Three-dimensional arterial spin labeling and diffusion kurtosis imaging in evaluating perfusion and infarct area size in acute cerebral ischemia

BACKGROUND Early thrombolytic therapy is crucial to treat acute cerebral infarction,especially since the onset of thrombolytic therapy takes 1-6 h.Therefore,early diagnosis and evaluation of cerebral infarction is important.AIM To investigate the diagnostic value of magnetic resonance multi-delay threedimensional arterial spin labeling(3DASL)and diffusion kurtosis imaging(DKI)in evaluating the perfusion and infarct area size in patients with acute cerebral ischemia.METHODS Eighty-four patients who experienced acute cerebral ischemia from March 2019 to February 2021 were included.All patients in the acute stage underwent magnetic resonance-based examination,and the data were processed by the system’s own software.The apparent diffusion coefficient(ADC),average diffusion coefficient(MD),axial diffusion(AD),radial diffusion(RD),average kurtosis(MK),radial kurtosis(fairly RK),axial kurtosis(AK),and perfusion parameters post-labeling delays(PLD)in the focal area and its corresponding area were compared.The correlation between the lesion area of cerebral infarction under MK and MD and T2-weighted imaging(T2WI)was analyzed.RESULTS The DKI parameters of focal and control areas in the study subjects were compared.The ADC,MD,AD,and RD values in the lesion area were significantly lower than those in the control area.The MK,RK,and AK values in the lesion area were significantly higher than those in the control area.The MK/MD value in the infarct lesions was used to determine the matching situation.MK/MD<5 mm was considered matching and MK/MD≥5 mm was considered mismatching.PLD1.5s and PLD2.5s perfusion parameters in the central,peripheral,and control areas of the infarct lesions in MK/MD-matched and-unmatched patients were not significantly different.PLD1.5s and PLD2.5s perfusion parameter values in the central area of the infarct lesions in MK/MD-matched and-unmatched patients were significantly lower than those in peripheral and control areas.The MK and MD maps showed a lesion area of 20.08±5.74 cm^(2) and 22.09±5.58 cm^(2),respectively.T2WI showed a lesion area of 19.76±5.02 cm^(2).There were no significant differences in the cerebral infarction lesion areas measured using the three methods.MK,MD,and T2WI showed a good correlation.CONCLUSION DKI parameters showed significant difference between the focal and control areas in patients with acute ischemic cerebral infarction.3DASL can effectively determine the changes in perfusion levels in the lesion area.There was a high correlation between the area of the infarct lesions diagnosed by DKI and T2WI.

Application of diffusion kurtosis imaging technology in evaluating early mild traumatic brain injury

Objective To explore the value of magnetic resonance diffusion kurtosis imaging in diagnosing early tiny changes of brain tissue after mild traumatic brain injury.Methods A total of 22 patients with mild traumatic brain injury(study group)and 20 healthy subjects(control group)were enrolled in this study,and diffusion kurtosis imaging magnetic resonance scanning was employed in all subjects.fractional anisotropy,fractional anisotropy of kurtosis,mean kurtosis,axial kurtosis and radial kurtosis of diffusion kurtosis imaging parameters in the genu of corpus callosum,splenium corporis callosi,internal capsule,thalamus,putamen,cortex of frontal lobe,temporal lobe and parietal lobe at control group,the injured side and the mirror regions were measured,and the results were compared between the two groups.The receiver operating characteristic curve was used to evaluate the ability of different parameters in diagnosing mild traumatic brain injury.Results Compared with the control group,in the study group fractional anisotropy values of bilateral genu of corpus callosum,splenium corporis callosi,internal capsule and thalamus were significantly reduced,and fractional anisotropy of kurtosis values of bilateral thalamus and putamen were significantly reduced,and the differences were statistically significant(P<0.05).Compared with the control group,in the study group mean kurtosis and axial kurtosis values of bilateral genu of corpus callosum,posterior limb of Internal capsule,thalamus,putamen and cortex of temporal lobe were significantly reduced,while radial kurtosis values in the genu of corpus callosum,thalamus,cortex of frontal lobe,temporal lobe at the injured side were increased,and the differences were statistically significant(P<0.05).Conclusion DKI techniques can sensitively detect the early tiny pathologic changes of cerebral tissue in mild traumatic brain injury patients,which provide more imaging evidence for the clinical early diagnosis treatment and prognosis.

