eight categories of degenerative changes were used for screening for the existence of OA. Cases with no less than one type of degenerative change were diagnosed as OA. RESULTS: In all, 71 patients (70.3%) were diagnosed as having OA in the joints with disk displacement. In the univariate analysis, the proportion of subjects with non-JE (grade 0) was higher in the OA group (p = 0.003), while the proportion of subjects with extensive effusion (grade 2) was lower in the OA group (p = 0.02). In the multivariate logistic regression analysis, non-JE was independently associated with the development of OA (odds ratio = 5.68, 95% confidence interval = 1.10-29.37, P = 0.04). CONCLUSION: The results suggested that non-JE was associated with OA in the joints with ADDwoR.

Whole-brain 320-detector row dynamic volume CT perfusion detected crossed cerebellar diaschisis after spontaneous intracerebral hemorrhage.

INTRODUCTION: The purpose of this study was to evaluate the value of 320-detector row CT used to detect crossed cerebellar diaschisis (CCD) in patients with unilateral supratentorial spontaneous intracerebral hemorrhage (SICH). METHODS: We investigated 62 of 156 patients with unilateral supratentorial SICH using 320-detector row CT scanning. Regional cerebral blood flow (rCBF), cerebral blood volume (rCBV), mean transit time (rMTT), and time to peak (rTTP) levels were measured in different regions of interest (ROIs) that were manually outlined on computed tomography perfusion (CTP) for the cerebrum, including normal-appearing brain tissue that surrounded the perilesional low-density area (NA) and the perihematomal low-density area (PA) in all patients and the cerebellum (ipsilateral and contralateral) in CCD-positive patients. RESULTS: Of 62 cases, a total of 14 met the criteria for CCD due to cerebellar perfusion asymmetry on CTP maps. In the quantitative analysis, significant differences were found in the perfusion parameters between the contralateral and ipsilateral cerebellum in CCD-positive cases. No significant differences were found between the CCD-positive group and the CCD-negative group according to the hematoma volume, NIHSS scores, and cerebral perfusion abnormality (each P > 0.05). The correlation analysis of the degree of NA, PA perfusion abnormality, and the degree of CCD severity showed negative and significant linear correlations (R, -0.66∼-0.56; P < 0.05). CONCLUSION: 320-detector row CT is a robust and practicable method for the comprehensive primary imaging work-up of CCD in unilateral supratentorial SICH patients.

Magnetic resonance imaging assessment of temporomandibular joint soft tissue injuries of intracapsular condylar fracture.

We evaluated the soft tissue of the temporomandibular joint (TMJ) with magnetic resonance imaging (MRI) after intracapsular condylar fracture. Eighteen consecutive patients (19 TMJ) were diagnosed between 1 January 2010 and 30 October 2011. They were examined using bilateral sagittal and coronal MRI, which were obtained immediately after injury to assess the displacement of the disc, whether there was a tear in capsule or the retrodiscal tissue, and whether there was an effusion in the joint. On the affected side MRI showed disc displacement in 15 of 19, tears in the capsule in 9, and tears in the retrodiscal tissue in 16. All 19 had joint effusions. It also showed 2 joints with abnormalities on the unaffected side. We conclude that MRI is useful for diagnosis and for estimating the amount of damage to the TMJ, and is helpful in planning treatment.

[Study of functional magnetic resonance imaging repeatability of linguistic-functional cortex].

