Adding liver R2* quantification to proton density fat fraction MRI of vertebral bone marrow improves the prediction of osteoporosis.

OBJECTIVES: To assess the predictive value of the combination of bone marrow (BM) proton density fat fraction (PDFF) and liver R2* for osteopenia and osteoporosis and the additional role of liver R2*. METHODS: A total of 107 healthy women were included between June 2019 and January 2021. Each participant underwent dual-energy X-ray absorptiometry (DXA) and chemical shift-encoded 3.0-T MRI. PDFF measurements were performed for each lumbar vertebral body, and R2* measurements were performed in liver segments. Agreement among measurements was assessed by Bland-Altman analysis. Receiver operating characteristic (ROC) curves were generated to select optimised cut-offs for BM PDFF and liver R2*. Univariable and multivariable logistic regressions were performed. The C statistic and continuous net reclassification improvement (NRI) were adopted to explore the incremental predictive ability of liver R2*. RESULTS: Bone mass decreased in 42 cases (39.3%) and nonbone mass decreased in 65 cases (60.7%). There were significant differences among the age groups, menopausal status groups, PDFF > 45.0% groups, and R2* > 67.7 groups. Each measurement had good reproducibility. The odds ratios (95% CIs) were 4.05 (1.22-13.43) for PDFF and 4.34 (1.41-13.35) for R2*. The C statistic (95% CI) without R2* was 0.888 (0.827-0.950), and with R2* was 0.900 (0.841-0.960). The NRI resulting from the combination of PDFF and R2* was 75.6% (p < 0.01). CONCLUSION: The predictive improvement over the use of BM PDFF and other traditional risk factors demonstrates the potential of liver R2* as a biomarker for osteopenia and osteoporosis in healthy women. KEY POINTS: • Liver R2* is a biomarker for the assessment of osteopenia and osteoporosis. • Liver R2* improved the ability to predict osteopenia and osteoporosis. • The intra- and interobserver measurements showed high agreement.

Prediction of Vascular Invasion Using a 3-Point Scale Computed Tomography Grading System in Pancreatic Ductal Adenocarcinoma: Correlation With Surgery.

OBJECTIVE: The aim of this study was to evaluate the correlation between a 3-point scale multidetector computed tomography (MDCT) grading system and surgical exploration in predicting vascular invasion and resectability in patients with pancreatic ductal adenocarcinoma (PDA). METHODS: Fifty-five patients with surgical and pathologic confirmation of PDA were retrospectively analyzed by 3 radiologists independently. All patients had MDCT examination with multiplanar reformatted images, computed tomography (CT) angiography, and negative-contrast CT cholangiopancreatography (nCTCP). A 3-point scale CT grading system and criteria for unresectability adopting the latest guidelines were used in predicting the correlation between the invasion and resectability of 5 peripancreatic vessels and surgical grade and pathology. RESULTS: Tumor location was correctly identified in all patients including 2 isodense lesions by means of nCTCP. The mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT were 92%, 83%, 95%, 78%, and 90%, respectively, in predicting tumor resectability compared with surgery and pathology and with good agreement (κ = 0.72-0.77). A correlation was observed between CT and surgical grade in predicting vascular invasion on a per-vessel basis, and the agreement presented as good to excellent (κ = 0.66-1.00). CONCLUSIONS: A 3-point scale CT grading system is a simple and practical method in predicting peripancreatic vessel invasion and, importantly, correlates with surgical grade and pathology. Axial images combined with multiplanar reformation, nCTCP, and CT angiography can strengthen the comprehensive evaluation of PDA for resectability.

Presurgical Evaluation of Pancreatic Cancer: A Comprehensive Imaging Comparison of CT Versus MRI.

OBJECTIVE: The purpose of this study was to compare comprehensive CT and MRI in the presurgical evaluation of pancreatic cancer. MATERIALS AND METHODS: Thirty-eight patients with pathologically proven pancreatic cancer were included in a retrospective study. CT with negative-contrast CT cholangiopancreatography and CT angiography (CTA) (CT image set) versus MRI with MRCP and MR angiography (MRI image set) were analyzed independently by two reviewers for tumor detection, extension, metastasis, vascular invasion, and resectability. These results were compared with the surgical and pathologic findings. RESULTS: The rate of detection of tumors was higher with MRI than with CT but not significantly so (reviewer 1, p = 1.000; reviewer 2, p = 0.500). In the evaluation of vessel involvement, nodal status, and resectability, although CT had higher ROC AUC values than did MRI (reviewer 1, 0.913 vs 0.858, 0.613 vs 0.503, and 0.866 vs 0.774; reviewer 2, 0.879 vs 0.849, 0.640 vs 0.583, and 0.830 vs 0.815), the differences were not statistically significant (p = 0.189 vs 0.494, 0.328 vs 0.244, and 0.193 vs 0.813 for reviewers 1 and 2). In the evaluation of tumor extension and organ metastases in the 38 patients, correct diagnosis of one of two liver metastases was achieved with both image sets, one case of omental and one case of peritoneal seeding were underestimated, and one case of stomach invasion was overestimated. CONCLUSION: MRI and CT had similar performance in the presurgical evaluation of pancreatic cancer.

Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography.

OBJECTIVES: The purpose of this study was to compare CT with negative-contrast CT cholangiopancreatography (nCTCP) using subvolume minimum intensity projection (MinIP) versus MRI with MRCP in differentiating noncalculous periampullary obstruction. METHODS: Sixty-four patients with clinically proven noncalculous periampullary obstructions who had undergone both MDCT and MR examinations before operation were reviewed retrospectively. Two reviewers independently interpreted the two image sets (the CT with nCTCP set [CT set] vs. the MRI with MRCP set [MRI set]) in differentiating both benign from malignant obstruction and pancreatic head carcinoma (PHC) from non-PHC, and the results were compared to the final clinical records. RESULTS: In this study, no statistically significant differences were observed in the accuracy of differentiating benign from malignant periampullary obstruction (p = 0.754 for reviewer 1 and p = 0.508 for reviewer 2) on the two image sets. The accuracy of differentiating PHC from non-PHC was also statistically insignificant (p = 0.125 for reviewer 1 and p = 1.000 for reviewer 2) on the two image sets. CONCLUSION: The CT set provides a comparable performance to that of the MRI set in differentiating noncalculous periampullary obstruction. KEY POINTS: • nCTCP with subvolume MinIP is a practical tool in evaluating biliary obstruction • Two image sets have a comparable performance in differentiating noncalculous periampullary obstruction • MDCT could serve as an alternative in patients not eligible for MRI.

Preoperative Evaluation of Malignant Perihilar Biliary Obstruction: Negative-Contrast CT Cholangiopancreatography and CT Angiography Versus MRCP and MR Angiography.

OBJECTIVE: The purpose of this study was to compare negative-contrast CT cholangiopancreatography (CTCP) and CT angiography (CTA) with MRCP and MR angiography (MRA) for the preoperative evaluation of malignant perihilar biliary obstruction. MATERIALS AND METHODS: Twenty-one patients with pathologically proven malignant perihilar biliary obstructions who had undergone both CT and MRI examinations were reviewed retrospectively. Two reviewers independently analyzed the two image sets-the negative-contrast CTCP and CTA images (i.e., CT set) and the MRCP and MRA images (i.e., MRI set)-in preoperatively evaluating the classification of malignant perihilar biliary obstruction, hepatic artery and portal vein invasion, nodal metastasis, and organ spread. The results were compared with surgical and pathologic records. RESULTS: For the classification of malignant perihilar biliary obstruction on the two image sets, the accuracy was not statistically significant (p = 1.000 for reviewer 1 and p = 0.500 for reviewer 2). For the evaluation of portal vein invasion, nodal metastasis, and organ spread, the accuracies were also not statistically significantly different (p = 0.335, 0.339, and 0.781 for reviewer 1; and p = 0.403, 0.495, and 0.325 for reviewer 2, respectively). In the assessment of hepatic artery status, the accuracy was statistically significant (p = 0.046 for reviewer 1 and p = 0.036 for reviewer 2). CONCLUSION: Compared with the MRI set, the CT set provides equivalent performance in assessing the classification of malignant perihilar biliary obstruction, portal vein involvement, nodal metastasis, and organ spread, but has higher accuracy in assessing arterial invasion.

Differential diagnosis of periampullary carcinomas: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography.

BACKGROUND: Negative-contrast CT cholangiopancreatography (nCTCP) has been introduced into clinical practice recently. In the present study, we compared CT with nCTCP vs. MRI with MR cholangiopancreatography (MRCP) for the differential diagnosis of periampullary carcinomas. METHODS: Fifty-nine patients with pathologically proven periampullary carcinomas who had received both CT and MR examinations before operation were reviewed retrospectively. Two reviewers independently interpreted the two image sets [the two-dimensional (2D)-CT with nCTCP set (CT set) vs. the 2D-MRI with MRCP set (MRI set)] in differentiating periampullary carcinomas, and the results were compared to the final pathologic records. RESULTS: An interobserver agreement with a weighed κ value of 0.868 for the CT set and 0.701 for the MRI set was obtained for both reviewers in this study. No statistically significant differences were observed in the accuracy of identifying each of the periampullary carcinomas of four origins (P values of 0.250, 0.500, 0.500, and 1.000 for reviewer 1 in comparison with 1.000, 0.625, 0.687, and 1.000 for reviewer 2 on the two image sets, respectively). CONCLUSION: The CT set provides a comparable performance to that of the MRI set in differentiating periampullary carcinomas, and it may be an alternative to 2D-MRI with MRCP in assessing malignant biliary obstruction in patients who are not suitable for MR examinations.

