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Diabetes is a chronic non-communicable disease affecting over 400 million people worldwide. Diabetic patients are at a high risk of various complications, such as cardiovascular, renal, and other diseases. The pathogenesis of diabetes (both type 1 and type 2 diabetes) is associated with a functional impairment of pancreatic β-cells. Consequently, most efforts to manage and prevent diabetes have focused on preserving β-cells and their function. Advances in imaging techniques, such as magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography, and single-photon-emission computed tomography, have enabled noninvasive and quantitative detection and characterization of the population and function of β-cells in vivo. These advantages aid in defining and monitoring the progress of diabetes and determining the efficacy of anti-diabetic therapies. Beyond β-cell targeting, molecular imaging of biomarkers associated with the development of diabetes, e.g., lymphocyte infiltration, insulitis, and metabolic changes, may also be a promising strategy for early detection of diabetes, monitoring its progression, and occurrence of complications, as well as facilitating exploration of new therapeutic interventions. Moreover, molecular imaging of glucose uptake, production and excretion in specified tissues is critical for understanding the pathogenesis of diabetes. In the current review, we summarize and discuss recent advances in noninvasive imaging technologies for imaging of biomarkers beyond β-cells for early diagnosis of diabetes, investigation of glucose metabolism, and precise diagnosis and monitoring of diabetic complications for better management of diabetic patients. Unlabelled Image [ABSTRACT FROM AUTHOR]

Purpose: To evaluate image quality of non-contrast-enhanced magnetic resonance angiography (MRA) and compare transplant renal artery stenosis (TRAS) seen by non-contrast-enhanced MRA with digital subtraction angiography (DSA) as the gold standard.Materials and Methods: 330 patients receiving 369 non-contrast-enhanced MRA examinations from July 2014 to June 2017 were included. Thirty patients received at least two MRA examinations. Image quality was independently assessed by two radiologists. Inter-observer agreement was analyzed. Transplant renal artery anatomy and complications were evaluated and compared with DSA. If possible, accuracy was calculated on a per-artery basis.Results: Good or excellent image quality was found in 95.4 % (352/369) of examinations with good inter-observer agreement (K=0.760). Twenty-two patients with DSA had 28 non-contrast-enhanced MRA examinations within a 2-month period. Of these, 19 patients had TRAS, two patients had pseudoaneurysms, and one patient had a normal transplant renal artery but an occluded external iliac artery. Non-contrast-enhanced MRA correctly detected 19 TRAS and nine normal arteries, giving 96.6 % accuracy on a per-artery basis.Conclusions: Non-contrast-enhanced MRA demonstrates a good depiction of the transplanted renal artery and shows good correlation with DSA in cases where there was TRAS.Key Points: • Good or excellent image quality was found in 95.4 % of examinations. • Non-contrast-enhanced MRA can clearly map transplant renal artery anatomy. • Non-contrast-enhanced MRA is a reliable tool to detect TRAS. [ABSTRACT FROM AUTHOR]

Hepatic encephalopathy (HE) is a neurological or neuropsychological complication due to liver failure or portosystemic shunting. The clinical manifestation is highly variable, which can exhibit mild cognitive or motor impairment initially, or gradually progress to a coma, even death, without treatment. Neuroimaging plays a critical role in uncovering the neural mechanism of HE. In particular, multimodality MR imaging is able to assess both structural and functional derangements of the brain with HE in focal or neural network perspectives. In recent years, there has been rapid development in novel MR technologies and applications to investigate the pathophysiological mechanism of HE. Therefore, it is necessary to update the latest MR findings regarding HE by use of multimodality MRI to refine and deepen our understanding of the neural traits in HE. Herein, this review highlights the latest MR imaging findings in HE to refresh our understanding of MRI application in HE. [ABSTRACT FROM AUTHOR]

The (micron+nano) bimodal sized SiC p /Al2014 composites fabricated by semi-solid stirring exhibited fine α-Al grains, well-dispersed bimodal sized SiC p and well-bonded interface between SiC p and matrix. The yield and ultimate tensile strength of the extruded bimodal sized SiC p /Al2014 composites were significantly enhanced, compared to the extruded single-sized SiC p /Al2014 composites. [ABSTRACT FROM AUTHOR]

Patients with end-stage renal disease (ESRD) suffer from a number of complex neurological complications including vascular damage and cognitive dysfunction. It is of great significance to detect the neurological complications and improve the prognosis of ESRD patients. Many new noninvasive MRI techniques have been steadily used for the diagnosis of occult central nervous system complications in ESRD patients. This gives an opportunity to understand the pathophysiological mechanisms of these neurological disorders. This paper is a review that presents the MRI findings of occult brain damage in ESRD patients, outlines the applications of advanced MRI techniques, and introduces a brief perspective in this study field. [ABSTRACT FROM AUTHOR]

The tensile properties at elevated temperature of nano-SiC p /Al2014 composites have been investigated. The nano-SiC p can remarkably improve the tensile strength at 493 K of Al2014 alloy without sacrificing the ductility. The strengthening effect for the matrix alloy of 0.5 vol% nano-particles is superior to that of 4 vol% micron-particles. [ABSTRACT FROM AUTHOR]

Background: Coronary to pulmonary artery fistula (CPAF) is rare; reports on the prevalence and types of CPAF in a large cohort of patients are scarce. Purpose: To analyze the prevalence and types of CPAF on computed tomography coronary angiography (CTCA) in a large Chinese population. Material and Methods: CTCA data of 58,533 patients from five Chinese tertiary referral medical centers were retrospectively studied. The prevalence, origin, aneurysmal sac, fistula tracts, and extracardiac communication of CPAF were recorded. CTCA findings were compared with conventional coronary angiography when possible. Results: Ninety-nine patients had CPAF (prevalence of 0.17%). Of the 99 CPAF cases, fistulas were found to originate from either both coronary arteries in 52 patients or from one coronary artery (33 cases from the left and 14 cases from the right coronary artery). Ten CPAF patients were complicated with the communication of extracardiac arteries. Fifteen (15.2%) CPAF patients had aneurysmal sac formation. Thirty (30.3%) patients had a single fistula tract, while 69 (69.7%) patients had multiple fistula tracts. CTCA findings in 16 patients were similar to those at DSA. Conclusion: Based on this large cohort, the prevalence of CPAF in the Chinese population is about 0.17%, with origin from either the left or right coronary artery or from both. CTCA can clearly visualize the types, abnormal vascular tracts, and aneurysmal sac formation of CPAF. [ABSTRACT FROM AUTHOR]

Purpose To explore changes in functional connectivity and topological organization of brain functional networks in cirrhotic patients with minimal hepatic encephalopathy (MHE) and non hepatic encephalopathy (nonHE) and their relationship with clinical markers. Materials and methods Resting-state functional MR imaging was acquired in 22 MHE, 29 nonHE patients and 33 healthy controls. Functional connectivity networks were obtained by computing temporal correlations between any pairs of 90 cortical and subcortical regions. Graph analysis measures were quantitatively assessed for each subject. One-way analysis of covariance was applied to identify statistical differences of functional connectivity and network parameters among three groups. Correlations between clinical markers, such as Child–Pugh scores, venous blood ammonia level, and number connection test type A (NCT-A)/digit symbol test (DST) scores, and connectivity/graph metrics were calculated. Results Thirty functional connectivities represented by edges were found to be abnormal ( P < 0.05, FDR corrected) in cirrhotic patients, in which 16 edges (53.3%) were related with sub-cortical regions. MHE patients showed abnormal small-world attributes in the functional connectivity networks. Cirrhotic patients had significantly reduced nodal degree in 8 cortical regions and increased nodal centrality in 3 cortical regions. Twenty edges were correlated with either NCT-A or DST scores, in which 13 edges were related with sub-cortical regions. No correlation was found between Child–Pugh scores and graph theoretical measures in cirrhotic patients. Conclusion Disturbances of brain functional connectivity and small world property loss are associated with neurocognitive impairment of cirrhotic patients. Reorganization of brain network occurred during disease progression from nonHE to MHE. [ABSTRACT FROM AUTHOR]

• The time-by-APOE ε4 interaction on brain FC demonstrates at a young age. • After follow-up for nearly 3 years, young ε4 carriers reveal decreased FC among time. • And the left superior temporal gyrus is the most sensitive brain region. APOE ε4 is risk for cognitive decline even in normal aging, but its effect on the whole-brain functional connectivity (FC) among time in young adults remain elusive. This study aimed to validate the time-by- APOE ε4 interaction on brain FC of this specific population. Longitudinal changes in neuropsychological assessments and resting-state functional magnetic resonance imaging in 26 ε4 carriers and 26 matched non- ε4 carriers were measured for about 3 years. Whole-brain FC was calculated, and a full factorial design was used to compare the difference among groups. Two-sample t test was used for post-hoc analysis. Pearson's correlation analysis was conducted to investigate the relationships between FC and cognitive tests. Of 26 specially appointed ROIs, left superior temporal gyrus (TG) was most sensitive to the effect of time-by-gene interaction. Specifically, the alteration of FC was distributed between the left TG and right TG with GRF correction (voxel- P < 0.001, cluster- P < 0.05), and decreased in ε4 carriers while increased in non- ε4. The main effect of gene showed ε4 carriers has lower FC between left TG and right middle frontal gyrus as compared with non- ε4 both at baseline and follow-up study; ε4 carriers has lower FC between left TG and right supramarginal as compared with non- ε4 at baseline, but no difference in follow-up study. The time-by- APOE ε4 interaction on brain FC was demonstrated at a young age, and left TG was the earliest affected brain regions. The young adult ε4 carriers experience decreased FC among time in the absence overt clinical symptoms. [ABSTRACT FROM AUTHOR]

