Parallel CNN-Deep Learning Clinical-Imaging Signature for Assessing Pathologic Grade and Prognosis of Soft Tissue Sarcoma Patients.

BACKGROUND: Traditional biopsies pose risks and may not accurately reflect soft tissue sarcoma (STS) heterogeneity. MRI provides a noninvasive, comprehensive alternative. PURPOSE: To assess the diagnostic accuracy of histological grading and prognosis in STS patients when integrating clinical-imaging parameters with deep learning (DL) features from preoperative MR images. STUDY TYPE: Retrospective/prospective. POPULATION: 354 pathologically confirmed STS patients (226 low-grade, 128 high-grade) from three hospitals and the Cancer Imaging Archive (TCIA), divided into training (n = 185), external test (n = 125), and TCIA cohorts (n = 44). 12 patients (6 low-grade, 6 high-grade) were enrolled into prospective validation cohort. FIELD STRENGTH/SEQUENCE: 1.5 T and 3.0 T/Unenhanced T1-weighted and fat-suppressed-T2-weighted. ASSESSMENT: DL features were extracted from MR images using a parallel ResNet-18 model to construct DL signature. Clinical-imaging characteristics included age, gender, tumor-node-metastasis stage and MRI semantic features (depth, number, heterogeneity at T1WI/FS-T2WI, necrosis, and peritumoral edema). Logistic regression analysis identified significant risk factors for the clinical model. A DL clinical-imaging signature (DLCS) was constructed by incorporating DL signature with risk factors, evaluated for risk stratification, and assessed for progression-free survival (PFS) in retrospective cohorts, with an average follow-up of 23 ± 22 months. STATISTICAL TESTS: Logistic regression, Cox regression, Kaplan-Meier curves, log-rank test, area under the receiver operating characteristic curve (AUC)，and decision curve analysis. A P-value <0.05 was considered significant. RESULTS: The AUC values for DLCS in the external test, TCIA, and prospective test cohorts (0.834, 0.838, 0.819) were superior to clinical model (0.662, 0.685, 0.694). Decision curve analysis showed that the DLCS model provided greater clinical net benefit over the DL and clinical models. Also, the DLCS model was able to risk-stratify patients and assess PFS. DATA CONCLUSION: The DLCS exhibited strong capabilities in histological grading and prognosis assessment for STS patients, and may have potential to aid in the formulation of personalized treatment plans. TECHNICAL EFFICACY: Stage 2.

Clinical validation of the use of prototype software for automatic cartilage segmentation to quantify knee cartilage in volunteers.

BACKGROUND: The cartilage segmentation algorithms make it possible to accurately evaluate the morphology and degeneration of cartilage. There are some factors (location of cartilage subregions, hydrarthrosis and cartilage degeneration) that may influence the accuracy of segmentation. It is valuable to evaluate and compare the accuracy and clinical value of volume and mean T2* values generated directly from automatic knee cartilage segmentation with those from manually corrected results using prototype software. METHOD: Thirty-two volunteers were recruited, all of whom underwent right knee magnetic resonance imaging examinations. Morphological images were obtained using a three-dimensional (3D) high-resolution Double-Echo in Steady-State (DESS) sequence, and biochemical images were obtained using a two-dimensional T2* mapping sequence. Cartilage score criteria ranged from 0 to 2 and were obtained using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). The femoral, patellar, and tibial cartilages were automatically segmented and divided into subregions using the post-processing prototype software. Afterwards, all the subregions were carefully checked and manual corrections were done where needed. The dice coefficient correlations for each subregion by the automatic segmentation were calculated. RESULTS: Cartilage volume after applying the manual correction was significantly lower than automatic segmentation (P < 0.05). The percentages of the cartilage volume change for each subregion after manual correction were all smaller than 5%. In all the subregions, the mean T2* relaxation time within manual corrected subregions was significantly lower than in regions after automatic segmentation (P < 0.05). The average time for the automatic segmentation of the whole knee was around 6 min, while the average time for manual correction of the whole knee was around 27 min. CONCLUSIONS: Automatic segmentation of cartilage volume has a high dice coefficient correlation and it can provide accurate quantitative information about cartilage efficiently without individual bias. Advances in knowledge: Magnetic resonance imaging is the most promising method to detect structural changes in cartilage tissue. Unfortunately, due to the structure and morphology of the cartilages obtaining accurate segmentations can be problematic. There are some factors (location of cartilage subregions, hydrarthrosis and cartilage degeneration) that may influence segmentation accuracy. We therefore assessed the factors that influence segmentations error.

