Evaluation of left ventricular blood flow kinetic energy in patients with hypertension by four-dimensional flow cardiovascular magnetic resonance imaging: a preliminary study.

OBJECTIVES: To evaluate the intra-cavity left ventricular (LV) blood flow kinetic energy (KE) parameters using four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) in patients with hypertension (HTN). METHODS: Forty-two HTN patients and twenty age-/gender-matched healthy controls who underwent CMR including cines, pre-/post-T1 mapping, and whole-heart 4D flow imaging were retrospectively evaluated. HTN patients were further divided into two subgroups: with preserved ejection fraction (HTN-pEF) and with reduced ejection fraction (HTN-rEF). KE parameters were indexed to LV end-diastolic volume (EDV) to obtain averaged LV, minimal, systolic, diastolic, peak E-wave, peak A-wave, E-wave, and A-wave KEiEDV, as well as the proportion of in-plane LV KE (%), the time difference (TD). These parameters were compared between the HTN group and healthy controls, also between two subgroups. The correlation of LV blood flow KE parameters with LV function and extracellular volume fraction (ECV) were analyzed in the HTN group using multivariate regression analysis. RESULTS: Peak E-wave KEiEDV in the HTN group was significantly lower (p = 0.01), while in-plane KE and TD were significantly higher (all p < 0.01) than those in healthy controls. Compared to the HTN-pEF subgroup, the proportion of in-plane KE and TD was significantly increased in the HTN-rEF subgroup (all p < 0.01). Only the proportion of in-plane KE demonstrated an independent correlation with ECV (ß* = 0.59, p < 0.01). CONCLUSIONS: The decreased peak E-wave KEiEDV and the increased proportion of in-plane KE, TD reflected the alterations of LV blood flow in HTN patients, and the proportion of in-plane KE was independently associated with ECV. KEY POINTS: • 4D flow CMR demonstrated that the peak E-wave KEiEDV was decreased, while the in-plane KE and time difference (TD) were increased in hypertensive (HTN) patients. • The proportion of in-plane KE and TD was further increased in HTN patients with reduced ejection fraction than in HTN patients with preserved ejection fraction, and the proportion of in-plane KE was independently associated with extracellular volume fraction in HTN patients. • 4D flow CMR intra-cavity blood flow KE parameters might reveal the LV hemodynamic status in preclinical HTN patients.

Evaluation of bone mineral density and body compositions interrelation in young and middle-aged male patients with Crohn's disease by quantitative computed tomography.

Background: The aim of this study was to investigate the characteristics of bone mineral density (BMD) and body compositions, and the impact of body compositions on BMD in young and middle-aged male patients with Crohn's disease (CD). Methods: Patients with CD (n = 198) and normal controls (n = 123) underwent quantitative computed tomography (QCT) examination of lumbar vertebrae 1-3 (L1-3). The BMD and bone geometric parameters were measured and outputted by QCT post-process software. Meanwhile, body composition parameters, including subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), lean mass (LM), and muscles mass around lumbar vertebrae were also acquired by QCT. Blood indicators [interleukin (IL)-6, IL-8, tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), Ca, and P] were collected from clinical medical records. Independent t-test was used to compare these variables between the CD group and the normal control group. Results: There was no significant difference in age, height, and weight between the CD group and the control group (p > 0.05), indicating that the sample size was relatively balanced. Mean BMD in the CD group were lower than those in the control group, but the difference was not statistically significant (p > 0.05). The bone geometric parameters of the CD group, including cortical area/density (Ct. Ar, Ct. BMD) and trabecular area/density (Tb. Ar and Tb. BMD), were significantly lower than those of the control group (p < 0.05), so were the body composition parameters including total adipose tissue (TAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), lean mass (LM), and muscles mass (p < 0.05). In addition, the level of plasma IL-6, IL-8, CRP, and TNF-α of the CD group were higher than those of the control group (p < 0.05). On the contrary, the body mass index (BMI) and serum Ca and P levels of the CD group were lower than those of the control group (p < 0.05). Through multiple linear regression analysis, Tb. BMD, VAT, Ct. Ar, LM, Ca, and IL-8 entered the regression model and revealed a significant contribution to BMD. Conclusions: Patients with CD could suffer from reduction in BMD. However, the parameters of bone geometric parameters are more sensitive and accurate than BMD changes. Among them, Tb. BMD, VAT, Ct. Ar, and LM have significant effects on BMD reduction.

Quantitative analysis of the MRI features in the differentiation of benign, borderline, and malignant epithelial ovarian tumors.

