Radiomics Based on DCE-MRI for Predicting Response to Neoadjuvant Therapy in Breast Cancer.

RATIONALE AND OBJECTIVES: To compare the value of radiomics and diameter% based on pre- and early-treatment dynamic enhanced MR (DCE-MRI) of the breast in predicting response to neoadjuvant therapy (NAT) in breast cancer and to construct a tool for early noninvasive prediction of NAT outcomes. MATERIALS AND METHODS: Retrospective analysis of clinical and imaging data of 142 patients with primary invasive breast cancer who underwent DCE-MRI before and after two cycles of NAT at our institution. Enroled patients were randomly assigned in a 7:3 ratio to the training group and the test group. Patients were divided into pathological complete response (pCR) and non-pathological complete response groups based on surgical pathology findings after NAT. The maximum diameter relative regression values (Diameter%) before and after treatment were calculated and the conventional imaging Diameter% model was constructed. Based on pre- and early-NAT DCE-MRI, the optimal features of pre-NAT, early-NAT, and delta radiomics were screened using redundancy analysis, least absolute shrinkage, and selection operator methods to construct the corresponding radiomics model and calculate the Radscores. Indicators that were statistically significant in the univariate analysis of clinical data were further screened by stepwise regression and combined with Radscores to construct the fusion model. All models were evaluated and compared. RESULTS: In the test set, the area under the curve (AUC) of the delta radiomics model (0.87) was higher than that of the pre-NAT, early-NAT radiomics models (0.57, 0.78) and the Diameter% model (0.83). The fusion model had the best efficacy in predicting pCR after NAT, with AUCs of 0.91 in the training and test sets. And its nomogram plot showed that Radscore of early-NAT radiomics had the greatest weight. In the test set, the fusion model and Delta radiomics model improved the efficacy of predicting pCR by 35.56% and 14.19%, respectively, compared to the Diameter% model (P = 0 and .039). Clinical decision curves showed the highest overall clinical benefit for the fusion model. CONCLUSION: Radiomics, especially delta and early-NAT radiomics, may be potential biomarkers for early noninvasive prediction of NAT outcomes. And a fusion model constructed from meaningful clinicopathological indicators combined with radiomics can effectively predict NAT response.

Altered functional connectivity of the thalamus in primary angle-closure glaucoma patients: A resting-state fMRI study.

Background and objectives: Glaucoma is one of the leading irreversible causes of blindness worldwide, and previous studies have shown that there is abnormal functional connectivity (FC) in the visual cortex of glaucoma patients. The thalamus is a relay nucleus for visual signals; however, it is not yet clear how the FC of the thalamus is altered in glaucoma. This study investigated the alterations in thalamic FC in patients with primary angle-closure glaucoma (PACG) by using resting-state functional MRI (rs-fMRI). We hypothesized that PACG patients have abnormal FC between the thalamus and visual as well as extravisual brain regions. Methods: Clinically confirmed PACG patients and age- and gender-matched healthy controls (HCs) were evaluated by T1 anatomical and functional MRI on a 3 T scanner. Thirty-four PACG patients and 33 HCs were included in the rs-fMRI analysis. All PACG patients underwent complete ophthalmological examinations; included retinal nerve fiber layer thickness (RNFLT), intraocular pressure (IOP), average cup-to-disc ratio (A-C/D), and vertical cup-to-disc ratio (V-C/D). After the MRI data were preprocessed, the bilateral thalamus was chosen as the seed point; and the differences in resting-state FC between groups were evaluated. The brain regions that significantly differed between PACG patients and HCs were identified, and the correlations were then evaluated between the FC coefficients of these regions and clinical variables. Results: Compared with the HCs, the PACG patients showed decreased FC between the bilateral thalamus and right transverse temporal gyrus, between the bilateral thalamus and left anterior cingulate cortex, and between the left thalamus and left insula. Concurrently, increased FC was found between the bilateral thalamus and left superior frontal gyrus in PACG patients. The FC between the bilateral thalamus and left superior frontal gyrus was positively correlated with RNFLT and negatively correlated with the A-C/D and V-C/D. The FC between the left thalamus and left insula was negatively correlated with IOP. Conclusion: Extensive abnormal resting-state functional connections between the thalamus and visual and extravisual brain areas were found in PACG patients, and there were certain correlations with clinical variables, suggesting that abnormal thalamic FC plays an important role in the progression of PACG.

