Publications by authors named "Li-Zhen Lin"

106 Publications

The application of apparent diffusion coefficients derived from intratumoral and peritumoral zones for assessing pathologic prognostic factors in rectal cancer.

Eur Radiol 2022 Mar 23. Epub 2022 Mar 23.

Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, 32# Second Section of First Ring Road, Qingyang District, Chengdu, 610070, Sichuan, China.

Objective: To investigate the diagnostic performance of the apparent diffusion coefficient (ADC) derived from intratumoral and peritumoral zones for assessing pathologic prognostic factors in rectal cancer.

Materials And Methods: One hundred forty-six patients with rectal cancer who underwent preoperative MRI were prospectively enrolled. Two radiologists independently placed free-hand regions of interest (ROIs) in the largest tumor cross section and three small ROIs on the peritumoral zone adjacent to the tumor contour. Maximum values of tumor ADC (ADC), minimum values of tumor ADC (ADC), mean values of tumor ADC (ADC), mean values of peritumor ADC (ADC), and ADC/ADC (ADC ratio) were obtained on ADC maps and correlated with prognostic factors using uni- and multivariate logistic regression, and receiver operating characteristic curve (ROC) analysis.

Results: Interobserver agreement was excellent for ADC and ADC (intraclass correlation coefficient [ICC], 0.915-0.958), and were good for ADC, ADC, and ADC ratio (ICC, 0.774-0.878). The ADC ratio was significantly higher in the poor differentiation, T3-4 stage, lymph node metastasis (LNM)-positive, extranodal extension (ENE)-positive, tumor deposit (TD)-positive, and lymphovascular invasion (LVI)-positive groups than that in the well-moderate differentiation, T1-2 stage, LNM-negative, ENE-negative, TD-negative, and LVI-negative groups (p = 0.008, < 0.001, < 0.001, 0.001, < 0.001, and < 0.001, respectively). The area under the ROC curve (AUC) of the ADC ratio was the highest for assessing poor differentiation (0.700), T3-4 stage (0.707), LNM-positive (0.776), TD-positive (0.848), and LVI-positive (0.778). Both the ADC ratio (AUC = 0.677) and ADC (AUC = 0.686) showed higher diagnostic performance for assessing ENE.

Conclusion: The ADC ratio could provide better predictive performance for assessing preoperative prognostic factors in resectable rectal cancer.

Key Points: • Both the peritumor/tumor ADC ratio and ADC are correlated with important prognostic factors of resectable rectal cancer. • Both peritumor ADC and peritumor/tumor ADC ratio had higher diagnostic performance than tumor ADC for assessment of prognostic factors in resectable rectal cancer. • Peritumor/tumor ADC ratio showed the most capability for the assessment of prognostic factors in resectable rectal cancer.
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http://dx.doi.org/10.1007/s00330-022-08717-3DOI Listing
March 2022

Distinguishing Cardiac Amyloidosis and Hypertrophic Cardiomyopathy by Thickness and Myocardial Deformation of the Right Ventricle.

Cardiol Res Pract 2022 1;2022:4364279. Epub 2022 Feb 1.

Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education; West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

Objectives: To compare right ventricular thickness (RVT) and deformation of cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) patients.

Methods: Sixty CA (mean age 58 ± 10 years; 33 males (55%)) and sixty HCM patients (mean age 55 ± 14 years; 27 males (45%)) were retrospectively enrolled. RVT, global radical peak strain (GRPS), global longitudinal peak strain (GLPS), and global circumferential peak stain (GCPS) were analyzed. To determine the cutoff values of the RVT and RV strain parameters for distinguishing CA from HCM, the areas under the receiver operating characteristic curve (AUCs) were analyzed.

Results: RVT of CA patients was significantly thicker than that of HCM patients (7.8 ± 2.1 vs 5.9 ± 1.3,  < 0.001). Moreover, significantly decreased RV-GRPS (12.1 ± 6.9 vs 23.5 ± 12.1,  < 0.001), RV-GCPS (-3.4 ± 2.2 vs -5.6 ± 3.5,  < 0.001), and RV-GLPS (-4.6 ± 2.3 vs -11.1 ± 4.9,  < 0.001) were observed in CA patients compared with HCM patients. RVT and RV strain demonstrate comparable diagnostic accuracy in differentiating CA from HCM. In particular, RV-GLPS combined with RVT showed the best performance for discriminating CA from HCM (AUC = 0.92, 95% CI: 0.85 to 0.96,  = 0.0001).

