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OBJECTIVES: To evaluate the value of time-serial CT radiomics features in predicting progression-free survival (PFS) for lung adenocarcinoma (LUAD) patients after epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) therapy. MATERIALS AND METHODS: LUAD patients treated with EGFR-TKIs were retrospectively included from three independent institutes and divided into training and validation cohorts. Intratumoral and peritumoral features were extracted from time-serial non-contrast chest CT (including pre-therapy and first follow-up images); moreover, the percentage variation per unit time (day) was introduced to adjust for the different follow-up periods of each patient. Test-retest was performed to exclude irreproducible features, while the Boruta algorithm was used to select critical radiomics features. Radiomics signatures were constructed with random forest survival models in the training cohort and compared against baseline clinical characteristics through Cox regression and nonparametric testing of concordance indices (C-indices). RESULTS: The training cohort included 131 patients (74 women, 56.5%) from one institute and the validation cohort encompassed 41 patients (24 women, 58.5%) from two other institutes. The optimal signature contained 10 features and 7 were unit time feature variations. The comprehensive radiomics model outperformed the pre-therapy clinical characteristics in predicting PFS (training: 0.78, 95% CI: [0.72, 0.84] versus 0.55, 95% CI: [0.49, 0.62], p < 0.001; validation: 0.72, 95% CI: [0.60, 0.84] versus 0.54, 95% CI: [0.42, 0.66], p < 0.001). CONCLUSION: Radiomics signature derived from time-serial CT images demonstrated optimal prognostic performance of disease progression. This dynamic imaging biomarker holds the promise of monitoring treatment response and achieving personalized management. KEY POINTS: ⢠The intrinsic tumor heterogeneity can be highly dynamic under the therapeutic effect of EGFR-TKI treatment, and the inevitable development of drug resistance may disrupt the duration of clinical benefit. Decision-making remained challenging in practice to detect the emergence of acquired resistance during the early response phase. ⢠Time-serial CT-based radiomics signature integrating intra- and peritumoral features offered the potential to predict progression-free survival for LUAD patients treated with EGFR-TKIs. ⢠The dynamic imaging signature allowed for prognostic risk stratification.
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Adenocarcinoma del Pulmón , Neoplasias Pulmonares , Humanos , Femenino , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/tratamiento farmacológico , Pronóstico , Estudios Retrospectivos , Adenocarcinoma del Pulmón/diagnóstico por imagen , Adenocarcinoma del Pulmón/tratamiento farmacológico , Adenocarcinoma del Pulmón/patología , Tomografía Computarizada por Rayos X/métodos , Receptores ErbB , Medición de RiesgoRESUMEN
PURPOSE: The aim of the study is to explore interhemispheric homotopic functional connectivity alterations in systemic lupus erythematosus (SLE) patients with and without neuropsychiatric lupus (NPSLE and non-NPSLE, respectively) and their potential correlations with clinical characteristics and neuropsychological performance. METHODS: Based on resting-state functional MRI (rs-fMRI) data collected from SLE patients and matched healthy controls (HCs), the voxel-mirrored homotopic connectivity (VMHC) analysis was conducted to measure functional homotopy. Subsequently, correlations between altered functional homotopy and clinical/neuropsychological data were analyzed. RESULTS: Compared with the HC group, both NPSLE and non-NPSLE groups showed attenuated homotopic connectivity in middle temporal gyrus (MTG), cuneus (CUN), middle occipital gyrus (MOG), angular gyrus (ANG), and postcentral gyrus (PoCG). NPSLE patients also exhibited decreased homotopic connectivity in inferior parietal gyrus (IPG) and middle frontal gyrus (MFG). Compared with non-NPSLE patients, NPSLE patients showed weaker interhemispheric homotopic functional connectivity in MOG. Decreased homotopic functional connectivity in PoCG, IPG, and MOG were associated with the anxiety state of SLE patients. CONCLUSIONS: Our findings revealed attenuated functional homotopy in both NPSLE and non-NPSLE groups compared to the HC group, which appeared to be more severe in patients with comorbid neuropsychiatric lupus. Interhemispheric homotopy dysconnectivity may participate in the neuropathology of anxiety symptoms in SLE.
