Myxoinflammatory fibroblastic sarcoma of the liver: Case report and literature review.

RATIONALE: Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare low-grade malignant soft tissue sarcoma that primarily affects the distal extremities in adults, with the highest incidence in patients in their 40s and 50s. It has a high local recurrence rate and a low metastasis rate. Although MIFSs have been documented in other sites, an MIFS in the liver is highly unusual. Herein, we present a case of a patient with hepatic MIFS. PATIENT CONCERNS: The patient was a 58-year-old Chinese man with abdominal pain as the primary symptom. Abdominal computed tomography and magnetic resonance imaging revealed a mass in the right posterior lobe of the liver. The patient underwent surgical excision, and the excised specimen was identified as MIFS. Three years later, the patient returned to our hospital for abdominal pain. Computed tomography and magnetic resonance imaging revealed a mass in liver segments 2/3/4. DIAGNOSIS: Postoperative pathological examination of the tumor revealed the recurrence of MIFS. INTERVENTIONS: The patient underwent surgical resection of the MIFS. OUTCOMES: The patient received multiple pirarubicin-based chemotherapy treatments and an ALK inhibitor (anlotinib) within 6 months after surgery, but the tumor recurred. LESSONS: MIFS can not only occur in the proximal limbs, trunk, head, and neck but can also affect the abdominal organs. Surgical resection remains the primary treatment option for MIFS in the absence of any contraindications. Because the recurrence rate of MIFS is high, meticulous long-term monitoring is required.

Prognostic Value of Segmental Strain After ST-Elevation Myocardial Infarction: Insights From the EARLY Assessment of MYOcardial Tissue Characteristics by Cardiac Magnetic Resonance (EARLY-MYO-CMR) Study.

BACKGROUND: The prognostic value of left ventricular segmental strain (SS) in ST-elevation myocardial infarction (STEMI) remains unclear. HYPOTHESIS: To assess the prognostic value and application of SS. STUDY TYPE: Retrospective analysis of a prospective registry. POPULATION: Five hundred and forty-four patients after STEMI (500 in Cohort 1, 44 in Cohort 2). FIELD STRENGTH/SEQUENCE: 3 T, balanced steady-state free precession, gradient echo, and gradient echo contrast-enhanced images. ASSESSMENT: Participants underwent cardiac MR during the acute phase after STEMI. Infarct-related artery (IRA) strain was determined based on SS obtained from cine images. The primary endpoint was the composite of major adverse cardiovascular events (MACEs) after 8 years of follow-up. In Cohort 2, SS stability was assessed by MR twice within 8 days. Contrast and non-contrast risk models based on SS were established, leading to the development of an algorithm. STATISTICAL TEST: Student's t-test, Mann-Whitney U-test, Cox and logistic regression, Kaplan-Meier analysis, net reclassification index (NRI). P < 0.05 was considered significant. RESULTS: During a median follow-up of 5.2 years, 83 patients from Cohort 1 experienced a MACE. Among SS, IRA peak circumferential strain (IRA-CS) was an independent factor for MACEs (adjusted hazard ratio 1.099), providing incremental prognostic value (NRI 0.180, P = 0.10). Patients with worse IRA-CS (>-8.64%) demonstrated a heightened susceptibility to MACE. Additionally, IRA-CS was significantly associated with microvascular obstruction (MVO) (adjusted odds ratio 1.084) and infarct size (r = 0.395). IRA-CS showed comparable prognostic effectiveness to global peak circumferential strain (NRI 0.100, P = 0.39), also counterbalancing contrast and non-contrast risk models (NRI 0.205, P = 0.05). In Cohort 2, IRA-CS demonstrated stability between two time points (P = 0.10). Based on risk models incorporating IRA-CS, algorithm "HJKL" was preliminarily proposed for stratification. DATA CONCLUSIONS: IRA-CS is an important prognostic factor, and an algorithm based on it is proposed for stratification. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

Application Study of Brain Structure and Functional Magnetic Resonance Imaging in Patients with Systemic Lupus Erythematosus and Cognitive Dysfunction.

