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BACKGROUND: T1-weighted (T1W) magnetic resonance imaging (MRI) using the delay alternating with nutation for excitation-sampling perfection with application-optimized contrasts using different flip angle evolution (DANTE-SPACE) is the preferred imaging technique for evaluation of the vessel wall. PURPOSE: To evaluate the intra- and inter-rater reproducibility of carotid wall segmentation on T1W DANTE-SPACE in patients with symptomatic (acute stroke or transient ischemic attack) internal carotid artery (ICA) stenosis. MATERIAL AND METHODS: This prospective study included 25 patients with acute (≤3 months) stroke or transient ischemic attack and 50%-99% stenosis of the ICA. All patients underwent 3.0-T high-resolution carotid MRI. Two radiologists independently performed the manual segmentation of the vessel wall and inner lumen of the bilateral carotid artery on DANTE-SPACE. The intraclass correlation coefficient (ICC), Dice similarity coefficient (DSC), and Hausdorff distance (HD) were calculated. RESULTS: The ICCs for intra-rater reproducibility of carotid wall volume, inner lumen volume, and normalized wall index were 0.965, 0.990, and 0.962, respectively. The ICCs for inter-rater reproducibility of carotid wall volume, inner lumen, and normalized wall index were 0.856, 0.981, and 0.904. DSC and HD for intra- and inter-rater reproducibility of carotid wall segmentation were as follows: 0.873 and 0.809 (DSC); and 0.079 and 0.118 (HD), respectively. For evaluation of reproducibility only in the carotid artery with symptomatic stenosis, the ICCs for intra- and inter-rater reproducibility indicated all perfect agreement. CONCLUSION: T1W DANTE-SPACE is a reproducible sequence for evaluation of the carotid wall using carotid MRI in patients with symptomatic ICA stenosis.
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Intracranial vessel wall imaging (VWI), which requires both high spatial resolution and high signal-to-noise ratio (SNR), is an ideal candidate for deep learning (DL)-based image quality improvement. Conventional VWI (Conv-VWI, voxel size 0.51 × 0.51 × 0.45 mm3) and denoised super-resolution DL-VWI (0.28 × 0.28 × 0.45 mm3) of 117 patients were analyzed in this retrospective study. Quality of the images were compared qualitatively and quantitatively. Diagnostic performance for identifying potentially culprit atherosclerotic plaques, using lesion enhancement and presence of intraplaque hemorrhage (IPH), was evaluated. DL-VWI significantly outperformed Conv-VWI in all image quality ratings (all P < .001). DL-VWI demonstrated higher SNR and contrast-to-noise ratio (CNR) than Conv-VWI, both in normal walls (basilar artery; SNR 4.83 ± 1.23 vs. 3.02 ± 0.59, P < .001) and lesions (contrast-enhanced images; SNR 22.12 ± 11.68 vs. 8.33 ± 3.26, P < .001). In the assessment of 86 lesions, DL-VWI showed higher confidence of detection (4.56 ± 0.55 vs. 2.62 ± 0.77, P < .001), more concordant IPH characterization (Cohen's Kappa 0.85 vs. 0.59) and greater enhancement. For culprit plaque identification, IPH exhibited higher sensitivity in DL-VWI compared to Conv-VWI (70.6% vs. 23.5%) and excellent specificity (94.3% vs. 94.3%). Deep learning application of intracranial vessel wall images successfully improved the quality and resolution of the images. This aided in detecting vessel wall lesions and intraplaque hemorrhage, and in identifying potentially culprit atherosclerotic plaques.
Subject(s)
Deep Learning , Magnetic Resonance Imaging , Plaque, Atherosclerotic , Humans , Plaque, Atherosclerotic/diagnostic imaging , Male , Female , Middle Aged , Aged , Retrospective Studies , Magnetic Resonance Imaging/methods , Signal-To-Noise Ratio , AdultABSTRACT
In response to the increasing demand for spheroid-based cancer research, the importance of developing integrated platforms that can simultaneously facilitate high-throughput spheroid production and multiplexed analysis is emphasized. In addition, the understanding of how the size and cellular composition of tumors directly influence their internal structures and functionalities underlines the critical need to produce spheroids of diverse sizes and compositions on a large scale. To address this rising demand, this work presents a configurable and linkable in vitro three-dimensional (3D) cell culture kit (CLiCK) for spheroids, termed CLiCK-Spheroid. This platform consists of three primary components: a hanging drop microarray (HDMA), a concave pillar microarray (CPMA), and gradient blocks. The HDMA alone produces a homogeneous spheroid array, while its combination with the gradient block enables one-step generation of a size-gradient spheroid array. Using the size-gradient spheroid arrays, the occurrence of necrotic cores based on spheroid size is demonstrated. Additionally, spheroids in a single batch can be conveniently compartmentalized and regrouped using a CPMA, enhancing the versatility of spheroid arrays and enabling multiplexed drug treatments. By combining the different assembly methods, this work has achieved high-throughput production of cell composition-gradient spheroid arrays, with noticeable variations in morphology and vascularization based on cell compositions.
