Correlation of endolymphatic hydrops and perilymphatic enhancement with the clinical features of Ménière's disease.

OBJECTIVES: To use three-dimensional real inversion recovery (3D-real IR) MRI to investigate correlations between endolymphatic hydrops (EH) grades or the degree of perilymphatic enhancement (PE) and clinical features of Ménière's disease (MD), as previous findings have been inconsistent. METHODS: A total of 273 consecutive patients with definite unilateral MD were retrospectively enrolled from September 2020 to October 2021. All patients underwent 3D-real IR and 3D-T2WI 6 h after intravenous gadolinium injection. MD-related symptom duration and vertigo frequency were recorded. EH grades were evaluated, the signal intensity ratio (SIR) was measured, and correlations between clinical features and EH, PE were assessed respectively. RESULTS: The study included 123 males and 150 females, with a mean age of 53.0 years. A longer duration of vertigo was associated with higher cochlear EH grades, whereas the opposite was true for the duration of aural fullness. A longer time since vertigo onset was associated with higher vestibular EH grades; the opposite was true for the duration of individual vertigo attacks. The multiple regression analysis revealed that age, tinnitus duration, and vestibular EH were risk factors for SIR. Furthermore, the low-frequency hearing threshold (HT) was a risk factor for cochlear and vestibular EH, and the SIR. CONCLUSION: The EH grade and SIR (an indicator for the quantitative evaluation of PE) were correlated with clinical features and HT of MD; thus, imaging can be a valuable tool in planning individualised treatment. CLINICAL RELEVANCE STATEMENT: This study revealed that the grade of endolymphatic hydrops and degree of perilymphatic enhancement positively correlates with the length of time since onset of clinical symptoms and hearing thresholds in patients with Ménière's disease, facilitating the tailored treatment. KEY POINTS: • Relationships between 3-dimensional real inversion recovery features and clinical symptoms in Ménière's disease are unknown. • Symptom duration and hearing thresholds correlated with endolymphatic hydrops grades and degree of perilymphatic enhancement. • MRI features correlate with MD severity; thus, imaging is valuable for planning tailored treatment.

MRI can help differentiate Ménière's disease from other menieriform diseases.

It is difficult to distinguish other pathologies mimicking Ménière's disease (MD) clinically. This study aims to investigate the differences of imaging findings and features between MD and other menieriform diseases via intravenous gadolinium-enhanced magnetic resonance imaging (MRI). 426 patients with menieriform symptoms, including MD, vestibular migraine (VM), and vestibular schwannoma (VS), underwent 3D-FLAIR and 3D-T2WI MRI 6 h after the intravenous gadolinium injection. MR images were analyzed for inner ear morphology, perilymphatic enhancement (PE), EH and other abnormalities. EH was observed at a higher rate in MD patients (85.71%) than patients with other menieriform diseases (VM group = 14.75%, VS group = 37.50%). The prevalence of unilateral EH as well as both cochlear and vestibular EH showed significant differences between MD and VM groups. The prevalence of cochlear EH (I and II) and vestibular EH (II and III) was different between MD and VM groups. The prevalence of PE was higher in MD than VM group. The degrees of cochlear and vestibular hydrops were higher in the definite than probable MD group (P < 0.05). Using these imaging features, MRI can be used to help differentiate MD from other menieriform diseases.

Improving diagnostic accuracy for probable and definite Ménière's disease using magnetic resonance imaging.