Objective: This study was aimed to investigate the application value of brain magnetic resonance imaging (MRI) technique, including arterial spin labeling (ASL) and diffusion tensor imaging (DTI) in patients with systemic lupus erythematosus (SLE) and cognitive dysfunction (CDF). Methods: A total of 50 patients with SLE admitted to the hospital from September 2020 to December 2022 were selected and divided into the group with CDF (n = 21) and the group without CDF (n = 29) according to the score of Montreal Cognitive Assessment Scale (MoCA). Additionally, 10 healthy individuals who underwent physical examinations during the same period were recruited as controls. After the conventional MRI, DTI and ASL data of all subjects were collected, statistical parametric mapping software combined with voxel morphology is applied for gray matter volume, white matter and gray matter cerebral blood flow (CBF) analysis among different groups. Results: There is a statistically significant difference in conventional MRI findings between the SLE group and the control group (P < .05). However, There was no significant difference in white matter fractional anisotropy (FA) values between the two groups (P > .05). The apparent diffusion coefficients (ADC) of the right precuneus and the right Brodmann's area 21 and 6 in SLE patients with CDF were significantly higher than SLE patients without CDF (P < .05). In comparison to the non-CDF group, the CDF group exhibited reduced gray matter volume, primarily in the anterior cingulate gyrus, left frontal lobe, and right insula (P < .05). Meanwhile, the white matter and gray matter cerebral blood flow (CBF) of SLE patients with CDF were significantly lower than those without CDF. (P < .05). Correlation analysis showed that the MoCA score was positively associated with the volume of gray matter in the right insula, bilateral frontal lobe, left temporal lobe, and cingulate gyrus (P < .05). Additionally, MoCA score was also found to be positively associated with the CBF of white matter and gray matter (P < .05). Conclusions: Alterations in gray matter volume and CBF in SLE patients are closely associated with combined CDF and can be observed by DTI and ASL techniques.

Assessment of radiation doses and DNA damage in pediatric patients undergoing interventional procedures for vascular anomalies.

Interventional procedures (IPs) have been widely used to treat vascular anomalies (VA) in recent years. However, patients are exposed to low-dose X-ray ionizing radiation (IR) during these fluoroscopy-guided IPs. We collected clinical information and IR doses during IPs and measured biomarkers including γ-H2AX, chromosome aberrations (CA), and micronuclei (MN), which underpin radiation-induced DNA damage, from 74 pediatric patients before and after IPs. For the 74 children, the range of dose-area product (DAP) values was from 1.2 to 1754.6 Gy∙cm2, with a median value of 27.1 Gy∙cm2. DAP values were significantly higher in children with lesions in the head and neck than in the limbs and trunk; the age and weight of children revealed a strong positive correlation with DAP values. The treated patients as a group demonstrated an increase in all three endpoints relative to baseline following IPs. Children with vascular tumors have a higher risk of dicentric chromosome + centric ring (dic+r) and cytokinesis-block micronucleus (CBMN) after IPs than children with vascular malformations. The younger the patient, the greater the risk of CA after IPs. Moreover, rogue cells (RCs) were found in five children (approximately 10%) after IPs, and the rates of dic+r and CBMN were significantly higher than those of other children (Z = -3.576, p < 0.001). These results suggest that there may be some children with VA who are particularly sensitive to IR, but more data and more in-depth experiments will be needed to verify this in the future.

Correlation of a guidewire maximum insertion length with tortuous radial artery and the success rate during transradial coronary angiography.

BACKGROUND: Percutaneous coronary intervention (PCI) is a safe and effective therapy for patients with obstructive coronary artery disease (CAD). We aimed to assess the correlation between the success rate of angiography and the maximum insertion length and resistance of a soft-tipped guidewire. METHODS: Five hundred twenty-one patients were treated by successful radial artery puncture. According to whether the guidewire resistance, the patients were divided to three groups. 17 patients were maximum insertion length of guidewire ≤ 30 cm when resistance was encountered (group 1). 17 patients were maximum insertion length of guidewire between 30 and 45 cm when resistance was encountered (group 2). 487 patients were no resistance encountered (group 3). RESULTS: The coronary angiography success rates of group 1, 2, and 3 were 52.94%, 47.05%, 98.97%, respectively. Typically, angiography can be completed in patients with Ω-shaped, S-shape or Z-shaped tortuosity. CONCLUSIONS: The maximum insertion length of straight guidewire and resistance can be used to determine radial artery status. The radial artery tortuosity or spasm significantly affects the success rate of coronary angiography.

