What benefit can be obtained from magnetic resonance imaging diagnosis with artificial intelligence in prostate cancer compared with clinical assessments?

The present study aimed to explore the potential of artificial intelligence(AI)methodology based on magnetic resonance(MR)images to aid in the management of prostate cancer(PCa).To this end,we reviewed and summarized the studies comparing the diagnostic and predictive performance for PCa between AI and common clinical assessment methods based on MR images and/or clinical characteristics,thereby investigating whether AI methods are generally superior to common clinical assessment methods for the diagnosis and prediction fields of PCa.First,we found that,in the included studies of the present study,AI methods were generally equal to or better than the clinical assessment methods for the risk assessment of PCa,such as risk stratification of prostate lesions and the prediction of therapeutic outcomes or PCa progression.In particular,for the diagnosis of clinically significant PCa,the AI methods achieved a higher summary receiver operator characteristic curve(SROC-AUC)than that of the clinical assessment methods(0.87 vs.0.82).For the prediction of adverse pathology,the AI methods also achieved a higher SROC-AUC than that of the clinical assessment methods(0.86 vs.0.75).Second,as revealed by the radiomics quality score(RQS),the studies included in the present study presented a relatively high total average RQS of 15.2(11.0–20.0).Further,the scores of the individual RQS elements implied that the AI models in these studies were constructed with relatively perfect and standard radiomics processes,but the exact generalizability and clinical practicality of the AI models should be further validated using higher levels of evidence,such as prospective studies and open-testing datasets.

Optimal b value of diffusion-weighted imaging on a 3.0T magnetic resonance scanner in Crohn's disease

AIM: To determine the optimal b value of diffusion-weighted imaging for detecting active inflammation in Crohn’s disease.

Incremental value of magnetic resonance imaging in the advanced management of prostate cancer

Prostate cancer is a major public health burden throughout the world.The high incidence of prostate cancer,combined with earlier detection and downstaging at the time of diagnosis,and the slow natural progression and biological heterogeneity of the disease,has made its management a complex and controversial issue.There is growing demand for patient-specific therapies that can minimize treatment morbidity while maximizing treatment benefits.There are a number of clinical parameters and clinical nomograms to help with the choice of treatment.Magnetic resonance imaging(MRI)is a technique which makes safer,more individualized therapies possible due to high spatial resolution,superior contrast resolution,multiplanar capability,and a large field of view.Other MRI techniques such as MR spectroscopic imaging,dynamic contrast-enhanced MRI or perfusion MRI,and diffusion-weighted imaging complement MRI by reflecting tissue biochemistry,Brownian motion of water molecules,and capillary wall permeability,respectively.This editorial review highlights the incremental value of MRI in the advanced management of prostate cancer to non-invasively improve cancer staging,biologic potential,treatment planning,therapy response,local recurrence,and to guide target biopsy for clinical suspected cancer with previous negative biopsy.Finally,some future prospects for MRI in prostate cancer management are given.

Clinical features,radiological imaging,and treatment strategies of nonmetallic intraorbital foreign bodies:a retrospective analysis

AIM:To provide comprehensive data on nonmetallic intraorbital foreign bodies(IOFBs)by summarizing and analyzing material types,clinical manifestations,imaging features,and treatment strategies.METHODS:Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed.The types of foreign bodies,clinical features,imaging manifestations,and treatment outcomes were analyzed.RESULTS:Among all cases,67.8%(19/28)of the foreign bodies were organic.The top three entrances were the upper eyelid skin(7/28),lower fornix conjunctiva(6/28),and lower eyelid skin(4/28).In most cases(11/28,39.3%),foreign bodies remained in the medial orbits.The major clinical manifestations included eyelid redness and swelling(20/28,71.4%),conjunctival congestion and edema(17/28,60.7%),and ophthalmoptosis(15/28,53.6%).Infection was the main complication,which occurred in 57.1%(16/28)of all cases.Computerized tomography(CT)values differed for different foreign bodies and varied in the different periods after injury.The plant-and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging(MRI).The prognosis varied with different foreign body types,surgery timing,and intraoperative management.CONCLUSION:The majority of nonmetallic IOFBs are organic and often remain in the superior,medial,and inferior areas of the orbit.Clinical manifestations vary owing to their different textures.CT and MRI facilitate the identification of foreign body materials.Plant-derived foreign bodies should be completely removed,and surgical treatment is a complicated process.