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OBJECTIVE: We aimed to investigate risk factors for the recurrence of distal anterior cerebral artery (DACA) aneurysms after endovascular treatment (EVT). METHODS: The clinical and radiologic outcomes of DACA aneurysms treated with endovascular methods at a single tertiary hospital from September 2008 to December 2021 were retrospectively reviewed. We measured the angle between 2 distal branches of DACA aneurysms and categorized the angle as follows: 1) wide-angle (≥180°), and 2) narrow-angle type configuration (<180°). Univariate and multivariate analyses were performed to demonstrate the relationships between characteristics of DACA aneurysm and recurrence risk. RESULTS: In total, 132 DACA aneurysms were treated in our institution. Among these, 47 DACA aneurysms after EVT were included in this study. Forty patients underwent coil embolization without stent, 7 for stent-assisted coil embolization. At the last follow-up (mean 30.2 ± 24.2 months), overall recurrence rate was 23.4% (n = 11). Recurrence rate of the wide-angle type (9 of 23, 39.1%) was significantly greater than narrow-angle type (2 of 24, 8.3%) (P = 0.041; odds ratio 8.174, 95% confidence interval 1.094-61.066). Irregular shape of the DACA aneurysm also showed significantly greater recurrence rate (P = 0.011; odds ratio 10.663, 95% confidence interval 1.701-66.838) after endovascular treatment. CONCLUSIONS: The wide-angle between 2 distal branches of DACA aneurysm and irregular shape might be independent risk factors for the recurrence after endovascular treatment for DACA aneurysms.
Subject(s)
Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Recurrence , Humans , Female , Male , Intracranial Aneurysm/surgery , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/therapy , Middle Aged , Risk Factors , Endovascular Procedures/methods , Retrospective Studies , Aged , Embolization, Therapeutic/methods , Adult , Anterior Cerebral Artery/surgery , Anterior Cerebral Artery/diagnostic imaging , Stents , Treatment OutcomeABSTRACT
PURPOSE: Recent studies have shown promise of MR-based radiomics in predicting the survival of patients with untreated glioblastoma. This study aimed to comprehensively collate evidence to assess the prognostic value of radiomics in glioblastoma. METHODS: PubMed-MEDLINE, Embase, and Web of Science were searched to find original articles investigating the prognostic value of MR-based radiomics in glioblastoma published up to July 14, 2023. Concordance indexes (C-indexes) and Cox proportional hazards ratios (HRs) of overall survival (OS) and progression-free survival (PFS) were pooled via random-effects modeling. For studies aimed at classifying long-term and short-term PFS, a hierarchical regression model was used to calculate pooled sensitivity and specificity. Between-study heterogeneity was assessed using the Higgin inconsistency index (I2). Subgroup regression analysis was performed to find potential factors contributing to heterogeneity. Publication bias was assessed via funnel plots and the Egger test. RESULTS: Among 1371 abstracts, 18 and 17 studies were included for qualitative and quantitative data synthesis, respectively. Respective pooled C-indexes and HRs for OS were 0.65 (95 % confidence interval [CI], 0.58-0.72) and 2.88 (95 % CI, 2.28-3.64), whereas those for PFS were 0.61 (95 % CI, 0.55-0.66) and 2.78 (95 % CI, 1.91-4.03). Among 4 studies that predicted short-term PFS, the pooled sensitivity and specificity were 0.77 (95 % CI, 0.58-0.89) and 0.60 (95 % CI, 0.45-0.73), respectively. There was a substantial between-study heterogeneity among studies with the survival endpoint of OS C-index (n = 9, I2 = 83.8 %). Publication bias was not observed overall. CONCLUSION: Pretreatment MR-based radiomics provided modest prognostic value in both OS and PFS in patients with glioblastoma.
