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Background: In patients with Cushing's disease, the preoperative identification of pituitary adenomas is crucial to treatment. However, increasing diagnostic accuracy remains an unresolved issue., Purpose: To evaluate the diagnostic accuracy and the impact of readers' experience regarding high-resolution contrast-enhanced magnetic resonance imaging (hrMRI) for identifying pituitary adenomas in comparison with conventional contrast-enhanced MRI (cMRI) and dynamic contrast-enhanced MRI (dMRI)., Study Type: Retrospective., Population: Sixty-five patients (median age, 39 years; interquartile range [IQR], 28-53 years; 60% females) with treatment-naïve Cushing's disease., Field Strength/sequence: 3-T, seven fast spin echo sequences., Assessment: The diagnostic accuracies of identifying pituitary adenomas on cMRI, dMRI, combined cMRI and dMRI (cdMRI), and hrMRI were independently evaluated by six readers with three experience levels (high: >20 years, modest: 10-20 years, low: <10 years; two readers for each experience level). Readers were asked to localize the lesion, and measure its diameter on the sequence where identified. The reference standard was postoperative histopathology. The impact of readers' experience and interobserver agreement were assessed. Image quality was assessed using a 5-point Likert scale, including overall image quality, sharpness, and structural conspicuity., Statistical Tests: McNemar's test, Cochran's test, Wilcoxon signed-rank test, Mann-Whitney U test, and κ statistics for interobserver agreement. A P-value <0.05 was considered statistically significant., Results: For identifying pituitary adenomas (median diameter, 5 mm; IQR, 4-5 mm), hrMRI had significantly higher sensitivity (87.7%-93.8%) than cMRI, dMRI, and cdMRI (52.3%-75.4%) for readers with different experience levels. The interobserver agreement was moderate (κ = 0.461-0.523). The sensitivity for hrMRI was comparable between readers with different experience levels (P = 0.371). All image quality scores on hrMRI were significantly higher than cMRI and dMRI (5.0 vs. 4.0)., Data Conclusion: For identifying pituitary adenomas in patients with treatment-naïve Cushing's disease, hrMRI may show high diagnostic accuracy and seems not to be affected by readers' experience., Level of Evidence: 3 TECHNICAL EFFICACY: Stage 2., (© 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Background: The inter-scanner reproducibility of brain volumetry is important in multi-site neuroimaging studies, where the reliability of automated brain segmentation (ABS) tools plays an important role. This study aimed to evaluate the influence of ABS tools on the consistency and reproducibility of the quantified brain volumetry from different scanners., Methods: We included fifteen healthy volunteers who were scanned with 3D isotropic brain T1-weighted sequence on three different 3.0 Tesla MRI scanners (GE, Siemens and Philips). For each individual, the time span between image acquisitions on different scanners was limited to 1 h. All the T1-weighted images were processed with FreeSurfer v6.0, FSL v5.0 and AccuBrain ® with default settings to obtain volumetry of brain tissues (e.g. gray matter) and substructures (e.g. basal ganglia structures) if available. Coefficient of variation (CV) was calculated to test inter-scanner variability in brain volumetry of various structures as quantified by these ABS tools., Results: The mean inter-scanner CV values per brain structure among three MRI scanners ranged from 6.946 to 12.29% (mean, 9.577%) for FreeSurfer, 7.245 to 20.98% (mean, 12.60%) for FSL and 1.348 to 8.800% (mean value, 3.546%) for AccuBrain ® . In addition, AccuBrain ® and FreeSurfer achieved the lowest mean values of region-specific CV between GE and Siemens scanners (from 0.818 to 5.958% for AccuBrain ® , and from 0.903 to 7.977% for FreeSurfer), while FSL-FIRST had the lowest mean values of region-specific CV between GE and Philips scanners (from 2.603 to 16.310%). AccuBrain ® also had the lowest mean values of region-specific CV between Siemens and Philips scanners (from 1.138 to 6.615%)., Conclusion: There is a large discrepancy in the inter-scanner reproducibility of brain volumetry when using different processing software. Image acquisition protocols and selection of ABS tool for brain volumetry quantification have impact on the robustness of results in multi-site studies.