Evaluation of diffusion weighted imaging of magnetic resonance imaging in small focal hepatic lesions:a quantitative study in 56 cases

Diffusion-weighted imaging (DWI) as a new technique of magnetic resonance imaging (MRI) is used to detect focal hepatic lesions. This study was designed to evaluate the significance of DWI to differentiate focal hepatic lesions less than 3 cm in diameter by the quantitation of apparent diffusion coefficient (ADC) values. METHODS:DWI using 1.5T MRI scanner unit was performed with a spin-echo single-shot echo planar imaging (EPI) in 56 cases of small focal hepatic lesions, including hepatocellular carcinoma (11), hepatic metastatic tumor (15 ), hepatic cavernous hemangioma (14), and hepatic cyst (16).The ADC values of these lesions were calculated respectively. The ratios of the ADC values of lesion/liver in hepatocellular carcinomas and hepatic metastatic tumors were also estimated. RESULTS:The mean ADC values (mm2/s) were (0.93±0.06) ×10-3 in hepatocellular carcinomas, (1.09±0.18)×10-3 in hepatic metastatic tumors,(1.95±0.38)×10-3 in hepatic cavernous hemangiomas, and (3.18±0.33) ×10-3 in hepatic cysts. The ratios of ADC values of lesion/liver were 0.90±0.06 and 1.15±0.14 in hepatocellular carcinoma and hepatic metastatic tumors respectively, which were significantly different (P<0.05). CONCLUSION:The measurement of ADC values and the ratios of ADC values of lesion/liver are helpful in MR diagnosis and differentiation of focal hepatic lesions.

Efficacy of digital breast tomosynthesis combined with magnetic resonance imaging in the diagnosis of early breast cancer

BACKGROUND The incidence and mortality rate of breast cancer in China rank 120th and 163rd,worldwide,respectively.The incidence of breast cancer is on the rise;the risk increases with age but is slightly reduced after menopause.Early screening,diagnosis,and timely determination of the best treatment plan can ensure clinical efficacy and prognosis.AIM To evaluate the clinical value of magnetic resonance imaging(MRI) combined with digital breast tomosynthesis(DBT) in diagnosing early breast cancer and the effect of breast-conserving surgery by arc incision.METHODS This study was divided into two parts.Firstly,110 patients with early breast cancer confirmed by pathological examination and 110 with benign breast diseases diagnosed simultaneously in Changzhi People’s Hospital of Shanxi Province and Shanxi Dayi Hospital from May 2019 to September 2020 were included in the breast cancer group and the benign group,respectively.Both groups underwent DBT and MRI examination,and the pathological results were used as the gold standard to evaluate the effectiveness of the combined application of DBT and MRI in the diagnosis of early breast cancer.Secondly,according to the operation method,110 patients with breast cancer were divided into either a breast-conserving group(69 patients) or a modified radical mastectomy group(41 patients).The surgical effect,cosmetic effect,and quality of life of the two groups were compared.RESULTS Among the 110 cases of breast cancer,66 were of invasive ductal carcinoma(60.00%),and 22 were of ductal carcinoma in situ(20.00%).Among the 110 cases of benign breast tumors,55 were of breast fibromas(50.00%),and 27 were of breast adenosis(24.55%).The sensitivity,specificity,and area under the curve(AUC) of DBT in the differential diagnosis of benign and malignant breast tumors were 73.64%,84.55%,and 0.791,respectively.The sensitivity,specificity,and AUC of MRI in the differential diagnosis of benign and malignant breast tumors were 84.55%,85.45%,and 0.850,respectively.The sensitivity,specificity,and AUC of DBT combined with MRI in the differential diagnosis of benign and malignant breast tumors were 97.27%,93.64%,and 0.955,respectively.The blood loss,operation time and hospitalization time of the breast-conserving group were significantly lower than those of the modified radical treatment group,and the difference was statistically significant(P < 0.05).After 3 mo of observation,the breast cosmetic effect of the breast-conserving group was better than that of the modified radical group,and the difference was statistically significant(P < 0.05).Before surgery,the quality-of-life scores of the breast-conserving and modified radical mastectomy groups did not differ(P > 0.05).Three months after surgery,the quality-of-life scores in both groups were higher than those before surgery(P < 0.05),and the quality-of-life score of the breast-conserving group was higher than that of the modified radical group(P < 0.05).In the observation of tumor recurrence rate two years after the operation,four patients in the breast-conserving group and one in the modified radical treatment group had a postoperative recurrence.There was no significant difference in the recurrence rate between the two groups(χ2 = 0.668,P = 0.414 > 0.05).CONCLUSION MRI combined with DBT in diagnosing early breast cancer can significantly improve the diagnostic efficacy compared with the two alone.Breast-conserving surgery leads to better cosmetic breast effects and reduces the impact of surgery on postoperative quality of life.

