Localization Evaluation of Primary Middle Ear Cholesteatoma With Fusion of Turbo Spin-Echo Diffusion-Weighted Imaging and High-Resolution Computed Tomography.

OBJECTIVE: The aim of the study is to evaluate the application of high-resolution computed tomography (HRCT) and turbo spin-echo diffusion-weighted imaging (TSE-DWI) fusion imaging for localization of middle ear cholesteatomas. METHODS: Eighty-six patients with clinically suspected middle ear cholesteatomas were enrolled prospectively. Ear TSE-DWI and HRCT scans were performed using a postprocessing workstation to generate a TSE-DWI-CT fusion image. Subsequently, all the enrolled patients received surgical treatment. According to the STAM system (difficult access sites [S], the tympanic cavity [T], the attic [A], and the mastoid [M]), the agreement between the localization of lesions evaluated by HRCT, TSE-DWI, and TSE-DWI-CT fusion images and the intraoperatively recorded localization were computed using Cohen κ statistic. RESULTS: Based on the pathological results, the enrolled patients were divided into a cholesteatoma (n = 50) and a noncholesteatoma group (n = 36). The area under the receiver operator characteristic curve for diagnosis of cholesteatoma with TSE-DWI-CT fusion imaging was identical to that using the TSE-DWI images (0.924 vs 0.924, P > 0.05), but was significantly higher than that with HRCT imaging (0.924 vs 0.767, P = 0.0005). Furthermore, the diagnostic sensitivity and specificity of TSE-DWI-CT fusion imaging for cholesteatomas were 96.0% and 88.9%, respectively. Depending on whether the cholesteatoma extended to the mastoid, TSE-DWI-CT fusion imaging demonstrated good agreement with the intraoperative record for localization of lesions (κ = 0.808) and had a high accuracy of localization by the STAM system. CONCLUSIONS: Turbo spin-echo-DWI-CT fusion images have a very high diagnostic value for the preoperative localization of cholesteatomas.

Clinical study of transcranial sonography image characteristics in patients with obstructive sleep apnea.

OBJECTIVE: This study aimed to explore the relationship between patients with obstructive sleep apnea (OSA) from subgroups of varying severity and substantia nigra (SN) hyperechogenicity as well as cerebral blood flow detected by transcranial sonography (TCS). The study also explored if there were differences in damage of the SN and in the cerebral blood flow between the bilateral sides. METHODS: Right-handed men diagnosed with OSA by polysomnography were recruited from August 2018 to August 2020. The included patients were divided into 3 subgroups (mild, moderate, and severe OSA), and all patients underwent TCS. RESULTS: Among the 157 study patients (30 with mild OSA, 25 moderate, and 102 severe), the overall prevalence of SN hyperechogenicity was 15% (23/157). The hyperechogenicity detection rates were 3% (4/157) in the right SN subgroup and 13% (20/157) in the left SN subgroup, which were significantly different. The left side always had reduced blood flow on TCS (P < 0.05). No correlation was observed between the severity of OSA and the detection rates of SN hyperechogenicity (P > 0.05). CONCLUSION: Patients with OSA showed a higher detection rate of SN hyperechogenicity on the left compared with the right side. The left middle cerebral arteries had reduced blood flow, which was consistent with the more severe damage of the left SN. No relationship was observed between the severity of OSA and the detection rate of SN hyperechogenicity or hemodynamic parameters.

Ultrasound exploration of muscle characteristic changes and diabetic peripheral neuropathy in diabetic patients.

PURPOSE: Using brightness mode ultrasound combined with shear wave elastography, this study aims to detect structural and functional changes of the medial head of gastrocnemius (MG) in type 2 diabetes mellitus (T2DM) patients with or without diabetic peripheral neuropathy (DPN). METHODS: 149 T2DM patients (DPN group and non-DPN group) and 60 healthy volunteers (control group) were enrolled. We measured the absolute difference of fascicle length (FL), pennation angle (PA), and shear wave velocity (SWV) of both MG in neutral position and maximal ankle joint's plantar flexion and calculated ΔFL, ΔPA, and ΔSWV. These three parameters, along with muscle thickness (MT), were compared among the three groups. RESULTS: In the DPN group, the MG's MT, ΔPA, and ΔSWV were significantly lower than in the non-DPN group (p < 0.01); these parameters achieved the highest scores in the control group (p < 0.01). The area under the receiver operating characteristic curve of the combination of ΔSWV and ΔFL was the largest for predicting inpatients with or without DPN. CONCLUSIONS: Decreased muscle mass (MT) and muscle contractibility (ΔFL and ΔSWV) were detected in patients with T2DM, with or without DPN. ΔSWV and ΔFL of the MG showed high-diagnostic accuracy for DPN warning signs.