Signal characteristics of normal adult bone marrow in whole-body diffusion-weighted imaging.

BACKGROUND: Knowledge of the signal characteristics of normal adult bone marrow in whole-body diffusion-weighted (DW) images (WB-DWI) is essential for correctly interpreting DW images in clinical practice; however, these factors have not yet been clearly determined. PURPOSE: To evaluate the signal characteristics of normal adult bone marrow in WB-DWI, to correlate these characteristics with age and gender, and to determine the causes of these phenomena. MATERIAL AND METHODS: Ninety-eight healthy volunteers underwent WB-DWI (b = 0 and 800 s/mm(2)). Two radiologists visually evaluated the signal characteristics of bone marrow in DW images separately. One radiologist measured the apparent diffusion coefficient (ADC) of the thoracic and lumbar vertebrae, bilateral femur (including head, neck, and proximal and distal femoral shaft), bilateral humeral head, ilium, and scapula. The signal characteristics of normal bone marrow were analyzed. RESULTS: The visual evaluation results of DW images indicated that hyperintensity of bone marrow was more frequently seen in women aged 21-50 years (68.4%) than in men aged 21-50 years (3.3%) (P < 0.001), men aged 51-81 years (5.9%) (P < 0.001), and women aged 51-81 years (15.4%) (P = 0.001). However, no statistically significant difference was found between men and women aged 51-81 years (P = 0.565). The ADC of bone marrow was significantly higher in women than in men aged 21-50 years. Bone marrow ADC showed significant negative correlation with age in women but not in men. CONCLUSION: The signal intensity of bone marrow varies with age and gender in DW images. ADC and the T2 shine-through effect contributed to the bone marrow signal intensity in DW images, and the latter effect may predominate.

Multiple plexiform schwannomas in the plantar aspect of the foot: case report and literature review.

BACKGROUND: Plexiform schwannoma (PS) is a rare, peripheral nerve sheath tumor arranged in a plexiform pattern. CASE PRESENTATION: We report an unusual case of a 19-year-old woman, who complained of pain in the plantar aspect of the left foot. Magnetic resonance image (MRI) demonstrates three solitary nodules of varying sizes in the deep soft tissue of the plantar aspect of the foot that are homogeneously isointense to skeletal muscle on T1-weighted images and hyperintense on T2-weighted fat-suppressed images, especially the rim of the lesion. Subsequent pathological examination confirmed the diagnosis of PS. CONCLUSION: MRI characteristic plays an important role in detecting this rare lesion. A review of the literature on PS is also presented.

The signal intensity characteristics of normal bone marrow in diffusion weighted imaging at various menstrual status women.

PURPOSE: Diffuse hyperintensities of the bone marrow in whole-body diffusion-weighted (DW) imaging (DWI) have been encountered more frequently in females aged 21-50 compared to elder females or men. Therefore, we aimed to visually evaluate DWI among pre-, peri- and postmenopausal women and to verify whether it correlates also quantitatively with hormonal status. METHOD: The prospective study was approved by our institutional review board and informed consent was obtained in a total of 70 healthy premenopausal, perimenopausal, and postmenopausal women aged 40-58 years from February 2017 to October 2017. The bone marrow DW imaging signal characteristics were visually evaluated in comparison to the erector spinae muscle. Imaging data were acquired using a 1.5 T MRI yielding signal intensity values from a DWI-pulse sequence (b-value of 800 s/mm2; apparent diffusion coefficient (ADC) maps from b-values of 0-800 s/mm2), and a T2 mapping sequence covering the L2-L4 lumbar vertebrae. Serous estradiol (E2), follicle stimulating hormone (FSH), and luteinizing hormone (LH) were measured through venous blood assay. The relationship of the mean DW signal intensity (SIDWI) with T2 values, female hormone level, and mean ADC were analyzed using Spearman's rho test. RESULTS: The proportion of diffuse DWI hyperintensities of the bone marrow was significantly higher in premenopausal (91% (21/23)) women compared to peri- (75% (18/24)) and postmenopausal (8% (2/23)) women. A positive correlation was observed for the mean SIDWI (median [interquartile range], 47.33 [30.14]) and mean T2 (mean ± SD, 121.01 ± 13.54) (r = 0.438, p < 0.001) as well as for the mean SIDWI and E2 (median [interquartile range], 52.45 [92.78]) (r = 0.407, p < 0.001). A negative correlation was observed for the mean SIDWI and serous FSH (median [interquartile range], 15.55 [42.08]) as well as for the mean SIDWI and serous LH (median [interquartile range], 6.96 [31.06]) (r = -0.557, p < 0.001; r = -0.535, p < 0.001; respectively), but no significant correlation was found for mean SIDWI and mean ADC (mean ± SD, 599.36 ± 82.70) (r = 0.099, p = 0.415). A negative correlation was also encountered for the mean T2 values and serous FSH (r = -0.339, p = 0.004) as well as for the mean T2 values and serous LH (r = -0.281, p = 0.018). CONCLUSIONS: The mean SIDWI correlates positively with mean T2 and serous E2 values, while there's no significant correlation with mean ADC, indicating that T2 shine-through effects might interfere with bone marrow signaling on DW images. Knowledge of the bone marrow signal characteristics changing in DW images in close relationship with menstrual status is essential to correctly interpret DWI in clinical practice.