OBJECTIVE: To explore the reproducibility and stability of brain functional area in the response of language tasks during Chinese word processing with functional magnetic resonance imaging (fMRI) by follow-up scanning so as to provide rationales for clinical preoperative localization and the mechanisms of recovery from aphasia. METHODS: The fMRI data were collected by scanning semantic and phonologic judgments in 15 healthy volunteers. Each subject was scanned twice by the same fMRI procedure of both language tasks with an interval of 1 month. By analyzing the effective overlapping average activation maps, the reproducibility of inter-subject imaging result for two language tasks were estimated by selecting the main language areas, such as Broca's area and Wernicke's area as the region of interest (ROI). By individually calculating the spatial distance of ROI centroid coordinates in the same activating range before and after test, the inter-subject stability in between-session was calculated quantitatively. RESULTS: Both language tasks activated more than one language-related brain areas in cerebral hemispheres. Both language tasks induced significant BOLD response in Broca's and Wernicke's areas with a tendency of left lateralization. The number of subjects in terms of the activation of both language tasks in Broca's and Wernicke's areas accounted over a half of the total subjects. As compared with the phonologic judgment task, the semantic judgment task showed better reproducibility in Broca's area. In the same spatial distance of ROI centroid coordinates, the stability of Broca's area was higher than that of Wernicke's area while the stability of semantic judgment in Broca's area higher than that of phonologic judgment. CONCLUSION: Such main language domains as Broca's and Wernicke's areas can be effectively activated by both semantic and phonologic judgments. By comparison, semantic judgment in Broca's area shows a higher level of reproducibility and stability. Thus it is applicable for clinical preoperative localization and the mechanisms of recovery from aphasia.

In vivo tracing of superparamagnetic iron oxide-labeled bone marrow mesenchymal stem cells transplanted for traumatic brain injury by susceptibility weighted imaging in a rat model.

OBJECTIVE: To label rat bone marrow mesenchymal stem cells (BMSCs) with superparamagnetic iron oxide (SPIO) in vitro, and to monitor the survival and location of these labeled BMSCs in a rat model of traumatic brain injury (TBI) by susceptibility weighted imaging (SWI) sequence. METHODS: BMSCs were cultured in vitro and then labeled with SPIO. Totally 24 male Sprague Dawley (SD) rats weighing 200-250 g were randomly divided into 4 groups: Groups A-D (n equal to 6 for each group). Moderate TBI models of all the rats were developed in the left hemisphere following Feeney's method. Group A was the experimental group and stereotaxic transplantation of BMSCs labeled with SPIO into the region nearby the contusion was conducted in this group 24 hours after TBI modeling. The other three groups were control groups with transplantation of SPIO, unlabeled BMSCs and injection of nutrient solution respectively conducted in Groups B, C and D at the same time. Monitoring of these SPIO-labeled BMSCs by SWI was performed one day, one week and three weeks after implantation. RESULTS: Numerous BMSCs were successfully labeled with SPIO. They were positive for Prussian blue staining and intracytoplasm positive blue stained particles were found under a microscope (200). Scattered little iron particles were observed in the vesicles by electron microscopy (5000). MRI of the transplantation sites of the left hemisphere demonstrated a low signal intensity on magnitude images, phase images and SWI images for all the test rats in Group A, and the lesion in the left parietal cortex demonstrated a semicircular low intensity on SWI images, which clearly showed the distribution and migration of BMSCs in the first and third weeks. For Group B, a low signal intensity by MRI was only observed on the first day but undetected during the following examination. No signals were observed in Groups C and D at any time points. CONCLUSION: SWI sequence in vivo can consecutively and noninvasively trace and demonstrate the status and distribution of BMSCs labeled with SPIO in the brain of TBI model rats.

[Study of intracerebral focus changes on CADASIL by using MR imaging].

OBJECTIVE: To investigate dynamic changes of intracerebral focus on cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). METHODS: Using the modified Scheltens scale, the magnetic resonance (MR) changes of lesion distribution, size and shape in 7 patients from a CADASIL family were retrospectively analyzed during 3 years observed. RESULTS: In 6 of 7 patients, the number and volume of lesion areas in the white matter were increased (parietal lobe, n = 6; temporal lobe, n = 5; frontal lobe, n = 3; occipital lobe, n = 2) and some areas even became confluent as a mass or chain. New lacunar infarcts (n = 1 - 5) appeared in 5 patients and the arcuate fiber were involved in 1 patients. Slight enlargement could be seen in lateral ventricle (n = 1) or lateral ventricle with third ventricle (n = 1). CONCLUSION: MR imaging can help us to reveal dynamic changes of brain lesions and prognosis in patients with CADASIL.

[Functional magnetic resonance imaging of whole brain related to motor preparation and execution].