Diagnosis and management of ischemic cardiomyopathy: Role of cardiovascular magnetic resonance imaging

Coronary artery disease(CAD) represents an important cause of mortality. Cardiovascular magnetic resonance(CMR) imaging evolved as an imaging modality that allows the assessment of myocardial function, perfusion, contractile reserve and extent of fibrosis in a single comprehensive exam. This review highlights the role of CMR in the differential diagnosis of acute chest pain by detecting the location of obstructive CAD or necrosis and identifying other conditions like stress cardiomyopathy or myocarditis that can present with acute chest pain. Besides, it underlines the prognostic implication of perfusion abnormalities in the setting of acute chest pain. Furthermore, the review addresses the role of CMR to detect significant CAD in patients with stable CAD. It elucidates the accuracy and clinical utility of CMR with respect to other imaging modalitieslike single-photon emission computed tomography and positron emission tomography. Besides, the prognostic value of CMR stress testing is discussed. Additionally, it summarizes the available CMR techniques to assess myocardial viability and describes algorithm to identify those patient who might profit from revascularization those who should be treated medically. Finally, future promising imaging techniques that will provide further insights into the fundamental disease processes in ischemic cardiomyopathy are discussed.

Survivors of COVID-19 exhibit altered amplitudes of low frequency fluctuation in the brain: a resting-state functional magnetic resonance imaging study at 1-year follow-up

Although some short-term follow-up studies have found that individuals recovering from coronavirus disease 2019(COVID-19)exhibit anxiety,depression,and altered brain microstructure,their long-term physical problems,neuropsychiatric sequelae,and changes in brain function remain unknown.This observational cohort study collected 1-year follow-up data from 22 patients who had been hospitalized with COVID-19(8 males and 11 females,aged 54.2±8.7 years).Fatigue and myalgia were persistent symptoms at the 1-year follow-up.The resting state functional magnetic resonance imaging revealed that compared with 29 healthy controls(7 males and 18 females,aged 50.5±11.6 years),COVID-19 survivors had greatly increased amplitude of low-frequency fluctuation(ALFF)values in the left precentral gyrus,middle frontal gyrus,inferior frontal gyrus of operculum,inferior frontal gyrus of triangle,insula,hippocampus,parahippocampal gyrus,fusiform gyrus,postcentral gyrus,inferior parietal angular gyrus,supramarginal gyrus,angular gyrus,thalamus,middle temporal gyrus,inferior temporal gyrus,caudate,and putamen.ALFF values in the left caudate of the COVID-19 survivors were positively correlated with their Athens Insomnia Scale scores,and those in the left precentral gyrus were positively correlated with neutrophil count during hospitalization.The long-term follow-up results suggest that the ALFF in brain regions related to mood and sleep regulation were altered in COVID-19 survivors.This can help us understand the neurobiological mechanisms of COVID-19-related neuropsychiatric sequelae.This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University(approval No.2020 S004)on March 19,2020.

