MRI features for prediction of the intravenous chemotherapy effect in patients with retinoblastoma.

AIM: To investigate the value of orbital magnetic resonance imaging (MRI) features in predicting the efficacy of intravenous chemotherapy (IVC) for patients with retinoblastoma (RB). MATERIALS AND METHODS: The pretreatment clinical and MRI data of 100 eyes from 80 RB patients who underwent IVC were collected retrospectively. There were 59 eyes in the effective group and 41 eyes in the ineffective group, and the baseline data of the two groups were compared statistically. Three radiologists reviewed and evaluated each lesion independently based on 25 MRI features. The predictive values of the MRI features for IVC efficacy were assessed by multi-factor logistic regression analysis, and their odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Receiver operating characteristic curves (ROCs) with the area under the curve (AUC) were used to determine the predictive abilities. A predictive model was constructed by integrating all independent predictors visualised by the nomogram. RESULTS: There were no statistically significant differences in sex or age between the effective and ineffective groups. The results of multivariate regression analysis showed that laterality, margin, and anterior eye segment enhancement were identified as independent factors that could predict IVC efficacy. The predictive model combining these three features was constructed, and it had an AUC of 0.732 (95% CI: 0.633, 0.831, p<0.01), a sensitivity of 71.2%, and a specificity of 70.7%. CONCLUSION: The data demonstrate that the orbital MRI features can be used to predict IVC efficiency before RB patients are treated.

[The value of dynamic contrast-enhanced MRI in the differentiation between benign and malignant lacrimal epithelial tumors].

Objective: To investigate the diagnostic performance of multiparametric dynamic contrast-enhanced MRI(DCE-MRI) for the differentiation between benign and malignant larcrimal gland epithelial tumors. Methods: The clinical and imaging data of 104 patients with epithelial tumors of the lacrimal gland who underwent orbital MRI scan and met the inclusion criteria in Beijing Tongren Hospital from January 2011 to December 2017 were retrospectively collected, including 48 males and 56 females, aged from 12 to 77 (43±7) years. Sixty-three cases of benign epithelial tumors and 41 cases of malignant epithelial tumors were examined by DCE-MRI. The parameters of semiquantitative analysis including: time to peak enhancement (Tpeak), maximum enhancement ratio (ERmax), Slope, washout ratio (WR) and time-signal intensity curve (TIC) types. The parameters of quantitative analysis including: volume transfer constant (Ktrans), the extravascular extracellular volume fraction (Ve) and rate constant (Kep). Receiver operating characteristic (ROC) curve analysis was performed for DCE-MRI parameters with statistically significant differences, the area under the curve (AUC) was calculated, the diagnostic threshold was determined, and the diagnostic performance was evaluated. Logistic regression analysis was used to determine the best parameters for differential diagnosis of benign and malignant epithelial tumors of the lacrimal gland. Results: For the semiquantitative analysis of DCE-MRI, malignant lacrimal gland epithelial tumor had a significantly shorter Tpeak than benign masses [(103.77±57.87) s vs (187.80±77.01) s,P<0.001)], while had a higher value in ERmax, Slope [M(Q1,Q3)] and WR in malignant masses compared with benign one [1.55±0.39 vs 1.36±0.33; 1.76 (0.97,2.27) vs 0.62 (0.50,0.93); 7.70%(1.40%, 21.60%)% vs 0(0, 0),all P<0.05)].The TICs of benign lacrimal tumors mainly showed a persistent type (49/63),while most malignant lacrimal tumors mainly showed a plateau type (25/41). For the quantitative analysis of DCE-MRI, the values of Ktrans and Kep[M(Q1,Q3)] in malignant tumors were significantly greater than those of benign tumors (0.99±0.52/min vs 0.43±0.23/min, P<0.001; 1.33(0.83, 1.55)/min vs 0.55(0.46, 0.68)/min, P<0.001). No significant difference in Ve was found between the groups (0.76±0.20 vs 0.73±0.22,P=0.467). Through the statistical analysis, TIC types (OR=3.887,95%CI: 1.409-10.725) and Ktrans(OR=50.979,95%CI: 6.046-429.830) can provide superior diagnostic performance for predicting malignant lacrimal gland epithelial tumors, with a sensitivity of 78.05%, specificity of 77.78%,and sensitivity of 70.73%, specificity of 95.24%, respevtively. Furthermore, the comprehensive diagnostic performance of Ktrans in AUC was proven to be significantly better than that of TIC [0.875 (0.796-0.932) vs 0.798 (0.708-0.870),P=0.049]. Conclusions: Multiparametric DCE-MRI is helpful for the differential diagnosis of benign and malignant epithelial tumors of lacrimal gland. TIC type and Ktrans have higher diagnostic value, and the diagnostic performance of Ktrans is better than that of TIC.

