Efficacy of comprehensive remote ischemic conditioning in elderly patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention

BACKGROUND Remote ischemic conditioning(RIC)is used to protect against myocardial injury.However,there is no adequate evidence for comprehensive RIC in elderly patients with ST-segment elevation myocardial infarction(STEMI).This study aimed to test whether comprehensive RIC,started pre-primary percutaneous coronary intervention(PPCI)and repeated daily on 1-30 days post-PPCI,can improve myocardial salvage index(SI),left ventricular ejection fraction(LVEF),Kansas City Cardiomyopathy Questionnaire Clinical Summary Score(KCCQ-CSS)and 6-min walk test distance(6MWD)in elderly patients with acute STEMI during 12 months follow-up.METHODS 328 consenting elderly patients were randomized to receive standard PPCI plus comprehensive RIC(the treatment group)or standard PPCI(the control group).SI at 5-7 days after PPCI,LVEF,left ventricular end-diastolic volume index(LVEDVI),left ventricular end-systolic volume index(LVESVI),KCCQ-CSS,6MWD and adverse events rates were measured and assessed.RESULTS SI was significantly higher in the treatment group[interquartile range(IQR):0.38-0.66,P=0.037].There were no significant differences in major adverse events at 12 months.Although the differences of LVEDVI,LVESVI and LVEF between the treatment group and the control group did not reach statistical significance at 6 months and 12 months,LVEF tended to be higher,LVEDVI tended to be lower in the treatment group.The KCCQ-CSS was significantly higher in the treatment group at 1 month(IQR:46.5-87,P=0.001)and 12 months(IQR:55-93,P=0.008).There was significant difference in 6MWD between the treatment group and the control group(IQR:258-360 vs.IQR:250-345,P=0.002)at 1 month and(IQR:360-445 vs.IQR:345-432,P=0.035)at 12 months.A modest correlation was found between SI and LVEF(r=0.452,P<0.01),KCCQ-CSS(r=0.440,P<0.01)and 6MWD(r=0.384,P<0.01)respectively at 12 months.CONCLUSIONS The comprehensive RIC can improve SI,KCCQ-CSS and 6MWD.It may be an adjunctive therapy to PPCI in elderly patients with STEMI.

Effects of Structural Changes in Subchondral Bone on Articular Cartilage in a Beagle Dog Model

Objective Using MR T2-mapping and histopathologic score for articular cartilage to evaluate the effect of structural changes in subchondral bone on articular cartilage. Methods Twenty-four male Beagle dogs were randomly divided into a subchondral bone defect group （n = 12） and a bone cement group （n = 12）. Models of subchondral bone defectin the medial tibial plateau and subchondral bone filled with bone cement were constructed. In all dogs, the left knee joint was used as the experimental sideand the right knee as the sham side. The T2 value for articular cartilage at the medial tibial plateau was measured at postoperative weeks 4, 8, 16, and 24. The articular cartilage specimens were stained with hematoxylin and eosin, and evaluated using the Mankin score. Results There was a statistically significant difference （P 〈 0.05） in Mankin score between the bone defect group and the cement group at postoperative weeks 16 and 24. There was a statistically significant difference in the T2 values between the bone defect group and its sham group （P 〈 0.05） from week 8, and between the cement group and its sham group （P 〈 0.05） from week 16. There was significant difference in T2 values between the two experimental groups at postoperative week 24 （P 〈 0.01）. The T2 value for articular cartilage was positively correlated with the Mankin score （ρ = 0.758, P 〈 0.01）. Conclusion Structural changes in subchondral bone can lead to degeneration of the adjacent articular cartilage. Defects in subchondral bone cause more severe degeneration of cartilage than subchondral bone filled with cement. The T2 value for articular cartilage increases with the extent of degeneration. MR T2-mapping images and the T2 value for articular cartilage can indicate earlycartilage degeneration.