A mounting body of evidences suggests that patients with chronic heart failure (HF) frequently experience cognitive impairments, but the neuroanatomical mechanism underlying these impairments remains elusive. In this retrospective study, 49 chronic HF patients and 49 healthy controls (HCs) underwent brain structural MRI scans and cognitive assessments. Cortical morphology index (cortical thickness, complexity, sulcal depth and gyrification) were evaluated. Correlations between cortical morphology and cognitive scores and clinical variables were explored. Logistic regression analysis was employed to identify risk factors for predicting 3‐year major adverse cardiovascular events. Compared with HCs, patients with chronic HF exhibited decreased cognitive scores (p <.001) and decreased cortical thickness, sulcal depth and gyrification in brain regions involved cognition, sensorimotor, autonomic nervous system (family‐wise error correction, all p values <.05). Notably, HF duration and New York Heart Association (NYHA) demonstrated negative correlations with abnormal cortex morphology, particularly HF duration and thickness in left precentral gyrus (r = −.387, p =.006). Cortical morphology characteristics exhibited positive associations with global cognition, particularly cortical thickness in left pars opercularis (r =.476, p <.001). NYHA class is an independent risk factor for adverse outcome (p =.001). The observed correlation between abnormal cortical morphology and global cognition suggested that cortical morphology may serve as a promising imaging biomarker and provide insights into neuroanatomical underpinnings of cognitive impairment in patients with chronic HF. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic encephalopathy (HE) is a severe neuropsychiatric complication of liver diseases characterized by neuroinflammation. The efficacies of nonabsorbable rifaximin (RIF) and lactulose (LAC) have been well documented in the treatment of HE. [18F]PBR146 is a translocator protein (TSPO) radiotracer used for in vivo neuroinflammation imaging. This study investigated anti‐neuroinflammation effect of RIF or/and LAC in chronic HE rats by [18F]PBR146 micro‐PET/CT. Methods: Bile duct ligation (BDL) operation induced chronic HE models, and this study included Sham+normal saline (NS), BDL+NS, BDL+RIF, BDL+LAC, and BDL+RIF+LAC groups. Behavioral assessment was performed to analyze the motor function, and fecal samples were collected after successfully established the chronic HE model (more than 28 days post‐surgery). In addition, fecal samples collection and micro‐PET/CT scans were performed sequentially. And we also collected the blood plasma, liver, intestinal, and brain samples after sacrificing the rats for further biochemical and pathological analyses. Results: The RIF‐ and/or LAC‐treated BDL rats showed similar behavioral results with Sham+NS group, while the treatment could not reverse the biliary obstruction resulting in sustained liver injury. The RIF or/and LAC treatments can inhibit IFN‐γ and IL‐10 productions. The global brain uptake values of [18F]PBR146 in BDL+NS group was significantly higher than other groups (p <.0001). The brain regions analysis showed that the basal ganglia, hippocampus, and cingulate cortex had radiotracer uptake differences among groups (all p <.05), which were consistent with the brain immunohistochemistry results. Sham+NS group was mainly enriched in Christensenella, Coprobacillus, and Pseudoflavonifractor. BDL+NS group was mainly enriched in Barnesiella, Alloprevotella, Enterococcus, and Enterorhabdus. BDL+RIF+LAC group was enriched in Parabacteroides, Bacteroides, Allobaculum, Bifidobacterium, and Parasutterella. Conclusions: RIF or/and LAC had anti‐neuroinflammation in BDL‐induced chronic HE rats with gut microbiota alterations. The [18F]PBR146 could be used for monitoring RIF or/and LAC treatment efficacy of chronic HE rats. [ABSTRACT FROM AUTHOR]

Background: Small peripheral lung nodules detected on computed tomography (CT) scans are often difficult to find during thoracoscopic resection, and the present localizing techniques are inefficient or impractical. Purpose: To evaluate a novel marking procedure for small peripheral pulmonary nodules using an embolization coil. Material and Methods: Patients with small peripheral pulmonary nodules underwent preoperative CT-guided nodule localization using an embolization coil and then resection by fluoroscopically-guided video-assisted thoracoscopic surgery (VATS; group A, n = 22), or, underwent conventional VATS without prior location procedures (group B, n = 16). Comparisons were made between group A and group B concerning operative time, hospitalization, postoperative drainage, and complications. Histopathological diagnoses were made immediately after resection of pulmonary nodules. Results: All CT-guided embolization coil fixations were successful. No patient in group A and eight (50%) in group B required conversion to open thoracotomy (P < 0.0001). No severe complications occurred in either group. Compared with group B, group A had a significantly shorter mean operative time and hospitalization, and less postoperative drainage. Conclusion: Preoperative localization of small peripheral pulmonary nodules using CT-guided embolization coil insertion and subsequent fluoroscopically-guided VATS resection is safer and more effective than conventional VATS. [ABSTRACT FROM AUTHOR]

Abstract: The compression yield strength and hardness of the TiB2/Al composites increase with the increase in the TiB2 content, while the fracture strain decreases, and the ultimate compression strength first increases and then decreases. The addition of Mg improves the ductility of the 50vol% TiB2/Al composite along with maintaining the ultimate compression strength. The fracture strain of the TiB2/Al–Mg composite increases from 8.18% to 10.68%. The addition of Mo significantly improves the compression yield strength and hardness of the composite while sacrificing the ductility. The compression yield strength and the hardness of the TiB2/Al–Mo composite are, respectively, 296MPa and 107.5Hv higher than that of the TiB2/Al composite, but the fracture strain decreases to 4.41%. With the addition of V, the TiB2/Al–V composite possesses the highest ultimate compression strength and relatively good ductility. The ultimate compression strength of the TiB2/Al–V composite is 218MPa higher than that of the TiB2/Al composite, and the fracture strain is 6.73%. [Copyright &y& Elsevier]

The article presents a study which evaluates the potential of three-dimensional contrast-enhanced magnetic resonance venography (3D-CE-MRV) in the detection of renal vein thrombosis (RVT). A comparison between 3D-CE-MRV and multidetector computed tomography (CT) venography is offered. The study concludes that 3D-CE-MRV is an optimal alternative for the detection of RVT due to its high diagnostic accuracy.

Abstract: Purpose: To evaluate the performance of dual-energy CT (DECT) based vascular iodine analysis for the detection of acute peripheral pulmonary thrombus (PE) in a canine model with histopathological findings as the reference standard. Materials and methods: The study protocol was approved by our institutional animal committee. Thrombi (n =12) or saline (n =4) were intravenously injected via right femoral vein in sixteen dogs, respectively. CT pulmonary angiography (CTPA) in DECT mode was performed and conventional CTPA images and DECT based vascular iodine studies using Lung Vessels application were reconstructed. Two radiologists visually evaluated the number and location of PEs using conventional CTPA and DECT series on a per-animal and a per-clot basis. Detailed histopathological examination of lung specimens and catheter angiography served as reference standard. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of DECT and CTPA were calculated on a segmental and subsegmental or more distal pulmonary artery basis. Weighted κ values were computed to evaluate inter-modality and inter-reader agreement. Results: Thirteen dogs were enrolled for final image analysis (experimental group=9, control group=4). Histopathological results revealed 237 emboli in 45 lung lobes in 9 experimental dogs, 11 emboli in segmental pulmonary arteries, 49 in subsegmental pulmonary arteries, 177 in fifth-order or more distal pulmonary arteries. Overall sensitivity, specificity, accuracy, PPV, and NPV for CTPA plus DECT were 93.1%, 76.9%, 87.8%, 89.4%, and 84.2% for the detection of pulmonary emboli. With CTPA versus DECT, sensitivities, specificities, accuracies, PPVs, and NPVs are all 100% for the detection of pulmonary emboli on a segmental pulmonary artery basis, 88.9%, 100%, 96.0%, 100%, and 94.1% for CTPA and 90.4%, 93.0%, 92.0%, 88.7%, and 94.1% for DECT on a subsegmental pulmonary artery basis; 23.8%, 96.4%, 50.4%, 93.5%, and 36.7% for CTPA and 95.9%, 75.5%, 88.2%, 86.5%, and 91.9% on a sub-subsegmental and more distal pulmonary artery basis, respectively. Good inter-modality (κ =0.65, P <0.001) and inter-reader (κ =0.70, P <0.001) agreement were observed. Conclusion: With histopathological findings as the reference standard, DECT based vascular iodine analysis improves the sensitivity for detecting peripheral PE compared with CTPA, albeit at the price of decreased specificity and PPV. [Copyright &y& Elsevier]

Objectives: Low-grade cerebral oedema is considered to be pathognomonic of minimal hepatic encephalopathy (MHE) in cirrhotic patients. The purpose of this study was to investigate both the grey matter (GM) and white matter (WM) changes in a homogeneous cohort of patients with MHE by combining voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS).Methods: Twenty-five MHE patients and 25 healthy controls participated in the study with three-dimensional T1 and diffusion-tensor imaging. Group differences in regional GM volume were assessed using VBM analysis while differences in fractional anisotropy (FA), mean diffusivity (MD) of WM were compared using TBSS analysis.Results: VBM displayed extensively decreased GM volume in MHE, mainly located in the frontal and temporal cortices, paracentral lobule, caudate, putamen and amygdale, and increased GM volume in the thalamus. TBSS showed decreased FA in MHE patients in the corpus callosum, cingulum, internal/external capsule, corticospinal tract, superior longitudinal fasciculus and posterior corona radiata. Areas of increased MD in MHE patients were more extensive and included, in addition to all the areas of decreased FA, the anterior corona radiata, inferior fronto-occipital fasciculus, fornix and the middle cerebellar peduncle.Conclusion: The results suggest that cortical atrophy and low-grade brain oedema in WM co-exist in MHE. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To investigate the role of arterial-spin labeling (ASL) MRI to non-invasively characterize the patterns of cerebral blood flow (CBF) changes in cirrhotic patients and to assess the potential of ASL MRI to characterize minimal hepatic encephalopathy (MHE). Materials and methods: This study was approved by the local ethics committee, and written informed consent was obtained from all participants. Thirty six cirrhosis patients without overt hepatic encephalopathy (16 MHE patients and 20 non hepatic encephalopathy (non-HE) patients) and 25 controls underwent ASL MRI, and CBF was measured for each subject. One-way ANOCOVA test with age and gender as covariences was used to compare CBF difference among three groups, and post hoc analysis was performed between each two groups. Region-based correlation analysis was applied between Child–Pugh score, venous blood ammonia level, neuropsychological tests and CBF values in cirrhosis patients. Receiver operator characteristic (ROC) analysis was used for assessing CBF measurements in ASL MRI to differentiate MHE from non-HE patients. Results: The gray matter CBF of MHE patients (71.09±11.88mLmin−1 100g−1) was significantly higher than that of non-HE patients (55.28±12.30mLmin−1 100g−1, P <0.01) and controls (52.09±9.27mLmin−1 100g−1, P <0.001). Voxel-wise ANOCOVA results showed that CBFs were significantly different among three groups in multiple gray matter areas (P <0.05, Bonferroni corrected). Post hoc comparisons showed that CBF of these brain regions was increased in MHE patients compared with controls and non-HE patients (P <0.05, Bonferroni corrected). CBF of the right putamen was of the highest sensitivity (93.8%) and moderate specificity (75.0%) for characterization of MHE when using the cutoff value of 50.57mLmin−1 100g−1. CBFs in the bilateral median cingulate gyri, left supramarginal gyrus, right angular gyrus, right heschl gyrus and right superior temporal gyrus have both sensitivity and specificity of approximately 80% for the diagnosis of MHE. Conclusion: Higher CBF was found in many brain regions in cirrhotic patients than controls and gradually increased with the progress of disease. CBF measured with ASL MRI can be a useful marker for differentiating MHE from non-HE patients. [Copyright &y& Elsevier]

