Journal of Neuroimaging最新文献_第4页

Deep learning from head CT scans to predict elevated intracranial pressure 从头部 CT 扫描进行深度学习，预测颅内压升高。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-10-10 DOI: 10.1111/jon.13241

Ryota Sato, Yukinori Akiyama, Takeshi Mikami, Ayumu Yamaoka, Chie Kamada, Kyoya Sakashita, Yasuhiro Takahashi, Yusuke Kimura, Katsuya Komatsu, Nobuhiro Mikuni

Background and Purpose

Elevated intracranial pressure (ICP) resulting from severe head injury or stroke poses a risk of secondary brain injury that requires neurosurgical intervention. However, currently available noninvasive monitoring techniques for predicting ICP are not sufficiently advanced. We aimed to develop a minimally invasive ICP prediction model using simple CT images to prevent secondary brain injury caused by elevated ICP.

Methods

We used the following three methods to determine the presence or absence of elevated ICP using midbrain-level CT images: (1) a deep learning model created using the Python (PY) programming language; (2) a model based on cistern narrowing and scaling of brainstem deformities and presence of hydrocephalus, analyzed using the statistical tool Prediction One (PO); and (3) identification of ICP by senior residents (SRs). We compared the accuracy of the validation and test data using fivefold cross-validation and visualized or quantified the areas of interest in the models.

Results

The accuracy of the validation data for the PY, PO, and SR methods was 83.68% (83.42%-85.13%), 85.71% (73.81%-88.10%), and 66.67% (55.96%-72.62%), respectively. Significant differences in accuracy were observed between the PY and SR methods. Test data accuracy was 77.27% (70.45%-77.2%), 84.09% (75.00%-85.23%), and 61.36% (56.82%-68.18%), respectively.

Conclusions

Overall, the outcomes suggest that these newly developed models may be valuable tools for the rapid and accurate detection of elevated ICP in clinical practice. These models can easily be applied to other sites, as a single CT image at the midbrain level can provide a highly accurate diagnosis.

背景和目的：严重颅脑损伤或中风导致的颅内压（ICP）升高有可能造成继发性脑损伤，需要神经外科手术干预。然而，目前用于预测 ICP 的无创监测技术还不够先进。我们旨在利用简单的 CT 图像开发一种微创的 ICP 预测模型，以防止 ICP 升高造成继发性脑损伤：我们使用以下三种方法通过中脑水平的 CT 图像来判断是否存在 ICP 升高：（1）使用 Python（PY）编程语言创建的深度学习模型；（2）使用统计工具 Prediction One（PO）分析的基于脑干畸形和存在脑积水的蝶窦狭窄和缩放的模型；以及（3）由资深住院医师（SR）识别 ICP。我们使用五倍交叉验证法比较了验证数据和测试数据的准确性，并对模型中的相关区域进行了可视化或量化：PY、PO 和 SR 方法的验证数据准确率分别为 83.68%（83.42%-85.13%）、85.71%（73.81%-88.10%）和 66.67%（55.96%-72.62%）。PY方法和SR方法的准确率存在显著差异。测试数据准确率分别为 77.27%（70.45%-77.2%）、84.09%（75.00%-85.23%）和 61.36%（56.82%-68.18%）：总之，研究结果表明，这些新开发的模型可能是在临床实践中快速准确检测 ICP 升高的重要工具。这些模型很容易应用到其他部位，因为中脑水平的单张 CT 图像就能提供高度准确的诊断。

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引用次数: 0

Quantification of porcine lower thoracic spinal cord morphology with intact dura mater using high-resolution μCT 利用高分辨率μCT对猪下胸椎脊髓形态和完整硬脑膜进行量化。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-10-10 DOI: 10.1111/jon.13239

Justin Chin, Megan L. Settell, Meagan K. Brucker-Hahn, Daniel Lust, Jichu Zhang, Aniruddha R. Upadhye, Bruce Knudsen, Ashlesha Deshmukh, Kip A. Ludwig, Igor A. Lavrov, Andrew R. Crofton, Scott F. Lempka, Mingming Zhang, Andrew J. Shoffstall

Background and Purpose

Spinal cord stimulation (SCS) is approved by the Food and Drug Administration for treating chronic intractable pain in the back, trunk, or limbs through stimulation of the dorsal column. Numerous studies have used swine as an analog of the human spinal cord to better understand SCS and further improve its efficacy. We performed high-resolution imaging of the porcine spinal cord with intact dura mater using micro-computed tomography (μCT) to construct detailed 3-dimensional (3D) visualizations of the spinal cord and characterize the morphology of the dorsal and ventral rootlets.