Epidemiological studies of accessory cardiac bronchus and a new variant.

Accessory cardiac bronchus (ACB) is a rare tracheobronchial branching abnormality which originates from the medial wall of the intermediate or main bronchus and is directed to the heart. Three types of ACB have been recognized: type (a) is similar to a short diverticulum, type (b) is a long bronchus ventilating a small undeveloped lobule, and type (c) is an intermediate type with a long diverticulum but no bronchial or alveolar arborization. Herein, we report 40 consecutive cases of ACB detected in 10,287 routine spiral computed tomography (CT) examinations of the chest. The frequency of the anomaly was 0.39%. The study included 17 females and 23 males (female to male ratio 1:1.35). A total of 24 cases belonged to type (a), 14 cases were type (b), and 2 cases were type (c). The mean largest diameter of ACB was 7.9 (range, 4.0 to 12.0) mm and the mean length was 7.5 (range, 3.0 to 18.0) mm. The mean ratio of the largest diameter to length was 1.1, the ratio for (a) was often greater than 1, and the ratios of (b) and (c) were often less than 1. The ACB originated from the intermediate bronchus in 29 cases, which accounted for the largest proportion. The ACB originated from the basal bronchus of the lower lobe in 11 cases (6 cases from the right lower lobe and 5 from the left), which has never been reported before and may be a new variant.

Diagnostic accuracy of dual-energy computed tomography (DECT) to detect non-traumatic bone marrow edema: A systematic review and meta-analysis.

PURPOSE: This meta-analysis aimed to evaluate the diagnostic performance of dual-energy computed tomography (DECT) for detecting bone marrow edema (BME) in non-traumatic patients. METHODS: A systematic search of PubMed, EMBASE, and the Cochrane Library databases was performed up to October 1, 2021 for relevant original studies. Study details were extracted by two independent reviewers. A bivariate mixed-effects regression model was used to assess comprehensive diagnostic performance, and a subgroup analysis was performed to evaluate sources of variability. The risk of bias was evaluated with the QUADAS-2 tool. RESULTS: Ten studies involving 2463 regions, including hands, ankles, hips, and sacroiliac joints, were evaluated in this meta-analysis. Summary sensitivity, specificity, and area under the receiver operating characteristic curve values for BME were 88.4% (95% confidence interval (CI) 82.4%-92.5%), 96.1% (95% CI 94.4%-97.3%), and 0.98 (95% CI 96%-99%), respectively. The subgroup analysis showed that studies using a thicker slice (≥1 mm) had a higher sensitivity, and studies with older patients (≥60 years), fewer included patients (<40), and bones other than the pelvis had a higher specificity. Studies presented a generally low or unclear risk for bias and applicability concerns. CONCLUSIONS: DECT has an excellent diagnostic performance for detecting BME in non-traumatic patients and may provide an alternative to magnetic resonance imaging (MRI) for the detection of non-traumatic BME in the future, especially when MRI is unavailable or contraindicated.

Shyness and School Engagement in Chinese Suburban Preschoolers: A Moderated Mediation Model of Teacher-Child Closeness and Child Gender.