Subject(s)
Glioblastoma , Humans , Prognosis , Glioblastoma/diagnostic imaging , Progression-Free Survival , Proportional Hazards ModelsABSTRACT
Neurogenin 3 (NGN3) is a key transcription factor in the cell fate determination of endocrine progenitors (EPs) in the developing pancreas. Previous studies have shown that the stability and activity of NGN3 are regulated by phosphorylation. However, the role of NGN3 methylation is poorly understood. Here, we report that protein arginine methyltransferase-1 (PRMT1)-mediated arginine 65 methylation of NGN3 is required for the pancreatic endocrine development of human embryonic stem cells (hESCs) in vitro. We found that inducible PRMT1-knockout (P-iKO) hESCs did not differentiate from EPs into endocrine cells (ECs) in the presence of doxycycline. Loss of PRMT1 caused NGN3 accumulation in the cytoplasm of EPs and decreased the transcriptional activity of NGN3. We found that PRMT1 specifically methylates NGN3 arginine 65 and that this modification is a prerequisite for ubiquitin-mediated degradation. Our findings demonstrate that arginine 65 methylation of NGN3 is a key molecular switch in hESCs permitting their differentiation into pancreatic ECs.
Subject(s)
Human Embryonic Stem Cells , Humans , Human Embryonic Stem Cells/metabolism , Methylation , Arginine/metabolism , Basic Helix-Loop-Helix Transcription Factors/genetics , Basic Helix-Loop-Helix Transcription Factors/metabolism , Pancreas , Cell Differentiation/genetics , Methyltransferases/metabolism , Protein-Arginine N-Methyltransferases/genetics , Protein-Arginine N-Methyltransferases/metabolism , Repressor Proteins/genetics , Repressor Proteins/metabolismABSTRACT
PURPOSE: To assess the diagnostic accuracy of dynamic susceptibility contrast, dynamic contrast-enhancement, MR spectroscopy (MRS), and diffusion-weighted imaging for differentiating high-grade (HGGs) from low-grade gliomas (LGGs). METHODS: Seventy-two patients (16 LGGs, 56 HGGs) with pathologically confirmed gliomas were retrospectively included. From three-dimensionally segmented tumor, histogram analyses of relative cerebral blood volume (rCBV), volume transfer constant (Ktrans), and apparent diffusion coefficient (ADC) were performed. Choline-to-creatinine ratio (Cho/Cr) was calculated using MRS. Logistic regression analyses were performed to differentiate HGGs (grade ≥ 3) from LGGs (grade ≤ 2). Areas under the receiver operating characteristics curves (AUC) were plotted. Subgroup analysis was performed between IDH-wildtype glioblastomas and IDH-mutant astrocytomas. Pairwise Spearman's correlation coefficients (ρ) were computed. RESULTS: HGGs had higher 95th percentile rCBV, Ktrans and Cho/Cr (P < 0.01) than LGGs. AUC of 95th percentiles of rCBV and Ktrans were 0.79 (95% CI, 0.67-0.91) and 0.74 (95% CI, 0.59-0.88), respectively. AUC of 5th percentile of ADC was 0.63 (95% CI, 0.48-0.79), and that of Cho/Cr was 0.67 (95% CI, 0.52-0.81). IDH-wildtype glioblastomas and IDH-mutant astrocytomas showed significantly different 95th percentile rCBV (P = 0.04) and Ktrans (P < 0.01), with Ktrans showing the highest AUC (0.73, 95% CI 0.57-0.89) in IDH status prediction. Moderate correlations were observed between 95th percentile rCBV and Ktrans (ρ = 0.47), Cho/Cr (ρ = 0.40), and 5th percentile ADC (ρ = -0.36) (all P < 0.01). CONCLUSIONS: The 95th percentile rCBV may be most helpful in discriminating HGGs from LGGs. The 95th percentile Ktrans may aid predicting IDH status of diffuse gliomas.
Subject(s)
Brain Neoplasms , Glioblastoma , Glioma , Multiparametric Magnetic Resonance Imaging , Humans , Magnetic Resonance Imaging/methods , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Retrospective Studies , Neoplasm Grading , Glioma/diagnostic imaging , Glioma/pathology , Magnetic Resonance Spectroscopy/methods , Diffusion Magnetic Resonance Imaging/methods , CholineABSTRACT
Precise evaluation of the feeders, fistulous points, and draining veins plays a key role for successful embolization of intracranial dural arteriovenous fistulas (DAVF). Digital subtraction angiography (DSA) is a gold standard diagnostic tool to assess the exact angioarchitecture of DAVFs. With the advent of new image postprocessing techniques, we lately have been able to apply image fusion techniques with two different image sets obtained with flat panel detector rotational angiography. This new technique can provide additional and better pretherapeutic information of DAVFs over the conventional 2D and 3D angiographies. In addition, it can be used during the endovascular treatment to help the accurate and precise navigation of the microcatheter and microguidwire inside the vessels and identify the proper location of microcatheter in the targeted shunting pouch. In this study, we briefly review the process of an image fusion technique and introduce our clinical application for treating DAVFs, especially focused on the transvenous embolization.
