Manual behavior scoring is labor-intensive and subjective. Video-capable large language models (LLMs) offer a transformative, scalable solution for accelerating and standardizing neuroscience workflows. We benchmarked state-of-the-art video LLMs (Gemini 2.5 Pro, Qwen3-VL, and VideoLLaMA3) for automated behavioral segmentation and scoring of mice performing a water-reaching task. Videos of mice performing water reaching were analyzed by the LLMs. Accuracy was compared across different models and against prompt adjustments within Gemini. To assess classification determinants, video fidelity was altered through pixel interpolation and key regions blurred (paws/snout-mouth). In addition, the models were asked to describe the mouse's actions over time. Finally, an open-source rat lever-pressing dataset was utilized to validate behavioral segmentation under a few-shot learning framework, assessing the impact of visual examples on the identification of discrete action sequences. Gemini 2.5 Pro ( 0.74 ± 0.12 accuracy) and Qwen3-VL-30B ( 0.67 ± 0.13 ) exhibited the ability to classify trial outcomes. Reliable classification required a minimum pixel resolution of 0.28 mm per pixel and careful consideration of the model frame tokenization rate. Accuracy is significantly reduced upon obscuring the snout-mouth area. In 549 / 1058 of videos, Gemini 2.5 Pro also provided completely accurate frame-to-frame behavior segmentations. The inclusion of visual examples improved model detection of user-defined behaviors. Video-LLMs offer potential to accelerate neuroscience by providing scalable, objective quantification of goal-directed behaviors. By producing temporal annotations, Gemini enables fast first-pass labeling that markedly streamlines manual dataset curation.

BACKGROUND:Developing novel technologies to effectively alleviate negative symptoms of schizophrenia remains challenging. While non-invasive brain stimulation targeting the dorsolateral prefrontal cortex (DLPFC) has shown potential, its outcomes have been inconsistent. Transcranial alternating current stimulation (tACS), which modulates specific frequency synchronization across long-range brain networks, offers new insights into optimizing the therapeutic efficacy for negative symptoms. OBJECTIVE:To examine the efficacy and safety of a 7 Hz, right DLPFC-occipital tACS protocol for negative symptoms. METHODS:Sixty schizophrenia patients with prominent negative symptoms were randomized to receive 10 sessions of active or sham tACS. The primary outcome was reduction rate of Positive and Negative Syndrome Scale (PANSS) negative subscale. Secondary outcomes included changes in Scale for the Assessment of Negative Symptoms (SANS) scores and other PANSS scores. General linear mixed model analysis of covariance was used for an intent-to-treat sample. RESULTS:No significant interaction between group and time of assessment was found for the PANSS negative subscale (F = 0.614, p = 0.543). Only SANS Anhedonia-Asociality showed a significant interaction between group and time (F = 4.596, p = 0.012), whereas all other secondary outcomes showed no significant interaction. In the active tACS group, significant interactions between time and illness duration were observed for SANS Affective Flattening scores (F = 3.689, p = 0.020) and PANSS negative subscale (F = 3.868, p = 0.024). CONCLUSION:The application of 7 Hz, fronto-occipital tACS did not yield significant immediate or short-term effects in alleviating negative symptoms, suggesting that stimulation parameters require further optimization.

Objective To examine abnormalities in EEG microstate dynamics in patients with major depressive disorder (MDD) and to explore their associations with anxiety and somatization symptoms.Methods We enrolled 30 patients with MDD and 40 healthy controls. Resting-state EEG was recorded and analyzed using microstate segmentation (classes A-D). Temporal parameters (mean duration, occurrence, time coverage, and transition probabilities) were compared between groups, and correlations with clinical symptoms (HAMD, HAMA, MADRS) were examined.Results Compared with controls, patients with MDD exhibited a significantly longer duration, higher occurrence, and greater time coverage of microstate C, while microstate B showed reduced occurrence and coverage. Transition probability analyses revealed fewer transitions from A to B, A to D, B to A, B to D, and D to A, and more transitions between C and D. Symptom correlations indicated that microstate B occurrence was positively associated with HAMD anxiety/somatization scores, while transitions from C to D and from D to C were negatively correlated with anxiety/somatization scores.Conclusions MDD is characterized by alterations in microstate B and C dynamics and disrupted transitions between C and D, some of which relate to symptom dimensions, suggesting that EEG microstate features may serve as potential neurophysiological markers in major depressive disorder.