Brain Functional Network Analysis of Patients with Primary Angle-Closure Glaucoma.

OBJECTIVES: Recent resting-state functional magnetic resonance imaging (fMRI) studies have focused on glaucoma-related neuronal degeneration in structural and spontaneous functional brain activity. However, there are limited studies regarding the differences in the topological organization of the functional brain network in patients with glaucoma. In this study, we aimed to assess both potential alterations and the network efficiency in the functional brain networks of patients with primary angle-closure glaucoma (PACG). METHODS: We applied resting-state fMRI data to construct the functional connectivity network of 33 patients with PACG (54.21 ± 7.21 years) and 33 gender- and age-matched healthy controls (52.42 ± 7.80 years). The differences in the global and regional topological brain network properties between the two groups were assessed using graph theoretical analysis. Partial correlations between the altered regional values and clinical parameters were computed for patients with PACG. RESULTS: No significant differences in global topological measures were identified between the two groups. However, significant regional alterations were identified in the patients with PACG, including differences within visual and nonvisual (somatomotor and cognition-emotion) regions. The normalized clustering coefficient and normalized local efficiency of the right superior parietal gyrus were significantly correlated with the retinal fiber layer thickness (RNFLT) and the vertical cup to disk ratio (V C/D). In addition, the normalized node betweenness of the left middle frontal gyrus (orbital portion) was significantly correlated with the V C/D in the patients with PACG. CONCLUSIONS: Our results suggest that regional inefficiency with decrease and compensatory increase in local functional properties of visual and nonvisual nodes preserved the brain network of the PACG at the global level.

Renal epithelioid angiomyolipoma: computed tomography manifestation and radiologic-pathologic correlation depending on different epithelioid component percentages.

BACKGROUND: Renal epithelioid angiomyolipoma (EAML) is a rare and potentially malignant mesenchymal lesion mainly composed of epithelioid cells. Although some case reports or small case series have been published, the computed tomography (CT) manifestations and radiologic-pathologic correlation depending on different epithelioid component percentages have not been studied before. OBJECTIVE: To investigate the CT manifestation and radiologic-pathologic correlation between renal EAML and angiomyolipoma (AML) with epithelioid component. METHODS: The clinicopathologic and imaging data of 53 patients with an original diagnosis of EAML or AML with epithelioid component were retrospectively collected from three hospitals. All tissue specimens were re-sectioned and re-observed under the microscope. Samples were divided into an EAML group (≥ 80% epithelioid component, n = 25) and AML with epithelioid component group (5% ≤ epithelioid component < 80%, n = 28). Two radiologists reviewed the images in consensus, describing and comparing the CT manifestation, including the long diameter of the tumor, morphology, presence of necrosis or cystic change, hemorrhage, fat, calcification, enlarged blood vessels, and dynamic enhancement pattern according to the Hounsfield unit value of each CT phase between the two groups. The radiologic-pathologic correlation depending on the different percentages of epithelioid component were studied. RESULTS: The long diameter of the tumor, presence of necrosis or cystic change, fat, enhancement pattern, and tumor-to-cortex enhancement ratio of the cortical phase between the two groups were significantly different (z = - 2.932, P = 0.003; χ2 = 18.020, P < 0.001; χ2 = 16.377, P < 0.001; P = 0.020; and T = - 3.944, P < 0.001, respectively). In multivariate logistic regression analysis, the significant predictive factors of EAML included the presence of necrosis or cystic change [odds ratio (OR) 11.864, P = 0.001] and absence of fat (OR 0.095, P = 0.003). Correlation analysis found that the presence of necrosis or cystic change (r = 0.679, P < 0.001) and fat (r = - 0.603, P < 0.001) were both moderately related to the epithelioid component percentage. The combined model based on the presence of necrosis or cystic change and absence of fat yielded the best diagnostic performance in discriminating EAML and AML with epithelioid component with the highest area under the curve (0.887). CONCLUSION: EAML has characteristic CT signs; these characteristic CT signs are closely related to the epithelioid component percentage. The presence of necrosis or cystic change and the absence of fat were independent predictors of EAML.