PURPOSE: To determine whether magnetic resonance imaging (MRI) can improve diagnostic accuracy for definite and probable Ménière's disease (MD) based on perilymphatic enhancement (PE) and endolymphatic hydrops (EH). METHODS: 363 patients with unilateral MD (probable MD, n = 75 and definite MD, n = 288) were recruited. A three-dimensional zoomed imaging technique with parallel transmission SPACE real inversion recovery was performed 6 h after intravenous gadolinium injection to investigate the presence of PE and to evaluate the grading and location of EH. PE and EH characteristics were analyzed and compared between the probable and definite MD groups. RESULTS: The cochlear and vestibular EH grading on the affected side was more severe in the definite MD group than that in the probable MD group (P < 0.001). The EH locations within the inner ear on the affected side also differed between the two groups (χ2 = 81.15, P < 0.001). The signal intensity ratio (SIR) on the affected side was significantly higher in the definite MD group than in the probable MD group (t = 2.18, P < 0.05). The assessment of the combination of PE and EH parameters within the inner ear revealed a higher area under the curve (AUC) in the definite MD group (0.82) compared with the AUCs of the parameters assessed alone. CONCLUSION: The assessment of a combination of PE and EH parameters improved the diagnostic accuracy for probable and definite MD, suggesting that MRI findings may be clinically useful in the diagnosis of MD.

The clinical value of DCE-MRI for differentiating secondary laryngeal cartilage lesions.

To explore the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the assessment of laryngeal cartilage lesions. In this study, 3 groups of cases were selected, including 16 cases benign lesions of the laryngopharynx as the benign group, 17 cases malignant lesions of laryngopharynx as the malignant group and 23 healthy adults as the control group. Conventional magnetic resonance imaging and DCE-MRI were performed with a 3.0 T MR scanner. cutoff, sensitivity, specificity and area under the curve values were calculated via receiver operating characteristic curve analysis based on the pathologic findings of surgically resected specimens. There were significant differences in the values of the volume transfer constant (Ktrans), the rate constant between the extravascular extracellular space and blood plasma (Kep) and The extravascular extracellular space fractional volume (Ve) between the control, benign and malignant groups (P < .005). Among the 3 groups, the malignant group had the highest Ktrans and Ve values (0.8681 ±â€…0.3034 and 0.6186 ±â€…0.2405, respectively), and the benign group had the highest Kep value (2.445 ±â€…0.7346). The cutoff points of the Ktrans, Kep, and Ve values of the control, benign and malignant groups were 0.39, 1.261, and 0.195; 0.471, 0.964, and 0.235; and 0.706, 2.005, and 0.659, respectively. The Ktrans, Kep, and Ve values obtained via DCE-MRI may enable differentiating laryngeal cartilage lesions. DCE-MRI can be used to evaluate laryngeal cartilage lesions accurately and quantitatively.

Longitudinal variation of endolymphatic hydrops in patients with Ménière's disease.

Background: The relationships of endolymphatic hydrops (EH) and perilymphatic enhancement (PE) with Ménière's disease (MD) remains unclear. This study aimed to describe the dynamic variation of EH and PE for MD patients over 2 hospitalizations by applying magnetic resonance imaging (MRI) to further clarify the relationships of EH and PE with MD. Methods: A total of 77 MD patients who underwent inner ear MRI after intravenous administration of gadolinium and pure-tone average (PTA) testing during a first and second hospitalization were included. The degree of EH and PE were evaluated via MRI, and the duration and frequency of vertigo attacks and PTA were collected and recorded. The PTA, EH, and PE for the 2 hospitalizations were compared, and the relationships of EH and cochlear PE with the MD stage were investigated. Results: There was no difference between the 2 hospitalizations for duration of vertigo attacks or frequency of vertigo attacks. However, there were significant differences in PTA (Z=-3.02, P=0.003). Additionally, the cochlear and vestibular EH in the asymptomatic ear at the second hospitalization was significantly worse than that of the first hospitalization (Z=-2.33 and -2.49, P=0.020 and 0.013, respectively), while there were no differences in EH and PE in the affected ear (all P>0.05). Moreover, the degree of cochlear and vestibular EH was correlated with MD stage (both P<0.01). Conclusions: Although EH and PE in the affected ear were unchanged over 2 hospitalizations, an underlying EH in the asymptomatic ear and hearing loss in the affected ear for MD patients developed longitudinally with the duration of disease, and EH varied with the natural course of MD whereas PE did not. Therefore, EH instead of PE is necessary but insufficient to cause the clinical symptoms of MD.

