Diffusion kurtosis imaging differs between primary central nervous system lymphoma and high-grade glioma and is correlated with the diverse nuclear-to-cytoplasmic ratio: a histopathologic, biopsy-based study.

OBJECTIVES: To determine whether water kurtosis and diffusional metrics derived from diffusional kurtosis imaging (DKI) within primary central nervous system lymphomas (PCNSLs) and high-grade gliomas (HGGs) correlate with cellularity and/or nuclear-to-cytoplasmic (N/C) ratio. METHODS: Forty-four and 43 pathologically confirmed high-grade glioma and primary central nervous system lymphoma specimens between May 2013 and November 2016 were retrospectively reviewed. Diffusional metrics, kurtosis metrics, cellularity, and N/C ratios in PCNSLs and HGGs were compared using the Mann-Whitney U test (significant level, p < 0.007 [0.05/7]); Bonferroni correction). RESULTS: Mean kurtosis (MK), axial kurtosis (K//), and radial kurtosis (K⊥) in PCNSLs were 0.857 (0.693-0.924), 0.837 (0.660-0.941), and 0.834 (0.685-0.937), respectively; and 0.629 (0.524-0.716), 0.575 (0.511-0.689), and 0.675 (0.532-0.766), respectively, in HGGs (all p < 0.001). No significant differences in fractional anisotropy (FA), mean diffusion (MD), axial diffusion (λ//), and radial diffusion (λ⊥) were found between HGGs and PCNSLs. Cellularity was higher in PCNSLs than in HGGs (p = 0.125); whereas, the N/C ratio in PCNSLs was significantly higher than that in HGGs (p < 0.001). All DKI metrics (FA, MD, λ//, λ⊥, MK, K//, and K⊥) were significantly correlated with N/C ratio in PCNSLs with correlation coefficients being rho = 0.418, - 0.722, - 0.525, - 0.768, 0.704, 0.579, and 0.686, respectively. Cellularity in PCNSLs and HGGs did not correlate with any kurtosis or diffusional metrics. CONCLUSIONS: Difference of kurtosis parameters between PCNSLs and HGGs is correlated with their diverse N/C ratio. KEY POINTS: • DKI has considerable value in differentiating between PCNSLs and HGGs. • DKI can provide important information on nuclear-to-cytoplasmic ratio. • Difference of kurtosis parameters between PCNSLs and HGGs correlated well with their diverse N/C ratios.

Application of pulmonary ultrasound in the diagnosis of COVID-19 pneumonia in neonates / 中华儿科杂志

Objective To investigate the application of pulmonary ultrasound in the diagnosis of neonatal novel coronavirus pneumonia (COVID-19). Methods In this retrospective study, the clinical data of 5 infants, who were admitted to the Department of Neonatology in Wuhan Children's hospital from 31 th January to 25 th February 2020, were collected. Bedside pulmondary ultrasound was conducted on admission, during the hospitalization, and before discharge, and the result were compared with the chest X-ray or CT done at the same time. Results Among the 5 cases who aged 1-18 days, 3 were male. The main clinical manifestations were respiratory and gastrointestinal symptoms. The pulmonary ultrasonography on admission showed abnormal pleural line and pulmonary edema of different severity in all 5 cases, presented as increase and fusion of B-line, and pulmonary interstitial syndrome; among them, one case also had a small-range consolidation. The chest CT on admission showed no obvious parenchymal infiltration in 2 cases, small strip or patchy high-density shadow in 2 cases, and ground glass change in one case. The re-examination of ultrosound during the hospitalization and at discharge showed improvement in all cases and were consistent with the chest X-ray taken at the sametime. Conclusions The main changes on the pulmonary ultrasonography in neonates with COVID-19 pneumonia are increase and fusion of B-line, abnormal pleural line, and nalveolar interstitial syndrome, and may combined with small range of pulmonary consolidation. The sensitivity of pulmonary ultrasound is higher than chest X-ray and CT in the diagnosis of pulmonary edema, and could be used in monitoring and evaluation of the disease.

Perfusion imaging of brain gliomas using arterial spin labeling: correlation with histopathological vascular density in MRI-guided biopsies.