[Analysis of the predictive value of plateletcrit for the degree of liver fibrosis in patients with chronic HBV infection with ALT less than two times the upper limit of normal].

Objective: Plateletcrit (PCT) is considered a new potential index to predict the degree of liver fibrosis in patients with chronic hepatitis B (CHB). This study aimed to explore the predictive value of PCT for the degree of liver fibrosis in patients with chronic hepatitis B virus (HBV) infection with alanine aminotransferase (ALT) < 2× upper limit of normal (ULN). Measurement data were compared using the t-test, ANOVA, or non-parametric test (Mann-Whitney U test). Categorical variables were compared using χ (2) test or Fisher's exact test. Methods: 140 cases with chronic HBV infection who underwent liver biopsy and ALT < 2×ULN were enrolled from January 2016 to March 2021. Univariate and multivariate logistic regression and the area under the receiver operating characteristic curve (AUC) were used to determine the predictive value of PCT for the degree of liver fibrosis. The likelihood ratio (LR) was used to optimize the selection of the diagnostic cut-off. Results: (1) Among the 140 cases, there were 34 (24.3%) cases in the S0 stage, 47 (33.6%) cases in the S1 stage, 16 (11.4%) cases in the S2 stage, 19 (13.6%) cases in the S3 stage, and 24 (17.1%) cases in the S4 stage. The overall mean PCT level was 0.19 ± 0.06%. (2) Univariate analysis revealed that PCT between patients with stages of liver fibrosis was S(0-1) and S(2-4) (0.20% ± 0.05% vs. 0.16% ± 0.06%, t = 3.955, P < 0.001), S(0 -2) and S(3-4) (0.20% ± 0.05% vs. 0.15% ± 0.06%, t = 5.631, P < 0.001) and S(0-3) and S4 (0.20% ± 0.05% vs. 0.12% ± 0.05%, t = 7.113, P < 0.001), respectively, and the differences were statistically significant. Multivariate logistic regression analysis showed that PCT was an independent risk factor for liver fibrosis stages S(2-4), S(3-4), and S4 (OR = 0.925, 95% CI: 0.859 - 0.997, P = 0.042; OR = 0.867, 95% CI: 0.789 - 0.954, P = 0.003; OR = 0.708, 95% CI: 0.593 - 0.846; P < 0.001). (3) The AUCs of PCT were 0.702, 0.777, and 0.885 for diagnosing liver fibrosis stages S(2-4), S(3-4), and S4 in patients with chronic HBV infection with ALT < 2×ULN. PCT was superior for the cirrhosis (S4) diagnosis. 92 (65.7%) cases were diagnosed as cirrhosis or non-cirrhosis according to the LR optimized diagnostic and exclusion diagnostic cut-offs (≤0.09%, ≤0.17%), with an accuracy of 97.8%. Conclusion: PCT has a high diagnostic and exclusion value for cirrhotic patients with chronic HBV infection with ALT < 2×ULN. Furthermore, it can be used as a non-invasive diagnostic index for determining and assisting the diagnosis of cirrhosis in resource-constrained areas, reducing the need for pathological examination of liver biopsies, and it has the advantage of being simple and intuitive without complex calculations.

Use of real-time artificial intelligence in detection of abnormal image patterns in standard sonographic reference planes in screening for fetal intracranial malformations.