Purpose: The preoperative prediction of treatment response is important for determining individual treatment strategies for invasive functional pituitary adenoma (IFPA). This study aimed to develop and validate a magnetic resonance imaging (MRI)-based radiomic signature for preoperative prediction of treatment response in IFPA., Method: One hundred and sixty-three patients with IFPA were enrolled and divided into primary (n = 108) and validation cohorts (n = 55) according to time point. IFPA patients were divided into remission and non-remission according to postoperative hormone levels. Radiomic features were extracted from their MR images and a radiomic signature was built using a support vector machine. Subsequently, multivariable logistic regression analysis was used to select the most informative clinical features, and a radiomic model incorporating the radiomic signature and selected clinical features was constructed and used as the final predictive model., Results: Seven radiomic features were selected to construct the radiomic signature, which achieved an area under the curve (AUC) of 0.834 and 0.808 on the primary and validation cohorts respectively. The radiomic model incorporating the radiomic signature and Knosp grade showed good discrimination abilities and calibration, with AUCs of 0.832 and 0.811 for the primary and validation cohorts respectively. The radiomic signature and radiomic model better estimated the treatment responses of patients with IFPA than our clinical features model. Decision curve analysis showed the radiomic model was clinically useful., Conclusions: This radiomic model may help neurosurgeons predict the treatment responses of patients with IFPA before surgery and determine individual treatment strategies., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: To compare the hippocampal internal architecture (HIA) between 3 and 7 Tesla (T) magnetic resonance imaging (MRI) in patients with temporal lobe epilepsy (TLE), and to investigate the relationship between HIA and hippocampal volume, and postoperative outcomes., Materials and Methods: Thirty-nine TLE patients were recruited with 3 and 7 T MRI scans and a semi-quantitative assessment of the HIA was performed. Differences in HIA scores between 3 and 7 T MRI were evaluated. HIA and hippocampal volume asymmetry were also calculated and compared. The utility of HIA and hippocampal volume asymmetry in epilepsy lateralization, and the predictive value between these two indicators were compared. The relationship between HIA and postoperative outcomes was investigated in 25 patients with amygdalohippocampectomy., Results: HIA scores of epileptogenic hippocampi were lower than those of non-epileptogenic hippocampi at 3 and 7 T MRI. Higher HIA scores were observed at 7 T MRI. The HIA asymmetry and hippocampal volume asymmetry were both strong predictors for epilepsy lateralization and did not show difference in predictive value. No statistical differences in HIA asymmetry were observed between seizure-free patients (ILAE 1) compared to patients with seizures (ILAE 2-5)., Conclusions: Visualization of hippocampal internal architecture (HIA) may be improved at 7 T MRI. HIA asymmetry is a significant predictor of laterality of seizure onset in TLE patients and has similar predictive value as hippocampal volume asymmetry, however, HIA asymmetry at 7 T does not have extra value in determining epilepsy lateralization and neither does predict surgical outcomes., (Copyright © 2019 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Objective: Dermatomyositis (DM) and polymyositis (PM) make up the largest group of potentially treatable myopathies and require early diagnosis. This study investigates whether the edema of thigh muscles in DM/PM can be quantitatively assessed by a novel accelerated T2 mapping technique-GRAPPATINI., Methods: Three conventional MR sequences and GRAPPATINI accelerated T2 mapping of bilateral thighs from 20 patients (7 DM and 13 PM) and 10 healthy volunteers were prospectively carried out on a 3 T MR scanner. Afterwards, T2 values of 477 thigh muscles from the patients and the healthy controls were manually measured. In addition, the correlations between T2 values and serum muscle enzymes in patients were also analyzed., Results: The new GRAPPATINI technique made quantitative T2 mapping of bilateral thighs feasible with a scanning time of only 2 min 18 s. Moreover, GRAPPATINI-generated T2 values of muscles from patients were markedly higher than those from healthy subjects ( p < 0.001). GRAPPATINI accelerated T2 mapping appeared a more sensitive technique in that some DM/PM muscles appearing normal per conventional MRI had increased T2 relaxation time. Furthermore, GRAPPATINI-generated T2 values of DM/PM thigh muscles positively correlated with serum enzyme levels ( p < 0.001), which reflected the severity of myopathy., Conclusion: GRAPPATINI can significantly shorten acquisition time of T2 mapping and may potentially be applied clinically in DM and PM., Advances in Knowledge: GRAPPATINI acceleration makes T2 mapping feasible in clinical practice in providing quantitative information regarding thigh muscle inflammation in DM and PM.