Methods

We obtained spinal cords from Yorkshire/Landrace crossbred swine (N = 7), stained samples with osmium tetroxide, and performed μCT imaging of the T12-T15 levels at isotropic voxel resolutions ranging from 3.3 to 50 μm. We measured the anatomical morphology using the 3D volumes and compared our results to measurements previously collected from swine and human spinal cords via microdissection techniques in prior literature.

Results

While the porcine thoracic-lumbar spinal cord is a popular model for SCS, we highlight multiple notable differences compared to previously published T8-T12 human measurements including rootlet counts (porcine dorsal/ventral: 12.2 ± 2.6, 26.6 ± 3.4; human dorsal/ventral: 5.3 ± 1.3, 4.4 ± 2.4), rootlet angles (porcine ventral-rostral: 161 ± 1°, ventral-caudal: 155 ± 6°, dorsal-rostral: 148 ± 9°, dorsal-caudal: 142 ± 6°; human ventral-rostral: 170 ± 3°, ventral-caudal: 22 ± 10°, dorsal-rostral: 171 ± 3°, dorsal-caudal: 15 ± 7°), and the presence and count of dorsal rootlet bundles.

Conclusions

Detailed measurements and highlighted differences between human and porcine spinal cords can inform variations in modeling and electrophysiological experiments between the two species. In contrast to other approaches for measuring the spinal cord and rootlet morphology, our method keeps the dura intact, reducing potential artifacts from dissection.

背景和目的：脊髓刺激疗法（SCS）已获美国食品和药物管理局批准，用于通过刺激背柱治疗背部、躯干或四肢的慢性顽固性疼痛。许多研究将猪作为人类脊髓的类似物，以更好地了解 SCS 并进一步提高其疗效。我们使用微型计算机断层扫描（μCT）对猪脊髓和完整硬脑膜进行了高分辨率成像，以构建脊髓的详细三维（3D）可视化图像，并确定背侧和腹侧小根的形态特征：我们从约克郡/兰德良种杂交猪（N = 7）身上获取脊髓，用四氧化锇对样本进行染色，然后以 3.3 至 50 μm 的各向同性体素分辨率对 T12 至 T15 层进行μCT 成像。我们利用三维体积测量了解剖形态，并将我们的结果与之前文献中通过显微切割技术从猪和人脊髓收集的测量结果进行了比较：4）、小根角度（猪腹喙：161 ± 1°，腹尾：155 ± 6°，背喙：148 ± 9°，背尾：142 ± 6°；人腹喙：170 ± 3°，腹尾：22 ± 10°，背喙：171 ± 3°，背尾：15 ± 7°）以及背侧小根束的存在和数量：结论：对人和猪脊髓的详细测量和突出差异可为两个物种之间的建模和电生理实验提供信息。与其他测量脊髓和小根形态的方法相比，我们的方法保持了硬脊膜的完整，减少了解剖可能造成的伪影。

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引用次数: 0

Slowly expanding lesions are associated with disease activity and gray matter loss in relapse-onset multiple sclerosis 缓慢扩大的病变与复发型多发性硬化症的疾病活动和灰质丢失有关。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-10-10 DOI: 10.1111/jon.13243

Hiroaki Yokote, Yusei Miyazaki, Juichi Fujimori, Yoichiro Nishida, Shuta Toru, Masaaki Niino, Ichiro Nakashima, Yoshiharu Miura, Takanori Yokota

Background and Purpose

Slowly expanding lesions (SELs) have been proposed as novel MRI markers of chronic active lesions in multiple sclerosis (MS). However, the mechanism through which SELs affect brain volume loss in patients with MS remains unknown. Additionally, the prevalence and significance of SELs in Asian patients with MS remain unclear. This study aimed to investigate the association between SELs and no evidence of disease activity (NEDA)-3 status as well as brain volume loss in Japanese patients.

Methods

A total of 99 patients with relapse-onset MS were retrospectively evaluated. SELs were identified on brain MRI based on local deformation when consecutive scans were registered longitudinally. We developed a logistic regression model and generalized linear mixed models (GLMMs) to evaluate the association between the number of SELs and disease activity and changes in brain volume.

Results

During the observation period (2.0 ± 0.22 years), 35 patients developed at least one SEL. Multivariable logistic regression analysis showed that ≥2 SELs were associated with 0.2 times the risk of achieving a NEDA-3 status. GLMMs revealed that the number of SELs was negatively associated with volume changes in the cortex (p = .00169) and subcortical gray matter (p = .00964) after correction for multiple comparisons.

Conclusion

SELs were identified in Japanese patients with MS during the 2-year observation period. The number of SELs is associated with disease activity and brain volume loss, suggesting that the number of SELs could be a biomarker of disease activity in MS.

