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Background: Compared with the conventional work‐up (CWU) including computed tomography (CT) of the chest and abdomen, MRI of the head and neck, and skeletal scintigraphy, positron emission tomography (PET)/MRI might improve diagnostic accuracy, shorten the work‐up time, and reduce false‐positive (FP) findings in patients with nasopharyngeal carcinoma (NPC). However, evidence of cost‐effectiveness is needed for the adoption of PET/MRI for the initial staging in NPC. Purpose: To evaluate the cost‐effectiveness and clinical value of PET/MRI as an initial staging procedure for NPC. Study Type: Retrospective cohort cost effectiveness study. Subjects: Three hundred forty‐three patients with a median age of 51 (13–81) years underwent PET/MRI before treatment (the PET/MRI group) and the remaining 677 patients with a median age of 55 (15–95) years only underwent CWU (the CWU group). There were 80 (23.3%) females and 193 (28.5%) females in the PET/MRI and CWU groups, respectively. Field Strength/Sequence: 3‐T integrated PET/MRI system, diffusion‐weighted echo‐planar imaging (b = 0 and 1000 s/mm2) and [18F] fluorodeoxyglucose PET. Assessment: The primary end point was the FP rate. Costs were determined as issued in 2021 by the Medical Insurance Administration Bureau of Zhejiang, China. Statistical Tests: Incremental cost effectiveness ratio (ICER) measured cost of using PET/MRI per percent of patients who avoided a FP. A P‐value <0.05 was considered statistically significant. Results: For the whole group, the de novo metastatic disease rate was 5.2% (53/1020). A total of 187 patients with FP results were observed. Significantly more patients with FP results were observed in the CWU group compared to the PET/MRI group (25.6% vs. 4.1%). The ICER was $54 for each percent of patients avoiding a FP finding. Data Conclusion: Compared with CWU, PET/MRI may reduce the FP risk. Furthermore, PET/MRI may be cost‐effective as an initial staging procedure for NPC. Evidence Level: 3 Technical Efficacy: Stage 6 [ABSTRACT FROM AUTHOR]

Introduction: Diabetic nephropathy (DN) has become a major public health burden in China. A more stable method is needed to reflect the different stages of renal function impairment. We aimed to determine the possible practicability of machine learning (ML)-based multimodal MRI texture analysis (mMRI-TA) for assessing renal function in DN. Methods: For this retrospective study, 70 patients (between 1 January 2013 and 1 January 2020) were included and randomly assigned to the training cohort (n1 = 49) and the testing cohort (n2 = 21). According to the estimated glomerular filtration rate (eGFR), patients were assigned into the normal renal function (normal-RF) group, the non-severe renal function impairment (non-sRI) group, and the severe renal function impairment (sRI) group. Based on the largest coronal image of T2WI, the speeded up robust features (SURF) algorithm was used for texture feature extraction. Analysis of variance (ANOVA) and relief and recursive feature elimination (RFE) were applied to select the important features and then support vector machine (SVM), logistic regression (LR), and random forest (RF) algorithms were used for the model construction. The values of area under the curve (AUC) on receiver operating characteristic (ROC) curve analysis were used to assess their performance. The robust T2WI model was selected to construct a multimodal MRI model by combining the measured BOLD (blood oxygenation level-dependent) and diffusion-weighted imaging (DWI) values. Results: The mMRI-TA model achieved robust and excellent performance in classifying the sRI group, non-sRI group, and normal-RF group, with an AUC of 0.978 (95% confidence interval [CI]: 0.963, 0.993), 0.852 (95% CI: 0.798, 0.902), and 0.972 (95% CI: 0.995, 1.000), respectively, in the training cohort and 0.961 (95% CI: 0.853, 1.000), 0.809 (95% CI: 0.600, 0.980), and 0.850 (95% CI: 0.638, 0.988), respectively, in the testing cohort. Discussion: The model built from multimodal MRI on DN outperformed other models in assessing renal function and fibrosis. Compared to the single T2WI sequence, mMRI-TA can improve the performance in assessing renal function. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate lesions of sacroiliac joint (SIJ) by combination of diffusion-weighted imaging (DWI) and magnetization transfer (MT). Methods: A retrospective study was used in this study. Forty-nine ankylosing spondylitis (AS) patients admitted to The China Academy of Chinese Medical Sciences Xiyuan Hospital from May 2020 to October 2020 were collected into active and inactive groups. Twenty-two healthy volunteers were recruited. Apparent diffusion coefficient (ADC) values for bone marrow edema (BME), sclerosis area, fat deposit area, and normal-appearing bone marrow (NABM) (both patients and healthy volunteers) and the magnetization transfer (MT) rate of the cartilage (MTRc) were analyzed in the groups. The above five parameters (ADC (NABM), ADC (BME) and ADC (fat deposit) and MTRc) between the active group and the inactive group were compared. The effectiveness of each parameter in diagnosing sacroiliac arthritis of ankylosing spondylitis were analyzed, and the predictive value of the parameters was compared. Results: ADC(BME), ADC(NABM) and MTRc showed statistically significant differences between the active and inactive groups (P <0.05). ADC (BME) and ADC (NABM) could predict the activity of AS sacroiliac arthritis (P <0.01). ADC (NABM) and MTRc were significantly different between healthy volunteers and the active group (P <0.01). The areas under the ROC curve (AUCs) of ADC (BME)_ADC(NABM), ADC(NABM)_MTR, and ADC(BME)_MTRc were 0.885 (cut-off value=0.69), 0.849 (cut-off value=0.56) and 0.864 (cut-off value=0.60), respectively. The predictive ability of the combined index ADC (BME)_MTRc and ADC(NABM)_MTRc was increased. Conclusion: The ability to diagnose and predict AS might be improved by the combination of diffusion-weighted imaging (DWI) and magnetization transfer (MT). [ABSTRACT FROM AUTHOR]

Background: Morphological awareness (MA) deficit is strongly associated with Chinese developmental dyslexia (DD). However, little is known about the white matter substrates underlying the MA deficit in Chinese children with DD., Methods: In the current study, 34 Chinese children with DD and 42 typical developmental (TD) children were recruited to complete a diffusion magnetic resonance imaging scan and cognitive tests for MA. We conducted linear regression to test the correlation between MA and DTI metrics, the structural abnormalities of the tracts related to MA, and the interaction effect of DTI metrics by group on MA., Results: First, MA was significant related to the right inferior occipito-frontal fascicle (IFO) and inferior longitudinal fsciculus (ILF), the bilateral thalamo-occipital (T&#95;OCC) and the left arcuate fasciculus (AF); second, compared to TD children, Chinese children with DD had lower axial diffusivity (AD) in the right IFO and T&#95;OCC; third, there were significant interactions between metrics (fractional anisotropy (FA) and radial diffusivity (RD)) of the right IFO and MA in groups. The FA and RD of the right IFO were significantly associated with MA in children with DD but not in TD children., Conclusion: In conclusion, compared to TD children, Chinese children with DD had axonal degeneration not only in the ventral tract (the right IFO) but also the visuospatial tract (the right T&#95;OCC) which were associated with their MA deficit. And Chinese MA involved not only the ventral tracts, but also the visuospatial pathway and dorsal tracts., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The study of brain differences across Eastern and Western populations provides vital insights for understanding potential cultural and genetic influences on cognition and mental health. Diffusion MRI (dMRI) tractography is an important tool in assessing white matter (WM) connectivity and brain tissue microstructure across different populations. However, a comprehensive investigation into WM fiber tracts between Eastern and Western populations is challenged due to the lack of a cross-population WM atlas and the large site-specific variability of dMRI data. This study presents a dMRI tractography atlas, namely the East-West WM Atlas, for concurrent WM mapping between Eastern and Western populations and creates a large, harmonized dMRI dataset (n=306) based on the Human Connectome Project and the Chinese Human Connectome Project. The curated WM atlas, as well as subject-specific data including the harmonized dMRI data, the whole brain tractography data, and parcellated WM fiber tracts and their diffusion measures, are publicly released. This resource is a valuable addition to facilitating the exploration of brain commonalities and differences across diverse cultural backgrounds., (© 2024. The Author(s).)