Development and Validation of a Deep Learning-Based Model Using Computed Tomography Imaging for Predicting Disease Severity of Coronavirus Disease 2019.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) is sweeping the globe and has resulted in infections in millions of people. Patients with COVID-19 face a high fatality risk once symptoms worsen; therefore, early identification of severely ill patients can enable early intervention, prevent disease progression, and help reduce mortality. This study aims to develop an artificial intelligence-assisted tool using computed tomography (CT) imaging to predict disease severity and further estimate the risk of developing severe disease in patients suffering from COVID-19. MATERIALS AND METHODS: Initial CT images of 408 confirmed COVID-19 patients were retrospectively collected between January 1, 2020 and March 18, 2020 from hospitals in Honghu and Nanchang. The data of 303 patients in the People's Hospital of Honghu were assigned as the training data, and those of 105 patients in The First Affiliated Hospital of Nanchang University were assigned as the test dataset. A deep learning based-model using multiple instance learning and residual convolutional neural network (ResNet34) was developed and validated. The discrimination ability and prediction accuracy of the model were evaluated using the receiver operating characteristic curve and confusion matrix, respectively. RESULTS: The deep learning-based model had an area under the curve (AUC) of 0.987 (95% confidence interval [CI]: 0.968-1.00) and an accuracy of 97.4% in the training set, whereas it had an AUC of 0.892 (0.828-0.955) and an accuracy of 81.9% in the test set. In the subgroup analysis of patients who had non-severe COVID-19 on admission, the model achieved AUCs of 0.955 (0.884-1.00) and 0.923 (0.864-0.983) and accuracies of 97.0 and 81.6% in the Honghu and Nanchang subgroups, respectively. CONCLUSION: Our deep learning-based model can accurately predict disease severity as well as disease progression in COVID-19 patients using CT imaging, offering promise for guiding clinical treatment.

Altered functional connectivity density in primary angle-closure glaucoma patients at resting-state.

BACKGROUND: Primary angle-closure glaucoma (PACG) is a neurodegenerative disease. Previous structural and functional studies of functional magnetic resonance imaging (fMRI) have demonstrated widespread dysfunction of spontaneous activity in the PACG brain. In this study, we applied a data-driven graph theory approach of functional connectivity density (FCD) mapping to investigate the altered local and global functional connectivity (FC) of the cortex in PACG. METHODS: Forty-five PACG patients (53.28±10.79 years, 17 males/28 females) and 46 well-matched healthy controls (HCs) (52.67±11.01 years,18 males/28 females) received resting-state fMRI scans. All PACG patients finished complete ophthalmologic examinations, including retinal nerve fiber layer thickness (RNFLT), intraocular pressure (IOP), average cup to disc ratio (A-C/D), and vertical cup to disc ratio (V-C/D). We calculated the between-group FCD difference for short-range and long-range in each voxel. Then, we generated the intrinsic FC of the seed region with the whole brain. Finally, correlations were investigated between FCD value of the altered regions and clinical variables. RESULTS: PACG patients showed increased short-range FCD in the left inferior frontal gyrus (IFG)/insula/parahippocampal gyrus and right IFG/insula (P<0.05, corrected), compared with the HCs. Simultaneously, the decreased regions in short-range FCD map were the occipital/cuneus/precuneus/superior parietal/postcentral lobe (P<0.05, corrected). In the PACG groups, decreased long-range FCD was observed in the left middle frontal gyrus compared to the HC (P<0.05, corrected). RNFLT was positively correlated with decreased short-range FCD value of the occipital/cuneus/precuneus/superior parietal/postcentral lobes, and the A-C/D was negatively correlated with the increased short-range FCD value of the left IFG/insula/parahippocampal gyrus, and the right IFG/insula. CONCLUSIONS: Our findings suggest that PACG can induce extensive brain dysfunction, and showed different spatial distribution in short- and long-range FCD.

Intrinsic Functional Connectivity Alterations of the Primary Visual Cortex in Primary Angle-Closure Glaucoma Patients before and after Surgery: A Resting-State fMRI Study.