Resting-State Functional Connectivity of the Thalamus in Complete Spinal Cord Injury.

Background. Neuroimaging studies of spinal cord injury (SCI) have mostly examined the functional organization of the cortex, with only limited focus on the subcortical substrates of the injury. However, thalamus is an important modulator and sensory relay that requires investigation at a subnuclei level to gain insight into the neuroplasticity following SCI. Objective. To use resting-state functional magnetic resonance imaging to examine the functional connectivity (FC) of thalamic subnuclei in complete SCI patients. Methods. A seed-based connectivity analysis was applied for 3 thalamic subnuclei: pulvinar, mediodorsal, and ventrolateral nucleus in each hemisphere. A nonparametric 2-sample t test with permutations was applied for each of the 6 thalamic seeds to compute FC differences between 22 healthy controls and 19 complete SCI patients with paraplegia. Results. Connectivity analysis showed a decrease in the FC of the bilateral mediodorsal nucleus with right superior temporal gyrus and anterior cingulate cortex in the SCI group. Similarly, the left ventrolateral nucleus exhibited decreased FC with left superior temporal gyrus in SCI group. In contrast, left pulvinar nucleus demonstrated an increase in FC with left inferior frontal gyrus and left inferior parietal lobule in SCI group. Our findings also indicate a negative relationship between postinjury durations and thalamic FC to regions of sensorimotor and visual cortices, where longer postinjury durations (~12 months) is associated with higher negative connectivity between these regions. Conclusion. This study provides evidence for reorganization in the thalamocortical connections known to be involved in multisensory integration and affective processing, with possible implications in the generation of sensory abnormalities after SCI.

Differences in Cortical Gray Matter Atrophy of Paraplegia and Tetraplegia after Complete Spinal Cord Injury.

Anatomical studies of spinal cord injury (SCI) using magnetic resonance imaging (MRI) report diverging observations, from "no changes" to "tissue atrophy in motor and non-motor regions." These discrepancies among studies can be attributed to heterogeneity in extent, level, and post-injury duration observed within the SCI population. But, no studies have investigated structural changes associated with different levels of injury (paraplegia vs. tetraplegia). High-resolution MRI images were processed using a voxel-based morphometry technique to compare regional gray matter volume (GMV) between 16 complete paraplegia and 7 complete tetraplegia SCI subjects scanned within 2 years of injury when compared to 22 age-matched healthy controls using one-way analysis of covariance (ANCOVA). A post-hoc analysis using a region of interest-based approach was utilized to quantify GMV differences between healthy controls and subgroups of SCI. A voxel-wise one-sample t-test was also performed to evaluate the mean effect of post-injury duration on GMV of the SCI group. ANCOVA resulted in altered GMV in inferior frontal gyrus, bilateral mid orbital gyrus extending to rectal gyrus, and anterior cingulate cortex. Post-hoc analysis, in general, indicated GM atrophy after SCI, but tetraplegia showed a greater decrease in GMV when compared to paraplegia and healthy controls. Further, the GMV of the middle frontal gyrus, superior frontal gyrus, inferior frontal gyrus, insula, mid-orbital gyrus, and middle temporal gyrus was positively correlated with post-injury duration in both paraplegia and tetraplegia groups. GM atrophy after SCI is affected by level of cord injury, with higher levels of injury resulting in greater loss of GMV. Magnitude of GMV loss in the frontal cortex after SCI also appears to be dynamic within the first 2 years of injury. Understanding the effect of injury level and injury duration on structural changes after SCI can help to better understand the mechanisms leading to positive and negative clinical outcome in SCI patients.