Yolk sac tumor of the fourth ventricle in a 3-year-old boy: imaging features.

PURPOSE: Yolk sac tumor (YST) is a rare malignant germ cell tumor and typically occurs in gonads. It is extremely rare in the brain, especially in the fourth ventricle. METHODS: This study reported the case of a 3-year-old boy with intermittent vomiting for 11 days and then intermittent twitch for 5 h. RESULTS: Brain computed tomography showed a slightly higher density mass in the fourth ventricle. Brain magnetic resonance imaging showed an irregular lobulated expansive mass in the fourth ventricle, appearing with the low intensity on T1-weighted images, and uneven hyperintensity on T2-weighted images. The enhanced scan showed inhomogeneous and strong enhancement, with multiple small cyst-like areas of no enhancement. Tortuous tumor vessel also can be seen. The pathological results after surgical resection showed an YST in the fourth ventricle. CONCLUSION: When a mass is observed in the fourth ventricle in children, with uneven signal with hemorrhage and cystic change, inhomogeneous and strong enhancement, and facilitated diffusion on diffusion-weighted imaging, YST should be considered. The increase of α-fetoprotein value can help differential diagnosis.

Diffusion-weighted MRI findings in Sjögren's syndrome: a preliminary study.

BACKGROUND: Parotid glands diffusion-weighted imaging (DWI) in Sjögren's syndrome patients have provided conflicting results currently. PURPOSE: To determine if parotid gland DWI using a small region of interest (ROI) can provide diagnosis and assess therapeutic efficacy in Sjögren's syndrome. MATERIAL AND METHODS: Twenty-three women with Sjögren's syndrome, five with dry mouth who did not meet diagnostic criteria for Sjögren's syndrome, and 11 healthy volunteers (controls) were evaluated with DWI. All participants received routine T1-weighted (T1W) imaging and T2-weighted (T2W) fat-suppressed imaging, and DWI. The SI ratios (SIRs) and ADC ratios (ADCRs) for parotid gland/spinal cord were then calculated. Approximately 8-10 round ROIs measuring approximately 5 mm(2) were placed on each lobe of the parotid gland, and the signal intensity (SI) was measured while avoiding fat, ducts, and blood vessels. A ROI encompassing the entire lobe of the parotid gland was also used to measure SI. RESULTS: Using 5 mm(2) ROIs significantly higher DWI SIRs were noted in participants with Sjögren's syndrome compared with either participants with dry mouth without Sjögren's syndrome or healthy volunteers (all, P <0.001). The difference was not related to the presence of fat. No differences were noted when the larger ROI was used. In addition, parotid gland from untreated Sjögren's participants showed significantly higher SIRs compared with those from treated participants (P = 0.015). CONCLUSION: A small ROI DWI can provide morphological and functional information on the parotid gland in Sjögren's syndrome patients, and can aid in the diagnosis and evaluation of therapeutic efficacy.

Comparing the Double-Echo Steady-State with Water Excitation and Constructive Interference in Steady-State Sequence Techniques for Identifying Extracranial Facial Nerve and Tumor Positions in Patients with Parotid Tumors.

