BACKGROUND AND PURPOSE:Accurate cerebral arteriovenous malformation (CAVM) nidus volume measurement is important for evaluating treatment strategy and neurologic prognosis. This study aimed to compare the accuracy of silent MRA for measuring CAVM nidus volume with TOF-MRA and to analyze the clinical factors that may affect the nidus volume measurement. MATERIALS AND METHODS:A total of 45 patients diagnosed with CAVM who received silent MRA, TOF-MRA, and DSA examinations were retrospectively enrolled. A standardized protocol was used for nidus volume measurement using thresholding by these three imaging tools. RESULTS:The mean nidus volume measured by 3D-DSA, silent MRA, and TOF-MRA was 9.073 (SD, 7.667) mL, 9.55 (SD, 7.814) mL, and 7.773(SD, 7.11) mL, respectively. The linear correlation coefficient of the nidus volume was 0.976 (P < .001) and .966 (P < .001), respectively. Silent MRA was significantly higher than TOF MRA in nidus overlap volume (0.775 [SD. 0.109] versus 0.538 [SD. 0.206] P = .00), while TOF MRA was significantly higher than silent MRA in absolute volume difference (0.196 [SD. 0.192] versus 0.114 [SD. 0.147], P = .005). For both silent MRA and TOF-MRA, the nidus overlap volume and absolute volume difference were significantly associated with previous embolization status. CONCLUSIONS:Nidus volume measurement by silent MRA is comparable with DSA and is practical. Silent MRA can be used for nidus volume measurement and as a follow-up tool for evaluating nidus volume change after therapy.

BACKGROUND:FDG-PET aids presurgical epilepsy evaluation but is limited by access and radiation exposure. PURPOSE:To evaluate synthetic FDG-PET generated from T1-weighted imaging and resting-state fMRI metrics. STUDY TYPE:Retrospective. POPULATION:481 participants underwent simultaneous FDG PET/MR. Internal cohort: 311 epilepsy patients split into training/validation/internal test sets (n = 249/31/31; age 18.79 ± 16.33/22.20 ± 11.21/21.65 ± 17.62 years; male/female 145/104, 13/18, 22/9). External cohort: 115 temporal lobe epilepsy patients (age 25.36 ± 10.95 years; male/female 68/47) and 55 healthy controls (age 27.62 ± 5.82 years; male/female 24/31); 92 had surgery with 1-year outcome. FIELD STRENGTH:Hybrid PET/MR at 3.0 T; gradient-echo T1WI, echo-planar imaging and resting-state BOLD gradient-echo EPI. ASSESSMENT:Performance was assessed using SSIM, PSNR, MSE, NRMSE, SUVR correlation, and Bland-Altman analysis. Three blinded readers performed visual quality grading and detection of temporal lobe hypometabolism. Hippocampal radiomics was used for classification of hippocampal sclerosis and Engel outcome. STATISTICAL TESTS:t-tests, chi-square tests, Pearson correlation, Kolmogorov-Smirnov tests, DeLong tests, and false discovery rate correction. RESULTS:Excellent/Good visual ratings occurred in 82.8% (166/201), with Fleiss' κ = 0.42. SSIM was 0.98 ± 0.01 (internal) and 0.97 ± 0.01 (external); PSNR was 66.66 ± 1.25 and 64.16 ± 1.83, respectively. SUVR correlation with ground-truth PET was r = 0.94 (internal) and r = 0.89 (external); Bland-Altman bias was -0.02 (95% limits of agreement: -0.22 to 0.18) internally and -0.00002 (95% limits: -0.35 to 0.35) externally. Detection accuracy for temporal hypometabolism was 90.3% (internal; κ = 0.735) and 87.1% (external; κ = 0.758). Radiomics AUCs using synthetic PET were 0.72 (95% CI: 0.62-0.83) for hippocampal sclerosis versus healthy controls and 0.77 (95% CI: 0.67-0.87) for Engel IA versus IB-IV; DeLong tests versus ground-truth PET were non-significant (p = 0.56 and p = 0.48). CONCLUSION:Multisequence MRI-based synthetic PET showed high agreement with ground-truth PET across image-quality and quantitative SUVR metrics, providing a PET-like metabolic surrogate when FDG-PET is unavailable or impractical. LEVEL OF EVIDENCE:Evidence Level 3. STAGES OF TECHNICAL EFFICACY:Stage 3.

