Reference Ranges of Ventricular Morphology and Function in Healthy Chinese Adults: A Multicenter 3 T MRI Study.

BACKGROUND: Magnetic resonance imaging (MRI) reference ranges for ventricular morphology and function in the Chinese population are lacking. PURPOSE: To establish the MRI reference ranges of left and right ventricular (LV and RV) morphology and function based on a large multicenter cohort. STUDY TYPE: Prospective. POPULATION: One thousand and twelve healthy Chinese Han adults. FIELD STRENGTH/SEQUENCE: Balanced steady-state free procession cine sequence at 3.0 T. ASSESSMENT: Biventricular end-diastolic, end-systolic, stroke volume, and ejection fraction (EDV, ESV, SV, and EF), LV mass (LVM), end-diastolic and end-systolic dimension (LVEDD and LVESD), anteroseptal wall thickness (AS), and posterolateral wall thickness (PL) were measured. Body surface area (BSA) and height were used to index biventricular parameters. Parameters were compared between age groups and sex. STATISTICAL TESTS: Independent-samples t-tests or Mann-Whitney U test to compare mean values between sexes; ANOVA or Kruskal-Wallis test to compare mean values among age groups; linear regression to assess the relationships between cardiac parameters and age (correlation coefficient, r). A P value <0.05 was considered statistically significant. RESULTS: The biventricular volumes, LVM, LVEDD, RVEDV/LVEDV ratio, LVESD, AS, and PL were significantly greater in males than in females, even after indexing to BSA or height, while LVEF and RVEF were significantly lower in males than in females. For both sexes, age was significantly negatively correlated with biventricular volumes (male and female: LVEDV [r = -0.491; r = -0.373], LVESV [r = -0.194; r = -0.184], RVEDV [r = -0.639; r = -0.506], RVESV [r = -0.270; r = -0.223]), with similar correlations after BSA normalization. LVEF (r = 0.043) and RVEF (r = 0.033) showed a significant correlation with age in females, but not in males (P = 0.889; P = 0.282). DATA CONCLUSION: MRI reference ranges for biventricular morphology and function in Chinese adults are presented and show significant associations with age and sex. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

Reference ranges of myocardial T1 and T2 mapping in healthy Chinese adults: a multicenter 3T cardiovascular magnetic resonance study.

BACKGROUND: Although reference ranges of T1 and T2 mapping are well established for cardiovascular magnetic resonance (CMR) at 1.5T, data for 3T are still lacking. The objective of this study is to establish reference ranges of myocardial T1 and T2 based on a large multicenter cohort of healthy Chinese adults at 3T CMR. METHODS: A total of 1015 healthy Chinese adults (515 men, age range: 19-87 years) from 11 medical centers who underwent CMR using 3T Siemens scanners were prospectively enrolled. T1 mapping was performed with a motion-corrected modified Look-Locker inversion recovery sequence using a 5(3)3 scheme. T2 mapping images were acquired using T2-prepared fast low-angle shot sequence. T1 and T2 relaxation times were quantified for each slice and each myocardial segment. The T1 mapping and extracellular volume standardization (T1MES) phantom was used for quality assurance at each center prior to subject scanning. RESULTS: The phantom analysis showed strong consistency of spin echo, T1 mapping, and T2 mapping among centers. In the entire cohort, global T1 and T2 reference values were 1193 ± 34 ms and 36 ± 2.5 ms. Global T1 and T2 values were higher in females than in males (T1: 1211 ± 29 ms vs. 1176 ± 30 ms, p < 0.001; T2: 37 ± 2.3 ms vs. 35 ± 2.5 ms, p < 0.001). There were statistical differences in global T2 across age groups (p < 0.001), but not in global T1. Linear regression showed no correlation between age and global T1 or T2 values. In males, positive correlation was found between heart rate and global T1 (r = 0.479, p < 0.001). CONCLUSIONS: Using phantom-validated imaging sequences, we provide reference ranges for myocardial T1 and T2 values on 3T scanners in healthy Chinese adults, which can be applied across participating sites. Trial registration URL: http://www.chictr.org.cn/index.aspx . Unique identifier: ChiCTR1900025518. Registration name: 3T magnetic resonance myocardial quantitative imaging standardization and reference value study: a multi-center clinical study.