Spectrum of intracranial incidental findings on pediatric brain magnetic resonance imaging:What clinician should know?

Intracranial incidental findings on magnetic resonance imaging(MRI) of the brain continue to generate interest in healthy control,research,and clinical subjects.However,in clinical practice,the discovery of incidental findings acts as a "distractor".This review is based on existing heterogeneous reports,their clinical implications,and how the results of incidental findings influence clinical management.This draws attention to the followings:(1) the prevalence of clinically significant incidental findings is low;(2) there is a lack of a systematic approach to classification;and discusses(3) how to deal with the detected incidental findings based a proposed common clinical profile.Individualized neurological care requires an active discussion regarding the need for neuroimaging.Clinical significance of incidental findings should be decided based on lesion's neuroradiologic characteristics in the given clinical context.Available evidence suggests that the outcome of an incidentally found "serious lesion in children" is excellent.Future studies of intracranial incidental findings on pediatric brain MRI should be focused on a homogeneous population.The study should address this clinical knowledge based review powered by the statistical analyses.

Importance of b value in diffusion weighted imaging for the diagnosis of pancreatic cancer

AIM:To investigate the use of multi-b-value diffusionweighted imaging in diagnosing pancreatic cancer.METHODS:We retrospectively analyzed 33 cases of pancreatic cancer and 12 cases of benign pancreatic tumors at the Second Affiliated Hospital of Kunming Medical University from December 2008 to January2011.The demographic characteristics,clinical presentation,routine magnetic resonance imaging and diffusion weighted imaging(DWI)features with different b values were reviewed.Continuous data were expressed as mean±SD.Comparisons between pancreatic cancer and benign pancreatic tumors were performed using the Student’s t test.A probability of P<0.05 was considered statistically significant.RESULTS:Thirty-three patients with pancreatic cancer were identified.The mean age at diagnosis was 60±5.6 years.The male:female ratio was 21:12.Twenty cases were confirmed by surgical resection and 13 by biopsy of metastases.T1 weighted images demonstrated a pancreatic head mass in 16 patients,a pancreatic body mass in 10 cases,and a pancreatic tail mass with pancreatic atrophy in 7 cases.Eight patients had hepatic metastases,13 had invasion or envelopment of mesenteric vessels,4 had bone metastases,and 8had lymph node metastases.DWI demonstrated an irregular intense mass with unclear margins.Necrotic tissue demonstrated an uneven low signal.A b of 1100s/mm2was associated with a high intensity signal with poor anatomical delineation.A b of 700 s/mm2was associated with apparent diffusion coefficients(ADCs)that were useful in distinguishing benign and malignant pancreatic tumors(P<0.05).b values of 50,350,400,450 and 1100 s/mm2were associated with ADCs that did not differentiate the two tumors.CONCLUSION:Low b value images demonstrated superior anatomical details when compared to high b value images.Tumor tissue definition was high and contrast with the surrounding tissues was good.DWI was useful in diagnosing pancreatic cancer.