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Lupus Eritematoso Sistémico , Vasculitis por Lupus del Sistema Nervioso Central , Humanos , Lupus Eritematoso Sistémico/diagnóstico por imagen , Vasculitis por Lupus del Sistema Nervioso Central/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: The management of severe and recalcitrant diabetic foot ulcers is challenging. Distraction osteogenesis is accompanied by vascularization and regeneration of the surrounding tissues. Longitudinal distraction of the proximal tibia stimulates increased and prolonged blood flow to the distal tibia. However, the effects of transverse distraction of the proximal tibia cortex on severe and recalcitrant diabetic foot ulcers are largely unknown. QUESTIONS/PURPOSES: (1) Does tibial cortex transverse distraction increase healing and decrease major amputation and recurrence of severe and recalcitrant diabetic foot ulcers compared with routine management (which generally included débridement, revascularization, negative pressure wound therapy, local or free flaps, or skin grafts as indicated)? (2) Does neovascularization and perfusion increase at the foot after the procedure? (3) What are the complications of tibial cortex transverse distraction in patients with severe and recalcitrant diabetic foot ulcers? METHODS: Between July 2014 and March 2017, we treated 136 patients with diabetes mellitus and University of Texas Grade 2B to 3D ulcers (wound penetrating to the tendon, capsule, bone, or joint with infection and/or ischemia). The patients had failed to respond to treatment for at least 6 months, and their ulcers had a mean ± SD area of 44 cm ± 10 cm. All 136 patients underwent tibial cortex transverse distraction (partial corticotomy of the upper tibia, which was in normal condition, followed by 4 weeks of transverse distraction medially then laterally). We compared these patients with the last 137 consecutive patients we treated with standard surgical treatment, consisting of débridement, revascularization, local or free flap or skin equivalent, or graft reconstruction along with negative-pressure wound therapy between May 2011 and June 2013; there was a 1-year period during which both treatments were in use, and we did not include patients whose procedures were performed during this time in either group. Patients in both groups received standard off-loading and wound care. The patients lost to follow-up by 2 years (0.7% of the treatment group [one of 137] and 1.4% of the control group [two of 139]; p = 0.57) were excluded. The patients in the treatment and control groups had a mean age of 61 years and 60 years, respectively, and they were predominantly men in both groups (70% [95 of 136] versus 64% [88 of 137]; p = 0.32). There were no differences with respect to parameters associated with the likelihood of ulcer healing, such as diabetes and ulcer duration, ulcer grades and area, smoking, and arterial status. We compared the groups with respect to ulcer healing (complete epithelialization without discharge, maintained for at least 2 weeks, which was determined by an assessor not involved with clinical care) in a 2-year follow-up, the proportion of ulcers that healed by 6 months, major amputation, recurrence, and complications in the 2-year follow-up. Foot arterial status and perfusion were assessed in the tibial cortex transverse distraction group using CT angiography and perfusion imaging. RESULTS: The tibial cortex transverse distraction group had a higher proportion of ulcers that healed in the 2-year follow-up than the control group (96% [131 of 136] versus 68% [98 of 137]; odds ratio 10.40 [95% confidence interval 3.96 to 27.43]; p < 0.001). By 6 months, a higher proportion of ulcers healed in the tibia cortex transverse distraction group than the control group (93% [126 of 136] versus 41% [56 of 137]; OR 18.2 [95% CI 8.80 to 37.76]; p < 0.001). Lower proportions of patients in the tibia cortex transverse distraction group underwent major amputation (2.9% [four of 136] versus 23% [31 of 137], OR 0.10 [95% CI 0.04 to 0.30]; p < 0.001) or had recurrences 2.9% (4 of 136) versus 17% (23 of 137), OR 0.20 [95% CI 0.05 to 0.45]; p < 0.001) than the control group in 2-year follow-up. In the feet of the patients in the tibial cortex transverse distraction group, there was a higher density of small vessels (19 ± 2.1/mm versus 9 ± 1.9/mm; mean difference 10/mm; p = 0.010), higher blood flow (24 ± 5 mL/100 g/min versus 8 ± 2.4 mL/100 g/min, mean difference 16 mL/100 g/min; p = 0.004) and blood volume (2.5 ± 0.29 mL/100 g versus 1.3 ± 0.33 mL/100 g, mean difference 1.2 mL/100 g; p = 0.03) 12 weeks postoperatively than preoperatively. Complications included closed fractures at the corticotomy site (in 1.5% of patients; two of 136), which were treated with closed reduction and healed, as well as pin-site infections (in 2.2% of patients; three of 136), which were treated with dressing changes and they resolved without osteomyelitis. CONCLUSIONS: Proximal tibial cortex transverse distraction substantially facilitated healing and limb salvage and decreased the recurrence of severe and recalcitrant diabetic foot ulcers. The surgical techniques were relatively straightforward although the treatment was unorthodox, and the complications were few and minor. These findings suggest that tibial cortex transverse distraction is an effective procedure to treat severe and recalcitrant diabetic foot ulcers compared with standard surgical therapy. Randomized controlled trials are required to confirm these findings. LEVEL OF EVIDENCE: Level II, therapeutic study.