Magnetic resonance imaging (MRI) is the most commonly used imaging method to evaluate glioma recurrence. However, conventional MRI has difficulty distinguishing glioma accurately. This study aimed to explore the value of diffusion weighted imaging (DWI) in evaluating glioma recurrence and post-treatment-related changes. PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database and China Science and Technology Journal Database were extensively searched in accordance with inclusion criteria and exclusion criteria to obtain appropriate included studies. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Combined sensitivity and specificity and the area under the summary receiver operating characteristic curve (SROC) with the 95% confidence interval (CI) were calculated. Seventeen high-quality studies were included. The combined sensitivity was 0.82 (95% CI: 0.76–0.87), the specificity was 0.83 (95% CI: 0.76–0.89), the positive likelihood ratio was 4.9 (95% CI: 3.2–7.5), the negative likelihood ratio was 0.21 (95% CI: 0.15–0.30), the diagnostic odds ratio was 23 (95%: CI 11–48), and the area under the SROC was 0.90 (95% CI: 0.87–0.92). This meta-analysis suggests that DWI has high sensitivity, specificity and accuracy in differentiating glioma recurrence. [ABSTRACT FROM AUTHOR]

Pure thalamic infarct is a rare lacunar stroke type, with little known about long-term outcomes. This 8-year, single-center, retrospective study evaluated the clinical background, etiology, Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, and 8-year follow-up results in 27 patients with pure thalamic infarcts identified by MR diffusion-weighted imaging in Dalian, China. All patients presented chief complaints of limb weakness or sensory disturbances. Hypertension (24/27, 88.9%), diabetes (12/27, 44.4%), atrial fibrillation (1/27, 3.7%), hyperlipidemia (10/27, 37%), hyperhomocysteinemia (6/27, 22.2%), smoking history (10/27, 37%; 9/15, 60% for men; 1/12, 8.3% for women), and excessive alcohol consumption history (7/27, 25.9%; 7/15, 46.7% for men; 0 for women) were observed in our patient population. Based on TOAST classification, 1 patient had large artery atherosclerosis (7.14%), 23 had small vessel occlusion (SVO; 85.2%), and 3 patients were unidentified due to lack of cerebral angiography. The thalamic blood supply classification were as follows: 23 (85.2%), inferolateral territory; 1 (3.7%), tuberothalamic territory; 2 (7.4%), combination of tuberothalamic and paramedian arteries; 1 (3.7%), combination of inferolateral and paramedian arteries; 0, posterior choroidal arteries. During the 8-year follow-up, 3 patients died of colon cancer, multi-organ failure, and kidney failure, respectively; 7 presented with a recurrent stroke; while 10 recovered well with their risk factors under control. In conclusion, our cohort of pure thalamic infarcts were mainly due to SVO (TOAST), with hypertension as the main risk factor, and the inferolateral artery as the most implicated arterial territory. Less severe outcome or stroke recurrence are identified in long-term follow-up of pure thalamic infarcts. Other comorbidities would be cause of death in aged patients. [ABSTRACT FROM AUTHOR]

Objective: To characterize the magnetic resonance imaging (MRI) features of anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis and explore their clinical relevance. Methods: Patients with anti-LGI1 encephalitis who underwent MRI at our center were included in this study. Baseline and follow-up MRI characteristics were evaluated, and relationships between lesion location and clinical symptoms were analyzed. The extent of signal abnormalities within the lesion overlap region was measured and correlated with modified Rankin Scale scores and serum antibody titer. Results: Seventy-six patients were enrolled, of which 57 (75%) were classified as MR positive. Brain lesions were located in medial temporal lobe (MTL) (89%) and basal ganglia (BG) (28%). Hippocampus and amygdala were lesion hubs with more than 50% lesion overlap. BG lesions were found in 30% of patients with faciobrachial dystonic seizure (FBDS) and only 7% of patients without FBDS (p = 0.013). Meanwhile, MTL lesions were more commonly observed in patients with memory impairment (70 vs. 0%, p = 0.017). MRI features included hyperintensity and edema at baseline, as well as hypointensity and atrophy at follow-up. Correlations between signal intensity of lesion hubs (including hippocampus and amygdala) and modified Rankin Scale scores were found on T2 (r = 0.414, p < 0.001) and diffusion-weighted imaging (r = 0.456, p < 0.001). Conclusion: MTL and BG are two important structures affected by anti-LGI1 encephalitis, and they are associated with distinctive symptoms. Our study provided evidence from Chinese patients that BG lesions are more commonly observed in patients with FBDS, potentially suggesting BG localization. Furthermore, in addition to supporting diagnosis, MRI has the potential to quantify disease severity. [ABSTRACT FROM AUTHOR]

Background: Research conducted in Western countries has suggested that high-dose statin therapy can lead to the regression of carotid atherosclerotic plaques and can reduce periprocedural ischemic complication rates in individuals undergoing carotid artery stenting (CAS). However, whether this same therapeutic approach is of value in patients of Chinese ethnicity is not as well-established. Methods: This is a single-center, prospective, parallel-controlled, intervention-based efficacy study that will enroll a total of 130 Chinese patients with cervical carotid stenosis who are scheduled to undergo CAS. These patients will be randomly divided into a routine treatment group and a high-dose atorvastatin group. Individuals in the routine treatment group will be administered standard of care 20 mg/day atorvastatin treatment. Individuals in the high-dose atorvastatin group will be administered 80 mg/day atorvastatin for 3 days prior to and following CAS. The primary outcome of this study will be the cumulative incidence of new cerebral ischemic lesions on diffusion-weighted magnetic resonance imaging (DW-MRI) within 5 days following CAS, and of transient ischemic attacks (TIAs) or ischemic stroke within 30 days after CAS. Discussion: This study is the first to assess whether high-dose atorvastatin treatment is capable of reducing the incidence of perioperative cerebral ischemic injury in patients of Chinese ethnicity undergoing CAS. These results will offer evidence regarding which statin treatment regimens are more appropriate when treating Chinese patients undergoing CAS in an effort to minimize their risk of any perioperative cerebral ischemic injury. Trial Registration: ClinicalTrials.gov NCT03079115; registered March 14, 2017. [ABSTRACT FROM AUTHOR]

Background: Creutzfeldt-Jakob Disease (CJD) is a rapidly progressive neurodegenerative disease caused by the misfolded version of the cellular prion protein. Here we report four cases of sporadic CJD (sCJD) and describe the diagnostic methods available in order avoid missed or delayed recognition of CJD in China. Case presentation: We report four patients diagnosed with sCJD between March 2018 and December 2019 at Xiangya Hospital and the Second Xiangya Hospital of Central South University. All patients were admitted to the hospital because of a progressive cognitive decline. Although their routine tests and biochemical indicators in the cerebrospinal fluid (CSF), as well as computed tomography (CT) imaging, did not reveal any apparent abnormalities, the presence of "cortical ribboning" was incidentally found on diffusion-weighted imaging (DWI). The patients were subsequently diagnosed with CJD based on positive testing for 14-3-3 protein in their CSF, and the presence of periodic sharp and slow wave complexes (PSWCs) on their electroencephalograms (EEG). Additionally, two of patients was confirmed pathological examination of cerebral biopsies demonstrating neuronal loss, gliosis, and spongiform changes. Conclusions: CJD is a rare disease and is easily misdiagnosed by clinician in China due to a lack of recognition and awareness of CJD. Based on our experience described in this report, enhanced vigilance for CJD is required for patients with rapidly progressive dementia in China and other developing countries. DWI, EEG and detection of 14-3-3 protein in CSF should be performed in order to achieve a timely diagnosis of CJD. [ABSTRACT FROM AUTHOR]

Background: The X-linked form of Charcot-Marie-Tooth disease type 1 (CMTX1) is an inherited peripheral neuropathy that arises in patients with mutations in the gap-junction beta-1 gene (GJB1).Case Presentation: Three young male patients from Southern China with pes cavus experienced multiple episodes of transient central nervous system (CNS) dysfunction. Three patients all had reversible posterior leukoencephalopathy as detected by brain diffusion-weighted magnetic resonance imaging (MRI-DWI). Nerve conduction velocity (NCV) showed sensorimotor polyneuropathy with mixed demyelinating and axonal features. Genetic testing indicated a c.425G > A (p.Arg142Glu) or c.563 C > T (p.Thr188Ile) or c.103G > C (p.Val35Leu) mutation in GJB1. The unique feature of this report is the identification of two novel mutations: c.563 C > T and sc.103G > C of the GJB1 gene detected in two families respectively. Another unique feature is that peripheral neuropathy symptoms in the three patients were insidious and found at the onset of CNS symptoms.Conclusions: Posterior leukoencephalopathy is involved in CMTX1 patients. The white matter changes in MRI of CMTX1 patients are reversible and recover later than CNS symptoms. [ABSTRACT FROM AUTHOR]

Background: The associations between the clinical characteristics and diffusion-weighted imaging (DWI) positivity in patients with a clinical diagnosis of transient ischemic attack (TIA) are still poorly understood. The purpose of our study was to determine the incidence of TIA related acute infarction by DWI, and to determine the underlying predictors of DWI positivity in TIA patients. Methods: Between Jan 2017 and Dec 2018, we retrospectively enrolled 430 patients with a clinical diagnosis of TIA who underwent DWI. Patients were divided into those with acute ischemic lesions (DWI positive group) and those without (DWI negative group). The clinical characteristics, laboratory data, and imaging parameters were compared between the two groups. Results: A total of 430 time-based TIA patients (mean age, 61.4 ± 13.0) were enrolled in this study. About 126 (29.3%) of TIA patients had a DWI positive lesion in our series. Comparing TIA patients with positive DWI to those with negative DWI, acute lesions were more likely to be more male, have higher hyperlipidemia and a smoking history, more speech abnormalities and increased motor weakness; and higher systolic and diastolic blood pressure, homocysteine, fasting blood glucose, and the scores of ABCD2, ABCD3, ABCD3-I, and Dawson. Several independent predictors of DWI positivity were identified with logistic regression analysis: motor weakness (odds ratio 4.861, P = 0.021), speech abnormalities (odds ratio 4.029, P = 0.024), and ABCD3-I (odds ratio 13.141, P = 0.001). ABCD3-I showed the greatest area under the ROC curve, with a sensitivity of 85.7% and specificity of 72.4%. Conclusion: In patients with a clinical diagnosis of TIA, 29.3% demonstrated acute DWI lesions on brain magnetic resonance imaging (MRI). They were associated with motor weakness, speech abnormalities and higher ABCD3-I score at admission. [ABSTRACT FROM AUTHOR]