OBJECTIVES: To develop and validate an artificial intelligence system, the Prenatal ultrasound diagnosis Artificial Intelligence Conduct System (PAICS), to detect different patterns of fetal intracranial abnormality in standard sonographic reference planes for screening for congenital central nervous system (CNS) malformations. METHODS: Neurosonographic images from normal fetuses and fetuses with CNS malformations at 18-40 gestational weeks were retrieved from the databases of two tertiary hospitals in China and assigned randomly (ratio, 8:1:1) to training, fine-tuning and internal validation datasets to develop and evaluate the PAICS. The system was built based on a real-time convolutional neural network (CNN) algorithm, You Only Look Once, version 3 (YOLOv3). An image dataset from a third tertiary hospital was used to further validate, externally, the performance of the PAICS and to compare its performance with that of sonologists with different levels of expertise. Furthermore, a prospective video dataset was employed to evaluate the performance of the PAICS in a real-time scan scenario. The diagnostic accuracy, sensitivity, specificity and area under the receiver-operating-characteristics curve (AUC) were calculated to assess the performance of the PAICS and to compare this with the performance of sonologists with different levels of experience. RESULTS: In total, 43 890 images from 16 297 pregnancies and 169 videos from 166 pregnancies were used to develop and validate the PAICS. The system achieved excellent performance in identifying 10 types of intracranial image pattern, with macro- and microaverage AUCs, respectively, of 0.933 (95% CI, 0.798-1.000) and 0.977 (95% CI, 0.970-0.985) for the internal validation image dataset, 0.902 (95% CI, 0.816-0.989) and 0.898 (95% CI, 0.885-0.911) for the external validation image dataset and 0.969 (95% CI, 0.886-1.000) and 0.981 (95% CI, 0.974-0.988) in the real-time scan setting. The performance of the PAICS was comparable to that of expert sonologists in terms of macro- and microaverage accuracy (P = 0.863 and P = 0.775, respectively), sensitivity (P = 0.883, P = 0.846) and AUC (P = 0.891, P = 0.788), but required significantly less time (0.025 s per image for PAICS vs 4.4 s for experts, P < 0.001). CONCLUSIONS: Both in the image dataset and in the real-time scan setting, the PAICS achieved excellent diagnostic performance for various fetal CNS abnormalities. Its performance was comparable to that of experts, but it required less time. A CNN algorithm can be trained to detect fetal CNS abnormalities. The PAICS has the potential to be an effective and efficient tool in screening for fetal CNS malformations in clinical practice. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

HuR counteracts miR-330 to promote STAT3 translation during inflammation-induced muscle wasting.

Debilitating cancer-induced muscle wasting, a syndrome known as cachexia, is lethal. Here we report a posttranscriptional pathway involving the RNA-binding protein HuR as a key player in the onset of this syndrome. Under these conditions, HuR switches its function from a promoter of muscle fiber formation to become an inducer of muscle loss. HuR binds to the STAT3 (signal transducer and activator of transcription 3) mRNA, which encodes one of the main effectors of this condition, promoting its expression both in vitro and in vivo. While HuR does not affect the stability and the cellular movement of this transcript, HuR promotes the translation of the STAT3 mRNA by preventing miR-330 (microRNA 330)-mediated translation inhibition. To achieve this effect, HuR directly binds to a U-rich element in the STAT3 mRNA-3'untranslated region (UTR) located within the vicinity of the miR-330 seed element. Even though the binding sites of HuR and miR-330 do not overlap, the recruitment of either one of them to the STAT3-3'UTR negatively impacts the binding and the function of the other factor. Therefore, together, our data establish the competitive interplay between HuR and miR-330 as a mechanism via which muscle fibers modulate, in part, STAT3 expression to determine their fate in response to promoters of muscle wasting.

[Analysis of the cognitive effects of monocular blindness and related influencing factors].

Objective: To investigate the cognitive effects of monocular blindness and related influencing factors. Methods: A cross-sectional study was conducted. The patients with monocular blindness (the age of onset <16 years) were enrolled from Beijing Tongren Eye Center, Beijing Tongren Hospital between January 2018 and June 2020. The Montreal cognitive assessment (MoCA) scale was applied to assess seven cognitive domains including visuospatial and executive function, naming, attention, etc. Based on MoCA scores, all the patients were classified into two groups: normal cognitive functions and cognitive impairment. Spearman's correlation was used to perform the single factor analysis of the influencing factors of cognitive functions. Multivariate linear regression analyses were applied to identify the independent influencing risk factors. Results: A total of 45 patients with monocular blindness were enrolled. There were 25 males and 20 females, with age at testing being (27±10) years.The incidence of cognitive impairment in 45 patients was 60.0% (27/45). The abnormal items ranking from a high to low rate were language (95.6%, 43 cases), delayed recall (75.6%, 34 cases), visuospatial and executive function (60.0%, 27 cases), abstract (44.4%, 20 cases), attention (35.6%, 16 cases), naming (20.0%, 9 cases), and orientation (0%). There were statistically significant differences (all P<0.05) in total score (21.9±3.3 vs. 27.4±1.4), visuospatial and executive function (3.2±1.7 vs. 4.6±0.7), naming (2.7±0.6 vs. 2.9±0.2), attention (5.3±1.0 vs. 5.8±0.4), language (1.1±0.8 vs. 1.8±0.8), abstract (1.1±0.8 vs. 1.8±0.5) and delayed recall (2.3±1.3 vs. 4.4±0.8) between two groups of patients with and without cognitive impairment. Spearman's correlation analysis showed visuospatial and executive functions, attention, abstract and MoCA total score were positively correlated with education years (correlation coefficients being 0.355, 0.424, 0.434 and 0.370, respectively; all P<0.05). Multiple linear regression showed that duration of blindness was correlated with naming (ß=-0.325), and years of education correlated with attention (ß=0.472), abstract ability (ß=0.441) and MoCA total score (ß=0.390) (all P<0.05). Conclusions: Monocular blindness may affect language, delayed memory and visuospatial executive functions. The duration of blindness is an independent risk factor, and higher education is a protective factor of the cognitive impairment.