Assessment of optic nerve and optic tract alterations in patients with orbital space-occupying lesions using probabilistic diffusion tractography

AIM: To investigate the diffusion changes in both the optic nerve and optic tract in orbital space-occupying lesion patients with decreased visual acuity, and its clinical significance using probabilistic diffusion tractography(PDT). METHODS: Twenty patients with orbital space-occupying lesions and 25 age-and gender-matched healthy persons were included. All patients and controls underwent routine orbital magnetic resonance imaging and diffusion tensor imaging(DTI), using a 3.0 T magnetic resonance scanner(Trio Tim Siemens). After the image data were preprocessed, each DTI parameters of the optic nerve and optic tract was obtained by PDT, including fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity(AD) and radial diffusivity(RD). The asymmetry index(AI) of each parameter was calculated. Compared the parameters of the affected side optic nerve and ipsilateral optic tract with the contralateral side by paired sample t-test;compared AI of parameters of optic nerve and optic tract between the patient group and the control group by independent sample t-test. Patients were divided into threesubgroups according to the low vision grade standard of WHO, compared the FA and AI of FA between the three subgroups by single factor variance analysis. RESULTS: The affected side optic nerve presented significantly decreased FA, increased MD, AD, and RD values compared to the unaffected side(P<0.05). The AI of FA, MD, AD, and RD of optic nerve in the patients was significantly higher than that of the controls(P<0.05). The comparison results of the optic tract showed that there was no significant difference between the patient group and control group in terms of the bilateral optic tracts in patients(P>0.05). The AIs of the FA value of the optic nerve in the eyesight <0.1 subgroup was significantly higher than that in the other groups(P<0.05). CONCLUSION: FA, MD, AD, and RD of the affected side optic nerve of the orbital space-occupying lesions have significantly changed, the FA value is the most sensitive. The PDT could be a useful tool to provide valid quantitative markers of optic nerve injuries and evaluate the severity of orbital diseases, which other examinations cannot be acquired.

Diagnostic value of preoperative examination for evaluating margin status in breast cancer

BACKGROUND A positive resection margin is a major risk factor for local breast cancer recurrence after breast-conserving surgery(BCS).Preoperative imaging examinations are frequently employed to assess the surgical margin.AIM To investigate the role and value of preoperative imaging examinations[magnetic resonance imaging(MRI),molybdenum target,and ultrasound]in evaluating margins for BCS.METHODS A retrospective study was conducted on 323 breast cancer patients who met the criteria for BCS and consented to the procedure from January 2014 to July 2021.The study gathered preoperative imaging data(MRI,ultrasound,and molybdenum target examination)and intraoperative and postoperative pathological information.Based on their BCS outcomes,patients were categorized into positive and negative margin groups.Subsequently,the patients were randomly split into a training set(226 patients,approximately 70%)and a validation set(97 patients,approximately 30%).The imaging and pathological information was analyzed and summarized using R software.Non-conditional logistic regression and LASSO regression were conducted in the validation set to identify factors that might influence the failure of BCS.A column chart was generated and applied to the validation set to examine the relationship between pathological margin range and prognosis.This study aims to identify the risk factors associated with failure in BCS.RESULTS The multivariate non-conditional logistic regression analysis demonstrated that various factors raise the risk of positive margins following BCS.These factors comprise non-mass enhancement(NME)on dynamic contrastenhanced MRI,multiple focal vascular signs around the lesion on MRI,tumor size exceeding 2 cm,type III timesignal intensity curve,indistinct margins on molybdenum target examination,unclear margins on ultrasound examination,and estrogen receptor(ER)positivity in immunohistochemistry.LASSO regression was additionally employed in this study to identify four predictive factors for the model:ER,molybdenum target tumor type(MT Xmd Shape),maximum intensity projection imaging feature,and lesion type on MRI.The model constructed with these predictive factors exhibited strong consistency with the real-world scenario in both the training set and validation set.Particularly,the outcomes of the column chart model accurately predicted the likelihood of positive margins in BCS.CONCLUSION The proposed column chart model effectively predicts the success of BCS for breast cancer.The model utilizes preoperative ultrasound,molybdenum target,MRI,and core needle biopsy pathology evaluation results,all of which align with the real-world scenario.Hence,our model can offer dependable guidance for clinical decisionmaking concerning BCS.