Hepatic steatosis with mass effect: A case report.

BACKGROUND: Hepatic steatosis is a common radiologic finding. Some imaging inklings are the absence of a mass effect, and there is currently no report of hepatic steatosis with mass effect. CASE SUMMARY: A 23-year-old female was admitted due to a liver mass for half a month. No obvious abnormalities were found in physical and laboratory examinations. Ultrasound, computed tomography, and magnetic resonance imaging showed a huge mass between the liver and stomach with a significant mass effect, and the caudate lobe and left lobe of the liver were involved. The signal on T2- and T1- weighted fat-saturated images of the mass was significantly reduced, and the enhanced scan showed inhomogeneous enhancement. Surgical and pathological findings indicated the diagnosis of hepatic steatosis. The operation and re-review of the patient's images showed that the lesion was supplied by the branch of the hepatic artery. The signal on T1-weighted out-of-phase images of the lesion was lower than on in-phase images, and there was no black rim cancellation artifact around the hepatic steatosis area on T1-weighted out-of-phase images. The dynamic enhancement pattern of the lesion was similar to that of the adjacent normal liver parenchyma. The above characteristics suggested that the lesion was hepatic steatosis. However, in this case, the lesion showed exogenous growth and was mass-like, with an obvious mass effect, which has not been reported previously. CONCLUSION: Hepatic steatosis could grow exogenously and has an obvious mass effect. It needs to be distinguished from fat-rich tumors. The T1-weighted in- and out-of-phase images and dynamic enhanced scanning are valuable for differential diagnosis of this lesion.

A Rare Chordoma-The Epiglottic chordoma.

Chordomas are rare malignant bone tumors. Chordomas originate from notochordal elements. Chordomas have the phenotype of the embryonic notochord, characterized by the dual expression of cytokeratin and brachyury. Chordomas occur anywhere along the central axis. Rarely, chordomas occur in extra-axial structures. We could not find any reports on epiglottic chordoma. Here, we present a case of epiglottic chordoma to highlight this rare cause of laryngeal mass.

Eustachian tube teratoma: A case report.

BACKGROUND: Mature teratoma composed of all three basic germ cell layers of the head and neck is a rare disease. Teratomas involving the temporal bone are particularly scarce. CASE SUMMARY: A 48-year-old male patient with a history of chronic otitis of the left ear from infancy, for which he had been operated on twice, was referred to our hospital for chronic otitis, cholesteatoma and a middle ear mass. Computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed a eustachian tube teratoma, in which the anterior lower part and posterior upper part were connected by a thin membranaceous tissue. The mass was removed completely under general anesthesia by mastoidectomy. As of last follow-up (2 years post-surgery), the disease had not relapsed. CONCLUSION: Pre-operative CT and MRI are necessary for eustachian tube teratoma. Complete surgical resection provided excellent prognosis.

Diffusional kurtosis imaging in evaluation of microstructural changes of spinal cord in cervical spondylotic myelopathy feasibility study.

To explore the value of diffusion kurtosis imaging in the changes of spinal cord microstructures in patients with early cervical spondylotic myelopathy.Twenty nine patients with cervical myelopathy were selected in this study. All images were acquired on a 3.0 T MR scanner (Skyra, Siemens Medical Systems, Germany). The imaging parameters for diffusion kurtosis imaging were as follows: repetition time/echo time, 3000/91 ms; averages, 2; slice thickness/gap, 3/0.3 mm; number of slices, 17; field of view, 230 × 230 mm; Voxel size, 0.4 × 0.4 × 3.0 mm; 3 b-values (0, 1000, and 2000 s/mm) with diffusion encoding in 20 directions for each b-value. Values for fractional anisotropy, mean diffusivity, and mean diffusional kurtosis (MK) were calculated and compared between unaffected and affected spinal cords.In all patients MK was significantly lower in normal appearing spinal cords adjacent to the affected cervical spinal cords than in normal cervical spinal cords (0.862 ±â€Š0.051 vs 0.976 ±â€Š0.0924, P < .0001), but the difference of fractional anisotropy and apparent diffusion coefficient was no significant (P > .05). The affected cervical spinal cords had lower MK (0.716 ±â€Š0.0753), FA and higher apparent diffusion coefficient than normal cervical spinal cords (P < .001).MK values in the cervical spinal cord may reflect microstructural changes of spinal cord damage in cervical myelopathy, and it could potentially provide more information that obtained with conventional diffusion metrics.