Background: Ongoing efforts have been made to identify new neuroimaging markers to track amyotrophic lateral sclerosis (ALS) progression. This study aimed to explore the monitoring value of multimodal magnetic resonance imaging (MRI) in the disease progression of ALS., Methods: From September 2015 to March 2017, ten patients diagnosed with ALS in Peking Union Medical College Hospital completed head MRI scans at baseline and during follow-up. Multimodal MRI analyses, including gray matter (GM) volume measured by voxel-based morphometry; cerebral blood flow (CBF) evaluated by arterial spin labeling; functional connectivity, including low-frequency fluctuation (fALFF) and regional homogeneity (ReHo), measured by resting-state functional MRI; and integrity of white-matter (WM) fiber tracts evaluated by diffusion tensor imaging, were performed in these patients. Comparisons of imaging metrics were made between baseline and follow-up using paired t-test., Results: In the longitudinal comparisons, the brain structure (GM volume of the right precentral gyri, left postcentral gyri, and right thalami) and perfusion (CBF of the bilateral temporal poles, left precentral gyri, postcentral gyri, and right middle temporal gyri) in both motor and extramotor areas at follow-up were impaired to different extents when compared with those at baseline (all P < 0.05, false discovery rate adjusted). Functional connectivity was increased in the motor areas (fALFF of the right precentral gyri and superior frontal gyri, and ReHo of right precentral gyri) and decreased in the extramotor areas (fALFF of the bilateral middle frontal gyri and ReHo of the right precuneus and cingulate gyri) (all P < 0.001, unadjusted). No significant changes were detected in terms of brain WM measures., Conclusion: Multimodal MRI could be used to monitor short-term brain changes in ALS patients., Competing Interests: There are no conflicts of interest.

Purpose: To explore the incidence of abnormally located ovary in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome as compared to a control group with magnetic resonance imaging., Methods: Pelvic MR images of 83 MRKH patients and 60 age-matched normal females were retrospectively reviewed by two experienced gynecological radiologists in consensus. Characteristics including location of ovary, ovarian volume, and follicle counts were assessed. The incidence of abnormally located ovary was compared between MRKH patients and controls. The ovarian size and follicle counts were compared among three groups: abnormally located ovaries in MRKH patients, eutopic ovaries in MRKH patients, and normal controls., Results: In total, 166 ovaries of 83 MRKH patients and 120 ovaries of 60 control females were evaluated. Thirty-seven ovaries of 23 MRKH patients (28%, 23/83) were abnormally located, whereas 3 ovaries of three control females (5%, 3/60) were located in abnormal positions (P < 0.001). The mean volume was 9.2 ± 6.3 mL of the abnormally located ovaries in MRKH patients, 7.8 ± 4.0 mL of the eutopic ovaries in MRKH patients, and 8.9 ± 4.8 mL in control females (P > 0.05). No obvious differences were observed with regard to follicle counts among the three groups., Conclusion: Incidence of abnormally located ovary was significantly increased in patients with MRKH syndrome. Such knowledge is important for infertility treatment, evaluation of pelvic pain, and surgical planning for MRKH patients.

A 17-year-old adolescent boy with a history of hypoproteinemia underwent Ga-NEB PET/MRI to evaluate possible lymphatic disorders suggested by FDG PET/CT imaging. The images revealed multiple lesions with increased Ga-NEB uptake and high signal on T2-weighted images, consistent with likely lymphatic disorder. Histopathological examination from biopsied specimen confirmed lymphangioma.

Objective To evaluate the correlation of the positron emission tomography/magnetic resonance imaging (PET/MR) parameters with the pathological differentiation of head and neck squamous cell carcinoma(HNSCC) and the diagnostic efficiencies of PET/MR parameters. Methods Patients with clinical suspicion of HNSCC were included and underwent PET/MR scan. HNSCC was pathologically confirmed in all these patients. The PET/MR examination included PET and MR sequences of diffusion-weighted imaging (DWI) and T2-and T1-weighted imaging. The multiple parameters of PET/MR included the mean values of apparent diffusion coefficient(ADC mean ) and the maximum and mean values of standardized uptake value (SUV max and SUV mean ) were measured and estimated. The correlations of all the parameters and distribution between the different tumor differentiation groups were analyzed. Logistic regression was utilized to build the model as the PET/MR combined parameter for predicting the differentiation by multiple parameters of PET/MR. The receiver operating characteristic curve was calculated for each parameter and the combination. Results Totally 23 patients were included in this study:9 patients (9 males and 0 female) had well-differentiated tumor,with an average age of (61.0±6.8)years;14 cases had moderately-differentiated (n=10) or poorly-differentiated tumors (n=4),with an average age of (62.0±9.1) years. All the patients were males. There was statistical correlation between SUV mean and SUV max (P<0.001);however,ADC mean showed no statistical correlation with SUV max and with SUV mean (P=0.42,P=0.13). ADC mean and SUV mean showed significant difference between well-differentiated group and moderately-poorly-differentiated group (P=0.005,P=0.007). Compared with the individual parameters,the combination of PET/MR parameters with SUV mean and ADC mean had higher efficacy in predicting tumor differentiation,with an area under curve of 0.84. Conclusions The distributions of ADC mean ,SUV max and SUV mean differ among HNSCC with different pathological differentiation. Compared with the individual parameters,the combination of the PET/MR parameters has higher efficiency in predicting tumor differentiation.