Objective Accurate preoperative lateralization of temporal lobe epilepsy (TLE) remains challenging, particularly in cases with subtle or MRI-negative lesions. This study aimed to overcome limitations of conventional MRI by developing a diffusion spectrum imaging (DSI)-based machine learning approach for noninvasive TLE lateralization. Methods We retrospectively analyzed DSI scans from 49 unilateral TLE patients (29 left, 20 right) and 25 healthy controls (HC). Local connectome fingerprints and quantitative anisotropy (QA) features were extracted. A support vector machine (SVM) was trained to classify patients from controls and to identify the epileptogenic hemisphere. Model performance was evaluated using 10-fold stratified cross-validation, with feature selection and dimensionality reduction performed within each training fold. Results The DSI-based SVM achieved high accuracy in distinguishing TLE from HC. With fingerprint features, accuracy was 97.3% (sensitivity 0.959, specificity 1.000); QA features yielded the same accuracy 97.3% (sensitivity 0.980, specificity 0.960). For lateralization among patients, the fingerprint model reached 100% accuracy versus 91.8% for QA. In the three-class classification task (left TLE, right TLE and HC), the models achieved accuracies of 78.4% (fingerprint) and 73.0% (QA). The fingerprint-based classifier yielded F1-scores of 0.943 for HC, 0.727 for LTLE, and 0.650 for RTLE; QA achieved F1-scores of 0.875, 0.677, and 0.632, respectively. DeLong’s test found no significant AUC differences. Conclusion DSI-derived metrics combined with machine learning enable accurate, noninvasive lateralization of TLE. This approach addresses clinical necessities by reliably detecting epileptogenic zones, including cases with subtle structural abnormalities, offering significant potential to enhance presurgical decision-making and patient outcomes.

BACKGROUND:Whether signal intensity (SI) on Silent MRA reflects hemodynamics in brain arteriovenous malformations (BAVMs) is unclear. OBJECTIVES:To evaluate the relationship between Silent MRA SI and 4D flow-derived hemodynamic parameters and examine whether Silent MRA-based metrics are associated with symptomatic hemorrhage in BAVM. STUDY TYPE:Prospective and retrospective cohort study. SUBJECTS:Patients with BAVM who underwent DSA and MRI, including a hemodynamic cohort with Silent MRA and 4D flow (40 MRI from 28 patients: 28 baseline and 12 post-embolization follow-up), an untreated hemorrhage analysis cohort with Silent MRA (69 patients, 26 with symptomatic hemorrhage), and 16 healthy participants. FIELD STRENGTH/SEQUENCE:3.0T MRI; Silent MRA (arterial spin labeling with zero echo time readout) and electrocardiogram-gated 4D flow. ASSESSMENT:Silent MRA SI and 4D flow-derived average blood flow (flowavg), maximum through-plane velocity (Vmax), and average through-plane velocity (Vavg) were measured in intracranial arteries of healthy participants and in draining veins (DVs), feeding arteries (FAs), and non-feeding arteries (non-FAs) of patients. A venous burden index (VBI) was defined as normalized DV SI divided by the fourth power of DV radius. Associations between Silent MRA factors and hemorrhage were assessed before and after adjustment for age, sex, and angioarchitecture. Measurements were performed independently by two readers (15 and 5 years of experience). STATISTICAL TEST:Pearson or Spearman correlation, ANOVA, logistic regression; significance level p < 0.05. RESULTS:Silent MRA SI correlated with flowavg in DVs (r = 0.53), non-FAs (r = 0.42), and healthy arteries (r = 0.61), but not in FAs (p = 0.38), which exhibited higher velocities than other vessels (Vavg: FAs 27.93 ± 10.32, non-FAs 18.59 ± 7.54, DVs 12.42 ± 5.59). In hemorrhage analysis, DV ectasia (OR 0.25; 95% CI 0.09-0.70) and VBI (OR 1.42; 95% CI 1.15-1.98) were significant on univariable analysis; after multivariable adjustment, only VBI remained significant (OR 1.38; 95% CI 1.08-2.05). DATA CONCLUSION:Silent MRA SI reflected 4D flow hemodynamics in non-FAs and DVs, but not in higher-velocity FAs. Silent MRA-derived VBI showed potential for noninvasive hemorrhage risk stratification in BAVM. EVIDENCE LEVEL:3. TECHNICAL EFFICACY STAGE:2.

