RESUMEN
OBJECTIVE: This study aimed to build and validate a radiomics-integrated model with whole-brain magnetic resonance imaging (MRI) to predict the progression of mild cognitive impairment (MCI) to Alzheimer's disease (AD). METHODS: 357 patients with MCI were selected from the ADNI database, which is an open-source database for AD with multicentre cooperation, of which 154 progressed to AD during the 48-month follow-up period. Subjects were divided into a training and test group. For each patient, the baseline T1WI MR images were automatically segmented into white matter, gray matter and cerebrospinal fluid (CSF), and radiomics features were extracted from each tissue. Based on the data from the training group, a radiomics signature was built using logistic regression after dimensionality reduction. The radiomics signatures, in combination with the apolipoprotein E4 (APOE4) and baseline neuropsychological scales, were used to build an integrated model using machine learning. The receiver operating characteristics (ROC) curve and data of the test group were used to evaluate the diagnostic accuracy and reliability of the model, respectively. In addition, the clinical prognostic efficacy of the model was evaluated based on the time of progression from MCI to AD. RESULTS: Stepwise logistic regression analysis showed that the APOE4, clinical dementia rating, AD assessment scale, and radiomics signature were independent predictors of MCI progression to AD. The integrated model was constructed based on independent predictors using machine learning. The ROC curve showed that the accuracy of the model in the training and the test sets was 0.814 and 0.807, with a specificity of 0.671 and 0.738, and a sensitivity of 0.822 and 0.745, respectively. In addition, the model had the most significant diagnostic efficacy in predicting MCI progression to AD within 12 months, with an AUC of 0.814, sensitivity of 0.726, and specificity of 0.798. CONCLUSION: The integrated model based on whole-brain radiomics can accurately identify and predict the high-risk population of MCI patients who may progress to AD. Radiomics biomarkers are practical in the precursory stage of such disease.
RESUMEN
BACKGROUND: White matter hyperintensity (WMH) is widely observed in aging brain and is associated with various diseases. A pragmatic and handy method in the clinic to assess and follow up white matter disease is strongly in need. PURPOSE: To develop and validate a radiomics nomogram for the prediction of WMH progression. STUDY TYPE: Retrospective. POPULATION: Brain images of 193 WMH patients from the Picture Archiving and Communication Systems (PACS) database in the A Medical Center (Zhejiang Provincial People's Hospital). MRI data of 127 WMH patients from the PACS database in the B Medical Center (Zhejiang Lishui People's Hospital) were included for external validation. All of the patients were at least 60 years old. FIELD STRENGTH/SEQUENCE: T1 -fluid attenuated inversion recovery images were acquired using a 3T scanner. ASSESSMENT: WMH was evaluated utilizing the Fazekas scale based on MRI. WMH progression was assessed with a follow-up MRI using a visual rating scale. Three neuroradiologists, who were blinded to the clinical data, assessed the images independently. Moreover, interobserver and intraobserver reproducibility were performed for the regions of interest for segmentation and feature extraction. STATISTICAL TESTS: A receiver operating characteristic (ROC) curve, the area under the curve (AUC) of the ROC was calculated, along with sensitivity and specificity. Also, a Hosmer-Lemeshow test was performed. RESULTS: The AUC of radiomics signature in the primary, internal validation cohort, external validation cohort were 0.886, 0.816, and 0.787, respectively; the specificity were 71.79%, 72.22%, and 81%, respectively; the sensitivity were 92.68%, 87.94% and 78.3%, respectively. The radiomics nomogram in the primary cohort (AUC = 0.899) and the internal validation cohort (AUC = 0.84). The Hosmer-Lemeshow test showed no significant difference between the primary cohort and the internal validation cohort (P > 0.05). The AUC of the radiomics nomogram, radiomics signature, and hyperlipidemia in all patients from the primary and internal validation cohort was 0.878, 0.848, and 0.626, respectively. DATA CONCLUSION: This multicenter study demonstrated the use of a radiomics nomogram in predicting the progression of WMH with elderly adults (an age of at least 60 years) based on conventional MRI. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:535-546.