This study was designed to evaluate the ability of PET/MRI, using 18 F-FDG and 68 Ga-DOTATATE as tracers, to detect hormone-producing pituitary microadenoma when diagnosis is difficult using MRI alone. Methods: We recruited 37 patients with elevated hormone levels, including 19 with undiagnosable primary pituitary adenoma and 18 with suspected recurrent pituitary adenoma. 18 F-FDG PET/MRI and 68 Ga-DOTATATE PET/MRI were performed within 1 wk of each other in all patients. Within 2 wk afterward, 27 of the 37 patients underwent transsphenoidal adenomectomy, 3 underwent sella region radiotherapy, 1 underwent somatostatin therapy, and 6 had only clinical follow-up. The image characteristics and uptake levels were correlated with the surgical findings and pathologic results. Receiver-operating-characteristic curves were analyzed to determine the optimal cutoff to differentiate adenoma from normal pituitary tissue. The area under the receiver-operating-characteristic curve was calculated to compare diagnostic performance. Results: The PET/MR images were of diagnostic quality and without obvious image artifacts. The high contrast of the PET images provided complementary information to the fine anatomic display of the MR images. Increased 18 F-FDG uptake was clearly observed in all patients. MRI enhanced using a 0.05 mmol/kg dose of gadopentetate dimeglumine showed suggestive findings in only 47% of the patients with primary adenoma and 39% of those with recurrent adenoma; when a 0.1 mmol/kg dose was used, the respective percentages were 37% and 50%. The 18 F-FDG SUV max of the 16 primary adenomas that underwent transsphenoidal adenomectomy (6.8 ± 3.7) was significantly higher than that of normal pituitary tissue (3.2 ± 1.1, P < 0.01). The adenomas showed moderate 68 Ga-DOTATATE uptake (SUV max , 3.8 ± 2.6), but the 68 Ga-DOTATATE uptake was generally lower than that of normal pituitary tissue (SUV max , 6.2 ± 3.2, P < 0.05). In the 11 suspected recurrent pituitary adenomas that underwent transsphenoidal adenomectomy, the 18 F-FDG SUV max was 6.1 ± 3.5, significantly higher than that of normal pituitary tissue (2.5 ± 1.1, P < 0.01), and the 68 Ga-DOTATATE SUV max was 3.0 ± 1.1, significantly lower than that of normal pituitary tissue (5.5 ± 1.7, P < 0.01). The 18 F-FDG/ 68 Ga-DOTATATE SUV max ratio of the adenomas (2.3 ± 1.5) was significantly higher than that of normal pituitary tissue (0.6 ± 0.3, P < 0.05). When the 18 F-FDG SUV max alone and the 18 F-FDG/ 68 Ga-DOTATATE SUV max ratio were used as criteria to discriminate between adenoma and pituitary tissue, the best analysis came from the ratio, and that from 18 F-FDG SUV max alone was slightly less, with optimal diagnostic cutoffs of 1.04 and 3.88, respectively. Conclusion: PET/MRI provides an ideal tool for the detection of hormone-producing pituitary microadenoma. Dual-tracer 18 F-FDG and 68 Ga-DOTATATE PET/MRI was useful for distinguishing pituitary microadenoma from normal pituitary tissue., (© 2018 by the Society of Nuclear Medicine and Molecular Imaging.)

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulation technique that has been used to treat neurological and psychiatric conditions. Although results of rTMS intervention are promising, so far, little is known about the rTMS effect on brain functional networks in clinical populations. In this study, we used a whole-brain connectivity analysis of resting-state functional magnetic resonance imaging data to uncover changes in functional connectivity following rTMS intervention and their association with motor symptoms in patients with multiple system atrophy (MSA). Patients were randomized to active rTMS or sham rTMS groups and completed a 10-session 5-Hz rTMS treatment over the left primary motor area. The results showed significant rTMS-related changes in motor symptoms and functional connectivity. Specifically, (1) significant improvement of motor symptoms was observed in the active rTMS group, but not in the sham rTMS group; and (2) several functional links involving the default mode, cerebellar, and limbic networks exhibited positive changes in functional connectivity in the active rTMS group. Moreover, the positive changes in functional connectivity were associated with improvement in motor symptoms for the active rTMS group. The present findings suggest that rTMS may improve motor symptoms by modulating functional links connecting to the default mode, cerebellar, and limbic networks, inferring a future therapeutic candidate for patients with MSA.