Abstract: Background: Three-dimensional contrast-enhanced MR pulmonary angiography (MRPA) is a suitable option for pulmonary embolism (PE) detection. However, there have been few reports on the diagnostic accuracy of MRPA for PE detection in a 3-T MR system. The purpose of this study was to evaluate the accuracy of MRPA in a 3-T MR system to detect acute PE with multidetector CT pulmonary angiography (CTPA) as reference standard. Methods: Twenty-seven patients (18 males and 9 females, mean age 38.9±14.4years) underwent both MRPA and CTPA within 3days (range, 0–3days) for evaluating PE. Pulmonary emboli in MRPA were independently analyzed on a per-patient and per-lobe basis by two radiologists. CTPA was regarded as reference standard, which was evaluated by another two radiologists in consensus. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for PE detection were calculated. Weighted κ values were calculated to evaluate agreement between readers. Results: Twenty-four patients had PE in 55 lung lobes in CTPA, while 3 patients had no PE detected. Readers 1 and 2 correctly detected 47 and 46 lung lobes having clots in 24 and 23 patients, corresponding to sensitivities, specificities, PPV, NPV, and accuracies of 100%, 100%, 100%, 100%, 100%; 100%, 66.7%, 96.0%, 100%, 96.4% on a per-patient basis and 85.5%, 100%, 100%, 90.9%, 94.1%; 83.6%, 93.7%, 90.2%, 89.2%, 89.6% on a per-lobe basis; respectively. Excellent inter-reader agreement (κ values=1.00 and 0.934; both P <0.001) were found for detecting PE on a per-patient and per-lobe analysis. Conclusion: Three-dimensional contrast-enhanced MRPA with a 3-T MR system is a suitable alternative modality to CTPA to detect PE on a per-patient basis based on this small cohort study. [Copyright &y& Elsevier]

Abstract: Background and purpose: Little is known about the role of thalamus in the pathophysiology of minimal hepatic encephalopathy (MHE). The purpose of this study was to investigate whether the thalamic functional connectivity was disrupted in cirrhotic patients with MHE by using resting-state functional magnetic resonance imaging (rs-fMRI). Materials and Methods: Twenty seven MHE patients and twenty seven age- and gender- matched healthy controls participated in the rs-fMRI scans. The functional connectivity of 11 thalamic nuclei were characterized by using a standard seed-based whole-brain correlation method and compared between MHE patients and healthy controls. Pearson correlation analysis was performed between the thalamic functional connectivity and venous blood ammonia levels/neuropsychological tests scores of patients. Results: The ventral anterior nucleus (VAN) and the ventral posterior medial nucleus (VPMN) in each side of thalamus showed abnormal functional connectivities in MHE. Compared with healthy controls, MHE patients demonstrated significant decreased functional connectivity between the right/left VAN and the bilateral putamen/pallidum, inferior frontal gyri, insula, supplementary motor area, right middle frontal gyrus, medial frontal gyrus. In addition, MHE patients showed significantly decreased functional connectivity with the right/left VPMN in the bilateral middle temporal gyri (MTG), temporal lobe, and right superior temporal gyrus. The venous blood ammonia levels of MHE patients negatively correlated with the functional connectivity between the VAN and the insula. Number connecting test scores showed negative correlation with the functional connectivity between the VAN and the insula, and between the VPMN and the MTG. Conclusion: MHE patients had disrupted thalamic functional connectivity, which mainly located in the bilateral ventral anterior nuclei and ventral posterior medial nuclei. The decreased connectivity between thalamus and many cortices, and basal ganglia indicated reduced integrity of thalamic RSN in MHE. [Copyright &y& Elsevier]

Background: Dual-energy CT (DECT) has been used to detect myocardial infarct. However, few comparable studies with histopathological findings as gold standard have been published. Purpose: To investigate the accuracy of DECT iodine maps for detecting acute myocardial infarction compared with single photon emission computed tomography (SPECT) in a canine model using histopathological findings as the reference standard. Material and Methods: A model of myocardial ischemia was created by ligating the left anterior descending (LAD) coronary artery after thoracotomy in six dogs, while another three dogs undergoing thoracotomy without LAD ligature served as a control group. Contrast-enhanced DECT scans of the heart were performed, followed by resting 99mTc-MIBI SPECT myocardial perfusion imaging in all nine dogs before and 3 h after the procedure. Triphenyltetrazolium chloride (TTC) staining was performed and analyzed. In the short axis of the left ventricle, the wall surface was divided into 17 segments, which were assessed for infarcted myocardium on conventional CT from average-weighted data, DECT myocardial iodine maps, conventional CT plus DECT, SPECT, and histopathology. Inter-observer and inter-modality agreement for conventional CT, DECT myocardial iodine maps, and SPECT were calculated. CT value of infracted and non-infracted areas was measured. Results: With the histopathological results as the reference standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 75.0% (30/40), 92.0% (104/113), 76.9% (30/39), 91.2% (104/114), 87.6% (134/153) for conventional CT, 85.0% (34/40), 84.1% (95/113), 65.4% (34/52), 94.1% (95/101), 84.3% (129/153) for DECT myocardial iodine maps; 87.5% (35/40), 92.9% (105/113), 81.4% (35/43), 95.5% (105/110), 91.5% (140/153) for conventional CT plus DECT; 82.5% (33/40), 90.3% (102/113), 75.0% (33/44), and 93.6% (102/109), 88.2% (135/153) for SPECT, respectively. Excellent inter-observer agreement (Kappa value >0.8) and good inter-modality agreement (Kappa value >0.6) for each modality were found. CT values of infarcted myocardium (26 ± 22 HU, 36 ± 33 HU, 34 ± 16 HU) were lower than those of non-infarcted myocardium (115 ± 16 HU, 121 ± 28 HU, 123 ± 11 HU) on images of 140 kVp, 80 kVp, and average-weighted 120 kVp images (all P < 0.05). Conclusion: With histopathology as the reference standard, DECT myocardial iodine maps can detect acute myocardial infarction with diagnostic accuracy comparable to resting SPECT myocardial perfusion imaging in a canine model. DECT plus conventional CT had a potential to improve the detection of acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Cerebral blood flow (CBF) changes after transjugular intrahepatic portosystemic shunt (TIPS) are still unclear. Our aim is to assess the TIPS-induced CBF changes and their potential clinical significance using the arterial spin labeling (ASL) perfusion magnetic resonance imaging. Materials and methods: Nine cirrhotic patients underwent ASL 1–8 days before and 4–7 days after TIPS. CBF was calculated at each voxel and mean CBF values were computed in the whole brain, gray matter and white matter. Changes of CBFs before and after TIPS were compared by paired t-test. Results: Voxel-wise results showed CBF diffusely increased in patients after TIPS, but no region with significant decrease in CBF was found, nor was any significant mean CBF difference detected in the whole brain, gray matter and white matter. Six patients out of nine showed a global CBF increase of 9–39%; one patient presented a global CBF decrease of 6%; another two showed a global CBF decrease of 16% and 31% respectively. Follow-up studies showed that the two patients with greatly decreased global CBF suffered from multiple episodes of overt hepatic encephalopathy (OHE) after TIPS and one died of OHE. Conclusions: CBF derived from noninvasive ASL MRI could be used as a useful biomarker to predict the development of OHE through consecutively tracking CBF changes in patients with inserted TIPS. Increased CBFs in many cortical regions could be common effects of the TIPS procedure, while decreased global CBF following TIPS might indicate the development of OHE. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the correlation between quantitative dual energy CT and perfusion CT measurements in rabbit VX2 liver tumors. Materials and methods: This study was approved by the institutional animal care and use committee at our institution. Nine rabbits with VX2 liver tumors underwent contrast-enhanced dual energy CT and perfusion CT. CT attenuation for the tumors and normal liver parenchyma and tumor-to-liver ratio were obtained at the 140kVp, 80kVp, average weighted images and dual energy CT iodine maps. Quantitative parameters for the viable tumor and adjacent liver were measured with perfusion CT. The correlation between the enhancement values of the tumor in iodine maps and perfusion CT parameters of each tumor was analyzed. Radiation dose from dual energy CT and perfusion CT was measured. Results: Enhancement values for the tumor were higher than that for normal liver parenchyma at the hepatic arterial phase (P <0.05). The highest tumor-to-liver ratio was obtained in hepatic arterial phase iodine map. Hepatic blood flow of the tumor was higher than that for adjacent liver (P <0.05). Enhancement values of hepatic tumors in the iodine maps positively correlated with permeability of capillary vessel surface (r =0.913, P <0.001), hepatic blood flow (r =0.512, P =0.010), and hepatic blood volume (r =0.464, P =0.022) at the hepatic arterial phases. The effective radiation dose from perfusion CT was higher than that from DECT (P <0.001). Conclusions: The enhancement values for viable tumor tissues measured in iodine maps were well correlated to perfusion CT measurements in rabbit VX2 liver tumors. Compared with perfusion CT, dual energy CT of the liver required a lower radiation dose. [Copyright &y& Elsevier]