Background: Whether there are differences in pathogenesis among different types and subtypes of cerebral watershed infarction (WSI) is controversial since they have been combined into a single group in most previous studies.Methods: We prospectively identified 340 supratentorial WSI patients at Beijing Chao-Yang Hospital, Capital Medical University, China and classified them based on diffusion-weighted imaging(DWI) templates. Baseline characteristics, clinical courses and neuroradiological features were compared among patients with different types and subtypes of WSI.Results: We identified 92 patients with cortical watershed infarction (CWI), 112 with internal watershed infarction (IWI) and 136 with mixed-type infarction. Compared with CWI patients, more IWI patients had critical stenosis of internal carotid artery (ICA) (P < 0.001). For the CWI group, patients with anterior watershed infarction (AWI) were more prone to critical ICA stenosis than those with posterior watershed infarction (PWI) (P = 0.011). For the IWI group, critical ICA stenosis was more prevalent in patients with partial IWI (P-IWI) than in those with confluent IWI (C-IWI) (P = 0.026). IWI patients were more frequently found to have clinical deterioration during the first 7 days of hospitalization and a poor prognosis at the 90th day than in CWI patients (P = 0.003 and P = 0.014, respectively).Conclusions: IWI, especially the P-IWI subtype, is associated with hemodynamic impairment (HDI), whereas CWI has a weaker correlation with ICA steno-occlusion. Furthermore, IWI patients are more prone to poor prognosis. [ABSTRACT FROM AUTHOR]

Brain atlases play important roles in studying anatomy and function of the brain. As increasing interests in multi-modal magnetic resonance imaging (MRI) approaches, such as combining structural MRI, diffusion weighted imaging (DWI), and resting-state functional MRI (rs-fMRI), there is a need to construct integrated brain atlases based on these three imaging modalities. This study constructed a multi-modal brain atlas for a Chinese aging population (n = 180, age: 22-79 years), which consists of a T1 atlas showing the brain morphology, a high angular resolution diffusion imaging (HARDI) atlas delineating the complex fiber architecture, and a rs-fMRI atlas reflecting brain intrinsic functional organization in one stereotaxic coordinate. We employed large deformation diffeomorphic metric mapping (LDDMM) and unbiased diffeomorphic atlas generation to simultaneously generate the T1 and HARDI atlases. Using spectral clustering, we generated 20 brain functional networks from rs-fMRI data. We demonstrated the use of the atlas to explore the coherent markers among the brain morphology, functional networks, and white matter tracts for aging and gender using joint independent component analysis., (© 2022. The Author(s).)

Abstract: Purpose: We investigated the correlation relationship between ADCs measured by MRI and SUVs measured by PET/CT of lesions on GIST (gastrointestinal stromal tumor) patients to verify if MR is able to replace or serve as an alternative to PET/CT in GIST staging and treatment monitoring. Materials and methods: Between September 2010 and January 2011, five patients with histologically proven metastatic GIST in Queen Mary Hospital, Hong Kong were enrolled into our study. All patients underwent both MRI and PET/CT scans at prognosis. Pearson''s correlations of twenty-nine lesions were conducted between 5 pairs of ADCs and SUVs values. Results: Lesions in the liver, peritoneum or bowel loops were found by PET/CT and no extra-abdominal lesion was identified. All twenty-nine lesions are identifiable by MRI with sensitivity of 100%. Significant inverse correlation were found between ADCmean and SUVmean (P =0.006), ADCmean and SUVmax (P =0.010), ADCmin and SUVmax (P =0.014), ADCmin and SUVmean (P =0.026), rADCmin and rSUVmax (P =0.047). Conclusion: DWI is comparable to PET/CT in visually detecting the GIST lesions’ location. Significant inverse correlations were found between ADCs from DWIBS and SUVs from PET/CT on data of GIST patients. This finding demonstrates that DWI is potentially capable of offering similar information for diagnosis and treatment response evaluating in GIST''s patients as PET/CT does. Furthermore, ADCmin, which is determined by single pixel, is not as reliable as ADCmean, which is weighted average value of the whole lesion volume. [Copyright &y& Elsevier]

Background: Language area-related lesion is a serious issue in neurosurgery. Removing the lesion in the language area and at the same time preserving language functions is a great challenge. Aim: In this study, we aimed to screen functional magnetic resonance imaging (fMRI) based task types suitable for activation of Broca and Wernicke areas in Chinese population, characterize lesion properties of functional area of Chinese language in brain, and assess the potential of fMRI-guided neuronavigation in clinical applications. Materials and Methods: Blood oxygen level-dependent fMRI has been used to localize language area prior to operation. We carried out extensive fMRI analyses and conducted operation on patients with lesions in speech area. Results: fMRI tests revealed that the reciting task in Chinese can steadily activate the Broca area, and paragraph comprehension task in Chinese can effectively activate the Wernicke area. Cortical stimulation of patients when being awake during operation validated the sensitivity and accuracy of fMRI. The safe distance between language activation area and removal of the lesion in language area was determined to be about 10 mm. Further investigation suggested that navigation of fMRI combined with diffuse tensor imaging can decrease the incidence of postoperative dysfunction and increase the success rate for complete removal of lesion. Conclusion: Taken together, these findings may be helpful to clinical therapy for language area-related lesions. [ABSTRACT FROM AUTHOR]

Background: To determine, in a meta-analysis, the diagnostic performance of quantitative diffusion-weighted (DW) MR imaging in patients with breast lesions. Methods: English and Chinese studies published prior to June 2009 to assess the diagnostic performance of quantitative DWI in patients with breast lesions were reviewed and summarized with reference to the inclusion and exclusion criteria. Methodological quality was assessed by using the quality assessment of diagnostic studies (QUADAS) instrument. Publication bias analysis was performed by using Comprehensive Meta-analysis version 2. Meta-Disc version 1.4 was used to describe primary results and explore homogeneity by Chi-square test and inconsistency index; to explore threshold effect by receiver operator characteristic (ROC) space and Spearman correlation coefficient; and to pool weighted sensitivity and specificity by fixed or random effect model. A summary ROC (sROC) curve was constructed to calculate the area under the curve (AUC). Results: Of 65 eligible studies, 13 with 615 malignant and 349 benign lesions were included in the original metaanalysis, among which heterogeneity arising from factors other than threshold effect and publication bias was explored. Methodological quality was moderate. The pooled weighted sensitivity and specificity with corresponding 95% confidence interval (CI) in one homogenous subgroup of studies using maximum b = 1000 s/mm² were 0.84 (0.80, 0.87) and 0.84 (0.79, 0.88) respectively. AUC of sROC was 0.9085. Sensitivity analysis demonstrated that the pooled estimates were stable and reliable. Conclusions: Quantitative DWI has a higher specificity to differentiate between benign and malignant breast lesions compared to that of contrast-enhanced MRI. However, large scale randomized control trials (RCTs) are necessary to assess its clinical value because of disunified diffusion gradient factor b and diagnosis threshold. [ABSTRACT FROM AUTHOR]

It is essential to identify high risk transient ischemic attack (TIA) patients. The previous study reported that the CSR (comprehensive stroke recurrence) model, a neuroimaging model, had a high predictive ability of recurrent stroke. The aims of this study were to validate the predictive value of CSR model in TIA patients and compare the predictive ability with ABCD 3 -I score. Data were analyzed from the prospective hospital-based database of patients with TIA which defined by the World Health Organization time-based criteria. The predictive outcome was stroke occurrence at 90 days. The receiver-operating characteristic (ROC) curves were plotted and the C statistics were calculated as a measure of predictive ability. Among 1186 eligible patients, the mean age was 57.28 ± 12.17 years, and 474 (40.0%) patients had positive diffusion-weighted imaging (DWI). There were 118 (9.9%) patients who had stroke within 90 days. In 1186 TIA patients, The C statistic of CSR model (0.754; 95% confidence interval [CI] 0.729-0.778) was similar with that of ABCD 3 -I score (0.717; 95% CI 0.691-0.743; Z = 1.400; P = 0.1616). In 474 TIA patients with positive DWI, C statistic of CSR model (0.725; 95% CI 0.683-0.765) was statistically higher than that of ABCD 3 -I score (0.626; 95% CI 0.581-0.670; Z = 2.294; P = 0.0245). The CSR model had good predictive value for assessing stroke risk after TIA, and it had a higher predictive value than ABCD 3 -I score for assessing stroke risk for TIA patients with positive DWI., (© 2022. The Author(s).)