Shyness is associated with poorer preschool engagement, but few studies have evaluated the underlying mechanisms in Chinese preschoolers. This study explored the mediating role of teacher-child closeness and the moderating role of child gender in the association between shyness and school engagement to fill this gap. With the cluster sampling method, a total of 532 young children (240 girls; Mage = 4.29 years, SD = 0.65 years) were recruited from 15 suburban kindergartens in East China. Mothers rated children's shyness, and teachers evaluated children's school engagement and teacher-child closeness five months later. The results reveal the following: (1) Shyness was related to higher cooperative participation and lower school avoidance; (2) Teacher-child closeness mediated the relationships between shyness and school engagement. Specifically, shyness negatively predicted teacher-child closeness, and teacher-child closeness positively predicted cooperative and independent participations and school liking, and negatively predicted school avoidance; (3) Child gender moderated the relationship between shyness and school engagement, and specifically, for boys but not girls, shyness was significantly linked with lower school avoidance; for girls but not boys, shyness was significantly related to higher cooperative participation and lower independent participation. These findings have implications for the school engagement of preschoolers.

Added value of computed tomography venography in the identification of abnormities in veins of lower extremities.

OBJECTIVE: To investigate the efficacy of direct computed tomography venography (CTV) in early and accurate detection of lower extremity venous (LEV) abnormalities. METHODS: Cross-sectional research was conducted in Hebei General Hospital of China. A total of 211 CTV reports of both lower extremities from January 2017 to September 2019, 75 color Doppler ultrasound (DUS) examinations, and eight intravascular angiography records of these patients over the same period were collected from the hospital. Comparisons were made for the reported number and percentage of LEV abnormalities (thrombosis, stenosis including severe stenosis, and varicosities). Chi-square test and t-test were applied to compare the rates and means, respectively. Significance level α was 0.05. Individual interviews were performed to understand the perceptions of medical staff and patients on the application of CTV, and the interview results were analyzed. RESULTS: Of the 75 cases with both CTV and DUS reports, 159 abnormalities occurring in the lower extremity deep veins (LEDV) were reported, among which 125 (79%) and 18 (11%) were reported by CTV and DUS on a single basis, respectively, whereas 16 (10%) were reported by CTV and DUS simultaneously. A statistically significant greater number of abnormalities in LEDV were identified by CTV than DUS in both males and females (χ2males = 78.449, χ2females = 27.574, χ2total = 104.164, p < .05). In the 211 CTV reports, among the 383 abnormalities reported in total, the common iliac vein (CIV) had the highest number of reported abnormalities (132, 34.5%), followed by the femoral vein (93, 24.3%). The ratios between LEDV abnormality and patient numbers were 1.055 and 0.688 for left and right sides in males, and 0.892 and 0.461 for left and right sides in females, respectively, with that for the left side statistically significantly higher than the right one (tmale = 2.896, tfemale = 4.347, p < .05). The incidence of thrombosis was 10.9% (95% CI = 6.7 ∼ 15.1%). Reported abnormities in CIV by CTV were in agreement with those by intravascular angiography. The medical staff believed that CTV could guide the performance of surgeries for LEV and the patients perceived CTV acceptable. CONCLUSIONS: Application of CTV for early and accurate detection of LEDV abnormalities including thrombosis has been proven to be efficient. Corresponding benefit in early intervention and reduction of severe complications of such abnormalities is of important value. CTV earned good recognition from medical staff and patients. Hence, it could be considered as part of global health assistance cooperation with developing countries to facilitate enhanced medical services.

Evaluation of ultralow-dose computed tomography on detection of pulmonary nodules in overweight or obese adult patients.

PURPOSE: To evaluate the accuracy of pulmonary nodule (PN) detection in overweight or obese adult patients using ultralow-dose computed tomography (ULDCT) with tin filtration at 100 kV and advanced model-based iterative reconstruction (ADMIRE). METHODS: Eighty-one patients with body mass indices of ≥25 kg/m2 were enrolled. All patients underwent low-dose chest CT (LDCT), followed by ULDCT. Two radiologists experienced in LDCT established the standard of reference (SOR) for PNs. The number, type, size, and location of PNs were identified in the SOR. Effective dose, objective image quality (IQ), and subjective IQ based on two radiologists' scores were compared between ULDCT and LDCT. The detection performances of radiologists based on ULDCT were calculated according to the nodule analyses. Logistic regression was used to test for independent predictors of PN detection sensitivity. RESULTS: Both the effective dose and objective IQ were lower for ULDCT than for LDCT (both p < 0.001). Both radiologists rated the subjective IQ of the overall IQ on ULDCT to be diagnostically sufficient. In total, 234 nodules (mean diameter, 3.4 ± 1.9 mm) were classified into 32 subsolid, 149 solid, and 53 calcified nodules according to the SOR. The overall sensitivity of ULDCT for nodule detection was 93.6%. Based on multivariate analyses, the nodule types (p = 0.015) and sizes (p = 0.013) were independent predictors of nodule detection. CONCLUSIONS: Compared with LDCT, ULDCT with tin filtration at 100 kV and ADMIRE could significantly reduce the radiation dose in overweight or obese patients while maintaining good sensitivity for nodule detection.

