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Objective To observe the value of subregional non-contrast CT(NCCT)radiomics features based on habitat imaging technology for predicting hematoma expansion(HE)in patients with spontaneous intracranial hemorrhage(sICH).Methods Data of 228 sICH patients with negative conventional imaging signs were retrospectively analyzed and divided into HE group(n=99)or non HE(NHE)group(n=129)based on the occurrence of HE nor not.also divided into training set(n=182)or test set(n=46)at a ratio of 8:2.Clinical data,NCCT data and laboratory examination results were compared between groups.Logistic regressive analysis was performed to screen the impact factors of HE.ROI of whole hematoma(ROIwhole)was sketched and clustered into 3 sub-regions(ROIsub1,ROIsub2 and ROIsub3,the latter located in the critical area between hematoma and brain tissue)with habitat imaging technology,and radiomics features of ROI were extracted and screened.Then 4 prediction models were constructed based on the above 4 ROI,and the efficacy of each model for predicting HE was analyzed.Results The fasting blood glucose in HE group was higher than that in NHE group(t=2.047,P=0.041),which was not independent impact factor for predicting HE in sICH patients(P=0.070)according to logistic regression analysis.The area under the curve of ROIsub3 radiomics model for predicting sICH HE in training and test set was 0.945 and 0.863,respectively,not significantly different with that of ROIwhole(0.921,0.813),ROIsub1(0.925,0.807)nor ROIsub2(0.909,0.720)(all P＞0.05).Decision curve analysis showed that ROIsub3 radiomics model could bring greater benefits than the other 3 models.Conclusion NCCT radiomics features of the critical area between hematoma and brain tissue based on habitat imaging technology had high value for predicting HE in sICH patients.
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BACKGROUND@#Studies have shown that the incidence and severity of corona virus disease 2019 (COVID-19) in patients with lung cancer are higher than those in healthy people. At present, the main anti-tumor treatments for lung cancer include surgery, immunotherapy, chemotherapy, radiotherapy, targeted therapy and anti-angiogenesis therapy. While the effects of different anti-tumor treatments on the occurrence and severity of COVID-19 pneumonia are not uniform. Therefore, we aimed to describe clinical characteristics and antitumor therapy of patients with lung cancer and COVID-19 pneumonia, and examined risk factors for severity in this population.@*METHODS@#From December 1, 2022 to February 15, 2023, a retrospective study was conducted in 217 patients diagnosed with COVID-19 and pathologically confirmed lung cancer in the Jinling Hospital. We collected data about patients' clinical features, antitumor treatment regimen within 6 months, and the diagnosis and treatment of COVID-19. Risk factors for occurrence and severity of COVID-19 pneumonia were identified by univariable and multivariable Logistic regression models.@*RESULTS@#(1) Among the 217 patients included, 51 (23.5%) developed COVID-19 pneumonia, of which 42 (82.4%) were classified as medium and 9 (17.6%) were classified as severe; (2) Univariate and multivariate analysis revealed overweight (OR=2.405, 95%CI: 1.095-5.286) and intrapulmonary focal radiotherapy (OR=2.977, 95%CI: 1.071-8.274) are risk factors for increasing occurrence of COVID-19 pneumonia, while other therapies are not; (3) Chronic obstructive pulmonary disease (COPD) history (OR=7.600, 95%CI: 1.430-40.387) was more likely to develop severe pneumonia and anti-tumor therapies such as intrapulmonary focal radiotherapy, chemotherapy, targeted therapy and immunotherapy did not increase severity.@*CONCLUSIONS@#Intrapulmonary focal radiation therapy within 6 months increased the incidence of COVID-19 pneumonia, but did not increase the severity. However, there was no safety concern for chemotherapy, targeted therapy, surgery and immunotherapy.