Abnormal white matter microstructure in Parkinson's disease revealed by diffusion tensor imaging A non-randomized concurrent control observation

BACKGROUND： Imaging has been used to determine gray matter volume and metabolism in subjects with depressed Parkinson＇s disease （DPD）. OBJECTIVE： To reveal abnormalities in orbitofrontal white matter and the anterior cingulate bundle in depressed and non-depressed Parkinson＇s disease （NDPD） patients using diffusion tensor imaging. DESIGN, TIME AND SETTING： A non-randomized, concurrent, control, neuroimaging study was performed at the Laboratory of Neurodegenerative Diseases and Center of Neuroimage, Xuanwu Hospital of Capital Medical University from July 2008 to January 2009. PARTICIPANTS： A total of 30 Parkinson＇s disease patients, including 14 males and 16 females, were included in the present study. All patients met Brain Bank criteria for idiopathic Parkinson＇s disease formulated by the United Kingdom Parkinson＇s Disease Society. Patients, who underwent previous head surgery, exhibited abnormal density on T2-weighted images, or Mini-Mental State Examination scores 〈 corresponding education level, were excluded from the study. METHODS： All 35 patients underwent MRI scans, including traditional T2-weighted and DTI scans. The patients were assigned to DPD （n = 16） and NDPD （n = 14） groups according to the Diagnostic and Statistical Manual of Mental Disorders-IV （DSM-IV） criteria. The fractional anisotropy values of regions of interest were compared between the NDPD and DPD groups. MAIN OUTCOME MEASURES： Abnormalities in the orbitofrontal white matter and anterior cingulate bundle. RESULTS： Compared with the NDPD group, the DPD group exhibited significantly lower fractional anisotropy values in orbitofrontal white matter and anterior cingulate bundle （P 〈 0.05）. CONCLUSION： Microstructure abnormalities existed in the orbitofrontal and anterior cingulate regions in DPD patients. This is the first report of abnormalities in the orbitofrontal white matter region in DPD patients.

Increasing the accuracy and reproducibility of positron emission tomography radiomics for predicting pelvic lymph node metastasis in patients with cervical cancer using 3D local binary pattern-based texture features

Background The reproducibility of positron emission tomography(PET)radiomics features is affected by several factors,such as scanning equipment,drug metabolism time and reconstruction algorithm.We aimed to explore the role of 3D local binary pattern(LBP)-based texture in increasing the accuracy and reproducibility of PET radiomics for predicting pelvic lymph node metastasis(PLNM)in patients with cervical cancer.Methods We retrospectively analysed data from 177 patients with cervical squamous cell carcinoma.They un-derwent18 F-fluorodeoxyglucose(18 F-FDG)whole-body PET/computed tomography(PET/CT),followed by pelvic 18 F-FDG PET/magnetic resonance imaging(PET/MR).We selected reproducible and informative PET radiomics features using Lin’s concordance correlation coefficient,least absolute shrinkage and selection operator algorithm,and established 4 models,PET/CT,PET/CT-fusion,PET/MR and PET/MR-fusion,using the logistic regression al-gorithm.We performed receiver operating characteristic(ROC)curve analysis to evaluate the models in the training data set(65 patients who underwent radical hysterectomy and pelvic lymph node dissection)and test data set(112 patients who received concurrent chemoradiotherapy or no treatment).The DeLong test was used for pairwise comparison of the ROC curves among the models.Results The distribution of age,squamous cell carcinoma(SCC),International Federation of Gynaecology and Obstetrics stage and PLNM between the training and test data sets were different(P<0.05).The LBP-transformed radiomics features(50/379)had higher reproducibility than the original radiomics features(9/107).Accuracy of each model in predicting PLNM was as follows:training data set:PET/CT=PET/CT-fusion=PET/MR-fusion(0.848)and test data set:PET/CT=PET/CT-fusion(0.985)>PET/MR=PET/MR-fusion(0.954).There was no statistical difference between the ROC curve of PET/CT and PET/MR models in both data sets(P>0.05).Conclusions The LBP-transformed radiomics features based on PET images could increase the accuracy and reproducibility of PET radiomics in predicting pelvic lymph node metastasis in cervical cancer to allow the model to be generalised for clinical use across multiple centres.