Objective: To evaluate the significance of magnetic resonance imaging (MRI) T2(*) value analysis in patients with iron overload and compare it with other clinical parameters., Methods: A total of 53 patients with suspected iron overload were recruited from four Beijing hospitals from December 2010 to December 2012. Their liver and heart T2(*) values were calculated and their serum ferritin (SF), transferrin saturation, blood transfusion volume and other clinical parameters were recorded and analyzed., Results: There were 37 males and 16 females with a medium age of 50 years(15-72 years). Their etiologies included myelodysplastic syndromes (MDS, n = 25), aplastic anemia (AA, n = 16), myelofibrosis (n = 5), hemochromatosis (n = 2) and β thalassaemia (n = 2), and 3 patients with high SF values were found on regular health examinations. Among them, there were transfusion history (n = 45), SF>1000 µg/L (n = 49), sign of iron overload (n = 10), abnormal liver function (n = 38) and hyperglycemia (n = 32). T2(*) value analysis showed that 10 patients had no evidence of iron overload, 43 patients had liver iron overload (14 mild, 22 moderate and 7 severe) and 2 patients had heart iron overload (1 MDS with heavy transfusion history and 1 AA with heart failure). No relations existed between T2(*) value and SF (P = 0.050) , T2(*) value and transfusion volume (P = 0.820) , and liver T2(*) value and heart T2(*) value (P = 0.129) ., Conclusions: MRI T2(*) value is an accurate way of quantitative detection of iron overload. It provides a comprehensive understanding of patients with iron overload in conjunctions with MRI T2(*) value and other clinical parameters.

Objective: To explore the transverse relaxation rate with gradient echo R2(*) changes in patients with Parkinsonian variant of multiple system atrophy (MSA-P) with a voxel-based analysis of R2(*) map., Methods: Whole brain structural images and multi-echo T2(*) weighted image were acquired in 27 patients with probable MSA-P and 24 healthy individuals. R2(*) maps of the MSA-P were compared with the controls by voxel-based methods., Result: Compared with the controls, MSA-P patients showed significant R2(*) decrease bilaterally in brain stem, cerebellar hemispheres, insular lobe, temporal lobes, caudate nucleus, and corpus callosum (P<0.005)., Conclusions: R2(*) can reveal the significant brain involvements of MSA-P. The introduction of gradient echo may increase the sensitivity, although the susceptible artifact may interfere the detection efficiency of R2(*).

Objective To compare the differences between the gray matter structures of amyotrophic lateral sclerosis (ALS) patients with limb-onset and bulbar-onset. Methods A total of 35 ALS patients with normal cognitive function were enrolled in Peking Union Medical College Hospital ALS Registry Platform from September 2013 to March 2018, and 20 healthy controls with matched age and education were included in the study. ALS patients were divided into limb-onset group (ALS-L group, n = 20) and bulbar-onset group (ALS-B group, n = 15) according to their clinical onset sites. Three-dimensional T1-fast spoiled gradient-recalled (3D-T1-FSPGR) of all subjects was collected. Gray matter volume of each group were compared using voxel-based morphometry (VBM). Within the compound region of interest (ROI) consisting of bilateral primary motor cortex, premotor cortex and supplementary motor area, the atrophy patterns of the motor cortex were compared between ALS-L group and ALS-B group. Results Compared with the control group, the ALS-L group had decreased gray matter volume in the left superior temporal gyrus-temporal pole (t = 3.932, uncorrected P < 0.001), left middle temporal gyrus (t = 3.836, uncorrected P < 0.001), right insula (t = 3.992, uncorrected P < 0.001). Compared with the ALS-B group, the ALS-L group had decreased gray matter volume in the right superior frontal gyrus (t = -3.158, uncorrected P < 0.001), left cingulate gyrus (t = -3.002, uncorrected P < 0.001). In the analysis of the motor cortex as ROI, the gray matter volume of the segments representing hand (t = 2.237, uncorrected P < 0.001) and lower limb (t = 2.728, uncorrected P < 0.001) of the left motor cortex in the ALS-L group was reduced significantly than that of ALS-B group. Conclusions ALS-L has more significant gray matter atrophy than ALS-B, and the local atrophy pattern of motor cortex in ALS patients corresponds to its functional disability.