Morphological and Structural Network Analysis of Sporadic Alzheimer's Disease Brains Based on the APOE4 Gene.

BACKGROUND: Alzheimer's disease (AD) is an increasingly common type of dementia. Apolipoprotein E (APOE) gene is a strong risk factor for AD. OBJECTIVE: Here, we explored alterations in grey matter structure (GMV) and networks in AD, as well as the effects of the APOEɛ4 allele on neuroimaging regions based on structural magnetic resonance imaging (sMRI). METHODS: All subjects underwent an sMRI scan. GMV and cortical thickness were calculated using voxel-based morphological analysis, and structural networks were constructed based on graph theory analysis to compare differences between AD and normal controls. RESULTS: The volumes of grey matter in the bilateral inferior temporal gyrus, right middle temporal gyrus, right inferior parietal lobule, right limbic lobe, right frontal lobe, left anterior cingulate gyrus, and bilateral olfactory cortex of patients with AD were significantly decreased. The cortical thickness in patients with AD was significantly reduced in the left lateral occipital lobe, inferior parietal lobe, orbitofrontal region, precuneus, superior parietal gyrus, right precentral gyrus, middle temporal gyrus, pars opercularis gyrus, insular gyrus, superior marginal gyrus, bilateral fusiform gyrus, and superior frontal gyrus. In terms of local properties, there were significant differences between the AD and control groups in these areas, including the right bank, right temporalis pole, bilateral middle temporal gyrus, right transverse temporal gyrus, left postcentral gyrus, and left parahippocampal gyrus. CONCLUSION: There were significant differences in the morphological and structural covariate networks between AD patients and healthy controls under APOEɛ4 allele effects.

Efficacy of urapidil for the treatment of patients with senile hypertension and acute heart failure.

BACKGROUND: Previous clinical studies have reported that urapidil can effectively treat patients with senile hypertension (SH) and acute heart failure (AHF). However, no studies have systematically assessed the efficacy and safety of urapidil for patients with SH and AHF. Thus, this study will investigate the efficacy and safety of urapidil for SH and AHF. METHODS: In this study, we will search the following electronic databases from inception to the June 30, 2019: MEDLINE, EMBASE, Cochrane Library, Google scholar, Springer, WANGFANG, and China Knowledge Resource Integrated Database. We will search all these electronic databases without language limitations. We will also search grey records to avoid missing potential literature. In this study, only randomized controlled trials on assessing efficacy and safety of urapidil for SH and AHF will be considered. We will use RevMan 5.3 software and STATA 15.0 software to carry out statistical analysis. RESULTS: This study will evaluate the efficacy and safety of urapidil for SH and AHF by assessing all-cause mortality, change in body weight, urine output, change in serum sodium; and incidence of all adverse events. CONCLUSION: This study will provide latest evidence of the efficacy and safety of urapidil for patients with SH and AHF. DISSEMINATION AND ETHICS: This study will only analyze published data; therefore, no ethical approval is needed. The findings of this study will be published at peer-reviewed journals. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019139344.

Efficacy of methylprednisolone for treatment of persistent vertigo.

BACKGROUND: This study will systematically investigate the efficacy and safety of methylprednisolone for treatment of persistent vertigo (PV). METHODS: All following electronic databases will be searched from inception to the June 30, 2019 without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, and Chinese Biomedical Literature Database. All randomized controlled trials focusing on assessing the efficacy and safety of methylprednisolone for patients with PV will be fully considered for inclusion. Cochrane risk of bias tool will be used for assessing methodological quality, and RevMan 5.3 software (Cochrane Community, London, UK) will be utilized for statistical analysis. RESULTS: This study will assess the efficacy and safety of methylprednisolone for PV via assessing primary outcome of vertigo, and secondary outcomes of somatization, depression, anxiety, health-related quality of life, and adverse events. CONCLUSION: This study will provide a high-quality evidence to judge whether methylprednisolone is an effective and safety therapy for patients with PV. DISSEMINATION AND ETHICS: No individual data will be utilized in this study, thus, it does not need ethical approval. The results of this study will be published at peer-reviewed journals. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138890.

Comparison of three-dimensional negative-contrast CT cholangiopancreatography with three-dimensional MR cholangiopancreatography for the diagnosis of obstructive biliary diseases.