Association Functional MRI Studies of Resting-State Amplitude of Low Frequency Fluctuation and Voxel-Based Morphometry in Patients With Occupational Noise-Induced Hearing Loss.

OBJECTIVES: To investigate changes in brain functional activity among occupational noise-induced hearing loss (NIHL) with tinnitus patients, using resting-state brain magnetic resonance imaging (Rs-fMRI) and voxel-based morphometry (VBM). METHODS: Mild (27) and Relative severe (15) patient groups, 30 matched healthy group, scanned by Rs-fMRI and T1WI 3D fast spoiled gradient echo, FSPGR, using voxel-based morphometry and amplitude of low frequency fluctuation to analyze the differences. RESULTS: Brain gray matter volume was significantly different among the three groups in the left occipitotemporal lateral gyrus, the anterior cingulate gyrus, the bilateral angular gyrus, the precuneus, and near the midline area of the cerebellum. The Rs-fMRI changes showed that amplitude of low frequency fluctuation differed significantly among the three groups in the right superior temporal gyrus, the right inferior frontal gyrus, and the right angular gyrus. CONCLUSION: All this provides a new perspective for understanding the pathophysiological mechanism of occupational noise-induced hearing loss and provides some theoretical bases for subsequent treatment.

A segmentation-independent volume rendering visualisation method might reduce redundant explorations and post-surgical complications of microvascular decompression.

OBJECTIVES: This study aimed to investigate the feasibility of segmentation-independent volume rendering (SI-VR) in visualising the root entry zone (REZ), and to explore the influence on the management of vascular compression syndromes (VCSs). METHODS: Two hundred and twenty patients with VCSs were recruited in this prospective study from July 2015 to May 2019. SI-VR was reconstructed based on inverted 3D fast spin echo T2WI. They were assigned to the experimental group and control group randomly. Patients in the experimental group would accept extra evaluation based on SI-VR before microvascular decompression. Image quality and diagnostic accuracy between SI-VR and 3D fast spin echo T2WI in the experimental group were compared by Mann-Whitney U test and chi-square test, separately. Interobserver agreement was performed with intraclass correlation coefficient. Postsurgical outcomes and complications between two groups were compared by chi-square test. RESULTS: SI-VR had a better interobserver agreement (0.82 vs 0.68) and diagnostic accuracy (95.5% vs 83.6%, p = 0.004) than that of 3D fast spin echo T2WI. Especially, significantly improved diagnostic accuracy was reached in detecting the multi-vascular branches compression (100% vs 15.4%, p < 0.001). There were fewer complications (7.1% vs 26.8%, p = 0.004) and less operation time (20.7 min vs 14.5 min, p = 0.007) but no significant difference of pain relief (p = 0.19) in the experimental group than in the control group. CONCLUSIONS: The SI-VR method is feasible for the precise demonstration of the anatomy structure along the REZ, with high reliability and reproducibility. Unbiased pre-surgical visualisation could reduce redundant explorations and post-surgical complications in patients who undergo microvascular decompression. KEY POINTS: • Visualisation of the root entry zone by the segmentation-independent volume rendering is in accordance with the landscape by the neuro-endoscopy. • Segmentation-independent volume rendering has an advantage over 3D fast spin echo T2WI in the visualisation of multi-vascular branches compression. • Presurgical 3D visualisation of the neurovascular compression at the root entry zone leads to less postsurgical complications from the decrease of redundant exploration.

A comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula.