To evaluate the performance of model-based dynamic contrast-enhanced (DCE)-MRI and diffusion-weighted imaging (DWI) in determining the disease activity of thyroid-associated ophthalmopathy (TAO), and to establish their additional value to fat-suppressed T2-weighted imaging (FS-T2WI) for staging TAO. Seventy-two patients with TAO (48 active, 96 eyes; 24 inactive, 48 eyes) were prospectively enrolled. DCE-MRI, DWI and FS-T2WI were scanned for pre-treatment evaluation. Simplified histogram parameters (min, mean, max) of DCE-MRI-derived Ktrans, Kep and Ve, apparent diffusion coefficient (ADC) and signal intensity ratio (SIR) on FS-T2WI of extraocular muscles were calculated for each orbit and compared between active and inactive groups. Multivariate analyses were used to identify independent indicators for disease activity. Receiver operating characteristic (ROC) curves analyses and DeLong tests were performed to evaluate and compare the performances of the identified significant imaging parameters and their combinations. Active TAO patients showed significantly higher mean and maximum Ve, higher minimum, mean and maximum ADC, higher minimum, mean and maximum SIR than inactive patients (p < 0.05). Mean SIR (odds ratio (OR) = 3.449, p = 0.002), mean ADC (OR = 1.008, p < 0.001), and mean Ve (OR = 14.138, p = 0.022) were found to be independent predictors of active TAO. Combination of mean Ve, mean ADC and mean SIR outperformed mean SIR alone in staging TAO (area under ROC curves, 0.839 vs 0.769, p = 0.016). DCE-MRI and DWI could determine the disease activity of TAO and provide additional value to FS-T2WI in staging TAO. Question Fat-suppressed T2-weighted imaging was the most commonly used imaging technique for determining the disease activity of thyroid-associated ophthalmopathy; however, its performance needs to be improved. Findings Dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging could provide added value to fat-suppressed T2-weighted imaging for determining the clinical activity of thyroid-associated ophthalmopathy. Clinical relevance Dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging can provide information about tissue permeability and water molecule diffusion of extraocular muscles in patients with thyroid-associated ophthalmopathy (TAO), and therefore provide additional value to fat-suppressed T2-weighted imaging in staging TAO.

BACKGROUND:Although subtle differences in cortico-striato-thalamo-cortical circuit structure and function are critical to the current understanding of the neurocircuitry in obsessive-compulsive disorder (OCD), emerging evidence suggests that the cerebellum may also be involved. However, much of this evidence comes from studies with small samples and notable methodological heterogeneity. METHODS:We conducted a mega-analysis of individual-participant data on cerebellar subregional volumes, comparing individuals with OCD and healthy controls (HCs) from the ENIGMA-OCD Working Group. Three-dimensional T1-weighted volumetric structural brain magnetic resonance imaging (MRI) scans from 1954 individuals with OCD and 2091 HCs across 22 sites (40 datasets) were processed using the ACAPULCO (Automatic Cerebellum Anatomical parcellation using U-Net Locally Constrained Optimization) pipeline to extract cerebellar parcellations. We harmonized the volume measures across sites using the ComBat algorithm. Multiple linear regression models were fitted to estimate group differences separately within the pediatric (<12 years), adolescent (12-17 years), and adult (from 18 years) samples, adjusting for age, gender, and intracranial volume. RESULTS:In adults with OCD (vs. HCs), we found significantly smaller volumes of the corpus medullare (d = -0.093, false discovery rate (FDR)-corrected p = .036), left VIIb (d = -0.085, pFDR = .039) and right VIIb (d = -0.091, pFDR = .036). None of the comparisons between children or adolescents with OCD versus HCs remained statistically significant after FDR correction. In all 3 age groups, cerebellar (subregional) volumes were significantly moderated by medication status. CONCLUSIONS:We report novel findings implicating specific cerebellar subregions across developmental stages of OCD and the key impact of medication status. Additional research on the functional significance of these findings may offer new translational leads.