الموضوعات
Humans , COVID-19 , Retrospective Studies , Lung Neoplasms/drug therapy , Incidence , Pneumonia/etiologyالملخص
@#Objective To investigate the effect of fluid attenuated inversion recovery (FLAIR) on hyperintense vascular sign in patients with unilateral middle cerebral artery chronic occlusion.Changes of HVS and prediction of cerebral infarction were also analyzed.Methods Patients with unilateral middle cerebral artery chronic occlusion who were hospitalized in Jiangdu People’s Neurology Department of Yangzhou City from July 2016 to August 2021 were enrolled.According to the presence or absence of cerebral infarction,they were divided into non-cerebral infarction group and cerebral infarction group.According to whether the cerebral infarction recurred during the follow-up,the cerebral infarction group was divided into recurrence group and non-recurrence group.Multivariate logistic regression model and ROC curve were used to analyze the risk and predictive value of FVHs and cerebral infarction in patients with unilateral middle cerebral artery chronic occlusion.Results (1)Univariate analysis showed that the fibrinogen level,HVS signs and FVHs score in cerebral infarction group were significantly higher than those in non-cerebral infarction group (P<0.05).The baseline FVHs score of recurrent cerebral infarction patients were significantly higher than that of non-recurrent cerebral infarction patients (P<0.05).(2)Logistic regression analysis showed that FVHs score had a significant independent positive correlation with the first occurrence of cerebral infarction (OR=2.499; 95%CI 1.481~4.218;P=0.001),and FVHs score was not independently associated with cerebral infarction recurrence (OR=1.356;95%CI 0.922~1.994;P=0.112);(3)ROC curve analysis showed that FVHs score ≥4 had certain predictive value for cerebral infarction in patients with unilateral middle cerebral artery chronic occlusion,with sensitivity of 73.3%,specificity of 66.2%,area under curve (AUC) of 0.669 (95%CI 0.476~0.861;P=0.041).Conclusion For patients with unilateral middle cerebral artery chronic occlusion,HVS may change in a process from scratch,and once the occurrence of HVS signs suggests that cerebral blood flow is decompensated,which is prone to cerebral infarction.FHVs score has certain predictive value for cerebral infarction.
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Objective:To investigate the clinical significance of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) in patients with chronic atherosclerotic middle cerebral artery occlusion.Methods:From July 2016 to November 2020, patients admitted to the Department of Neurology, Jiangdu People's Hospital of Yangzhou and first found chronic atherosclerotic middle cerebral artery occlusion were enrolled. The demographic, clinical and MRI imaging data were collected. According to the presence or absence of acute cerebral infarction, they were divided into the non-acute cerebral infarction group and the acute cerebral infarction group. According to the modified Rankin Scale score at 3 months after the onset, patients with acute cerebral infarction were further divided into the good outcome group (≤2) and the poor outcome group (>2). A multivariate logistic regression model was used to analyze the independent correlation between FVHs and the risk of cerebral infarction in patients with chronic atherosclerotic middle cerebral artery occlusion and the outcome in patients with cerebral infarction. Results:A total of 94 patients with chronic atherosclerotic middle cerebral artery occlusion were enrolled, including 38 with non-acute cerebral infarction (40.4%) and 56 with acute cerebral infarction (59.6%). In patients with acute cerebral infarction, 13 (23.2%) had a poor outcome, and 43 (76.8%) had a good outcome. The fibrinogen level, the proportion of patients with FVHs and the FVHs score in the cerebral infarction group were significantly higher than those in the non-cerebral infarction group (all P<0.05). Multivariate logistic regression analysis showed that the FVHs score was significantly, independently, and positively correlated with the risk of acute cerebral infarction (odds ratio 2.524, 95% confidence interval 1.400-4.552; P=0.002). The National Institutes of Health Stroke Scale score at admission, the modified Rankin Scale score at admission, and FVHs score in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that there was a significant independent negative correlation between the FVHs score and the outcome of patients with cerebral infarction (odds ratio 0.144, 95% confidence interval 0.045-0.459; P=0.001). Conclusions:FVHs suggest that the blood supply is in a state of decompensation. When FVHs are present, the risk of cerebral infarction in patients with chronic middle cerebral artery occlusion is significantly increased; the wider the range of FVHs, the higher the risk of poor outcome after cerebral infarction.