Using deep-learning algorithms to classify fetal brain ultrasound images as normal or abnormal.

OBJECTIVES: To evaluate the feasibility of using deep-learning algorithms to classify as normal or abnormal sonographic images of the fetal brain obtained in standard axial planes. METHODS: We included in the study images retrieved from a large hospital database from 10 251 normal and 2529 abnormal pregnancies. Abnormal cases were confirmed by neonatal ultrasound, follow-up examination or autopsy. After a series of pretraining data processing steps, 15 372 normal and 14 047 abnormal fetal brain images in standard axial planes were obtained. These were divided into training and test datasets (at case level rather than image level), at a ratio of approximately 8:2. The training data were used to train the algorithms for three purposes: performance of image segmentation along the fetal skull, classification of the image as normal or abnormal and localization of the lesion. The accuracy was then tested on the test datasets, with performance of segmentation being assessed using precision, recall and Dice's coefficient (DICE), calculated to measure the extent of overlap between human-labeled and machine-segmented regions. We assessed classification accuracy by calculating the sensitivity and specificity for abnormal images. Additionally, for 2491 abnormal images, we determined how well each lesion had been localized by overlaying heat maps created by an algorithm on the segmented ultrasound images; an expert judged these in terms of how satisfactory was the lesion localization by the algorithm, classifying this as having been done precisely, closely or irrelevantly. RESULTS: Segmentation precision, recall and DICE were 97.9%, 90.9% and 94.1%, respectively. For classification, the overall accuracy was 96.3%. The sensitivity and specificity for identification of abnormal images were 96.9% and 95.9%, respectively, and the area under the receiver-operating-characteristics curve was 0.989 (95% CI, 0.986-0.991). The algorithms located lesions precisely in 61.6% (1535/2491) of the abnormal images, closely in 24.6% (614/2491) and irrelevantly in 13.7% (342/2491). CONCLUSIONS: Deep-learning algorithms can be trained for segmentation and classification of normal and abnormal fetal brain ultrasound images in standard axial planes and can provide heat maps for lesion localization. This study lays the foundation for further research on the differential diagnosis of fetal intracranial abnormalities. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Pathological changes from the originating to the peripheral sites of Sinonasal Inverted Papilloma are the underlying mechanisms of preoperative MRI-tumor origin prediction.

BACKGROUND: Our previous study showed that convoluted cerebriform pattern (CCP)-based reverse tracing method in preoperative magnetic resonance imaging (MRI) is a reliable tool in predicting originating site of sinonasal inverted papilloma (SNIP). This study aimed to determine the underlying pathological mechanism of the preoperative MRI-CCP reverse tracing method by assessing the histopathological changes from the origin to the peripheral sites of SNIP. METHODOLOGY: The originating site of SNIP was predicted by preoperative MRI in 30 consecutive patients suspected to have primary SNIP. Samples of SNIP originating and peripheral sites were processed by pathological staining for evaluation of stroma score, micro-vessel density (MVD), and tight junction proteins (claudin-5, zonula occludens (ZO)-1 and occludin) expression. RESULTS: The originating site of SNIP was accurately predicted by preoperative MRI in all patients. Stroma scores, and MVD were significantly greater in the periphery of SNIP than in the originating site. In contrast, Claudin-5 expression in micro-vessels was greater at the originating site than the periphery. CONCLUSIONS: More edematous stroma and intensive micro-vessels with defective tight junction in periphery of SNIP result in more contrast agent diffusing and CCP that can only be observed at the periphery of SNIP on T2 and contrast-enhanced T1 weighted MR images, which may be the mechanisms underlying the CCP reverse tracing method.

[The value of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma].