Background:Studies applying machine learning to obsessive-compulsive disorder (OCD) typically report accuracy in homogeneous samples but rarely assess model reliability, generalizability, and interpretability needed for clinical use. Methods:We applied a transformer-based deep learning model, the Multi-Band Brain Net, to the ENIGMA-OCD cohort - the largest available resting-state functional magnetic resonance imaging (rs-fMRI) dataset in OCD with 1,706 participants (869 cases with OCD, 837 controls) across 23 sites worldwide. We evaluated model reliability by calculating calibration - the model's ability to "know what it doesn't know". We assessed generalizability using leave-one-site-out validation to test performance on unseen sites with different scanners, acquisition protocols, and patient populations. Finally, we examined interpretability by analyzing model attention weights to identify the neural connectivity patterns that influence model predictions. Results:The model achieved modest but competitive classification performance (AUROC = .653 ± .039). Crucially, while large-scale pretraining on the UK Biobank (N = 40,783) did not boost accuracy, it significantly enhanced model calibration by reducing overconfident predictions. Leave-one-site-out validation showed a generalization gap across sites (AUROC = .427-.819). Pretraining did not close this gap but removed scanner manufacturer bias. Finally, attention-based mapping identified biologically plausible patterns of widespread hypoconnectivity in OCD relative to healthy controls, particularly in low-frequency bands involving the default mode, salience, and somatomotor networks. These findings aligned with known OCD neurobiology. Conclusions:This study provides a framework for developing more reliable and trustworthy clinical artificial intelligence for OCD.

Abstract Elucidating the neurobiological basis of neurodevelopmental and psychiatric conditions (NDPCs) remains challenging because brain alterations vary within diagnoses and overlap across them. Whether diverse alterations follow a systematic organization that may reflect shared vulnerabilities remains unknown. Here, we assembled 10,135 individuals with schizophrenia, autism, bipolar, obsessive-compulsive, generalized anxiety, and major depressive disorders, and 11,998 reference participants across six continents through the ENIGMA consortium. Using normative modeling, we quantified individual deviations in cortical thickness, surface area, and subcortical volumes relative to lifespan reference trajectories (5 to 80 years). We show that structural deviations converged along cortical axes reflecting connectome organization, maturation, and cytoarchitectonic diversity. These axes mirrored typical population variation, but their expression differed across diagnoses and partly scaled with symptom severity. Even rare and highly individualized extreme deviations followed this organization, concentrating in densely connected regions. Finally, brain structural deviations overlapped substantially across diagnoses, while differences between them increased toward the association cortex. Together, we provide large-scale evidence that structural deviations across NDPCs are systematically constrained by the brain’s intrinsic architecture. This shared organization provides a framework for reconciling individual variability with transdiagnostic similarities and motivates an integrative, systems-level understanding of mental health.

OBJECTIVES:To investigate the value of synthetic MRI (SyMRI) of extraocular muscles (EOMs) in determining the disease activity of thyroid-associated ophthalmopathy (TAO). METHODS:Seventy-seven patients with TAO (31 active; 46 inactive) were prospectively enrolled. Orbital SyMRI was performed and post-processed to generate quantitative maps (T1 map, T2 map, and proton density [PD] map) and contrast-weighted images (double inversion recovery [DIR], short inversion recovery [STIR], and fluid-attenuated inversion recovery [FLAIR]). Maximum, mean, and minimum values of PD, T1 relaxation time (T1RT), and T2 relaxation time (T2RT) of EOMs, and the signal intensity ratio (SIR) of contrast-weighted images were calculated and compared between 2 groups. Multivariate logistic regression identified independent predictors of disease activity. Receiver operating characteristic curve analyses and DeLong tests evaluated and compared the diagnostic performance of significant parameters and combined models. RESULTS:Active TAO patients had higher values of both quantitative and semi-quantitative parameters than inactive patients, except for FLAIR-Min (all P < .05). DIR-Mean, PD-Mean, T1RT-Mean, and T2RT-Mean of EOMs were independently associated with active TAO (all P < .05). The combined model integrating 4 independent predictors showed higher diagnostic performance (AUC, 0.884; specificity, 89.13%; sensitivity, 77.42%) than DIR-Mean (AUC = 0.802), PD-Mean (AUC = 0.818), T1RT-Mean (AUC = 0.835), or T2RT-Mean (AUC = 0.824) alone in distinguishing active from inactive patients (all P < .05). CONCLUSIONS:SyMRI might be one promising imaging modality for determining the disease activity of TAO. ADVANCES IN KNOWLEDGE:SyMRI quantifies PD, T1RT, and T2RT in a single scan with clinically acceptable time. Our study innovatively synthesized multiple contrast-weighted images, improving the efficacy of TAO staging.