BACKGROUND AND PURPOSE: Reliable preoperative visualization of facial nerve morphology and understanding the spatial relationship between the facial nerve and tumors in the parotid gland can help clinicians perform safe and effective surgeries. Hence, this study aimed to compare the image quality of extracranial facial nerves obtained by using double-echo steady state with water excitation (DESS-WE) and CISS sequences and evaluate their diagnostic efficacy in the localization of parotid tumors. MATERIALS AND METHODS: In total, 32 facial nerves of 16 healthy volunteers and 25 facial nerves of 25 patients with parotid tumors were included in this retrospective study. All participants underwent noncontrast-enhanced extracranial facial nerve MR imaging with DESS-WE and CISS with a 3T MR scanner equipped with a 64-channel head and neck coil. Image quality was subjectively evaluated by using a 5-point Likert scale by 2 radiologists. Inter- and intrarater agreements were assessed by using the Cohen κ coefficient. Receiver operating characteristic analysis was performed, and the diagnostic efficacies of DESS-WE and CISS images in localizing parotid tumors were calculated. RESULTS: For healthy volunteers (11 men and 5 women; median age, 26 years), image quality scores for CISS were significantly higher than those for DESS-WE for the discrimination of the temporofacial and cervicofacial trunks (both, P < .001). In patients with parotid tumors (12 men and 13 women; median age, 58 years), CISS performed better than DESS-WE in terms of visualizing the spatial relationship of the facial nerve to the tumor and diagnostic confidence (both, P < .001). Regarding the localization of parotid tumors, CISS showed excellent performance, comparable to that of DESS-WE (area under the curve, 0.981 versus 0.942, P = .1489). CONCLUSIONS: CISS achieved diagnostic performance comparable to DESS-WE in parotid tumor localization, with favorable image quality and more reliable morphologic visualization of the facial nerve.

CT-based non-invasive identification of the most common gene mutation status in patients with non-small cell lung cancer.

BACKGROUND: Epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene homolog (KRAS) are mutually exclusive, and they are two important genes that are most prone to mutation in patients with non-small cell lung cancer. PURPOSE: This retrospective study investigated the ability of radiomics to predict the mutation status of EGFR and KRAS in patients with non-small cell lung cancer (NSCLC) and guide precision medicine. METHODS: Computed tomography images of 1045 NSCLC patients from five different institutions were collected, and 1204 imaging features were extracted. In the training set (EGFR: 678, KRAS: 246), Max-Relevance and Min-Redundancy and least absolute shrinkage and selection operator logistic regression were used to screen radiomics features. The combination of selected radiomics features and clinical factors was used to establish the combined models in identifying EGFR and KRAS mutation status, respectively, through stepwise logistic regression. Then, on two independent external validation sets (EGFR: 203/164, KRAS: 123/95), the performance of each model was evaluated separately, and then the overall performance of predicting the two mutation states was calculated. RESULTS: In the EGFR and KRAS groups, radiomics signatures comprised 14 and 10 radiomics features, respectively. They were mutually exclusive between the tumors with positive EGFR mutation and those with positive KRAS mutation in imaging phenotype. For the EGFR group, the area under the curve (AUC) of the combined model in the two validation sets was 0.871 (95% CI: 0.821-0.926) and 0.861 (95% CI: 0.802-0.911), respectively, whereas the AUC of the combined model in the two validation sets was 0.798 (95% CI: 0.739-0.850) and 0.778 (95% CI: 0.735-0.821), respectively, for the KRAS group. Considering both EGFR and KRAS, the overall precision, recall, and F1-score of the combined model in the two validation sets were 0.704, 0.844, and 0.768, as well as 0.754, 0.693, and 0.722, respectively. CONCLUSIONS: Our study demonstrates the potential of radiomics in the non-invasive identification of EGFR and KRAS mutation status, which may guide patients with non-small cell lung cancer to choose the most appropriate personalized treatment. This method can be used when biopsy will bring unacceptable risk to patients with NSCLC.

Diagnostic efficacy of virtual organ computer-assisted analysis in measuring the volume ratio of subchorionic hematoma with serum progesterone.