To explore a comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula to evaluate its morphology changes.Forty-six patients with anal fistula were enrolled. Each patient acquired a 3.0T magnetic resonance imaging (MRI) routine sequence, diffusion-weighted imaging (DWI) sequence and fat suppression T1 weighted imaging (FS T1WI) contrast enhancement (CE) scanning. To record the morphology performances of the internal orifice and the fistulas on the transverse images of fat suppression T2 weighted imaging (FS T2WI), DWI, FS T2WI combined with DWI, FS T1WI Gd-CE, with the standard of the surgical pathology results. Two observers evaluated images in consensus. The conspicuity and the diagnostic performance rate were compared between the 4 imaging data sets.The consistencies of interobservers about the conspicuity scores and the diagnostic performance rates of the internal orifice and the fistula were good. The conspicuity of the internal orifice was higher for the set of FS T2WI, FS T2WI+DWI, and FS T1WI+CE than DWI. The diagnostic performance rate of the internal orifice was higher for the set of FS T2WI, FS T2WI+DWI, and FS T1WI+CE than DWI. The conspicuity of the fistula was higher for the set of FS T2WI+DWI and FS T1WI+CE than FS T2WI or DWI. There were no significantly differences between the 4 sets of FS T2WI, DWI, FS T2WI+DWI, and FS T1WI+CE in the diagnostic performance rate of the fistula.The set of FS T2WI combined with DWI was comparable to FS T1WI CE in evaluation of anal fistula morphology changes.

Interventional Treatment Strategy for Primary Budd-Chiari Syndrome with Both Inferior Vena Cava and Hepatic Vein Involvement: Patients from Two Centers in China.

OBJECTIVE: This retrospective study evaluated interventional treatments (recanalization, balloon dilation, and/or stent placement) for Budd-Chiari syndrome (BCS), caused by combined obstruction of the inferior vena cava (IVC) and hepatic veins (HVs). METHODS: Before and after interventional therapy, patients with BCS (n = 162; asymptomatic 105.2 ± 103.3 mo; follow-up 15 [6-24] mo) underwent imaging studies (color Doppler ultrasound, CT, or MRI), and inferior vena cavography and manometry. Venous lesions were characterized by occlusion features, and presence of thrombosis and peripheral collateral vessels. RESULTS: One, 2, and 3 main HV occlusions were observed, respectively, in 25 (15.4%), 61 (37.7%), and 76 (46.9%) patients. Eighty-three (51.2%), 98 (60.5%), and 104 (64.2%) patients had, respectively, large accessory HVs, venous collaterals formed between the HVs, or venous communicating branches between the HV and the peritoneal veins. The middle, left, and right HV was patent in 32 (19.8%), 35 (21.6%), and 44 (27.2%) patients. Recanalization of both hepatic and caval occlusions was successful in 96% (51/53) of those attempted; recanalization of IVC occlusion was successful in 97% (106/109). Among 157 patients successfully treated, 146 were cured and 11 showed clinical improvement. Clinical symptoms were relieved in 82.4% after the initial intervention, and 94.2% after the second intervention. CONCLUSION: Recanalization and balloon angioplasty was effective for the management of BCS with concurrent HV and IVC occlusions. The majority of patients required only IVC recanalization. The outcome of patients treated only by IVC intervention was similar to that of patients given combined HV and IVC intervention.

Significance of malondialdehyde, superoxide dismutase and endotoxin levels in Budd-Chiari syndrome in patients and a rat model.