Objective: To explore the role of the scoring and strain ratio methods of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma. Methods: A cross-sectional study. Twenty-five patients (25 eyes) with choroidal melanoma treated in the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University from July to October 2016 were included in this study. There were 13 males and 12 females, with an average age of (48±12) years old. Twenty-five patients (25 eyes) with choroidal hemangioma treated in the same period were selected for differential diagnosis, including 12 males and 13 females, with an average age of (37±13) years. The lesions were examined by ultrasound elastography and scored, and the strain ratio of the tumor to the orbital tissue was measured. Two independent sample t test was used to compare the difference in the elasticity score and strain ratio between choroidal melanoma and choroidal hemangioma. The sensitivity, specificity and area under the receiver operating characteristic (ROC) curve were calculated to analyze the value of the two methods in the differential diagnosis of choroidal melanoma and choroidal hemangioma. Results: The elastography score of choroidal melanoma was (3.48±0.77) points, including 2 points in 3 cases, 3 points in 8 cases, 4 points in 13 cases, and 5 points in 1 case. The elastography score of hemangioma was (2.28±0.46) points, including 2 points in 18 cases and 3 points in 7 cases. The difference in the elasticity score between patients with the two kinds of tumors was statistically significant (t=6.694, P<0.01). The strain ratio was 42.97±15.83 and 12.21±9.24 in the patients with choroidal melanoma and choroidal hemangioma, respectively, and the difference was statistically significant (t=8.392, P<0.01). Using 3 points as the diagnostic critical point of the elastography score, the sensitivity was 88.0%, the specificity was 72.0%, and the area under the ROC curve was 0.80 (95% cofidence interval: 0.663 to 0.900, P<0.01). Using 21.67 as the diagnostic critical point of the strain ratio, the sensitivity was 92.0%, the specificity was 92.0%, and the area under the ROC curve was 0.92 (95% cofidence interval: 0.808 to 0.978, P<0.01). Conclusions: Ultrasound elastography plays a role in the differential diagnosis of choroidal melanoma and choroidal hemangioma. The differential diagnostic value of the strain ratio method is higher than the scoring method. (Chin J Ophthalmol, 2020, 56: 676-680).

Efficacy of PROPELLER in reducing ocular motion artefacts and improving image quality of orbital MRI at 3 T using an eye surface coil.

AIM: To evaluate the efficacy of periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) in reducing ocular motion artefacts and improving image quality of orbital magnetic resonance imaging (MRI) at 3 T using an eye surface coil. MATERIALS AND METHODS: Forty-six patients underwent orbital 3 T MRI using an eye surface coil. The pre-contrast axial T2-wighted (W) PROPELLER and T1 fluid-attenuated inversion recovery (FLAIR) PROPELLER imaging were performed on 21 patients, and conventional T2W and T1W imaging were performed on 25 patients. The ocular motion artefacts, delineation of anatomical structures, depiction of lesions, and image quality were evaluated independently by two radiologists using a five-point scale. The signal-to-noise ratios (SNRs) of anatomical structures and lesions were measured. RESULTS: The interobserver agreement was good to excellent (kappa values from 0.79 to 0.91). PROPELLER sequences had higher scoring than the conventional sequences in all cases (p<0.05). PROPELLER images showed fewer motion artefacts, higher image quality, and more clear delineation of anatomical structures and lesions than the non-PROPELLER images. T2W PROPELLER images produced higher SNRs in lens, vitreous body, lacrimal gland, and lesions than conventional T2W images (p<0.05). T1 FLAIR PROPELLER images showed lower SNRs in lens, vitreous body, medial rectus, lateral rectus, temporalis, and posterior half of optic nerve than conventional T1W images (p<0.05). CONCLUSION: PROPELLER can effectively reduce ocular motion artefacts and improve image quality, which plays an important role in clearly delineating anatomical structures and lesions on orbital 3 T MRI using an eye surface coil.

Parapharyngeal space paraganglioma: distinguishing vagal paragangliomas from carotid body tumours using standard MRI.