背景和目的：缓慢扩展病灶（SEL）被认为是多发性硬化症（MS）慢性活动性病灶的新型磁共振成像标记物。然而，SEL影响多发性硬化症患者脑容量损失的机制仍不清楚。此外，SELs在亚洲多发性硬化症患者中的发病率和意义仍不清楚。本研究旨在调查日本患者中SEL与无疾病活动证据（NEDA）-3状态以及脑容量损失之间的关系：方法：对99名复发型多发性硬化症患者进行了回顾性评估。方法：我们对 99 名复发多发性硬化症患者进行了回顾性评估，并根据纵向连续扫描时的局部变形在脑部 MRI 上识别出 SEL。我们建立了逻辑回归模型和广义线性混合模型（GLMMs）来评估SEL数量与疾病活动和脑容量变化之间的关联：在观察期间（2.0 ± 0.22 年），35 名患者至少出现了一次 SEL。多变量逻辑回归分析显示，≥2次SEL与达到NEDA-3状态的0.2倍风险相关。GLMMs显示，经多重比较校正后，SEL的数量与皮层（p = .00169）和皮层下灰质（p = .00964）的体积变化呈负相关：结论：在两年的观察期内，日本多发性硬化症患者中发现了SEL。结论：在日本多发性硬化症患者的两年观察期内发现了SELs，SELs的数量与疾病活动性和脑容量损失有关，这表明SELs的数量可能是多发性硬化症疾病活动性的生物标志物。

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引用次数: 0

A simplified approach to define cervical vertebral levels in spinal cord MRI studies 脊髓磁共振成像研究中界定颈椎水平的简化方法。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-10-06 DOI: 10.1111/jon.13240

Nico Papinutto, Ilaria Perretti, Jacob Mallott, Shuiting Cheng, Tiffany Cooper, Refujia Gomez, William A. Stern, Anna Pichiecchio, Eduardo Caverzasi, Roland G. Henry

Background and Purpose

Spinal cord (SC) cross-sectional areas (CSAs) assessed with MRI have proven to be extremely valuable imaging markers in several diseases. Among the challenges is the delineation of vertebral levels to determine level-dependent changes in cord atrophy. With this study, we aimed to (1) test the hypothesis that there is proportionality in the position of the first six intervertebral discs and the length of the upper portion of the SC and (2) show that a proportionality approach can simplify the CSA assessment across vertebrae offering good reliability.

Methods

Forty-six volunteers underwent standard T2-weighted and T1-weighted cervical SC MRI acquisitions. The distance between the obex and the intervertebral discs (from C2-C3 to T1-T2) was measured on the T2-weighted acquisitions of the entire cohort. In a test-retest experiment on 12 subjects, the % disc position values were used to define vertebral levels, and a comparison was performed with manual vertebrae assignment in terms of mean CSA and its coefficient of variation.

Results

The mean upper cord length for the cohort was 144.0 ± 13.1 mm. The discs’ level % position in the upper cord was found to be fairly consistent, with standard deviations of 0.8%-1.7%. The mean vertebral CSA obtained with the proportionality method was substantially equivalent to the manual approach in terms of mean CSA values and test-retest reliability.

Conclusions

With this study, we propose a proportionality method for the assignment of cervical SC vertebral levels that can simplify the processing of MRI datasets in the context of CSA measurements.

背景和目的：用核磁共振成像评估的脊髓（SC）横截面积（CSA）已被证明是多种疾病中极具价值的成像标记物。其中一个挑战是如何划分椎体水平，以确定脊髓萎缩的水平依赖性变化。通过这项研究，我们的目的是：（1）检验前六个椎间盘的位置与脊髓空洞上部的长度是否成比例的假设；（2）证明成比例的方法可以简化跨椎体的 CSA 评估，并提供良好的可靠性：方法：46 名志愿者接受了标准 T2 加权和 T1 加权颈椎 SC MRI 采集。在整个组群的 T2 加权采集中测量了斜方肌与椎间盘（从 C2-C3 到 T1-T2）之间的距离。在对 12 名受试者进行的重测实验中，椎间盘位置百分比值被用来定义椎体水平，并在平均 CSA 及其变异系数方面与手动椎体分配进行了比较：结果：研究组的平均上脊髓长度为 144.0 ± 13.1 毫米。椎间盘在上脊髓中的水平%位置相当一致，标准偏差为 0.8%-1.7%。就平均 CSA 值和测试-再测试可靠性而言，比例法获得的平均椎体 CSA 与人工方法基本相当：通过这项研究，我们提出了一种用于分配颈椎 SC 椎体水平的比例法，该方法可以简化 CSA 测量中 MRI 数据集的处理过程。