Abstract: Purpose: To assess the feasibility of dual energy CT (DECT) after aerosol inhalation of iodinated contrast medium for the evaluation of ventilation function in rabbits with airway obstruction. Materials and methods: The study was approved by our institutional animal experimental committee and performed according to animal care guidelines. Airway obstruction was created by injecting gelatin sponge into the right bronchus of 6 New Zealand rabbits. One additional rabbit served as control without airway obstruction. All 7 rabbits then underwent inhalation of aerosol iodinated contrast medium for 5min, followed by DECT of the lungs from which ventilation CT images were created. CT number and overlay value (calculated iodine enhancement on the ventilation images in hounsfield unit) of the obstructed and non-obstructed lung lobes were measured at 80-kVp, 140-kVp, and weighted average 120-kVp. Immediately after DECT scan, the rabbits were sacrificed, the lungs were removed and detailed pathological examination of the locations and parenchymal changes of the obstructed lung lobes were performed and correlated with DECT ventilation imaging findings. Results: Data from one rabbit with airway obstruction were excluded because of post-procedure pneumatothorax. Seventeen normal lung lobes without airway obstruction proven by histopathology had nearly homogeneous ventilation, while 13 abnormal lung lobes had ventilation defects on DECT ventilation images. CT numbers and overlay values of the normal (CT number, −737.77±71.46HU, −768.84±73.86HU, −731.86±65.92HU for 140-kVp, 80-kVp, and weighted average 120-kVp; overlay value, 46.58±19.49HU) and abnormal lung lobes (CT number, −183.58±173.37HU, −124.93±242.23HU, −166.07±191.57HU for 140-kVp, 80-kVp, and weighted average 120-kVp; overlay value, 0.00±0.00HU) were significantly different at 80-kVp, 140-kVp, and weighted average 120-kVp (P <0.001 for all). Diffuse hemorrhage, inflammatory cell infiltration, and exudation were observed at histopathology in the obstructed lung lobes. Conclusions: It is feasible to study regional lung ventilation function using DECT after aerosol inhalation of iodinated contrast medium in rabbit. The safety of inhalation of iodine contrast medium is unknown, and has to be investigated further before use of this new method in humans. [Copyright &y& Elsevier]

Coronary chronic total occlusion (CTO) often occurs in patients with obstructive coronary artery disease, which remains one of the greatest challenges for interventional cardiologists. Coronary computed tomography angiography (CCTA) with its emerging post-processing techniques can provide a detailed assessment of CTO lesions before percutaneous coronary intervention (PCI), playing an important role in the clinical management of CTO PCI, from early diagnosis, pre-procedural outcome prediction, the crossing algorithm planning, intraprocedural guidance, and finally post-procedural assessment and follow-up. In addition, the feasibility of CT perfusion (CTP) in patients with CTO has been validated. Combined CCTA and CTP have the great potential to be the one-stop-shop imaging modality for assessing both anatomy and function of CTO lesions. This review aims to make radiologists understand the role of CCTA in the diagnosis and assessment of CTO lesions, thus assisting interventionalists in optimizing CTO PCI crossing strategies with the expertise of radiologists. Critical relevance statement The anatomical features of CTO on CCTA can reveal the complexity of CTO lesions and are associated with CTO PCI outcome, thus helping interventionalists optimize CTO PCI crossing strategies. Key points • CTO is the common lesion in invasive coronary angiography, and CTO PCI is technically difficult and its success rate is relatively low. • Length, collaterals, and attenuation-related signs can help distinguish CTO from subtotal occlusion. • The anatomical features of CTO lesions can help grade the difficulty of CTO PCI and predict procedural outcomes and long-term outcomes of CTO PCI. • The real-time fusion of CCTA with fluoroscopic angiography can be applied in highly complicated CTO lesions. • After CTO PCI, CCTA can help guide a second CTO PCI re-entry or follow up stent patency. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the prognostic value of radiomics features based on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) images in patients with cardiac amyloidosis (CA). Methods: This retrospective study included 120 CA patients undergoing CMR at three institutions. Radiomics features were extracted from global and three different segments (base, mid-ventricular, and apex) of left ventricular (LV) on short-axis LGE images. Primary endpoint was all-cause mortality. The predictive performance of the radiomics features and semi-quantitative and quantitative LGE parameters were compared by ROC. The AUC was used to observe whether Rad-score had an incremental value for clinical stage. The Kaplan–Meier curve was used to further stratify the risk of CA patients. Results: During a median follow-up of 12.9 months, 30% (40/120) patients died. There was no significant difference in the predictive performance of the radiomics model in different LV sections in the validation set (AUCs of the global, basal, middle, and apical radiomics model were 0.75, 0.77, 0.76, and 0.77, respectively; all p > 0.05). The predictive performance of the Rad-score of the base-LV was better than that of the LGE total enhancement mass (AUC:0.77 vs. 0.54, p < 0.001) and LGE extent (AUC: 0.77 vs. 0.53, p = 0.004). Rad-score combined with Mayo stage had better predictive performance than Mayo stage alone (AUC: 0.86 vs. 0.81, p = 0.03). Rad-score (≥ 0.66) contributed to the risk stratification of all-cause mortality in CA. Conclusions: Compared to quantitative LGE parameters, radiomics can better predict all-cause mortality in CA, while the combination of radiomics and Mayo stage could provide higher predictive accuracy. Clinical relevance statement: Radiomics analysis provides incremental value and improved risk stratification for all-cause mortality in patients with cardiac amyloidosis. Key Points: • Radiomics in LV-base was superior to LGE semi-quantitative and quantitative parameters for predicting all-cause mortality in CA. • Rad-score combined with Mayo stage had better predictive performance than Mayo stage alone or radiomics alone. • Rad-score ≥ 0.66 was associated with a significantly increased risk of all-cause mortality in CA patients. [ABSTRACT FROM AUTHOR]

Objectives: To explore the clinical potential of multiparametric cardiac magnetic resonance (CMR) in evaluating myocardial inflammation in patients with exertional heat illness (EHI). Methods: This prospective study enrolled 28 males with EHI (18 patients with exertional heat exhaustion (EHE) and 10 with exertional heat stroke (EHS)) and 18 age-matched male healthy controls (HC). All subjects underwent multiparametric CMR, and 9 patients had follow-up CMR measurements 3 months after recovery from EHI. CMR-derived left ventricular geometry, function, strain, native T1, extracellular volume (ECV), T2, T2*, and late gadolinium enhancement (LGE) were obtained and compared among different groups. Results: Compared with HC, EHI patients showed increased global ECV, T2, and T2* values (22.6% ± 4.1 vs. 19.7% ± 1.7; 46.8 ms ± 3.4 vs. 45.1 ms ± 1.2; 25.5 ms ± 2.2 vs. 23.8 ms ± 1.7; all p < 0.05). Subgroup analysis showed that ECV was higher in the EHS patients than those in EHE and HC groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). Repeated CMR measurements at 3 months after baseline CMR showed persistently higher ECV than HC (p = 0.042). Conclusions: With multiparametric CMR, EHI patients demonstrated increased global ECV, T2, and persistent myocardial inflammation at 3-month follow-up after EHI episode. Therefore, multiparametric CMR might be an effective method in evaluating myocardial inflammation in patients with EHI. Clinical relevance statement: This study showed persistent myocardial inflammation after an exertional heat illness (EHI) episode demonstrated by multiparametric CMR, which is a potential promising method to evaluate the severity of myocardial inflammation and guide return to work, play, or duty in EHI patients. Key Points: • EHI patients showed an increased global extracellular volume (ECV), late gadolinium enhancement, and T2 value, indicating myocardial edema and fibrosis. • ECV was higher in the exertional heat stroke patients than exertional heat exhaustion and healthy control groups (24.7% ± 4.9 vs. 21.4% ± 3.2, 24.7% ± 4.9 vs. 19.7% ± 1.7; both p < 0.05). • EHI patients showed persistent myocardial inflammation with higher ECV than healthy controls 3 months after index CMR (22.3% ± 2.4 vs. 19.7% ± 1.7, p = 0.042). [ABSTRACT FROM AUTHOR]

Objectives: To investigate the predictive value of CT-derived fractional flow reserve (FFRCT) in anastomosis occlusion after coronary artery bypass graft (CABG) surgery. Methods: Patients undergoing CABG with both pre- and post-operative coronary computed tomographic angiography (CCTA) were retrospectively included. Preoperative CCTA studies were used to evaluate anatomical and FFRCT information of target vessels. A diameter stenosis (DS) ≥ 70% or left main > 50% was considered to be anatomically severe, while FFRCT value ≤ 0.80 be functionally significant. The primary endpoint was anastomosis occlusion evaluated on post-operative CCTA during follow-up. Predictors of anastomosis occlusion were assessed by the multivariate binary logistic regression with generalized estimating equations. Results: A total of 270 anastomoses were identified in 88 enrolled patients. Forty-one anastomoses from 30 patients exhibited occlusion during a follow-up of 15.3 months after CABG. The occluded group had significantly increased prevalence of non-severe DS (58.5% vs. 40.2%; p = 0.023) and non-significant FFRCT (48.8% vs. 10.0%; p < 0.001). Multivariable analysis indicated FFRCT ≤ 0.80 (odds ratio [OR]: 0.10, 95% CI: 0.03–0.33; p < 0.001) and older age (OR: 0.92, 95% CI: 0.87–0.97; p = 0.001) were predictors for bypass patency during follow-up, while myocardial infarction history and anastomosis to a local lesion or bifurcation (all p value < 0.05) were predictors of occlusion. Adding FFRCT into the model based on the clinical and anatomical predictors had an improved AUC of 0.848 (p = 0.005). Conclusions: FFRCT ≤ 0.80 was associated with a significant risk reduction of anastomosis occlusion after CABG. Preoperative judgment of the hemodynamic significance may improve the CABG surgery strategy and reduce graft failure. Key Points: • FFRCT≤ 0.80 was associated with a significant risk reduction of anastomosis occlusion after CABG. • The addition of FFRCTinto the integrated model including clinical (age and history of myocardial infarction) and anatomical CCTA indicators (local lesion and bifurcation) significantly improved the model performance with an AUC of 0.848 (p = 0.005). • Preoperative judgment of the hemodynamic significance may help improve the decision-making and surgery planning in patients indicated for CABG and significantly reduce graft failure, without an extra radiation exposure and risk of invasive procedure. [ABSTRACT FROM AUTHOR]