Background Schizophrenia (SCZ) exhibits considerable overlap with other psychiatric disorders in clinical symptoms and brain structural abnormalities, yet the relationship between these shared neuroanatomical patterns and individual clinical manifestations remains poorly understood. Methods We conducted a longitudinal study of 100 first-episode SCZ patients and 97 healthy controls (HCs), acquiring structural magnetic resonance imaging data at baseline and post antipsychotic treatment. Using normative modeling and summary statistics from eight psychiatric disorders, we computed a cross-disorder regional vulnerability index (RVI) that captures morphological similarity patterns across eight psychiatric disorders at the individual level. Results We found that SCZ patients demonstrated the highest RVI to bipolar disorder, major depressive disorder, and obsessive-compulsive disorder, with similarity levels increasing over the disease course. Cross-disorder RVI effectively discriminated SCZ patients from HCs, achieving classification accuracies of 0.83 at baseline and 0.87 at follow-up. Particularly, cross-disorder RVIs significantly correlated with symptom severity (p = 0.005), revealing divergent associations between positive and negative syndrome scales. Baseline cross-disorder RVI also predicted the improvement of negative syndrome following antipsychotic treatment (p = 0.021). Conclusions These findings highlight the potential of cross-disorder brain similarity profiling to improve personalized diagnosis and treatment in individuals with SCZ.

Background and Hypothesis Antipsychotics (APs) are often used among individuals with clinical high risk (CHR) for psychosis and affect cortical thickness (CT). Whether clinical and CT changes after initial AP use correlate with long-term clinical outcomes remains largely unknown. Study Design One hundred and thirty-eight CHRs and 65 healthy controls accepted 2 MRI scans at an interval of 2 months. CHRs were categorized as responders (n = 53) and non-responders (n = 69) based on their response to APs after 2-month treatment. According to 2-year outcomes, they were also subdivided into converters (n = 26) and non-converters (n = 96). The relationships among short-term CT changes, AP effects, and long-term outcomes were explored. Study Results At baseline, CHRs had CT reduction in the right inferior temporal cortex with a correlation with clinical symptoms. At 2 month, CHRs showed steeper gray matter loss in bilateral frontotemporal regions than healthy controls. Cortical thickness change rates of the clusters located in bilateral middle temporal and right lateral orbitofrontal cortex were negatively correlated with the cumulative AP dose. Furthermore, 2-year psychosis conversion rate was significantly higher in non-responders than responders (33.3% vs 5.1%). A random forest model based on demographic, clinical, baseline, and longitudinal CT variables predicted 2-year conversion with an AUC of 0.90 (accuracy: 0.83, sensitivity: 0.78, and specificity: 0.89), with model predictive power driven primarily by symptom and CT variables. Conclusions These findings contribute valuable insights into the potential impact of early AP treatment on brain morphology and clinical trajectories and highlight the importance of monitoring the initial treatment responses.