INTRODUCTION: This study was designed to determine if cerebral blood flow (CBF) derived from arterial spin labeling (ASL) perfusion imaging could be used to quantitatively evaluate the microvascular density (MVD) of brain gliomas on a "point-to-point" basis by matching CBF areas and surgical biopsy sites as accurate as possible. METHODS: The study enrolled 47 patients with treatment-naive brain gliomas who underwent preoperative ASL, 3D T1-weighted imaging with gadolinium contrast enhancement (3D T1C+), and T2 fluid acquisition of inversion recovery (T2FLAIR) sequences before stereotactic surgery. We histologically quantified MVD from CD34-stained sections of stereotactic biopsies and co-registered biopsy locations with localized CBF measurements. The correlation between CBF and MVD was determined using Spearman's correlation coefficient. P ≤ .05 was considered statistically significant. RESULTS: Of the 47 patients enrolled in the study, 6 were excluded from the analysis because of brain shift or poor co-registration and localization of the biopsy site during surgery. Finally, 84 biopsies from 41 subjects were included in the analysis. CBF showed a statistically significant positive correlation with MVD (ρ = 0.567; P = .029). CONCLUSION: ASL can be a useful noninvasive perfusion MR method for quantitative evaluation of the MVD of brain gliomas.

Pharmacoeconomic Evaluation of Wenxin Granules in the Treatment of Cardiovascular Diseases Based on Meta-analysis / 中国药房

OBJECTIVE:To evaluate the effectiveness,safety and economy about Wenxin granules in the treatment of cardio-vascular diseases based on Meta-analysis. METHODS:Using“Wenxin granules”“Wenxinkeli”“Wenxin”as the search terms, searching PubMed,ProQuest,Springer,The Cochrane Library,CNKI,VIP and Wanfang data(Jan. 2000-Oct. 2015)through com-puter,relevant journals and conference papers by hand,randomized controlled trials about Wenxin granules in the treatment of car-diovascular diseases were screened and classified according to indications. Meta-analysis was performed by using RevMan 5.3 soft-ware,while cost-effectiveness analysis and minimum cost analysis were used for economic evaluation. RESULTS:Totally,38 liter-atures were involved,including 20 literatures of arhythmia,9 of premature ventricualr contraction,4 of coronary disease angina pectoris,3 of unstable angina pectoris,2 of pediatric viral myocarditis. Meta-analysis showed that compared with control drug, Wenxin granules showed better clinical efficacy for arrhythmia with less ADR;showed better clinical efficacy and ECG efficacy for premature ventricualr contraction with less ADR;showed better clinical efficacy for angina pectoris of coronary disease,unstable angina pectoris and pediatric viral myocarditis,with statistical significance (P<0.05). The incremental cost-effectiveness analysis showed that the additional cost of Wenxin granules in the treatment of above indications was worth it all,compared to control drug. Single factor sensitivity analysis supported the stability of results. CONCLUSIONS:Wenxin granules have a better effectiveness, safety and economy in the treatment of cardiovascular diseases,but still need high-quality evidence to support.

Safety and short-term efficacy of MR guided focused ultrasound surgery for bone metastasis-induced pain palliation / 中华放射学杂志

Objective To discuss the safety and short-term efficacy of MR-guided focused ultrasound surgery (MRgFUS) for pain palliation of bone metastases patients.Methods Fourteen patients with painful bone metastases were recruited in this prospective study.The treating efficacy was characterized by numerical rating scale (NRS),the brief pain inventory quality of life (BPI-QOL) survey,and Karnosky performance status scale (KPS).Adverse events occurred pre-and post-treatment were analyzed.Normal distributed statistics was analyzed by using paired-samples t test or Wilcoxon rank sum test.Results Fourteen patients were treated with MRgFUS,2 patients dropped out of the study.The NRS ratings are 6.50(4.00),5.00 (5.25),2.50(5.00),2.50(4.75),2.00 (6.00) for pre-treatment,one week,one month,two months,and three months,respectively.Such variances of NRS ratings were statistically significant (Z=-2.773,-2.740,-2.769,-2.675;P＜0.05).The BPI-QOL ratings were (42.42± 8.27),(30.67 ± 12.29),(29.17±15.38),(29.92± 17.67) and (35.67± 19.28),respectively.The BPI-QOL ratings decreased in the first two months after the treatment which is statistically significant (t=3.231,2.820 and 2.453;P＜0.05);whereas for the third month,the BPI-QOL rating was statistically insignificant compared with the one before the treatment (P＞0.05).The KPS ratings were 80(28),80(20),65(45) for pre-treatment,one week and three months after treatment,respectively.Three months after the treatment,the KPS ratings decreased which was statistically significant compared with the one before the treatment (Z=-2.204,P＜0.05).After the treatment,one patient developed deep venous thrombosis,three patients reported lower extremities numbness,two patients had soft tissue edema around the lesions.Conclusions MRgFUS is effective for short-term pain palliation of bone metastases.Such noninvasive technique is safe and can improve patients' living condition.