Inhibition of Notch 1 signaling in the subacute stage after stroke promotes striatal astrocyte-derived neurogenesis

Inhibition of Notch1 signaling has been shown to promote astrocyte-derived neurogenesis after stroke.To investigate the regulatory role of Notch1 signaling in this process,in this study,we used a rat model of stroke based on middle cerebral artery occlusion and assessed the behavior of reactive astrocytes post-stroke.We used theγ-secretase inhibitor N-[N-(3,5-diuorophenacetyl)-1-alanyl]-S-phenylglycine t-butylester(DAPT)to block Notch1 signaling at 1,4,and 7 days after injury.Our results showed that only administration of DAPT at 4 days after stroke promoted astrocyte-derived neurogenesis,as manifested by recovery of white matter fiber bundle integrity on magnetic resonance imaging,which is consistent with recovery of neurologic function.These findings suggest that inhibition of Notch1 signaling at the subacute stage post-stroke mediates neural repair by promoting astrocyte-derived neurogenesis.

Diffusion kurtosis imaging: correlation analysis of quantitative model parameters with molecular features in advanced lung adenocarcinoma

Background:Due to development of magnetic resonance-based functional imaging, it is easier to detect micro-structural alterations of tumor tissues. The aim of this study was to conduct a preliminary evaluation of the correlation of non-Gaussian diffusion kurtosis imaging (DKI) parameters with expression of molecular markers (epidermal growth factor receptor [ EGFR];anaplastic lymphoma kinase [ ALK];Ki-67 protein) in patients with advanced lung adenocarcinoma, using routine diffusion-weighted imaging as the reference standard. Methods::Data from patients with primary lung adenocarcinoma diagnosed at Cancer Hospital, Chinese Academy of Medical Sciences (CHCAMS) from 2016 to 2019 were collected for retrospective analysis. The pathologic and magnetic resonance imaging data of 96 patients who met the inclusion criteria were included in this study. Specifically, the Kapp and Dapp parameters measured from the DKI model;apparent diffusion coefficient (ADC) value from the diffusion-weighted imaging model;and the EGFR, ALK, and Ki-67 biomarkers detected by immunohistochemistry and/or molecular biology techniques after biopsy or surgery were evaluated. The relations between quantitative parameters (ADC, Kapp, Dapp) and pathologic outcomes ( EGFR, ALK, and Ki-67 expression) were analyzed by Spearman correlation test. Results:Of the 96 lung adenocarcinoma lesions (from 96 patients), the number of EGFR- and ALK-positive and high Ki-67 expressing lesions were 53, 12, and 83, respectively. The Kapp values were significantly higher among patients with EGFR-positive mutations (0.81 ± 0.12 vs. 0.66 ± 0.10, t = 6.41, P < 0.001), ALK rearrangement-negative (0.76 ± 0.12 vs. 0.60 ± 0.15, t = 4.09, P < 0.001), and high Ki-67 proliferative index (PI) (0.76 ± 0.12 vs. 0.58 ± 0.13, t = 4.88, P < 0.001). The Dapp values were significantly lower among patients with high Ki-67 PI (3.19 ± 0.69 μm 2/ms vs. 4.20 ± 0.83 μm 2/ms, t = 4.80, P < 0.001) and EGFR-positive mutations (3.11 ± 0.73 μm 2/ms vs. 3.59 ± 0.77 μm ^2/ms, t = 3.12, P = 0.002). The differences in mean Dapp (3.73 ± 1.26 μm^ 2/ms vs. 3.26 ± 0.68 μm 2/ms, t = 1.96, P = 0.053) or ADC values ([1.34 ± 0.81] × 10^ -3 mm ^2/s vs. [1.33 ± 0.41] × 10 ^-3 mm ^2/s, t = 0.07, P = 0.941) between the groups with or without ALK rearrangements were not statistically significant. The ADC values were significantly lower among patients with EGFR-positive mutation ([1.19 ± 0.37] × 10 ^-3 mm^ 2/s vs. [1.50 ± 0.53] × 10 ^-3 mm ^2/s, t = 3.38, P = 0.001) and high Ki-67 PI ([1.28 ± 0.39] × 10 -3 mm 2/s vs. [1.67 ± 0.77] × 10^ -3 mm^ 2/s, t = 2.88, P = 0.005). Kapp was strongly positively correlated with EGFR mutations ( r = 0.844, P = 0.008), strongly positively correlated with Ki-67 PI ( r = 0.882, P = 0.001), and strongly negatively correlated with ALK rearrangements ( r = -0.772, P = 0.001). Dapp was moderately correlated with EGFR mutations ( r = -0.650, P = 0.024) or Ki-67 PI ( r = -0.734, P = 0.012). ADC was moderately correlated with Ki-67 PI ( r = -0.679, P = 0.033). Conclusions:The Kapp value of DKI parameters was strongly correlated with different expression of EGFR, ALK, and Ki-67 in advanced lung adenocarcinoma. The results potentially indicate a surrogate measure of the status of different molecular markers assessed by non-invasive imaging tools.