Conclusions: Right ventricular myocardial thickness and deformation of CA patients was more severe than HCM patients. RV-GLPS combined with RVT presents an excellent diagnostic performance in distinguishing CA and HCM.
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http://dx.doi.org/10.1155/2022/4364279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8825671PMC
February 2022

APA scoring system: a novel predictive model based on risk factors of pregnancy loss for recurrent spontaneous abortion patients.

J Obstet Gynaecol 2022 Jan 20:1-6. Epub 2022 Jan 20.

Center of Prenatal Diagnosis, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.

The aim of this study was to analyse the risk factors of pregnancy loss of patients with recurrent spontaneous abortion (RSA) and develop a scoring system to predict RSA. Clinical data of 242 cases, with RSA who were treated at Fujian Provincial Maternity and Children's Hospital, were selected. The factors of pregnancy loss for RSA patients were evaluated by univariate and multivariate analyses. There were 242 RSA patients, of whom 34 (14.0%) developed pregnancy loss. A multivariate analysis showed the following adverse risk factors for RSA: antinuclear antibody spectrum, protein s deficiency and antiphospholipid antibodies. The pregnancy loss rates of antinuclear antibody spectrum group, protein S deficiency group and antiphospholipid antibodies group were 25.0%, 22.5% and 19.4%, respectively. Each of these factors contributed 1 point to the risk score. The pregnancy loss rates were 6.3%, 24.6%, 50% for the low-, intermediate- and high-risk categories, respectively ( < .001). The area under the receiver operating characteristic curve for the score of RSA was .733. Our findings suggest that this validated and simple scoring system could accurately predict the risk of pregnancy loss of RSA patients. The score might be helpful in the selection of risk-adapted interventions to decrease the incidence. Impact Statement The live birth rate increases to 80%-90% after anticoagulant and/or immunosuppressive treatment in patients with RSA. However, there is still a high rate of re-abortion even after active treatment. Antinuclear antibody spectrum, protein s deficiency and antiphospholipid antibodies were independent risk factors for pregnancy loss. A novel predictive model based on these factors was then established and validated. The newly developed score might be helpful in the selection of risk-adapted interventions to decrease the incidence. For patients in the intermediate-risk and high-risk groups, we should conduct more targeted studies and formulate corresponding therapies to improve the success rate of treatment.
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http://dx.doi.org/10.1080/01443615.2021.2021507DOI Listing
January 2022

Value of intravoxel incoherent motion for assessment of lymph node status and tumor response after chemoradiation therapy in locally advanced rectal cancer.

Eur J Radiol 2022 Jan 13;146:110106. Epub 2021 Dec 13.

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China. Electronic address:

Objective: To assess the role of region of interest (ROI) selection of intravoxel incoherent motion (IVIM) for predicting lymph node metastases (LNM) and tumor response after chemoradiation therapy (CRT) in locally advanced rectal cancer.

Materials And Methods: Seventy-nine patients with biopsy-proven rectal adenocarcinoma who underwent pre- and post-CRT MRI and surgery were prospectively enrolled. The exclusion criteria included nonresectable and/or metastatic disease and loss of follow-up. Pathological stage was determined using ypTNM stage and tumor regression grade. Slow diffusion coefficient (D), fast diffusion coefficient (D*), perfusion-related diffusion fraction (f), apparent diffusion coefficient (ADC) and their percentage changes (Δ%) were evaluated by two readers using whole-volume, single-slice and small samples ROI methods. Risk factors including carcinoembryonic antigen, post-CRT T-staging, extramural venous invasion and IVIM parameters were evaluated through multivariate analyses. Areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate diagnostic performance. Duration of follow-up was two-year. Recurrence-free survival of patients with LNM and tumor response was estimated using Kaplan-Meier analysis.