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Objective To investigate the predictive value of Essen stroke risk scale (ESRS) scores in stenosis of patients with anterior circulation acute ischemic stroke.Methods A total of 98 patients with atherosclerotic stroke in anterior circulation,admitted to our hospital from June 2011 to June 2013,were selected and performed head+neck CTA inspection cycle and ESRS.According to the ESRS scores,the patients were divided into low risk group (n=35),high risk group (n=44) and extremely high risk group (n=19).The relationship between the cerebrovascular morphology characteristics and ESRS scores were analyzed,and the predictive value of ESRS scores in stenosis was analyzed.Results (1) The distributions of these stenosis (the intracranial segment,the extracranial segment and combined intracranial and extracranial segments) were not significantly different among the three groups (P＞0.05).(2) Following the increase of ESRS scores,the degrees of luminal stenosis showed an increased trend in both circulation symptom side and non-symptom side (x2=9.784,P=0.002;xx2=9.215,P=0.002).(3) When the ESRS scores were higher than or equal to 3 points,the sensitivity of predicting mild stenosis was 63.6％,specificity 53.4％,with area under receiver operating characteristic curve (AUC) of 0.595 (P=0.182,95％CI:0.445-0.764);the sensitivity of predicting moderate stenosis,severe stenosis and occlusion was 60.3％,specificity 66.7％,with AUC of 0.679 (P=0.005,95％CI:0.553-0.805).Conclusions ESRS scores can predict the severity of the stenosis in patients with atherosclerotic cerebral stroke of anterior circulation.The patients having ESRS ≥ 3 scores should accept cerebrovascular examination to provide a certain basis for early and effective stratified intervention.
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Objective To explore the effect of vertebral artery dominance on basilar artery morphology and vascular vertigo,and understand the possible mechanisms.Methods Fifty-seven patients with vascular vertigo,admitted to our hospital from June 2011 to May 2013,were selected in our study; according to the head CTA vascular imaging,they were divided into vertebral artery dominance group (n=28) and vertebral artery non-dominance group (n=29).The clinical information and vertigo degrees from all of the patients were collected to analyze the vertebral-basilar artery and its relationship with vascular vertigo.Results In 28 patients with vertebral artery dominance,the left side of the dominance was noted in 21 patients (75％) and the right side of the dominance in 7 (25％),with statistically significant difference (x2=8.361,P=0.001); statistical significance of curve rate on both sides of the basal artery morphology was noted (x2=7.729,P=0.006).Most of its characteristic dominance of vertebral artery was C type,and the minority was S type and non-C type.The rate of basal artery bent in the dominant group was significantly higher than that in the non-dominant group (85.71％ and 31.03％,x2=18.196,P=0.000).The diameter (4.68±0.57 mm) and basal artery tortuosity (3.50+0.93 mm) in the dominant group were significantly larger than those in the non-dominant group (4.11 ±0.37 and 1.72±0.57,t=6.289,P=0.015; t=4.621,P=0.036).The theory length of basal artery showed no statistical significance between the two groups (P＞0.05).The greater the differences of both sides of the vertebral artery diameter,and the more obvious the basal diameter and basal artery tortuosity (P＜0.05).The level of vertigo in the non-dominant group was significantly higher than that in the dominant group (t=4.386,P=0.041).Vertigo severity level was positively associated with basal artery tortuosity and vertebral artery diameter (r=0.328,P=0.013; r=0.458,P=0.002).Conclusions There is higher rate of bending degree level and dizziness in patients of dominance of vertebral artery.Vertebral artery dominance is associated with vascular vertigo.