Assessment of the right and left ventricular function in patients with cor pulmonale using high-definition CT

Background Cor pulmonale is often associated with changes of structure and function of the right ventricle （RV） and thus further affects functional changes of the left heart.Our study aimed to assess the left ventricular （LV） and RV function in patients with cor pulmonale using high-definition CT （HDCT）.Methods We prospectively studied 18 cor pulmonale patients determined by the pulmonary function test,clinical examination,chest radiograph,electrocardiogram,and echocardiogram.The subject group was compared to a control group consisting of 18 subjects.The RV and LV functions and RV myocardial mass （MM） were obtained by HDCT in the two groups.The results were compared between the two groups using the independent sample t test.Echocardiographic examination for cardiac function analysis was performed on the same day.Results The RV end-diastolic volume （EDV）,RV end-systolic volume （ESV） and RV myocardial mass were significantly larger in the 18 cor pulmonale patients than in the control group （P〈0.05）.The right ventricular ejection fraction （RVEF） was significantly lower in the 18 cor pulmonale patients than in controls （P〈0.01）.The left ventricular EDV （LVEDV） and LVEF were significantly lower in cor pulmonale patients than in controls （P〈0.01）.There were strong correlations between MDCT and echocardiography,rRVEF=0.839 and rLVEF=0.916,respectively.Conclusions HDCT can accurately quantify RV and LV function.The right ventricular function is impaired in patients with cor pulmonale,while at the same time the left ventricular function is also impaired.

Clinical Features of Patients with Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders

Background： Neuromyelitis optica spectrum disorder （NMOSD） was long believed to be an aggressive form of multiple sclerosis （MS）. This study aimed to describe the clinical features of patients with MS and NMOSD to assist in differential diagnoses in clinical practice. Methods： Data including the patients＇ serum and cerebrospinal fluid （CSF） tests, image findings, and clinical information from 175 patients with MS or NMOSD at Xuanwu Hospital, Capital Medical University from November 2012 to May 2014 were collected and analyzed retrospectively. An enzyme-linked immunosorbent assay was performed to detect the myelin oligodendrocyte glycoprotein （MOG） autoantibodies in CSF and serum. Cell-based assays were used to detect aquaporin-4-antibody （AQP4-Ab）. The Chi-square test was used to compare the categorical variables. Wilcoxon rank sum test was peribrmed to analyze the continuous variables. Results： Totally 85 MS patients （49%） and 90 NMOSD patients （51%） were enrolled, including 124 （71%） women and 51 （29%） men. Fewer MS patients （6%） had autoinamune diseases compared to NMOSD （19%） （x2= 6.9, P 〈 0.01 ）. Patients with NMOSD had higher Expanded Disability Status Scale scores （3.5 [3]） than MS group （2 [2]） （x2= -3.69, P 〈 0.01）. The CSF levels of white cell count and protein in both two groups were slightly elevated titan the normal range, without significant difference between each other. Positivity of serum AQP4-Ab in NMOSD patients was higher than that in MS patients （MS： 0, NMOSD： 67%; x2= 63.9, P 〈 0.01 ）. Oligoclonal bands in CSF among NMOSD patients were remarkably lower than that among MS （MS： 59%, NMOSD： 20%; x2= 25.7, P 〈 0.01）. No significant difference of MOG autoantibodies was found between the two groups. Conclusion： The different CSF features combined with clinical, magnetic resonance imaging, and serum characteristics between Chinese patients with MS and NMOSD could assist in the differential diagnosis.