OBJECTIVE: This study aims to investigate the value of the quantitative indicators of MRI in the differential diagnoses of benign, borderline, and malignant epithelial ovarian tumors (EOTs). MATERIALS AND METHODS: The study population comprised 477 women with 513 masses who underwent MRI and operation, including benign EOTs (BeEOTs), borderline EOTs (BEOTs), and malignant EOTs (MEOTs). The clinical information and MRI findings of the three groups were compared. Then, multivariate logistic regression analysis was performed to find the independent diagnostic factors. The receiver operating characteristic (ROC) curves were also used to evaluate the diagnostic performance of the quantitative indicators of MRI and clinical information in differentiating BeEOTs from BEOTs or differentiating BEOTs from MEOTs. RESULTS: The MEOTs likely involved postmenopausal women and showed higher CA-125, HE4 levels, ROMA indices, peritoneal carcinomatosis and bilateral involvement than BeEOTs and BEOTs. Compared with BEOTs, BeEOTs and MEOTs appeared to be more frequently oligocystic (P < 0.001). BeEOTs were more likely to show mild enhancement (P < 0.001) and less ascites (P = 0.003) than BEOTs and MEOTs. In the quantitative indicators of MRI, BeEOTs usually showed thin-walled cysts and no solid component. BEOTs displayed irregular thickened wall and less solid portion. MEOTs were more frequently characterized as solid or predominantly solid mass (P < 0.001) than BeEOTs and BEOTs. The multivariate logistic regression analysis showed that volume of the solid portion (P = 0.006), maximum diameter of the solid portion (P = 0.038), enhancement degrees (P < 0.001), and peritoneal carcinomatosis (P = 0.011) were significant indicators for the differential diagnosis of the three groups. The area under the curves (AUCs) of above indicators and combination of four image features except peritoneal carcinomatosis for the differential diagnosis of BeEOTs and BEOTs, BEOTs and MEOTs ranged from 0.74 to 0.85, 0.58 to 0.79, respectively. CONCLUSION: In this study, the characteristics of MRI can provide objective quantitative indicators for the accurate imaging diagnosis of three categories of EOTs and are helpful for clinical decision-making. Among these MRI characteristics, the volume, diameter, and enhancement degrees of the solid portion showed good diagnostic performance.

Differentiation of borderline tumors from type I ovarian epithelial cancers on CT and MR imaging.

PURPOSE: To investigate the value of CT and MR imaging features in differentiating borderline ovarian tumor (BOT) from type I ovarian epithelial cancer (OEC), which could be significant for suitable clinical treatment and assessment of the prognosis of the patient. METHODS: Thirty-three patients with BOTs and 35 patients with type I OECs proven by pathology were retrospectively evaluated. The clinico-pathological information (age, premenopausal status, CA-125, and Ki-67) and imaging characteristics were compared between two groups of ovarian tumors. The diagnostic performance of the imaging features was evaluated using receiver operating characteristic analysis. The best predictor variables for type I EOCs were recognized via multivariate analyses. RESULTS: BOTs are more likely to involve younger patients and frequently show lower CA-125 values and lower proliferation indices (Ki-67 < 15%) than type I OECs. Compared with type I OECs, BOTs were more often purely cystic (15/33, 45.45% vs. 1/35, 2.86%; p < 0.001) and displayed less frequent mural nodules (16/33, 48.48% vs. 28/35, 80.00%; p = 0.007), less frequently unclear margin (3/33, 9.09% vs. 11/35, 31.43%; p = 0.023), smaller solid portion (0.56 ± 2.66 vs. 4.51 ± 3.88; p < 0.001), and thinner walls (0.3 ± 0.17 vs. 0.55 ± 0.24; p < 0.001). The maximum wall thickness presented the largest area under the curve (AUC, 0.848). Multivariate analysis revealed that the solid portion size (OR 10.822, p = 0.002) and maximum wall thickness (OR 9.130, p = 0.001) were independent indicators for the differential diagnosis between the two groups of lesions. CONCLUSION: The solid portion size and maximum wall thickness significantly influenced the classification of the two groups of ovarian tumors.

Quantitative Evaluation of the Compressed L5 and S1 Nerve Roots in Unilateral Lumbar Disc Herniation by Using Diffusion Tensor Imaging.

BACKGROUND AND PURPOSE: Nerve root compression by lumbar disc herniation (LDH) induces a series of clinical symptoms, seriously affecting the patient's life and work. The purpose of this study is to investigate microstructural changes and fiber bundle abnormalities of the compressed L5 and S1 nerve roots in young patients with unilateral LDH by using diffusion tensor imaging (DTI). METHODS: Forty young patients with unilateral LDH and 17 healthy volunteers participated in the study, and 33 patients received follow-up DTI examination after one month of conservative treatment. Fractional anisotropy (FA), apparent diffusion coefficient (ADC) and trace weight (TraceW) values of the L5 and S1 nerve roots were measured on FA maps. RESULTS: The mean FA, ADC and TraceW values of the affected nerve roots were 0.259 ± 0.047, 1.79 ± 0.252 and 0.076 ± 0.025, respectively. Compared to the contralateral side and volunteers, the affected nerve roots showed a decreased FA (P < 0.01), an increased ADC (P < 0.01) and TraceW (P < 0.05). The compression severity had a moderately negative correlation with FA (r = -0.646, P < 0.01) and positive correlation with ADC (r = 0.408, P < 0.01) but not with TraceW (r = 0.298, P = 0.06). For 33 patients with follow-up study after conservative treatment, FA (0.286 ± 0.06) and ADC (1.630 ± 0.046) in the affected nerve roots showed an increasing and a decreasing trend, respectively. Moreover, FA values (14 cases; 0.246 ± 0.015, P = 0.213) in the severe compression group had no significant changes between initial and follow-up data. CONCLUSIONS: DTI is able to assess microstructural abnormalities of the compressed nerve roots and has potentially practical value for prognostic evaluation after treatment in patients with LDH.