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Objective To investigate the relationship between carotid artery calcification and ischemic stroke.Methods The demographic data,vascular risk factors and clinical features of patients with acute ischemic stroke and non-acute stroke patients admitted in the same period were collected retrospectively.All the patients received 64-slice spiral CT examination,and the scan data were transmitted to a GE workstation.A smart score software was used to evaluate carotid artery calcification.Multivariate logistic regression analysis was used to identify the independent risk factors for ischemic stroke.Receiver operator characteristic (ROC) curve was used to analyze and determine the predictive value of carotid artery calcification in acute ischemic stroke.Results A total of 86 patients with acute ischemic stroke and 89 with non-acute stroke (control group) were enrolled.In addition to the previous stroke history,there were no significant differences in age,gender,and vascular risk factors between the ischemic stroke group and the control group.The calcium score (338.57 ± 77.35 vs.147.79 ± 64.52; t =4.065,P =0.045),total calcified volume (372.22 ± 78.73 mm3 vs.197.27 ±61.12 mm3; t =4.740,P =0.031),and calcification quality (70.33 ± 13.83 mg vs.32.44 ± 12.27 mg; t =6.673,P =0.011) of the ischemic stroke group were significantly higher than those of the control group.In patients with ischemic stroke,there were no significant differences in the carotid artery calcification score (335.50 ± 85.95 vs.312.73 ± 90.61; t =0.052,P =0.820),total calcified volume (357.91 ± 88.93 mm3 vs.311.71 ± 81.43 mm3; t=0.071,P=0.791),and calcium quality (59.68± 17.36 mg vs.51.29 ± 18.69 mg; t =0.071,P =0.791) between the symptomatic sides and non-symptomatic sides.Multivariate logistic regression analysis showed that the carotid artery calcification score (odds ratio [OR] 4.963,95％ confidence interval [CI] 5.932-18.994; P=0.019),total calcified volume (OR 5.967,95％ CI 3.940-14.993; P =0.015),and calcium quality (OR 6.815,95％ CI 4.703-21.946; P =0.007) were the independent risk factors for ischemic stroke.The ROC curve analysis of carotid artery calcification score showed that when it was 231.25,it had a predictive value for acute ischemic stroke.The sensitivity was 85.4％,specificity was 89.9％,positive predictive value was 87.1％,and negative predictive value was 89.1％.The area under the ROC curve was 0.891 (95％ CI 0.808-0.913; P =0.027).Conclusions Carotid artery calcification is one of the independent risk factors for ischemic stroke.Carotid artery calcification score has some predictive value for acute ischemic stroke.
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Objective To investigate the application of CT microvascular permeability surface (PS) in acute ischemic stroke. Methods Thirty patients suffering from acute or sub-acute cerebral infarction underwent CT perfusion (CTP) combining with CTA. Cerebral hemodynamic parameters (cerebral blood flow [CBF], cerebral blood volume [CBV], time to peak [TTP], PS) between lesions and contralateral side were compared. The manifestation of microvascular hyper permeability were analyzed. Results Significant differences were found in cerebral hemodynamic parameters between the core of cerebral infarction and the contralateral hemisphere (P＜0.05). There was no significant difference in CBF and CBV between the surrounding of cerebral infarction and the contralateral hemisphere, but PS and TTP showed delaying and heightening, the difference was significant (P＜0.05). High-density extravasation of contrast media in infarction zone was observed 30 min after CTP in 3 patients, the value of PS reached (9.20±1.43) ml/100 (ml·min). Conclusion CT microvascular PS may monitor hemorrhagic transformation in acute ischemic stroke, and guide thrombolytic therapy.
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Mild cognitive impairment(MCI)refers to cognitive regression which goes beyond one'S age and education level,but does not influence the activities of daily living.More than half patients with MCI will develop dementia within five years.Therefore,MCI is considered as a risk status of dementia.Early diagnosis of MCI prevents against patients developing dementia. Voxel-based morphometry(VBM)technique quantitatively calculates the size of global and local gray matter voxel and signal intensity.It is a full automatic analysis technique of objective brain morphology.This article reviews the application of VBM technique in patient with MCI.