OBJECTIVE: To investigate the roles the different functional activation areas in whole human brain related to movement play during motor preparation (CUE) and execution (GO). METHODS: Event-related functional MRI technique was used on 12 right-handed healthy subjects to record the brain activation in a manner of delayed sequential finger movement. Activation maps and time-signal intensity curves were generated. RESULTS: Bilateral anterior parts of supplementary motor area (Pre-SMA), bilateral posterior parietal cortex (PPC), and bilateral anterior premotor cortex (PMC) were strongly activated during the preparation period, while bilateral SMA proper, and contralateral primary motor cortex (M1) were strongly activated during the execution period, Cerebellar cortex was activated during both periods. The time-signal intensity curves based on single voxel indicated that above-mentioned brain areas were activated during both periods to different degrees; however, the characteristics of distribution in every area were different. CONCLUSION: The brain areas related to movement are activated differently during preparation period and execution period, areas close to M1 participate in the motor execution process mainly, and the areas away from M1 are concerned with motor preparation process chiefly.

Application of MRI in indirect temporomandibular joint injury without condylar fracture.

OBJECTIVE: To discuss the application of MRI in indirect temporomandibular joint injury without condylar fracture. METHODS: MRI examination on temporomandibular joint was conducted in 28 patients with indirect injury to temporomandibular joint without condylar fracture. The scanning sequence included T(1)WI, PDWI on oblique sagittal section at both open and closed mouth positions, and T(1)WI, T(2)WI on oblique coronal section. The MRI appearance was analyzed by 2 senior radiologists. RESULTS: Among the 56 temporomandibular joints of 28 patients, 35 joints exhibited pathological changes on MRI, in which there were 9 bone injuries, 21 articular disc dislocation, 24 intracapsular hematocele and hydrops. CONCLUSIONS: MRI can clearly reveal bone injury, articular disc dislocation as well as articular capsule abnormality in the indirect injury of temporomandibular joint without condylar fracture. It is highly advocated in clinical use.

[Study of paroxysmal kinesigenic dyskinesia with fMRI].

OBJECTIVE: To detect the differences in subcortical structures between patients with paroxysmal kinesigenic dyskinesia (PKD) and normal subjects during movement preparation and execution. METHODS: The PKD patients performed a movement task, in which a CUE signal (preparation) indicated the movement sequence prior to the appearance of an imperative GO signal (execution). Event-related functional magnetic resonance imaging (fMRI) and 3dDeconvolve program of AFNI were used to estimate the hemodynamic response function and to generate activation maps. RESULT: During movement preparation, the activated brain areas in PKD patients were less than those of normal subject, and there was no activation in basal ganglia in PKD patients. During execution, the activation was also less in PKD patients except in bilateral M1. CONCLUSION: During intermission, abnormalities of the brain still exist in PKD patients when during preparing or performing movement. The movement circuit in the brain displays an unusual state. The attack may be caused by reducing of inhibition in brain areas.

[Lateralized distribution of motor areas involved in voluntary movement].

OBJECTIVE: To investigate the brain functional laterality in motor areas during motor execution systematically. METHODS: Functional magnetic resonance imaging (fMRI) was employed combined with right hand sequential finger movement task to investigate brain activation pattern and laterality in 8 right-handed subjects. 3dDeconvolve program of AFNI was used to estimate the hemodynamic response function and to generate activation maps. Then the laterality index (LI) was calculated and tested statistically. RESULT: All motor areas including the areas which were previously considered to be engage in movement preparation only were activated in movement execution. In the activation map, it appeared left lateralization in cerebra and right lateralization in cerebella. After further statistical test, it was found that in primary motor area (M1), supplementary motor area (SMA) and posterior parietal cortex (PPC), there were left lateralization. While in premotor cortex (PMC), cingulate gyrus and basal ganglia (BG), the lateralization tendency was not obvious. The activation in cerebella is characterized with right lateralization. CONCLUSION: Though there are tiny differences among subjects, most of the motor areas appear lateralized activation. Past studies only observed laterality in several motor areas. It may be due to the difficulty of the task or the experimental design.