OBJECTIVE:To evaluate iron deposition patterns in patients with cerebral cavernous malformation-related epilepsy (CRE) using quantitative susceptibility mapping (QSM) for detailed analysis of iron distribution associated with a history of epilepsy and severity. METHODS:This study is part of the Quantitative Susceptibility Biomarker and Brain Structural Property for Cerebral Cavernous Malformation Related Epilepsy (CRESS) cohort, a prospective multicenter study. QSM was used to quantify iron deposition in patients with sporadic cerebral cavernous malformation (CCMs). Lesions were segmented into intralesional, perilesional, and extralesional areas, with mean susceptibility values calculated for each subregion and analyzed in relation to epilepsy severity and duration. RESULTS:Among the 46 patients studied, those with a history of epilepsy had significantly higher iron deposition values in the perilesional (p =.012) and extralesional areas (p =.01), as well as a greater extent of iron deposition (p <.001) compared to those without epilepsy. The extent of iron deposition effectively distinguished patients with and without epilepsy, with an area under the curve (AUC) of 0.901 (95% confidence interval [CI]: 0.816-0.985). Among patients with epilepsy, iron deposition in the extralesional area was positively correlated with the severity of epilepsy (r2 = 0.181, p =.043), and the extent of iron deposition was positively correlated with the duration of epilepsy (r2 =.214, p =.026). SIGNIFICANCE:This study highlights QSM as a non-invasive tool for assessing iron deposition in CRE, identifying distinct subregional iron deposition patterns linked to epilepsy status and severity.

BACKGROUND:To prospectively validate an imaging-based classification system for cerebral cavernous malformation (CCM) associated with developmental venous anomaly (DVA) in a multicenter cohort, and to evaluate the association between DVA subtypes and hemorrhage risk. METHODS:This prospective multicenter cohort study was conducted as part of the CRESS study (Quantitative Susceptibility Biomarker and Brain Structural Property for Cerebral Cavernous Malformation Related Epilepsy) at 2 tertiary neurosurgical centers in China. Patients with sporadic CCM and coexisting DVA were consecutively enrolled and prospectively followed for data collection between September 2019 and March 2024. Eligible patients had a single sporadic CCM with a coexisting DVA, confirmed by contrast-enhanced magnetic resonance imaging or susceptibility-weighted imaging, and provided written informed consent for scheduled follow-up. Patients were classified into 3 subtypes (Groups A, B, and C) based on DVA morphology and its anatomic relationship with the CCM by 2 independent neuroradiologists blinded to outcomes. Clinical, demographic, and imaging data were collected, and patients were followed at scheduled intervals. The primary outcome was symptomatic hemorrhage. Outcomes were assessed throughout the follow-up period from enrollment until the first occurrence of symptomatic hemorrhage or censoring. Kaplan-Meier survival analysis and multivariable Cox regression were used to assess hemorrhage risk across subtypes. RESULTS:Of the 237 patients, 37.6% were classified as Group A, 13.5% as Group B, and 48.9% as Group C. Over a median follow-up of 51.4 months, 75 (31.5%) patients experienced hemorrhagic events. Group C showed a markedly higher annual hemorrhage incidence (17.2 per 100 patient-years) compared with Group A (4.1 per 100 patient-years) and Group B (2.2 per 100 patient-years). Multivariable analysis confirmed that Group C was independently associated with increased hemorrhage risk compared with Group A (adjusted hazard ratio, 4.51 [95% CI, 2.42-8.40]). Other significant predictors included infratentorial location (hazard ratio, 2.67 [95% CI, 1.61-4.49]), history of previous hemorrhage (hazard ratio, 2.04 [95% CI, 1.24-3.35]), and Zabramski type I lesions (hazard ratio, 1.94 [95% CI, 1.02-3.72]). CONCLUSIONS:CCM located at the distal branches of DVA with radially converging veins (Group C) carries a significantly higher risk of symptomatic hemorrhage. This imaging-based classification offers a practical framework for risk stratification and may inform individualized surveillance strategies. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT04076449.

AIMS:Autoscopic phenomena (AP) are distinct manifestations of epileptic seizure semiology and are also identified in diverse psychiatric disorders. Our study aimed to map the brain AP network and characterize its multimodal signatures. METHODS:By performing lesion network mapping using the human connectome dataset (n = 1000), we investigated the brain AP network derived from 25 cases of AP caused by distributed focal brain lesions (n = 19) and direct electrical stimulation (DES) (n = 6). We further studied the multimodal signatures of the AP network, including exploring spatial correlation with human cortical developmental and evolutionary expansions, neurotransmitters, and electrophysiological rhythms. RESULTS:We mapped a common AP network primarily involving the bilateral angular gyrus, posterior medial cortex, intraparietal sulcus, cuneus, fusiform and insula. Specifically, the bilateral thalamic pulvinar were identified as subcortical hubs. We further found a significant negative correlation between the AP network and developmental and evolutionary expansions. Particularly, the spatial density of norepinephrine transporter and the alpha frequency band power were significantly positively correlated with the AP network. CONCLUSION:Our study identified a common brain AP network and uncovered its multimodal signatures. These findings may clarify the network mechanisms underpinning AP, providing novel insights into bodily self-consciousness.