[Display omitted] In recent years, branched or star-shaped Au nanostructures composed of core and protruding arms have attracted much attention due to their unique optical properties and morphology. As the clinically adapted nanoagent, prussian blue (PB) has recently gained widespread attention in cancer theranostics with potential applications in magnetic resonance (MR) imaging. In this article, we propose a hybrid star gold nanostructure（Au-star@PB）as a novel theranostic agent for T1-weighted magnetic resonance imaging (MRI)/ photoacoustic imaging（PAI） and photothermal therapy (PTT) of tumors. Importantly, the Au-star@PB nanoparticles function as effective MRI/PA contrast agents in vivo by increasing T1-weighted MR/PAI signal intensity and as effective PTT agents in vivo by decreasing the tumor volume in MCF-7 tumor bearing BALB / c mouse model as well as in vitro by lessening tumor cells growth rate. Interestingly, we found the main photothermal effect of Au-star@PB is derived from Au-star, but not PB. In summary, the hybrid structure of Au-star@PB NPs with good biological safety, significant photostability, dual imaging capability, and high therapeutic efficiency, might offer a novel avenue for the future diagnosis and treatment of cancer. [ABSTRACT FROM AUTHOR]

The progression of functional connectivity (FC) patterns from non-hepatic encephalopathy (non-HE) to minimal HE (MHE) is not well known. This resting-state functional magnetic resonance imaging (rs-fMRI) study investigated the evolution of intrinsic FC patterns from non-HE to MHE. A total of 103 cirrhotic patients (MHE, n = 34 and non-HE, n = 69) and 103 healthy controls underwent rs-fMRI scanning. Maps of distant and local FC density (dFCD and lFCD, respectively) were compared among MHE, non-HE, and healthy control groups. Decreased lFCD in anterior cingulate cortex, pre- and postcentral gyri, cuneus, lingual gyrus, and putamen was observed in both MHE and non-HE patients relative to controls. There was no difference in lFCD between MHE and non-HE groups. The latter showed decreased dFCD in inferior parietal lobule, cuneus, and medial frontal cortex relative to controls; however, MHE patients showed decreased dFCD in frontal and parietal cortices as well as increased dFCD in thalamus and caudate head relative to control and non-HE groups. Abnormal FCD values in some regions correlated with MHE patients' neuropsychological performance. In conclusion, lFCD and dFCD were perturbed in MHE. Impaired dFCD in regions within the cortico-striato-thalamic circuit may be more closely associated with the development of MHE. [ABSTRACT FROM AUTHOR]

Background: The G allele in retinoid-related orphan receptor alpha (RORA, rs8042149) gene is associated with post-traumatic stress disorder (PTSD) diagnosis and more severe symptoms, reported in the first genome-wide association study of PTSD and subsequent replication studies. Although recent MRI studies identified brain structural deficits in RORA rs8042149 risk G allele carriers, the neural mechanism underlying RORA-related brain structural changes in PTSD remains poorly understood.Methods: This study included 227 Han Chinese adults who lost their only child. Cortical thickness and subcortical volume were extracted using FreeSurfer, and PTSD severity was assessed using the Clinician-Administered PTSD Scale. Hierarchical linear regression was used to assess the interaction effect between RORA genotypes (T/T, G/T, and G/G) and PTSD severity on cortical and subcortical structures.Results: Significant genotype × PTSD symptom severity interaction effects were found for bilateral transverse temporal gyrus thickness. For individuals with the homozygous T/T genotype, current PTSD symptom severity was positively associated with bilateral transverse temporal gyrus thickness. For individuals with heterozygous G/T genotype, current PTSD symptom severity was negatively associated with the left transverse temporal gyrus thickness. No significant main or interaction effects were found in any subcortical regions.Limitation: Cross-sectional design of this study.Conclusion: These findings suggest that the non-risk T/T genotype - but not the risk G allele carriers - has a potentially protective or compensatory role on temporal gyrus thickness in adults who lost their only child. These results highlight the moderation effect of RORA polymorphism on the relationship between PTSD symptom severity and cortical structural changes. [ABSTRACT FROM AUTHOR]

Objectives: To map time-dependent cardiac structural and functional change patterns after renal transplantation (KT) using cardiac magnetic resonance (CMR). Methods: Fifty-three patients with pre-KT and post-KT CMR exams were retrospectively analyzed. Patients were divided into three groups according to the time of post-KT CMR: group 1 (3 months post-KT, n = 16), group 2 (6 months post-KT, n = 21), and group 3 (over 9 months post-KT, n = 16). Twenty-one age- and sex-matched healthy controls (HC) were recruited for the study. CMR-derived left ventricular (LV) volumes, LV mass index (LVMi), LV ejection fraction (LVEF), global radial strain (GRS), global circumferential strain (GCS), global longitudinal strain (GLS), and native T1 value were compared. The association between the changes of CMR parameters was assessed. Results: LVMi post-KT decreased in groups 2 (p < 0.001) and 3 (p = 0.004) but both groups had higher LVMi values compared to HC (both p < 0.001). GLS post-KT was decreased in group 1 (p = 0.021), but slightly increased in group 2 (p = 0.728) and group 3 (p = 0.100) without significant difference. GLS post-KT in group 3 was not different from HC (p = 0.104). LVEF, GRS, and GCS post-KT in groups 2 and 3 significantly increased and showed no significant difference from HC. The post-KT native T1 value in all three groups significantly decreased; however, no group showed any significant difference from HC. The change of LVEF was associated with the change of GCS, GRS, and GLS. Conclusions: Although GRS, GCS, GLS, and native T1 values reversed to normal level, LVMi remained impaired in median 14 months after KT. Key Points: • Kidney transplantation has favorable effects on cardiac structure and function. • In a median 14 months of follow-up after KT, left ventricle strain and native T1 value reversed to normal level while LV mass index (LVMi) did not. Left ventricular hypertrophy may help to explain why KT recipients are still at increased cardiovascular risk. • The reason for the decrease of native T1 value after KT may be more than myocardial fibrosis and needs to be further studied. [ABSTRACT FROM AUTHOR]

Objectives: To propose a novel functional Coronary Artery Disease–Reporting and Data System (CAD-RADS) category system integrated with coronary CT angiography (CCTA)–derived fractional flow reserve (FFRCT) and to validate its effect on therapeutic decision and prognosis in patients with coronary artery disease (CAD). Methods: Firstly, we proposed a novel functional CAD-RADS and evaluated the performance of functional CAD-RADS for guiding treatment strategies with actual clinical treatment as a reference standard in a retrospective multicenter cohort with CCTA and invasive FFR performed in all patients (n = 466). Net reclassification improvement (NRI) of functional CAD-RADS over anatomical CAD-RADS was calculated. Secondly, the prognostic value of functional CAD-RADS in a prospective two-arm cohort (566 [FFRCT arm] vs. 567 [CCTA arm]) was calculated, after a 1-year follow-up, functional CAD-RADS in FFRCT arm (n = 513) and anatomical CAD-RADS in CCTA arm (n = 511) to determine patients at risk of adverse outcomes were compared with a Cox hazard proportional model. Results: Functional CAD-RADS demonstrated superior value over anatomical CAD-RADS (AUC: 0.828 vs. 0.681, p < 0.001) and comparable performance to FFR (AUC: 0.828 vs. 0.848, p = 0.253) in guiding therapeutic decisions. Functional CAD-RADS resulted in the revision of management plan as determined by anatomical CAD-RADS in 30.0% of patients (n = 140) (NRI = 0.369, p < 0.001). Functional CAD-RADS was an independent predictor for 1-year outcomes with indexes of concordance of 0.795 and the corresponding value was 0.751 in anatomical CAD-RADS. Conclusion: The novel functional CAD-RADS gained incremental value in guiding therapeutic decision-making compared with anatomical CAD-RADS and comparable power in 1-year prognosis with anatomical CAD-RADS in a real-world scenario. Key Points: • The novel functional CAD-RADS category system with FFRCTintegrated into the anatomical CAD-RADS categories was originally proposed. • The novel functional CAD-RADS category system was validated superior value over anatomical CAD-RADS (AUC: 0.828 vs. 0.681, p < 0.001) in guiding therapeutic decisions and revised management plan in 30.0% of patients as determined by anatomical CAD-RADS (net reclassification improvement index = 0.369, p < 0.001). • Functional CAD-RADS was an independent predictor with an index of concordance of 0.795 and 0.751 in anatomical CAD-RADS for 1-year prognosis of adverse outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To explore downstream management and outcomes of machine learning (ML)–based CT derived fractional flow reserve (FFRCT) strategy compared with an anatomical coronary computed tomography angiography (CCTA) alone assessment in participants with intermediate coronary artery stenosis. Methods: In this prospective study conducted from April 2018 to March 2019, participants were assigned to either the CCTA or FFRCT group. The primary endpoint was the rate of invasive coronary angiography (ICA) that demonstrated non-obstructive disease at 90 days. Secondary endpoints included coronary revascularization and major adverse cardiovascular events (MACE) at 1-year follow-up. Results: In total, 567 participants were allocated to the CCTA group and 566 to the FFRCT group. At 90 days, the rate of ICA without obstructive disease was higher in the CCTA group (33.3%, 39/117) than that (19.8%, 19/96) in the FFRCT group (risk difference [RD] = 13.5%, 95% confidence interval [CI]: 8.4%, 18.6%; p = 0.03). The ICA referral rate was higher in the CCTA group (27.5%, 156/567) than in the FFRCT group (20.3%, 115/566) (RD = 7.2%, 95% CI: 2.3%, 12.1%; p = 0.003). The revascularization-to-ICA ratio was lower in the CCTA group than that in the FFRCT group (RD = 19.8%, 95% CI: 14.1%, 25.5%, p = 0.002). MACE was more common in the CCTA group than that in the FFRCT group at 1 year (HR: 1.73; 95% CI: 1.01, 2.95; p = 0.04). Conclusion: In patients with intermediate stenosis, the FFRCT strategy appears to be associated with a lower rate of referral for ICA, ICA without obstructive disease, and 1-year MACE when compared to the anatomical CCTA alone strategy. Key Points: • In stable patients with intermediate stenosis, ML-based FFRCT strategy was associated with a lower referral ICA rate, a lower normalcy rate of ICA, and higher revascularization-to-ICA ratio than the CCTA strategy. • Compared with the CCTA strategy, ML-based FFRCTshows superior outcome prediction value which appears to be associated with a lower rate of 1-year MACE. • ML-based FFRCT strategy as a non-invasive "one-stop-shop" modality may be the potential to change diagnostic workflows in patients with suspected coronary artery disease. [ABSTRACT FROM AUTHOR]