Background: Arterial spin labeling (ASL) is helpful in early diagnosis and differential diagnosis of Alzheimer's disease (AD), with advantages including no exposure to radioactivity, no injection of a contrast agent, more accessible, and relatively less expensive. Objective: To establish the perfusion pattern of different dementia in Chinese population and evaluate the effectiveness of ASL in differentiating AD from cognitive unimpaired (CU), mild cognitive impairment (MCI), and frontotemporal dementia (FTD). Methods: Four groups of participants were enrolled, including AD, FTD, MCI, and CU based on clinical diagnosis from PUMCH dementia cohort. ASL image was collected using 3D spiral fast spin echo–based pseudo-continuous ASL pulse sequence with background suppression and a high resolution T1-weighted scan covering the whole brain. Data processing was performed using Dr. Brain Platform to get cerebral blood flow (ml/100g/min) in every region of interest cortices. Results: Participants included 66 AD, 26 FTD, 21 MCI, and 21 CU. Statistically, widespread hypoperfusion neocortices, most significantly in temporal-parietal-occipital cortices, but not hippocampus and subcortical nucleus were found in AD. Hypoperfusion in parietal lobe was most significantly associated with cognitive decline in AD. Hypoperfusion in parietal lobe was found in MCI and extended to adjacent temporal, occipital and posterior cingulate cortices in AD. Significant reduced perfusion in frontal and temporal cortices, including subcortical nucleus and anterior cingulate cortex were found in FTD. Hypoperfusion regions were relatively symmetrical in AD and left predominant especially in FTD. Conclusion: Specific patterns of ASL hypoperfusion were helpful in differentiating AD from CU, MCI, and FTD. [ABSTRACT FROM AUTHOR]

Background: Iron-overloaded patients are recognized as presenting an increased risk of osteoporosis. However, studies on the correlation between osteoporosis and organ iron overload are controversial or scarce. The aim of this study is to assess bone mineral density (BMD) and trabecular bone score (TBS) in correlation with hepatic and pancreatic iron overload. Methods: Forty-one patients diagnosed with hemoglobinopathies, were studied. BMDs of the lumbar spine (LS), femoral neck (FN), and total hip (TH) were analyzed by Dual-energy X-ray absorptiometry (DXA) scan. LS bone quality was derived from each spine DXA examination using the TBS analysis. Hepatic and pancreatic iron overload were obtained with a multi-echo gradient echo T2* technique. Results: Abnormal microarchitecture and abnormal bone mass were observed in 19/41 (46.3%) and 9/41 (22.0%) patients, respectively. For 26 males, BMD, T-score and Z-score of LS were significantly lower among subjects with moderate-severe hepatic iron-overload than their counterparts, as it is between no- and pancreatic iron-overload groups. For 15 females, patients with moderate-severe hepatic iron-overload had significantly lower BMD and T-score of FN and TH, and patients with pancreatic iron-overload had significantly lower BMD, T-score of FN, and lower BMD, T-score and Z-score of TH than their counterparts. Moreover, pancreatic T2*-value was positively correlated with BMD and T-score at all analyzed sites and Z-score at TH. Conclusion: These data showed lower bone mass in patients with organ iron overload, particularly for LS in males, FN and TH in females. TBS may well represent a complementary tool for the evaluation of bone quality and the risk of fracture in iron-overloaded patients. [ABSTRACT FROM AUTHOR]

Microtia-atresia is a congenital malformation of the external ear, often affecting one side and being associated with severe-to-profound unilateral conductive hearing loss (UCHL). Although the impact of unilateral hearing loss (UHL) on speech recognition, sound localization and brain plasticity has been intensively investigated, less is known about the subjects with unilateral microtia-atresia (UMA). Considering these UMA subjects have hearing loss from birth, we hypothesize it has a great effect on brain organization. A questionnaire on speech recognition and spatial listening ability was administered to 40 subjects with UMA and 40 age- and sex-matched controls. UMA subjects showed poorer speech recognition in laboratory and poorer spatial listening ability. However, cognitive scores determined by the Montreal Cognitive Assessment (MoCA) and Wechsler Intelligence Scale for Children (WISC-IV) did not differ significantly in these two groups. The impact of hearing loss in UMA on brain functional organization was examined by comparing resting-state fMRIs (rs-fMRI) in 27 subjects with right-sided UMA and 27 matched controls. UMA subjects had increased nodal betweenness in visual networks and DMN but decreases in auditory and attention networks. These results indicate that UCHL in UMA causes significant abnormalities in brain organization. The impact of UCHL on cognition should be further examined with a battery of tests that are more challenging and better focused on the cognitive networks identified. [ABSTRACT FROM AUTHOR]