AIM: To evaluate whether standard magnetic resonance imaging (MRI) could distinguish vagal paragangliomas (VPs) from carotid body tumours (CBTs) in the parapharyngeal space. METHODS AND MATERIALS: Thirteen VPs in 13 patients and 29 CBTs in 26 patients were included in this study. MRI features were evaluated independently by two head and neck radiologists with 10 and 16 years of experience (X.Wang and Y.Chen). RESULTS: Significant differences were found in shape, direction of internal carotid artery (ICA) displacement, splaying of the carotid bifurcation, involvement of the jugular foramen, and maximum vertical diameters between VPs and CBTs (p=0.016, <0.001, <0.001, <0.001 and <0.001, respectively). Splaying of the carotid bifurcation was found in all the 29 CBTs for both observers, whereas only four VPs for observer 1 and two for observer 2 showed this feature. The ICA was displaced posteriorly in all the 29 patients with CBTs for both observers, and only three patients with VPs for observer 1 and two for observer 2. Involvement of the jugular foramen was found in seven patients with VPs for both observers, while none of patients with CBT showed this feature. With the combination of splaying of the carotid bifurcation and involvement of the jugular foramen, the multiple logistic regression model revealed the diagnostic accuracy was 95.2% for observer 1 and 97.6% for observer 2. With the combination of ICA displacement direction and involvement of the jugular foramen, the diagnostic accuracy was 97.6% for both observers. CONCLUSION: MRI features can effectively differentiate VPs from CBTs in the parapharyngeal space.

Nuclear Phosphoinositides: Their Regulation and Roles in Nuclear Functions.

Polyphosphoinositides (PPIns) are a family of seven lipid messengers that regulate a vast array of signalling pathways to control cell proliferation, migration, survival and differentiation. PPIns are differentially present in various sub-cellular compartments and, through the recruitment and regulation of specific proteins, are key regulators of compartment identity and function. Phosphoinositides and the enzymes that synthesise and degrade them are also present in the nuclear membrane and in nuclear membraneless compartments such as nuclear speckles. Here we discuss how PPIns in the nucleus are modulated in response to external cues and how they function to control downstream signalling. Finally we suggest a role for nuclear PPIns in liquid phase separations that are involved in the formation of membraneless compartments within the nucleus.

[Value of CT in the differential diagnosis of Pseudomonas aeruginosa sinusitis and fungal ball in paranasal sinus caused by Aspergilus flavus].

Objective: To evaluate the value of CT in the differential diagnosis of Pseudomonas aeruginosa sinusitis and fungal ball in paranasal sinus caused by Aspergilus flavus. Methods: In this retrospective study, CT results of 74 cases of Pseudomonas aeruginosa sinusitis including 31 male cases and 43 female cases with age onset from 15 to 74 years old (mean±SD was 50±13) and 72 cases of fungal ball in paranasal sinus caused by Aspergilus flavus including 28 male cases and 44 female cases with age onset from 25 to 78 years old (mean±SD was 53±15) at Beijing Tongren Hospital confirmed by histopathology were enrolled from January 2013 to May 2017. The CT characteristics of the two groups of cases were compared using χ(2) test, and P<0.05 was considered statistically significant. Results: Soft tissue opacification of the involved paranasal sinus was found on CT in each case of the two groups. There were significant differences in the rate of single sinus involvement (44.6% and 90.3% respectively), the incidence of lesion associated with maxillary sinus (91.9% and 70.8% respectively), ethmoid sinus (41.9% and 2.8% respectively), frontal sinus (29.7% and 0 respectively), calcification (50.0% and 72.2% respectively), and the enlargement of maxillary sinus opening (13.2% and 35.3% respectively), in addition to the central calcification (83.8% and 59.6% respectively) between the two groups (all P<0.05). However, the incidence of sphenoid sinus involvement (32.4% and 34.7% respectively), bone sclerosis (56.8% and 62.5% respectively) or destruction(18.9% and 16.7% respectively) were not found different between the two groups (P>0.05). Conclusion: Though the CT findings are similar between the two diseases such as soft tissue opacification of the involved paranasal sinus with calcification and bone sclerosis or destruction, there are still a few characteristics on CT in differentiating the one from the other. The involvement of multi-sinuses, maxillary sinus, ethmoid sinus and frontal sinus, the central calcification are more common in the Pseudomonas aeruginosa sinusitis. However, the CT features including single sinus involvement, calcification and enlargement of maxillary sinus opening, can be seen more often in the fungal ball in paranasal sinus caused by Aspergilus flavus.

[Value of the apparent diffusion coefficient in diffusion weighted imaging at 3.0T MR for differentiating lacrimal gland tumors].

