Altered effective connectivity within the cingulo-frontal-parietal cognitive attention networks in chronic low back pain: a dynamic causal modeling study.

Dysfunction of the cingulo-frontal-parietal (CFP) cognitive attention network has been associated with the pathophysiology of chronic low back pain (cLBP). However, the direction of information processing within this network remains largely unknown. We aimed to study the effective connectivity among the CFP regions in 36 cLBP patients and 36 healthy controls by dynamic causal modeling (DCM). Both the resting-state and task-related (Multi-Source Interference Task, MSIT) functional magnetic resonance imaging (fMRI) data were collected and analyzed. The relationship between the effective connectivity of the CFP regions and clinical measures was also examined. Our results suggested that cLBP had significantly altered resting-state effective connectivity of the prefrontal cortex (PFC)-to-mid-cingulate cortex (MCC) (increased) and MCC-to-left superior parietal cortex (LPC) (decreased) pathways as compared with healthy controls. MSIT-related DCM suggested that the interference task could significantly increase the effective connectivity of the right superior parietal cortex (RPC)-to-PFC and RPC-to-MCC pathways in cLBP than that in healthy controls. The control task could significantly decrease the effective connectivity of the MCC-to-LPC and MCC-to-RPC pathways in cLBP than that in healthy controls. The endogenous connectivity of the PFC-to-RPC pathway in cLBP was significantly lower than that in healthy controls. No significant correlations were found between the effective connectivity within CFP networks and pain/depression scores in patients with cLBP. In summary, our findings suggested altered effective connectivity in multiple pathways within the CFP network in both resting-state and performing attention-demanding tasks in patients with cLBP, which extends our understanding of attention dysfunction in patients with cLBP.

Altered Amygdala-prefrontal Connectivity in Chronic Nonspecific Low Back Pain: Resting-state fMRI and Dynamic Causal Modelling Study.

Chronic nonspecific low back pain (cNLBP) is a leading contributor to disease burden worldwide that is difficult to treat due to its nonspecific aetiology and complexity. The amygdala is a complex of structurally and functionally heterogeneous nuclei that serve as a key neural substrate for the interactions between pain and negative affective states. However, whether the functions of amygdalar subcomponents are differentially altered in cNLBP remains unknown. Little attention has focused on effective connectivity of the amygdala with the cortex in cNLBP. In this study, thirty-three patients with cNLBP and 33 healthy controls (HCs) were included. Resting-state functional connectivity (rsFC) and effective connectivity of the amygdala and its subregions were examined. Our results showed that the patient group exhibited significantly greater rsFC between the left amygdala and left dorsal medial prefrontal cortex (mPFC), which was negatively correlated with pain intensity ratings. Subregional analyses suggested a difference located at the superficial nuclei of the amygdala. Dynamic causal modelling revealed significantly lower effective connectivity from the left amygdala to the dorsal mPFC in patients with cNLBP than in HCs. Both groups exhibited stronger effective connectivity from the left amygdala to the right amygdala. In summary, these findings not only suggested altered rsFC of the amygdala-mPFC pathway in cNLBP but also implicated an abnormal direction of information processing between the amygdala and mPFC in these patients. Our results further highlight the involvement of the amygdala in the neuropathology of cNLBP.

The utility of measuring the apparent diffusion coefficient for peritumoral zone in assessing infiltration depth of endometrial cancer.

BACKGROUND: The invasion depth of endometrial cancer is one of the most important prognosis factors. The aim of the current study was to investigate the diagnostic value of the apparent diffusion coefficient (ADC) of the peritumoral zone for assessing the infiltration depth of endometrial cancer. METHODS: An institutional review board approved this prospective study, and all study participants provided informed consent. A total of 58 patients (mean age 54 ± 8.3 years, range 34-69 years) with endometrial cancer were prospectively enrolled. Two radiologists assessed all preoperative magnetic resonance images with T1, T2, and diffusion-weighted imaging, and determined the location of the deepest invasion of the tumor. The peritumoral zone was defined as a 5-mm-thick zone surrounding and adjacent to the cancerous endometrium. The mean ADC (ADCm) values of the tumor and the peritumoral zone were measured. Sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve (Az) were calculated for visual inspection, and an ADC cutoff value for the peri-endometrial zone was determined for predicting the myometrial invasion depth. RESULTS: The ADCm values of tumors and peritumoral zones were 0.83 × 10- 3 mm2/sec and 1.06 × 10- 3 mm2/sec, respectively. There was no significant difference between the ADCm values of the tumors in the superficial and deep myometrial invasion groups (P > 0.05). However, the ADCm value at the peritumoral zone in the deep myometrial invasion group (1.23 × 10- 3 mm2/sec) significantly differed from that in the superficial myometrial invasion group (0.99 × 10- 3 mm2/sec) (p = 0.005). In assessments of deep myometrial invasion, the sensitivity, specificity, negative predictive value, and positive predictive value were 0.58, 0.93, 0.84, and 0.77, respectively, for the ADCm cutoff value of the peritumoral zone, and 0.71, 0.80, 0.87, and 0.60. respectively, for visual inspection. The accuracy of myometrial invasion depth assessment using the ADCm cutoff value and visual inspection were 83 and 78%, respectively. The Az for both was 0.76. CONCLUSION: ADCm at the peritumoral zone can predict deep myometrial invasion of endometrial cancer. This value can therefore enhance confidence in preoperative endometrial cancer evaluation, and when tailoring surgical approaches.

