Exploring the relationship between lesion morphology and pathogenesis in acute small subcortical infarction.

Introduction Acute small subcortical infarctions (SSIs) result from occlusions of small penetrating arteries, and the underlying pathological factors can have different clinical implications. The objective of this study was to assess the clinical relevance of acute SSIs based on their sizes and morphologies. Methods This retrospective case-control study analyzed clinical and imaging data of stroke patients with acute SSIs in penetrating artery territories who underwent MRI within 5 days of stroke onset, registered between 2016 and 2020. We categorized these patients into three groups based on size and morphology: diameter < 20mm, diameter ≧ 20mm, and separated lesions. We then evaluated their clinical characteristics and outcomes. Results We analyzed 726 stroke patients with SSIs, among whom 573 had a diameter <20mm, 99 had a diameter ≥20mm, and 54 had separated lesions. The patients had a median age of 70 years and a median National Institutes of Health Stroke Scale (NIHSS) score of 4 on arrival. Patients who experienced early neurological deterioration (END) had a significantly lower chance of good functional outcomes (27.3% vs. 64.4%, p<0.001). Patients with a diameter ≧20mm had the most severe NIHSS on arrival and at day 3, the highest rate of END, and the lowest rate of good outcome at 3 months. The incidence of cardioembolism did not differ between patients with diameters of ≥20mm and <20mm. However, multiple logistic regression analysis revealed that separated lesions were more likely to be associated with cardioembolic stroke (adjusted odds ratio [aOR], 7.6; 95% confidence interval [CI], 2.0-28.5) and parent artery stenosis >50% (aOR, 3.8; 95% CI, 2.1-7.0) than a diameter of <20mm. Moreover, SSIs with a diameter of ≥20mm was found to be associated with an increased risk of END compared to that with a diameter of <20mm (aOR, 2.9; 95% CI, 1.7-5.2). Conclusion Our study suggests that the sizes and morphologies of acute SSIs may indicate different underlying pathologies and be linked to diverse clinical outcomes. Our findings also challenge the current imaging criteria for embolic stroke of undetermined source, as we did not find a link between large subcortical infarction and cardioembolic stroke.

Association of Aortic Arch Calcification with Acute Ischemic Stroke Subtypes and Endovascular Thrombectomy Outcomes.

PURPOSE: To analyze the aortic arch calcification (AAC) on computed tomography (CT) scans, with the goal of predicting the subtypes of patients with ischemic stroke and endovascular thrombectomy (EVT) outcomes. MATERIALS AND METHODS: Automated analysis was used to quantify AAC on CT scans. From January 2020 to March 2021, 119 patients diagnosed with ischemic stroke were analyzed, and the feasibility of EVT was assessed; 43 underwent the procedure. RESULTS: AAC was present in 117 (98.3%) of 119 patients. There was a significant difference (P <.001) in AAC severity among all patients with ischemic stroke according to the Trial of ORG 10172 in Acute Stroke Treatment classification. In patients who underwent EVT, AAC severity was significantly related to the thrombolysis in cerebral infarction grade, thrombectomy procedure time, and modified Rankin scale at discharge (P =.002, P =.035 and P =.015, respectively). Multivariate logistic regression analysis also showed that severe AAC (volume, ≥1,000 mm3) (adjusted odds ratio [OR], 12.1; adjusted 95% confidence interval [CI]), 2.1-36.4; P =.001) and intracranial atherosclerotic disease (adjusted OR, 9.5; adjusted 95% CI, 2.3-33.7; P =.001) were both independently associated with poor thrombolysis reperfusion rate. CONCLUSIONS: A high proportion of patients with ischemic stroke have AAC, the severity of which is a potential imaging marker of ischemic stroke subtypes and the outcome of EVT.

Human thirst behavior requires transformation of sensory inputs by intrinsic brain networks.

BACKGROUND: To survive and thrive, many animals, including humans, have evolved goal-directed behaviors that can respond to specific physiological needs. An example is thirst, where the physiological need to maintain water balance drives the behavioral basic instinct to drink. Determining the neural basis of such behaviors, including thirst response, can provide insights into the way brain-wide systems transform sensory inputs into behavioral outputs. However, the neural basis underlying this spontaneous behavior remains unclear. Here, we provide a model of the neural basis of human thirst behavior. RESULTS: We used fMRI, coupled with functional connectivity analysis and serial-multiple mediation analysis, we found that the physiological need for water is first detected by the median preoptic nucleus (MnPO), which then regulates the intention of drinking via serial large-scale spontaneous thought-related intrinsic network interactions that include the default mode network, salience network, and frontal-parietal control network. CONCLUSIONS: Our study demonstrates that the transformation in humans of sensory inputs for a single physiological need, such as to maintain water balance, requires large-scale intrinsic brain networks to transform this input into a spontaneous human behavioral response.