Objective: To investigate the diagnostic value of apparent diffusion coefficient in diffusion weighted imaging at 3.0 T MR for the differentiation in the larcrimal gland tumors. Methods: A total of 73 cases, 36 males and 37 female; mean age 14-81(44±15)years, with lacrimal gland tumors confirmed by pathology in Beijing Tongren Hospital were retrospectively analyzed between January 2011 and April 2016.All cases underwent the preoperative routine MRI and DWI scan, the ADC values were measured in region of interest within the solid zone. The cases were divided into benign and malignant group by the histopathology, according the different pathological categories, the malignant cases were further divided into the epithelial and non-epithelial malignacy. The receiver operating characteristic curve (ROC) was constructed using various cut points of ADC for different parameters to confirm the diagnostic threshold value and evaluate the diagnostic efficacy. Results: There were totally 77 lesions in 73 cases, of which 69 involved unilateral lacrimal gland,4 bilateral lacrimal glands. The mean ADC value of malignant and benign masses in lacrimal gland was (1.36±0.16) and (0.90±0.30)×10(-3) mm(2)/s respectively. There was significantly statistical difference between the both(t=-8.319, P<0.01). The mean ADC value of epithelial and non-epithelial malignacy in lacrimal gland was (1.08±0.18) and (0.54±0.09)×10(-3) mm(2)/s respectively. There was significantly statistical difference between the both(t=11.988, P<0.01). The area under the ROC for distinguishing malignant from benign lesions was 0.940. Using an ADC value of 1.275×10(-3) mm(2)/s as the threshold value, the best result obtained had a sensitivity of 94.4%(34/36), specificity of 82.9%(34/41), accuracy of 88.3%(68/77). The area under the ROC for differentiating non-epithelial from epithelial malignacy was 1.0. Using an ADC value of 0.736×10(-3) mm(2)/s as the threshold value, the best result obtained had a sensitivity of 100%, specificity of 100%, accuracy of 100%. Conclusion: The ADC value is helpful in differentiation among different kinds of tumors in lacrimal masses.

[Magnetic resonance imaging study of endolymphatic hydrops based on 3D-FLAIR sequence after single-dose intravenous gadolinium injection].

Objective: To investigate the visualization of endolymph in patients with otogenic vertigo by intravenous administration of single dose of gadolinium contrast agents and magnetic resonance three-dimensional fluid-attenuated inversion recovery sequence (3D-FLAIR MRI), and further assess the extent of endolymphatic hydrops. Methods: From Beijing Tongren Hospital of Capital Medical University between October 2017 and June 2018, 30 patients (16 males, 14 females) with unilateral otogenic vertigo were involved in this study, with the age of 30 to 68 years, mean age of (53±10) years. Eight hours after intravenous administration of single dose (0.1 mmol/kg, body weight) of gadopentetate (Gd-DTPA), 3D-FLAIR sequence was performed in 30 patients. The location of endolymphatic hydrops was observed and then the degree of hydrops was quantitatively elevated by two radiologists. The consistency test was used to analyze the location and degree of endolymphatic hydrops in the two radiologists and the paired t-test was used to compare the difference between the affected and healthy side of endolymphatic spaces of the patients with otogenic vertigo. Results: In 30 patients, the gadolinium distributed in all parts of the perilymph inside the inner ear, and can accurately outline the boundaries of the peri-and endolymph. Twenty-six patients (26/30, 86.7%) were found to have unilateral endolymphatic hydrops, including 18 mild hydrops, 8 significant hydrops. The two radiologists had a very good agreement on the assessment of endolymphatic hydrops(kappa=0.864, ICC=0.959). In the 3D-FLAIR MR images of 26 patients with endolymphatic hydrops, the saccule (26/26, 100%) had a higher rate of hydrops than the cochlea and utricle(16/26, 61.5%; 14/26, 53.8%), and two radiologists had a very good agreement on the location of endolymphatic hydrops(kappa=0.820). Moreover, there was a significantly statistical difference between the affected and healthy area of the endolymphatic space in this study (P<0.01). Conclusion: The technique of 3D-FLAIR MR imaging through single dose intravenous gadolinium injection is feasible, which can estimate endolymphatic hydrops in patients with otogenic vertigo, and accurately classify the degree of hydrops.

[Quantitative dynamic contrast enhancement MR imaging parameters in the prediction and evaluation of the treatment response of malignant sinonasal tumors to chemotherapy:a preliminary result].