Radiographic findings of hemolymphangioma in four patients: A case report.

Due to the rarity of hemolymphangioma, a limited number of cases of the disease have been reported in the literature thus far. The present case report describes the cases of 4 patients with hemolymphangioma that were diagnosed and treated at the Second Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China). All patients were female, with a mean age of 44.7 years and a mean duration of symptoms prior to diagnosis of 2.7 years. The diagnosis of hemolymphangioma was determined by postoperative histopathology in all patients. A total of 2 patients were diagnosed with tumors that exhibited cystic characteristics (one in the mediastinum and the other in the neck), which was determined by computed tomography and magnetic resonance imaging. Another of the patients' tumors was located in the left forearm, and 1 patient had multifocal hemolymphangioma in the mediastinum and spleen. All patients underwent surgery and were asymptomatic during the follow-up periods (range, 8-15 months). In the present case report, the radiographic findings of the 4 cases are presented, including the unusual imaging characteristics that were observed, and relevant reports in the literature are discussed.

Significant MRI indicators of malignancy for breast non-mass enhancement.

OBJECTIVE: To explore and evaluate new malignant predictors of breast non-mass enhancement lesions using the new BI-RADS MRI lexicon. METHODS: A dataset involving 422 consecutive women underwent breast 3.0 T MRI between January 2014 and July 2016 was assembled for this study. Each case was retrospectively reviewed by 3 radiologists. Eighty-four lesions that present non-mass enhancement in 79 patients were identified in the study. Dynamic contrast-enhanced MRI features were analyzed using univariate and multivariate analyses to identify significant indicators of malignancy. RESULTS: Of 84 non-mass enhancement lesions, 52 (61.9%) were malignant and 32 (38.1%) were benign. Segmental distribution (P = 0.015 from univariate analysis; OR = 4.739, P = 0.008 from multivariate analysis), cluster ring enhancement (P = 0.017 from univariate analysis; OR = 3.601, P = 0.032 from multivariate analysis), time-intensity curve of plateau (P = 0.002 from univariate analysis; OR = 3.525, P = 0.027 from multivariate analysis) and phase to peak (P = 0.06 from univariate analysis; OR = 6.327, P = 0.015 from multivariate analysis) were significantly different between malignant and benign lesions. CONCLUSIONS: This study demonstrated that segmental distribution, clustered ring enhancement, and short time to peak could act as new malignant predictors for breast non-mass enhancement detected on 3.0 T MRI.

[Brain gray matter abnormalities revealed by voxel-based morphometry in patients with chronic low back pain].

OBJECTIVE: To explore the morphometric abnormalities of brain gray matter (GM) in patients with chronic low back pain (CLBP). METHODS: Thirty patients with CLBP and 30 healthy individuals were enrolled and examined with a 3.0 T magnetic resonance (MR) scanner. High-resolution T1 structural MR data were acquired and data analysis was performed using voxel-based morphometry (VBM) in FMRIB Software Library. The morphological differences were compared between the two groups. RESULTS: s Compared with the healthy control subjects, patients with CLBP showed decreased GM volumes in several brain cortical areas including the bilateral superior frontal gyrus, right frontal pole, left insular cortex, left middle and left inferior temporal gyrus (P<0.05, after TFCE correction). Increased GM volumes were found in the patients in the subcortical structures including the left thalamus, bilateral putamen, bilateral nucleus accumben and right caudate nucleus (P<0.05, after TFCE correction). CONCLUSION: Patients with CLBP have different patterns of GM abnormalities in different brain regions, characterized by reduced GM volume in cerebral cortical regions and increased GM volume in the subcortical nuclei. Such changes might be associated with the maladaptation of the brain in chronic pain state.