Percutaneous Radiofrequency Rhizotomy Is Equally Effective for Trigeminal Neuralgia Patients with or Without Neurovascular Compression.

BACKGROUND: Neurovascular compression (NVC) in patients with trigeminal neuralgia (TN) can be a factor of treatment outcome, especially in microvascular decompression and stereotactic radiosurgery. No such effect has been reported in percutaneous radiofrequency rhizotomy (RF). This study aims to investigate whether NVC affects the efficacy of RF in patients with TN. METHODS: We retrospectively reviewed patients with TN who received RF in our institution. Pretreatment magnetic resonance imaging was performed in every patient, and the presence of NVC was reviewed independently by two physicians. The patients were followed up at least for a year after the treatment. Pain severity was assessed with a numeric rating scale (NRS). RESULTS: Sixty-two patients were included in the study. All of the patients had single-sided lesions, and 35 patients had NVC. There were no significant differences between these two groups of patients in terms of gender distribution, age, and pretreatment pain severity. Comparable pain severity improvement was found at 1-year follow-up between these two groups (NRS 7.93 ± 0.492 without compression vs 7.57 ± 0.451 with compression, P = 0.600). No significant difference in posttreatment pain severity at 1 year was found between these two patient groups (NRS 1.37 ± 0.466 without compression vs 1.66 ± 0.458 with compression, P = 0.667). CONCLUSIONS: For patients with TN treated by RF, the presence or absence of NVC is not likely to affect the 1-year pain control rate.

Resting-State Functional Connectivity and Brain Network Abnormalities in Depressive Patients with Suicidal Ideation.

Our study aimed to investigate whether changes in brain function measured with functional magnetic resonance imaging (fMRI) can be detected among individuals with depressive disorders and suicidal ideation. The association between depression severity and brain images is also discussed. Our study recruited 111 participants in three groups: 35 depressive patients with suicidal ideation (SI), 32 depressive patients without suicidal ideation (NS), and 44 healthy controls (HCs). All participants were scanned using 3T MRI to obtain resting-state functional images, and functional connectivity (FC), amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and graph theoretical analysis (GTA) were performed. We found functional activity differences, such as the hippocampus and thalamus, in the SI group compared with the NS group. We also concluded lower activity in the thalamus and cuneus regions were related to suicidal ideation. We also found several functional connectivity of the brain areas, such as hippocampus, cuneus, and frontal regions, in the SI group correlated with Hamilton Depression Rating Scale (HAM-D) and Hospital Anxiety and Depression Scale (HADS). A graph theoretical analysis (GTA) and network-based statistical (NBS) analysis revealed different topological organization and slightly better local segregation of the brain network in healthy participants compared with those in depressive patients with suicidal ideation. We suggest that brain functional connectivity may be affected in depressive patients with suicidal ideation.

Do initially non-dehydrated patients with acute ischemic stroke need fluid supplement?

Background: We previously found that dehydration is an independent predictor of early deterioration after acute ischemic stroke and rehydration helps to improve outcomes. There is limited evidence of how to treat patients who are initially non-dehydrated. In this study, we tested the hypothesis that rehydration therapy, based on the daily urine specific gravity, will improve the outcome of ischemic stroke patients who are initially non-dehydrated. Methods: We conducted a single-arm prospective study of patients with acute ischemic stroke with historical controls. For the first 5 days of study group, a daily urine specific gravity of > 1.020 g/ml was taken as indication for rehydration and patients were advised to drink water via oral or tubal feeding with a dose of 5 ml/kg body weight right away and after dinner. Control group patients were rehydrated without reference to urine specific gravity. An increase in National Institutes of Health Stroke Scale score of ≥ 4 within three days was defined as having stroke-in-evolution. Scores of ≤ 1 on the modified Rankin scale at 3 months were considered to indicate a favorable outcome. Results: A total of 125 patients were analyzed, 46 in the study group and 79 in the control group. The groups did not significantly differ in the stroke-in-evolution rate (4.3% vs. 8.2%, P = 0.474). The rate of favorable outcome at 3 months was significantly higher in the study group than in the control group (56.5% vs. 27.8%, P = 0.001). Conclusions: Urine specific gravity-based hydration might be a useful method to improve functional outcomes of patients with acute ischemic stroke who were non-dehydrated at admission.