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Pie Diabético/cirugía , Recuperación del Miembro , Osteogénesis por Distracción/métodos , Tibia/cirugía , Amputación Quirúrgica , Desbridamiento , Femenino , Pie/irrigación sanguínea , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica , Recurrencia , Índice de Severidad de la Enfermedad , Colgajos Quirúrgicos , Cicatrización de HeridasRESUMEN
BACKGROUND: Parkinson's disease is a progressive degenerative nervous system disease. Recent studies have shown that secondary changes in the GABA system play directly affect the pathogenesis of PD. There is still much debate about GABA concentrations because currently, GABA concentrations in the brain tissue are obtained indirectly by measuring its concentration in the blood and cerebrospinal fluid. These results are unreliable. Magnetic resonance spectroscopy (MRS) is the only noninvasive method for evaluating the concentration of metabolites in living brain tissue and has been widely applied in research and clinical practice. In addition, combining MEGA-PRESS technology with LCModel software for quantitative GABA measurements is largely recognized. At present, the PD monkeys model in primates has been increasingly proficient. Primates are more similar to humans in terms of brain structure and function than other animals. However, 3.0 T MRS studies involving the PD monkey model to measure metabolites in living subjects with PD are still rare. The study was performed at 3.0 T MRI with control monkeys and PD monkeys that were injected methyl-phenyl-tetrahydropyridine (MPTP) in one side of common carotid artery before and 3 months after successful model establishment to measure GABA concentrations in the bilateral striatum. Behavioral observations were performed for all animals, and the behavioral score was recorded. After 3 months, the GABA concentration in the bilateral striatum was measured in both groups by high-performance liquid chromatography (HPLC). The data obtained from magnetic resonance spectroscopy (MRS) were compared with the actual measured GABA concentrations in tissues isolated from the corresponding regions, and their correlations with the behavior score were analyzed. The research objectives are to investigate the changes of γ-aminobutyric acid (GABA) concentration in the bilateral striatum of monkeys with Parkinson's disease (PD) and the value of quantitatively measuring its concentration by noninvasive 3.0 T spectroscopy. RESULTS: (1) The MRS results showed that the GABA concentration in the injured side of the striatum of the PD monkeys was higher than in the contralateral side, but the difference was not statistically significant (P = 0.154). Compared with that the blank control group, the GABA concentration in the striatum of the PD monkeys increased, but there was no difference between the groups (P = 0.381; P = 0.425). (2) The GABA concentration that determined from the isolated specimens by HPLC in the injured side of the striatum of the PD monkeys was significantly higher than that in the contralateral side (P < 0.01). Compared with the blank control group, the PD monkeys had higher GABA concentrations in both sides of the striatum, and there was a significant difference in the lesion side (P = 0.004), while there was a non-significant difference in the contralateral side (P = 0.475). (3) The mean GABA concentration in the injured striatum of PD monkeys determined by MRS was not significantly correlated with the behavioral score (r = 0.146, P = 0.688). The mean GABA concentration in the injured striatum determined from the isolated specimens was positively correlated with the behavioral score in the same period (r = 0.444, P = 0.038). CONCLUSION: The GABA concentration in the injured striatum of PD monkeys is increased and positively correlated with behavioral changes. Validity of noninvasive 3.0 T MRS to detect PD neurotransmitter changes is limited.
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Cuerpo Estriado/metabolismo , Espectroscopía de Resonancia Magnética , Enfermedad de Parkinson Secundaria/metabolismo , Ácido gamma-Aminobutírico/metabolismo , 1-Metil-4-fenil-1,2,3,6-Tetrahidropiridina , Animales , Cromatografía Líquida de Alta Presión , Macaca fascicularis , Masculino , Enfermedad de Parkinson Secundaria/inducido químicamente , Índice de Severidad de la EnfermedadRESUMEN
Advancements in artificial intelligence (AI) offer promising tools for improving diagnostic accuracy and patient outcomes in cardiovascular medicine. This study explores the potential of AI-assisted measurements in enhancing the prediction of major adverse cardiac events (MACE) in patients with coronary artery disease (CAD). We conducted a retrospective cohort study involving patients diagnosed with CAD who underwent coronary computed tomography angiography (CCTA). Participants were classified into MACE and non-MACE groups based on their clinical outcomes. Clinical characteristics and AI-assisted measurements of CCTA parameters, including CT-derived fractional flow reserve (CT-FFR) and fat attenuation index (FAI), were collected. Both univariate and multivariable logistic regression analyses were performed to identify independent predictors of MACE, which were used to build predictive models. Statistical analyses revealed three independent predictors of MACE: severe stenosis, CT-FFR ≤ 0.8, and mean FAI (P < 0.05). Seven predictive models incorporating various combinations of these predictors were developed. The model combining all three predictors demonstrated superior performance, as evidenced by the receiver operating characteristic (ROC) curve, with an area under the curve (AUC) of 0.811 (95% CI 0.774 - 0.847), a sensitivity of 0.776, and a specificity of 0.726. Our findings suggest that AI-assisted CCTA analysis, particularly using FFR and FAI, could significantly improve the prediction of MACE in CAD patients, thereby potentially aiding clinical decision-making.
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Objective: Telomerase reverse transcriptase (TERT) promoter mutation status in gliomas is a key determinant of treatment strategy and prognosis. This study aimed to analyze the radiogenomic features and construct radiogenomic models utilizing medical imaging techniques to predict the TERT promoter mutation status in gliomas. Methods: This was a retrospective study of 304 patients with gliomas. T1-weighted contrast-enhanced, apparent diffusion coefficient, and diffusion-weighted imaging MRI sequences were used for radiomic feature extraction. A total of 3,948 features were extracted from MRI images using the FAE software. These included 14 shape features, 18 histogram features, 24 gray level run length matrix, 14 gray level dependence matrix, 16 gray level run length matrix, 16 gray level size zone matrix (GLSZM), 5 neighboring gray tone difference matrix, and 744 wavelet transforms. The dataset was randomly divided into training and testing sets in a ratio of 7:3. Three feature selection methods and six classification algorithms were used to model the selected features. Predictive performance was evaluated using receiver operating characteristic curve analysis. Results: Among the evaluated classification algorithms, the combination model of recursive feature elimination (RFE) with linear regression (LR) using six features showed the best diagnostic performance (area under the curve: 0.733, 0.562, and 0.633 in the training, validation, and testing sets, respectively). The next best-performing models were naive Bayes, linear discriminant analysis, autoencoder, and support vector machine. Regarding the three feature selection algorithms, RFE showed the most consistent performance, followed by relief and ANOVA. T1-enhanced entropy and GLSZM derived from T1-enhanced images were identified as the most critical radiomics features for distinguishing TERT promoter mutation status. Conclusion: The LR and LRLasso models, mainly based on T1-enhanced entropy and GLSZM, showed good predictive ability for TERT promoter mutations in gliomas using radiomics models.