Key point:IRM appears promising and well tolerated as first-line therapy for newly diagnosed PCNS DLBCL in a small pilot cohort; these hypothesis-generating results require confirmation in larger prospective studies. Background:Primary diffuse large B-cell lymphoma of the central nervous system (PCNS DLBCL) is a rare, aggressive lymphoma with rising incidence in elderly patients. Bruton tyrosine kinase (BTK) inhibitors show promise in recurrent/refractory cases, warranting exploration in newly diagnosed disease. Methods:This single-center pilot study evaluated the safety/efficacy of ibrutinib, rituximab, and high-dose methotrexate (IRM) in nine newly diagnosed PCNS DLBCL patients (2018-2019). Treatment included 4 cycles of IRM induction, consolidation (HSCT or 2 additional IRM cycles), and maintenance therapy (ibrutinib/lenalidomide). Results:After induction, overall response rate (ORR) was 100% (complete response [CR]: 77.8%, partial response [PR]: 22.2%). Post-consolidation, CR increased to 88.9%. At a median follow-up of 77.6 months, 5-year overall survival (OS) and progression-free survival (PFS) rates were both 77.8%, with 8 patients in sustained CR and one progression. No treatment-related deaths occurred; grade ≥3 adverse events were rare (2 neutropenia, 2 anemia, 1 gastrointestinal bleeding). Conclusion:In this small pilot cohort, IRM showed promising activity and tolerability as first-line therapy for PCNS DLBCL. These descriptive findings warrant confirmation in larger prospective trials (#ChiCTR1900027811).

Background: Preliminary small-sample studies suggest that silent magnetic resonance angiography (MRA) has an advantage over time-of-flight MRA (TOF MRA) in the characterization of brain arteriovenous malformation (BAVM), but did not examine whether the imaging performance of silent MRA was affected by the intrinsic features of BAVM or common clinical factors. This study sought to compare silent MRA and TOF MRA in terms of the visualization and grading of BAVMs in various clinical settings. Methods: In total, 85 participants (50 males, 35 females; mean age: 33.5 +/- 15.2 years) with BAVM who underwent both silent MRA and TOF MRA using a 3 Tesla (3T) magnetic resonance imaging (MRI) system were consecutively recruited from the Capital Medical University Xuanwu Hospital between April 2020 and October 2022 to participate in this cross-sectional retrospective study. The patients were divided into subgroups according to new hemorrhage presentation, embolization, size, and nidus compactness. Image quality scoring on a 4-point scale, and the accuracy of characteristic visulization and Spetzler-Martin grading were compared between the two MRA techniques and each MRA subgroup using the rank-sum Wilcoxon test and Fisher's exact test with digital subtraction angiography (DSA) as the reference standard. A multivariable chi-square test was used to examine the interactions between the grouping factors. A P value <0.05 was considered statistically significant. Results: The average image quality scores were significantly higher for silent MRA than those for TOF MRA overall (2.83 +/- 0.42 versus 2.46 +/- 0.66, P<0.001) and in each subgroup (P<0.05). For silent MRA, the average image quality score for BAVM in each subgroup did not differ significantly (P>0.05). For TOF MRA, the image quality scores for the new hemorrhage, small nidus, and diffuse nidus groups was significantly reduced (P=0.001, <0.001, and 0.037, respectively). The accuracy of silent MRA was significantly better than that of TOF MRA in terms of nidus size and Spetzler-Martin grading (P<0.001), but did not differ significantly in terms of deep venous drainage and associated aneurysm (P=0.402, 0.098, respectively). In relation to silent MRA, the image quality, detection of BAVM characteristics, and grading were similar across the new hemorrhage, embolization, size, and compactness subgroups (P=0.066-0.959). In relation to TOF MRA, the accuracy of nidus size grading was significantly lower in the medium-size subgroup than the small- size subgroup (P<0.001). Conclusions: Silent MRA performed well in imaging BAVM, and high performance in determining nidus size and Spetzler-Martin grading, but its ability to detect deep venous drainage was limited.