Artificial neural networks improve LDCT lung cancer screening: a comparative validation study.

BACKGROUND: This study proposes a prediction model for the automatic assessment of lung cancer risk based on an artificial neural network (ANN) with a data-driven approach to the low-dose computed tomography (LDCT) standardized structure report. METHODS: This comparative validation study analysed a prospective cohort from Chiayi Chang Gung Memorial Hospital, Taiwan. In total, 836 asymptomatic patients who had undergone LDCT scans between February 2017 and August 2018 were included, comprising 27 lung cancer cases and 809 controls. A derivation cohort of 602 participants (19 lung cancer cases and 583 controls) was collected to construct the ANN prediction model. A comparative validation of the ANN and Lung-RADS was conducted with a prospective cohort of 234 participants (8 lung cancer cases and 226 controls). The areas under the curves (AUCs) of the receiver operating characteristic (ROC) curves were used to compare the prediction models. RESULTS: At the cut-off of category 3, the Lung-RADS had a sensitivity of 12.5%, specificity of 96.0%, positive predictive value of 10.0%, and negative predictive value of 96.9%. At its optimal cut-off value, the ANN had a sensitivity of 75.0%, specificity of 85.0%, positive predictive value of 15.0%, and negative predictive value of 99.0%. The area under the ROC curve was 0.764 for the Lung-RADS and 0.873 for the ANN (P = 0.01). The two most important predictors used by the ANN for predicting lung cancer were the documented sizes of partially solid nodules and ground-glass nodules. CONCLUSIONS: Compared to the Lung-RADS, the ANN provided better sensitivity for the detection of lung cancer in an Asian population. In addition, the ANN provided a more refined discriminative ability than the Lung-RADS for lung cancer risk stratification with population-specific demographic characteristics. When lung nodules are detected and documented in a standardized structured report, ANNs may better provide important insights for lung cancer prediction than conventional rule-based criteria.

Endovascular management of spontaneous delayed migration of the flow-diverter stent.

BACKGROUND AND PURPOSE: Spontaneous delayed migration of the flow-diverter stent (FD) is an unusual complication that can be fatal. The purpose of this study is to report our experience and review the literature for the management of delayed FD migration. MATERIALS AND METHODS: Between November 2013 and June 2017, 122 patients treated by FD at our institution were enrolled. We also performed a comprehensive review of the literature. RESULTS: Six patients (4.9%) were found to have spontaneous delayed migration of their FD. The device migrated proximally in 4 patients and distally in 2 patients. One patient had temporal lobe infarction due to stent migration, and another had subarachnoid haemorrhage (SAH). Three patients were treated with a 2nd or 3rd FD, while 2 were treated with stent-assisted coiling, and one was treated with sacrifice of the parent internal carotid artery. According to our results and the literature, the prevalence rate of delayed FD migration ranges from 2.2% to 4.9%, and the mortality and morbidity rate of delayed FD migration is 40%. CONCLUSIONS: Neuro-interventionalists should be aware of this complication and be familiar with risk factors, preventive methods and treatment options. If there is any concern regarding the size or position of the FD, early imaging follow-up and endovascular treatment should be indicated.

Diffusion tensor imaging for assessment of microstructural changes associate with treatment outcome at one-year after radiofrequency Rhizotomy in trigeminal neuralgia.