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BACKGROUND: Accurately predicting the hepatocellular carcinoma (HCC) grade may facilitate the rational selection of treatment strategies. The diagnostic efficacy of the combination of Gadolinium ethoxybenzy diethylenetriamine pentaacetic (Gd-EOB-DTPA) enhancement T1 mapping and apparent diffusion coefficient (ADC) values in predicting HCC grade needs further validation. OBJECTIVES: This study aimed to assess the capacity of Gd-EOB-DTPA-enhanced T1 mapping and ADC values, both individually and in combination, to discriminate between different grades of HCC. MATERIALS AND METHODS: From July 2017 to February 2020, 96 patients (male, 83; mean age, 53.67 years; age range, 29-71 years) clinically diagnosed with HCC were included in the present study. All patients underwent Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI, including T1 mapping sequence) before surgery or biopsy. All the patients were categorized into 3 groups according to the pathological results (including 24 cases of well-differentiated HCCs, 59 cases of moderately differentiated HCCs, 13 cases of and poorly differentiated HCCs). The mean Gd-EOB-DTPA enhanced T1 values (ΔT1=[(T1pre-T1post)/T1pre]×100%) and ADC values between different grading groups of HCC were calculated and compared. The area under the characteristics curve (AUC), the diagnostic threshold, sensitivity, and specificity of ΔT1 and ADC for differential diagnosis were analyzed. RESULTS: Mean ΔT1 was 58% for well-differentiated HCCs, 50% for moderately-differentiated HCCs, and 43% for poorly-differentiated HCCs. ΔT1 showed statistical differences between the groups (P<0.001). The mean ADC values of the 3 groups were 1.11×10-3 mm2/s, 0.91×10-3 mm2/s, and 0.80×10-3mm2/s, respectively. ADC showed statistical differences between the groups (P<0.001). In discriminating well- differentiated group from the moderately differentiated group, the AUC of ΔT1 was 0.751 (95% CI: 0.642, 0.859), the AUC of ADC was 0.782 (95% CI: 0.671, 0.894), the AUC of combined model was 0.811 (95% CI: 0.709, 0.914). In discriminating the poorly differentiated group from the moderately differentiated group, the AUC of ΔT1 was 0.768 (95% CI: 0.634, 0.902), the AUC of ADC was 0.754 (95% CI: 0.603, 0.904), and the AUC of the combined model was 0.841 (95% CI: 0.729, 0.953). CONCLUSION: Gd-EOB-DTPA enhanced T1 mapping, and ADC values have complementary effects on the sensitivity and specificity for identifying different HCC grades. A combined model of Gd-EOB-DTPA-enhanced MRI T1 mapping and ADC values could improve diagnostic performance for predicting HCC grades.
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Carcinoma Hepatocelular , Medios de Contraste , Gadolinio DTPA , Neoplasias Hepáticas , Clasificación del Tumor , Humanos , Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Persona de Mediana Edad , Masculino , Femenino , Anciano , Adulto , Imagen de Difusión por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/métodos , Estudios Retrospectivos , Sensibilidad y Especificidad , Curva ROCRESUMEN
Background: Reliable predictors for rehabilitation outcomes in patients with congenital sensorineural hearing loss (CSNHL) after cochlear implantation (CI) are lacking. The purchase of this study was to develop a nomogram based on clinical characteristics and neuroimaging features to predict the outcome in children with CSNHL after CI. Methods: Children with CSNHL prior to CI surgery and children with normal hearing were enrolled into the study. Clinical data, high resolution computed tomography (HRCT) for ototemporal bone, conventional brain MRI for structural analysis and brain resting-state fMRI (rs-fMRI) for the power spectrum assessment were assessed. A nomogram combining both clinical and imaging data was constructed using multivariate logistic regression analysis. Model performance was evaluated and validated using bootstrap resampling. Results: The final cohort consisted of 72 children with CSNHL (41 children with poor outcome and 31 children with good outcome) and 32 healthy controls. The white matter lesion from structural assessment and six power spectrum parameters from rs-fMRI, including Power4, Power13, Power14, Power19, Power23 and Power25 were used to build the nomogram. The area under the receiver operating characteristic (ROC) curve of the nomogram obtained using the bootstrapping method was 0.812 (95 % CI = 0.772-0.836). The calibration curve showed no statistical difference between the predicted value and the actual value, indicating a robust performance of the nomogram. The clinical decision analysis curve showed a high clinical value of this model. Conclusions: The nomogram constructed with clinical data, and neuroimaging features encompassing ototemporal bone measurements, white matter lesion values from structural brain MRI and power spectrum data from rs-fMRI showed a robust performance in predicting outcome of hearing rehabilitation in children with CSNHL after CI.