Objectives: To examine the diagnostic accuracy of machine learning–based coronary CT angiography–derived fractional flow reserve (FFRCT) in diabetes mellitus (DM) patients. Methods: In total, 484 patients with suspected or known coronary artery disease from 11 Chinese medical centers were retrospectively analyzed. All patients underwent CCTA, FFRCT, and invasive FFR. The patients were further grouped into mild (25~49 %), moderate (50~69 %), and severe (≥ 70 %) according to CCTA stenosis degree and Agatston score < 400 and Agatston score ≥ 400 groups according to coronary artery calcium severity. Propensity score matching (PSM) was used to match DM (n = 112) and non-DM (n = 214) groups. Sensitivity, specificity, accuracy, and area under the curve (AUC) with 95 % confidence interval (CI) were calculated and compared. Results: Sensitivity, specificity, accuracy, and AUC of FFRCT were 0.79, 0.96, 0.87, and 0.91 in DM patients and 0.82, 0.93, 0.89, and 0.89 in non-DM patients without significant difference (all p > 0.05) on a per-patient level. The accuracies of FFRCT had no significant difference among different coronary stenosis subgroups and between two coronary calcium subgroups (all p > 0.05) in the DM and non-DM groups. After PSM grouping, the accuracies of FFRCT were 0.88 in the DM group and 0.87 in the non-DM group without a statistical difference (p > 0.05). Conclusions: DM has no negative impact on the diagnostic accuracy of machine learning–based FFRCT. Key Points: • ML-based FFRCThas a high discriminative accuracy of hemodynamic ischemia, which is not affected by DM. • FFRCTwas superior to the CCTA alone for the detection of ischemia relevance of coronary artery stenosis in both DM and non-DM patients. • Coronary calcification had no significant effect on the diagnostic accuracy of FFRCTto detect ischemia in DM patients. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The exact neuro-pathophysiological effect of transjugular intrahepatic portosystemic shunt (TIPS) on brain function remains unclear. The purpose of this study was to investigate the longitudinal brain activity changes in cirrhotic patients with TIPS insertion using resting-state functional MRI (fMRI) with regional homogeneity (ReHo) method. Methods: Fifteen cirrhotic patients without overt hepatic encephalopathy (OHE) planned for TIPS procedure and 15 age- and gender-matched healthy controls were included in this study. Eleven of the 15 patients underwent repeated fMRI examinations at median 7-day following TIPS, 8 patients in median 3-month, and 7 patients in median 1-year follow-up duration, respectively. Regional homogeneity was calculated by the Kendall's coefficient of concordance (KCC) and compared between patients before TIPS and healthy controls with two-sample t test as well as pre-and post-TIPS patients with paired t test. Correlations between the pre- and post-TIPS changes of ReHo and the changes of venous blood ammonia level and number connection test type A (NCT-A)/digit symbol test (DST) scores were calculated by crossing subjects. Results: Compared with healthy controls, 15 cirrhotic patients before TIPS procedure showed decreased ReHo in the bilateral frontal, parietal, temporal and occipital lobes and increased ReHo in the bilateral caudate. Compared with the pre-TIPS patients, 11 post-TIPS patients in the median 7-day follow-up examinations demonstrated decreased ReHo in the medial frontal gyrus (MFG), superior parietal gyrus (SPG), middle/superior temporal gyrus (M/STG), anterior cingulate cortex (ACC), caudate, and increased ReHo in the insula. Eight post-TIPS patients in the median 3-month follow-up examinations showed widespread decreased ReHo in the bilateral frontal and parietal lobes, ACC, caudate, and increased ReHo in the insula and precuneus/cuneus. In the median 1-year follow-up studies, seven post-TIPS patients displayed decreased ReHo in the bilateral frontal and parietal lobes, ACC, supplementary motor area (SMA), posterior cingulate cortex (PCC), and increased ReHo in the caudate and insula (P <0.05, Alphasim corrected). The changes of ReHo values in bilateral IPL, MFG, caudate and SMA were correlated with changes of DST scores during the median 3-month follow-up (all P <0.05). Conclusion: The TIPS implantation had a persistent effect on brain function in cirrhotic patients including both predominant impairment and compensation mechanisms, with the most significant alterations in the median 3-month period after TIPS. The ReHo analysis may be potentially valuable for uncovering the mechanism of TIPS’ effects on brain function. [Copyright &y& Elsevier]

Objectives: To investigate the feasibility and prognostic implications of coronary CT angiography (CCTA) derived fractional flow reserve (FFRCT) in patients who have undergone stents implantation. Methods: Firstly, the feasibility of FFRCT in stented vessels was validated. The diagnostic performance of FFRCT in identifying hemodynamically in-stent restenosis (ISR) in 33 patients with invasive FFR ≤ 0.88 as reference standard, intra-group correlation coefficient (ICC) between FFRCT and FFR was calculated. Secondly, prognostic value was assessed with 115 patients with serial CCTA scans after PCI. Stent characteristics (location, diameter, length, etc.), CCTA measurements (minimum lumen diameter [MLD], minimum lumen area [MLA], ISR), and FFRCT measurements (FFRCT, ΔFFRCT, ΔFFRCT/stent length) both at baseline and follow-up were recorded. Longitudinal analysis included changes of MLD, MLA, ISR, and FFRCT. The primary endpoint was major adverse cardiovascular events (MACE). Results: Per-patient accuracy of FFRCT was 0.85 in identifying hemodynamically ISR. FFRCT had a good correlation with FFR (ICC = 0.84). 15.7% (18/115) developed MACE during 25 months since follow-up CCTA. Lasso regression identified age and follow-up ΔFFRCT/length as candidate variables. In the Cox proportional hazards model, age (hazard ratio [HR], 1.102 [95% CI, 1.032–1.177]; p = 0.004) and follow-up ΔFFRCT/length (HR, 1.014 [95% CI, 1.006–1.023]; p = 0.001) were independently associated with MACE (c-index = 0.856). Time-dependent ROC analysis showed AUC was 0.787 (95% CI, 0.594–0.980) at 25 months to predict adverse outcome. After bootstrap validation with 1000 resamplings, the bias-corrected c-index was 0.846. Conclusions: Noninvasive ML-based FFRCT is feasible in patients following stents implantation and shows prognostic value in predicting adverse events after stents implantation in low-moderate risk patients. Key Points: • Machine-learning-based FFRCTis feasible to evaluate the functional significance of in-stent restenosis in patients with stent implantation. • Follow-up △FFRCTalong with the stent length might have prognostic implication in patients with stent implantation and low-to-moderate risk after 2 years follow-up. The prognostic role of FFRCTin patients with moderate-to-high or high risk needs to be further studied. • FFRCTmight refine the clinical pathway of patients with stent implantation to invasive catheterization. [ABSTRACT FROM AUTHOR]

Objective: To compare the value of reduced field-of-view (FOV) intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and arterial spin labeling (ASL) for assessing renal allograft fibrosis and predicting long-term dysfunction. Methods: This prospective study included 175 renal transplant recipients undergoing reduced FOV IVIM DWI, ASL, and biopsies. Renal allograft fibrosis was categorized into ci0, ci1, ci2, and ci3 fibrosis according to biopsy results. A total of 83 participants followed for a median of 39 (IQR, 21–42) months were dichotomized into stable and impaired allograft function groups based on follow-up estimated glomerular filtration rate. Total apparent diffusion coefficient (ADCT), pure diffusion ADC, pseudo-perfusion ADC, perfusion fraction f from IVIM DWI, and renal blood flow (RBF) from ASL were calculated and compared. The area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic and predictive performances. Results: RBF was different in ci0 vs ci1 (147.9 ± 46.3 vs 126.0 ± 49.4 ml/min/100 g, p =.02) and ci2 vs ci3 (92.9 ± 46.9 vs 70.8 ± 37.8 ml/min/100 g, p =.03). RBF in the stable group was higher than that in the impaired group (144.73 ± 49.33 vs 102.19 ± 47.58 ml/min/100 g, p <.001). AUCs in distinguishing renal allograft fibrosis and predicting long-term allograft dysfunction for RBF were higher than cortical ADCT (ci0 vs ci1–3, 0.76 vs 0.59, p <.001; ci0–1 vs ci2–3, 0.79 vs 0.68, p =.01; ci0–2 vs ci3, 0.79 vs 0.68, p =.01; 0.76 vs 0.60, p =.04, respectively). Conclusion: Compared to reduced FOV IVIM DWI, ASL was a more promising technique for noninvasively distinguishing renal allograft fibrosis degree and predicting long-term allograft dysfunction. Key Points: • Compared to total ADC from rFOV IVIM DWI, RBF from ASL can distinguish no fibrosis (ci0) vs mild fibrosis (ci1) (p =.02) and moderate fibrosis (ci2) vs severe fibrosis (ci3) (p =.04). • RBF had superior performance than diffusion parameters in discriminating fibrosis (no fibrosis [ci0] vs fibrosis [ci1–3], mild fibrosis [ci0–1] vs moderate to severe fibrosis [ci2–3], non-severe [ci0–2] vs severe [ci3] fibrosis; AUC = 0.76 vs 0.59, p <.001; 0.79 vs 0.68, p =.01; 0.79 vs 0.68, p =.01). • Compared to reduced FOV IVIM DWI, ASL was a more promising technique for noninvasively predicting long-term allograft dysfunction (AUC = 0.76 vs 0.60, p =.04). [ABSTRACT FROM AUTHOR]