Non-Gaussian diffusion MR imaging of glioma: comparisons of multiple diffusion parameters and correlation with histologic grade and MIB-1 (Ki-67 labeling) index.

INTRODUCTION: This study was conducted to compare the association of Gaussian and non-Gaussian magnetic resonance imaging (MRI)-derived parameters with histologic grade and MIB-1 (Ki-67 labeling) index (MI) in brain glioma. METHODS: Sixty-five patients with pathologically confirmed glioma, who underwent diffusion-weighted MRI with 2 b values (0, 1000 s/mm(2)) and 22 b values (≤5000 s/mm(2)), respectively, were divided into three groups of grade II (n = 35), grade III (n = 8), and grade IV (n = 22). Comparisons by two groups were made for apparent diffusion coefficient (ADC), slow diffusion coefficient (Dslow), distributed diffusion coefficient (DDC), and heterogeneity index α. Analyses of receiver operating characteristic (ROC) curve were performed to maximize the area under the curve (AUC) for differentiating grade III + IV (high-grade glioma, HGG) from grade II (low-grade glioma, LGG) and grade IV (glioblastoma multiforme, GBM) from grade II + III (other grade glioma, OGG). Correlations with MI were analyzed for the MRI parameters. RESULTS: On tumor regions, the values of ADC, Dslow, DDC, and α were significantly higher in grade II [(1.37 ± 0.29, 0.70 ± 0.11, 1.39 ± 0.34) (×10(-3) mm(2)/s) and 0.88 ± 0.05, respectively] than in grade III [(0.99 ± 0.13, 0.55 ± 0.07, 1.04 ± 0.20) (×10(-3) mm(2)/s) and 0.80 ± 0.03, respectively] and grade IV [(1.03 ± 0.14, 0.50 ± 0.05, 1.02 ± 0.16) (×10(-3) mm(2)/s) and 0.76 ± 0.04, respectively] (all P < 0.001). The parameter α showed the highest AUCs of 0.950 and 0.922 in discriminating HGG from LGG and GBM from OGG, respectively. Significant correlations with histologic grade and MI were observed for the MRI parameters. CONCLUSION: The non-Gaussian MRI-derived parameters α and Dslow are superior to ADC in glioma grading, which are comparable with ADC as reliable biomarkers in noninvasively predicting the proliferation level of glioma malignancy.

Comparison of contrast-enhanced SPACE and CISS in evaluating cavernous sinus invasion by pituitary macroadenomas on 3-T magnetic resonance.

PURPOSE: SPACE (sampling perfection with application-optimized contrasts by using different flip angle evolutions) and CISS (constructive interference in steady state) are 3-dimensional sequences that can increase the signal intensity of cavernous sinus. The purpose of this study was to determine whether contrast-enhanced (CE) SPACE and CE CISS can well demonstrate cavernous sinus invasion (CSI) by pituitary macroadenoma and which one performed better. METHODS: In 56 cavernous sinuses from 28 patients with pituitary macroadenoma, CSI grades and image quality were assessed by using CE SPACE and CISS. The assessment results were compared with Knops' classification on T1-weighted images. The interreader agreement of assessment results were analyzed with k statistics. Qualitative analyses were compared using the Wilcoxon signed-ranks test. RESULTS: Two radiologists were in substantial agreement of CSI evaluation on both CE SPACE (k = 0.87) and CE CISS (k = 0.83). The evaluation results on CE SPACE (k = 0.76) were more coincident with Knops' classification than CE CISS (k = 0.71). Identification of CSI worked well with either CE SPACE or CE CISS, but CE SPACE performed better (mean, 3.48 ± 0.61 vs 3.28 ± 0.80; P < 0.05). Contrast-enhanced SPACE had significantly higher image scores than CE CISS in description of the relationship between pituitary adenoma and internal carotid artery (mean, 3.26 ± 0.93 vs 2.96 ± 1.01; P < 0.05). Contrast-enhanced CISS demonstrated more susceptibility artifacts (10.7% vs 0%; P < 0.05) and vessel flow artifacts (53.6% vs 0%; P < 0.05). There was no significant difference regarding contrast enhancement of pituitary adenoma and cavernous sinus (mean, 3.07 ± 1.12 vs 3.04 ± 0.96; P > 0.05). CONCLUSIONS: Contrast-enhanced SPACE is superior than CE CISS for identification of CSI by pituitary macroadenoma.