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BACKGROUND: Dysfunction of the glymphatic system in the brain in different stages of altered glucose metabolism and its influencing factors are not well characterized. AIM: To investigate the function of the glymphatic system and its clinical correlates in patients with different glucose metabolism states, the present study employed diffusion tensor imaging along the perivascular space (DTI-ALPS) index. METHODS: Sample size was calculated using the pwr package in R software. This cross-sectional study enrolled 22 patients with normal glucose metabolism (NGM), 20 patients with prediabetes, and 22 patients with type 2 diabetes mellitus (T2DM). A 3.0T magnetic resonance imaging was used to evaluate the function of the glymphatic system. The mini-mental state examination (MMSE) was used to assess general cognitive function. The DTI-ALPS index of bilateral basal ganglia and the mean DTI-ALPS index was calculated. Further, the correlation between DTI-ALPS and clinical features was assessed. RESULTS: The left-side, right-side, and mean DTI-ALPS index in the T2DM group were significantly lower than that in the NGM group. The right-side DTI-ALPS and mean DTI-ALPS index in the T2DM group were significantly lower than those in the prediabetes group. DTI-ALPS index lateralization was not observed. The MMSE score in the T2DM group was significantly lower than that in the NGM and prediabetes group. After controlling for sex, the left-side DTI-ALPS and mean DTI-ALPS index in the prediabetes group were positively correlated with 2-hour postprandial blood glucose level; the left-side DTI-ALPS index was negatively correlated with total cholesterol and low-density lipoprotein level. The right-side DTI-ALPS and mean DTI-ALPS index were negatively correlated with the glycosylated hemoglobin level and waist-to-hip ratio in the prediabetes group. The left-side, right-side, and mean DTI-ALPS index in the T2DM group were positively correlated with height. The left-side and mean DTI-ALPS index in the T2DM group were negatively correlated with high-density lipoprotein levels. CONCLUSION: Cerebral glymphatic system dysfunction may mainly occur in the T2DM stage. Various clinical variables were found to affect the DTI-ALPS index in different glucose metabolism states. This study enhances our understanding of the pathophysiology of diabetic brain damage and provides some potential biological evidence for its early diagnosis.
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Objective: To investigate the clinical utility of multi-parameter MRI-based radiomics nomogram for predicting telomerase reverse transcriptase (TERT) promoter mutation status and prognosis in adult glioblastoma (GBM). Methods: We retrospectively analyzed MRI and pathological data of 152 GBM patients. A total of 2,832 radiomics features were extracted and filtered from preoperative MRI images. A radiomics nomogram was created on the basis of radiomics signature (rad-score) and clinical traits. The performance of the nomogram in TERT mutation identification was assessed using receiver operating characteristic (ROC) curve, calibration curves, and clinical decision curves. Pathologically confirmed TERT mutations and risk score-based TERT mutations were employed to assess patient prognosis, respectively. Results: The random forest (RF) algorithm outperformed the other two algorithms, yielding the best diagnostic efficacy in differentiating TERT mutations, with area under the curve (AUC) values of 0.892 (95% CI: 0.828-0.956) and 0.824 (95% CI: 0.677-0.971) in the training set and validation sets, respectively. Furthermore, the predictive power of the radiomics nomogram constructed with the rad-score and clinical variables reached 0.916 (95%CI: 0.864, 0.968) in the training set and 0.880 (95%CI: 0.743, 1) in the validation set. Calibration curve and decision curve analysis findings further uphold the clinical application value of the radiomics nomogram. The overall survival of the high-risk subgroup was significantly shorter than that of the low-risk subgroup, which was consistent with the results of the pathologically confirmed TERT mutation group. Conclusion: The radiomics nomogram could non-invasively provide promising insights for predicting TERT mutations and prognosis in GBM patients with excellent identification and calibration abilities.
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Designing fast and simple quantitative methods on cheap and disposable electrodes for the early detection of HeLa cells is highly desirable for clinical diagnostics and public health. In this work, we developed a label-free and sensitive electrochemical cytosensor for HeLa cell detection based on the gated molecular transport across vertically ordered mesoporous silica films (VMSFs) on the disposable indium tin oxide (ITO) electrode. As high affinity for a folate receptor existed on the membrane of HeLa cancer cells, folic acid (FA) functionalized VMSF could regulate the transport of electrochemical probe (Fe(CN)6 3-) by the specific recognition and adhesion of HeLa cells toward the VMSF surface. In addition, VMSF, served as a solid skeleton, is able to effectively prevent the direct contact of cells with the underlying electrode, remaining the underlying electrode activity and favoring the diffusion of Fe(CN)6 3-. Once specific adhesion of HeLa cells to the VMSF surface happens, Fe(CN)6 3- redox probe exhibits impeded transport in the silica nanochannels, ultimately resulting in the decreased electrochemical responses and realizing the quantitative determination of HeLa cells with a broad linear range (101-105 cells/mL) and a low limit of detection (4 cells/mL). The proposed electrochemical cytosensor shows a great potential application for the early diagnosis of cervical cancer.
