Xinlan Xiao

Intrauterine placental site nodule or plaque: a case description

Background: Gray matter heterotopia (GMH) involves the abnormal migration of cortical neurons into the white matter and is often associated with epileptic seizures. Although conventional magnetic resonance imaging only provides the anatomical details of GMH, this study investigated the potential differences between GMH and normal gray matter (NGM) using arterial spin labeling (ASL) and magnetic resonance image compilation (MAGiC) quantitative techniques. Methods: Retrospective data collection was conducted on 32 cases of GMH at the Second Affiliated Hospital of Nanchang University between October 2022 and October 2023. Patients underwent T1 brain volume (BRAVO), T2 weight imaging, ASL, and MAGiC sequences. Cerebral blood flow (CBF) values with postlabeling delays of 1.5 s and 2.5 s in ASL, along with T1, T2, and proton density values in MAGiC sequences, were measured and normalized against those of normal white matter. Paired-sample t-tests were applied to compare quantitative values between NGM and GMH before and after normalization. Results: The average CBF values of GMH with dual postlabeling delays (31.96 mL/100 g/min and 35.13 mL/100 g/min) were both significantly lower than those of NGM (52.69 mL/100 g/min and 56.93 mL/100 g/min) (PConclusions: NGM and GMH demonstrate quantitative differences in the ASL and MAGiC sequences.

Background: Intraoperative hemorrhage in meningioma surgery represents a critical clinical challenge. In this study, we aimed to investigate the feasibility of predicting intraoperative blood loss (IBL) in non-embolized meningiomas using the cerebral blood flow (CBF) information estimated from three-dimensional (3D) pseudo-continuous arterial spin labeling (pCASL) magnetic resonance imaging (MRI). Methods: A total of 48 non-embolized meningioma patients who underwent preoperative 3D pCASL from September 2017 to July 2024 were retrospectively studied. IBL was recorded during the operation. The meningioma’s CBF was normalized to the contralateral normal gray matter’s CBF, yielding the normalized CBF, which was analyzed, along with MRI-based tumor anatomy including volume, the volume ratio between tumor and total brain (VRTB), maximum tumor diameter, and location. Patients were divided into high and low blood loss groups at a 400 mL threshold. Logistic regression was employed to find the parameters correlated with IBL. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis [area under the curve (AUC)] and the Delong test. Results: Clinical and radiological analysis revealed significant differences in tumor volume, VRTB, maximum tumor diameter, and normalized CBF between subgroups. Multivariate logistic regression identified VRTB [odds ratio (OR) =2.055, 95% confidence interval (CI): 1.250–3.379], and normalized CBF (OR =1.428, 95% CI: 1.109–1.838) as significant predictors of elevated IBL. Optimal cutoff values were 3.293% for VRTB and 1.817 for normalized CBF. The AUCs were 0.751 for VRTB and 0.683 for normalized CBF, with no significant difference between them (Delong test, P=0.582). The combined risk factors’ AUC, including both VRTB and normalized CBF, was 0.867, showing a significant difference from normalized CBF (P=0.010) but not from VRTB (P=0.099). Conclusions: The normalized CBF and VRTB may serve as promising non-invasive imaging biomarkers to predict IBL and guide meningioma surgery.

Focal cortical dysplasia (FCD) is the most common epileptogenic developmental malformation. The diagnosis of FCD is challenging. We generated a radiomics nomogram based on multiparametric magnetic resonance imaging (MRI) to diagnose FCD and identify laterality early. Forty-three patients treated between July 2017 and May 2022 with histopathologically confirmed FCD were retrospectively enrolled. The contralateral unaffected hemispheres were included as the control group. Therefore, 86 ROIs were finally included. Using January 2021 as the time cutoff, those admitted after January 2021 were included in the hold-out set (n = 20). The remaining patients were separated randomly (8:2 ratio) into training (n = 55) and validation (n = 11) sets. All preoperative and postoperative MR images, including T1-weighted (T1w), T2-weighted (T2w), fluid-attenuated inversion recovery (FLAIR), and combined (T1w + T2w + FLAIR) images, were included. The least absolute shrinkage and selection operator (LASSO) was used to select features. Multivariable logistic regression analysis was used to develop the diagnosis model. The performance of the radiomic nomogram was evaluated with an area under the curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration and clinical utility. The model-based radiomics features that were selected from combined sequences (T1w + T2w + FLAIR) had the highest performances in all models and showed better diagnostic performance than inexperienced radiologists in the training (AUCs: 0.847 VS. 0.664, p = 0.008), validation (AUC: 0.857 VS. 0.521, p = 0.155), and hold-out sets (AUCs: 0.828 VS. 0.571, p = 0.080). The positive values of NRI (0.402, 0.607, 0.424) and IDI (0.158, 0.264, 0.264) in the three sets indicated that the diagnostic performance of Model-Combined improved significantly. The radiomics nomogram fit well in calibration curves (p > 0.05), and decision curve analysis further confirmed the clinical usefulness of the nomogram. Additionally, the contrast (the radiomics feature) of the FCD lesions not only played a crucial role in the classifier but also had a significant correlation (r = -0.319, p < 0.05) with the duration of FCD. The radiomics nomogram generated by logistic regression model-based multiparametric MRI represents an important advancement in FCD diagnosis and treatment.