OBJECTIVES:The feasibility of programmed death protein-1 inhibitors (PD-1i) for intermediate-stage hepatocellular carcinoma (iHCC) is not yet fully understood. This study aimed to compare the efficacy and safety of transarterial chemoembolization (TACE) and lenvatinib (LEN) (TACE-LEN) plus PD-1i (TACE-LEN-PD-1i) with TACE-LEN in patients with unresectable iHCC (uiHCC). MATERIAL AND METHODS:From January 01, 2020, to June 30, 2023, 345 patients with uiHCC undergoing TACE-LEN-PD-1i (n = 156) or TACE-LEN (n = 189) were enrolled at five tertiary centers. Tumor responses, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs) were compared retrospectively. RESULTS:TACE-LEN-PD-1i resulted in a better objective response rate (ORR) (4 weeks after the first TACE, 67.3% vs. 51.9%, P = 0.004; best response, 72.4% vs. 52.4%, P = 0.001) over TACE-LEN. Patients undergoing TACE-LEN-PD-1i had a better median OS (30.5 vs. 22.0 months, P < 0.001) and PFS (13.0 vs. 8.5 months, P < 0.001) than those undergoing TACE-LEN. Meanwhile, the conversion rate was also higher in TACE-LEN-PD-1i (23.1% vs. 13.8%, P = 0.030). In the whole cohort, the patients with conversion resection were associated with a significantly higher median PFS (15.5 vs. 9.0 months, P < 0.001) and OS (36.0 vs. 23.0 months, P < 0.001) than those without conversion resection. The grade 1-4 TRAEs between TACE-LEN-PD-1i and TACE-LEN were not significantly different. No grade 5 TRAEs were observed. CONCLUSIONS:TACE-LEN-PD-1i was safe and well-tolerated. Combination of PD-1i improves the efficacy of TACE-LEN by enhancing ORR and PFS in patients with uiHCC.

Neural-network-based pose estimation models have become increasingly popular for quantitative analysis of mouse behavior, yet most recordings still use a single 2-D camera view and therefore lack the depth cues needed for accurate 3-D kinematics. Existing open-source 3-D mouse datasets for training deep-learning models cover only a narrow range of environments and do not generalize well to various laboratory settings. To overcome these limitations, we introduce PyMouse Lifter , a pipeline that automatically reconstructs 3-D mouse poses from ordinary 2-D top-view videos with minimal manual 2-D annotation. PyMouse Lifter combines (i) an anatomically realistic 3-D mouse model for automated data synthesis, (ii) a monocular depth estimation model, and (iii) a 2-D key-point estimation model, enabling accurate 3-D reconstruction (model-based 3D inference) in virtually any open-field arena without using depth or multiple camera views for reconstruction. We validate the system on multiple datasets against depth-camera ground truth and show that the lifted 3D trajectories yield improved behavior classification over 2-D data and can be implemented in real time. ### Competing Interest Statement The authors have declared no competing interest. Canadian Institute for Health Rsearch, PJT-180631, FDN-143209 Natural Sciences and Engineering Research Council, https://ror.org/01h531d29, GPIN-2022-03723

Evidence suggests that attenuated mismatch negative (MMN) waves have a close link to auditory verbal hallucinations (AVH) and their clinical outcomes, especially impaired neural oscillations such as θ, β representing attentional control. In current study, thirty patients with schizophrenia and AVH (SZ) and twenty-nine healthy controls (HC) underwent multi-feature MMN paradigm measurements including frequency and duration deviant stimuli (fMMN and dMMN). Clinical symptoms and MMN paradigm were followed up among SZ group after 8-week treatment. Results demonstrated that hallucinating patients exhibited attenuated dMMN amplitudes across Fz (p = 0.010), F1 (p = 0.020) and F2 (p = 0.014) electrodes, which were trendily recovered after treatment. Meanwhile, θ band and TBR at frontal fMMN and right temporal dMMN were significantly reduced in SZs. After treatment, SZs showed reduced scores of Hoffman's Auditory Hallucinations Rating Scale (AHRS), with a remarkable recovery in right temporal TBR of dMMN (p = 0.042) and a trending change in frontal TBR of fMMN (p = 0.090). The β band was decreased in dMMN (p = 0.035) by time. Additionally, P3 scores of Positive and Negative Syndrome Scale (PANSS) were negatively correlated with θ band of fMMN at baseline. Baseline scores of AHRS negatively predicted changes of dMMN amplitude after treatment, and changes of β band in left temporal dMMN predicted the reduction in scores of PANSS negative scale. These findings supported that deficits in θ oscillation and TBR during auditory attention process were crucial to clinical progression of schizophrenia with AVH.