Objective: Accurate nidus segmentation and quantification have long been challenging but important tasks in the clinical management of Cerebral Arteriovenous Malformation (CAVM). However, there are still dilemmas in nidus segmentation, such as difficulty defining the demarcation of the nidus, observer-dependent variation and time consumption. The aim of this study is to develop an artificial intelligence model to automatically segment the nidus on Time-Of-Flight Magnetic Resonance Angiography (TOF-MRA) images. Methods: A total of 92 patients with CAVM who underwent both TOF-MRA and DSA examinations were enrolled. Two neurosurgeons manually segmented the nidus on TOF-MRA images, which were regarded as the groundtruth reference. A U-Net-based AI model was created for automatic nidus detection and segmentation on TOFMRA images. Results: The mean nidus volumes of the AI segmentation model and the ground truth were 5.427 +/- 4.996 and 4.824 +/- 4.567 mL, respectively. The mean difference in the nidus volume between the two groups was 0.603 +/- 1.514 mL, which was not statistically significant (P = 0.693). The DSC, precision and recall of the test set were 0.754 +/- 0.074, 0.713 +/- 0.102 and 0.816 +/- 0.098, respectively. The linear correlation coefficient of the nidus volume between these two groups was 0.988, p < 0.001. Conclusion: The performance of the AI segmentation model is moderate consistent with that of manual segmentation. This AI model has great potential in clinical settings, such as preoperative planning, treatment efficacy evaluation, risk stratification and follow-up.

Background and Significance: Primary central nervous system lymphoma (PCNSL) is a rare and aggressive form of extranodal non-Hodgkin lymphoma with an increasing incidence, particularly among the elderly. The optimal treatment strategies for newly diagnosed PCNSL remain elusive. The Bruton's tyrosine kinase (BTK) inhibitor-ibrutinib, has shown promise in recurrent/refractory CNS lymphoma due to its efficacy and ability to penetrate the blood-brain barrier. This prospective study explored the combination of ibrutinib, rituximab, and HD-MTX ( IRM regimen) as a novel therapeutic approach for newly diagnosed PCNSL, aiming to improve response rates and minimize toxicity. Study Population: Thirty-two patients with newly diagnosed PCNSL were enrolled between January 1, 2020, and May 2024.The median age of the participants was 59 years, with a Karnofsky Performance Status (KPS) score ranging from 20 to 40. Location of Participating Centers: This single-center study was conducted at the Department of Hematology, Xuanwu Hospital, Capital Medical University, Beijing, China. Inclusion Criteria: Newly diagnosed patients with PCNSL confirmed by brain biopsy; aged 18-80 years; signed informed consent; at least one measurable lesion; ECOG 0-4; leucocytes ≥5x10^9/L, hemoglobin ≥80 g/L, platelets ≥75x10^9/L, bilirubin ≤1.5 ULN, AST ≤2.5 ULN, ALT ≤2.5 ULN, creatinine ≤1.5 ULN; LEVF ≥50%; effective contraception for men or women of childbearing age; expected survival time of at least 6 months. Exclusion Criteria: Participated in other clinical trials within 3 months before enrollment. Patients who participated in non-intervention studies were eligible to participate in this study; Received blood transfusion, erythropoietin (EPO), granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF) treatment within 14 days before enrollment; Patients who are planned to be vaccinated with live virus, or patients who have been vaccinated within 28 days (or 5 half-life of the vaccine) before enrollment; History of gastrointestinal perforation and/or fistula within 6 months before enrollment; Those who have contraindications to any of the components in the Ibutinib-R-HD-MTX scheme; The patient had previously received treatment for lymphoma, including: chemotherapy, immunotherapy, local radiotherapy for lymphoma, surgical treatment (except tumor or pathological tissue biopsy and surgical removal not for lymphoma) and any BTK inhibitor treatment before enrollment. History of other malignancies that may affect the compliance of the research protocol or the analysis of the results (there are cured skin cells that have cured and have not relapsed within 3 years before enrollment, or skin melanoma or cervical Patients with a history of carcinoma in situ can be enrolled);Severe non-malignant tumor diseases that can affect compliance with the study protocol, such as severe cardiovascular disease (such as New York Heart Association Class III or IV heart disease, myocardial infarction or unstable type within the last 6 months)，arrhythmia or unstable angina), uncontrolled diabetes and hypertension; Known uncontrolled active infectious disease or any major infection event requiring intravenous antibiotic treatment or hospitalization (excluding tumor fever) within 4 weeks before enrollment; Human immunodeficiency virus (HIV) antibody is positive; Hepatitis C virus (HCV) antigens or antibodies were positive; Hepatitis B virus (HBV) surface antigen positive, and HBV-DNA> 10^3 copy number; Researchers consider whether anyone is unsuitable for enrollment. Endpoints: Primary endpoint: ORR. Secondary endpoints: PFS, OS and safety profile. Current Status: As of June 30, 2024, the median follow-up was 25.1 months. Of the 32 enrolled patients, 8 patients were withdrawn due to drug allergies and dropout (loss to follow-up and disease progression). Among the remaining 24 patients, 13 completed consolidation therapy and entered maintenance therapy. Five patients just completed 4 cycles of induction therapy, and six are still undergoing induction therapy. No severe adverse reactions, such as atrial fibrillation or pulmonary fungal infections, were reported. Further detailed results will be available upon study completion.