Results: Interobserver agreement were good for pre- and post-CRT three ROI methods (intraclass correlation coefficient [ICC], 0.581-0.953). Whole-volume ROI-derived Δ%D was an independent risk factor for LNM, non-pathological complete response (non-pCR) and poor response (odds ratio, 0.940, 0.952, 0.805, respectively; all p < 0.001). Whole-volume ROI-derived Δ%D showed best AUC of 0.810, 0.851 and 0.903 for LNM, non-pCR and poor response (cutoff value, 31.8%, 54.5%, 52.8%, respectively). Patients with post-CRT LNM showed reduction in 2-year recurrence-free survival (hazard ratio, 3.253).

Conclusions: Whole-volume ROI-derived Δ%D provided high diagnostic performance for evaluating post-CRT LNM and tumor response. Patients with post-CRT LNM showed earlier recurrence.
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http://dx.doi.org/10.1016/j.ejrad.2021.110106DOI Listing
January 2022

Prognostic value of ground glass opacity on computed tomography in pathological stage I pulmonary adenocarcinoma: A meta-analysis.

World J Clin Cases 2021 Nov;9(33):10222-10232

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.

Background: The clinical role of ground glass opacity (GGO) on computed tomography (CT) in stage I pulmonary adenocarcinoma patients currently remains unclear.

Aim: To explore the prognostic value of GGO on CT in lung adenocarcinoma patients who were pathologically diagnosed with tumor-node-metastasis stage I.

Methods: A comprehensive and systematic search was conducted through the PubMed, EMBASE and Web of Science databases up to April 3, 2021. The hazard ratio (HR) and corresponding 95% confidence interval (CI) were combined to assess the association between the presence of GGO and prognosis, representing overall survival and disease-free survival. Subgroup analysis based on the ratio of GGO was also conducted. STATA 12.0 software was used for statistical analysis.

Results: A total of 12 studies involving 4467 patients were included. The pooled results indicated that the GGO predicted favorable overall survival (HR = 0.44, 95%CI: 0.34-0.59, < 0.001) and disease-free survival (HR = 0.35, 95%CI: 0.18-0.70, = 0.003). Subgroup analysis based on the ratio of GGO further demonstrated that the proportion of GGO was a good prognostic indicator in pathological stage I pulmonary adenocarcinoma patients, and patients with a higher ratio of GGO showed better prognosis than patients with a lower GGO ratio did.

Conclusion: This meta-analysis manifested that the presence of GGO on CT predicted favorable prognosis in tumor-node-metastasis stage I lung adenocarcinoma. Patients with a higher GGO ratio were more likely to have a better prognosis than patients with a lower GGO ratio.
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http://dx.doi.org/10.12998/wjcc.v9.i33.10222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8638064PMC
November 2021

Early and late recurrences in lymph node-negative gastric cancer: a retrospective cohort study.

Ann Saudi Med 2021 Nov-Dec;41(6):336-349. Epub 2021 Dec 2.

From the Department of Surgery, Qingyang's People's Hospital, Qingyan, China.

Background: Predictors of recurrence in patients with lymph node-negative gastric cancer (GC) who have undergone curative resection have been widely investigated, but not the effects of predictors on timing of recurrence.

Objective: Determine the factors associated with early and late recurrence in patients with node-negative GC.

Design: Retrospective cohort.

Setting: Academic tertiary care center.

Patients And Methods: The study included patients with node-negative GC after curative resection between 2008 and 2018 at two institutions. Early and late recurrences were determined using a minimum value approach to evaluate the optimal cutoff for recurrence-free survival (RFS). A competing risk model and landmark analysis were used to analyze factors associated with early and late recurrences.

Main Outcome Measures: Recurrence-free survival and factors associated with survival.

Sample Size: 606.

Results: After a median follow-up of 70 months, 50 (8.3%) patients experienced recurrent disease. The optimal length of RFS for distinguishing between early (n=26) and late recurrence (n=24) was 24 months (=.0013). The median RFS in the early and late recurrence groups was 11 and 32 months, respectively. Diffuse tumors (hazard ratio 3.358, =.014), advanced T stage (HR 8.804, =.003), perineural invasion (HR 10.955, <.001), and anemia (HR 2.351, =.018) were independent predictors of early recurrence. Mixed tumor location (HR 5.586, =.002), advanced T stage (HR 5.066, <.001), lymphovascular invasion (HR 5.902, <.001), and elevated CA19-9 levels (HR 5.227, <.001) were independent predictors of late recurrence. Similar results were obtained in the landmark analysis.