PURPOSE: To investigate the altered intrinsic functional connectivity (iFC) of the primary visual cortex (V1) in primary angle-closure glaucoma (PACG) patients before and after surgery using resting-state functional MRI. MATERIALS AND METHODS: Twenty-five preoperative PACG (pre-PACG) patients and 25 well-matched healthy controls (HCs) were included in this study, and 9 PACG patients were assessed again at least 3 months after treatment (post-PACG). We generated the iFC maps of the seed regions in the centers of the left and right V1 and conducted group comparisons. Then, the relationships between the altered iFC coefficients and clinical variables were investigated in the pre-PACG patients. RESULTS: Compared with the HCs, the pre-PACG patients showed decreased iFC between the left V1 and right V2 (covering the cuneus, calcarine and lingual gyrus) and increased iFC between the left V1 and left temporal-parietal region, left frontal opercula-insula-basal ganglia region, right insula-basal ganglia region, and right inferior parietal lobule (P < 0.01, corrected). Compared with the pre-PACG patients, the post-PACG patients showed increased iFC between the left V1 and bilateral V2, and between the left V1 and left or right postcentral gyrus; in addition, they showed decreased iFC between the left V1 and the dorsal-attention and frontoparietal-control networks. In the pre-PACG patients, visual activity (VA) was positively correlated with increased iFC between the left V1 and the left temporal-parietal region or the right inferior parietal lobule. Similar patterns of alterations were observed in the right V1-iFC in both the pre- and post-PACG patients. CONCLUSIONS: The primary findings have demonstrated a gradual decrease in visual information integration in the left V1-V2 pathway and VA-related functional compensation in the pre-PACG patients, generating further evidence of functional restoration in post-PACG patients.

Altered intrinsic regional brain spontaneous activity in patients with comitant strabismus: a resting-state functional MRI study.

OBJECTIVE: To investigate the underlying regional homogeneity (ReHo) of brain-activity abnormalities in patients with comitant strabismus (CS) and their relationship with behavioral performance. METHODS: Twenty patients with CS (ten men and ten women) and 20 (ten men and ten women) age-, sex-, and education-matched healthy controls (HCs) underwent resting-state functional magnetic resonance imaging scans. The ReHo method was used to assess local features of spontaneous brain activities. Patients with CS were distinguished from HCs by receiver operating characteristic curve. Correlation analysis was performed to explore the relationship between the observed mean ReHo values of the different brain areas and behavioral performance. RESULTS: Compared to HCs, the patients with CS showed significantly increased ReHo values in the right inferior temporal cortex/fusiform gyrus/cerebellum anterior lobe, right lingual gyrus, and bilateral cingulate gyrus. We did not find any relationship between the observed mean ReHo values of the different brain areas and behavioral performance. CONCLUSION: CS causes dysfunction in many brain regions, which may explain the fusion compensation in CS.

Altered intrinsic regional spontaneous brain activity in patients with optic neuritis: a resting-state functional magnetic resonance imaging study.

OBJECTIVE: To investigate the underlying regional homogeneity (ReHo) in brain-activity deficit in patients with optic neuritis (ON) and its relationship with behavioral performance. MATERIALS AND METHODS: In total, twelve patients with ON (four males and eight females) and twelve (four males and eight females) age-, sex-, and education-matched healthy controls underwent resting-state functional magnetic resonance imaging scans. The ReHo method was used to assess the local features of spontaneous brain activity. Correlation analysis was used to explore the relationship between the observed mean ReHo values of the different brain areas and the visual evoked potential (VEP) in patients with ON. RESULTS: Compared with the healthy controls, patients with ON showed lower ReHo in the left cerebellum, posterior lobe, left middle temporal gyrus, right insula, right superior temporal gyrus, left middle frontal gyrus, bilateral anterior cingulate cortex, left superior frontal gyrus, right superior frontal gyrus, and right precentral gyrus, and higher ReHo in the cluster of the left fusiform gyrus and right inferior parietal lobule. Meanwhile, we found that the VEP amplitude of the right eye in patients with ON showed a positive correlation with the ReHo signal value of the left cerebellum posterior lobe (r=0.701, P=0.011), the right superior frontal gyrus (r=0.731, P=0.007), and the left fusiform gyrus (r=0.644, P=0.024). We also found that the VEP latency of the right eye in ON showed a positive correlation with the ReHo signal value of the right insula (r=0.595, P=0.041). CONCLUSION: ON may involve dysfunction in the default-mode network, which may reflect the underlying pathologic mechanism.