Purpose: To determine the utility of intravoxel incoherent motion (IVIM) diffusion-weighted imaging in quantitative analysis of preoperative tumor (T) and node (N) stages of gastric cancer, and to quantify the diagnostic threshold of IVIM parameters for serosal invasion and lymphatic metastasis.Materials and Methods: From October 2016 to February 2020, 98 patients with gastric cancer who were receiving treatment in Zhongshan Hospital, China, were subject to an IVIM sequence imaging analysis. The IVIM sequence data were imported into software for post-processing of tumor regions of interest, and the IVIM parameters (the microvascular volume fraction (f), the molecular diffusion coefficient (D) and perfusion-related incoherent microcirculation (D*) were calculated. The variation of these IVIM parameters with different tumor-node metastasis (TNM) stages were analyzed by one-way analysis of variance. The IVIM parameters of serosal invasion and lymphatic metastasis were examined by receiver operating characteristic curve analysis and t-tests.Results: A total of 98 gastric cancer patients (65 males and 33 females) with an average age of 61.9 years were enrolled in this study. There were 14 patients in stage T1, 14 in stage T2, 10 in stage T3 and 60 in stage T4a+b. There were 37 patients in stage N0, 19 in stage N1, 18 in stage N2 and 24 in stage N3. Statistically significant associations were found between the D values and T stages of gastric cancer. The D values of stage T4 cancers were significantly different from those of stage T2, T3 and T4 cancers. The D value decreased with increasing T stage. The mean D values of stages were 1.432 × 10-3 mm2/s (T1), 1.225 × 10-3 mm2/s (T2), 1.154 × 10-3 mm2/s (T3) and 0.9468 × 10-3 mm2/s (T4). The extent of the invasion of serosa was found to be significantly correlated with D value, with the diagnostic threshold for D being 1.107 × 10-3 mm2/s. In addition, different pathological N stages of gastric cancer lesions showed statistically significantly variations in f values, but no correlation was found with different N stages. Finally, the extent of lymphatic metastasis was found to be correlated with D values, with the diagnostic threshold being 1.1739 × 10-3 mm2/s. There was no statistically significant correlation between the IVIM MRI parameters and tumor size. The grade of tumor was found to be significantly correlated with D* value, with the diagnostic threshold for D* being 1.516 × 10-2 mm2/s. There was no statistically significant correlation between the ADC value and tumor size. There was a significant difference in the ADC values among different T and N stage cancers. ADC value had statistically significant to distinguish gastric cancer with or without serosal invasion, its detection efficiency was not as high as that of D value, with an AUC of 0.628 and 0.830, respectively. The ADC value was not statistically significant in distinguishing gastric cancer with or without lymphatic metastasis (P ≥ 0.05). The ADC value had not statistically significant in distinguishing gastric cancer between low and medium-high grade (P ≥ 0.05).Conclusion: We found that significant differences existed between whole-volume IVIM parameters of different T or N stages in gastric cancers, and were able to quantify different T or N stages of gastric cancer by the values of these parameters. The results of this quantitative study provide new tools for evaluating the prognosis of gastric cancer and will be valuable for the development of an new imaging method for determining the morphological stages of gastric cancer. [ABSTRACT FROM AUTHOR]

Aim: To explore the magnetic resonance imaging (MRI) differences between pancreatic neuroendocrine tumour grade 3 (pNET-G3) and pancreatic neuroendocrine carcinoma grade 3 (pNEC-G3).Materials and Methods: Between 2009 and 2019, 31 patients underwent pNEN-G3 resection with preoperative MRI in two local hospitals in China. The 31 patients were assigned to a pNET-G3 group (n=13) or a pNEC-G3 group (n=18). The MRI findings between the groups were compared.Results: There was no statistically significant difference between the two groups in lesion size, clinical characteristics, or laboratory indexes. The lesions showed high or slightly higher signal on diffusion-weighted imaging and decreased apparent diffusion coefficient (ADC) values, which differed between the two groups (p=0.013). The difference between the groups regarding positive enhancement integral, arterial phase and portal phase signal enhancement ratio were statistically significant; however, the delayed phase signal enhancement ratio was not significantly different.Conclusions: pNET-G3 and pNEC-G3 showed different characteristics on MRI. In particular, the ADC value and dynamic enhanced imaging could have an important role in distinguishing between the two. [ABSTRACT FROM AUTHOR]

Functional and structural brain alterations have been noted in carpal tunnel syndrome (CTS), the most common entrapment peripheral neuropathy. Previous studies were mainly focused on somatosensory cortices. However, the changes of white matter diffusion properties in nonsensorimotor cortices remain uninvestigated. We utilized a modified tract-based spatial statistics (TBSS) pipeline to explore CTS-related white matter plasticity, omitting the skeletonization step and registering diffusion tensor imaging (DTI) data to a study-specific, high resolution T1 template by an optimized registration method. The modified TBSS was demonstrated to be more sensitive to detect changes in white matter integrity than the standard TBSS approach. In this study, 25 moderate/severe CTS patients and 17 age- and sex-matched healthy controls (HC) were evaluated with DTI. Fractional anisotropy (FA) and radial diffusivity (RD) were calculated for group comparison. And the relationship between diffusion parameters and clinical assessments was also analyzed. Comparing with the healthy controls, CTS patients showed significantly increased FA and decreased RD in areas of multisensory integration and motor control involving the central opercular cortex and supplementary motor area (SMA) of the dominant hemisphere. Moreover, altered diffusion parameters in the central opercular cortex of the dominant hemisphere were significantly correlated with Boston Carpal Tunnel Questionnaire (BCTQ) scores. It is considered to be a form of maladaptive neuroplastic response to CTS-associated afference and motor control deficits. Such insight may be helpful in developing new strategies for the treatment of CTS., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: To explore the radiomics features of T2 weighted image (T2WI) and readout-segmented echo-planar imaging (RS-EPI) plus difusion-weighted imaging (DWI), to develop an automated mahchine-learning model based on the said radiomics features, and to test the value of this model in predicting preoperative T staging of rectal cancer., Methods: The study retrospectively reviewed 131 patients who were diagnosed with rectal cancer confirmed by the pathology results of their surgical specimens at West China Hospital of Sichuan University between October, 2017 and December, 2018. In addition, these patients had preoperative rectal MRI. Tumor regions from preoperative MRI were manually segmented by radiologists with the ITK-SNAP software from T2WI and RS-EPI DWI images. PyRadiomics was used to extract 200 features-100 from T2WI and 100 from the apparent diffusion coefficient (ADC) calculated from the RS-EPI DWI. MWMOTE and NEATER were used to resample and balance the dataset, and 13 cases of T 1-2 stage simulation cases were added. The overall dataset was divided into a training set (111 cases) and a test set (37 cases) by a ratio of 3∶1. Tree-based Pipeline Optimization Tool (TPOT) was applied on the training set to optimize model parameters and to select the most important radiomics features for modeling. Five independent T stage models were developed accordingly. Accuracy and the area under the curve ( AUC ) of receiver operating characteristic (ROC) were used to pick out the optimal model, which was then applied on the training set and the original dataset to predict the T stage of rectal cancer., Results: The performance of the the five T staging models recommended by automated machine learning were as follows: The accuracy for the training set ranged from 0.802 to 0.838, sensitivity, from 0.762 to 0.825, specificity, from 0.833 to 0.896, AUC , from 0.841 to 0.893, and average precision (AP) from 0.870 to 0.901. After comparison, an optimal model was picked out, with sensitivity, specificity and AUC for the training set reaching 0.810, 0.875, and 0.893, respectively. The sensitivity, specificity and AUC for the test set were 0.810, 0.813, and 0.810, respectively. The sensitivity, specificity and AUC for the original dataset were 0.810, 0.830, and 0.860, respectively., Conclusion: Based on the radiomics data of T2WI and RS-EPI DWI, the model established by automated machine learning showed a fairly high accuracy in predicting rectal cancer T stage., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

Purpose: Reading comprehension is closely associated with word recognition, particularly at the early stage of reading development. This association is reflected in children with reading difficulties (RD) who demonstrate poor reading comprehension along with delayed word recognition or reduced recognition accuracy. Although the neural mechanisms underlying reading comprehension and word recognition are well studied, few has investigated the white matter (WM) structures that the two processes potentially share., Methods: To explore the issue, behavioral scores (word recognition & reading comprehension) and diffusion spectrum imaging (DSI) were acquired from Chinese-speaking children with RD and their age-matched typically developing children. WM structures were measured with generalized fractional anisotropy and normalized quantitative anisotropy to optimize fiber tracking precision., Results: The children with RD performed significantly poorer than the typically developing children in both behavioral tasks. Between group differences of WM structure were found in the right superior temporal gyrus, the left medial frontal gyrus, the left medial frontal gyrus, and the left caudate body. A significant association between reading comprehension and Chinese character recognition and the DSI indices were found in the corpus callosum. The findings demonstrated the microstructural difference between children with and without reading difficulties go beyond the well-established reading network. Further, the association between the WM integrity of the corpus callosum and the behavioral scores reveals the involvement of the WM structure in both tasks., Conclusion: It suggests the two reading-related skills have partially overlapped neural mechanism. Associating the corpus callosum with the reading skills leads to the reconsideration of the right hemisphere role in the typical reading process and, potentially, how it compensates for children with reading difficulties., Competing Interests: The authors have declared that no competing interests exist.