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OBJECTIVE: The study aimed to analyze computed tomography and magnetic resonance imaging features of patients with solitary extramedullary plasmacytoma. METHODS: Ten cases with solitary extramedullary plasmacytoma were included in this study. CT and MRI features of solitary extramedullary plasmacytoma were retrospectively analyzed. RESULTS: This study included both males (n = 8) and females (n = 2), with a median age of 48 (range 21-72 years old). The organs or anatomical structures involved were nasopharynx (n = 3), orbit (n = 1), left tentorium (n = 1), nasal cavity and meatus (n = 2), small intestine and mesentery (n = 1), as well as posterior thoracic wall (n = 2). The median maximum diameter of the tumors was 3.2 cm (range 0.8- 15.2 cm). The tumor shapes were round (n = 7), stripped (n = 1), irregular (n = 1), and nodular (n = 1). The margin of the tumors was well-defined (n = 7) and partially well-defined (n = 3). There were 3 cases with bone destruction and 1 with a tissue invasion adjacent to the tumor, calcification (n = 1), and cystic degeneration (n = 2). Enlarged tumoral vessels (n = 4) could also be observed. The CT attenuation and MR signal intensity of tumors were heterogeneous (n = 4) and homogenous (n = 6). After the injection of the contrast agent, marked (n = 5), mild (n = 1), mild to moderate (n = 1), and delayed enhancement (n = 1) could be observed. CONCLUSION: A well-defined homogeneous solitary mass occurring at the head and neck with a marked enhancement, an adjacent tissue invasion, enlarged tumoral vessels, and bone destruction can indicate the diagnosis of solitary extramedullary plasmacytoma.
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Neoplasias Óseas , Plasmacitoma , Masculino , Femenino , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Plasmacitoma/diagnóstico por imagen , Estudios Retrospectivos , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND PURPOSE: The presence of TERT promoter mutations has been associated with worse prognosis and resistance to therapy for patients with glioblastoma (GBM). This study aimed to determine whether the combination model of different feature selections and classification algorithms based on multiparameter MRI can be used to predict TERT subtype in GBM patients. METHODS: A total of 143 patients were included in our retrospective study, and 2553 features were obtained. The datasets were randomly divided into training and test sets in a ratio of 7:3. The synthetic minority oversampling technique was used to achieve data balance. The Pearson correlation coefficients were used for dimension reduction. Three feature selections and five classification algorithms were used to model the selected features. Finally, 10-fold cross validation was applied to the training dataset. RESULTS: A model with eight features generated by recursive feature elimination (RFE) and linear discriminant analysis (LDA) showed the greatest diagnostic performance (area under the curve values for the training, validation, and testing sets: 0.983, 0.964, and 0.926, respectively), followed by relief and random forest (RF), analysis of variance and RF. Furthermore, the relief was the optimal feature selection for separately evaluating those five classification algorithms, and RF was the most preferable algorithm for separately assessing the three feature selectors. ADC entropy was the parameter that made the greatest contribution to the discrimination of TERT mutations. CONCLUSIONS: Radiomics model generated by RFE and LDA mainly based on ADC entropy showed good performance in predicting TERT promoter mutations in GBM.
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Glioblastoma , Telomerasa , Humanos , Glioblastoma/diagnóstico por imagen , Glioblastoma/genética , Estudios Retrospectivos , Radiómica , Imagen por Resonancia Magnética/métodos , Mutación , Telomerasa/genéticaRESUMEN
Objective: This study was conducted to develop and validate a radiomics-clinics combined model-based magnetic resonance imaging (MRI) radiomics and clinical features for the early prediction of radiation-induced temporal lobe injury (RTLI) in patients with nasopharyngeal carcinoma (NPC). Methods: This retrospective study was conducted using data from 130 patients with NPC (80 patients with and 50 patients without RTLI) who received radiotherapy. Cases were assigned randomly to training (n = 91) and testing (n = 39) datasets. Data on 168 medial temporal lobe texture features were extracted from T1WI, T2WI, and T1WI-CE MRI sequences obtained at the end of radiotherapy courses. Clinics, radiomics, and radiomics-clinics combined models (based on selected radiomics signatures and clinical factors) were constructed using machine learning software. Univariate logistic regression analysis was performed to identify independent clinical factors. The area under the ROC curve (AUC) was performed to evaluate the performance of three models. A nomogram, decision curves, and calibration curves were used to assess the performance of the combined model. Results: Six texture features and three independent clinical factors associated significantly with RTLI were used to build the combined model. The AUCs for the combined and radiomics models were 0.962 [95% confidence interval (CI), 0.9306-0.9939] and 0.904 (95% CI, 0.8431-0.9651), respectively, for the training cohort and 0.947 (95% CI, 0.8841-1.0000) and 0.891 (95% CI, 0.7903-0.9930), respectively, for the testing cohort. All of these values exceeded those for the clinics model (AUC = 0.809 and 0.713 for the training and testing cohorts, respectively). Decision curve analysis showed that the combined model had a good corrective effect. Conclusion: The radiomics-clinics combined model developed in this study showed good performance for predicting RTLI in patients with NPC.
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PURPOSE: To evaluate the clinical utility of amide proton transfer-weighted imaging (APTw) and arterial spin labeling (ASL) in differentiating solitary brain metastases (SBMs) from glioblastomas (GBMs). METHODS: Forty-eight patients diagnosed with brain tumors were enrolled. All patients underwent conventional MRI, APTw, and ASL scans on a 3.0 T MRI system. The mean APTw value and mean cerebral blood flow (CBF) value were measured. The differences in various parameters between GBMs and SBMs were assessed using the independent-samples t-test. The quantitative performance of these MRI parameters in distinguishing between GBMs and SBMs was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: GBMs exhibited significantly higher APTw and CBF values in peritumoral regions compared with SBMs (P < 0.05). There was no significant difference between SBMs and GBMs in tumor cores. APTw MRI had a higher diagnostic efficiency in differentiating SBMs from GBMs (area under the curve [AUC]: 0.864; 75.0% sensitivity and 81.8% specificity). Combined use of APTw and CBF value increased the AUC to 0.927. CONCLUSION: APTw may be superior to ASL for distinguishing between SBMs and GBMs. Combination of APTw and ASL showed better discrimination and a superior diagnostic performance.