Budd-Chiari syndrome (BCS) is a rare clinical syndrome caused by the obstruction of hepatic venous outflow. In theory, hepatic congestion and hypoxia induce pathological damage and changes in the liver. However, at present, laboratory evidence supporting this theory is lacking. The aim of the present study was to assess the expression and significance of the hypoxia-associated indicators malondialdehyde (MDA), superoxide dismutase (SOD) and endotoxin (ET) in the liver and serum of subjects with BCS. An animal model of BCS was established by partial ligation of the inferior vena cava (IVC) in rats. The levels of MDA, SOD and ET in the serum of BCS patients, as well as in the liver and serum of rats with BCS, were detected and analyzed. In human patients with BCS, the serum levels of MDA, ET and SOD were significantly different from those in healthy control subjects. In the animal model, similar trends were observed regarding the MDA, ET and SOD levels in liver homogenate and serum (P<0.05), the degree of which was more pronounced in the liver homogenate than in the serum. At 6 weeks after the surgery, these indicators reached peak/valley levels in the experimental group and were at least partially restored by week 12. A negative correlation between MDA and SOD, a positive correlation between MDA and ET, and a negative correlation between SOD and ET was identified. In conclusion, the levels of hypoxia-associated indicators significantly changed with BCS progression, suggesting that hypoxia is a major factor in the pathogenesis of BCS.

Outcomes of endovascular interventional therapy for primary Budd-Chiari syndrome caused by hepatic venous obstruction.

To date, interventional therapy for patients with Budd-Chiari syndrome (BCS) due to hepatic vein obstruction (HVO) has not been standardized in China. In Western countries, BCS primarily occurs due to thrombosis and the majority of patients receive thrombolysis. In China, BCS is mostly caused by the membranous occlusion of the HV or IVC. The present retrospective study evaluated the efficacy of recanalization techniques in patients with primary BCS due to HVO. The data of 69 patients with BCS due to HVO, who underwent endovascular therapy at 2 centers in China between December 2010 and December 2012, were analyzed. All of the patients underwent balloon angioplasty. In addition, 14, 6 and 5 patients received thrombolysis, endovascular stent and thrombolysis + endovascular stent, respectively. The overall technical success rate was 95.7% (66/69), and was comparable among the treatments. The HV pressure after the treatments was significantly lower compared with that prior to the procedures (23.3±6.9 vs. 46.5±8.6 cmH2O; P<0.001). The mean follow-up duration was 75 months (range, 60-84 months). During the 5-year follow-up, 10 patients (15.2%) had developed a recurrence of BCS-associated symptoms, of which 7 were successfully treated. The cumulative survival rates at 12, 36 and 60 months after endovascular interventional therapy (balloon angioplasty or combined treatment) were 98.5, 98.5 and 93.9%, respectively. After treatment by endovascular therapy, the patients with BCS caused by HVO had high survival rates and low recurrence rates in the short- and mid-term.

Diffusion tensor imaging for evaluating perianal fistula: Feasibility study.

To explore the feasibility of using diffusion tensor imaging (DTI) in the diagnosis of anal fistula and evaluating its activity.Thirty-four patients with perianal fistulas were examined with DTI on a 3.0 T magnetic resonance imaging (MRI) before undergoing surgery. Based on the surgery requirement and preoperative examinations, the lesions fell into 2 groups: the positive inflammation activity (PIA) group and the negative inflammation activity (NIA) group. Each lesion was divided into 3 regions of interest (ROIs) (i.e., the fistula area, edema area, and distant normal-appearing area). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated and analyzed.There were statistically significant differences in FA and ADC values of the fistula area, edema area, and distant normal-appearing area. The FA values of the fistula area, edema area, and distant normal-appearing area in PIA were 0.134 ±â€Š0.046, 0.225 ±â€Š0.060, 0.343 ±â€Š0.070, respectively. The ADC values (×10 mm/s) of the fistula area, edema area, and distant normal-appearing area in PIA were 0.979 ±â€Š0.441, 1.542 ±â€Š0.274, 1.864 ±â€Š0.336, respectively. The FA values of the fistula area, edema area, and distant normal-appearing area in NIA were 0.183 ±â€Š0.057, 0.286 ±â€Š0.059, 0.382 ±â€Š0.084, respectively. The ADC values (×10 mm/s) of the fistula area, edema area, and distant normal-appearing area in NIA were 1.393 ±â€Š0.256, 1.518 ±â€Š0.274, 1.703 ±â€Š0.432, respectively. Regarding the activity, the FA and ADC values of the PIA group were lower than those of the NIA group in the fistula area, and the differences were statistically significant (P = .009, .004). The FA values of the edema area in the PIA group were lower than those in the NIA group, and the difference was statistically significant. The ADC values of the edema area, and both the FA and ADC values of the distant normal-appearing area all exhibited no statistically significant differences between the 2 groups.DTI parameters may reflect microstructures of perianal fiatulas via quantitative information. FA and ADC values were instrumental in evaluating the activity of perianal fistulas.