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OBJECTIVE: We aimed to compare the clinical and radiological outcomes of vertebral artery dissecting aneurysms (VADAs) stratified using different endovascular treatment methods. METHODS: We retrospectively reviewed 116 patients with VADAs treated at a single tertiary institute between September 2008 and December 2020. We analyzed and compared the clinical and radiological parameters according to different treatment methods. RESULTS: In total, 127 endovascular procedures were performed in 116 patients. We initially treated 46 patients with parent artery occlusion, 9 with coil embolization without stent, 43 with single stent with or without coil, 16 with multiple stents with or without coils, and 13 with flow-diverting stent. At the last follow-up (mean 37.8 ± 30.9 months), the complete occlusion rate (85.7%) was higher in the multiple-stent group than in the groups that received other reconstructive treatment methods. Moreover, the recurrence (0%) and retreatment (0%) rates were significantly lower in the multiple stent group (P < 0.001). The coil embolization-only group showed the highest recurrence (n = 5, 62.5%) and incomplete occlusion (n = 1, 12.5%) rates. The single-stent group showed higher recurrence (n = 9, 22.5%) and retreatment (n = 3, 7%) rates. Multivariate logistic regression analyses showed that coil embolization without stent placement (odds ratio = 172.76, 95% confidence interval = 6.83-4366.85; P = 0.002) was significantly associated with recurrence. At the last follow-up (mean, 42.1 ± 37.7 months), we achieved favorable clinical outcomes (modified Rankin Scale ≤2) in 106 of 127 patients. CONCLUSION: When treating VADAs, multiple stent placements may play a key role in achieving favorable long-term radiological outcomes.
Subject(s)
Aortic Dissection , Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Vertebral Artery Dissection , Humans , Vertebral Artery/diagnostic imaging , Vertebral Artery/surgery , Retrospective Studies , Treatment Outcome , Embolization, Therapeutic/methods , Vertebral Artery Dissection/diagnostic imaging , Vertebral Artery Dissection/surgery , Stents , Endovascular Procedures/methods , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Cerebral AngiographyABSTRACT
BACKGROUND: A score derived from the concentrations of α-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) and tumor volume (TV), called ADV score, has been shown to be prognostic of hepatocellular carcinoma (HCC) recurrence following hepatic resection (HR) or liver transplantation. METHODS: This multicenter, multinational validation study included 9200 patients who underwent HR from 2010 to 2017 at 10 Korean and 73 Japanese centers, and were followed up until 2020. RESULTS: AFP, DCP, and TV showed weak correlations (ρ ≤ .463, r ≤ .189, p < .001). Disease-free survival (DFS), overall survival (OS), and post-recurrence survival rates were dependent on 1.0 log and 2.0 log intervals of ADV scores (p < .001). Receiver operating characteristic (ROC) curve analysis showed that ADV score cutoffs of 5.0 log for DFS and OS yielded the areas under the curve ≥ .577, with both being significantly prognostic of tumor recurrence and patient mortality at 3 years. ADV score cutoffs of ADV 4.0 log and 8.0 log, derived through K-adaptive partitioning method, showed higher prognostic contrasts in DFS and OS. ROC curve analysis showed that an ADV score cutoff of 4.2 log was suggestive of microvascular invasion, with both microvascular invasion and an ADV score cutoff of 4.2 log showing similar DFS rates. CONCLUSIONS: This international validation study demonstrated that ADV score is an integrated surrogate biomarker for post-resection prognosis of HCC. Prognostic prediction using ADV score can provide reliable information that can assist in planning treatment of patients with different stages of HCC and guide individualized post-resection follow-up based on the relative risk of HCC recurrence.