Background and Purpose: The Trial of Org 10 172 in Acute Stroke Treatment (TOAST) system is the most widely used aetiological categorisation system in clinical practice and research. Limited studies have validated the accuracy of routine aetiological diagnosis of patients with ischaemic stroke according to the TOAST criteria when the reported subtype is assumed to be correct. We investigated the agreement between centralised and non-centralised (site-reported, at discharge) stroke subtypes in the Third China National Stroke Registry (CNSR-III), and analysed the influence of classification consistency on evaluation during hospitalisation and for secondary prevention strategy., Methods: All patients with ischaemic stroke from the CNSR-III study with complete diffusion-weighted imaging data were included. We used multivariable Cox proportional-hazard regression models to evaluate the factors associated with consistency between centralised and non-centralised stroke subtypes. Sensitivity analyses were conducted of the subgroup of patients with complete information., Results: This study included 12 180 patients (mean age, 62.3 years; and women, 31.4%). Agreement between centralised and non-centralised subtype was the highest for the large-artery atherosclerosis subtype stroke (77.4% of centralised patients), followed by the small-vessel occlusion subtype (40.6% of centralised patients). Agreements for cardioembolism and stroke of other determined aetiology subtypes were 38.7% and 12.2%, respectively. Patient-level and hospital-level factors were associated with the inconsistency between centralised/non-centralised aetiological subtyping. This inconsistency was related to differences in secondary prevention strategies. Only 15.3% of the newly diagnosed patients with cardioembolism underwent centralised subtyping with indications to receive oral anticoagulants at discharge. In comparison, 51.3% of the consistent cardioembolism group and 42.0% of the centrally reassigned cardioembolism group with anticoagulation indications were prescribed oral anticoagulants., Conclusions: Substantial inconsistency exists between centralised and non-centralised subtyping in China. Inaccurate aetiological subtyping could lead to inadequate secondary prevention, especially in patients with cardioembolic stroke., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Single subcortical infarction (SSI) in the middle cerebral artery (MCA) territory can be classified into proximal SSI (pSSI) and distal SSI (dSSI) based on the heterogeneous pathogenesis. It is hypothesized that pSSI is more relevant with atherosclerosis, as low-density lipoprotein cholesterol (LDL-C) is the major atherogenic lipoprotein, we conducted the present study to investigate the association between LDL-C levels and pSSI in comparison with dSSI., Patients and Methods: This study is a subset of the Chinese Intracranial Atherosclerosis study. A total of 380 with SSI in the MCA territory classified as small artery occlusion stroke were enrolled in this study. 3.0-T magnetic resonance imaging (MRI) was performed to categorize the participants into two groups, pSSI (extending to the basal surface of MCA) and dSSI (not extending to the basal surface of MCA)., Results: Out of the 380 enrolled participants (273 men and 107 women), the proportion of pSSI and dSSI were 53.2% (202/380) versus 46.8% (178/380) based on MRI. The results of univariate and multivariate logistic regression were both at the borderline level of statistical significance. Further stratified analyses revealed that age is an interaction factor (P = 0.03), the association between LDL-C levels and the pSSI in participants aged over 65 had a significant positive relation (OR: 1.56; 95%CI: 1.14-2.12)., Conclusion: LDL-C level is an independent risk factor for pSSI in patients aged over 65. Our result is in accordance with the hypothesis that pSSI is more relevant with atherosclerosis, thus appropriate treatment should be applied differently to pSSI and dSSI., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Accurate assessment of tumor response in rectal cancer could help individualize treatment., Purpose: To evaluate the role of diffusion-weighted imaging (DWI) based on readout-segmented echo-planar imaging (rs-EPI) in assessing tumor response after neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC)., Material and Methods: Sixty-three patients with LARC who received neoadjuvant CRT and surgery were enrolled retrospectively. They all underwent pre- and post-CRT magnetic resonance examinations, including DWI using rs-EPI. According to pathological results, patients were grouped as pathological complete responder (pCR, n = 16) and non-pCR (n = 47). Visual assessment of residual tumor and whole-tumor histogram analysis of pre- and post-CRT apparent diffusion coefficient (ADC) map was performed by two radiologists; tumor volume on ADC map was also recorded., Results: Overall inter-observer agreement was good for histogram analysis (ICC = 0.543-0.999). Tumor volume reduction rate on ADC map showed no significant difference between the two groups ( P  = 0.468). Post-CRT mean, quantile values, and their percentage changes were higher in the pCR group (all P  < 0.001). Post-CRT mean value had a good diagnostic power in selecting pCR (AUC = 0.855), with a cut-off value of 1.345 × 10 -3  mm 2 /s, yielding a sensitivity of 83%, specificity of 81.3%. Post-CRT 95% quantile value had the highest AUC (AUC = 0.868) among quantile values, and a higher specificity (87.5% vs. 81.3%) than mean value with comparable overall diagnostic performance ( P  = 0.563). Visual assessment showed a sensitivity of 85.1%, specificity of 68.8% in selecting pCR., Conclusion: Quantitative ADC value of rs-EPI DWI could reliably evaluate tumor response in patients with LARC. Post-CRT 95% quantile ADC value could help mean value to more accurately identify pCR.

Purpose: Silent new ischemic cerebral lesions (sNICL) detected by diffusion-weighted imaging (DWI) are common after carotid artery stenting (CAS). As part of the Revascularization of Extracranial Carotid Artery Stenosis (RECAS) study, this work aimed to determine predictors of sNICL detected by DWI following CAS., Methods: A total of 694 patients eligible for the RECAS study treated in Xuanwu Hospital, Capital Medical University, with complete imaging data were included in this retrospective study. The patients were asymptomatic after CAS, and those with stroke, transient ischemic attack (TIA), or death were excluded. The RECAS protocol specified that DWI was completed 1-7 days before the procedure and within 3 days after CAS. Several parameters were assessed for associations with sNICL occurrence after CAS in univariate analysis. Finally, multivariate analysis was performed to determine risk factors for sNICL., Results: The rate of post-procedural sNICL in CAS was 51.3% (356/694 patients with sNICL). All patients underwent stenting with embolic protection devices. Univariate analysis showed that diabetes mellitus (P = 0.008), ipsilateral calcified plaques (P = 0.036), ipsilateral ulcerated plaques (P = 0.026), pre-dilatation (P = 0.003), and open-cell stent use (P < 0.001) were significantly associated with sNICL occurrence in CAS. Multivariate analysis revealed that diabetes mellitus (P = 0.006), ipsilateral calcified plaques (P = 0.024), ipsilateral ulcerated plaques (P = 0.021), and open-cell stent use (P < 0.001) were independent risk factors for sNICL., Conclusions: Patients with diabetes, calcified or ulcerated plaques who undergo CAS with open-cell stent application, are at high risk of sNICL. Large-scale prospective randomized controlled trials are needed to confirm these findings.

Background: The effect of cerebral small vessel disease (CSVD) and intracranial arterial stenosis (ICAS) on stroke outcomes remains unclear., Methods: Data of 1045 patients with minor stroke or transient ischaemic attack (TIA) were obtained from 45 sites of the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. We assessed the associations of burdens of CSVD and ICAS with new strokes and bleeding events using multivariate Cox regression models and those with modified Rankin Scale (mRS) scores using ordinal logistic regression models., Results: Among the 1045 patients, CSVD was present in 830 cases (79.4%) and ICAS in 460 (44.0%). Patients with >1 ICAS segment showed the highest risk of new strokes (HR 2.03, 95% CI 1.15 to 3.56, p=0.01). No association between CSVD and the occurrence of new strokes was found. The presence of severe CSVD (common OR (cOR) 2.01, 95% CI 1.40 to 2.89, p<0.001) and >1 ICAS segment (cOR 2.15, 95% CI 1.57 to 2.93, p<0.001) was associated with higher mRS scores. Severe CSVD (HR 10.70, 95% CI 1.16 to 99.04, p=0.04), but not ICAS, was associated with a higher risk of bleeding events. Six-point modified CSVD score improved the predictive power for bleeding events and disability., Interpretation: CSVD is associated with more disability and bleeding events, and ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months. CSVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes., Trial Registration Number: NCT00979589., Competing Interests: Competing interests: CJ is the principal investigator of the POINT trial, a NIH-sponsored trial with clopidogrel and placebo donated by Sanofi., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Transient ischemic attack (TIA) is often recurrent, and about one-third of patients will progress to cerebral infarction. Rapidly identifying high-risk patients is pivotal to prevent the development of cerebral infarction. Therefore, this study aimed to evaluate the value of ABCD score, ABCD score combined with magnetic resonance diffusion weighted imaging (DWI) and intracranial arterial magnetic resonance angiography (MRA) in predicting cerebral infarction after 2 to 30 days of transient ischemic attack (TIA).182 patients with TIA from August 2011 to August 2014 were enrolled as study subjects, and their clinical data, test results of DWI and MRA were collected. The incidence of cerebral infarction was observed at 2 days, 7 days and 30 days after TIA in patients with TIA, through scoring according to the 7-point ABCD score method proposed by Johnston. The relationship between ABCD score, performances of DWI and MRA and the early incidence of cerebral infarction after TIA was analyzed. The accuracy rating of ABCD score and ABCD + DWI + MRA score used for predicting the early incidence of cerebral infarction after TIA were compared with each other.The incidence of cerebral infarction after TIA was 19 cases (10.4%) in 2 days, 42 cases (23.1%) in 7 days, 56 cases (30.8%) in 30 days respectively. For the ABCD score of incidence of cerebral infarction 2 to 30 days after TIA, that of those with high risk was higher than that with medium risk, and that with the medium risk was higher than that with low risk (P < .05). The area under the curve of ABCD + DWI + MRA score and ABCD score predicting the incidence of cerebral infarction was: in 2 days: 0.782 and 0.748, in 7 days: 0.839 and 0.801, in 30 days: 0.780 and 0.757, P < .05.Compared with ABCD score, ABCD score combined with DWI and MRA can further improve the accuracy of prediction for cerebral infarction after TIA.