BACKGROUND: Trigeminal neuralgia (TN) is characterized by facial pain that may be sudden, intense, and recurrent. Neurosurgical interventions, such as radiofrequency rhizotomy, can relieve TN pain, but their mechanisms and effects are unknown. The aim of the present study was to investigate the microstructural tissue changes of the trigeminal nerve (TGN) in patients with TN after they underwent radiofrequency rhizotomy. METHODS: Thirty-seven patients with TN were recruited, and diffusion tensor imaging was obtained before and two weeks after radiofrequency rhizotomy. By manually selecting the cisternal segment of the TGN, we measured the volume of the TGN, fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD). The TGN volume and mean value of the DTI metrics of the post-rhizotomy lesion side were compared with those of the normal side and those of the pre-rhizotomy lesion side, and they were correlated to the post-rhizotomy visual analogue scale (VAS) pain scores after a one-year follow-up. RESULTS: The alterations before and after rhizotomy showed a significantly increased TGN volume and FA, and a decreased ADC, AD, and RD. The post-rhizotomy lesion side showed a significantly decreased TGN volume, FA, and AD compared with the normal side; however, no significant difference in the ADC and RD were found between the groups. The TGN volume was significantly higher in the non-responders than in the responders (P = 0.016). CONCLUSION: Our results may reflect that the effects of radiofrequency rhizotomy in TN patients include axonal damage with perineural edema and that prolonged swelling associated with recurrence might be predicted by MRI images. Further studies are necessary to understand how DTI metrics can quantitatively represent the pathophysiology of TN and to examine the application of DTI in the treatment of TN.

Evaluation of venous pathology of the lower extremities with triggered angiography non-contrast-enhanced magnetic resonance imaging.

BACKGROUND: To explore the diagnostic performance of triggered angiography non-contrast-enhanced magnetic resonance imaging (TRANCE-MRI) for the evaluation of venous pathology of the lower extremity. METHODS: This was a single-centre prospective cohort study of 25 patients with suspected venous disease in the lower extremities. Each patient received Doppler ultrasonography (for venous evaluation) before the scheduled TRANCE-MRI (for venous and arterial evaluations) on a 1.5 T MR scanner (Philips Ingenia, Philips Healthcare, Best, the Netherlands), followed by lymphography and computed tomography angiography that were arranged according to the diagnostic indications. RESULTS: The sensitivity, specificity and accuracy of TRANCE-MRI were 85.7%, 88/9 and 88%, respectively. The inter-rater agreement for deep vein thrombosis (DVT) of the thigh between the ultrasonography and TRANCE-MRI results was substantial agreement (Cohen's kappa κ, 0.72). In ultrasonography-negative cases, TRANCE-MRI detected four additional cases (16%, 4/25) of DVT; three cases (12%, 3/25) of venous compression caused by pelvic lymphadenopathy, hip prosthesis or knee joint effusion; one case (4%, 1/25) of vena cava anomaly; two cases (8%, 2/25) of occult peripheral artery disease (PAD); and one case (4%, 1/25) of an occluded bypass graft. CONCLUSION: TRANCE-MRI can be used as an alternative and objective tool for assessing lower extremity diseases, especially suspected venous pathology. Compared with ultrasonography, TRANCE-MRI plays a better role in assessing varicose veins of the lower extremities and deep veins of the pelvis and abdomen. However, false-positive results may occur in the left common iliac vein of elderly patients. Finally, occult PAD rarely occurs in patients with suspected lower extremity venous disease. Therefore, we recommend performing the TRANCE-MRV protocol instead of the full protocol (MRV + MRA) in the clinical setting in patients with venous scenarios.

Altered structure and functional connection in patients with classical trigeminal neuralgia.

Classical trigeminal neuralgia (TN) is a specific type of neuropathic orofacial pain of which the plasticity of brain structure and connectivity have remained largely unknown. A total of 62 TN patients were included and referred to MRI scans. Voxel-based morphometry was used to analyze the change of gray matter volume. Resting-state functional imaging was used to analyze the connectivity between brain regions. The results showed gray matter volume reduction in components of the prefrontal cortex, precentral gyrus, cerebellar tonsil, thalamus, hypothalamus, and nucleus accumbens among right TN patient and in the inferior frontal gyrus, precentral gyrus, cerebellum, thalamus, ventral striatum, and putamen among left TN patients. The connections between the right superior frontal gyrus and right middle frontal gyrus were lower in right TN patients. The connection between the left precentral gyrus and the left superior frontal gyrus was lower while the connection between bilateral thalamus was higher in left TN patients. The changes of volume in bilateral thalamus of right TN patients and left ventral striatum of left TN patients, and the connectivity between bilateral thalamus of left TN patients were moderately correlated with pain duration. These findings suggest that brain regions such as the thalamus may not only be involved in processing of pain stimuli but also be important for the development of TN. The left hemisphere may be dominant in processing and modulation of TN pain signal. Chronification of TN induces volume changes in brain regions which are associated with emotional or cognitive modulation of pain. Hum Brain Mapp 39:609-621, 2018. © 2017 Wiley Periodicals, Inc.