Subject(s)
Carcinoma, Hepatocellular , Liver Neoplasms , Humans , Prognosis , alpha-Fetoproteins/analysis , Japan , Retrospective Studies , Neoplasm Recurrence, Local , Biomarkers , Republic of Korea/epidemiology , Biomarkers, TumorABSTRACT
OBJECTIVES: The study aimed to develop a deep neural network (DNN)-based noise reduction and image quality improvement by only using routine clinical scans and evaluate its performance in 3D high-resolution MRI. METHODS: This retrospective study included T1-weighted magnetization-prepared rapid gradient-echo (MP-RAGE) images from 185 clinical scans: 135 for DNN training, 11 for DNN validation, 20 for qualitative evaluation, and 19 for quantitative evaluation. Additionally, 18 vessel wall imaging (VWI) data were included to evaluate generalization. In each scan of the DNN training set, two noise-independent images were generated from the k-space data, resulting in an input-label pair. 2.5D U-net architecture was utilized for the DNN model. Qualitative evaluation between conventional MP-RAGE and DNN-based MP-RAGE was performed by two radiologists in image quality, fine structure delineation, and lesion conspicuity. Quantitative evaluation was performed with full sampled data as a reference by measuring quantitative error metrics and volumetry at 7 different simulated noise levels. DNN application on VWI was evaluated by two radiologists in image quality. RESULTS: Our DNN-based MP-RAGE outperformed conventional MP-RAGE in all image quality parameters (average scores = 3.7 vs. 4.9, p < 0.001). In the quantitative evaluation, DNN showed better error metrics (p < 0.001) and comparable (p > 0.09) or better (p < 0.02) volumetry results than conventional MP-RAGE. DNN application to VWI also revealed improved image quality (3.5 vs. 4.6, p < 0.001). CONCLUSION: The proposed DNN model successfully denoises 3D MR image and improves its image quality by using routine clinical scans only. KEY POINTS: ⢠Our deep learning framework successfully improved conventional 3D high-resolution MRI in all image quality parameters, fine structure delineation, and lesion conspicuity. ⢠Compared to conventional MRI, the proposed deep neural network-based MRI revealed better quantitative error metrics and comparable or better volumetry results. ⢠Deep neural network application to 3D MRI whose pulse sequences and parameters were different from the training data showed improvement in image quality, revealing the potential to generalize on various clinical MRI.
Subject(s)
Deep Learning , Humans , Retrospective Studies , Quality Improvement , Imaging, Three-Dimensional/methods , Magnetic Resonance Imaging/methods , Image Processing, Computer-Assisted/methodsABSTRACT
BACKGROUND: The spread of unvetted scientific information about COVID-19 presents a significant challenge to public health, adding to the urgency for increased understanding of COVID-19 information-seeking preferences that will allow for the delivery of evidence-based health communication. This study examined factors associated with COVID-19 information-seeking behavior. METHODS: An online survey was conducted with US adults (N = 1800) to identify key interpersonal (e.g., friends, health care providers) and mediated (e.g., TV, social media) sources of COVID-19 information. Logistic regression models were fitted to explore correlates of information-seeking. RESULTS: Study findings show that the first sought and most trusted sources of COVID-19 information had different relationships with sociodemographic characteristics, perceived discrimination, and self-efficacy. Older adults had greater odds of seeking information from print materials (e.g., newspapers and magazines) and TV first. Participants with less educational attainment and greater self-efficacy preferred interpersonal sources first, with notably less preference for mass media compared to health care providers. Those with more experiences with discrimination were more likely to seek information from friends, relatives, and co-workers. Additionally, greater self-efficacy was related to increased trust in interpersonal sources. CONCLUSION: Study results have implications for tailoring health communication strategies to reach specific subgroups, including those more vulnerable to severe illness from COVID-19. A set of recommendations are provided to assist in campaign development.
Subject(s)
COVID-19 , Health Communication , Humans , Aged , Pandemics , COVID-19/epidemiology , Infodemic , Information Seeking Behavior , Surveys and QuestionnairesABSTRACT
Noonan syndrome (NS) is a genetic disorder mainly caused by gain-of-function mutations in Src homology region 2-containing protein tyrosine phosphatase 2 (SHP2). Although diverse neurological manifestations are commonly diagnosed in NS patients, the mechanisms as to how SHP2 mutations induce the neurodevelopmental defects associated with NS remain elusive. Here, we report that cortical organoids (NS-COs) derived from NS-induced pluripotent stem cells (iPSCs) exhibit developmental abnormalities, especially in excitatory neurons (ENs). Although NS-COs develop normally in their appearance, single-cell transcriptomic analysis revealed an increase in the EN population and overexpression of cortical layer markers in NS-COs. Surprisingly, the EN subpopulation co-expressing the upper layer marker SATB2 and the deep layer maker CTIP2 was enriched in NS-COs during cortical development. In parallel with the developmental disruptions, NS-COs also exhibited reduced synaptic connectivity. Collectively, our findings suggest that perturbed cortical layer identity and impeded neuronal connectivity contribute to the neurological manifestations of NS.