Objective:To explore the application value of silent MR angiography (MRA) in imaging of brain arteriovenous malformation (BAVM) in children.Methods:A total of 20 children with BAVM confirmed by digital subtraction angiography (DSA) were retrospectively collected. All children were imaged by silent MRA and time-of-flight MRA (TOF MRA) in the same examination. The image quality of feeding artery, nidus and drainage vein of BAVM was evaluated using the four-point method. Wilcoxon rank-sum test was utilized to compare the image quality scores between silent MRA and TOF MRA. Weighted Kappa statistics used to evaluate the inter-modality agreement of silent MRA and TOF MRA with DSA in displaying of angioarchitecture characteristics and determination of Spetzler-Martin grading.Results:Among the 20 BAVMs, significant differences in image quality scores of the nidus (2.75±0.55 versus 2.20±0.70) and drainage vein (2.60±0.68 versus 2.20±0.77) were observed between silent MRA and TOF MRA ( Z=-3.05, P=0.002; Z=-2.13, P=0.033, respectively). The agreement between silent MRA and DSA was excellent in nidus size grading, deep venous drainage, associated aneurysm and SM grading (Kappa 0.91, 1.00, 0.83 and 0.93, respectively); The agreement between TOF MRA and DSA was fair to moderate (Kappa 0.46, 0.59, 0.35 and 0.47, respectively). Conclusions:Silent MRA showes better image quality compared to TOF MRA and improves the evaluation of angioarchitecture characteristics and Spetzler-Martin grading of BAVMs in children.

AbstractObjectivesEpileptic patients suffer from seizure recurrence after surgery due to the challenging localization. Improvement of the noninvasive imaging‐based approach for a better definition of the abnormalities would be helpful for a better outcome.MethodsThe quantitative anisotropy (QA) of diffusion spectrum imaging (DSI) is a quantitative scalar of evaluating the water diffusivity. Herein, we investigated the association between neuronal diameters or density acquired in literature and QA of DSI as well as the seizure localization in temporal lobe epilepsy. Thirty healthy controls (HCs) and 30 patients with hippocampal sclerosis (HS) were retrospectively analyzed. QA values were calculated and interactively compared between the areas with different neuronal diameter/density acquired from literature in the HCP‐1021 template. Diagnostic tests were performed on Z‐transformed asymmetry indices (AIs) of QA (which exclude physical asymmetry) among HS patients to evaluate its clinical value.ResultsThe QA values in HCs conformed with different pyramidal cell distributions ranged from giant to small; corresponding groups were the motor‐sensory, associative, and limbic groups, respectively. Additionally, the QA value was correlated with the neuronal diameter/density in cortical layer IIIc (correlation coefficient with diameter: 0.529, p = 0.035; density: −0.678, p = 0.011). Decreases in cingulum hippocampal segments (Chs) were consistently observed on the sclerosed side in patients. The area under the curve of the Z‐transformed AI in Chs to the lateralization of HS was 0.957 (sensitivity: 0.909, specificity: 0.895).InterpretationQA based on DSI is likely to be useful to provide information to reflect the neuronal diameter/density and further facilitate localization of epileptic tissues.