Application of cerebral MR perfusion imaging using pulsed arterial spin labeling technique in patients with amnestic-type mild cognitive impairment and mild Alzheimer disease / 中华放射学杂志

Objective To study the value of relative cerebral blood flow(rCBF)changes in patients with amnestic-type mild cognitive impairment (aMCI)and mild Alzheimer disease(AD) using MRI pulsed arterial spin labeling(PASL).Methods A prospective study recruited 37 aMCI patients (aMCI group),30 mild AD patients(mild AD group) and 30 healthy volunteers (normal control group) from March 2011 to December 2013,MRI using PASL for cerebral perfusion imaging was performed and data of rCBF were collected.Taking age as covariate,analysis of variance (ANONA)was carried out to assess the difference of rCBF among all the three groups,then Bonferroni was done between every two groups.A follow-up examination using PASL was performed in the seventeen patients of the aMCI group.And paired t-test was used for comparing the longitudinal change of their rCBF data.Results Compared with the normal control group,the aMCI group showed significant increase of rCBF in bilateral posterior cingulate cortices and precuneus (cluster number 2 785,P＜0.05).While the mild AD group showed decrease of rCBF in the left inferior and superior parietal lobes,the angular,middle frontal lobe,as well as the right superior temporal lobe (cluster number 3 459-5 206,P＜0.05).When compared with the aMCI group,the mild AD group showed regional hypoperfusion in bilateral middle frontal lobes,the left precuneus,the right postcentral and inferior parietal lobe (cluster number 3 236-19 863,P＜0.05).In the longitudinal study of the 17 aMCI patients,an increased rCBF was found to coexist with reduced rCBF in the left inferior frontal and lateral occipital cortex,bilateral frontal poles and paracingulate gyrus,with hyperperfusion dominated.Increased rCBF was also detected in the left temporal lobe,the angular gyrus and precuneus,while decreased rCBF was present in the left putamen,the operculum and right corpus callosum (P＜0.05).Conclusions ASL perfusion imaging is a valuable method for dynamic monitoring of the cerebral perfusion changes in aMCI and AD patients.PASL will assist in finding a useful imaging biomarker for early diagnosis of AD.

Demonstration of Adamkiewicz artery using gemstone spectral CT angiography with optimal monochromatic technique / 中华放射学杂志

Objective To investigate the Adamkiewicz artery visualization using gemstone spectral CT angiography (CTA) with optimal monochromatic technique.Methods The prospective study was approved by the local institutional review board,and written informed consents were obtained for all the examinations.The successive 58 patients with suspected aortic aneurysm or dissection underwent aortic gemstone spectral CTA.They were divided into two groups based on the different reconstruction protocols:A,optimal monochromatic reconstruction;B,polychromatic reconstruction.Visualization rate of Adamkiewicz artery in two groups were recorded.Objective(measure CT value of the descending aorta and calculate signal-to-noise ratio [CNR]) and subjective (score of Adamkiewicz artery visualization) were evaluated.Paired samples t,Chi-square and Mann-Whitney U test were used for statistical analysis.Results CT value of descending aorta and CNR of group A [(568.4 ± 57.5)HU and (52.3 ± 8.1)] were significantly higher than group B[(346.2 ± 48.6)HU and (26.7 ± 3.7)] (t=12.70 and 15.20,P＜0.01).The visualization rate of Adamkiewicz artery in group A (94.8％,55/58) was higher than B (82.8％,48/58;x2=4.20,P=0.04).The score of group A (55 cases,3.9±0.8) was significantly higher than the group B (48 cases,3.4±1.0)(Z=-2.40,P=0.02).Conelusion Gemstone spectral CTA with optimal monochromatic reconstruction can improve the visualization efficiency and quality of the Adamkiewicz artery compared with routine polychromatic reconstruction protocol.