Objective: To investigate the utility of coronary CT angiography-derived fractional flow reserve (FFRCT) and plaque progression in patients undergoing serial coronary CT angiography for predicting major adverse cardiovascular events (MACE).Methods: This retrospective study evaluated patients suspected or known coronary artery disease who underwent serial coronary CT angiography examinations between January 2006 and December 2017 and followed up until June 2019. The primary endpoint was MACE, defined as acute coronary syndrome, rehospitalization due to progressive angina, percutaneous coronary intervention, or cardiac death. FFRCT and plaque parameters were analyzed on a per-vessel and per-patient basis. Univariable and multivariable COX regression analysis determined predictors of MACE. The prognostic value of FFRCT and plaque progression were assessed in nested models.Results: Two hundred eighty-four patients (median age, 61 years (interquartile range, 54-70); 202 males) were evaluated. MACE was observed in 45 patients (15.8%, 45/284). By Cox multivariable regression modeling, vessel-specific FFRCT ≤ 0.80 was associated with a 2.4-fold increased risk of MACE (HR (95% CI): 2.4 (1.3-4.4); p = 0.005) and plaque progression was associated with a 9-fold increased risk of MACE (HR (95% CI): 9 (3.5-23); p < 0.001) after adjusting for clinical and imaging risk factors. FFRCT and plaque progression improved the prediction of events over coronary artery calcium (CAC) score and high-risk plaques (HRP) in the receiver operating characteristics analysis (area under the curve: 0.70 to 0.86; p = 0.002).Conclusions: Fractional flow reserve and plaque progression assessed by serial coronary CT angiography predicted the risk of future MACE.Key Points: • Vessel-specific CT angiography-derived fractional flow reserve (FFRCT) ≤ 0.80 and plaque progression improved the prediction of events over current risk factors. • Major adverse cardiovascular events (MACE) significantly increased with the presence of plaque progression at follow-up stratified by the FFRCT change group. [ABSTRACT FROM AUTHOR]

Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumor, which rarely occurs in bone. We present a case of ASPS in a 23-year-old man with a 2-month history of back pain. Computed tomography scanning and magnetic resonance images demonstrated a destructive process in the 12th thoracic vertebra associated with a unilateral soft tissue mass. The tumor showed evidence of hypervascularity on MRI; it obviously was enhanced on T1-weighted images after injection of Gd-GDPA, and signal voids were shown on all pulse sequences which may help to differentiate ASPS from other tumors of the vertebra. We believe that this is the first case of ASPS arising in a vertebra. [ABSTRACT FROM AUTHOR]

Objectives: To develop a deep learning-based method for simultaneous myocardium and pericardial fat quantification from coronary computed tomography angiography (CCTA) for the diagnosis and treatment of cardiovascular disease (CVD).Methods: We retrospectively identified CCTA data obtained between May 2008 and July 2018 in a multicenter (six centers) CVD study. The proposed method was evaluated on 422 patients' data by two studies. The first overall study involves training model on CVD patients and testing on non-CVD patients, as well as training on non-CVD patients and testing on CVD patients. The second study was performed using the leave-center-out approach. The method performance was evaluated using Dice similarity coefficient (DSC), Jaccard index (JAC), 95% Hausdorff distance (HD95), mean surface distance (MSD), residual mean square distance (RMSD), and the center of mass distance (CMD). The robustness of the proposed method was tested using the nonparametric Kruskal-Wallis test and post hoc test to assess the equality of distribution of DSC values among different tests.Results: The automatic segmentation achieved a strong correlation with contour (ICC and R > 0.97, p value < 0.001 throughout all tests). The accuracy of the proposed method remained high through all the tests, with the median DSC higher than 0.88 for pericardial fat and 0.96 for myocardium. The proposed method also resulted in mean MSD, RMSD, HD95, and CMD of less than 1.36 mm for pericardial fat and 1.00 mm for myocardium.Conclusions: The proposed deep learning-based segmentation method enables accurate simultaneous quantification of myocardium and pericardial fat in a multicenter study.Key Points: • Deep learning-based myocardium and pericardial fat segmentation method tested on 422 patients' coronary computed tomography angiography in a multicenter study. • The proposed method provides segmentations with high volumetric accuracy (ICC and R > 0.97, p value < 0.001) and similar shape as manual annotation by experienced radiologists (median Dice similarity coefficient ≥ 0.88 for pericardial fat and 0.96 for myocardium). [ABSTRACT FROM AUTHOR]

CT-derived fractional flow reserve (CT-FFR) has been widely applied in coronary hemodynamic assessment. However, the feasieablity and standardization measurement in intracranial artery stenosis (ICAS) remains to be defined. To demonstrate the feasibility of CT-FFR in ICAS functional assessment and explore the optimal CT-FFR measurement position with invasive FFR as reference standard. Nineteen patients (mean age, 58.6 years ± 1.9 [SD]; 13 men) with moderate to severe (≥50 %) ICAS undergoing guidewire-based pressure measurement and preoperative head CT angiography (CTA) were retrospectively enrolled. CT-FFR was measured in the following standard measurement positions, including the end of stenosis (D0), 1 cm distal to the stenosis (D1) and 2 cm distal to the stenosis (D2). Diagnostic performance of CT-FFR was assessed by the area under the curve (AUC) of receiver operating characteristic curves by assuming invasive FFR ≤ 0.80 or 0.75 as hemodynamically significant stenosis. Excellent intra- and inter-observer agreement (ICC range, 0.930–0.992) was observed for CT-FFR measurement in different positions. Under different FFR thresholds, the diagnostic performance of CT-FFR D1 showed perfect prediction with AUC values of 1.000 (95 % CI: 0.824, 1.000). The sensitivity, specificity and AUC of CT-FFR D1 ≤ 0.80 in detecting FFR ≤ 0.80 was 0.94 (95 % CI: 0.68, 1.00), 1.00 (95 % CI: 0.31, 1.00) and 0.969 (95 % CI: 0.772, 1.000), respectively. Similar performance of CT-FFR D1 ≤ 0.75 was obtained for identifying FFR ≤ 0.75 with the AUC of 0.964. The strongest correlation (r = 0.915, p < 0.001) and agreement (mean difference: 0.02, 95 % limits of agreement: −0.16 to 0.19) were observed between CT-FFR D1 and FFR. Cerebral CT-derived fractional flow reserve (CT-FFR) measured 1 cm distal to stenosis achieved the most comparable results with invasive FFR, which indicated its potentially promising clinical application for evaluating the functional relevance of intracranial artery stenosis. [ABSTRACT FROM AUTHOR]

The purpose of this study is to develop a deep learning method for thyroid delineation with high accuracy, efficiency, and robustness in noncontrast-enhanced head and neck CTs. The cross-sectional analysis consisted of six tests, including randomized cross-validation and hold-out experiments, tests of prediction accuracy between cancer and benign and cross-gender analysis were performed to evaluate the proposed deep-learning-based performance method. CT images of 1977 patients with suspected thyroid carcinoma were retrospectively investigated. The automatically segmented thyroid gland volume was compared against physician-approved clinical contours using metrics, the Pearson correlation and Bland–Altman analysis. Quantitative metrics included: the Dice similarity coefficient (DSC), sensitivity, specificity, Jaccard index (JAC), Hausdorff distance (HD), mean surface distance (MSD), residual mean square distance (RMSD) and the center of mass distance (CMD). The robustness of the proposed method was further tested using the nonparametric Kruskal–Wallis test to assess the equality of distribution of DSC values. The proposed method's accuracy remained high through all the tests, with the median DSC, JAC, sensitivity and specificity higher than 0.913, 0.839, 0.856 and 0.979, respectively. The proposed method also resulted in median MSD, RMSD, HD and CMD, of less than 0.31 mm, 0.48 mm, 2.06 mm and 0.50 mm, respectively. The MSD and RMSD were 0.40 ± 0.29 mm and 0.70 ± 0.46 mm, respectively. Concurrent testing of the proposed method with 3D U-Net and V-Net showed that the proposed method had significantly improved performance. The proposed deep-learning method achieved accurate and robust performance through six cross-sectional analysis tests. [ABSTRACT FROM AUTHOR]

Objectives: To utilize a deep learning model for automatic detection of abnormalities in chest CT images from COVID-19 patients and compare its quantitative determination performance with radiological residents. Methods: A deep learning algorithm consisted of lesion detection, segmentation, and location was trained and validated in 14,435 participants with chest CT images and definite pathogen diagnosis. The algorithm was tested in a non-overlapping dataset of 96 confirmed COVID-19 patients in three hospitals across China during the outbreak. Quantitative detection performance of the model was compared with three radiological residents with two experienced radiologists' reading reports as reference standard by assessing the accuracy, sensitivity, specificity, and F1 score. Results: Of 96 patients, 88 had pneumonia lesions on CT images and 8 had no abnormities on CT images. For per-patient basis, the algorithm showed superior sensitivity of 1.00 (95% confidence interval (CI) 0.95, 1.00) and F1 score of 0.97 in detecting lesions from CT images of COVID-19 pneumonia patients. While for per-lung lobe basis, the algorithm achieved a sensitivity of 0.96 (95% CI 0.94, 0.98) and a slightly inferior F1 score of 0.86. The median volume of lesions calculated by algorithm was 40.10 cm3. An average running speed of 20.3 s ± 5.8 per case demonstrated the algorithm was much faster than the residents in assessing CT images (all p < 0.017). The deep learning algorithm can also assist radiologists make quicker diagnosis (all p < 0.0001) with superior diagnostic performance. Conclusions: The algorithm showed excellent performance in detecting COVID-19 pneumonia on chest CT images compared with resident radiologists. Key Points: • The higher sensitivity of deep learning model in detecting COVID-19 pneumonia were found compared with radiological residents on a per-lobe and per-patient basis. • The deep learning model improves diagnosis efficiency by shortening processing time. • The deep learning model can automatically calculate the volume of the lesions and whole lung. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the impact of machine learning (ML)–based fractional flow reserve derived from computed tomography (FFRCT) compared to invasive coronary angiography (ICA) for therapeutic decision-making and patient outcome in patients with suspected coronary artery disease (CAD). Methods: One thousand one hundred twenty-one consecutive patients with stable chest pain who underwent coronary computed tomography angiography (CCTA) followed ICA within 90 days between January 2007 and December 2016 were included in this retrospective study. Medical records were reviewed for the endpoint of major adverse cardiac events (MACEs). FFRCT values were calculated using an artificial intelligence (AI) ML platform. Disagreements between hemodynamic significant stenosis via FFRCT and severe stenosis on qualitative CCTA and ICA were also evaluated. Results: After FFRCT results were revealed, a change in the proposed treatment regimen chosen based on ICA results was seen in 167 patients (14.9%). Over a median follow-up time of 26 months (4–48 months), FFRCT ≤ 0.80 was associated with MACE (HR, 6.84 (95% CI, 3.57 to 13.11); p < 0.001), with superior prognostic value compared to severe stenosis on ICA (HR, 1.84 (95% CI, 1.24 to 2.73), p = 0.002) and CCTA (HR, 1.47 (95% CI, 1.01 to 2.14, p = 0.045). Reserving ICA and revascularization for vessels with positive FFRCT could have reduced the rate of ICA by 54.5% and lead to 4.4% fewer percutaneous interventions. Conclusions: This study indicated ML-based FFRCT had superior prognostic value when compared to severe anatomic stenosis on CCTA and adding FFRCT may direct therapeutic decision-making with the potential to improve efficiency of ICA. Key Points: • ML-based FFRCTshows superior outcome prediction value when compared to severe anatomic stenosis on CCTA. • FFRCTnoninvasively informs therapeutic decision-making with potential to change diagnostic workflows and enhance efficiencies in patients with suspected CAD. • Reserving ICA and revascularization for vessels with positive FFRCTmay reduce the normalcy rate of ICA and improve its efficiency. [ABSTRACT FROM AUTHOR]