Interstitial lung disease in Primary Sjögren's syndrome.

BACKGROUND: Interstitial lung disease (ILD) may cause life-threatening complications of primary Sjogren's syndrome (pSS), and has a poor prognosis in terms of survival and quality of life. To date, few studies have investigated the risk factors for ILD detected by high-resolution computed tomography (HRCT) in pSS patients with or without respiratory symptoms. METHODS: Data of 333 patients with newly diagnosed pSS were retrospectively analysed. Interstitial lung disease involvement was defined as typical abnormalities on HRCT and/or pulmonary function tests. Multivariate regression model was used to evaluate the association between interstitial lung disease and pSS characteristics. RESULTS: Sixty-six patients (19.82%) were diagnosed with pSS-ILD. Ground glass opacities (87.88%) and septal/sub pleural lines (81.82%) were most frequent. Based on pulmonary high-resolution computed tomography, patients were divided into nonspecific (n = 42), usual (n = 20), lymphocytic interstitial pneumonia (n = 3) and cryptogenic organising pneumonia (n = 1) groups. There was a strong association between erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) and the HRCT-score. Pulmonary function tests revealed impaired diffusion capacity for carbon monoxide and total lung capacity, and coexistence of small airway lesions in pSS-interstitial lung disease. On logistic regression analysis, age, Raynaud's phenomenon, lymphopenia, cough, dyspnoea and rampant dental caries were risk factors associated with pSS-interstitial lung disease. CONCLUSIONS: Interstitial lung disease involvement in pSS is a common clinical occurrence. The clinical manifestation is nonspecific and variable; Raynaud's phenomenon and lymphopenia may predict its onset. pSS patients with advanced age, dry cough and dyspnoea should be systematically evaluated for ILD involvement and managed according to their symptoms.

The nuclear receptor co-repressor 1 is a novel cardioprotective factor against acute myocardial ischemia-reperfusion injury.

Acute myocardial ischemia/reperfusion (MI/R) is a major determinant of prognosis in myocardial infarction patients, while effective therapies are currently lacking. Nuclear receptor co-repressor 1 (NCoR1) is emerging as a critical regulator of cell survival and death signaling in mammals. However, the role of NCoR1 in the pathogenesis of acute MI/R injury remains unknown. Here, we observed that NCoR1 was highly expressed in the mouse heart and significantly downregulated after acute MI/R injury. Cardiomyocyte-specific NCoR1 deletion led to significantly increased infarct size and exacerbated cardiac dysfunction compared to wild-type littermates. Moreover, cardiomyocyte-specific NCoR1 deficiency exacerbated MI/R-induced mitochondrial dysfunction and apoptotic pathway activation. Transcriptomic profiling results indicated that cardiomyocyte-specific NCoR1 deficiency pivotally promoted activation of inflammatory pathways. Through integrated omics analysis, signal transducer and activator of transcription 1 (STAT1) was identified as a downstream target trans-repressed by NCoR1. STAT1 activation played a key mediating role in the detrimental effects of NCoR1 deficiency in MI/R injury. Collectively, our findings provided the first evidence that cardiomyocyte-expressed NCoR1 functioned as a crucial cardioprotective factor against acute MI/R injury by targeting the STAT1 pathway in heart.

Non-contrast-enhanced magnetic resonance imaging technique diagnoses DVT and classifies thrombus.