BACKGROUND: Subchorionic hematoma (SCH) is a common complication in early pregnancy characterized by the accumulation of blood between the uterine wall and the chorionic membrane. SCH can lead to adverse pregnancy outcomes such as miscarriage, preterm birth, and other complications. Early detection and accurate assessment of SCH are crucial for appropriate management and improved pregnancy outcomes. AIM: To evaluate the diagnostic efficacy of virtual organ computer-assisted analysis (VOCAL) in measuring the volume ratio of SCH to gestational sac (GS) combined with serum progesterone on early pregnancy outcomes in patients with SCH. METHODS: A total of 153 patients with SCH in their first-trimester pregnancies between 6 and 11 wk were enrolled. All patients were followed up until a gestational age of 20 wk. The parameters of transvaginal two-dimensional ultrasound, including the circumference of SCH (Cs), surface area of SCH (Ss), circumference of GS (Cg), and surface area of GS (Sg), and the parameters of VOCAL with transvaginal three-dimensional ultrasound, including the three-dimensional volume of SCH (3DVs) and GS (3DVg), were recorded. The size of the SCH and its ratio to the GS size (Cs/Cg, Ss/Sg, 3DVs/3DVg) were recorded and compared. RESULTS: Compared with those in the normal pregnancy group, the adverse pregnancy group had higher Cs/Cg, Ss/Sg, and 3DVs/3DVg ratios (P < 0.05). When 3DVs/3DVg was 0.220, the highest predictive performance predicted adverse pregnancy outcomes, resulting in an AUC of 0.767, and the sensitivity, specificity were 70.2%, 75% respectively. VOCAL measuring 3DVs/3DVg combined with serum progesterone gave a diagnostic AUC of 0.824 for early pregnancy outcome in SCH patients, with a high sensitivity of 82.1% and a specificity of 72.1%, which showed a significant difference between AUC. CONCLUSION: VOCAL-measured 3DVs/3DVg effectively quantifies the severity of SCH, while combined serum progesterone better predicts adverse pregnancy outcomes.

Prenatal diagnosis of fetal unilateral lung agenesis complicated with cardiac malposition.

BACKGROUND: Fetal unilateral lung agenesis, complicated with cardiac shifting, is a rare anomaly, the diagnosis of which remains a challenge for many sonographers in routine screening programs. The present study describes a systematic approach for the diagnosis of fetal unilateral lung agenesis and cardiac malpositions in routine prenatal screening. METHODS: A total of 18 cases of fetal unilateral lung agenesis complicated with cardiac malposition were reviewed. A systematic method was proposed to identify the fetal left side and right side according to the fetal head position and posture by acquiring a long axis and transverse view of the fetus. Fetal unilateral lung agenesis was diagnosed by evaluation of the ipsilateral pulmonary artery. The diagnosis was confirmed by postnatal echocardiography, digital radiology, and computed tomography after birth or by autopsy findings. RESULTS: The left-sided fetal heart with the cardiac apex rotating to the left and posterior were confirmed in all 7 left lung agenesis cases, while the rightward shifting of the fetal heart together with the cardiac axis deviating to the right were confirmed in all 11 cases of right lung agenesis. The disappearance of the ipsilateral pulmonary artery was confirmed in all 18 cases of unilateral lung agenesis. Cardiac anomalies were present in a total of 7 of the 18 cases of lung agenesis with 4 of 7 in cases of left lung agenesis and 3 of 11 in cases of right agenesis. CONCLUSIONS: The systematic approach introduced in the current report is helpful in the diagnosis of fetal unilateral lung agenesis complicated with cardiac malposition. The information provided by this study may be helpful to better understand unilateral lung agenesis anatomically and to facilitate its potential examination.

Radiographic, CT, and MRI Features of Generalized Lymphatic Anomaly in a Boy.

BACKGROUND: Generalized lymphatic anomaly (GLA) is a rare condition, mainly involving bones, soft tissue, and internal organs. The diagnosis of GLA is often difficult. CASE PRESENTATION: We report a case of GLA in a boy who was initially treated for suspected Langerhans cell histiocytosis and discuss the potential imaging features of GLA. The clinical and imaging data of a case of GLA in an 8-year-old boy were analyzed retrospectively, and the literature was reviewed. RESULTS: The case shows the imaging features of GLA with multiskeletal diffuse expansile cystic osteolytic lesions penetrating the cortical surface and extending within the cortex and a pumice-like or rotten wood-like rough appearance on volume-rendered 3D CT images. Soft tissue multi-cystic masses increase diagnostic confidence. Fatty infiltration appears in multiple vertebral bodies and sternum, namely, abnormal T1 and T2 hyperintense and fat-suppressed T2 hypointense on MRI and the corresponding low density similar to that of fat on CT, suggesting that GLA involves the vertebrae and sternum, which may be accompanied by chylothorax. CONCLUSION: GLA in bone has typical features on CT. MRI reveals its cystic nature, and typical soft tissue lesions and chylothorax increase confidence in the diagnosis.

4D Transperineal Ultrasound for the Diagnosis and Classification of Stress Urinary Incontinence in Postmenopausal Women.