Background: Three-dimensional pseudo-continuous arterial spin-labeling (3D pCASL) with dual postlabeling delay (PLD) captures both early and delayed cerebral blood flow (CBF), yet its potential in reflecting blood flow regulation in hydrocephalus patients remains uncertain. This study investigated the hemodynamic characteristics in patients with hydrocephalus and whether the difference in cerebral blood flow using short and long PLDs (ΔCBF = CBFPLD =2.5 s − CBFPLD =1.5 s) could reflect cerebral regulation and further aimed to demonstrate the associations between regional ΔCBF and the degree of ventricular dilatation. Methods: This retrospective study included consecutive patients with hydrocephalus and control participants attending The Second Affiliated Hospital of Nanchang University from December 2017 to December 2022. The CBF in 18 brain regions was manually delineated by two radiologists. Regional CBF and ΔCBF were compared via covariance analyses. The associations between ΔCBF and the degree of ventricular dilatation were investigated using linear regression analyses and interaction analysis. Results: In total, 58 patients with communicating hydrocephalus, 57 patients with obstructive hydrocephalus, and 52 controls were analyzed. CBF of the hydrocephalus groups was lower than that of the control group at the shorter PLD. CBF was higher at a longer PLD, with no difference between the hydrocephalus groups and the control group in some regions. The hydrocephalus groups showed a higher ΔCBF compared to the control group. Furthermore, in the left medial watershed (10.6±5.66 vs. 7.01±5.88 mL/100 g/min; P=0.038), communicating hydrocephalus exhibited greater ΔCBF than did obstructive hydrocephalus. ΔCBF of the right posterior external watershed [adjusted β: 0.276; 95% confidence interval (CI): 0.047–0.505; P=0.019] and right parietal cortex (adjusted β: 0.277; 95% CI: 0.056–0.498; P=0.015) in the obstructive hydrocephalus group and ΔCBF of the left internal watershed (adjusted β: 0.274; 95% CI: 0.013–0.536; P=0.040) in the communicating hydrocephalus group were associated with the degree of ventricular dilatation, respectively. Conclusions: Patients with hydrocephalus showed cerebral regulation in maintaining adequate CBF, resulting in longer arterial transit times. The ability to regulate CBF in brain regions represented by the watershed was associated with the degree of ventricular dilation.

Intracranial granulomatous inflammation caused by cryptococcal infection: a case study and literature analysis

Background: Cognitive impairment is commonly observed in hydrocephalus patients. Ventricular enlargement compresses brain parenchyma, especially the white matter (WM).Purpose: To investigate whether the relationship between ventricular dilation and cognitive decline in hydrocephalus patients is mediated by WM alterations.Study Type: Retrospective.Population: 51 communicating hydrocephalus patients (median age, 54 years), 50 obstructive hydrocephalus patients (median age, 49 years), and 53 control subjects (median age, 50 years).Field Strength/Sequence: Diffusion tensors imaging, 3D T1 BRAVO, 3D FIESTA, CUBE T2, and FLAIR sequences at 3T.Assessment: DTI parameters (skeletonized fractional anisotropy (FA), skeletonized mean diffusivity (MD), and peak width of skeletonized mean diffusivity p(PSMD)) were extracted using FSL software. Global, periventricular, and deep white matter hyperintensity (WMH) volumes, degree of ventricular enlargement (Evans index), and other conventional imaging markers (number of lacunes and perivascular spaces, intracranial and brain volume) were extracted using united imaging intelligence. Cognitive tests included Montreal cognitive assessment (MoCA), clock drawing test (CDT), and vocabulary fluency test (VFT).Statistical Tests: Multivariable linear regression analysis, mediation analyses, and dominance analysis. P‐value β = −0.0917, 95% confidence interval (CI): −0.205, −0.024) and normalized global WMH volume (β = −0.0635, 95% CI: −0.13, −0.0005) together mediated 37.2% of the association between Evans index and MoCA. A comparable causal pathway was found for periventricular WMHs but not for deep WMHs. Dominance analysis indicated skeletonized FA values had a greater impact on cognition than WMH volume. The skeletonized FA values also mediated the association between Evans index and CDT (β = −0.0897, 95% CI: −0.165, −0.026) and VFT (β = −0.1589, 95% CI: −0.27, −0.083).Conclusion: WM alterations were causal mediators between ventricular dilation and cognitive decline in hydrocephalus patients.Evidence Level: 3.Technical Efficacy: Stage 3.

Generally, due to the complexity of the skull base structures, it is difficult to differentiate cavernous vascular malformation and meningioma in the cavernous sinus area using conventional imaging studies. Cavernous sinus venous malformation are characterized by increased capillary masses without a direct arterial supply, typically leading to low perfusion. On the other hand, meningiomas receive arterial blood supply to the tumour and often exhibit high perfusion. So, arterial spin labelling (ASL) can be helpful in distinguishing between the 2 tumour types. However, in our specific case of a cavernous sinus venous malformation, the ASL imaging showed hyperperfusion. Further analysis revealed that this hyperperfusion on ASL can occur when cavernous sinus venous malformation is associated with arteriovenous fistula malformation.