Background Preoperative assessment of the consistency of pituitary macroadenomas (PMA) might be needed for surgical planning. Purpose To investigate the diagnostic performance of radiomics models based on multiparametric magnetic resonance imaging (mpMRI) for preoperatively evaluating the tumor consistency of PMA. Study Type Retrospective. Population One hundred and fifty‐six PMA patients (soft consistency, N = 104 vs. hard consistency, N = 52), divided into training ( N = 108) and test ( N = 48) cohorts. The tumor consistency was determined on surgical findings. Field Strength/Sequence T1‐weighted imaging (T1WI), contrast‐enhanced T1WI (T1CE), and T2‐weighted imaging (T2WI) using spin‐echo sequences with a 3.0‐T scanner. Assessment An automated three‐dimensional (3D) segmentation was performed to generate the volume of interest (VOI) on T2WI, then T1WI/T1CE were coregistered to T2WI. A total of 388 radiomic features were extracted on each VOI of mpMRI. The top‐discriminative features were identified using the minimum‐redundancy maximum‐relevance method and 0.632+ bootstrapping. The radiomics models based on each sequence and their combinations were established via the random forest (RF) and support vector machine (SVM), and independently evaluated for their ability in distinguishing PMA consistency. Statistical Tests Mann–Whitney U ‐test and Chi‐square test were used for comparison analysis. The area under the receiver operating characteristic curve (AUC), accuracy (ACC), sensitivity (SEN), specificity (SPE), and relative standard deviation (RSD) were calculated to evaluate each model's performance. ACC with P ‐value<0.05 was considered statistically significant. Results Eleven mpMRI‐based features exhibited statistically significant differences between soft and hard PMA in the training cohort. The radiomics model built on combined T1WI/T1CE/T2WI demonstrated the best performance among all the radiomics models with an AUC of 0.90 (95% confidence interval [CI]: 0.87–0.92), ACC of 0.87 (CI: 0.84–0.89), SEN of 0.83 (CI: 0.81–0.85), and SPE of 0.87 (CI: 0.85–0.99) in the test cohort. Data Conclusion Radiomic features based on mpMRI have good performance in the presurgical evaluation of PMA consistency. Level of Evidence 3 Technical Efficacy Stage 2

目的 探讨蝶窦异位垂体瘤的临床表现及影像特征,旨在提高诊断准确率.方法 搜集2010年1月至2020年5月本院手术证实的12例蝶窦异位垂体瘤.分析其临床特征,化验检查特征及CT、MRI特征.结果 12例蝶窦异位垂体瘤中2例患者无症状,偶然发现,其余10例临床表现不典型,部分症状与肿瘤的大小、对邻近结构的侵犯相关.血激素检查12例病例均出现2种以上激素异常.CT平扫12例均表现肿块周围骨质压迫性骨质吸收、骨质破坏,未见骨质增生硬化征象.MRI上12例肿瘤T1WI/T2 WI上表现为不均匀等信号,中度不均匀强化.12例中2例出现空泡蝶鞍.结论蝶窦异位垂体瘤具有典型的CT及MRI表现,术前血激素检查多能发现一种或多种激素水平异常.认识这些特征,可显著提高术前诊断准确率.

To evaluate the diagnostic accuracy of super-selective pseudo-continuous arterial spin labeling (ss-pCASL) at depicting external carotid artery (ECA) perfusion territory in moyamoya disease (MMD). In total, 103 patients with MMD who underwent both ss-pCASL and digital subtraction angiography (DSA, the reference standard) were included. There were 3, 184, and 19 normal, preoperative, and postoperative MMD hemispheres, respectively. The ss-pCASL results were interpreted by two different visual inspection criteria: presence or absence and definite or indefinite ECA perfusion territory. The performance of ss-pCASL at depiction of ECA perfusion territory was compared to that of DSA. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The κ statistic was used to assess intermodality and inter-reader agreement. When interpreted as presence or absence, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ss-pCASL for depicting ECA perfusion territory were 78.3 %, 79.6 %, 92.5 %, 53.4 %, and 78.6 %, respectively, and the intermodality and inter-reader agreement were κ = 0.49 (CI: 0.43 – 0.55, p < 0.01) and 0.71 (CI: 0.66 – 0.76, p < 0.01), respectively. When interpreted as definite or indefinite, the respective values were 61.1%, 100%, 100%, 44.5%, 70.4%, κ = 0.42 (CI: 0.37 – 0.47, p < 0.01), and 0.90 (CI: 0.87 – 0.93, p < 0.01). ss-pCASL has substantial sensitivity and specificity compared with DSA for depicting the presence versus absence of ECA perfusion territory in MMD. As a noninvasive method in which no ion radiation or contrast medium is needed, ss-pCASL may potentially reduce the need for repeated DSA examination. • Super-selective pseudo-continuous arterial spin labeling (ss-pCASL) is a noninvasive vessel-selective MR technique to demonstrate perfusion territory of a single cerebral artery. • Compared with digital subtraction angiography, ss-pCASL has substantial sensitivity and specificity for depicting the perfusion territory of the external carotid artery in brain parenchyma in moyamoya disease. • ss-pCASL may potentially reduce the need for repeated DSA examination.