Purpose: The proportion of acute symptomatic lacunar infarction lesions that undergo cavitation and the factors influencing cavity formation are yet unclear, particularly in the Chinese population. Hence, we investigated changes in the diameter of acute lacunar infarction lesions and identified the risk factors for the progression of these lesions., Methods: A total of 160 patients (mean age 66 years) with acute symptomatic lacunar infarction lesions underwent two magnetic resonance imaging (MRI) examinations: diffusion-weighted imaging (DWI) at onset (lesion diameter < 20 mm) and T2-weighted imaging/fluid-attenuated inversion recovery sequences at follow-up (median follow-up time 389 days). Lacunar infarction lesion progression was categorized as complete cavitation (lacune), partial cavitation, white matter lesion (WML), or disappearance of the lesion. The risk factors for cavity formation were evaluated., Results: Upon follow-up MRI, lesions had changed to lacunes in 20 (12.5%) patients, partial cavitation in 23 (14.4%), WMLs in 97 (60.6%), and had disappeared in 20 (12.5%). Lacune formation was related to hypertension (P = 0.026); cavity (lacune and partial cavitation) formation was related to diabetes (P = 0.009) and diameter change (P = 0.015)., Conclusions: Approximately a quarter of the acute symptomatic lacunar infarction lesions observed with follow-up MRI were cavitated. Hypertension was negatively associated with lacune formation; diabetes and diameter change were negatively associated with cavity formation.

Background: The Brain Tumor Reporting and Data System (BT-RADS) category 3 is suitable for identifying cases with intermediate probability of tumor recurrence that do not meet the Response Assessment in Neuro-Oncology (RANO) criteria for progression. The aim of this study was to evaluate the added value of dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC PWI) and diffusion-weighted imaging (DWI) to BT-RADS for differentiating tumor recurrence from non-recurrence in postoperative high-grade glioma (HGG) patients with category 3 lesions., Methods: Patients with BT-RADS category 3 lesions were included. The maximal relative cerebral blood volume (rCBV max ) and the mean apparent diffusion coefficient (ADC mean ) values were measured. The added value of DSC PWI and DWI to BT-RADS was evaluated by receiver operating characteristic (ROC) curve analysis., Results: Fifty-one of 91 patients had tumor recurrence, and 40 patients did not. There were significant differences in rCBV max and ADC mean between the tumor recurrence group and non-recurrence group. Compared to BT-RADS alone, the addition of DSC PWI to BT-RADS increased the area under curve (AUC) from 0.76 (95% confidence interval [CI] 0.66-0.84) to 0.90 (95% CI 0.81-0.95) for differentiating tumor recurrence from non-recurrence. The addition of DWI to BT-RADS increased the AUC from 0.76 (95% CI 0.66-0.84) to 0.88 (95% CI 0.80-0.94). The combination of BT-RADS, DSC PWI, and DWI exhibited the best diagnostic performance (AUC = 0.95; 95% CI 0.88-0.98) for differentiating tumor recurrence from non-recurrence., Conclusion: Adding DSC PWI and DWI to BT-RADS can significantly improve the diagnostic performance for differentiating tumor recurrence from non-recurrence in BT-RADS category 3 lesions.

Background: Sporadic Creutzfeldt-Jakob disease (sCJD) is an extremely rare fatal and infectious neurodegenerative brain disorder characterized by rapidly progressive dementia, cerebellar ataxia, and visual disturbances. This article summarizes the retrospective analysis of 104 sCJD patients in the First Medical Center of Chinese PLA General Hospital from 2003 to 2019., Methods: A retrospective analysis of the medical records of the 104 patients diagnosed with sCJD was performed from the aspects of demographic data, clinical manifestations, laboratory examinations, cerebrospinal fluid analysis, electroencephalograms (EEGs), diffusion-weighted imaging (DWI) scans, positron emission tomography (PET) scans, and prion protein gene mutations., Results: In the 104 sCJD patients, pathological evidence of a spongiform change was found in 11 patients, while the remaining 93 patients were probable sCJD. The 104 patients included 57 males and 47 females, with the age of onset ranging from 29 to 82 (mean: 58, median: 60) years. The time from disease onset to death ranged from 1 to 36 months. Most of the patients died 7-12 months after the onset of sCJD. In most patients, rapidly progressive dementia appeared as the initial symptom, followed by cerebellar ataxia, visual disturbances, and neurobehavioral disorders. Most patients' DWI images showed symmetric or asymmetric hyperintensity in the cortex. In terms of EEGs, 38.2% of the patients had periodic sharp wave complexes. The sensitivity of 14-3-3 protein detection was 34.1%. The brain PET scans of 50 patients with sCJD presented 96% sensitivity for the diagnosis of sCJD., Conclusions: This study indicated that sCJD occurred at an early age in patients in China. The sensitivity of 14-3-3 protein detection was significantly low, but brain PET was highly sensitive in the diagnosis of sCJD., (The Author(s). Published by S. Karger AG, Basel.)

The aim of this study was to evaluate the risk factors and elucidate the clinical characteristics of cancer-associated ischemic stroke to differentiate it from conventional ischemic stroke in China and East Asia. Between June 2012 and June 2016, a retrospective analysis was performed on 609 stroke patients with cancer. They were divided into 3 groups: cancer-stroke group (CSG, 203 cases), stroke group (SG, 203 cases), and cancer group (CG, 203 cases). The D-dimer levels and diffusion-weighted imaging lesion (DWI) pattern were compared to an age- and sex-matched control group. The most common cancer types were colorectal cancer (20.2%) and lung cancer (18.72%). The average D-dimer level in stroke patients and cancer patients were 0.34 and 1.50 mg/L, respectively. The descending levels of D-dimer from cancer types were lung cancer (2.06 mg/L), pancreas (1.74 mg/L), gastric (1.61 mg/L), among others. Univariate analysis of the CSG and the others shows there were significant differences in the prevalence of the levels of D-dimer and DWI pattern, hypertension, diabetes mellitus, and thrombus. CSG has a unique pathological characteristic including high plasma D-dimer levels and multiple vascular lesions. The results show that D-dimer and DWI can be used as diagnostic index in clinical practice.

Mild cognitive impairment (MCI) is a heterogeneous cognitive disorder that is often comorbid with Parkinson's diseases (PD). The amnestic subtype of PD-MCI (PD-aMCI) has a higher risk to develop dementia. However, there is a lack of studies on the white matter (WM) structural changes of PD-aMCI. We characterized the WM structural changes of PD-aMCI (n = 17) with cognitively normal PD (PD-CN, n = 19) and normal controls (n = 20), using voxel-based and tract-based spatial statistics (TBSS) analyses on fractional anisotropy (FA) axial diffusivity (AD), and radial diffusivity (RD). By excluding and then including the motor performance as a covariate in the comparison analysis between PD-aMCI and PD-CN, we attempted to discern the influences of two neuropathological mechanisms on the WM structural changes of PD-aMCI. The correlation analyses between memory and voxel-based WM measures in all PD patients were also performed (n = 36). The results showed that PD-aMCI had smaller FA values than PD-CN in the diffuse WM areas, and PD-CN had higher AD and RD values than normal controls in the right caudate. Most FA difference between PD-aMCI and PD-CN could be weakened by the motor adjustment. The FA differences between PD-aMCI and PD-CN were largely spatially overlapped with the memory-correlated FA values. Our findings demonstrated that the WM structural differences between PD-aMCI and PD-CN were mainly memory-related, and the influence of motor adjustment might indicate a common mechanism underlying both motor and memory impairment in PD-aMCI, possibly reflecting a predominant influence of dopaminergic neuropathology., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) was shown to have a transient reduction in diffusion. Such changes would be used as an early detection to reduce excessive treatments and promote recovery without sequelae. The current research evaluated the high b-value (b = 3000 s/mm) diffusion-weighted imaging (DWI) assessment in MERS., Methods: Sixteen pediatric patients showed MERS used DWI (b = 1000 and 3000 s/mm). To record number of lesions, the signal intensities, signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), contrast ratios (CRs), the apparent diffusion coefficients (ADCs) were measured in the normal parenchyma and lesions., Results: Lesions were more apparent with high b-value. The ADC values and CNR in the lesions and surrounding normal brain parenchyma were relatively low at a high compared to standard b-value DWI (SNR: 144.67 ± 33.03, 85.72 ± 31.50; CNR: 20.82 ± 17.64, 49.62 ± 33.06; for b = 1000 and 3000 s/mm). The CR was significantly higher at a high compared to low b-value DWI (CR: 0.06 ± 0.07 versus 0.40 ± 0.14)., Conclusion: High b-value DWI could detect more lesions and could obviously improve the detection of lesions in pediatric patients with MERS.