Accuracy of Presurgical Functional MR Imaging for Language Mapping of Brain Tumors: A Systematic Review and Meta-Analysis.

Purpose To compare functional magnetic resonance (MR) imaging for language mapping (hereafter, language functional MR imaging) with direct cortical stimulation (DCS) in patients with brain tumors and to assess factors associated with its accuracy. Materials and Methods PubMed/MEDLINE and related databases were searched for research articles published between January 2000 and September 2016. Findings were pooled by using bivariate random-effects and hierarchic summary receiver operating characteristic curve models. Meta-regression and subgroup analyses were performed to evaluate whether publication year, functional MR imaging paradigm, magnetic field strength, statistical threshold, and analysis software affected classification accuracy. Results Ten articles with a total of 214 patients were included in the analysis. On a per-patient basis, the pooled sensitivity and specificity of functional MR imaging was 44% (95% confidence interval [CI]: 14%, 78%) and 80% (95% CI: 54%, 93%), respectively. On a per-tag basis (ie, each DCS stimulation site or "tag" was considered a separate data point across all patients), the pooled sensitivity and specificity were 67% (95% CI: 51%, 80%) and 55% (95% CI: 25%, 82%), respectively. The per-tag analysis showed significantly higher sensitivity for studies with shorter functional MR imaging session times (P = .03) and relaxed statistical threshold (P = .05). Significantly higher specificity was found when expressive language task (P = .02), longer functional MR imaging session times (P < .01), visual presentation of stimuli (P = .04), and stringent statistical threshold (P = .01) were used. Conclusion Results of this study showed moderate accuracy of language functional MR imaging when compared with intraoperative DCS, and the included studies displayed significant methodologic heterogeneity. © RSNA, 2017 Online supplemental material is available for this article.

Urine-Specific Gravity-Based Hydration Prevents Stroke in Evolution in Patients with Acute Ischemic Stroke.

BACKGROUND: Early neurological deterioration after ischemic stroke (stroke-in-evolution [SIE]) is associated with poorer outcomes. Previous studies have demonstrated a link between hydration status and the development of SIE. In this study, we tested the hypothesis that rehydration therapy, administered on the basis of urine-specific gravity (USG) findings, might reduce the development of SIE. METHODS: We conducted a single-arm prospective study of patients with acute ischemic stroke with historical controls. For the study group, a USG higher than 1.010 was taken as an indication for rehydration. Control group patients were rehydrated without referring to USG. An increase in National Institutes of Health Stroke Scale (NIHSS) score of 4 or higher within 3 days was defined as having SIE. RESULTS: A total of 445 patients were analyzed, 167 in the study group and 278 in the control group. The proportion of patients who developed SIE was numerically, but not significantly, lower in the study group (5.9%; 10 of 167) compared with the control group (11.5%; 32 of 278). Among patients with a USG higher than 1.010 at admission, the SIE rate was significantly reduced in the study group compared with the control group (6.1% versus 16.0%; P = .021), while the rate of SIE was similar in those with a USG of 1.010 or lower at admission. Multivariate logistic regression analysis confirmed that USG-based hydration was an independent factor associated with reducing SIE. CONCLUSIONS: USG might be a convenient and useful method for guiding fluid therapy in patients with acute ischemic stroke. USG-based hydration reduced the incidence of SIE among patients with a USG higher than 1.010 at admission.

Favorable outcome of blood urea nitrogen/creatinine-based hydration therapy 3 months after acute ischemic stroke.