The accuracy of non-contrast MRI in diagnosing acute deep vein thrombosis (DVT) of the lower extremities is different. To explore the application of high-resolution non-contrast 3D CUBE T1-weighted MRI in the lower extremities DVT. We recruited 26 patients suspected DVT of the lower extremities from Hebei General Hospital in China. All patients underwent high-resolution non-contrast 3D CUBE T1-weighted MRI. We evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of diagnosing thrombosis. And we divided thrombi into two parts: filling thrombus (FT) and non-filling thrombus (NFT), compared the agreement between MRI and Ultrasound (US) and analysed the locations of thrombi. Compared with US, MRI yielded a sensitivity of 79%, a specificity of 94.2% in mean value, a sensitivity of 85.7%, 97.4%, and 51.7% in iliac, femoral-popliteal, and calf segments respectively, a specificity of 97.6%, 88.3%, and 98.2% in iliac, femoral-popliteal, and in calf segments respectively. The accuracy of MRI in the diagnosis of lower extremity DVT was in very good agreement (κ = 0.711, 95% CI 0.627, 0.795). The FT was the most part in US and CUBE (68/56), CUBE can detect more NFT in femoral vein than US (22/4). 3D CUBE T1-weighted MRI can be used to accurately diagnose acute DVT and detect more NFT. It has the potential of follow-up at the end of treatment to establish a new baseline to stop anticoagulant drug.

Gray matter volume reduction with different disease duration in trigeminal neuralgia.

PURPOSE: Structural magnetic resonance imaging is widely used to explore brain gray and white matter structure in trigeminal neuralgia (TN) but has yielded conflicting findings. This study investigated the relationship between disease duration as a clinical feature of TN and changes in brain structure. METHODS: We divided 49 TN patients into three groups (TN1-TN3) based on disease duration (TN1 = 1.1 ± 0.7 (0-2) years, TN2 = 4.8 ± 1.5 (3-7) years, TN3 = 15.1 ± 5.5 (10-30) years). We used voxel-based morphometry (VBM) to compare the gray matter volume (GMV) across groups and between TN patients and 18 matched healthy control subjects. RESULTS: The TN1 group showed reduced GMV of pain-related regions in the cerebellum; the TN2 group showed reduced GMV in the thalamus and the motor/sensory cortex; and the TN3 group showed reduced GMV in the emotional and reward circuits compared with healthy controls. Similar brain regions, including bilateral hippocampi, caudate, left insular cortex, and medial superior frontal cortex, were affected in TN2 and TN3 compared with TN1. CONCLUSION: Disease duration can explain differences in structural alterations-especially in pain-related brain regions-in TN. These results highlight the advanced structural neuroimaging method that are valuable tools to assess the trigeminal system in TN and may further our current understanding of TN pathology.

Combined high-resolution 3D CUBE T1-weighted imaging and non-contrast-enhanced magnetic resonance venography for evaluation of vein stenosis in May-Thurner syndrome.

PURPOSE: To explore the feasibility of high-resolution MRI 3-dimensional (3D) CUBE T1-weighted magnetic resonance imaging (MRI) in combination with non-contrast-enhanced (NCE) magnetic resonance venography (MRV) for the assessment of lumen stenosis in May-Thurner syndrome. METHODS: Twenty-nine patients underwent computed tomography venography (CTV) and high-resolution MRI-CUBE T1, and NCE MRV acquisitions. ANOVA and LSD tests were used to compare the stenosis rate and narrowest and distal diameters of the vessel lumen. RESULTS: There were no significant differences in the estimated stenosis rate between CTV, CUBE T1, and NCE MRV (p = 0.768). However, there were significant differences in the measured stenosis diameters of the left common iliac vein (LCIV), with CTV giving the largest mean diameter and CUBE had the smallest mean diameter (p < 0.05). The measured normal LCIV diameters did not significantly differ between MRV and CUBE (p = 0.075) but were significantly larger on CTV than on MRV and CUBE (p < 0.05). CONCLUSIONS: Compared with CTV, a combination of CUBE and MRV could provide an improved assessment of the degree of lumen stenosis in May-Thurner syndrome and demonstrate acute thrombosis. MRI underestimates the diameter of the vessel in comparison with CTV. MRI can be a substitute tool for Duplex ultrasound and CTV.