Prolactin elevation associated with antipsychotic use significantly affects medication adherence and long-term treatment outcomes in patients with schizophrenia. The currently available data are insufficient to guide the monitoring and management of elevated prolactin levels in patients on antipsychotic medications. This study aimed to explore the patterns of prolactin level elevation associated with nine second-generation antipsychotics (SGAs) in a real-world setting and compare the associated risks. This retrospective cohort study utilized data from the inpatient electronic medical records of a large mental health center in China from 2007 to 2019. The study included patients diagnosed with schizophrenia (ICD-10 criteria) who received SGA therapy and whose serum prolactin levels were measured. Exposures were the use of nine specific SGAs (amisulpride, risperidone, paliperidone, ziprasidone, olanzapine, perospirone, quetiapine, clozapine, or aripiprazole), including polytherapy and monotherapy. The primary outcome was incident prolactin elevation in patients during hospitalization. An adjusted stratified Cox proportional hazards regression analysis was used to compare the hazard ratios (HRs) of prolactin level elevation across the nine SGAs. In addition, a dose–response analysis of these SGAs was conducted using the defined daily dose (DDD) method. Dose categories were as follows: < 0.6 DDDs/day (low dose), 0.6 to < 1.1 DDDs/day (medium dose), and ≥ 1.1 DDDs/day (high dose). This study included 6489 patients with schizophrenia (mean [SD] age, 35.1 [14.2] years; 3396 males [52.3

BACKGROUND:A subset of first-episode schizophrenia (FES) patients responds poorly to initial antipsychotic therapy. The hippocampus is an early-affected region in schizophrenia, yet neurobiological markers predicting treatment response remain unclear. Arterial spin labeling (ASL) magnetic resonance imaging (MRI) allows non-invasive measurement of cerebral blood flow (CBF), but studies on hippocampal perfusion in acute FES, particularly in those receiving electroconvulsive therapy (ECT) with antipsychotics, are limited. METHODS:Fifty FES patients and 28 age- and sex-matched healthy controls underwent high-resolution ASL MRI to assess hippocampal CBF. Patients received either antipsychotics alone (n = 20) or in combination with ECT (n = 30). MRI Scans were acquired before and after six weeks of treatment. Analysis of covariance and linear mixed-effects models were used to assess group differences and longitudinal effects, adjusting for relevant covariates. RESULTS:At baseline, FES patients exhibited significantly lower hippocampal CBF compared to healthy controls, with no significant difference in hippocampal volume. Longitudinal analysis revealed a significant group × time interaction for hippocampal CBF. Post hoc analysis indicated a significant increase in CBF after treatment in the FES group, while hippocampal volume remained unchanged. CBF changes were not significantly correlated with symptom reduction. We further examined the group differences in longitudinal changes between the ECT + Drug group and the Drug group, however no significant results were found. CONCLUSION:Our findings suggest that functional, but not structural, hippocampal alterations are present in early schizophrenia and may be responsive to treatment. These preliminary results should be interpreted cautiously and validated in larger samples with extended follow-up and neurochemical assessments.