{"title":"A simplified approach to define cervical vertebral levels in spinal cord MRI studies","authors":"Nico Papinutto, Ilaria Perretti, Jacob Mallott, Shuiting Cheng, Tiffany Cooper, Refujia Gomez, William A. Stern, Anna Pichiecchio, Eduardo Caverzasi, Roland G. Henry","doi":"10.1111/jon.13240","DOIUrl":"10.1111/jon.13240","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Purpose</h3>\u0000 \u0000 <p>Spinal cord (SC) cross-sectional areas (CSAs) assessed with MRI have proven to be extremely valuable imaging markers in several diseases. Among the challenges is the delineation of vertebral levels to determine level-dependent changes in cord atrophy. With this study, we aimed to (1) test the hypothesis that there is proportionality in the position of the first six intervertebral discs and the length of the upper portion of the SC and (2) show that a proportionality approach can simplify the CSA assessment across vertebrae offering good reliability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-six volunteers underwent standard T2-weighted and T1-weighted cervical SC MRI acquisitions. The distance between the obex and the intervertebral discs (from C2-C3 to T1-T2) was measured on the T2-weighted acquisitions of the entire cohort. In a test-retest experiment on 12 subjects, the % disc position values were used to define vertebral levels, and a comparison was performed with manual vertebrae assignment in terms of mean CSA and its coefficient of variation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean upper cord length for the cohort was 144.0 ± 13.1 mm. The discs’ level % position in the upper cord was found to be fairly consistent, with standard deviations of 0.8%-1.7%. The mean vertebral CSA obtained with the proportionality method was substantially equivalent to the manual approach in terms of mean CSA values and test-retest reliability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>With this study, we propose a proportionality method for the assignment of cervical SC vertebral levels that can simplify the processing of MRI datasets in the context of CSA measurements.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 6","pages":"639-645"},"PeriodicalIF":2.3,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jon.13240","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intracerebral hemorrhage risk after adjunct intraarterial thrombolysis in thrombectomy-treated acute ischemic stroke 血栓切除术治疗急性缺血性脑卒中后辅助动脉内溶栓的脑内出血风险。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-09-22 DOI: 10.1111/jon.13238

Adnan I. Qureshi, Yilun Huang, Ibrahim A. Bhatti, Camilo R. Gomez, Daniel F. Hanley, Daniel E. Ford, Ameer E. Hassan, Thanh N. Nguyen, Alejandro M. Spiotta, Erol Veznedaroglu, Ronald F. Budzik, Rishi Gupta, Raul G. Nogueira, Antonin Krajina, Bruno Bartolini, Joey English, Blaise Baxter, David S. Liebeskind

Background and Purpose

Intraarterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intraarterial thrombolysis may increase the risk of post-thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups.

Methods

We analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry. The occurrence of any (asymptomatic and symptomatic) post-thrombectomy ICH was ascertained using standard definition requiring serial neurological examinations and computed tomographic scans acquired within 48 hours of the thrombectomy. We determined the risk of ICH in subgroups defined by clinical characteristics and the use of intravenous (IV) thrombolysis.

Results

A total of 146 (7.5%) patients received intraarterial thrombolysis among 1953 acute ischemic stroke patients who underwent mechanical thrombectomy. The proportion of patients who developed any ICH was 26 (17.8%) and 510 (28.2%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .006). The proportion of patients who developed symptomatic ICH was 4 (2.7%) and 30 (1.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .34). Among patients who received IV thrombolysis (n = 1042), the proportion of patients who developed any ICH was 9 (16.7%) and 294 (30.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .028). The risk was not different in strata defined by age, gender, location of occlusion, preprocedure National Institutes of Health Stroke Scale score, time interval between symptom onset and thrombectomy, Alberta Stroke Program Early CT Score, systolic blood pressure, and serum glucose concentrations.

Conclusions

In patients undergoing mechanical thrombectomy, the risk of any ICH and symptomatic ICH was not increased with intraarterial thrombolysis, including in those who had already received IV thrombolytics.

背景和目的：越来越多的急性缺血性卒中患者考虑将动脉内溶栓作为机械取栓术的辅助手段，以加强再灌注。在某些患者亚群中，动脉内溶栓可能会增加血栓切除术后脑内出血（ICH）的风险：方法：我们分析了在多中心登记中接受机械溶栓治疗的急性缺血性脑卒中患者。血栓切除术后任何（无症状和有症状）ICH的发生都是根据标准定义确定的，要求在血栓切除术后48小时内进行连续的神经系统检查和计算机断层扫描。我们根据临床特征和静脉（IV）溶栓的使用情况确定了亚组的 ICH 风险：在 1953 名接受机械血栓切除术的急性缺血性脑卒中患者中，共有 146 名（7.5%）患者接受了动脉内溶栓治疗。接受和未接受动脉内溶栓治疗的患者中，发生任何 ICH 的比例分别为 26 例（17.8%）和 510 例（28.2%）（p = .006）。接受和未接受动脉内溶栓治疗的患者中，出现症状性 ICH 的比例分别为 4（2.7%）和 30（1.7%）（p = .34）。在接受静脉溶栓治疗的患者（n = 1042）中，接受和未接受动脉内溶栓治疗的患者发生任何 ICH 的比例分别为 9（16.7%）和 294（30.7%）（p = .028）。根据年龄、性别、闭塞位置、术前美国国立卫生研究院卒中量表评分、症状出现与血栓切除术之间的时间间隔、阿尔伯塔省卒中项目早期CT评分、收缩压和血清葡萄糖浓度等因素确定的分层风险没有差异：在接受机械血栓切除术的患者中，动脉内溶栓不会增加任何 ICH 和症状性 ICH 的风险，包括那些已经接受过静脉溶栓治疗的患者。