OBJECTIVE: To explore 4D transperineal ultrasound (TPUS) parameters distinguishing urethral hypermobility (UH) and intrinsic sphincter deficiency (ISD) in stress urinary incontinence (SUI). STUDY DESIGN: Observational study. Place and Duration of the Study: The Second Affiliated Hospital of Soochow University, China, from January 2018 to January 2022. METHODOLOGY: According to valsalva leak point pressure (VLPP), postmenopausal SUI women were divided into UH and ISD groups, and healthy women were set as control group. Medical data and ultrasound parameters were analysed for their diagnostic values on SUI. RESULTS: In women with SUI, body mass index, parity, urethral funnel formation rate, bladder neck descent (BND), retrovesical angle (RVA) under the maximum valsalva manoeuver (MVM), urethral rotation angle (URA) and levator hiatus area (LHA) were higher, but bladder neck internal angle (BIA), urethral length (UL) at rest and UL under MVM were smaller than those in control (p<0.05). In the UH group, BIA, BND, and UL under MVM were higher, but ICIQ-SF score and urethral funnel formation rate were smaller than those in the ISD group, and Cystocele Green's type differed significantly (p<0.05). Smaller BIA, shorter UL under MVM, and higher ICIQ-SF score were more likely to diagnose ISD, while Cystocele Green's type II were likely to diagnose UH (p<0.05). The area under receiver operator characteristic curve of the logistic regression model was 0.864 with 90.6% sensitivity and 71.9% specificity. VLPP was positively correlated with BIA and UL under MVM but negatively correlated with the ICIQ-SF score. CONCLUSION: Parameters of 4D TPUS can differentiate UH and ISD in SUI. KEY WORDS: Stress urinary incontinence, Transperineal ultrasound, Valsalva leak point pressure, Urethral hypermobility, Intrinsic sphincter deficiency.

Diagnostic value of ACR TI-RADS combined with three-dimensional shear wave elastography in ACR TI-RADS 4 and 5 thyroid nodules.

BACKGROUND: Three-dimensional shear wave elastography (3D-SWE) is a promising method in distinguishing benign and malignant thyroid nodules. By combining with conventional method, it may further improve the diagnostic value. The study aimed to assess the diagnostic value of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules. METHODS: All nodules were examined by conventional ultrasonography, ACR TI-RADS classification, and 3D-SWE examination. Conventional ultrasonography was used to observe the location, size, shape, margin, echogenicity, taller-than-wide sign, microcalcification, and blood flow of thyroid nodules, and then ACR TI-RADS classification was performed. The Young's modulus values (3D-C-Emax, 3D-C-Emean, and elastography standard deviation [3D-C-Esd]) were measured on the reconstructed coronal plane images. According to the receiver operating characteristic (ROC) curve, the best diagnostic efficiency among 3D-C-Emax, 3D-C-Emean, and 3D-C-Esd was selected and the cut-off threshold was calculated. According to the surgical pathology, they were divided into benign group and malignant group. And appropriate statistical methods such as t -test and Mann-Whitney U test were used to compare the difference between the two groups. On this basis, 3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules. RESULTS: Of the 112 thyroid nodules, 62 were malignant and 50 were benign. The optimal cut-off value of three-dimensional maximum Young's modulus in coronal plane (3D-C-Emax) was 51.5 kPa and the area under the curve (AUC) was 0.798. The AUC, sensitivity, specificity, and accuracy of conventional ACR TI-RADS were 0.828, 83.9%, 66.0%, and 75.9%, respectively. The AUC, sensitivity, specificity, and accuracy of combined ACR TI-RADS were 0.845, 90.3%, 66.0%, and 79.5%, respectively. The difference between the two AUC values was statistically significant. CONCLUSIONS: Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS. The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements. It can be used as an effective method in the diagnosis of thyroid nodules.

The value of ultrasound measurement of muscle thickness at different sites and shear wave elastography in Parkinson's disease with sarcopenia: a pilot study.