Diagnostic performance of magnetic resonance venography in the detection of recanalization in patients with chronic cerebral venous sinus thrombus

Background In the chronic stage of cerebral venous sinus thrombosis （CVST）, recanalization can result in disparate MR appearances. We aimed to prospectively investigate the diagnostic accuracy of magnetic resonance venography （MRV） in the evaluation of the recanalization of CVST. Methods This study prospectively evaluated the diagnostic performance of 2-dimensional time-of-flight （2D-TOF） MRV in thirty-two consecutive patients during a threeto six-month follow-up for CVST. Both 2D-TOF MRV and digital substraction angiography （DSA） were undertaken. Diagnostic accuracy of 2D-TOF MRV in the detection of recanalized thrombus was evaluated using DSA as the reference standard. Results MRV and DSA were completed without complications in all 32 patients. The sensitivity, specificity, positive predictive value, and negative predictive value of 2D-TOF MRV for the detection of recanalization on a segmental basis were 91% （62/68）, 93% （37/40）, 95% （62/65）, and 86% （37/43） respectively. Conclusion 2D-TOF MRV provides high sensitivity and specificity for the diagnosis of recanalized CVST segments.

Reproducible Abnormalities and Diagnostic Generalizability of White Matter in Alzheimer’s Disease

Alzheimer’s disease(AD)is associated with the impairment of white matter(WM)tracts.The current study aimed to verify the utility of WM as the neuroimaging marker of AD with multisite diffusion tensor imaging datasets[321 patients with AD,265 patients with mild cognitive impairment(MCI),279 normal controls(NC)],a unified pipeline,and independent site cross-validation.Automated fiber quantification was used to extract diffusion profiles along tracts.Random-effects meta-analyses showed a reproducible degeneration pattern in which fractional anisotropy significantly decreased in the AD and MCI groups compared with NC.Machine learning models using tract-based features showed good generalizability among independent site cross-validation.The diffusion metrics of the altered regions and the AD probability predicted by the models were highly correlated with cognitive ability in the AD and MCI groups.We highlighted the reproducibility and generalizability of the degeneration pattern of WM tracts in AD.

Lipid signal in evaluation of intracranial meningiomas

Background Using magnetic resonance imaging, diagnosis of malignant meningioma from benign meningioma with atypical features is uncertain. We evaluated the value of lipid signal in differentiating intracranial meningiomas. Methods ^1H-magnetic resonance spectroscopy （MRS） using a point resolved spectroscopy （TR/TE 1000/144 ms） sequences were performed on 34 patients on a 3.0 T scanner. Lipid peak located at 1.3 ppm was evaluated. MRS data from these tumours were compared with histopathological findings （including hematoxylin and eosin staining and KP-1 staining）. Results Twenty-nine meningiomas were histologically benign （eleven meningothelial, thirteen fibrous, four transitional and one microcystic）, three were atypical, and two were anaplastic. Lipid signal was detected in ten cases： two anaplastic three atypical, two fibrous and three rneningothelial meningiomas. All voxels with lipid peak in the spectrum from the tumour were evaluated. With creatinine peak in the normal white matter chosen as internal standard, lipid/creatinine ratios of anaplastic, atypical and benign meningiomas were 0.844±0.027 （range from 0.725 to 0.994）, 0.465±0.023 （range from 0.239 to 0.724）, and 0.373±0.016 （range from 0.172 to 0.571） respectively. Highly significant differences were noted between anaplastic and the other two subtypes. Patchy necrosis was observed in anaplastic meningioma, while focal necrosis was noted in atypical meningioma with HE stain. However, no necrosis was found in benign group. KP-1 stain demonstrated histocytes containing lipids in the necrotic region of anaplastic and atypical meningioma. Conclusion The lipid signal at 1.3 ppm is a useful marker in evaluating the malignancy of intracranial meningiomas, especially in the differential diagnosis of anaplastic meningioma.

Interhemispheric cistern lipoma associated with malformations of cortical development, hypogenesis of the corpus callosum, and abnormal vasculature

To the Editor:Intracranial lipomas(ICLs)are very rare congenital malformative lesions accounting for about 0.1%to 1.7%of all intracranial tumors.[1,2]Herein we describe a rare case of a lipoma affecting the cerebral interhemispheric cisterns in association with malformations of cortical development(MCD),hypogenesis of the corpus callosum,and abnormal vasculature.