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引用次数: 0

Human performance in predicting enhancement quality of gliomas using gadolinium-free MRI sequences 利用无钆磁共振成像序列预测胶质瘤增强质量的人类表现。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-09-19 DOI: 10.1111/jon.13233

Aynur Azizova, Ivar J. H. G. Wamelink, Yeva Prysiazhniuk, Marcus Cakmak, Elif Kaya, Jan Petr, Frederik Barkhof, Vera C. Keil

Background and Purpose

To develop and test a decision tree for predicting contrast enhancement quality and shape using precontrast magnetic resonance imaging (MRI) sequences in a large adult-type diffuse glioma cohort.

Methods

Preoperative MRI scans (development/optimization/test sets: n = 31/38/303, male = 17/22/189, mean age = 52/59/56.7 years, high-grade glioma = 22/33/249) were retrospectively evaluated, including pre- and postcontrast T1-weighted, T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted imaging sequences. Enhancement prediction decision tree (EPDT) was developed using development and optimization sets, incorporating four imaging features: necrosis, diffusion restriction, T2 inhomogeneity, and nonenhancing tumor margins. EPDT accuracy was assessed on a test set by three raters of variable experience. True enhancement features (gold standard) were evaluated using pre- and postcontrast T1-weighted images. Statistical analysis used confusion matrices, Cohen's/Fleiss’ kappa, and Kendall's W. Significance threshold was p < .05.

Results

Raters 1, 2, and 3 achieved overall accuracies of .86 (95% confidence interval [CI]: .81-.90), .89 (95% CI: .85-.92), and .92 (95% CI: .89-.95), respectively, in predicting enhancement quality (marked, mild, or no enhancement). Regarding shape, defined as the thickness of enhancing margin (solid, rim, or no enhancement), accuracies were .84 (95% CI: .79-.88), .88 (95% CI: .84-.92), and .89 (95% CI: .85-.92). Intrarater intergroup agreement comparing predicted and true enhancement features consistently reached substantial levels (≥.68 [95% CI: .61-.75]). Interrater comparison showed at least moderate agreement (group: ≥.42 [95% CI: .36-.48], pairwise: ≥.61 [95% CI: .50-.72]). Among the imaging features in the EPDT, necrosis assessment displayed the highest intra- and interrater consistency (≥.80 [95% CI: .73-.88]).

Conclusion

The proposed EPDT has high accuracy in predicting enhancement patterns of gliomas irrespective of rater experience.

背景与目的：在一个大型成人型弥漫性胶质瘤队列中开发并测试一种决策树，用于利用对比前磁共振成像（MRI）序列预测对比增强的质量和形状：对术前 MRI 扫描（开发/优化/测试集：n = 31/38/303，男性 = 17/22/189，平均年龄 = 52/59/56.7岁，高级别胶质瘤 = 22/33/249）进行回顾性评估，包括对比前和对比后 T1 加权、T2 加权、流体增强反转恢复和弥散加权成像序列。利用开发和优化集开发了增强预测决策树（EPDT），其中包含四个成像特征：坏死、弥散受限、T2 不均匀性和肿瘤边缘不增强。EPDT 的准确性由三位经验各异的评定者在测试集上进行评估。使用对比前和对比后的 T1 加权图像对真实增强特征（金标准）进行评估。统计分析采用混淆矩阵、Cohen's/Fleiss' kappa 和 Kendall's W：评分者 1、2 和 3 预测增强质量（明显、轻度或无增强）的总体准确率分别为 0.86（95% 置信区间 [CI]：0.81-.90）、0.89（95% CI：0.85-.92）和 0.92（95% CI：0.89-.95）。关于形状，即增强边缘的厚度（实心、边缘或无增强），准确率分别为 0.84（95% CI：0.79-.88）、0.88（95% CI：0.84-.92）和 0.89（95% CI：0.85-.92）。比较预测增强特征和真实增强特征的组间一致性达到了相当高的水平（≥.68 [95% CI: .61-.75]）。相互比较至少显示出中等程度的一致性（组间：≥.42 [95% CI：.36-.48]，配对：≥.61 [95% CI：.50-.72]）。在 EPDT 的影像学特征中，坏死评估显示出最高的内部和相互间一致性（≥.80 [95% CI：.73-.88]）：无论评分者的经验如何，所提出的 EPDT 在预测胶质瘤的增强模式方面都具有很高的准确性。