PURPOSE: The purpose of our study was to compare three-dimensional (3D) negative-contrast CT cholangiopancreatography (3D-nCTCP) with 3D MR cholangiopancreatography (3D-MRCP) for the diagnosis of obstructive biliary diseases. MATERIALS AND METHODS: 3D-nCTCP and 3D-MRCP were performed on seventy clinically documented obstructive biliary diseases patients. The accuracy of each technique in determining the location and cause of biliary obstruction was evaluated compared with the final clinical diagnoses. RESULTS: Both methods achieved 100% of accuracy in the diagnosis of the presence and location of biliary obstruction, and had a similar sensitivity, specificity, accuracy in differentiating benign from malignant biliary obstruction or calculous from noncalculous biliary obstruction (p>0.05). At 3D-nCTCP, six patients with stones were misinterpreted as cholangitis (N=2), papillitis (N=3), or bile duct adenocarcinoma (N=1); two metastases were mistaken as acute pancreatitis or pancreatic head carcinomas, and one intrahepatic cholangiocarcinoma was misled as bile duct adenoma. At 3D-MRCP, one small stone, one ampullary adenoma, and one intrahepatic cholangiocarcinoma were mistaken as cholangitis, ampullary stone, and intrahepatic bile duct stone, respectively, and three gallbladder carcinomas and another intrahepatic cholangiocarcinoma were misdiagnosed as hilar cholangiocarcinoma (N=3) or common hepatic duct stone (N=1); four metastases were mistaken as pancreatic head carcinomas (N=3) or distal cholangiocarcinoma (N=1). The overall accuracy in making specific diagnosis of the cause of biliary obstruction was 87.1% for 3D-nCTCP and 84.3% for 3D-MRCP, respectively, (p>0.05). CONCLUSION: 3D-nCTCP has the similar effects as 3D-MRCP for the diagnosis of biliary obstruction and, the location and the cause of biliary obstruction. In view of selected cases contraindications for MRI, 3D-nCTCP is a potential substitute.

Influence of fluid-attenuated inversion-recovery on stroke apparent diffusion coefficient measurements and its clinical application.

BACKGROUND AND PURPOSE: The application of a fluid-attenuated inversion-recovery pulse with a conventional diffusion-weighted MRI sequence (FLAIR DWI) decreases the partial volume effects from cerebrospinal fluid on apparent diffusion coefficient (ADC) measurements. For this reason, FLAIR DWI may be more useful in the evaluation of ischemic stroke, but few studies have looked at the effect of FLAIR on ADC measurements in this setting. This study quantitatively compares FLAIR DWI and conventional DWI in ischemic stroke of varying ages to assess the potential advantages of this technique. METHODS: We respectively analyzed 139 DWI studies in patients with ischemic stroke with and without FLAIR at varying time points ranging from hyperacute to chronic. ADC values were measured in each lesion, as well as in the contralateral normal side. Comparisons were made between the ADC values obtained from the DWI sequences with and without FLAIR for both the lesion and the normal contralateral side. RESULTS: The ADC measurements within the ischemic lesion were very similar on FLAIR DWI and conventional DWI for lesions less than 14 days old (p>0.05), but were significantly decreased on FLAIR DWI for lesions between 15 and 30 days old and in lesions >31 days old (chronic stage) (p<0.01). The contralateral ADC values were all significantly decreased on the FLAIR DWI sequence compared with conventional DWI (p<0.01). CONCLUSIONS: The application of an inversion pulse does not significantly affect the ADC values for early stage ischemic stroke (less than 14 days from symptom onset), but results in a more accurate relative ADC measurement by reducing the cerebrospinal fluid partial volume effects of the normal contralateral side. In addition, combined with the conventional DWI, FLAIR DWI may be helpful in determining the age of ischemic lesions.

Regional diffusion changes of cerebral grey matter during normal aging--a fluid-inversion prepared diffusion imaging study.

BACKGROUND AND PURPOSE: Although diffusion characteristics of white matter (WM) and its aging effects have been well described in the literature, diffusion characteristics of grey matter (GM), especially the cortical GM, have not been fully evaluated. In the present study, we used the fluid-inversion prepared diffusion imaging (FLIPD) technique to determine if there are age-related water diffusivity changes in GM. MATERIALS AND METHODS: 120 healthy volunteers were recruited for our study. They were divided into three age groups: group one (20-39 years old), group two (40-59 years old) and group three (60 years or older). All patients were evaluated with MRI using FLIPD at 3.0T. Apparent diffusion coefficient (ADC) values of the frontal GM, cingulate cortex and thalami were determined bilaterally by region-of-interest analysis. RESULTS: Group three had significantly higher ADC values in both thalami and the left frontal GM compared to group two or group one. No ADC value difference was found among the three groups in the right frontal GM and bilateral cingulate cortex. There was a significant positive correlation between individual ADC values and age in both thalami and left frontal GM. For the cingulate cortex and the right frontal GM, ADC values did not correlate significantly with advancing age. CONCLUSION: Statistically significant age-related diffusion changes were observed in both thalami and the left frontal cortex. The data reported here may serve as a reference for future studies.