Objectives: To build models based on conventional logistic regression (LR) and machine learning (ML) algorithms combining clinical, morphological, and hemodynamic information to predict individual rupture status of unruptured intracranial aneurysms (UIAs), afterwards tested in internal and external validation datasets.Methods: Patients with intracranial aneurysms diagnosed by computed tomography angiography and confirmed by invasive cerebral angiograph or clipping surgery were included. The prediction models were developed based on clinical, aneurysm morphological, and hemodynamic parameters by conventional LR and ML methods.Results: The training, internal validation, and external validation cohorts were composed of 807 patients, 200 patients, and 108 patients, respectively. The area under curves (AUCs) of conventional LR models 1 (clinical), 2 (clinical and aneurysm morphological), and 3 (clinical, aneurysm morphological and hemodynamic characteristics) were 0.608, 0.765, and 0.886, respectively (all p < 0.05). The AUCs of ML models using random forest (RF), multilayer perceptron (MLP), and support vector machine (SVM) were 0.871, 0.851, and 0.863, respectively. There were no difference among AUCs of conventional LR, RF, and SVM (all p > 0.05/6), while the AUC of MLP was lower than that of conventional LR (p = 0.0055).Conclusion: Hemodynamic parameters play an important role in the prediction performance of the models. ML methods cannot outperform conventional LR in prediction models for rupture status of UIAs integrating clinical, aneurysm morphological, and hemodynamic parameters.Key Points: • The addition of hemodynamic parameters can improve prediction performance for rupture status of unruptured intracranial aneurysms. • Machine learning algorithms cannot outperform conventional logistic regression in prediction models for rupture status integrating clinical, aneurysm morphological, and hemodynamic parameters. • Models integrating clinical, aneurysm morphological, and hemodynamic parameters may help choose the optimal management. [ABSTRACT FROM AUTHOR]

Background: FK506 binding protein 5 (FKBP5) rs1360780 polymorphism has been identified as a molecular genetic marker associated with the dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis. The impact of FKBP5 rs1360780 on the large-scale brain network connectivity in healthy adults is still unknown.Methods: 479 healthy volunteers (age: 20-80years) completed MRI scans, neuropsychological assessments and blood analysis.All subjects were divided into CC, CT and TT genotypes. Within and between network connectivities (10 sub-networks) were calculated using resting state functional MRI (rs-fMRI) data. The genetic effects and gene-gender/age interaction on large-scale network connectivity were explored.Results: Compared with CC and CT groups, TT group showed increased intra-connectivity in default mode network (DMN) and increased inter-connectivity mainly distributed among the network of DMN, salience network (SAN), dorsal attention network (DAN), ventral attention network (VAN), subcortical network (SUB), and visual network (VIS). Gene-by-gender and gene-by-age interaction were found in inter-connectivity of DAN to VIS and DMN to FPN, respectively. The altered connectivities correlated with anxiety status test score.Limitations: Plasma adrenocorticotropic hormone (ACTH) or cortisol were not measured,or else, we could estimate the hypothalamic-pituitary-adrenal (HPA) axis activity which may strengthen our results.Conclusions: FKBP5 rs1360780 modulates the large-scale brain network connectivity in healthy adults. TT carriers showed the increased intra- and inter-connectivities mainly distributed among the network of DMN, SAN, DAN, VAN, SUB and VIS. [ABSTRACT FROM AUTHOR]

Purpose. To assess the impact of sinogram-affirmed iterative reconstruction (SAFIRE) on risk category for coronary artery disease by combining coronary calcium score measurement and coronary CT angiography (CCTA). Materials and Methods. Eighty-nine patients (64.0% male) older than 18 years (64.4 ± 10.3 years) underwent coronary artery calcium scanning and prospectively ECG-triggered sequential CCTA examination. All raw data acquired in coronary artery calcium scanning were reconstructed by both filtered back projection (FBP) and SAFIRE algorithms with 5 different levels. Objective image quality and calcium quantification were evaluated and compared between FBP and all SAFIRE levels by the Sphericity Assumed test or Greenhouse-Geisser ε correction coefficient. Coronary artery stenosis was assessed in CCTA. Risk categories of all patients and of the patients with coronary artery stenosis in CCTA were compared between FBP and all SAFIRE levels by the Friedman test. Results. The reconstruction protocol from traditional FBP to SAFIRE 5 was associated with a gradual reduction in CT value and image noise (P < 0.001) but associated with a gradual improvement in the signal-to-noise ratio (P < 0.001). There was a gradual reduction in coronary calcification quantification (Agatston score: from 73.5 in FBP to 38.1 in SAFIRE 5, P < 0.001) from traditional FBP to SAFIRE 5. There was a significant difference for the risk category between FBP and all levels of SAFIRE in all patients (from 3.5 in FBP to 3.2 in SAFIRE 5, P < 0.001) and in the patients with coronary artery stenosis in CCTA (from 4.0 in FBP to 3.6 in SAFIRE 5, P < 0.001). Conclusions. SAFIRE significantly reduces coronary calcification quantification compared to FBP, resulting in the reduction of risk categories based on the Agatston score. The risk categories of the patients with coronary artery stenosis in CCTA may also decline. Thus, SAFIRE may lead risk categories to underestimate the existence of significant coronary artery stenosis. [ABSTRACT FROM AUTHOR]

Background: Functional dyspepsia (FD) subtypes may differ in terms of pathophysiology, but the underlying mechanisms remain poorly understood.Purpose: To explore spontaneous brain activity in two main FD subtypes, namely epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), using the amplitude of low-frequency fluctuation (ALFF).Material and Methods: Thirty-one FD patients (18 EPS and 13 PDS) and 22 matched healthy controls (HC) underwent resting-state functional MRI scanning. Spontaneous brain activity was evaluated by measuring the ALFF and then compared among the EPS, PDS, and HC groups with ANOVA test. Pearson correlation analysis was performed between the ALFF values and clinical indices.Results: Compared to healthy controls, both EPS and PDS patients had increased ALFF in the bilateral precentral/postcentral gyri, insula, and thalami. Furthermore, only the EPS patients displayed increased ALFF in the right middle and inferior frontal gyri, and only the PDS patients showed increased ALFF in the left posterior cingulate cortex (PCC). The ALFF values in the left thalamus were positively correlated with the sleep disturbance in EPS patients, and the ALFF values in the right precentral/postcentral gyri showed a positive correlation with the symptom score in PDS patients.Conclusion: EPS and PDS had similarities of higher spontaneous brain activity in the primary motor/sensory areas and homeostatic-afferent network regions, and differences in the prefrontal region and PCC, providing evidence to suggest the similarity and diversity of pathophysiology in FD subtypes. [ABSTRACT FROM AUTHOR]

Epicardial adipose tissue (EAT) is a visceral fat deposit, that's known for its association with factors, such as obesity, diabetes mellitus, age, and hypertension. Segmentation of the EAT in a fast and reproducible way is important for the interpretation of its role as an independent risk marker intricate. However, EAT has a variable distribution, and various diseases may affect the volume of the EAT, which can increase the complexity of the already time-consuming manual segmentation work. We propose a 3D deep attention U-Net method to automatically segment the EAT from coronary computed tomography angiography (CCTA). Five-fold cross-validation and hold-out experiments were used to evaluate the proposed method through a retrospective investigation of 200 patients. The automatically segmented EAT volume was compared with physician-approved clinical contours. Quantitative metrics used were the Dice similarity coefficient (DSC), sensitivity, specificity, Jaccard index (JAC), Hausdorff distance (HD), mean surface distance (MSD), residual mean square distance (RMSD), and the center of mass distance (CMD). For cross-validation, the median DSC, sensitivity, and specificity were 92.7%, 91.1%, and 95.1%, respectively, with JAC, HD, CMD, MSD, and RMSD are 82.9% ± 8.8%, 3.77 ± 1.86 mm, 1.98 ± 1.50 mm, 0.37 ± 0.24 mm, and 0.65 ± 0.37 mm, respectively. For the hold-out test, the accuracy of the proposed method remained high. We developed a novel deep learning-based approach for the automated segmentation of the EAT on CCTA images. We demonstrated the high accuracy of the proposed learning-based segmentation method through comparison with ground truth contour of 200 clinical patient cases using 8 quantitative metrics, Pearson correlation, and Bland-Altman analysis. Our automatic EAT segmentation results show the potential of the proposed method to be used in computer-aided diagnosis of coronary artery diseases (CADs) in clinical settings. [ABSTRACT FROM AUTHOR]