Subject(s)
Induced Pluripotent Stem Cells , Noonan Syndrome , Humans , Organoids , Noonan Syndrome/genetics , Brain , NeuronsABSTRACT
OBJECTIVE: To assess clinical outcomes of ruptured vertebral artery dissecting aneurysms, focusing on comparing parent artery occlusion (PAO) with stent-assisted treatments, and to identify risk factors for unfavorable outcomes and postprocedural complications. METHODS: This retrospective review included 36 ruptured vertebral artery dissecting aneurysms treated between February 2009 and April 2020. Treatment modalities included PAO without stent and stent-assisted treatments. Stent-assisted treatments included PAO with posterior inferior cerebellar artery (PICA) stenting and stent-assisted coiling. Univariate and multivariate analyses were conducted to evaluate risk factors for unfavorable outcomes and postprocedural complications. RESULTS: Patients were treated with PAO only (24, 66.7%), PAO with PICA stenting (4, 11.1%), and PAO with stent-assisted coiling (8, 22.2%). There were only fusiform aneurysms with PICA involvement in the PAO with PICA stenting group. In the stent-assisted coiling group, 4 aneurysms incorporated PICA, and 4 aneurysms involved dominant vertebral artery. Old age (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.01-1.56, P = 0.044) and poor Hunt-Hess grade (OR = 537.99, 95% CI = 6.73-42994.1, P = 0.005) were significantly associated with unfavorable clinical outcomes after a mean follow-up of 37.5 ± 32.8 months. Fusiform dilatation shape (OR = 15.97, 95% CI = 1.52-167.38, P = 0.021) and PICA involvement (OR = 13.71, 95% CI = 1.29-145.89, P = 0.030) were independent risk factors for ischemic complications. CONCLUSIONS: Unfavorable clinical outcomes were significantly related to old age and poor Hunt-Hess grade. There were no significant differences between treatment groups in clinical outcomes or ischemic complications. Stent-assisted treatments might be effective and safe methods for ruptured vertebral artery dissecting aneurysms.
Subject(s)
Aneurysm, Ruptured , Aortic Dissection , Craniocerebral Trauma , Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Vertebral Artery Dissection , Humans , Infant , Vertebral Artery/diagnostic imaging , Vertebral Artery/surgery , Treatment Outcome , Vertebral Artery Dissection/diagnostic imaging , Vertebral Artery Dissection/surgery , Stents , Embolization, Therapeutic/methods , Retrospective Studies , Endovascular Procedures/methods , Craniocerebral Trauma/therapy , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/surgery , Intracranial Aneurysm/therapyABSTRACT
OBJECTIVES: Acquiring high-quality magnetic resonance imaging (MRI) of the head and neck region is often challenging due to motion and susceptibility artifacts. This study aimed to compare image quality of 2 high-resolution three-dimensional (3D) MRI sequences of the neck, controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA)-volumetric interpolated breath-hold examination (VIBE), and golden-angle radial sparse parallel imaging (GRASP)-VIBE. MATERIALS AND METHODS: One hundred seventy-three patients indicated for contrast-enhanced neck MRI examination were scanned using 3 T scanners and both CAIPIRINHA-VIBE and GRASP-VIBE with nearly isotropic 3D acquisitions (<1 mm in-plane resolution with analogous acquisition times). Patients' MRI scans were independently rated by 2 radiologists using a 5-grade Likert scale for overall image quality, artifact level, mucosal and lesion conspicuity, and fat suppression degree at separate anatomical regions. Interobserver agreement was calculated using the Cohen κ coefficient. The quality ratings of both sequences were compared using the Mann-Whitney U test. Nonuniformity