Safety of endovascular therapy for symptomatic intracranial artery stenosis:a national prospective registry

Introduction The safety outcomes of endovascular therapy for intracranial artery stenosis in a real-world stetting are largely unknown.The Clinical Registration Trial of Intracranial Stenting for Patients with Symptomatic Intracranial Artery Stenosis(CRTICAS)was a prospective,multicentre,real-world registry designed to assess these outcomes and the impact of centre experience.Methods 1140 severe,symptomatic intracranial arterial stenosis(ICAS)patients treated with endovascular therapy were included from 26 centres,further divided into three groups according to the annual centre volume of intracranial angioplasty and stent placement procedures over 2 years:(1)high volume for≥25 cases/year;(2)moderate volume for 10–25 cases/year and(3)low volume for<10 cases/year.Results The rate of 30-day stroke,transient ischaemic attack or death was 9.7%(111),with 5.4%,21.1%and 9.7%in high-volume,moderate-volume and low-volume centres,respectively(p<0.05).Multivariable logistic regression confirmed high-volume centres had a significantly lower primary endpoint compared with moderate-volume centres(OR=0.187,95%CI:0.056 to 0.627;p≤0.0001),while moderate-volume and low-volume centres showed no significant difference(p=0.8456).Conclusion Compared with the preceding randomised controlled trials,this real-world,prospective,multicentre registry shows a lower complication rate of endovascular treatment for symptomatic ICAS.Non-uniform utilisation in endovascular technology,institutional experience and patient selection in different volumes of centres may have an impact on overall safety of this treatment.

Assessing structural integrity of the pyramidal tracts with difusion spectrum imaging to predict postoperative motor function in pediatric epilepsy patients with hemispherectomy

Background:Hemispherectomy is an efective treatment option for patients with drug-resistant epilepsy caused by hemispheric lesions.However,patients often have deterioration of their motor functions postoperatively.Difusion spectrum imaging(DSI)was reliable in presenting the natural shape of the white matter fbers.At the same time,the natural sprawl pyramid tract(PT)might be more intuitive for predicting postoperative motor functions.Therefore,we assessed the motor functions by the natural shape revealed by DSI tractography.Methods:Ten children with drug-resistant epilepsy who were candidates for hemispherectomy performed DSI PTs tractography and transcranial magnetic stimulation(TMS)for motor mapping.The motor function was evaluated with muscle strength and hand grasping capability.Pyramidal tract(PT)structural integrity and TMS mapping results were compared between patients who remained stable and those with deteriorated motor functions.Receiver operating characteristic(ROC)curves with PTs asymmetric ratio were analyzed to evaluate DSI tractography diagnostic value.Results:All patients underwent DSI acquisition,while four patients successfully performed TMS.One patient had no response to TMS until the maximal machine output was reached.Four patients failed to perform TMS due to lacking cooperation.One patient was contraindicated to TMS.DSI successfully reconstructed the sharp angle fan-shaped PTs within the hemisphere.The accurate fber distribution with fber termination and thickness within the lesioned hemisphere was replicated with DSI tractography.No signifcance was found in patients’age,sex,seizure frequency,or medication between patients with stable or deteriorated postoperative motor functions.DSI efectively predicted postoperative motor function as stable with damaged PTs,mild deterioration with atrophied PTs,and intact PTs with contralateral innervation confrmed by intracranial stimulation.The area under the curve(AUC)of DSI tractography was 0.84.According to ROC,the cut-of value of PTs asymmetric ratio was 11.5%with 100%sensitivity and 75%specifcity.The sensitivity and specifcity of TMS were 2/3 and 1/2,respectively.Conclusions:The anatomic integrity of PTs with DSI tractography could efectively predict postoperative motor function after hemispherectomy.This enables neurosurgeons to inform patients and relatives about postoperative motor functions with direct morphological evidence of PTs to help them with their surgical decisions.