Application of Computed Tomography Perfusion Imaging-guided Mechanical Thrombectomy in Ischemic Stroke Patients with Large Vessel Occlusion beyond the Therapeutic Time Window.

INTRODUCTION: To explore the feasibility of applying computed tomography perfusion (CTP) imaging-guided mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion beyond the therapeutic time window. METHODS: The clinical data of acute cerebral infarction patients with large vessel occlusion who were beyond the therapeutic time window and admitted to Handan Central Hospital from January 2021 to March 2022 were retrospectively analyzed. All patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) and were examined by one-stop CTP imaging. The preoperative onset time of the disease was more than 6 h. Fourteen patients underwent magnetic resonance imaging examination at the same time. Fifty-four patients were retrospectively divided into two groups based on the treatment methods: the mechanical thrombectomy group had 21 patients and the conservative treatment group had 33 patients. NIHSS scoring and computed tomography scan were performed before treatment, 6 h, 24 h, 7 days, and 30 days after treatment. RESULTS: The NIHSS scores of the patients with acute cerebral large vessel occlusion who underwent CTP imaging-guided mechanical thrombectomy at 6 h, 24 h, 7 days, and 30 days after treatment were compared with those of the conventional treatment group. The NIHSS score of the mechanical thrombectomy group was significantly better, and the difference was statistically significant (P < 0.05). In terms of the prognosis rate and expansion rate of infarct core volume, the patients of the mechanical thrombectomy group had a better prognosis, and the difference was statistically significant (P < 0.05). Artificial intelligence-assisted CTP diagnosis can facilitate the automatic evaluation of diseases and enable quick judgments that are independent of radiologists' evaluation, but it may pose a problem in the determination of infarct core volume (either being too high or too low). CONCLUSION: It is of great significance to apply CTP imaging in guiding the mechanical thrombectomy procedure in acute stroke patients with large vessel occlusion who are beyond the therapeutic time window.

The application of 3-dimensional magnetic resonance imaging in nasopharyngeal carcinoma with pterygopalatine fossa invasion.

OBJECT: The pterygopalatine fossa (PPF) is a covert neurovascular pathway in the skull base and connects with numerous intracranial and extracranial spaces. The aim of this study was to explore the magnetic resonance imaging (MRI) features of PPF invasion in patients with nasopharyngeal carcinoma (NPC). MATERIAL AND METHODS: The medical records of 88 patients with stage T3 or T4 NPC were retrospectively analyzed. The 3-Dimensional (3D) volumetric images of MRI were reconstructed for the tiny connecting conduits of the invaded PPFs in the NPC patients. The infiltration incidence of conduits and connected further structures were calculated. RESULTS: Forty-six PPFs from 37 patients were invaded by NPC. The proportions of stage T4 NPC and intracranial extension were higher in patients with PPF invasion than that without PPF invasion (P < 0.05). Each connecting conduit of the PPF had corresponding optimal reconstructed orientation based on 3D volumetric MRI images. The first three most common infiltrated conduits were palatovaginal canal, vidian canal and sphenopalatine foramen, which were adjacent to the nasopharynx. Among the conduits connecting with further structures, the most common infiltrated conduit was pterygomaxillary fissure, followed by foramen rotundum and inferior orbital fissure. Furthermore, The NPC lesions involved stage T4 structures via the conduits from 19.6% of the invaded PPFs. CONCLUSIONS: The application of high-quality reconstruction images based on 3D sequence of MRI in NPC patients proved to be feasible and beneficial for the manifestation of the invaded PPFs and connecting conduits.

Whole-Brain Volume CT Angiography can Effectively Detect Early Ischemic Cerebrovascular Diseases.