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引用次数: 0

Periaqueductal gray connectivity in spinal cord injury-induced neuropathic pain 脊髓损伤诱发的神经性疼痛中的uctal灰质周围连通性

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-09-09 DOI: 10.1111/jon.13237

Omid Shoraka, Mashaal Syed, Shreya Mandloi, Sara Thalheimer, Sara Naghizadeh Kashani, Joshua E. Heller, Feroze B. Mohamed, Ashwini D. Sharan, Kiran S. Talekar, Caio M. Matias, James S. Harrop, Laura Krisa, Mahdi Alizadeh

Background and Purpose

Neuropathic pain (NP) is a debilitating condition following spinal cord injury (SCI). The role of periaqueductal gray (PAG) in NP development following SCI remains underexplored. Using resting-state functional MRI (rsfMRI), our study aimed to demonstrate the alterations in functional connectivity (FC) of PAG in NP following SCI.

Methods

Ten SCI patients (SCI + NP, n = 7, and SCI − NP, n = 3), alongside 10 healthy controls (HCs), were enrolled. rsfMRI was conducted followed by seed-to-voxel analysis using PAG as the seed region and then group-based analysis comprising three groups (SCI + NP, SCI − NP, and HC). Age and gender were considered as confounding variables.

Results

Compared to HCs, SCI + NP demonstrated decreased FC between PAG and right insula, right frontal orbital cortex, right pallidum, dorsal raphe nucleus (DRN), red nuclei (RN), substantia nigra (SN), and ventral posterolateral (VPL) thalamic nuclei. Compared to SCI − NP, SCI + NP demonstrated increased FC between PAG and posterior cingulate cortex (PCC), hippocampus, cerebellar vermis lobules IV and V, and thalamic structures (posterior and lateral pulvinar, the mediodorsal nuclei, and the ventral lateral nuclei). Additionally, decreased FC between the PAG and VPL, geniculate bodies, intralaminar nuclei of thalamus, DRN, RN, SN, and prefrontal cortex was observed in this comparison.

Conclusions

Altered FC between PAG and right anterior insula, VPL, DRN, RN, SN, cerebellar vermis lobules IV and V, frontal cortex, and PCC was associated with NP sequelae of SCI. Additionally, SCI was independently associated with decreased FC between PAG and right posterior insula, cerebellar lobules IV and V, and cerebellar vermis lobules III, IV, and V.

背景和目的神经病理性疼痛（NP）是脊髓损伤（SCI）后的一种使人衰弱的症状。脊髓损伤后神经病理性疼痛（Neuropathic pain，NP）是一种使人衰弱的病症。我们的研究采用静息态功能磁共振成像（rsfMRI），旨在证明PAG在SCI后NP中功能连接性（FC）的改变。方法招募了10名SCI患者（SCI + NP，n = 7；SCI - NP，n = 3）和10名健康对照组（HC）。结果与 HCs 相比，SCI + NP 显示 PAG 与右侧岛叶、右侧额眶皮层、右侧苍白球、背侧剑突核（DRN）、红核（RN）、黑质（SN）和丘脑腹后外侧核（VPL）之间的 FC 减少。与 SCI - NP 相比，SCI + NP 显示 PAG 与后扣带回皮层 (PCC)、海马、小脑蚓部第四和第五小叶以及丘脑结构（后部和外侧脉络膜、内侧核和腹侧外侧核）之间的 FC 增加。结论 PAG与右侧前脑岛、VPL、DRN、RN、SN、小脑蚓部小叶IV和V、额叶皮质和PCC之间的FC改变与SCI的NP后遗症有关。此外，SCI还与PAG和右侧后岛叶、小脑第四和第五小叶以及小脑蚓部第三、第四和第五小叶之间的FC下降有关。

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引用次数: 0

Alterations in functional brain connectivity associated with developmental dyscalculia 与发育性计算障碍有关的大脑功能连接的改变。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-09-05 DOI: 10.1111/jon.13236

Roger Mateu-Estivill, Ana Adan, Sergi Grau, Xavier Rifà-Ros, Xavier Caldú, Núria Bargalló, Josep M. Serra-Grabulosa

Background and Purpose

In recent years, there has been a growing interest in the study of resting neural networks in different neurological and mental disorders. While previous studies suggest that the default mode network (DMN) may be altered in dyscalculia, the study of resting-state networks in the development of numerical skills, especially in children with developmental dyscalculia (DD), is scarce and relatively recent. Based on this, this study examines differences in resting-state functional connectivity (rs-FC) data of children with DD using functional connectivity multivariate pattern analysis (fc-MVPA), a data-driven methodology that summarizes properties of the entire connectome.