Stage and size using magnetic resonance imaging and endosonography in neoadjuvantly-treated rectal cancer

AIM: To assess the stage and size of rectal tumours using 1.5 Tesla (1.5T) magnetic resonance imaging (MRI) and three-dimensional (3D) endosonography (ERUS). METHODS: In this study, patients were recruited in a phaseⅠ/Ⅱ trial of neoadjuvant chemotherapy for biopsy-proven rectal cancer planned for surgical resection with or without preoperative radiotherapy. The feasibility and accuracy of 1.5T MRI and 3D ERUS were compared with the histopathology of the fixed surgical specimen (pathology) to determine the stage and size of the rectal cancer before and after neoadjuvant chemotherapy. A Philips Intera 1.5T with a cardiac 5-channel synergy surface coil was used for the MRI, and a B-K Medical Falcon 2101 EXL 3D-Probe was used at 13 MHz for the ERUS. Our hypothesis was that the staging accuracy would be the same when using MRI, ERUS and a combination of MRI and ERUS. For the combination, MRI was chosen for the assessment of the lymph nodes, and ERUS was chosen for the assessment of perirectal tissue penetration. The stage was dichotomised into stageⅠ and stage Ⅱ or greater. The size was measured as the supero-inferior length and the maximal transaxial area of the tumour. RESULTS: The staging feasibility was 37 of 37 for the MRI and 29 of 36 for the ERUS, with stenosis as a limiting factor. Complete sets of investigations were available in 18 patients for size and 23 patients for stage. The stage accuracy by MRI, ERUS and the combination of MRI and ERUS was 0.65, 0.70 and 0.74, respectively, before chemotherapy and 0.65, 0.78 and 0.83, respectively, after chemotherapy. The improvement of the post-chemotherapy staging using the combination of MRI and ERUS compared with the staging using MRI alone was significant (P = 0.046). The post-chemotherapy understaging frequency by MRI, ERUS and the combination of MRI and ERUS was 0.18, 0.14 and 0.045, respectively, and these differences were non-significant. The measurements of the supero-inferior length by ERUS compared with MRI were within 1.96 standard deviations of the difference between the methods (18 mm) for tumours smaller than 50 mm. The agreement with pathology was within 1.96 standard deviations of the difference between imaging and pathology for all tumours with MRI (15 mm) and for tumours that did not exceed 50 mm with ERUS (22 mm). Tumours exceeding 50 mm in length could not be reliably measured by ERUS due to the limit in the length of each recording. CONCLUSION: MRI is preferable to use when assessing the size of large or stenotic rectal tumours. However, staging accuracy is improved by combining MRI with ERUS.

Neuroimaging mechanisms of high-frequency repetitive transcranial magnetic stimulation for treatment of amnestic mild cognitive impairment:a double-blind randomized sham-controlled trial

Individuals with amnestic mild cognitive impairment(aMCI)have a high risk of developing Alzheimer’s disease.Although repetitive transcranial magnetic stimulation(rTMS)is considered a potentially effective treatment for cognitive impairment in patients with aMCI,the neuroimaging mechanisms are poorly understood.Therefore,we performed a double-blind randomized sham-controlled trial in which rTMS was applied to the left dorsolateral prefrontal cortex of aMCI patients recruited from a community near the Third Hospital Affiliated to Sun Yat-sen University,China.Twenty-four patients with aMCI were randomly assigned to receive true rTMS(treatment group,n=12,6 men and 6 women;age 65.08±4.89 years)or sham stimulation(sham group,n=12,5 men and 7 women;age 64.67±4.77 years).rTMS parameters included a stimulation frequency of 10 Hz,stimulation duration of 2 seconds,stimulation interval of 8 seconds,20 repetitions at 80%of the motor threshold,and 400 pulses per session.rTMS/sham stimulation was performed five times per week over a period of 4 consecutive weeks.Our results showed that compared with baseline,Montreal Cognitive Assessment scores were significantly increased and the value of the amplitude of low-frequency fluctuation(ALFF)was significantly increased at the end of treatment and 1 month after treatment.Compared with the sham group,the ALFF values in the right inferior frontal gyrus,triangular part of the inferior frontal gyrus,right precuneus,left angular gyrus,and right supramarginal gyrus were significantly increased,and the ALFF values in the right superior frontal gyrus were significantly decreased in the treatment group.These findings suggest that high-frequency rTMS can effectively improve cognitive function in aMCI patients and alter spontaneous brain activity in cognitive-related brain areas.This study was approved by the Ethics Committee of Shenzhen Baoan Hospital of Southern Medical University,China(approval No.BYL20190901)on September 3,2019 and registered in the Chinese Clinical Trials Registry(registration No.ChiCTR1900028180)on December 14,2019.