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Neoplasias Encefálicas , Glioblastoma , Humanos , Glioblastoma/diagnóstico por imagen , Glioblastoma/patología , Protones , Amidas , Marcadores de Spin , Neoplasias Encefálicas/patología , Imagen por Resonancia Magnética/métodosRESUMEN
PURPOSE: The RAF1 expression affects prognosis in patients with hepatocellular carcinoma (HCC) treated with sorafenib. We examined the expression of sorafenib-targeted gene RAF1 to ascertain its relationship with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (MRI) characteristics. We also explored the predictive potential of RAF1 expression markers in the treatment of HCC. PATIENTS AND METHODS: Sixty-five patients with HCC who underwent preoperative enhanced MRI scanning were included in this study. We analyzed the qualitative and quantitative characteristics of enhanced MRI findings in patients with HCC. Immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR) analyses were used to detect the protein and mRNA expression levels of RAF1 in HCC. Correlation and logistic regression analyses were used to evaluate the relationship between these image features and the RAF1 gene expression levels in HCC. RESULTS: The IHC analysis indicated a significant difference in tumor thrombus group (P = 0.037), RT-PCR results revealed a significant between-group difference for both tumor margins (P = 0.033) and capsule (P = 0.04). Binary logistic regression analysis results suggest that independent MRI predictors were regular tumor margins [P = 0.035, odds ratio (OR) = 3.145, 95% confidence interval (CI) 1.087-9.103] and thrombus (P = 0.046, OR = 4.421, 95% CI 1.024-19.08) with high RAF1expression; the tumor capsule was not an independent predictor. CONCLUSION: We found a correlation between MRI features and the RAF1 gene expression, Regular tumor margin and the presence of tumor thrombus are indicators of high RAF1 expression in HCC. Enhanced MRI may be useful for identifying patients with HCC eligible for targeted treatment.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/genética , Medios de Contraste , Gadolinio DTPA , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/genética , Imagen por Resonancia Magnética/métodos , Estudios RetrospectivosRESUMEN
RATIONALE AND OBJECTIVES: Neurodegeneration is an early event in the pathogenesis of diabetic retinopathy (DR). We assessed the white matter microstructural integrity of the visual pathway in diabetes patients vs. healthy subjects, and investigated the advantages of generalized Q-sampling imaging (GQI) in the assessment of the visual pathway. MATERIALS AND METHODS: T1-weighted, T2-weighted fluid-attenuated inversion recovery, and simultaneous multislice- diffusion sequences were acquired from 21 DR patients, 29 diabetes patients without DR (NDR group), and 28 age- and gender-matched healthy controls. Diffusion source images were reconstructed to GQI. Region of interest (ROI)-based analysis was utilized to evaluate microstructural alterations in the visual pathway. Multivariate linear regression analysis (forward stepwise method) was performed to investigate associations between clinical data and mean GQI parameters. RESULTS: ROI-based analyses indicated that the GQI parameters generalized fractional anisotropy, quantitative anisotropy (QA), and normalized QA (NQA) were significantly lower in the NDR group than in the healthy controls, and even lower in the DR group than in the NDR group. Disease duration was significantly and negatively correlated with mean generalized fractional anisotropy and mean NQA. CONCLUSION: GQI could sensitively and non-invasively evaluate the visual pathway in diabetes patients. The nerve fibers of the visual pathway were damaged before the onset of retinopathy, and this damage was aggravated after retinopathy onset, as a consequence of long exposure to hyperglycemia.
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Diabetes Mellitus Tipo 2 , Enfermedades de la Retina , Sustancia Blanca , Anisotropía , Encéfalo , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Imagen de Difusión Tensora/métodos , Humanos , Vías Visuales/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagenRESUMEN
Objective: This study aims to investigate the alterations in functional brain network in systemic lupus erythematosus patients without overt neuropsychiatric symptoms [neuropsychiatric systemic lupus erythematosus (non-NPSLE)] from the perspective of degree centrality (DC) and functional connectivity (FC) using resting-state functional magnetic resonance imaging (MRI) and multivariate pattern analysis (MVPA) approach. Methods: DC analysis was performed based on the resting-state functional MRI data derived from 47 non-NPSLE patients and 47 healthy controls (HCs). Nodes with abnormal DC were utilized as seeds for further FC analysis. The correlation between MRI variables and clinical or neuropsychological data was analyzed using Pearson correlation analysis. Finally, MVPA classification based on DC was performed. Results: When compared with the HCs, the non-NPSLE patients exhibited remarkably higher DC in the bilateral hippocampus (HIP), right insula (INS), and lower DC in the left superior parietal gyrus. Furthermore, the patients displayed significantly higher FC between the left HIP and the left INS/left dorsolateral middle frontal gyrus/left supramarginal gyrus and higher FC between the right HIP and the right middle temporal gyrus/right dorsolateral middle frontal gyrus/right dorsolateral inferior frontal gyrus/right supramarginal gyrus (all imaging variables mentioned earlier underwent cluster-level false discovery rate corrections, the voxel threshold was p < 0.001, cluster threshold was p < 0.05). Correlation analysis revealed significantly negative correlations between DC values of the right INS and disease activity and the DC values of the right HIP and the Montreal Cognitive Assessment scores. The accuracy, sensitivity, and specificity of MVPA classification based on DC were 72.34, 63.83, and 80.85%, respectively. The most discriminative power brain regions were chiefly located within the temporal, parietal, and frontal regions. Conclusion: Patients with non-NPSLE exhibited abnormal DC and FC in the brain network. MVPA based on DC possessed commendable classification ability. Our study may provide a novel perspective on the neuropathological mechanisms underlying subclinical brain damage in non-NPSLE.