OBJECTIVE: To investigate the role of whole-brain volume computed tomography (CT) perfusion in assessing early ischemic cerebrovascular diseases. MATERIALS AND METHODS: Seventy-two patients with early ischemic cerebrovascular diseases who had undergone routine CT scan and 320-row volume CT whole-brain perfusion imaging within 8 h after admission were retrospectively enrolled in this one-center case-sectional study. The perfusion parameters of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and dynamic CT angiogram (4D-CTA) were obtained and analyzed. RESULTS: Among 72 patients, 29 cases with 37 cerebral ischemic lesions were found in plain CT scan, whereas 51 cases with 76 lesions were found in whole-brain CT perfusion, with 30.6% more patients being detected. The CBF value was significantly lower in the abnormal than normal corresponding perfusion area in the healthy hemisphere (P<0.05), while the MTT and TTP values were significantly higher in the abnormal than the normal corresponding area (P<0.05). 4D-CTA image suggested that 59 cases had different degrees of stenosis or occlusion, including 11 mild, 18 moderate, 21 severe, and 9 occlusive cases. Four-D-CTA imaging could detect significantly (P<0.05) more patients with abnormal perfusion in severe cerebral vascular stenosis or occlusion than those with no, mild or moderate stenosis (93.33% vs. 16.67%) (P<0.05). The stenosis of intracranial and carotid arteries was positively correlated with MTT and TTP values (P<0.05). CONCLUSION: Whole-brain volume CT angiography can comprehensively display early cerebral ischemic lesions, cerebral blood perfusion status, and cerebral vascular stenosis, providing valuable information for early detection of ischemic cerebral diseases and appropriate treatment planning.

Preoperative Rim Enhancement on Magnetic Resonance Imaging Indicates Larger Tumor Size and Poor Prognosis in Chinese Basal-Like Breast Cancer Patients.

Background: This study was to investigate the prevalence of preoperative rim enhancement, and its association with clinicopathological features, relapse, and survival profiles in Chinese basal-like breast cancer (BC) patients. Materials and Methods: The preoperative breast magnetic resonance imaging images of 145 basal-like BC patients who underwent surgical excision were obtained to determine rim enhancement. Besides, based on disease status and survival status during follow-up, the 1-year relapse rate/mortality, 3-year relapse rate/mortality, 5-year relapse rate/mortality were calculated; disease-free survival (DFS) and overall survival (OS) were determined. Results: There were 51 (35.2%) patients with rim enhancement and 94 (64.8%) patients without rim enhancement. Furthermore, rim enhancement was associated with larger tumor size and advanced T stage, whereas it did not associate with age, pathological differentiation, N stage, or TNM stage. In addition, rim enhancement was associated with higher 1-, 3-, and 5-year relapse rate and shorter DFS; meanwhile, rim enhancement was associated with increased 1-, 3-, and 5-year mortality rate and decreased OS. By multivariate Cox's regression analyses, rim enhancement, pathological differentiation, and N stage independently predicted reduced DFS; T stage independently predicted declined OS. Conclusion: Preoperative rim enhancement on MRI might be a possible noninvasive indicator for guiding personalized treatment strategies and improving prognosis in Chinese basal-like BC patients.

The Application of Computed Tomography Perfusion in the Alberta Stroke Program Early Computed Tomography Score for Endovascular Treatment of Acute Ischemic Stroke in the Anterior Circulation.

OBJECTIVE: The present study investigated the predictive value of each perfusion parameter of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) in CT perfusion (CTP) imaging for the prognosis of endovascular treatment at the time of admission in patients with acute ischemic stroke in the anterior circulation. PATIENTS AND METHODS: The imaging data of 62 patients with acute ischemic stroke in the anterior circulation with an onset time of 6 h or less were retrospectively analyzed. All patients underwent the one-stop whole-brain dynamic volume four-dimensional (4D) CT angiography (CTA)-CTP and cranial magnetic resonance imaging (MRI) within seven days after treatment. The patients were divided into better and worse prognosis groups according to their clinical symptoms, combined with an MRI-ASPECTS score of ≤ 6 within seven days after treatment. The observed perfusion parameters included cerebral blood flow (CBF)-ASPECTS, cerebral blood volume (CBV)-ASPECTS, mean transit time (MTT)-ASPECTS, and time to peak (TTP)-ASPECTS. The difference in ASPECTS scores involving the CTP parameter, as well as diagnostic power, was compared between the two groups of patients. RESULTS: All CTP-ASPECTS scores negatively correlated with clinical prognosis. The higher the CTP-ASPECTS scores preceding treatment in patients with ischemic stroke in the anterior circulation, the better the prognosis. There were statistically significant differences in the scores of CBF-ASPECTS and CBV-ASPECTS between the two groups (P < 0.05). Receiver operating curve (ROC) analysis showed that the parameter with the largest area under the curve (AUC) was the CBF-ASPECTS score (P = 0.003), with a sensitivity of 90.9%, a specificity of 59.1%, and an AUC of 0.806, which was the most valuable prognostic predictor. CONCLUSION: The CBF-ASPECTS score presented significant value as a primary indicator for predicting the outcome of endovascular treatment in patients with acute ischemic stroke in the anterior circulation, and it had good application prospects in clinical practice.