Differentiation of true anophthalmia from clinical anophthalmia using neuroradiological imaging

Anophthalmia is a condition of the absence of an eye and the presence of a small eye within the orbit.It is associated with many known syndromes.Clinical findings,as well as imaging modalities and genetic analysis,are important in making the diagnosis.Imaging modalities are crucial scanning methods.Cryptophthalmos,cyclopia,synophthalmia and congenital cystic eye should be considered in differential diagnoses.We report two clinical anophthalmic siblings,emphasizing the importance of neuroradiological and orbital imaging findings in distinguishing true congenital anophthalmia from clinical anophthalmia.

Pancreatic imaging:Current status of clinical practices and small animal studies

Different causative factors acting on the pancreas can result in diseases such as pancreatitis, diabetes and pancreatic tumors. The high incidence and mortality of pancreatic diseases have placed diagnostic imaging in a crucial position in daily clinical practice. In this minireview article different pancreatic imaging techniques are discussed, from the standard clinical imaging modalities and state of the art clinical magnetic resonance imaging techniques to current situations in pre-clinical pancreatic imaging studies. In particular, the challenges of pre-clinical rodent pancreatic imaging are addressed, with both the image acquisition techniques and the post-processing methods for rodent pancreatic imaging elaborated.

Diffusion-weighted Single-shot Echo Planar MR Imaging of Normal Human Prostate Using Different b Values

This study examined the effect of different b values on diffusion-weighted MR imaging （DWI） of human prostate by using single-shot spin echo echo planar imaging （SE-EPI） sequences, observed the normal appearances and measured apparent diffusion coefficient （ADC） values in anatomical regions of normal prostate. Twenty-four healthy volunteers （mean age： 32 y） were studied by using a 1.5T system with a phased array surface multicoil. Two kinds of single-shot SE-EPI sequence were used to perform DWI in the prostate in volunteers, with five b values being 0, 30, 300, 500 to 1000 s/mm2. The image quality with different imaging parameters was analyzed and the ADC values in anatomical regions of normal prostate were measured. DWI of prostate was successfully obtained in all volunteers. The images were of good quality, without artifacts containing pixels within the prostate. The contrast was good between the different anatomical regions of the prostatic gland, i.e., the peripheral zone （PZ）, which exhibited higher signal intensity, and the central gland （CG）. Signal intensity contrast was related to the magnitude of b values. The ADC values in PZ and CG were （1.27±0.22）×10-3 mm2/s and （1.01±0.17）×10-3 mm2/s,respectively. The ADC values were found to be significantly higher in PZ than in CG （P〈0.05, paired t-test）. Significant differences were found between the slice-selecting component and both the read-out and phase-encoding components of the ADC values. It is concluded that SE-EPI is a suitable DWI sequence for human prostate. The contrast between PZ and CG is good when b values are low, while the diffusion and ADC values are accurate when b values are high. ADC values are higher in PZ than in CG in normal prostate. Diffusional anisotropy is present in normal prostatic tissue.