Primary malignancy in giant cell tumor of thoracic vertebrae: A case report.

RATIONALE: Primary malignancy in giant cell tumor of bone (PMGCTB) is extremely unusual. PMGCTB in the thoracic vertebrae is particularly rare. PATIENTS CONCERNS: A 23-year-old man was admitted with a chief complaint of chest pain associated with cough for approximately 3 days. Physical examination revealed a palpable, immobile, tender, 7 cm mass in the right paravertebral area of the thoracolumbar spine. DIAGNOSIS: Computed tomography images revealed an osteolytic, expansive, and eccentric lesion on the vertebral bodies and right accessory processes with spinal cord compression in the thoracic vertebra, with right rib also having bone destruction. Magnetic resonance imaging revealed multiple fluid-fluid levels occupying more than one-third of the lesions. On the basis of the imaging and pathological findings, the final pathological diagnosis was PMGCTB with aneurysmal bone cyst. INTERVENTIONS: The patient underwent successful wide spondylectomy of T9/10 to remove the tumor, and adjuvant chemotherapy based on the protocol used for osteosarcoma. OUTCOMES: After 4 years of follow-up, there is no clinical or radiological evidence of recurrence. LESSONS: PMGCTB is difficult to distinguish from giant cell tumor of bone. PMGCTB should be considered when lesions appear with multiple fluid-fluid levels and soft tissue mass.

Characterizing the Blood Oxygen Level-Dependent Fluctuations in Musculoskeletal Tumours Using Functional Magnetic Resonance Imaging.

This study characterized the blood oxygen level-dependent (BOLD) fluctuations in benign and malignant musculoskeletal tumours via power spectrum analyses in pre-established low-frequency bands. BOLD MRI and T1-weighted imaging (T1WI) were collected for 52 patients with musculoskeletal tumours. Three ROIs were drawn on the T1WI image in the tumours' central regions, peripheral regions and neighbouring tissue. The power spectrum of the BOLD within each ROI was calculated and divided into the following four frequency bands: 0.01-0.027 Hz, 0.027-0.073 Hz, 0.073-0.198 Hz, and 0.198-0.25 Hz. ANOVA was conducted for each frequency band with the following two factors: the location of the region of interest (LoR, three levels: tumour "centre", "peripheral" and "healthy tissue") and tumour characteristic (TC, two levels: "malignant" and "benign"). There was a significant main effect of LoR in the frequencies of 0.073-0.198 Hz and 0.198-0.25 Hz. These data were further processed with post-hoc pair-wise comparisons. BOLD fluctuations at 0.073-0.198 Hz were stronger in the peripheral than central regions of the malignant tumours; however, no such difference was observed for the benign tumours. Our findings provide evidence that the BOLD signal fluctuates with spatial heterogeneity in malignant musculoskeletal tumours at the frequency band of 0.073-0.198 Hz.

Differentiating benign from malignant bone tumors using fluid-fluid level features on magnetic resonance imaging.

OBJECTIVE: To analyze different fluid-fluid level features between benign and malignant bone tumors on magnetic resonance imaging (MRI). MATERIALS AND METHODS: This study was approved by the hospital ethics committee. We retrospectively analyzed 47 patients diagnosed with benign (n = 29) or malignant (n = 18) bone tumors demonstrated by biopsy/surgical resection and who showed the intratumoral fluid-fluid level on pre-surgical MRI. The maximum length of the largest fluid-fluid level and the ratio of the maximum length of the largest fluid-fluid level to the maximum length of a bone tumor in the sagittal plane were investigated for use in distinguishing benign from malignant tumors using the Mann-Whitney U-test and a receiver operating characteristic (ROC) analysis. Fluid-fluid level was categorized by quantity (multiple vs. single fluid-fluid level) and by T1-weighted image signal pattern (high/low, low/high, and undifferentiated), and the findings were compared between the benign and malignant groups using the χ(2) test. RESULTS: The ratio of the maximum length of the largest fluid-fluid level to the maximum length of bone tumors in the sagittal plane that allowed statistically significant differentiation between benign and malignant bone tumors had an area under the ROC curve of 0.758 (95% confidence interval, 0.616-0.899). A cutoff value of 41.5% (higher value suggests a benign tumor) had sensitivity of 73% and specificity of 83%. CONCLUSION: The ratio of the maximum length of the largest fluid-fluid level to the maximum length of a bone tumor in the sagittal plane may be useful to differentiate benign from malignant bone tumors.