and contrast-to-noise ratio values were measured in all subjects. Separate MRI scans were performed twice for each sequence in a phantom and healthy volunteer without contrast injection to calculate the signal-to-noise ratio (SNR). RESULTS: The scores of overall image quality, overall artifact level, motion artifact level, and conspicuity of the nasopharynx, oropharynx, oral cavity, hypopharynx, and larynx were all significantly higher in GRASP-VIBE than in CAIPIRINHA-VIBE (all P 's < 0.001). Moderate to substantial interobserver agreement was observed in overall image quality (GRASP-VIBE κ = 0.43; CAIPIRINHA-VIBE κ = 0.59) and motion artifact level (GRASP-VIBE κ = 0.51; CAIPIRINHA-VIBE κ = 0.65). Lesion conspicuity was significantly higher in GRASP-VIBE than in CAIPIRINHA-VIBE ( P = 0.005). The degree of fat suppression was weaker in the lower neck regions in GRASP-VIBE (3.90 ± 0.72) than in CAIPIRINHA-VIBE (4.97 ± 0.21) ( P < 0.001). The contrast-to-noise ratio at hypopharyngeal level was significantly higher in GRASP-VIBE (6.28 ± 4.77) than in CAIPIRINHA-VIBE (3.14 ± 9.95) ( P < 0.001). In the phantom study, the SNR of GRASP-VIBE was 12 times greater than that of CAIPIRINHA-VIBE. The in vivo SNR of the volunteer MRI scan was 13.6 in CAIPIRINHA-VIBE and 20.7 in GRASP-VIBE. CONCLUSIONS: Both sequences rendered excellent images for head and neck MRI scans. GRASP-VIBE provided better image quality, as well as mucosal and lesion conspicuities, with less motion artifacts, whereas CAIPIRINHA-VIBE provided better fat suppression in the lower neck regions.
Subject(s)
Image Enhancement , Image Interpretation, Computer-Assisted , Acceleration , Artifacts , Breath Holding , Contrast Media , Humans , Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Imaging, Three-Dimensional/methods , Magnetic Resonance Imaging/methods , Reproducibility of ResultsABSTRACT
OBJECTIVE: To assess focal mineral deposition in the globus pallidus (GP) by CT and quantitative susceptibility mapping (QSM) of MRI scans and evaluate its clinical significance, particularly cerebrovascular degeneration. MATERIALS AND METHODS: This study included 105 patients (66.1 ± 13.7 years; 40 male and 65 female) who underwent both CT and MRI with available QSM data between January 2017 and December 2019. The presence of focal mineral deposition in the GP on QSM (GPQSM) and CT (GPCT) was assessed visually using a three-point scale. Cerebrovascular risk factors and small vessel disease (SVD) imaging markers were also assessed. The clinical and radiological findings were compared between the different grades of GPQSM and GPCT. The relationship between GP grades and cerebrovascular risk factors and SVD imaging markers was assessed using univariable and multivariable linear regression analyses. RESULTS: GPCT and GPQSM were significantly associated (p < 0.001) but were not identical. Higher GPCT and GPQSM grades showed smaller gray matter (p = 0.030 and p = 0.025, respectively) and white matter (p = 0.013 and p = 0.019, respectively) volumes, as well as larger GP volumes (p < 0.001 for both). Among SVD markers, white matter hyperintensity was significantly associated with GPCT (p = 0.006) and brain atrophy was significantly associated with GPQSM (p = 0.032) in at univariable analysis. In multivariable analysis, the normalized volume of the GP was independently positively associated with GPCT (p < 0.001) and GPQSM (p = 0.002), while the normalized volume of the GM was independently negatively associated with GPCT (p = 0.040) and GPQSM (p = 0.035). CONCLUSION: Focal mineral deposition in the GP on CT and QSM might be a potential imaging marker of cerebral vascular degeneration. Both were associated with increased GP volume.