Objective: To investigate the value of quantitative dynamic contrast enhancement MR imaging (DCE-MRI) parameters in the prediction and evaluation of the response to neoadjuvant chemotherapy in patients with malignant sinonasal tumors by comparing the parameter values before and after chemotherapy. Methods: DCE-MRI was performed in 14 patients (6 male cases, 8 female cases, 16-83 years) with malignant sinonasal tumors before chemotherapy in Beijing Tongren Hospital from January 2012 to December 2013 in which DCE-MRI was performed in 8 patients on the 7th, 21st and 42nd days after chemotherapy. The values of quantitative parameter including K(trans), K(ep), and V(e) of the tumor were assessed and the change rate of these quantitative parameter values after chemotherapy was calculated. Results: Response to chemotherapy of the tumor was found in 11 patients with malignant sinonasal tumors,whereas no response to chemotherapy of the tumor was confirmed in 3 patients. K(trans) ((0.75±0.28)/min) and K(ep) ((3.23±1.48)/min) values of the tumor before chemotherapy in patients with response to chemotherapy were significantly bigger than those ((0.43±0.41)/min, (1.34±0.42)/min) in patients with no response to chemotherapy (all P<0.01).There was no significant difference in V(e) values between two groups (P=0.165). Compared with K(trans) values of the tumor before chemotherapy,the change rate of K(trans) values decreased more than 40% on the 7th,21st and 42nd days after chemotherapy in the patients with treatment response,whereas the change rate did not decrease significantly in the patients without treatment response. Conclusion: The bigger K(trans) and K(ep) values of the tumor before chemotherapy,the better the treatment response of the tumor to chemotherapy.

[Application of MRI in the etiological diagnosis of special forms of strabismus].

Objective: To explore the imaging features of patients with special forms of strabismus and summarize the subtypes by using MRI imaging techniques. Methods: A retrospective case series study. Among the patients who visited the Beijing Tongren Hospital between 2006 and 2016, 1 113 patients were identified with special forms of strabismus after complete ophthalmic and orthoptic evaluations. These patients were further evaluated using several types of high-resolution MRI techniques of the oculomotor nerves in the brain, the cavernous sinus, and the orbits. Results: Among the 1 113 patients, 818 patients (73.5%) were identified with MRI abnormal conditions, and 295 patients (26.5%) were identified with MRI normal conditions. Nine different disease types were identified in the studied populations, which included 257 patients (23.1%) with congenital cranial dysinnervation disorders, 209 patients (18.8%) with thyroid associated ophthalmopathy, and 169 patients (15.2%) with abnormalities of the extraocular muscles. Other diseases included orbital fractures (3.3%, 37 patients), intraorbital inflammations (2.7%, 30 patients), tumors (2.3%, 26 patients), injuries of medial rectus muscle after endoscopic sinus surgery (1.2%,13 patients), and lesions of cavernous sinus (2.0%, 22 patients). Additional 55 patients (4.9%) were identified with other causes such as high myopia fixed esotropia, and so on. Conclusion: Summarizing the common clinical characteristics and rules with the help of MRI can further clarify the etiology of special forms of strabismus, and accurately guide the diagnosis and treatment of strabismus. (Chin J Ophthalmol, 2019, 55: 361-368).

[Comparison of biometry with the Pentacam AXL, IOLMaster 700 and IOLMaster 500 in cataract patients].

Objective: To compare biometry with new biometers of Pentacam AXL and IOLMaster 700 and the widely used biometer of IOLMaster 500 in cataract patients. Methods: Cross-sectional study. A total of 223 eyes of 147 cataract patients from Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University during 4-8 December 2017 were recruited. There were 67 males and 80 females with an age of (64±11) years.The axial length (AL), mean keratometry (Km), anterior chamber depth (ACD) and white-to-white corneal diameter (WTW) from each device were recorded. The difference and agreement between the measurements were evaluated by ANOVA, LSD test, intraclass correlation coefficient and Bland-Altman analysis. Results: The success rate of AL measurement was 85.2% (190/223) with the Pentacam AXL, 96.9% (216/223) with the IOLMaster 700 and 90.6% (202/223) with the IOLMaster 500. There was no difference among devices in measuring the AL, Km and ACD (all P>0.05). Significant difference was found in WTW [(11.36±0.42) vs. (11.69±0.45) vs. (11.45±0.42) mm; F=34.696, P=0.000]. Intraclass correlation coefficient was 0.859-1.000, and Bland-Altman analysis showed good agreement among three devices. Conclusions: The new biometers of Pentacam AXL and IOLMaster 700 and the widely used IOLMaster 500 show no difference in measuring AL, Km and ACD. All three devices show good agreement in biometry of cataract patients. (Chin J Ophthalmol, 2019, 55: 515-521).