Clinical and imaging features of desmoid tumors of the extremities

BACKGROUND Desmoid fibroma is a rare soft tissue tumor originating from the aponeurosis,fascia,and muscle,and it is also known as aponeurotic fibroma,invasive fibroma,or ligamentous fibroma.AIM To investigate the clinical and imaging features of desmoid tumors of the extremities.METHODS Thirteen patients with desmoid fibroma of the extremities admitted to our hospital from October 2016 to March 2021 were included.All patients underwent computed tomography(CT),magnetic resonance imaging(MRI),and pathological examination of the lesion.Data on the diameter and distribution of the lesion,the relationship between the lesion morphology and surrounding structures,MRI and CT findings,and pathological features were statistically analyzed.RESULTS The lesion diameter ranged from 1.7 to 8.9 cm,with an average of 5.35±2.39 cm.All lesions were located in the deep muscular space,with the left and right forearm each accounting for 23.08%of cases.Among the 13 patients with desmoid fibroma of the extremities,the lesions were"patchy"in 1 case,irregular in 10,and quasi-round in 2.The boundary between the lesion and surrounding soft tissue was blurred in 10 cases,and the focus infiltrated along the tissue space and invaded the adjacent structures.Furthermore,the edge of the lesion showed"beard-like"infiltration in 2 cases;bone resorption and damage were found in 8,and bending of the bone was present in 2;the boundary of the focus was clear in 1.According to the MRI examination,the lesions were larger than 5 cm(61.54%),round or fusiform in shape(84.62%),had an unclear boundary(76.92%),showed uniform signal(69.23%),inhomogeneous enhancement(84.62%),and"root"or"claw"infiltration(69.23%).Neurovascular tract invasion was present in 30.77%of cases.CT examination showed that the desmoid tumors had slightly a lower density(69.23%),higher enhancement(61.54%),and unclear boundary(84.62%);a CT value<50 Hu was present in 53.85%of lesions,and the enhancement was uneven in 53.85%of cases.Microscopically,fibroblasts and myofibroblasts were arranged in strands and bundles,without obvious atypia but with occasional karyotyping;cells were surrounded by collagen tissue.There were disparities in the proportion of collagen tissue in different regions,with abundant collagen tissue and few tumor cells in some areas,similar to the structure of aponeuroses or ligaments,and tumor cells invading the surrounding tissues.CONCLUSION Desmoid tumors of the extremities have certain imaging features on CT and MRI.The two imaging techniques can be combined to improve the diagnostic accuracy,achieve a comprehensive diagnosis of the disease in the clinical practice,and reduce the risk of missed diagnosis or misdiagnosis.In addition,their use can ensure timely diagnosis and treatment.

Magnetic Resonance Imaging in the Acquired Demyelinating Disorders： A Pediatric Cohort Study

Objective： Describing the characteristics of the MRI （magnetic resonance imaging） of patients with ADD （acquired demyelinating disorder） followed in a specialized pediatric clinic. Methods： Descriptive and retrospective study of the MRIs of a pediatric ADD cohort. The included images were acquired in machines with 1.5 or 3T magnets. Low-quality images were excluded. The radiological characteristics of the lesions were described using the 2010 Revised McDonald Diagnostic Criteria regarding localization, contrast enhancement and optic nerve alterations. Results： Twenty-three patients were included （55% female）. The mean age of the first clinical event was 7.7 years. Most common diagnosis was Clinically Isolated Syndrome （35%）, followed by Multiple Sclerosis （30%）, Neuromyelitis Optica （17%） and Acute Disseminated Encephalomyelitis （17%）. Mean time elapsed until diagnosis was 1.8 years. Follow-up MRIs of ADEM patients showed complete or partial resolution of lesions; MS lesions were mostly localized in the brain and four patients had contrast enhancement of lesions in their last available MRI. All NMO （neuromyelitis optica） patients had extensive spinal lesions, and two had optic neuritis. All patients with CIS （clinically isolated syndrome） had focal spinal lesions and evolved with radiologic improvement. Conclusions： ADEM and CIS patients＇ MRIs showed lesion reduction, while MS and NMO patients developed new lesions during follow-up.