Methods

We performed fc-MVPA on resting-state images of a sample composed of a group of children with DD (n = 19, 8.06 ± 0.87 years) and an age- and sex-matched control group of typically developing children (n = 23, 7.76 ± 0.46 years).

Results

Analysis of fc-MVPA showed significant differences between group connectivity profiles in two clusters allocated in both the right and left medial temporal gyrus. Post hoc effect size results revealed a decreased rs-FC between each temporal pole and the DMN in children with DD and an increased rs-FC between each temporal pole and the sensorimotor network.

Conclusions

Our results suggest an aberrant information flow between resting-state networks in children with DD, demonstrating the importance of these networks for arithmetic development.

背景和目的：近年来，人们对不同神经和精神疾病中静息神经网络的研究越来越感兴趣。以往的研究表明，默认模式网络（DMN）可能在计算障碍中发生改变，但对静息态网络在计算技能发展中的作用，尤其是发育性计算障碍（DD）儿童的静息态网络的研究却相对较少。基于此，本研究利用功能连通性多变量模式分析（fc-MVPA）研究了发育性计算障碍儿童的静息态功能连通性（rs-FC）数据的差异：我们对一组 DD 儿童（n = 19，8.06 ± 0.87 岁）和一组年龄与性别匹配的发育正常对照组儿童（n = 23，7.76 ± 0.46 岁）的静息态图像进行了 fc-MVPA 分析：结果：fc-MVPA分析表明，在左右颞内侧回分配的两个群组中，组间连通性特征存在显著差异。事后效应大小结果显示，DD患儿每个颞极与DMN之间的rs-FC减少，而每个颞极与感觉运动网络之间的rs-FC增加：我们的研究结果表明，DD患儿静息态网络之间的信息流出现异常，这表明这些网络对算术的发展非常重要。

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引用次数: 0

Prevalence, trends, and outcomes of cerebral infarction in patients with aneurysmal subarachnoid hemorrhage in the USA 美国动脉瘤性蛛网膜下腔出血患者脑梗塞的发病率、趋势和预后。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-09-02 DOI: 10.1111/jon.13229

Adnan I. Qureshi, Ibrahim A. Bhatti, Syed A. Gillani, Jonathan Beall, Christy N. Cassarly, Byron Gajewski, Renee H. Martin, Jose I. Suarez, Chun Shing Kwok

Background and Purpose

Cerebral infarction remains an important cause of death or disability in patients with aneurysmal subarachnoid hemorrhage (SAH). The prevalence, trends, and outcomes of cerebral infarction in patients with aneurysmal SAH at a national level are not known.

Methods

We identified the proportion of patients who develop cerebral infarction (ascertained using validated methodology) among patients with aneurysmal SAH and annual trends using the Nationwide Inpatient Sample (NIS) from 2016 to 2021. We analyzed the effect of cerebral infarction on in-hospital mortality, routine discharge without palliative care (based on discharge disposition), poor outcome defined by the NIS SAH outcome measure, and length and costs of hospitalization after adjusting for potential confounders.

Results

A total of 35,305 (53.6%) patients developed cerebral infarction among 65,840 patients with aneurysmal SAH over a 6-year period. There was a trend toward an increase in the proportion of patients who developed cerebral infarction from 51.5% in 2016 to 56.1% in 2021 (p trend p<.001). Routine discharge was significantly lower (30.5% vs. 37.8%, odds ratio [OR] 0.82, 95% confidence interval [CI] 0.75-0.89, p<.001), and poor outcome defined by NIS-SAH outcome measure was significantly higher among patients with cerebral infarction compared with those without cerebral infarction (67.4% vs. 59.3%, OR 1.29, 95% CI 1.18-1.40, p<.001). There was no difference in in-hospital mortality (13.0% vs. 13.6%, OR 0.94, 95% CI 0.85-1.05, p = .30). The length of stay (median 18 days [interquartile range [IQR] 13-25] vs. 14 days [IQR 9-20]), coefficient 3.04, 95% CI 2.44-3.52 and hospitalization cost (median $96,823 vs. $71,311, coefficient 22,320, 95% CI 20,053-24,587) were significantly higher among patients who developed cerebral infarction compared with those who did not develop cerebral infarction.

Conclusions

Cerebral infarction was seen in 54% of the patients with a trend toward an increase in the affected proportion of patients with aneurysmal SAH. Patients with cerebral infarction had higher rates of adverse outcomes and required higher resources during hospitalization.