Background: Basal ganglia perivascular spaces are associated with cognitive decline and cardiovascular risk factors. There is a lack of studies on the cardiovascular risk burden of basal ganglia perivascular spaces (BG-PVS) and their relationship with gray matter volume (GMV) and GM cerebral blood flow (CBF) in the aging brain. Here, we investigated these two issues in a large sample of cognitively intact older adults. Methods: A total of 734 volunteers were recruited. MRI was performed with 3.0 T using a pseudo-continuous arterial spin labeling (pCASL) sequence and a sagittal isotropic T1-weighted sequence for CBF and GMV analysis. The images obtained from 406 participants were analyzed to investigate the relationship between the severity of BG-PVS and GMV/CBF. False discovery rate-corrected P -values (P FDR) of <0.05 were considered significant. The images obtained from 254 participants were used to study the relationship between the severity of BG-PVS and cardiovascular risk burden. BG-PVS were rated using a 5-grade score. The severity of BG-PVS was classified as mild (grade <3) and severe (grade ≥3). Cardiovascular risk burden was assessed with the Framingham General Cardiovascular Risk Score (FGCRS). Results: Severe basal ganglia perivascular spaces were associated with significantly smaller GMV and CBF in multiple cortical regions (P FDR <0.05), and were associated with significantly larger volume in the bilateral caudate nucleus, pallidum, and putamen (P FDR <0.05). The participants with severe BG-PVS were more likely to have a higher cardiovascular risk burden than the participants with mild BG-PVS (60.71% vs. 42.93%; P =0.02). Conclusion: In cognitively intact older adults, severe BG-PVS are associated with smaller cortical GMV and CBF, larger subcortical GMV, and higher cardiovascular risk burden. [ABSTRACT FROM AUTHOR]

Objectives: To detect and compare the features of interictal perfusion and volume asymmetry between temporal lobe epilepsy (TLE) patients with and without hippocampal sclerosis (HS). Methods: Sixty-one TLE patients (mean age 28.4 ± 9.3 years; 28 female/33 male) with unilateral signs of HS (TLE-HS+) and 25 TLE patients (mean age 29.8 ± 8.0 years; 17 female/8 male) without HS (TLE-HS-) were included. Thirty healthy volunteers served as controls (mean age 26.0 ± 8.7 years; 22 female/8 male). Brain segmentation and volume calculation were performed. Quantitative cerebral blood flow (CBF) values were measured based on arterial spin labeling (ASL). The asymmetry indices (AIs) of volume and perfusion were calculated. Results: TLE-HS+ (adjusted P = 0.001) and TLE-HS- patients (adjusted P = 0.006) had significantly higher hippocampal perfusion AIs than controls. TLE-HS+ and TLE-HS- had similar hippocampal perfusion AIs (adjusted P = 1.00). TLE-HS+ had higher hippocampal volume AIs than TLE-HS- and controls (adjusted P < 0.001). TLE-HS- and controls had similar hippocampal volume AIs (adjusted P = 1.00). All (100%) TLE-HS+ patients had positive hippocampal perfusion or volume AIs. No significant correlation between the AIs of hippocampal perfusion and volume was found in both TLE-HS+(P = 0.894) and TLE-HS- (P = 0.106) patients. TLE-HS+ patients demonstrated more extensive whole-brain asymmetry of both perfusion and volume than TLE-HS- patients. Conclusion: TLE-HS+ and TLE-HS- patients have different patterns of whole-brain perfusion and volume asymmetry. Hippocampal perfusion asymmetry was revealed in both TLE-HS+ and TLE-HS- patients. [ABSTRACT FROM AUTHOR]

Background and Purpose: To study the feasibility and clinical utility of head-neck joint high-resolution vessel wall imaging (HNJ-VWI) in the assessment of ischemic stroke.Methods: We reviewed our institutional HNJ-VWI database. Patients with transient ischemic attack (TIA) or ischemic stroke were included. Abnormal findings of intracranial and/or extracranial artery were assessed on three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) and HNJ-VWI modified from high-resolution 3D T1 sequence and classified into three groups including intracranial, extracranial and coexisting based on the locations. Etiologies of stroke were recorded according to Trial of Org 10172 in Acute Stroke Treatment criteria.Results: One hundred and ten consecutive patients were studied. 3D TOF MRA displayed 71.8% (79/110, based on patients) abnormal arteries (stenosis or occlusion) , while HNJ-VWI displayed 96.3% (106/110) abnormal arteries (plaque,wall thickness and occlusion) including four isolated extracranial lesions and ten coexisting lesions. The etiologies of TIA/ischemic stroke included large artery atherosclerosis (80 cases), cerebral small vessel disease (6 cases), cardiogenic (2 cases), dissection (6 cases), vasculitis (4 cases), moyamoya disease (6 cases), others (2 cases) and undetermined (4 cases). For patients with atherosclerosis stroke, re-infarctions were more common in coexisting group than intracranial group (extracranial vs. intracranial vs coexisting: 0% vs. 9.1% vs. 43.7%, p = 0.001).Conclusions: HNJ-VWI is a feasible and valuable technique in assessment of ischemic stroke by detecting extracranial and intracranial artery abnormalities with one-step scan. [ABSTRACT FROM AUTHOR]