3D-TOF-MRA联合MRI检测对原发性三叉神经痛的诊断价值

目的探究三维时间飞跃法磁共振血管成像(3D-TOF-MRA)联合磁共振成像(MRI)检测对原发性三叉神经痛(PTN)的诊断价值。方法回顾性收集2022年3月至2024年1月于河南省中医院就诊的78例PTN患者临床资料。男36例,女42例;年龄27~76(50.84±10.47)岁;左侧病变31例,右侧病变47例。分析PTN患者3D-TOF-MRA影像学特征,并比较其患侧、健侧MRI参数;比较不同检测方法的诊断结果,并进一步分析诊断效能。采用配对t检验和χ^(2)检验。结果患侧三叉神经根(TR)面积、神经脑桥夹角[(23.86±3.86)mm^(2)、(39.62±6.75)°]均小于健侧[(28.11±3.19)mm^(2)、(44.13±7.31)°](均P<0.05);患侧TR长度及跨岩尖转角与健侧比较,差异均无统计学意义(均P>0.05)。3D-TOF-MRA联合MRI检测的灵敏度为96.15%(75/78),高于3D-TOF-MRA的82.05%(64/78)和MRI的78.21%(61/78),3D-TOF-MRA联合MRI检测的漏诊率为3.85%(3/78),低于3D-TOF-MRA的17.95%(14/78)和MRI的21.79%(17/78)(P<0.05)。3D-TOF-MRA、MRI及3D-TOF-MRA联合MRI检测诊断不同分级PTN的Kappa值均>0.6,但3D-TOF-MRA联合MRI检测的Kappa值最高,为0.826(均P<0.05)。结论3D-TOF-MRA联合MRI检测可显著提高PTN的诊断灵敏度,降低漏诊率,且具有较高的一致性,有利于临床选择治疗方案、改善患者生活质量。

Increased activation of the caudate nucleus and parahippocampal gyrus in Parkinson's disease patients with dysphagia after repetitive transcranial magnetic stimulation:a case-control study

Repetitive transcranial magnetic stimulation(r TMS)has been shown to effectively improve impaired swallowing in Parkinson's disease(PD)patients with dysphagia.However,little is known about how r TMS affects the corresponding brain regions in this patient group.In this casecontrol study,we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy,Capital Medical University.The patients received high-frequency r TMS of the motor cortex once per day for 10 successive days.Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls.The results revealed that before treatment,PD patients with dysphagia showed greater activation in the precentral gyrus,supplementary motor area,and cerebellum compared with healthy controls,and this enhanced activation was weakened after treatment.Furthermore,before treatment,PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus,caudate nucleus,and left thalamus compared with healthy controls,and this activation increased after treatment.In addition,PD patients with dysphagia reported improved subjective swallowing sensations after r TMS.These findings suggest that swallowing function in PD patients with dysphagia improved after r TMS of the motor cortex.This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus.The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University(approval No.2018 bkky017)on March 6,2018 and was registered with Chinese Clinical Trial Registry(registration No.Chi CTR 1800017207)on July 18,2018.

Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features

Far lateral lumbar disc herniations(FLLDH)represent a separate category of disc pathology which includes both intraforaminal and extraforaminal lumbar disc herniations,that are characterized by a peculiar clinical presentation,diagnostic and treatment modalities as compared to the more frequent median and paramedian disc hernias.Surgical treatment often represents the only effective weapon for the cure of this disease and over the years different approaches have been developed that can reach the region of the foramen or external to it,with different degrees of invasiveness.The diagnosis is more demanding and still underestimated as it requires a more detailed knowledge in the spine anatomy and dedicated radiological studies.Computerized tomography and in particular magnetic resonance imaging are the appropriate tools for the diagnosis of FLLDH.Despite the widespread use of these diagnostic tests,many cases of FLLDH are overlooked due to insufficiently detailed radiological examinations or due to the execution of exams not focused to the foraminal or the extraforaminal region.Neurophysiological studies represent a valid aid in the diagnostic classification of this pathology and in some cases they can facilitate the differential diagnosis with other types of radiculopathies.In the present study,a comprehensive review of the clinical presentation,epidemiology,radiological study and the neurophysiological aspects is presented.