Background and Aim: Incidental pancreatic cystic lesions (PCLs) are being diagnosed more frequently. However, little is known about the prevalence of PCLs in the Chinese population. The aim of the study was to assess the crude prevalence of PCLs in individuals who underwent magnetic resonance imaging (MRI)., Methods: Data from consecutive patients who underwent MRI without pancreatic indications were included. MRI images were reviewed for the presence of pancreatic cysts. The prevalence of PCLs and high-risk PCLs in different gender and age groups was calculated. To assess the crude prevalence, the prevalence and demographic data were standardized on the basis of Chinese national population data in 2017., Results: A total of 10 987 individuals were included (7344 men). Incidental PCLs were identified in 212 individual (128 men). The prevalence of PCLs was 1.93%, and PCLs were more often discovered in women (1.74% vs 2.31%, P = 0.043). Prevalence increased with age (r = 0.804, P < 0.001). The prevalence of high-risk PCLs was 0.12% (n = 13). Gender predominance and age distribution showed no difference between high-risk PCLs and low-risk PCLs (P = 0.234 and P = 0.855), but cysts located in the pancreatic head were more likely to develop into high-risk PCLs (P = 0.001). After data standardization, the crude prevalence of PCLs was 1.31%, and PCLs were more often discovered in women (1.11% vs 1.5%, P < 0.001). The crude prevalence of high-risk PCLs was 0.07%., Conclusion: Pancreatic cystic lesions in the Chinese population are not rare. The prevalence of PCLs increased with age and is higher in the female population. The prevalence of high-risk PCLs should not be ignored., (© 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

In order to study the application of multi-modal magnetic resonance imaging (MRI) fusion technology in schizophrenia, a 4-way multi-modal fusion method based on mCCA+jICA is used to fuse the local consistency and functional network connection of resting-state functional MRI, gray matter volume of structural MRI, and partial anisotropy of diffusion MRI four characteristics of large sample of schizophrenic patients in multi-site China, trying to find out the common characteristics of function and structure of significant differences between schizophrenia and healthy controls. It is found that compared with normal people, schizophrenic patients show higher local consistency, lower gray matter volume, lower functional network connectivity and decreased white matter integrity in the anterior thalamic radiation, upper bundle and other bundles in brain areas such as basal ganglia network, hippocampus and prominence network. There is a significant correlation between a thalamocortical perceptual loop and auditory hallucination in schizophrenia, and there is a high degree of spatial consistency and commonality among the three MRI features. The higher the volume of gray matter in the dorsolateral and medial prefrontal cortex is, the higher the integrity of white matter fibers such as corticospinal tract, superior longitudinal tract and anterior thalamic radiation is, the higher the digital backward score is, and the better the working memory ability of the subjects is.

Background: To summarize the characteristics of primary central nervous system vasculitis from clinical, imaging, and pathological aspects by retrospective study., Methods: From March 2015 to December 2017, the data of the inpatients of primary central nervous system vasculitis in first Hospital of Jilin University were collected, and their clinical manifestation, imaging, and pathological characteristics were analyzed by using a descriptive method., Results: There were 18 patients, 10 males (55.56%) and 8 females (44.44%) separately. The age ranges from 16 years old to 49 years old, with the median age of 32 years old. There were 8 cases (44.44%) of epileptic seizure, 6 cases (33.33%) of abnormal behavior and cognition, 10 cases (55.56%) with sensorimotor abnormalities, 4 cases (22.22%) with dizziness, 4 cases (22.22%) with headache, 2 cases (11.11%) with facial pain, 2 cases (11.11%) with blurred vision, and 2 cases (11.11%) with unstable walking. Eight patients (44.44%) were identified with cerebral spinal fluid abnormalities. There were 12 cases (66.67%) with bilateral lesions and 6 cases (33.33%) with unilateral lesions, including the frontal lobe (18 cases, 100%), the parietal lobe (10 cases, 55.56%), the temporal and occipital lobe (8 cases, 44.44%). There were 12 cases (66.67%) combined with subcortical white matter involvement, 6 cases (33.33%) combined with meningeal involvement, 2 cases (11.11%) complicated with basal ganglia involvement and 2 cases (11.11%) complicated with spinal cord involvement. Most of the lesions were with unclear border (16 cases, 88.89%), 2 cases (11.11%) were with clear border. Cortical atrophy was identified in 6 cases (33.33%). There were 12 cases (66.67%) with the enhancement of the lesions and meningeal. The 3D Vessel Wall magnetic resonance imaging (VW-MRI) showed uniform thickness in all patients (18/18) with contrast enhancement of the vessel wall of the vasculitis artery., Conclusions: The clinical manifestation and imaging in primary central nervous system vasculitis are diverse. The 3D VW-MRI could achieve quantification assessment of vasculitis and provide more utility for primary angiitis of the central nervous system., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Cerebral microbleeds (CMBs) may be markers of intracerebral bleeding risk in patients receiving antithrombotic drugs. This study aimed to analyze CMBs and white matter hyperintensities (WMHs) in patients taking aspirin or clopidogrel.This retrospective study included patients with ischemic cardiovascular disease administered 75 mg/day aspirin (n = 150) or clopidogrel (n = 150, matched for age and gender) for >1 year (Affiliated Hospital of Inner Mongolia Medical University, China, from July, 2010 to July, 2015). Patients underwent T2-weighted imaging, T1-weighted imaging, diffusion-weighted imaging (DWI) and enhanced T2*-weighted angiography (ESWAN) imaging (3.0-Tesla scanner). Baseline vascular risk factors for CMBs and macroscopic bleeding (MB) were evaluated using univariate and multivariate analyses.The aspirin and clopidogrel groups did not differ significantly in baseline characteristics or prevalences of CMBs or MB. The odds of MB were higher in patients with CMBs than in patients without CMBs in both the aspirin (odds ratio, 95% confidence interval: 4.09, 1.93-8.68; P < .001) and clopidogrel (6.42, 2.83-14.57; P < .001) groups. The odds of WMHs were also higher in patients with CMBs in both the aspirin (3.28, 1.60-6.71; P = .001) and clopidogrel (4.09, 1.91-8.75; P < .001) groups. Patients receiving treatment for >5 years showed elevated risk of CMBs in the aspirin (0.17; 0.09-0.36; P < .001) and clopidogrel (0.15, 0.07-0.33; P < .001) groups as well as higher odds of MB in the aspirin (0.34, 0.16-0.71; P = .004) and clopidogrel (0.37, 0.17-0.80; P = .010) groups.The WMHs and MB were associated with CMBs in patients taking aspirin or clopidogrel for >1 year, and long-term use increased the risks of CMB and bleeding.

Background: Unilateral brain edema is a rare peri-ictal imaging abnormality related to focal status epilepticus. We present the largest series of these patients, describe their clinical features and magnetic resonance imaging (MRI) findings, and analyze the possible underlying pathophysiology., Methods: We reviewed the medical records in Southwest China's largest tertiary's children's medical center from 2011 to 2017. Patients with focal status epilepticus were included if acute-phase cerebral MRI showed unilateral edematous swelling of the epileptic hemisphere., Results: Eleven children were included. The age at which the patients presented with status epilepticus ranged from seven months to 10.8 years. All patients showed prolonged clonic seizures with marked unilateral predominance followed by hemiplegia of the ipsilateral limbs. The seizure duration ranged from one to 72 hours. All patients showed hyperintensities on T2-weighted images and diffusion-weighted images involving the whole pathologic hemisphere. Three patients showed involvement of the contralateral cerebellar hemisphere and one showed hippocampal herniation. Magnetic resonance angiography of the brain was performed in seven patients, among which three showed dilation of the affected hemispheric arteries. Three patients underwent follow-up MRI, and all the examinations revealed ipsilateral cerebral hemisphere atrophy., Conclusions: Focal status epilepticus may cause unilateral brain edema, and cytotoxic edema probably plays an important role in the pathophysiology of brain injury., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: The prognosis of patients with isolated brainstem infarction (BSI) differs on an individual patient basis. This study was undertaken to analyze the influences of different imaging and clinical features with the prognosis of patients with BSI., Methods: The study population was derived from a multicenter study of intracranial atherosclerosis in China. In the present study, 300 patients were selected who had experienced non-cardiogenic brain stem infarction within the prior 7 days. Evaluations included clinical characteristics, location and size of the brainstem infarction, and whether the infarction was located in multiple perforating branches of the brainstem. Poor prognosis was defined as the presence of disability within 1 year from the onset of disease., Results: In total, 281 patients were followed up at 1 year post-infarction. Of these 281 patients, 84 (29.9%) exhibited disability at 1 year; these patients showed a median National Institutes of Health Stroke Scale score of 6 on admission. Multiple logistic regression analysis showed that patients with BSI located in the territory of multiple perforating arteries, who were discharged without administration of statins, showed a poor 1-year prognosis., Conclusion: Isolated BSI involving multiple perforating arteries, without statin medication at discharge, indicated poor prognosis for patients with BSI.