Intravoxel Incoherent Motion Magnetic Resonance Imaging with Integrated Slice-specific Shimming for old myocardial infarction: A Pilot Study.

Currently, little is known regarding the value of quantitative parameters derived from the intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) with integrated slice-specific shimming (iShim) sequence in detecting old myocardial infarction and myocardial fibrosis. This study was to investigate the value of IVIM-MRI with iShim sequence in diagnosing old myocardial infarction and fibrosis. Thirty-five patients with both old myocardial infarction and myocardial fibrosis and 12 healthy volunteers were prospectively enrolled to undergo cardiac diffusion-weighted imaging (DWI) using seven b-values (0, 20, 60, 80, 120, 200 and 600 s/mm2). The iShim sequence was used for IVIM data acquisition, and the diffusion parameters, D, D* and f values for IVIM, and conventional apparent diffusion coefficient (ADC) were evaluated on the anterior, posterior and lateral walls of the ventricular septum using the short axis of the heart. Significant differences were found in the D, D* and f values between healthy subjects and patients with old myocardial infarction and myocardial fibrosis (P = 0.000), with the median value of the D and f significantly smaller in the myocardial infarction and fibrosis than in the normal control but the median value of D* significantly greater in the myocardial infarction and fibrosis than in the normal control. In the receiver operating curve analysis, the areas under the curve were 0.939, 0.988 and 0.959 for the D, D* and f values, respectively. The sensitivities and specificities were 84.6% and 94.4% for D, 88.9% and 84.6% for D* and 100% and 93.1% for the f values, respectively. In conclusion, the IVIM-derived parameters (D, D* and f) obtained using the iShim DWI technique showed high capacity in diagnosing old myocardial infarction and myocardial fibrosis by providing diffusion and perfusion information, which may have great importance in future clinical practice.

STROBE-A preliminary investigation of IVIM-DWI in cardiac imaging.

This study aims to explore the possibility to apply intravoxel incoherent motion-magnetic resonance imaging (IVIM-MRI) in cardiac imaging.Multi-b-value diffusion-weighted imaging (DWI) sequence scanning was performed on 12 healthy volunteers. A double exponential model was adopted, and the b-value sequence was 0, 20, 60, 80, 120, 200, and 600 second/mm. The D-value, D*-value, and f-value of the anterior posterior and lateral walls of the ventricular septum were respectively measured on the short axis section of the heart, the parameters of the myocardium in different blood supply areas in each segment were recorded, and the measured data of these different segments were compared using analysis of variance.Among these 12 healthy volunteers, the D-value, D*-value, and f-value of these 72 segments were not exactly equal, the D-values of the myocardium in the 5th and 11th segment were lower than those in the 2nd, 3rd, 8th, and 9th segments, and the pairwise differences were statistically significant (P < .001). Furthermore, the difference in D-value between the 5th and 11th segments was not statistically significant (P = 1.000). The D*-value and f-value of the myocardium in the 5th and 11th segment were higher than those in the 2nd, 3rd, 8th, and 9th segments, and the pairwise differences were statistically significant (P < .001). Furthermore, the differences in D*-value and f-value between the 5th and 11th segments was not statistically significant (P = .214, .787).The intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) technique can quantitatively reflect the diffusion and blood perfusion status of the myocardium.

Establishment and evaluation of the VX2 orthotopic lung cancer rabbit model: a ultra-minimal invasive percutaneous puncture inoculation method.