Microhemorrhage identified on 3.0 T MR susceptibility-weighted imaging for prognosis of viral encephalitis.

OBJECTIVE: To evaluate the relationship of microhemorrhage on susceptibility-weighted imaging (SWI) with the severity of clinical symptoms and the prognosis of viral encephalitis. MATERIALS AND METHODS: Thirty patients with clinically diagnosed viral encephalitis were divided into three groups according to the Glasgow Coma Scale (GCS) and the condition of recovery namely, Group I (n = 12): Glasgow Coma Scale (GCS)≥13 and recovered with no sequelae; Group II (n = 11): GCS 9-12 and recovered with some sequelae; Group III (n = 7): GCS 3-8 and recovered with more severe sequelae. The microhemorrhage detectability on SWI and conventional MR imaging in these three groups was compared and their correlations with different seriousness of clinical symptoms and prognosis were analyzed. RESULTS: There was a significant difference in microhemorrhage volume among different MR sequences (p < 0.05). SWI was more sensitive to detect microhemorrhage than conventional MR imaging techniques. Microhemorrhages on SWI were significantly different among the three groups (p < 0.01). The volume of microhemorrhage on SWI was well correlated with the degree of clinical symptoms and the prognosis of viral encephalitis. CONCLUSION: SWI can be used to detect microhemorrhage in patients with viral encephalitis. Assessment of microhemorrhage with SWI can provide useful information for the prognosis evaluation of viral encephalitis.

Quantitative dynamic susceptibility contrast perfusion-weighted imaging-guided customized gamma knife re-irradiation of recurrent high-grade gliomas.

INTRODUCTION: Treatment of recurrent high-grade gliomas (rHGG) has always been challenging. This study aimed to explore the treatment effect of quantitative dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI)-guided gamma knife radiosurgery (GKRS) on rHGG. METHODS: Between April 2014 and July 2016, 26 consecutive patients were treated by quantitative DSC-PWI-guided GKRS as salvage treatment for rHGG. The gross tumor volume (GTV) was defined as the high perfusion area on absolute cerebral blood volume maps, with a cutoff value of 22 ml/100 g. The clinical target volume (CTV) encompassed the GTV by 3 mm. Overall survival (OS) and progression-free survival (PFS) were calculated by the Kaplan-Meier method. Prognostic factors were tested by the log-rank (Mantel-Cox) test. RESULTS: With a median follow-up of 32 months, the median PFS after GKRS was 8 months (95% CI [6, 12]); the 1- and 2-year survival rates were 30.8 and 11.5%, respectively. The median OS was 25.5 months (95% CI [18, 40]); the 1- and 2-year survival rates were 96.2 and 57.7%, respectively. Pathology grade and CTV were identified as prognostic factors for PFS. However, none of the parameters tested were independent prognostic factors for OS among these selected patients. No severe radiotoxicity was observed among all patients. CONCLUSIONS: Quantitative DSC-PWI-guided GKRS is feasible for the treatment of rHGG and that these outcomes remain to be validated. Despite this, we think that carefully selected patients can benefit from this treatment method.

Application of DTI and ARFI imaging in differential diagnosis of parotid tumours.