Asunto(s)
Nomogramas , Sustancia Blanca , Adulto , Anciano , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sustancia Blanca/diagnóstico por imagenRESUMEN
<p><b>PURPOSE</b>Posterior fossa epidural hematomas (PFEDH) are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination mini-craniectomy.</p><p><b>METHODS</b>We retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015.</p><p><b>RESULTS</b>During this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications.</p><p><b>CONCLUSION</b>Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.</p>
RESUMEN
<p><b>BACKGROUND</b>During craniotomies using the transpetrosal-presigmoid approach, exposure of the sigmoid sinus remains an essential but hazardous step. In such procedures, accurate localization of the anterosuperior point of the transverse-sigmoid sinus junction (ASTS) is very important for reducing surgical morbidity. This study aimed to create an accurate and practical method for identifying the ASTS.</p><p><b>METHODS</b>On the lateral surfaces of 40 adult skulls (19 male skulls and 21 female skulls), a rectangular coordinate system was defined to measure the x and y coordinates of two points: the ASTS and the squamosal-parietomastoid suture junction (SP). With the coordinate system, the distribution characteristics of the ASTS were statistically analyzed and the differences between the ASTS and SP were investigated.</p><p><b>RESULTS</b>For ASTS-x, significant differences were found in different sides (P = 0.020); the ASTS-x in male skulls was significantly higher on the right side (P = 0.017); there was no significant difference between the sides in female skulls. There were no significant differences in gender or interaction of gender and side for ASTS-x, and for ASTS-y, there were no significant differences in side, gender, or interaction of gender and side. For both sides combined, the mean ASTS-x was significantly higher than the mean SP-x (P = 0.003) and the mean ASTS-y was significantly higher than the mean SP-y (P = 0.011).</p><p><b>CONCLUSIONS</b>This reference coordinate system may be an accurate and practical method for identifying the ASTS during presigmoid craniotomy. The SP might be difficult to find during presigmoid craniotomy and, therefore, it is not always a reliable landmark for defining the ASTS.</p>
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Senos Craneales , Craneotomía , Cráneo , Senos TransversosRESUMEN
OBJECTIVE@#To explore the suppressing effect of γ-secretase inhibitor DAPT on proliferation of human glioma cell line SHG-44 in vitro and its mechanism.@*METHODS@#The SHG-44 cell was treated by DAPT with different concentration. The proliferation of cells was detected by MTT assay; cell cycle and TSC of CD133(+) were determined by flow cytometry analysis technique; the key factor in Notch signaling pathway (Notch-1, Delta-1, Hes-1) was measured by reverse transcriptase-polymerase chain reaction and western blotting.@*RESULTS@#DAPT inhibited the growth and proliferation of SHG-44 cells significantly(P<0.05). And the inhibiting effect on SHG-44 cells produced by DAPT showed a dose-dependent manner. DAPT increased the rate of cells in G0/G1 phase of SHG-44 cells, while it decreased the rate of cells in S phase. TSC of CD133(+) was significantly reduced after DAPT treated SHG-44 cells. The expression of protein and mRNA of Notch-1, Delta-1 and Hes-1 were gradually downregulated with the increase of DAPT doses.@*CONCLUSIONS@#DAPT can downregulate these key factor in Notch signaling pathway, reduce the TSC of CD133+ and inhibit the proliferation of SHG-44 cells.
Asunto(s)
Humanos , Antineoplásicos , Farmacología , Ciclo Celular , Línea Celular Tumoral , Proliferación Celular , Forma de la Célula , Dipéptidos , Farmacología , Glioma , Transducción de SeñalRESUMEN
Objective To investigate the effect of co-culture with vascular endothelial cells on growth and apoptosis of C6 glioma cells under hypoxic condition.Methods C6 glioma cells and human umbilical vein endothelial cells were co-cultured with Transwell devices in 24-well plates;hypoxic condition was simulated by CoC12.C6 cells were divided into 4 groups:C6 cells and vascular endothelial cells were co-cultured under hypoxia as experimental group,while groups of co-culture of C6 cells and vascular endothelial cells under normoxia,monoculture of C6 cells under hypoxia,and monoculture of C6 cells under normoxia were used as controls.Apoptosis of C6 cells was detected by Annexin-V-FITC/PI double fluorescence staining and cell cycle of C6 cells was detected by flow cytometer 24 h after culture; the number of C6 cells was counted for 6 days and each growth curve was drew,respectively.Results After 24 h co-culture,apoptosis rate of C6 cells in the experimental group was obviously lower than that in control groups (P<0.05); apoptosis rate of C6 cells in the group of co-culture of C6 cells and vascular endothelial cells under normoxia was significantly lower than that in group ofmonoculture of C6 cells under normoxia (P<0.05).As compared with that in the other groups,the percentage of G0/G1 phase cells in the experimental group decreased apparently,but that of S phase cells was increased significantly in the experimental group (P<0.05); percentage of G0/G1 phase cells in the group of co-culture of C6 cells and vascular endothelial cells under normoxia was significantly lower than that in group ofmonoculture of C6 cells under normoxia,but that of S phase cells was significantly higher in group of co-culture of C6 cells and vascular endothelial cells under normoxia (P<0.05).After 6 d co-culture,C6 cells of each group grew fast in the first two days,reaching a peak during the following two days; in addition,C6 cells in experimental group grew fastest among the four groups,and its peak cell count was also the highest.Conclusion Co-culture with vascular endothelial cells under hypoxia can not only prevent glioma cells from apoptosis but also promote its growth.