BACKGROUND:Blonanserin, a novel antipsychotic, has demonstrated efficacy in treating both positive and negative symptoms. However, limited research exists on its dose-dependent effectiveness and safety in patients with and without prominent negative symptoms (PNS). AIM:To evaluate the effectiveness and safety of blonanserin monotherapy for first-episode schizophrenia in real-world clinical settings and to explore the efficacy and safety of different doses of blonanserin for patients with PNS and without PNS. METHODS:A 12-week, multicenter, prospective post-marketing surveillance was conducted. In this study, we included patients with first-episode schizophrenia who received blonanserin monotherapy. Patients were divided into those with PNS and without PNS, based on the Brief Psychiatric Rating Scale (BPRS) negative symptoms subscale scores. Additionally, patients were labeled as high-dose and low-dose groups according to the maximum daily dose they received. Effectiveness was assessed using the BPRS, and safety was evaluated through the incidence of adverse drug reactions (ADRs). RESULTS:A total of 653 patients were included in the analysis, with 613 completing the study. The BPRS total score decreased significantly from 47.94 ± 16.31 at baseline to 26.88 ± 9.47 at 12 weeks (P < 0.001). A significant interaction of PNS × dose × time was observed for BPRS total scores (F = 3.47, P = 0.040) and negative symptom subscale scores (F = 6.76, P = 0.002). In the PNS group, the high-dose group showed greater reductions in BPRS total scores (P = 0.001) and negative symptom subscale scores (P = 0.003) than the low-dose group in week 12. In the without PNS group, no significant difference was observed between the high-dose and low-dose groups at any visit. Most adverse reactions were mild or moderate, with extrapyramidal symptoms (9.3%) being most common; 1.5% of patients gained ≥ 7% body weight at 12 weeks. CONCLUSION:Blonanserin effectively alleviated the clinical symptoms of first-episode schizophrenia with an acceptable safety profile. High-dose blonanserin is particularly beneficial for patients with PNS in the acute phase of first-episode schizophrenia. However, due to the limitation of ADR reporting the real world, the ADR incidence observed in this study may be underestimated.

OBJECTIVE:To evaluate the ability of magnetization transfer imaging (MTI) to diagnose dysthyroid optic neuropathy (DON) and to establish the added value of MTI to conventional T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI). MATERIALS AND METHODS:One hundred and forty-nine patients with thyroid-associated ophthalmopathy were included and divided into training (46 eyes with DON and 148 eyes without DON) and validation (20 eyes with DON and 64 eyes without DON) cohorts. The orbital magnetic resonance imaging (MRI) protocols included coronal MTI, fat-suppressed T2WI, and DWI. The minimum, mean, and maximum values of the magnetization transfer ratio (MTR), signal intensity ratio (SIR), apparent diffusion coefficient (ADC) of each optic nerve (ON), and modified muscle index (mMI) of each orbit were calculated and compared between the groups. Multi-variable logistic regression analysis was performed to identify the independent imaging predictors of DON. The performance of each imaging predictor and their combinations using a binary logistic regression model for diagnosing DON was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS:Eyes with DON exhibited significantly lower MTRs and ADCs of the ON, increased SIRs of the ON, and increased mMI. The MTRmean of the ON, ADCmean of the ON, and mMI were independent predictors of DON. The multi-variable model incorporating these three variables yielded an area under the ROC curve (AUC) of 0.946 and showed significantly higher diagnostic performance than MTRmean (AUC = 0.831), ADCmean (AUC = 0.738), or mMI (AUC = 0.862) alone in the training cohort (all P < 0.001). In the validation cohort, the multi-variable model achieved satisfactory diagnostic performance (AUC = 0.926). CONCLUSION:MTI may be a useful non-invasive technique for diagnosing DON. MTR can provide additional value to conventional DWI in distinguishing patients with DON from those without DON.

To investigate the changes in brain white matter microstructure in patients with thyroid-associated ophthalmopathy (TAO) before and after glucocorticoid therapy using diffusion kurtosis imaging (DKI) with tract-based spatial statistics (TBSS) method. Twenty TAO patients and 20 healthy controls were enrolled for clinical and magnetic resonance imaging (MRI) examinations. All patients had intravenous glucocorticoid therapy, followed by MRI scans and clinical assessments three months after the treatment ended. TBSS was used to evaluate the mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), kurtosis fractional anisotropy, fractional anisotropy (FA) and mean diffusion of brain white matter. At baseline, TAO patients showed significantly decreased MK, AK, RK and FA in extensive white matter tracts compared to controls. After therapy, increased MK and AK were observed in comparison to the pre-therapy cohort. However, post-therapy TAO patients still exhibited reduced RK in partial white matter tracts compared to controls. RK values in left posterior thalamic radiation (PTR) showed a negative correlation with CAS in pre-therapy TAO patients. Meanwhile, RK values in left PTR were positively correlated with quality of life scores for visual functioning, and RK values in left anterior corona radiata were negatively correlated with anxiety scores in post-therapy TAO patients. Our findings suggested that TAO could lead to white matter deficits in the visual, cognitive, and emotional brain areas, which were partially restored after treatment.