BACKGROUND: Dehydration is associated with acute ischemic stroke. However, the relationship between hydration therapy given during acute ischemic stroke and clinical outcomes remains unclear. AIMS: We determined whether hydration therapy in patients with a blood urea nitrogen/creatinine (BUN/Cr) ratio of at least 15 improved clinical outcome. METHODS: We conducted a nonblinded, phase II, single-arm, prospective study of patients with acute ischemic stroke and BUN/Cr ratio of at least 15 with historical controls. The hydration group received intravenous bolus (300-500 mL) saline followed by maintenance saline infusion (40-80 mL/h for the first 72 hours), whereas the control group received maintenance saline infusion (40-60 mL/h for the first 24 hours and 0-60 mL/h for 24-72 hours after stroke). The study end point was the percentage of patients with a favorable outcome defined as modified Rankin scale score of 2 or lower at 3 months after stroke. RESULTS: A total of 237 patients were enrolled (hydration, n = 134; control, n = 103). The mean volume of saline infused within the first 72 hours was significantly larger (P < .001), and the rate of favorable outcome at 3 months after stroke was significantly higher (P = .016) in the hydration group than in the controls. Further analysis revealed that the difference was significant in the lacunar stroke subtype (P = .020) but not in the nonlacunar subtype. CONCLUSIONS: Blood urea nitrogen/Cr ratio-based saline hydration therapy in patients with acute ischemic stroke significantly increased the rate of favorable clinical outcome with functional independence at 3 months after stroke.

Application of MRI and intraoperative CT fusion images with integrated neuronavigation in percutaneous radiofrequency trigeminal rhizotomy.

BACKGROUND: Percutaneous radiofrequency trigeminal rhizotomy (RF-TR) has been an effective treatment modality for medically refractory trigeminal neuralgia. Our group has established a protocol for this procedure that includes intraoperative computed tomography (iCT) navigation. The depth of the puncture needle in our protocol was based on cadaveric studies, and anatomical localization was mainly by electric stimulation test. The limitation of the invisibility of the trigeminal cistern on CT imaging and bias from the patient's subjective expression during neurophysiologic stimulation might affect the accuracy of the needle tip and the treatment effect.This study aimed to evaluate the feasibility and preliminary results of the application of magnetic resonance imaging (MRI) and iCT fusion imaging in RF-TR. METHOD: The study included 13 patients who received RF-TR with iCT navigation and with recurrence within 3 years. Repeated RF-TR was performed with real-time guidance by MRI and iCT fusion imaging. RESULTS: A pain-free or partial satisfactory response was reported with 12 patients (92 %). There was a statistically significant difference in the depth of the needle tip before and after application of MRI and iCT fusion imaging. CONCLUSIONS: This preliminary study demonstrated that the application of MRI and iCT fusion could help with anatomical localization of the trigeminal cistern intraoperatively. The improvement in neuronavigation provides a choice in the treatment of recurrent or persistent trigeminal neuralgia after previous intervention. Long-term follow-up of the result is necessary to evaluate the benefit in terms of durability of therapeutic efficacy.

Value of enhancement technique in 3D-T2-STIR images of the brachial plexus.

OBJECTIVE: Imaging the brachial plexus is a challenge because of its complicated structure. The purpose of this study is to improve the diagnostic ability for brachial plexus via 3-dimensional T2-weighted short inversion time inversion recovery (3D-T2-STIR) technique with contrast agent administration. METHODS: Thirty patients with brachial plexopathies were recruited. The STIR sequences without and with contrast agent administration were performed on each subject. The grade of the diagnostic ability and the contrast ratio were assessed. RESULTS: After contrast agent administration, signals of the adjacent vessels were suppressed because of reduced T1 relaxation time similar to that of fat tissues. The outlines of nerves would be prominent with respect to surrounding tissues. Both diagnostic ability and contrast ratio were improved on 3D-T2-STIR with contrast agent administration. CONCLUSIONS: The maximum-intensity projection image of 3D-T2-STIR technique with contrast agent was superior to that without. It might be a better way to evaluate anatomies and pathologies of the brachial plexus. These advantages would improve the understanding and neurosurgical planning for brachial plexopathies in the future.

Longitudinal assessment of chemotherapy-induced brain connectivity changes in cerebral white matter and its correlation with cognitive functioning using the GQI.