OBJECTIVES: To explore the utility of diffusion tensor imaging (DTI) and acoustic radiation force impulse (ARFI) imaging in the diagnosis of parotid tumours. METHODS: 51 patients with parotid tumours were examined with DTI on 3.0-T MRI and ARFI imaging on an ultrasound scanner before surgery. Values of apparent diffusion coefficient (ADC), fractional anisotropy (FA) and shear-wave velocity (SWV) were calculated and analyzed with independent samples Wilcoxon-Mann-Whitney test. Cut-off values, sensitivity and specificity were calculated with receiver-operating characteristic (ROC) curve analysis. The value of combination was calculated through parallel test for the cut-off value of ADC, FA and SWV (combination = 0 or 1); then, ROC analysis was performed with pathological results as the gold standard to calculate the sensitivity and specificity for the combination of the three parameters distinguishing benign and malignant parotid tumours. Pathological diagnosis for every patient was made post-operatively from the tumour tissue taken during operation. RESULTS: There was a significant difference between benign and malignant tumours in the values of ADC, FA and SWV (p = 0.032, p = 0.011 and p < 0.0001); a significant difference in the values was also found between pleomorphic adenoma and malignant tumour (p = 0.0012, p < 0.0001 and p = 0.0002). The diagnosis cut-off points between benign and malignant tumours for ADC, FA and SWV were 1.02 × 10(-3) mm(2) s(-1), 0.24 and 2.76 m s(-1), respectively; the sensitivity for ADC, FA and SWV was 87.50, 62.50 and 68.75%; the specificity was 45.71, 82.86 and 97.14%. Analysis of the combination of the three parameters increased the sensitivity, specificity, Youden index and area under the ROC curve compared with analysis of each parameter alone for distinguishing benign and malignant tumours. CONCLUSIONS: The diagnostic value of the combination of the three parameters for distinguishing benign and malignant parotid tumours is the best; SWV is the preferred indicator. Parameters of DTI and ARFI may reflect the histological characteristics of parotid tumours and predict benignancy and malignancy and could provide quantitative information about the tumour. Combination of DTI with ARFI imaging had obvious advantage for the diagnosis of parotid tumours than each alone.

Predicting liver metastasis of gastrointestinal tract cancer by diffusion-weighted imaging of apparent diffusion coefficient values.

AIM: To determine if efficacy of chemotherapy on liver metastasis of gastrointestinal tract cancer can be predicted by apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI). METHODS: In total, 86 patients with liver metastasis of gastrointestinal tract cancer (156 metastatic lesions) diagnosed in our hospital were included in this study. The maximum diameters of these tumors were compared with each other before treatment, 2 wk after treatment, and 12 wk after treatment. Selected patients were classified as the effective group and the ineffective group, depending on the maximum diameter of the tumor after 12 wk of treatment; and the ADC values at different treatment times between the two groups were compared. Spearman rank correlation was used to analyze the relationship between ADC value and tumor diameter. Receiver operating characteristic curve (ROC curve) was used to analyze the ADC values before treatment to predict the patient's sensitivity and specificity degree of efficacy to the chemotherapy. RESULTS: There was no difference in age between the two groups and in maximum tumor diameter before treatment and 2 wk after treatment. However, after 12 wk of treatment, maximum tumor diameter in the effective group was significantly lower than that in the ineffective group (P < 0.05). Before treatment, ADC values in the ineffective group were significantly higher than those in the effective group (P < 0.05). There was no difference in ADC values between the effective and ineffective groups after 2 and 12 wk of treatment. However, ADC values were significantly higher after 2 and 12 wk of treatment compared to before treatment in the effective group (P < 0.05). Spearman rank correlation analysis showed that ADC value before treatment and the reduced percentage of the maximum tumor diameter after 12 wk of treatment were negatively correlated, while the increase in the percentage of the ADC value 12 wk after treatment and the decrease in the percentage of the maximum tumor diameter were significantly positively correlated. The results of the ROC curve showed that ADC value with a chemotherapy ineffective threshold value of 1.14 × 10(-3) mm(2)/s before treatment had a sensitivity and specificity of 94.3% and 76.7%, respectively. CONCLUSION: DWI ADC values can be used to predict the response of patients with liver metastasis of gastrointestinal tract cancer to chemotherapy with high sensitivity and relatively high specificity.