Subject(s)
Brain Mapping , Globus Pallidus , Brain , Brain Mapping/methods , Female , Globus Pallidus/diagnostic imaging , Gray Matter , Humans , Iron , Magnetic Resonance Imaging/methods , Male , Minerals , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: We aimed to compare clinical outcomes of acute ischemic stroke (AIS) due to internal carotid artery (ICA) occlusion following mechanical thrombectomy (MT), focusing on occlusion types. METHODS: We retrospectively reviewed 67 AIS patients who had an ICA occlusion on computed tomography angiography and underwent MT in a single tertiary center. ICA occlusion types were categorized as (1) true cervical ICA (cICA) occlusion (true occlusion), (2) pseudo-occlusion of the cICA (pseudo-occlusion), and (3) distal ICA (dICA) occlusion. We compared the clinical characteristics and their outcomes according to the ICA occlusion type. RESULTS: Fourteen patients were diagnosed with true occlusion, 32 with pseudo-occlusion, and 21 with dICA occlusion. The main etiologies were atherothrombotic in true occlusion (64.3%) and cardioembolic in pseudo-occlusion (81.3%) and dICA occlusion (71.4%) (P < 0.001). Pseudo-occlusion showed lower rates of successful reperfusion (37.5%, P = 0.009, 78.6% in true occlusion and 71.4% in dICA occlusion) and poor functional outcome at 3 months (18.8%, P = 0.037, 50% in true occlusion and 47.6% in dICA occlusion) with statistical significance. The infarction volume (169.4 ± 154.4 mL, P = 0.004, 29.2 ± 52.7 mL in true occlusion and 105.8 ± 13.4 mL in dICA occlusion) was significantly higher in pseudo-occlusion. On multivariate logistic analysis, pseudo-occlusion (odds ratio [OR]: 4.84, 95% confidence interval [CI] 1.02-22.87, P = 0.023) was an independent risk factor for poor reperfusion, which was significantly associated with a poor functional prognosis (OR: 22.04, 95% CI 1.99-243.83, P = 0.012). CONCLUSIONS: Patients with pseudo-occlusion showed poorer clinical outcomes compared with other ICA occlusion types, possibly due to a poor reperfusion rate after MT.
Subject(s)
Carotid Artery Diseases , Carotid Stenosis , Ischemic Stroke , Stroke , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/surgery , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/surgery , Carotid Stenosis/complications , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/surgery , Humans , Prognosis , Retrospective Studies , Stroke/diagnostic imaging , Stroke/etiology , Treatment OutcomeABSTRACT
Advanced non-metastatic nasopharyngeal carcinoma (NPC) has variable treatment outcomes. However, there are no prognostic biomarkers for identifying high-risk patients with NPC. The aim of this systematic review and meta-analysis was to comprehensively assess the prognostic value of magnetic resonance imaging (MRI)-based radiomics for untreated NPC. The PubMed-Medline and EMBASE databases were searched for relevant articles published up to 12 August 2021. The Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) checklist was used to determine the qualities of the selected studies. Random-effects modeling was used to calculate the pooled estimates of Harrell's concordance index (C-index) for progression-free survival (PFS). Between-study heterogeneity was evaluated using Higgins' inconsistency index (I2). Among the studies reported in the 57 articles screened, 10 with 3458 patients were eligible for qualitative and quantitative data syntheses. The mean adherence rate to the TRIPOD checklist was 68.6 ± 7.1%. The pooled estimate of the C-index was 0.762 (95% confidence interval, 0.687-0.837). Substantial between-study heterogeneity was observed (I2 = 89.2%). Overall, MRI-based radiomics shows good prognostic performance in predicting the PFS of patients with untreated NPC. However, more consistent and robust study protocols are necessary to validate the prognostic role of radiomics for NPC.
ABSTRACT
OBJECTIVE: This study aimed to evaluate the image quality and dose reduction of low-dose three-dimensional (3D) rotational angiography (RA) for evaluating intracranial aneurysms. MATERIALS AND METHODS: We retrospectively evaluated the clinical data and 3D RA datasets obtained from 146 prospectively registered patients (male:female, 46:100; median age, 58 years; range, 19-81 years). The subjective image quality of 79 examinations obtained from a conventional method and 67 examinations obtained from a low-dose (5-seconds and 0.10-µGy/frame) method was assessed by two neurointerventionists using a 3-point scale for four evaluation criteria. The total image quality score was then obtained as the average of the four scores. The image quality scores were compared between the two methods using a noninferiority statistical testing, with a margin of -0.2 (i.e., score of low-dose group - score of conventional group). For the evaluation of dose reduction, dose-area product (DAP) and air kerma (AK) were analyzed and compared between the two groups. RESULTS: The mean total image quality score ± standard deviation of the 3D RA was 2.97 ± 0.17 by reader 1 and 2.95 ± 0.20 by reader 2 for conventional group and 2.92 ± 0.30 and 2.95 ± 0.22, respectively, for low-dose group. The image quality of the 3D RA in the low-dose group was not inferior to that of the conventional group according to the total image quality score as well as individual scores for the four criteria in both readers. The mean DAP and AK per rotation were 5.87 Gy-cm² and 0.56 Gy, respectively, in the conventional group, and 1.32 Gy-cm² (p < 0.001) and 0.17 Gy (p < 0.001), respectively, in the low-dose group. CONCLUSION: Low-dose 3D RA was not inferior in image quality and reduced the radiation dose by 70%-77% compared to the conventional 3D RA in evaluating intracranial aneurysms.