Background: The diffusion-weighted imaging (DWI) brain stem score (BSS) is an easy to use and can predict the clinical outcome of acute basilar artery occlusion (BAO) who underwent endovascular thrombectomy. The purpose of the current study was to validate its performance in Chinese acute BAO patients treated with mechanical thrombectomy., Methods: Fifty consecutive patients with acute BAO who received early magnetic resonance imaging and treated with mechanical thrombectomy in a single-center were included. Early ischemic damage on DWI was evaluated by applying BSS system. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the score system and multivariate logistic regression analysis was performed to identify predictor of clinical outcome., Results: Favorable outcomes were achieved in 38% patients (19 of 50 patients). Recanalization was successful in 92% patients (46 of 50 patients). Mortality rate was 26% (n = 13/50). In ROC curve analysis, the area under ROC curve of BSS .864 (95% confidence interval [CI], .738-.945) to predict favorable and .769 (95% CI, .628-.877) to predictor mortality. In logistic regression adjusted for age, baseline National Institute of Health Stroke Scale and time to puncture, DWI BSS ≤2 (odds ratio [OR], 12.416; 95% CI, 2.520-61.179; P = .002) and DWI BSS >3 (OR, 7.871; 95% CI, 1.353-45.797; P = .022) were the independent predictor for favorable outcome and mortality at 3 months respectively., Conclusions: The results of this study suggest that the DWI BSS can be used to predict clinical outcome in patients with acute BAO treated with mechanical thrombectomy at 3 months., (Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Endovascular thrombectomy has been accepted as the standard of care for patients with acute ischemic stroke. Our aim was to investigate the clinical outcomes of patients with mild ischemic stroke with acute proximal large-vessel occlusion after endovascular treatment within 24 hours of symptom onset., Materials and Methods: Between January 2014 and August 2017, ninety-three Chinese patients with mild ischemic stroke (NIHSS scores, 0-8) and large-vessel occlusion with endovascular treatment were retrospectively enrolled from 7 comprehensive stroke centers. They were divided into 2 groups: ≤6 hours and 6-24 hours from symptom onset to groin puncture. We analyzed their modified Rankin Scale scores at 90 days, symptomatic intracranial hemorrhage at 48 hours, and mortality during 90 days. Multivariable linear regression analysis was used to identify predictors for NIHSS shift after discharge., Results: Twenty-nine patients received endovascular treatment within 6-24 hours after symptom onset and had an imaging mismatch based on perfusion CT or diffusion-weighted MR imaging. There were no substantial differences between the 2 groups in 90-day functional independence ( P = .54) and the risks of the combination of symptomatic intracranial hemorrhage and death ( P = .72). Two significant indicators of NIHSS shift were 48-hour symptomatic intracranial hemorrhage (unstandardized β = 7.28; 95% CI, 3.48-11.1; P < .001) and baseline systolic blood pressure (unstandardized β = 0.08; 95% CI, 0.03-0.14; P = .005)., Conclusions: Patients with mild ischemic stroke and large-vessel occlusion in the anterior circulation, an imaging mismatch, and endovascular treatment within 6-24 hours of initial symptoms showed no heterogeneity in the efficacy and safety outcome compared with those treated ≤6 hours from symptom onset., (© 2018 by American Journal of Neuroradiology.)

Purpose: We compared clinical characteristics and outcomes of the early-onset seizure post-stroke patients who had seizures occurring at stroke presentation (SSP) with other patients without SSP at a single institution in Eastern China., Methods: We reviewed 20,947 ischemic stroke patients in our hospital electronic medical records system from January 2007 to December 2016. Among them, there were 91 (0.43%) patients with early-onset seizure post-stroke. Among these 91 patients, there were 35 (0.16%) SSP patients and another 56 (0.27%) were designated as non SSP patients because they also had early-onset seizure post-stroke, but without SSP. We compared the clinical presentations of the SSP patients with those of the non SSP patients including baseline stroke risk factors, and 10-year Kaplan-Meier death risk after their first stroke., Results: In the SSP patients, 25.7% of them presented with posterior circulation infarction, whereas only 12.5% of the non SSP patients had this condition (P<0.05). In contrast, 17.1% of the SSP patients were being treated with antiepileptic drugs at discharge whereas 37.5% of the non SSP patients received such treatment (P<0.05). The percentage of SSP patients with temporal lobe lesions was less than in non SSP patients (P<0.05). However, brain stem and thalamus lesions were more frequently seen in SSP patients than non in SSP patients (P<0.05). The risk factors for ischemic stroke including a history of hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation were the same in these two groups (P>0.05). In the SSP patients group, the 10-year risk of death was 36.9% after the initial seizure incident, and in the non SSP patients group, the 10-year death risk was 40.1%, but this difference between the two groups was not significant (P>0.05)., Conclusions: Ischemic stroke patients with SSP had some unique signs that included a higher incidence of posterior circulation infarction than non SSP patients., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Schizophrenia has increasingly been considered a neurodevelopmental disorder, and the advancement of neuroimaging techniques and associated computational methods has enabled quantitative re-examination of this important theory on the pathogenesis of the disease. Inspired by previous findings from neonatal brains, we proposed that an increase in diffusion magnetic resonance imaging (dMRI) mean diffusivity (MD) should be observed in the cerebral cortex of schizophrenia patients compared with healthy controls, corresponding to lower tissue complexity and potentially a failure to reach cortical maturation. We tested this hypothesis using dMRI data from a Chinese Han population comprising patients from four different hospital sites. Utilizing data-driven methods based on the state-of-the-art tensor-based registration algorithm, significantly increased MD measurements were consistently observed in the cortex of schizophrenia patients across all four sites, despite differences in psychopathology, exposure to antipsychotic medication and scanners used for image acquisition. Specifically, we found increased MD in the limbic system of the schizophrenic brain, mainly involving the bilateral insular and prefrontal cortices. In light of the existing literature, we speculate that this may represent a neuroanatomical signature of the disorder, reflecting microstructural deficits due to developmental abnormalities. Our findings not only provide strong support to the abnormal neurodevelopment theory of schizophrenia, but also highlight an important neuroimaging endophenotype for monitoring the developmental trajectory of high-risk subjects of the disease, thereby facilitating early detection and prevention.

Purpose: To compare the angiographic and clinical outcomes of self-expanding stents (SES) with distal embolic protection devices (EPD) vs balloon-expandable stents (BES) without EPD in the treatment of symptomatic atherosclerotic vertebral artery ostial stenosis (VAOS)., Methods: Between July 2011 and March 2013, a prospective randomized trial was conducted involving 127 patients (mean age 67.3±10.2 years; 94 men) with symptomatic VAOS randomly assigned to treatment with SES + EPD (Precise RX or RX Acculink stent + Spider FX EPD; n=61) or BES (Palmaz Blue or Resolute RX; n=66) without EPD. In-stent restenosis (ISR) >50% detected by duplex ultrasound was the primary endpoint. Technical success, clinical success, complications within 30 days, and signal intensity abnormalities on diffusion weighted imaging (DWI) after stenting were compared., Results: The 30-day technical success rate was 95.5% (63/66) for SES+EPD vs 100% (70/70) for BES without EPD (p=0.072). DWI at 24 hours poststenting showed 2 hyperintense lesions in 2 (3.3%) SES + EPD cases and 15 hyperintense lesions in 13 (18.6%) BES patients (p<0.01). At a mean 18-month follow-up, the clinical success rate was 93.9% (62/66) for the SES + EPD group vs 85.7% (60/70) for the BES group (p=0.115). The ISR was seen in 16/70 (22.9%) arteries in the BES group and 2/66 (3.1%) arteries in SES + EPD group (p<0.01). Target vessel revascularization was performed in 7 (10.0%) BES arteries vs none in the SES + EPD group (p<0.01)., Conclusion: SES with EPD in the treatment of symptomatic VAOS is technically feasible and safe, with low rates of ISR and significantly reduced thromboembolic events on imaging when compared to BES without EPD., (© The Author(s) 2015.)

Aims: To validate whether the optimal magnetic resonance perfusion (MRP) thresholds for ischemic penumbra and infarct core, between voxel and volume-based analysis, are varied greatly among Chinese acute ischemic stroke patients., Materials and Methods: Acute ischemic stroke patients receiving intravenous thrombolysis within 6 h of onset that obtained acute and 24-h MRP were reviewed. Patients with either no reperfusion (<30% reperfusion at 24 h) or successful reperfusion (>70% reperfusion at 24 h) were enrolled to investigate the ischemic penumbra and infarct core, respectively. The final infarct was assessed on 24-h diffusion-weighted imaging (DWI), which was retrospectively matched to the baseline perfusion-weighted imaging (PWI) images by volume or voxel-based analysis. The optimal thresholds that determined by each approach were compared., Results: From June 2009 to Jan 2014, of 50 patients enrolled, 19 patients achieved no reperfusion, and 20 patients reperfused at 24 h. In patients with no reperfusion, Tmax > 6 seconds was proved of the best agreement with the final infarct in both volumetric analysis (ratio: 1.05, 95% limits of agreement:-0.23 to 2.33, P < 0.001) and voxel-by-voxel analysis (sensitivity: 72.3%, specificity: 74.3%). In patients with reperfusion, rMTT>225% (ratio:2.4, 95% limits of agreement: -6.5 to 11.4, P < 0.001) was found of the best volumetric agreement with the final infarct, while Tmax > 5.6 seconds (sensitivity: 76.8%, specificity: 70.3%) performed most accurately in voxel-based analysis., Conclusion: Among Chinese acute stroke patients, volume of Tmax >6 seconds may precisely target ischemic penumbra tissue as good as voxel-based analysis performed, albeit no concordant MRP parameter is found to accurately predict infarct core because reperfusion occurred within 24 h after thrombolysis fails to restrain the infarct growth., (© 2014 John Wiley & Sons Ltd.)