Convergent Neuroimaging and Molecular Signatures in Mild Cognitive Impairment and Alzheimer’s Disease:A Data-Driven Meta-Analysis with N=3,118

The current study aimed to evaluate the susceptibility to regional brain atrophy and its biological mechanism in Alzheimer’s disease(AD).We conducted data-driven meta-analyses to combine 3,118 structural magnetic resonance images from three datasets to obtain robust atrophy patterns.Then we introduced a set of radiogenomic analyses to investigate the biological basis of the atrophy patterns in AD.Our results showed that the hippocampus and amygdala exhibit the most severe atrophy,followed by the temporal,frontal,and occipital lobes in mild cognitive impairment(MCI)and AD.The extent of atrophy in MCI was less severe than that in AD.A series of biological processes related to the glutamate signaling pathway,cellular stress response,and synapse structure and function were investigated through gene set enrichment analysis.Our study contributes to understanding the manifestations of atrophy and a deeper understanding of the pathophysiological processes that contribute to atrophy,providing new insight for further clinical research on AD.

A Rarely Concerned Magnetic Resonance Image Sign of Spinal Nerve Root Hypertrophy in Type 1A Charcot-Marie-Tooth Disease

To the Editor： Charcot-Marie-Tooth disease （CMT） is a clinically and genetically heterogeneous inherited neuropathy, with Type 1 A being the most common. CMT IA is characterized by progressive weakness and atrophy of the distal limb muscles beginning in the peroneal group, mild distal sensory loss, diminished tendon reflexes, and slow nerve conduction velocity . Spinal nerve root hypertrophy is a distinct sign of CMT 1A. This sign can be detected on magnetic resonance images （MRI）, but it is often overlooked. Instead, diagnosis of this disease is often made basing on biopsy and genetic testing.

Surgical timing and long-term outcomes in patients with severe haemorrhagic spinal cord cavernous malformations

Background Surgical resection of the lesions remains the main treatment method for most symptomatic spinal cord cavernous malformations(SCCMs)to eliminate the occupation and associated subsequent lifelong haemorrhagic risk.However,the timing of surgical intervention remains controversial,especially for patients in the acute stage after severe haemorrhage.Methods Patients diagnosed with SCCMs who were surgically treated between January 2002 and December 2021 were selected and retrospectively reviewed.The Modified McCormick Scale(MMS)was used to evaluate neurological and disability status.All medical information was reviewed,and all patients were followed up for at least 6 months.Results A total of 279 patients were ultimately included.With regard to long-term outcomes,110(39.4%)patients improved,159(57.0%)remained unchanged and 10(3.6%)worsened.For patients with an MMS score of 2–5 on admission,in univariate and multivariate analyses,a≤6 weeks period between onset and surgery(adjusted OR 3.211,95%CI 1.504 to 6.856,p=0.003)was a significant predictor of improved MMS.Among 69 patients who first presented with severe haemorrhage,undergoing surgery within 6 weeks of the onset of severe haemorrhage(adjusted OR 4.901,95%CI 1.126 to 21.325,p=0.034)was significantly associated with improvement of MMS score.Conclusion Surgical timing can influence the long-term outcome of SCCMs.For patients with symptomatic SCCMs,especially those with severe haemorrhage,early surgical intervention within 6 weeks can provide more benefit.

Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease:beyond the cervicocephalic atherosclerosis?