Background: Patients with Parkinson's disease (PD) and sarcopenia often exhibit resilience, frailty, disability, and depression, highlighting the complex and interrelated nature of these conditions. Objective: Despite the presence of clinical manifestations of muscle atrophy in both PD and sarcopenia, accurately discerning the coexistence of sarcopenia in PD patients remains a challenging task with significant implications for treatment strategies and prognostic assessments. This study aims to elucidate the specific ultrasonic diagnostic parameters associated with PD accompanied by sarcopenia through a comparative analysis of muscle ultrasound parameters in patients with PD, thereby presenting a novel approach for rapid identification of this condition. Methods: A total of 110 participants were enrolled in this study, including patients with PD and control subjects. Demographic data, clinical characteristics, physical performance tests, appendicular skeletal muscle mass index (ASMI), bioelectrical impedance analysis and muscle ultrasound measurements were collected from all participants. The muscle ultrasound measurements encompassed assessments of muscle thickness, pennation angle and shear wave elastography at various anatomical sites. Results: Parkinson's disease patients exhibited decreased muscle strength and physical performance, and increased shear wave elastography value. In PD patients with sarcopenia, body circumference, including calf circumference, mid-arm circumference, Waist-to-Hip Ratio and body mass index (BMI) were all significantly decreased. Biceps brachii muscle thickness (MT) and gastrocnemius MT decreased in PD patients with sarcopenia and low ASMI. Binary logistic regression analysis revealed that male PD patients, BMI and gastrocnemius MT were predictive factors for ASMI in PD patients. Conclusion: Biceps brachii MT and gastrocnemius MT are important indicators for distinguishing whether PD patients have sarcopenia. Male patients, low BMI and gastrocnemius MT were identified as valid predictors of low ASMI in PD patients. The findings of this study provide important insights into the use of muscle ultrasound in the diagnosis of PD with sarcopenia.

Evaluation of normal fetal pulmonary veins using B-flow imaging with spatiotemporal image correlation and by traditional color Doppler echocardiography.

OBJECTIVE: The purpose of our report is to evaluate the use of color Doppler echocardiography (CDE) with four chamber view (4CV), scanning around left atrium, and four-dimensional echocardiography with B-flow imaging and spatiotemporal image correlation (4D BF-STIC) in detecting fetal pulmonary veins at 17 to 40 weeks' gestation. METHODS: This was a prospective study. Color Doppler echocardiography with 4CV, scanning around left atrium, and 4D BF-STIC were used to detect the pulmonary veins in 460 normal fetuses at 17 to 40 weeks of gestation. Routine prenatal screening was used to confirm that the fetuses were in good health with no cardiac or extra cardiac anomalies. All patients underwent follow up at one year. Twenty-two patients were excluded from the study. The number of pulmonary veins visualized using each method was recorded and then compared in six subgroups according to gestational age. RESULTS: Four-dimensional echocardiography with B-flow imaging and spatiotemporal image correlation was the best method to detect the greatest number of pulmonary veins between 17 and 31 weeks of gestation. Scanning around left atrium detected more pulmonary veins than the traditional 4CV method throughout the gestational period. CONCLUSIONS: The scanning around left atrium method proved to be the most suited for detecting pulmonary veins in clinical practice. 4D BF-STIC was superior in detecting the greatest number of pulmonary veins before 32 gestational weeks, but had limited clinical usage because it was very time-consuming and experience-dependent. The 4D method should be considered as a complement to traditional two-dimensional sonography, because it facilitates understanding of the anatomy and the spatial relationships of the cardiac structures.

Cognitive Performance is Associated with Altered Cerebral Hemodynamics Assessed by Transcranial Ultrasound in Parkinson's Disease.

Purpose: Cognitive impairment (CI) is a common but debilitating non-motor symptom in Parkinson's disease (PD). Although cerebrovascular functions are related to cognitive performance in healthy individuals, such a relation in PD remains elusive. This study aims to assess the association between cerebrovascular function and cognitive performance in PD individuals. Patients and Methods: Two-hundred-and-one PD individuals were retrospectively included. They were subsequently divided into two groups: PD with normal cognition (PD-NC) and PD with CI (PD-CI). Cerebral hemodynamic characteristics of the middle cerebral arteries were assessed by transcranial ultrasound. The association between scores in each cognitive domain and cerebral hemodynamic parameters was further analyzed using regression analyses. Additionally, a binary logistic regression model with backward stepwise procedure was applied to build the model for discriminating CI in PD individuals. An independent dataset of additional 46 PD individuals was used further. Results: The PD-CI group showed a relatively lower end-diastolic blood flow velocity (EDV, p < 0.05) and a higher resistive index (RI, p < 0.05) compared to the PD-NC group. RI showed significant associations with the memory item score of Montreal Cognitive Assessment (p < 0.05). A model combining clinical and hemodynamic variables was established with optimal efficiency (area under the curve, AUC = 0.651). Further replication of the model in an independent dataset yielded a great consistency (AUC = 0.704). Conclusion: In our study, cerebrovascular functions were significantly associated with the cognitive performance in PD individuals, especially with the memory task. The established model was effective in identifying CI in PD individuals, which might be a potentially useful tool to screen the cognitive decline in PD individuals at an early stage of the disease. Further studies with larger sample sizes in different populations are warranted.