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Background: Brain functional alterations have been observed in children with congenital sensorineural hearing loss (CSNHL). The purpose of this study was to assess the alterations of regional homogeneity in children with CSNHL. Methods: Forty-five children with CSNHL and 20 healthy controls were enrolled into this study. Brain resting-state functional MRI (rs-fMRI) for regional homogeneity including the Kendall coefficient consistency (KCC-ReHo) and the coherence-based parameter (Cohe-ReHo) was analyzed and compared between the two groups, i.e., the CSNHL group and the healthy control group. Results: Compared to the healthy controls, children with CSNHL showed increased Cohe-ReHo values in left calcarine and decreased values in bilateral ventrolateral prefrontal cortex (VLPFC) and right dorsolateral prefrontal cortex (DLPFC). Children with CSNHL also had increased KCC-ReHo values in the left calcarine, cuneus, precentral gyrus, and right superior parietal lobule (SPL) and decreased values in the left VLPFC and right DLPFC. Correlations were detected between the ReHo values and age of the children with CSNHL. There were positive correlations between ReHo values in the pre-cuneus/pre-frontal cortex and age (p < 0.05). There were negative correlations between ReHo values in bilateral temporal lobes, fusiform gyrus, parahippocampal gyrus and precentral gyrus, and age (p < 0.05). Conclusion: Children with CSNHL had RoHo alterations in the auditory, visual, motor, and other related brain cortices as compared to the healthy controls with normal hearing. There were significant correlations between ReHo values and age in brain regions involved in information integration and processing. Our study showed promising data using rs-fMRI ReHo parameters to assess brain functional alterations in children with CSNHL.
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BACKGROUND: The clinical treatment of patients with severe diabetic foot (DF) is difficult. Recently, the First Affiliated Hospital of Guangxi Medical University began to apply tibial transverse transport (TTT) in patients with DF. This treatment has achieved significant effects, but its mechanism of action is unclear. Recently, microcirculation and the pathogenesis of diabetes have become the foci of research in this field. The evaluation of the possible mechanism of microcirculation reconstruction requires relevant indicators. The aim of this study was to investigate the value of computed tomography perfusion in evaluations of the curative effects of TTT and establish corresponding quantitative evaluation indicators. METHODS: Twelve patients with DF treated with TTT were recruited as the research participants. All diabetic feet were divided into the transport foot (TF) group and nontransport foot (NTF) group according to whether the patients underwent TTT. All patients underwent CT shuttle scanning preoperatively and 8 weeks after surgery. The shuttle scan data were transferred to Siemens VPCT body software and postprocessed with Customized Tumor2. We chose the TF posterior tibial artery from a distance of approximately 15 cm to the bifurcation of the plantar medial artery and the lateral plantar artery as the input artery. We selected the centre of the bilateral medial plantar muscle group on the coronal and axial regions of interest. We applied a deconvolution approach to obtain data from both sides of the plantar tissue perfusion. Skin temperature (ST) detection was performed with an ST gun to measure the average ST values in the dorsal and plantar areas, the first and fifth heads of the phalanges, and the medial and lateral malleolus points of both feet of patients with DF preoperatively and 8 weeks after surgery. RESULTS: The preoperative and postoperative ST values of the patients in the TF group were 30.73 ± 1.86 °C and 32.22 ± 1.51 °C, respectively. The preoperative and postoperative ST values for the patients in the NTF group were 30.93 ± 2.65 °C and 32.07 ± 2.09 °C, respectively. There were significant differences in the preoperative and postoperative data between the TF (P = 0.001) and NTF (P = 0.013) groups. In the patients with DF who underwent TTT, there were both preoperative and postoperative differences inside the medial plantar muscle group in the relative blood volume (rBV) value and relative mean transit time (rMTT) (P = 0.027, P = 0.026, respectively). The postoperative BV in the NTF group was increased compared with the preoperative BV (P = 0.006). CONCLUSION: There were significant differences in relative BV, relative mean transit time, and ST between the two groups before and after surgery, and the postoperative BV in the NTF group and ST values in the two groups were increased compared with the preoperative values. The BV in the NTF group and the ST values in the two groups were effective indicators in evaluating the changes between preoperative and postoperative perfusion. These results indicate that TTT could increase plantar tissue perfusion as assessed by BV and ST; this increase was among the reasons for the surface healing of severe DF ulcers. TRANSLATIONAL POTENTIAL OF THIS ARTICLE: Preoperative CT perfusion evaluation can provide relevant information of blood vessels and microcirculation for clinical operation, and postoperative CT perfusion evaluation can provide postoperative efficacy evaluation for clinical operation. All patients received information about the study and signed a specific informed consent. Approval for this study was granted by the regional ethics committee [Regional Ethics Committee of the First Affiliated Hospital of Guangxi Medical University, China [(2018-(KY-E-069].