This study was designed to investigate the distribution of the independent parameters of PET and MR in tumour differentiation and staging and to evaluate the diagnostic efficiency of the independent parameters and combined model of PET/MR in the tumour differentiation of head and neck squamous cell carcinoma (HNSCC). The patients with the preliminary diagnosis of HNSCC were included and underwent the integrated PET/MR The parameters included the diffusion-weighted imaging, dynamic contrast enhancement and PET. The correlations between different parameters and the distribution in groups of tumour differentiation and staging were analysed. The combined model was established with complementary PET/MR parameters. The diagnostic efficiency of the independent parameters and combined model in the tumour differentiation were analysed by receiver operating characteristic curve. The correlations between the parameters of dynamic contrast enhancement and PET were most significant. There were significant differences between the well-differentiated group and the moderately/poorly differentiated group in terms of the mean values of apparent diffusion coefficient (ADC) and standardised uptake value (SUV) (p < 0.05). The distributions among different tumour stage groups were not statistically different in all the parameters. The diagnostic efficiency of tumour differentiation increased in the order of Kepmean, SUVmean, ADCmean, and the combined model. Compared with the independent parameter, the combination of multiple parameters with PET/MR can further improve the diagnostic performance of tumour differentiation in HNSCC. [ABSTRACT FROM AUTHOR]

Background: This study was to investigate the prevalence of preoperative rim enhancement, and its association with clinicopathological features, relapse, and survival profiles in Chinese basal-like breast cancer (BC) patients. Materials and Methods: The preoperative breast magnetic resonance imaging images of 145 basal-like BC patients who underwent surgical excision were obtained to determine rim enhancement. Besides, based on disease status and survival status during follow-up, the 1-year relapse rate/mortality, 3-year relapse rate/mortality, 5-year relapse rate/mortality were calculated; disease-free survival (DFS) and overall survival (OS) were determined. Results: There were 51 (35.2%) patients with rim enhancement and 94 (64.8%) patients without rim enhancement. Furthermore, rim enhancement was associated with larger tumor size and advanced T stage, whereas it did not associate with age, pathological differentiation, N stage, or TNM stage. In addition, rim enhancement was associated with higher 1-, 3-, and 5-year relapse rate and shorter DFS; meanwhile, rim enhancement was associated with increased 1-, 3-, and 5-year mortality rate and decreased OS. By multivariate Cox's regression analyses, rim enhancement, pathological differentiation, and N stage independently predicted reduced DFS; T stage independently predicted declined OS. Conclusion: Preoperative rim enhancement on MRI might be a possible noninvasive indicator for guiding personalized treatment strategies and improving prognosis in Chinese basal-like BC patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility of high-resolution 3D CUBE T1WI for intracranial vessel wall imaging.Methods: High-resolution 3D CUBE T1 weighted intracranial vessel wall images (0.4 mm × 0.4 mm × 0.4 mm) of 50 patients were retrospectively evaluated. A 5-point scale (1 poor, 5 excellent) was used to score the imaging quality for displaying the vessel wall of every intracranial artery segments. The inter-observer and intra-observer reproducibility of identifying plaques, intraplaque hemorrhage/luminal thrombosis, and wall enhancement were calculated.Results: Totally 893 artery segments were evaluated. 3D CUBE T1WI displayed the arteries wall and lumen clearly, with the highest score (4.920 ± 0.837) for the C6-7 segments and the lowest (3.370 ± 1.107) for the C3 segments of the internal carotid artery (ICA). Both intra-observer and inter-observer reproducibility were high for identification of normal walls (κ=0.928, 95% confidence interval [CI] 0.891-0.954; κ=0.911, CI 0.868-0.940), plaque (κ=0.924, CI 0.884-0.954; κ=0.907, CI 0.866-0.943), luminal thrombosis (κ=1.000, CI 1.000-1.000; κ=1.000, CI 1.000-1.000), and wall enhancement (κ=1.000, CI 1.000-1.000; κ=0.914, CI 0.863-0.961).Conclusions: High-resolution 3D CUBE T1WI displayed intracranial wall and lumen clearly, and detected intracranial artery abnormalities with high reproducibility. [ABSTRACT FROM AUTHOR]