Deep learning predicts epidermal growth factor receptor mutation subtypes in lung adenocarcinoma.

PURPOSE: This study aimed to explore the predictive ability of deep learning (DL) for the common epidermal growth factor receptor (EGFR) mutation subtypes in patients with lung adenocarcinoma. METHODS: A total of 665 patients with lung adenocarcinoma (528/137) were recruited from two different institutions. In the training set, an 18-layer convolutional neural network (CNN) and fivefold cross-validation strategy were used to establish a CNN model. Subsequently, an independent external validation cohort from the other institution was used to evaluate the predictive efficacy of the CNN model. Grad-weighted class activation mapping (Grad-CAM) technology was used for the visual interpretation of the CNN model. In addition, this study also compared the prediction abilities of the radiomics and CNN models. Receiver operating characteristic (ROC) curves, accuracy and precision values, and recall and F1-score were used to evaluate the effectiveness of the CNN model and compare its performance with that of the radiomics model. RESULTS: In the validation set, the micro- and macroaverage values of the area under the ROC curve of the CNN model to identify the three EGFR subtypes were 0.78 and 0.79, respectively. All evaluation indicators of the CNN model were better than those of the radiomics model. CONCLUSIONS: Our study confirmed the potential of DL for predicting the EGFR mutation status in lung adenocarcinoma. The imaging phenotypes of the three mutation subtypes were found to be different, which can provide a basis for choosing more accurate and personalized treatment in patients with lung adenocarcinoma.

[The value of turbo spin-echo diffusion weighted imaging in the diagnosis of temporal bone cholesteatoma].

Objective:The aim of this study is to evaluate the diagnostic value of turbo spin-echo（TSE） diffusion weighted imaging（DWI） in temporal bone cholesteatoma. Method:A prospective evaluated of 76 patients with suspected sacral cholesteatoma was performed using a Philips Ingenia 3.0T superconducting magnetic resonance scanner and a 32-channel head coil with turbo spin-echo diffusion weighted imaging（TSE-DWI） sequence and conventional magnetic resonance scan, and underwent surgery within the next two weeks. The pathological result is the gold standard, and the imaging diagnosis and surgery are performed. The intraoperative observation and pathological results were compared. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of TSE-DWI sequence in the diagnosis of temporal bone cholesteatoma were calculated. Result:Of the 76 patients with suspected temporal bone cholesteatoma, TSE-DWI scan was performed, 44 cases were diagnosed as cholesteatoma and 32 cases were non-cholesteatoma. Based on the pathology results, 46 cases were diagnosed as cholesteatoma, 30 cases were non-cholesteatoma. The accuracy of TSW-DWI sequence in the diagnosis of cholesteatoma was 89.47%, 3 cases were false negative and 5 cases was false positive. The sensitivity, specificity, positive predictive value and negative predictive value of TSE-DWI in the diagnosis of temporal bone cholesteatoma were 89.13%, 90.00%, 93.18%, and 84.38%, respectively. Conclusion:The TSE-DWI sequence has high signal-to-noise ratio and can improve the diagnostic accuracy and specificity. TSE-DWI sequence is of great value in clinical diagnosis and treatment.

Detailed identification of epidermal growth factor receptor mutations in lung adenocarcinoma: Combining radiomics with machine learning.