Can DKI-MRI predict recurrence and invasion of peritumoral zone of hepatocellular carcinoma after transcatheter arterial chemoembolization?

BACKGROUND Hepatocellular carcinoma(HCC)is a major cause of cancer-related mortality worldwide.Transcatheter arterial chemoembolization(TACE)has been performed as a palliative treatment for patients with HCC.However,HCC is easy to recur after TACE.Magnetic resonance imaging(MRI)has clinical potential in evaluating the TACE treatment effect for patients with liver cancer.However,traditional MRI has some limitations.AIM To explore the clinical potential of diffusion kurtosis imaging(DKI)in predicting recurrence and cellular invasion of the peritumoral liver zone of HCC after TACE.METHODSSeventy-six patients with 82 HCC nodules were recruited in this study and underwent DKI afterTACE. According to pathological examinations or the overall modified response evaluationcriteria in solid tumors (mRECIST) criterion, 48 and 34 nodules were divided into true progressionand pseudo-progression groups, respectively. The TACE-treated area, peritumoral liver zone, andfar-tumoral zone were evaluated on DKI-derived metric maps. Non-parametric U test and receiveroperating characteristic curve (ROC) analysis were used to evaluate the prediction performance ofeach DKI metric between the two groups. The independent t-test was used to compare each DKImetric between the peritumoral and far-tumoral zones of the true progression group.RESULTSDKI metrics, including mean diffusivity (MD), axial diffusivity (DA), radial diffusivity (DR), axialkurtosis (KA), and anisotropy fraction of kurtosis (Fak), showed statistically different valuesbetween the true progression and pseudo-progression groups (P < 0.05). Among these, MD, DA,and DR values were higher in pseudo-progression lesions than in true progression lesions,whereas KA and FAk values were higher in true progression lesions than in pseudo-progressionlesions. Moreover, for the true progression group, the peritumoral zone showed significantlydifferent DA, DR, KA, and FAk values from the far-tumoral zone. Furthermore, MD values of theliver parenchyma (peritumoral and far-tumoral zones) were significantly lower in the trueprogression group than in the pseudo-progression group (P < 0.05).CONCLUSIONDKI has been demonstrated with robust performance in predicting the therapeutic response ofHCC to TACE. Moreover, DKI might reveal cellular invasion of the peritumoral zone by moleculardiffusion-restricted change.