OBJECTIVES:To compare field-of-view optimized and constrained undistorted single-shot (FOCUS), multiplexed sensitivity-encoding (MUSE) and FOCUS-MUSE diffusion-weighted images (DWIs) in orbital imaging quality and staging performance for the patients with thyroid-associated ophthalmopathy (TAO). MATERIALS AND METHODS:67 TAOs underwent FOCUS, MUSE and FOCUS-MUSE DWIs. Qualitative (artifacts and geometric distortion, overall image quality, sharpness of boundaries) and quantitative parameters (geometric distortion ratio (GDR), signal-to-noise ratio (SNR), apparent diffusion coefficient (ADC) value, normalized ADC (nADC) value) were assessed. Additionally, nADC values of the extraocular muscles (EOMs) and mean nADC values were compared between active and inactive TAOs. Diagnostic performance was also evaluated. RESULTS:FOCUS-MUSE DWI exhibited significantly fewer artifacts and geometric distortion, superior overall image quality, enhanced sharpness of boundaries, higher SNR and lower GDR than MUSE and FOCUS DWIs (all p < 0.05). FOCUS-MUSE DWI showed significantly lower ADC values than MUSE (all p < 0.05) and FOCUS DWIs (all p < 0.05, except for that of superior EOM). The nADC values showed no significance among the three DWIs (all p > 0.05), except for that of the superior EOM. Furthermore, active TAOs showed higher nADC values than inactive TAOs in three DWIs (all p < 0.05). The mean nADC value of FOCUS-MUSE DWI (AUC, 0.890; sensitivity, 84.8%; specificity, 77.3%) performed better than that of MUSE (AUC, 0.713; sensitivity, 54.3%; specificity, 80.7%; p < 0.001) and FOCUS DWIs (AUC, 0.730; sensitivity, 47.8%; specificity, 90.9%; p < 0.001) in diagnosing active TAOs. CONCLUSIONS:FOCUS-MUSE DWI provides superior image quality and staging performance in assessing TAO than MUSE and FOCUS DWIs. We recommend its use for evaluating TAO patients in clinical practice. CRITICAL RELEVANCE STATEMENT:Field-of-view optimized and constrained undistorted single-shot multiplexed sensitivity-encoding DWI shows superior image quality and staging performance for thyroid-associated ophthalmopathy than other echo-planar imaging-based modified sequences. KEY POINTS:The superiority among different echo-planar imaging-based modified DWIs in thyroid-associated ophthalmopathy remains unclear. Field-of-view optimized and constrained undistorted single-shot multiplexed sensitivity-encoding (FOCUS-MUSE) DWI outperforms MUSE and FOCUS DWIs in imaging quality. Normalized apparent diffusion coefficient values derived from FOCUS-MUSE DWI improve staging performance of thyroid-associated ophthalmopathy.

To investigate the relationship between serologically abnormal lipid metabolism parameters and the onset of dysthyroid optic neuropathy (DON) in patients with thyroid-associated ophthalmopathy (TAO). A total of 183 patients clinically diagnosed with TAO in the Department of Endocrinology of our hospital from February 2019 to September 2023 were retrospectively enrolled, comprising 34 in the DON group and 149 in the non-DON group. We collected serological lipid metabolism parameters, thyroid function, fasting blood glucose, and other clinical parameters and compared these between the two groups. Multivariable logistic regression analysis was exploited to identify the risk factors associated with the occurrence of DON in patients with TAO. Patients in the DON group exhibited higher age (P < 0.001) and a greater proportion of men (P = 0.028) than those in the non-DON group. Serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose levels were elevated in patients with DON (P = 0.004, P = 0.068, and P = 0.026, respectively). Additionally, the proportions of high serum TC (35.3