PURPOSE: To investigate the use of radiomics in the in-depth identification of epidermal growth factor receptor (EGFR) mutation status in patients with lung adenocarcinoma. METHODS: Computed tomography images of 438 patients with lung adenocarcinoma were collected in two different institutions, and 496 radiomic features were extracted. In the training set, lasso logistic regression was used to establish radiomic signatures. Combining radiomic index and clinical features, five machine learning methods, and a tenfold cross-validation strategy were used to establish combined models for EGFR+ vs EGFR- , and 19Del vs L858R, groups. The predictive power of the models was then evaluated using an independent external validation cohort. RESULTS: In the EGFR+ vs EGFR- and 19Del vs L858R groups, radiomic signatures consisting of 12 and 7 radiomic features were established, respectively; the area under the curves (AUCs) of the lasso logistic regression model on the validation set was 0.76 and 0.71, respectively. After inclusion of the clinical features, the maximum AUC of combined models on the validation set was 0.79 and 0.74, respectively. Logistic regression analysis showed good performance in the two groups, with AUCs of 0.79 and 0.71 on the validation set. Additionally, the AUC of combined models in the EGFR+ vs EGFR- group was higher than that of the 19Del vs L858R group. CONCLUSIONS: Our study shows the potential of radiomics to predict EGFR mutation status. There are imaging phenotypic differences between EGFR+ and EGFR- , and between 19Del and L858R; these can be used to allow patients with lung adenocarcinoma to choose more appropriate and personalized treatment options.

Radiomics for the prediction of EGFR mutation subtypes in non-small cell lung cancer.

PURPOSE: This retrospective study was designed to investigate the ability of radiomics to predict the mutation status of epidermal growth factor receptor (EGFR) subtypes (19Del and L858R) in patients with non-small cell lung cancer (NSCLC). METHODS: In total, 312 patients with NSCLC were included, and 580 radiomic features were extracted from the computed tomography images of each patient. In the training set, univariate analysis was performed on the clinical and radiomic features; logistic regression models were established using a 5-fold cross validation strategy for the prediction of EGFR subtypes 19Del and L858R. Subsequently, the predictive ability of the joint models was evaluated using the test set. RESULTS: The results revealed that the radiomic features specific for EGFR 19Del and L858R were Gabor's MTRVariance, Gabor's PTREntropy, and sphericity. Additionally, the respective areas under the receiver operating characteristic curves of the EGFR 19Del and L858R joint models were 0.7925 and 0.7750 for the test set. CONCLUSIONS: Our study demonstrated the potential for radiomics to predict EGFR 19Del and L858R. Epidermal growth factor receptor 19Del and L858R exhibited distinct imaging phenotypes, which may help to guide the selection of more accurate and personalized treatment programs for patients with NSCLC.

CT and MRI features in adult patients with orbital subperiosteal abscess secondary to paranasal sinus mucocele.

Orbital subperiosteal abscess (OSPA) secondary to paranasal sinus mucocele (PSM) is rare, and it may be misdiagnosed as PSM with orbital invasion or even as a malignant neoplasm. The present study explored the computed tomography (CT) and magnetic resonance imaging (MRI) features of OSPA. The cases of 13 patients with OSPA secondary to PSM were retrospectively reviewed. CT had been performed in 12, MRI in 7, and postcontrast MRI in 4. OSPA was revealed as a well-demarcated, spindle-shaped mass that was broad-based and located beneath the superior orbital wall (orbital roof) in 11 and at the medial wall in 2. PSM appeared as an expansile cystic lesion in the ethmofrontal sinus in 7, frontal sinus in 5, and ethmoidal sinus in 1. Because the OSPA was connected to the PSM, it looked like a single lesion involving both the orbit and the sinus. All 12 OSPAs examined on CT were low-density; 9 of the 12 PSMs were low-density and 3 were iso-density. Densities of the OSPAs and PSMs were equal in 4 and slightly different in 8. Five of the 10 OSPAs occurring beneath the orbital roof had unclear boundaries with the PSMs on CT. On MRI, although both OSPAs and PSMs mainly demonstrated hypointensity on T1-weighted images and hyperintensity on T2-weighted images, the signal intensities were slightly different, and linear-shaped hypointensity could be found between them. Postcontrast MRI revealed arch- and ring-shaped enhancement, respectively, at the edge of the OSPA and the PSM. Septal enhancement separated them more clearly. PSM is an important cause of OSPA in adults. CT and MRI can accurately display these entities' characteristic findings and their anatomic relationship, as well as playing an important role in the differential diagnosis.