为了探究多参数磁共振图像(MP-MRI)特征对脑垂体瘤质地评估的应用价值,提出一种基于影像组学的计算机辅助诊断方法,以期实现术前肿瘤质地的准确判定,从而为手术入路的选择提供影像学依据.对磁共振图像(T1加权、T1加权对比增强、T2加权)的肿瘤区域分别提取6种共296维纹理特征.采用特征选择方法识别重要的影像组学特征,并且使用支持向量机和随机森林两种常用的分类器对垂体瘤质软与质韧进行判别.在84例临床研究样本共计252张MRI图像上,用所述方法进行训练、十折交叉验证及测试.实验结果表明,与单一 MRI图像特征相比较,所提出的MP-MRI特征组合能够获得更好的分类效果,分类准确率、敏感性、特异性、AUC分别达到89.80％、90.51％、89.88％、94.08％,表明MP-MRI影像组学特征能够有效准确地识别垂体瘤的软韧质地,有助于垂体瘤疗效和预后的改善.

BackgroundThe ABC/2 method is usually applied to evaluate intracerebral hemorrhage (ICH) volume on computed tomography (CT), although it might be inaccurate and not applicable in estimating extradural or subdural hemorrhage (EDH, SDH) volume due to their irregular hematoma shapes. This study aimed to evaluate deep framework optimized for the segmentation and quantification of ICH, EDH, and SDH.MethodsThe training datasets were 3,000 images retrospectively collected from a collaborating hospital (Hospital A) and segmented by the Dense U-Net framework. Three experienced radiologists determined the ground truth by marking the pixels as hemorrhage area. We utilized the Dice and intra-class correlation coefficients (ICC) to test the reliability of the ground truth. Moreover, the testing datasets consisted of 211 images (internal test) from Hospital A, and 86 ICH images (external test) from another hospital (Hospital B). In this study, we chose scatter plots, ICC, and Pearson correlation coefficients (PCC) with ground truth to evaluate the performance of the deep framework. Furthermore, to validate the effectiveness of the deep framework, we did a comparative analysis of the hemorrhage volume estimation between the deep model and the ABC/2 method.ResultsThe high Dice (0.89–0.95) and ICC (0.985–0.997) showed the consistency of the manual segmentations among the radiologists and the reliability of the ground truth. For the internal test, the Dice coefficients of ICH, EDH, and SDH were 0.90 ± 0.06, 0.88 ± 0.12, and 0.82 ± 0.16, respectively. For the external test, the segmentation Dice was 0.86 ± 0.09. Comparatively, the ICC and PCC of ICH volume estimations were 0.99 performed by Dense U-Net that overmatched the ABC/2 method.ConclusionThis study revealed the excellent performance of hematoma segmentation and volume evaluation based on Dense U-Net, which indicated our deep framework might contribute to efficiently developing treatment strategies for intracranial hemorrhage in clinics.

In this study, we report a familial cluster of cases which included five patients and two close contacts who were confirmed to have coronavirus disease 2019 (COVID-19). These participants had received real-time reverse transcription-polymerase chain reaction (RT-PCR) and chest X-rays (CXRs) before diagnosis. The follow-up CXRs of three patients in the family showed significant progression, with COVID-19 pneumonia, clinically worsening in a short period of time. Therefore, the results of follow-up CXRs in the short-term may be an adjunctive diagnostic method for COVID-19 disease diagnosis and its progression. Key Words: Chest X-ray, COVID-19, RT-PCR, Familial clustering.

目的 探讨磁共振增强三维双激发平衡式自由稳态进动(contrast-enhanced three-dimensional fast imaging employing steady-state acquisition with phase cycling,CE 3D-FIESTA-C)序列评价垂体大腺瘤与颅神经(cranial nerves,CNs)海绵窦段关系的价值.材料与方法 前瞻性收集40例垂体大腺瘤患者,所有患者均行CE 3D-FIESTA-C和增强三维容积(contrast-enhanced brain volume,CE BRAVO)序列扫描,统计每例患者双侧海绵窦内CNs的显示率.结果 在CE 3D-FIESTA-C序列上,第Ⅲ～Ⅵ对颅神经(CNⅢ、Ⅳ、Ⅴ1、Ⅴ2、Ⅵ)海绵窦段的显示率分别为75.0％、25.0％、71.3％、71.3％、41.3％,显示率均高于CE BRAVO序列(P<0.01).在CE 3D-FIESTA-C序列冠状位上,以颅神经因肿瘤影响中断或未显示判定同侧海绵窦受侵,诊断的敏感性和特异性分别为41.7％和95.8％.结论 CE 3D-FIESTA-C序列能较好地显示垂体大腺瘤患者CNⅢ～Ⅵ海绵窦段,通过观察CNⅢ～Ⅵ海绵窦段是否因肿瘤影响中断或未显示,可辅助诊断同侧海绵窦是否受侵.