Prediction of Intracerebral Hemorrhage After Endovascular Treatment of Acute Ischemic Stroke: Combining Quantitative Parameters on Dual-Energy CT with Clinical Related Factors.

OBJECTIVES: To evaluate the predictive value of dual-energy CT (DECT) quantitative parameters and clinical influence factors for intracerebral hemorrhage (ICH) complications after endovascular treatment in patients with acute ischemic stroke (AIS). METHODS: Seventy-two consecutive patients who underwent brain DECT immediately after endovascular treatment for AIS from November 2017 to October 2019 were included. Retrospectively, the volume of brain parenchymal hyperdensity area (HDA), the maximum iodine concentration, and maximum CT value on DECT images was evaluated and measured by two radiologists blinded to any clinical information independently. Follow-up CT imaging (24-72 h) were used to assess the development of ICH complications. DECT parameters and clinical influence factors were analyzed by Chi-square test or Fisher's exact test and Mann-Whitney U test. Receiver operating characteristic curves were generated for continuous variables. RESULTS: Follow-up CT images confirmed that forty of 72 patients (55.6%) developed ICH. The volume of HDA, median maximum iodine concentration and maximum CT value between ICH group and non-ICH group were significantly different (P < 0.001). Combining the DECT quantitative parameters with clinical predictors, receiver operating characteristic analysis revealed an area under the curve of 0.985, for identifying patients developing ICH with sensitivity, specificity, positive predictive value and negative predictive value were 90%, 100%, 100% and 88.9%, respectively. CONCLUSIONS: Three quantitative parameters of DECT and clinical predictors showed great predictive performance in identifing ICH complications in patients with brain parenchyma HDA after endovascular therapy, which may contribute to better clinical decision-making.

Triggering Receptor Expressed on Myeloid Cells-2 (TREM2) Interacts With Colony-Stimulating Factor 1 Receptor (CSF1R) but Is Not Necessary for CSF1/CSF1R-Mediated Microglial Survival.

Triggering receptor expressed on myeloid cells-2 (TREM2) and colony-stimulating factor 1 receptor (CSF1R) are crucial molecules for microgliopathy, which is characterized by microglia dysfunction and has recently been proposed as the neuropathological hallmark of neurological disorders. TREM2 and CSF1R are receptors expressed primarily in microglia in the brain and modulate microglial activation and survival. They are thought to be in close physical proximity. However, whether there is a direct interaction between these receptors remains elusive. Moreover, the physiological role and mechanism of the interaction of TREM2 and CSF1R remain to be determined. Here, we found that TREM2 interacted with CSF1R based on a co-immunoprecipitation assay. Additionally, we found that CSF1R knockdown significantly reduced the survival of primary microglia and increased the Trem2 mRNA level. In contrast, CSF1R expression was increased in Trem2-deficient microglia. Interestingly, administration of CSF1, the ligand of CSF1R, partially restored the survival of Trem2-deficient microglia in vitro and in vivo. Furthermore, CSF1 ameliorated Aß plaques deposition in Trem2-/-; 5XFAD mouse brain. These findings provide solid evidence that TREM2 and CSF1R have intrinsic abilities to form complexes and mutually modulate their expression. These findings also indicate the potential role of CSF1 in therapeutic intervention in TREM2 variant-bearing patients with a high risk of Alzheimer's disease (AD).

Detection of bone marrow edema in osteonecrosis of the femoral head using virtual noncalcium dual-energy computed tomography.