背景和目的：脑梗塞仍是动脉瘤性蛛网膜下腔出血（SAH）患者死亡或致残的重要原因。目前尚不清楚全国范围内动脉瘤性 SAH 患者脑梗塞的发病率、趋势和结果：我们利用 2016 年至 2021 年的全国住院患者样本（NIS）确定了动脉瘤性 SAH 患者中发生脑梗塞的比例（使用有效方法确定）和年度趋势。我们分析了脑梗死对院内死亡率、无姑息治疗的常规出院（基于出院处置）、NIS SAH结局测量所定义的不良结局以及调整潜在混杂因素后的住院时间和费用的影响：在65840名动脉瘤性SAH患者中，共有35305名（53.6%）患者在6年时间里发生了脑梗死。发生脑梗塞的患者比例呈上升趋势，从2016年的51.5%上升至2021年的56.1%（P趋势 p结论：脑梗塞在动脉瘤性SAH患者中的发生率为51.5%，而在动脉瘤性SAH患者中的发生率为56.1%：54%的患者发生了脑梗塞，动脉瘤性 SAH 患者中发生脑梗塞的比例呈上升趋势。脑梗死患者的不良后果发生率较高，住院期间所需的资源也较多。

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引用次数: 0

Perfusion imaging predicts short-term clinical outcome in isolated posterior cerebral artery occlusion stroke 灌注成像可预测孤立性大脑后动脉闭塞性卒中的短期临床预后。

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging

Pub Date : 2024-09-02 DOI: 10.1111/jon.13235

Hamza Adel Salim, Shenwen Huang, Dhairya A. Lakhani, Janet Mei, Aneri Balar, Basel Musmar, Nimer Adeeb, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z. Hyson, Mona Bahouth, Adam A. Dmytriw, Adrien Guenego, Gregory W. Albers's, Hanzhang Lu, Victor C. Urrutia, Kambiz Nael, Elisabeth B Marsh, Argye E. Hillis, Raf Llinas, Max Wintermark, Jeremy J. Heit, Tobias D. Faizy, Vivek Yedavalli

Background and Purpose

Ischemic strokes due to isolated posterior cerebral artery (PCA) occlusions represent 5% of all strokes but have significant impacts on patients’ quality of life, primarily due to visual deficits and thalamic involvement. Current guidelines for acute PCA occlusion management are sparse, and the prognostic value of perfusion imaging parameters remains underexplored.

Methods

We conducted a retrospective analysis of 32 patients with isolated PCA occlusions treated at Johns Hopkins Medical Institutions between January 2017 and March 2023. Patients underwent pretreatment perfusion imaging, with perfusion parameters analyzed using RAPID software. The primary outcome was short-term clinical outcome as measured by the National Institutes of Health Stroke Scale (NIHSS) at discharge.

Results

The median age of the cohort was 70 years, with 34% female and 66% male. Significant correlations were found between NIHSS at discharge and various perfusion parameters, including time-to-maximum (Tmax) >6 seconds (ρ = .55, p = .004), Tmax >8 seconds (ρ = .59, p = .002), Tmax >10 seconds (ρ = .6, p = .001), mismatch volume (ρ = .51, p = .008), and cerebral blood volume (CBV) < 34% (ρ = .59, p = .002).

Conclusions

Tmax and CBV volumes significantly correlated with discharge NIHSS with marginal superiority of Tmax >10 seconds and CBV <42% volumes. These findings suggest that CT and MR perfusion imaging can play a crucial role in the acute management of PCA strokes, though larger, standardized studies are needed to validate these results and refine imaging thresholds specific to posterior circulation infarcts.

背景和目的：孤立性大脑后动脉（PCA）闭塞导致的缺血性脑卒中占所有脑卒中的5%，但对患者的生活质量有重大影响，主要是由于视觉障碍和丘脑受累。目前关于急性 PCA 闭塞治疗的指南很少，灌注成像参数的预后价值仍未得到充分探讨：我们对2017年1月至2023年3月期间在约翰霍普金斯医疗机构接受治疗的32例孤立性PCA闭塞患者进行了回顾性分析。患者接受了预处理灌注成像，并使用 RAPID 软件分析了灌注参数。主要结果是出院时美国国立卫生研究院卒中量表（NIHSS）显示的短期临床结果：结果：组群的中位年龄为 70 岁，34% 为女性，66% 为男性。出院时的NIHSS与各种灌注参数之间存在显著相关性，包括最大时间（Tmax）>6秒（ρ = .55，p = .004）、最大时间>8秒（ρ = .59，p = .002）、最大时间>10秒（ρ = .6，p = .001）、错配容积（ρ = .51，p = .008）和脑血容量（CBV）<34%（ρ = .59，p = .002）：结论：Tmax 和 CBV 容量与出院 NIHSS 显著相关，其中 Tmax >10 秒和 CBV

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引用次数: 0