RESUMEN
<p><b>BACKGROUND</b>The presence of residual tumor after surgery for pituitary adenoma may necessitate further treatment. The suprasellar and parasellar extension of the tumor have been widely considered as the predictors for residual tumor. However there is scarcity of studies regarding the preoperative tumor volume and residual tumor. This study was conducted to evaluate if tumor volume could predict the outcome of transsphenoidal pituitary surgery.</p><p><b>METHODS</b>A prospective study was designed and 48 patients who underwent transsphenoidal pituitary surgery within 1 year in the First Affiliated Hospital of Xi'an Jiaotong University were included in this study. The preoperative tumor volume and immediate postoperative tumor volume (within 4 - 7 days) were calculated in the contrast magnetic resonance imaging by using the formula of ellipsoid. All these volumes were divided into three subgroups, i.e. group 1, group 2 and group 3 with preoperative volume of less than 4 cm(3), 4 - 8 cm(3), and more than 8 cm(3) respectively. The parasellar and suprasellar extension of the tumor were also classified by Knosp and modified Hardy's classifications.</p><p><b>RESULTS</b>Baseline characteristics were comparable. The preoperative tumor volume of more than 8 cm(3) (group 3, (12.1 ± 1.1) cm(3)) had increased risk on postoperative tumor residue (P < 0.01) than the other two groups ((2.1 ± 0.3) cm(3) and (6.1 ± 0.3) cm(3) in groups 1 and 2). The mean postoperative volume in group 3 patients ((2.2 ± 0.1) cm(3)) was significantly higher than the other two groups (P < 0.01).</p><p><b>CONCLUSION</b>Preoperative volume of more than 8 cm(3) can be considered as a predictor for postoperative residual volume.</p>
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Hipófisis , Patología , Cirugía General , Neoplasias Hipofisarias , Patología , Cirugía General , Estudios Prospectivos , Resultado del Tratamiento , Carga Tumoral , FisiologíaRESUMEN
<p><b>OBJECTIVE</b>To investigate the independent risk factors of traumatic brain injury (TBI) prognosis.</p><p><b>METHODS</b>A retrospective analysis was performed in 885 hospitalized TBI patients from January 1, 2003 to January 1,2010 in the First Affiliated Hospital of Medical College of Xi’an Jiaotong University .Single-factor and logisticregression analysis were conducted to evaluate the association of different variables with TBI outcome.</p><p><b>RESULTS</b>The single-factor analysis revealed significant association between several variables and TBI outcome, including age ( P=0.044 for the age group 40-60, Pü0.001 for the age group ≥60), complications ( P<0.001), cerebrospinal fluid leakage( P<0.001), Glasgow Coma Scale(GCS) ( P<0.001), pupillary light reflex ( P<0.001), shock ( P<0.001), associated extra-craniallesions ( P=0.01), subdural hematoma ( P<0.001), cerebral contusion ( P<0.001), diffuse axonal injury ( P<0.001), and subarachnoid hemorrhage( P<0.001), suggesting theinfluence of those factors on the prognosis of TBI. Furthermore, logistic regression analysis identified age, GCS score, pupillary light reflex, subdural hematoma,and subarachnoid hemorrhage as independent risk factors of TBI prognosis.</p><p><b>CONCLUSION</b>Age, GCS score, papillary lightreflex, subdural hematoma, and subarachnoid hemorrhage may be risk factors influencing the prognosis of TBI. Paying attention to those factors might improve the outcome of TBI in clinical treatment.</p>
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lesiones Encefálicas , Mortalidad , Escala de Coma de Glasgow , Modelos Logísticos , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
<p><b>OBJECTIVE</b>To discuss the early diagnostic methods and therapeutic principles of aneurysmal subarachnoid hemorrhage (SAH), and evaluate the therapeutic efficacy objectively.</p><p><b>METHODS</b>Using neuro-imaging examinations combined with case history and clinical symptoms to make the early diagnosis of 96 case with aneurysmal SAH, and Guglielmi detachable microcoil (GDC) was utilized for early intracapsular embolization in the ruptured aneurysms. Efficient symptomatic treatment was done early after operation.</p><p><b>RESULTS</b>All of 96 cases were early diagnosed and successfully embolized; Among them, the aneurysmal lumen was 100% occluded in 83 cases, 95% in 8 cases, 90% in 5 cases. There were 3 cases complicating with aneurysms rupture during operation, 5 cases with cerebral vasospasm. One case was affected by microcoil terminal escape after operation, 3 recurrent cases were all cured with secondary GDC embolization. There were 9 complications associated with embolization techniques and 13 cases (13.5%) occurring permanent sequelae associated with SAH. According to the Glasgow prognosis score, 77 patients got grade I, 7 grade II, 6 grade III, 3 grade IV, and 3 grade V. The mortality rate was 3.1%.</p><p><b>CONCLUSIONS</b>To make early etiological diagnosis of the SAH patients, using GDC to embolize the aneurysms, and earlier efficient symptomatic treatment are important methods to improve the curative rate and reduce the mortality rate.</p>