The purpose of the present work is to establish an ultra-minimal invasive percutaneous puncture inoculation method for a VX2 orthotopic lung cancer rabbit model with fewer technical difficulties, lower mortality of rabbits, a higher success rate and a shorter operation time, to evaluate the growth, metastasis and apoptosis of tumor by CT scans, necropsy, histological examination, flow cytometry and immunohistochemistry. The average inoculation time was 10-15 min per rabbit. The tumor-bearing rate was 100%. More than 90% of the tumor-bearing rabbits showed local solitary tumor with 2-10 mm diameters after two weeks post-inoculation, and the rate of chest seeding was only 8.3% (2/24). The tumors diameters increased to 4-16 mm, and irregularly short thorns were observed 3 weeks after inoculation. Five weeks post-inoculation, the liquefaction necrosis and a cavity developed, and the size of tumor grew further. Before natural death, the CT images showed that the tumors spread to the chest. The flow cytometry and immunohistochemistry indicated that there was less apoptosis in VX2 orthotopic lung cancer rabbit model compared to chemotherapy drug treatment group. Minimal invasive percutaneous puncture inoculation is an easy, fast and accurate method to establish the VX2 orthotopic lung cancer rabbit model, an ideal in situ tumor model similar to human malignant tumor growth.

Enhanced antitumor effect on intrapulmonary tumors of docetaxel lung-targeted liposomes in a rabbit model of VX2 orthotopic lung cancer.

Allergic reactions and severe systemic toxicity are two major challenges for the clinical application of docetaxel (DTX) for treatment of non-small-cell lung cancer (NSCLC). We developed a novel lung-targeted DTX-loaded liposome (DTX-LP), an efficient drug delivery system, with a patented DBaumNC technology to overcome these deficiencies. In the present study, we describe the targeting activity, tumor inhibition rate (TIR), survival, pathology, tumor apoptosis and metabolism of DTX after intravenous injection of DTX-LP compared to the DTX injection (DTX-IN) formulation based on the VX2 orthotopic lung cancer rabbit model. Biodistribution studies revealed the highest accumulation in lung and tumor within 12 h after the injection of DTX-LP. The increased TIR indicates that the growth of tumor was slowed. Pathology tests demonstrated that DTX-LP can reduce metastasis and toxicity to non-targeted organs, leading to greatly extended survival time and improved survival of tumor-bearing rabbits. Flow cytometry and immunohistochemistry confirmed that DTX-LP is highly efficacious in tumor tissue, leading to a significant increase of tumor apoptosis and decrease of proliferation and angiogenesis. The results from this study demonstrate the increased intrapulmonary tumor targeting activity, enhanced antitumor effect and reduced toxicity of DTX-LP compared to DTX-IN and highlight its clinical prospects for NSCLC therapy.

Diagnostic significance of diffusion-weighted MRI in patients with cervical cancer: a meta-analysis.

The aim of this meta-analysis is to demonstrate whether diffusion-weighted magnetic resonance imaging (DWI) could assist in the precise diagnosis of cervical cancer or not. Both English and Chinese electronic databases were searched for potential relevant studies followed by a comprehensive literature search without any language restriction. Two reviewers independently assessed the methodological quality of the included trials. Standardized mean difference (SMD) and its corresponding 95 % confidence interval (95 % CI) were calculated in this meta-analysis. We chose Version 12.0 STATA statistical software to analyze our statistical data. Thirteen eligible cohort studies were selected for statistical analysis, including 645 tumor tissues and 504 normal tissues. Combined SMD of apparent diffusion coefficient (ADC) suggested that the ADC value in cervical cancer tissues was significantly lower than that of normal tissue (SMD = 2.80, 95 % CI = 2.64 ~ 2.96, P < 0.001). Subgroup analysis stratified by ethnicity indicated a higher ADC value in the normal tissues compared to the cancer tissues in both the Asian and Caucasian subgroups (Asians: SMD = 2.83, 95 % CI = 2.64 ~ 3.02, P < 0.001; Caucasians: SMD = 2.73, 95 % CI = 2.45 ~ 3.01, P < 0.001, respectively). The results from the subgroup analysis by MRI machine type revealed a statistically significant difference in ADC value between normal cervical tissue and tumor tissues among all of the six MRI machine type subgroups (all P < 0.05). The main finding from our meta-analysis revealed that increased signal intensity on DWI and decreased signal on ADC seem to be useful in the diagnosis of cervical cancer. DWI could therefore be an important imaging tool in potentially identifying patients with cervical cancer.