PURPOSE: To determine the diagnostic performance of virtual noncalcium (VNCa) dual-energy computed tomography (DECT) in the detection of bone marrow edema (BME) in participants with osteonecrosis of the femoral head (ONFH). METHODS: In this prospective study, 24 consecutive participants (15 men, 9 women; mean age, 44 years, range, 21-72 years) diagnosed with ONFH who underwent DECT and magnetic resonance imaging (MRI) between September 2019 and January 2020 were involved. Two independent readers visually evaluated color-coded VNCa images using a binary classification (0 = normal bone marrow, 1 = BME). MRI served as the reference standard for the presence of BME. Interobserver agreement for the visual evaluation of VNCa DECT images was calculated with κ statistics. We determined computed tomography (CT) numbers on VNCa images and weighted-average CT sets using region-of-interest-based quantitative analysis. The t-test was used to compare the differences of CT values between BME areas and normal bone marrow areas. Receiver operating characteristic (ROC) curve was used to select an optimal CT values of VNCa images for detecting BME. A p value of <0.05 was considered as statistically significant. RESULTS: The sensitivity, specificity, and accuracy of Reader 1 and Reader 2, respectively, in the identification of BME at DECT were 95 % and 89 % (18 and 17 of 19), 96 % and 96 % (25 and 25 of 26), and 93 % (43 and 42 of 45). Interobserver agreement was excellent (κ = 0.86). The VNCa CT numbers of the BME area and the normal bone marrow area were -28.6 (-17.9--39.4) HU and -97.9 (-91.3--104.4) HU, respectively, with statistical significance (t = -10.6, p < 0.001). The weighted-average CT numbers of the BME area and the normal bone marrow area were 152.4(122.2-182.7) HU and 121.1(103.6-183.6) HU, respectively, with no statistical significance (t = -2.0, p > 0.05). The area under the receiver operating characteristic curve was 0.99 in differentiation of the BME from normal bone marrow. A cut-off value of -57.2 HU yielded overall sensitivity, specificity, and accuracy, respectively, of 95 % (18 of 19), 100 % (26 of 26), and 98 % (44 of 45) detection of BME in participants with ONFH. CONCLUSION: Visual and quantitative analyses of VNCa images shows excellent diagnostic performance for assessing BME in participants with ONFH.

Brain activity alterations in patients with Parkinson's disease with cognitive impairment based on resting-state functional MRI.

OBJECTIVE: This study aimed to investigate the differences in regional homogeneity (ReHo) values in patients with Parkinson's disease (PD) with cognitive impairment (PD-CI) and thus explore the neuropathological mechanism of PD-CI. METHODS: Resting-state functional magnetic resonance imaging scans were obtained from 36 patients with PD and 20 healthy controls (HCs) in this study. The PD group comprised 20 patients with PD-CI and 16 patients with PD with normal cognitive function (PD-NC). The data were analyzed using ReHo analysis to observe the changes in brain activity in patients with PD-CI and PD-NC. Statistical comparison was performed using covariance analysis and post hoc t tests. RESULTS: The patients in the PD-CI group were older than those in the PD-NC and HC groups. Compared with the HC group, the PD-CI group showed that the ReHo value decreased in the right supplementary motor area, left lingual gyrus, left thalamus, and left precuneus, but increased in the left fusiform gyrus. Compared with the HC group, the PD-NC group showed that the ReHo value decreased in the right cerebellum_6, but increased in the left inferior temporal gyrus, left orbital inferior frontal gyrus, and left precentral gyrus. Compared with the PD-NC group, the PD-CI group showed that the ReHo value decreased in the right precuneus, left triangular inferior frontal gyrus, left middle frontal gyrus, right opercular inferior frontal gyrus, left orbital inferior frontal gyrus, left supramarginal gyrus, left angular gyrus, left inferior temporal gyrus, and right cerebelum_7b, but increased in the left precentral gyrus and left fusiform gyrus. CONCLUSIONS: Age was a risk factor for cognitive decline in patients with PD. The ReHo value in the default mode network (DMN) was closely related to PD cognitive function, and the DMN was affected before CI and continuously deteriorated with disease progression. The disorder of visual conduction pathway was involved in CI in patients with PD, but these patients could recruit cognitive resources by improving visual-spatial ability. The cognitive function in such patients was related to the dopaminergic, cholinergic, and noradrenergic systems. The information transmission efficiency of the cerebellum-thalamus-cortex loop was reduced and involved in the cognitive decline process in patients with PD.