Objective: Breast cancer was the most prevalent type of cancer and had the highest incidence rate among women worldwide. The wide use of adjuvant chemotherapy might have a detrimental effect on the human brain and result in chemotherapy-related cognitive impairment (CICI) among breast cancer patients. Furthermore, prior to chemotherapy, patients reported cancer-related cognitive impairment (CRCI), which might be due to physiological factors or mood symptoms. The present longitudinal study aimed to investigate microstructural and macroscale white matter alterations by generalized q-sampling imaging (GQI). Methods: The participants were categorized into a pre-chemotherapy group (BB) if they were diagnosed with primary breast cancer and an age-matched noncancer control group (HC). Some participants returned for follow-up assessment. In the present follow up study, 28 matched pairs of BB/BBF (follow up after chemotherapy) individuals and 28 matched pairs of HC/HCF (follow up) individuals were included. We then used GQI and graph theoretical analysis (GTA) to detect microstructural alterations in the whole brain. In addition, we evaluated the relationship between longitudinal changes in GQI indices and neuropsychological tests as well as psychiatric comorbidity. Findings: The results showed that disruption of white matter integrity occurred in the default mode network (DMN) of patients after chemotherapy, such as in the corpus callosum (CC) and middle frontal gyrus (MFG). Furthermore, weaker connections between brain regions and lower segregation ability were observed in the post-chemotherapy group. Significant correlations were observed between neuropsychological tests and white matter tracts of the CC, MFG, posterior limb of the internal capsule (PLIC) and superior longitudinal fasciculus (SLF). Conclusion: The results provided evidence of white matter alterations in breast cancer patients, and they may serve as potential imaging markers of cognitive changes. In the future, the study may be beneficial to create and evaluate strategies designed to maintain or improve cognitive function in breast cancer patients undergoing chemotherapy.

Association of Longitudinal Changes in Cerebral Microstructure with Cognitive Functioning in Breast Cancer Survivors after Adjuvant Chemotherapy.

Background: Adjuvant chemotherapy for breast cancer might impact cognitive function and brain structure. Methods: In this study, we investigated the cerebral microstructural changes in breast cancer survivors after adjuvant chemotherapy and the correlation with cognitive function with both cross-sectional and longitudinal study designs. All participants underwent structural MRI. In total, we recruited 67 prechemotherapy patients (BB), 67 postchemotherapy patients (BA), and 77 healthy controls (BH). For the follow-up study, 28 participants in the BH and 28 in the BB groups returned for imaging and assessment (BHF, BBF). Voxel-based morphometry analysis was performed to evaluate differences in brain volume; vertex-based shape analysis was used to assess the shape alterations of subcortical regions. Moreover, multiple regression was applied to assess the association between the changes in neuropsychological assessment and brain volume. Results: The results showed brain volume reduction in the temporal and parietal gyrus in BB and BA patients. Among each group, we also found significant shape alterations in the caudate and thalamus. Volume reductions in the temporal regions and shape changes in the caudate and hippocampus were also observed in patients from time point 1 to time point 2 (postchemotherapy). An association between brain volume and cognitive performance was also found in the limbic system. Conclusions: Based on our findings, we can provide a better understanding of the cerebral structural changes in breast cancer survivors, establish a subsequent prediction model, and serve as a reference for subsequent treatment.

Correction: Masticatory muscle index for indicating skeletal muscle mass in patients with head and neck cancer.

[This corrects the article DOI: 10.1371/journal.pone.0251455.].

Investigating the effect of hypertension on vascular cognitive impairment by using the resting-state functional connectome.

Hypertension (HTN) affects over 1.2 billion individuals worldwide and is defined as systolic blood pressure (BP) ≥ 140 mmHg and diastolic BP ≥ 90 mmHg. Hypertension is also considered a high risk factor for cerebrovascular diseases, which may lead to vascular cognitive impairment (VCI). VCI is associated with executive dysfunction and is also a transitional stage between hypertension and vascular dementia. Hence, it is essential to establish a reliable approach to diagnosing the severity of VCI. In 28 HTN (51-83 yrs; 18 males, 10 females) and 28 healthy controls (HC) (51-75 yrs; 7 males, 21 females), we investigated which regions demonstrate alterations in the resting-state functional connectome due to vascular cognitive impairment in HTN by using the amplitude of the low-frequency fluctuations (ALFF), regional homogeneity (ReHo), graph theoretical analysis (GTA), and network-based statistic (NBS) methods. In the group comparison between ALFF/ReHo, HTN showed reduced spontaneous activity in the regions corresponding to vascular or metabolic dysfunction and enhanced brain activity, mainly in the primary somatosensory cortex and prefrontal areas. We also observed cognitive dysfunction in HTN, such as executive function, processing speed, and memory. Both the GTA and NBS analyses indicated that the HTN demonstrated complex local segregation, worse global integration, and weak functional connectivity. Our findings show that resting-state functional connectivity was altered, particularly in the frontal and parietal regions, by hypertensive individuals with potential vascular cognitive impairment.