Network Centrality of Resting-State fMRI in Primary Angle-Closure Glaucoma Before and After Surgery.

PURPOSE: Using voxel-wise degree centrality (DC), as measured by resting-state fMRI, we aimed to study alterations in the brain functional networks in patients with primary angle-closure glaucoma (PACG) and to reveal the plastic trajectories of surgery. METHODS: A total of 23 preoperative PACG patients (49.48 ± 14.37 years old) were recruited to undergo a resting-state fMRI scan, and 9 of them were rescanned 3 months after surgery. All PACG patients underwent a complete ophthalmologic examination, including intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness, vertical cup to disc ratio (V C/D), and average cup to disc ratio (A C/D). Another 23 gender- and age-matched healthy controls (48.18 ± 9.40 years old) underwent scanning once for comparison. The group difference in DC was calculated in each voxel, and the correlations between the DC value and each of the clinical variables were analyzed in the PACG patients. RESULTS: Preoperative PACG (pre-PACG) patients showed significantly decreased DC in the bilateral visual cortices but increased DC in the left anterior cingulate cortex (ACC) and caudate (p < 0.05, corrected) compared with the controls. Statistical analysis showed a significantly negative correlation between DC in the bilateral visual cortices and the IOP score and between DC in the anterior cingulate cortex (ACC) and both the A C/D and V C/D scores in the pre-PACG patients. Three months after surgery, these postoperative PACG (post-PACG) patients showed a significantly increased DC in both the bilateral visual cortices and the left precentral gyrus compared with the pre-PACG patients. CONCLUSIONS: Our results suggest that PACG may contribute to decreased functional centrality in the visual system and to increased degree centrality in cognition-emotional processing regions. Alterations in visual areas seem to parallel the cup to disc ratio, but not the duration of angle closure. The changes of functional centrality in PACG patients after operation may reveal the plasticity or degeneration of the visual-associated brain areas. Our findings may provide further understanding of the pathophysiology of PACG.

Disturbed spontaneous brain-activity pattern in patients with optic neuritis using amplitude of low-frequency fluctuation: a functional magnetic resonance imaging study.

OBJECTIVE: To use the amplitude of low-frequency fluctuation (ALFF) technique to investigate the local features of spontaneous brain activity in optic neuritis (ON) and their relationship with behavioral performance. MATERIALS AND METHODS: Twelve patients with ON (four male, eight female) and twelve age-, sex-, and education status-matched healthy controls (HCs) (four male, eight female) underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans. The ALFF technique was used to assess local features of spontaneous brain activity. Correlation analysis was used to explore the relationship between the observed mean ALFF values of the different areas and visual evoked potentials (VEPs) in patients with ON. RESULTS: Compared with HCs, patients with ON had significantly decreased ALFF values in the posterior and anterior lobes of the right cerebellum, right putamen, right inferior frontal gyrus, right insula, right supramarginal gyrus, right inferior parietal lobule, left medial frontal gyrus, left superior temporal gyrus, bilateral anterior cingulate/medial frontal gyrus, and bilateral precuneus, and significantly increased ALFF values in the posterior lobes of the left and right cerebellum, right inferior temporal gyrus, right inferior temporal/fusiform gyrus, left parahippocampal gyrus, left fusiform gyrus, left calcarine fissure, left inferior parietal lobule, and left cuneus. We found negative correlations between the mean ALFF signal value of the left parahippocampal gyrus and the VEP amplitude of the right eye in ON (r=-0.584, P=0.046), and a positive correlation between the mean ALFF signal value of the bilateral precuneus and the best-corrected visual acuity of the left eye (r=0.579, P=0.048) in patients with ON. CONCLUSION: ON mainly seems to involve dysfunction in the default-mode network, cerebellum, and limbic system, which may reflect the underlying pathologic mechanism of ON.