Background:Asymptomatic coronary artery stenosis(ACAS)≥50%is common in patients with acute ischemic cerebrovascular disease(AICVD),which portends a poor cardiovascular and cerebrovascular prognosis.Identifying ACAS>50%early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients.This study aimed to investigate whether aortic arch plaque(AAP),an early atherosclerotic manifestation of brain blood-supplying arteries,could be a predictor for ACAS>50%in AICVD.Methods:In this cross-sectional study,atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography(CTA)in AICVD patients without coronary artery disease history.The patients were divided into ACAS≥50%and non-ACAS≥50%groups according to whether CTA showed stenosis≥50%in at least one coronary arterial segment.The AAP characteristics of CTA were depicted from aspects of thickness,extent,and complexity.Results:Among 118 analyzed patients with AICVD,29/118(24.6%)patients had ACAS≥50%,while AAPs were observed in 86/118(72.9%)patients.Increased AAP thickness per millimeter(adjusted odds ratio[OR]:1.56,95%confidence interval[CI]:1.18-2.05),severe-extent AAP(adjusted OR:13.66,95%CI:2.33-80.15),and presence of complex AAP(adjusted OR:7.27,95%CI:2.30-23.03)were associated with ACAS≥50%among patients with AICVD,independently of clinical demographics and cervicocephalic atherosclerotic stenosis.The combination of AAP thickness,extent,and complexity predicted ACAS≥50%with an area under the receiver-operating characteristic curve of 0.78(95%CI:0.70-0.85,P<0.001).All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS≥50%in AICVD(all P<0.05).Conclusions:Thicker,severe-extent,and complex AAP were significant markers of the concomitant ACAS≥50%in AICVD,possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis.As an integral part of atherosclerosis of brain blood-supplying arteries,AAP should not be overlooked in predicting ACAS≥50%for patients with AICVD.

Diffusion tensor imaging in medial temporal lobe epilepsy

Background Diffusion tensor imaging （DTI） is a noninvasive imaging technique for the assessment of the integrity of cerebral tissues. This study was undertaken to assess the changes of diffusion indices of hippocampal formation （HF） in patients with medial temporal lobe epilepsy （MTLE）. Methods Fourteen patients with MTLE and 14 healthy subjects were evaluated. Mean diffusivity （MD） and fractional anisotropy （FA） from the symmetrical-voxel sampling regions of the anterior HF were calculated in all subjects. The MD and FA values were compared across the groups. Results No significant differences of MD and FA values were noted between right and left HF in the controls. In the patient group, MD significantly increased in the HF ipsilateral to the lesioned side [（9.27±1.09）×10^-4 mm^2/s], compared with the values in the contralateral HF [（8.20±0.59）×10^-4 min^2]s] （t = 4.479, P = 0.001） and healthy subjects [（7.58±0.51）×10^-4 mm^2/s] （P 〈 0.001）, but no significant differences were found in FA. When compared with the controls, patients had a significantly higher MD in the contralateral HF （P 〈 0.05）, but the difference in FA was not statistically significant. Conclusions DTI could detect hippocampal abnormality in patients with MTLE. This technique may be helpful for preoperative evaluation of such patients.

Dysembryoplastic neuroepithelial tumors： magnetic resonance imaging and magnetic resonance spectroscopy evaluation

Background Dysembryoplastic neuroepithelial tumor （DNT） is a rare benign neoplasm of the central nervous system affecting young people. A correct preoperative diagnosis is helpful for planning surgical strategies and improving prognosis. The purpose of this study was to characterize DNTs using magnetic resonance imaging （MRI） and magnetic resonance spectroscopy （MRS） and to analyze the value of these two techniques in the diagnosis of DNTs. Methods MR images of 13 patients with DNTs were reviewed retrospectively; and five of the patients also underwent MRS. Tumors were confirmed by surgery. The distribution, extension and signal features of the lesions were assessed, and the MRS results were analyzed. Results All tumors were supratentorial. The cortex was the main area involved, with nine tumors located in the temporal lobe, three in the frontal lobe, and one on the boundary between the temporal and occipital lobes. All cases had decreased signal intensity on Tl-weighted MR images and increased signal intensity on T2-weighted images. On fluid attenuated inversion recovery weighted images, the hyperintense ＂ring sign＂ and internal septation of the lesion were seen in 9 cases. Eight tumors had well-demarcated borders. Peritumoral edema or mass effect was absent in all cases. A contrast enhancement examination was performed in 9 cases. Contrast enhancement was absent in five cases, and four cases showed significant enhancement. The MRS showed a low N-acetylaspartate peak and a lack of elevated choline-containing component （Cho） or Cho-Cr ratio （Cho/Cr） in five patients. Conclusions The MRI findings of DNTs were stereotypical. The combination of MRI and MRS techniques were helpful in making a correct presurgical diagnosis.