Conclusions: Individualized therapeutic and follow-up strategies should be considered in future studies because of distinct patterns in predictors of early and late recurrence.

Limitations: Retrospective design, small sample size.

Conflict Of Interest: None.
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http://dx.doi.org/10.5144/0256-4947.2021.336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8650598PMC
December 2021

[Feasibility Study of Ultra-High-Resolution Low-Dose Temporal Bone CT with 1 024×1 024 Reconstruction Matrix Size].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Nov;52(6):1001-1005

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To investigate the feasibility of low-dose CT scan of the temporal bone combined with reconstruction matrix size of 1 024×1 024 and the effect of the reconstruction matrix size on image quality.

Methods: Normal-dose and low-dose bilateral temporal bone CT scans were performed on twelve adult male cadaveric skull specimens using the 160-slice multi-detector CT scanning of United Imaging Healthcare. Normal-dose CT images were reconstructed with matrix sizes of 512×512 and 1 024×1 024, while low-dose CT images were reconstructed with the matrix size of 1 024×1 024. CT value, noise, signal-to-noise ratio, contrast-to-noise ratio, the visualization scoring of 15 anatomical structures of the temporal bone, and the result of three-dimensional reconstruction of the ossicular chain were compared among the three groups.

Results: The radiation dose of low-dose CT scanning was reduced by about 50% compared with that of normal-dose CT. There was no significant difference in CT values of air, soft tissues and bones among the three groups. Low-dose temporal bone CT with the matrix size of 1 024×1 024 had higher noise, but much better visualization of temporal bone structure than the normal-dose temporal bone CT with matrix size of 512×512. Both the three-dimensional reconstructions of normal-dose and low-dose 1 024×1 024 matrix images were satisfactory and showed no significant difference. The morphology, size and relative position of malleus, incus, stapes, cochlea, and labyrinth, as well as the location of the ossicular chain in the cranium were all clearly displayed.

Conclusion: Low-dose temporal bone CT with the matrix size of 1 024×1 024 can be used to effectively reduce the radiation dose and significantly improve the spatial resolution and the visualization of the temporal bone anatomical structures compared with the normal-dose temporal bone CT with a matrix size of 512×512.
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http://dx.doi.org/10.12182/20210860202DOI Listing
November 2021

Association Between Heart Failure With Preserved Left Ventricular Ejection Fraction and Impaired Left Atrial Phasic Function in Hypertrophic Cardiomyopathy: Evaluation by Cardiac MRI Feature Tracking.

J Magn Reson Imaging 2021 Nov 19. Epub 2021 Nov 19.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.

Background: The majority of heart failure (HF) in hypertrophic cardiomyopathy (HCM) manifests as a phenotype with preserved left ventricular (LV) ejection fraction; however, the exact contribution of left atrial (LA) phasic function to HF with preserved ejection fraction (HFpEF) in HCM remains unresolved.

Purpose: To define the association between LA function and HFpEF in HCM patients using cardiac magnetic resonance imaging (MRI) feature tracking.

Study Type: Retrospective.

Population: One hundred and fifty-four HCM patients (HFpEF vs. non-HF: 55 [34 females] vs. 99 [43 females]).

Field Strength/sequence: 3.0 T/balanced steady-state free precession.

Assessment: LA reservoir function (reservoir strain [ε ], total ejection fraction [EF]), conduit function (conduit strain [ε ], passive EF), booster-pump function (booster strain [ε ] and active EF), LA volume index, and LV global longitudinal strain (LV GLS) were evaluated in HCM patients.

Statistical Tests: Chi-square test, Student's t-test, Mann-Whitney U test, multivariate linear regression, logistic regression, and net reclassification analysis were used. Two-sided P < 0.05 was considered statistically significant.

Results: No significant difference was found in LV GLS between the non-HF and HFpEF group (-10.67 ± 3.14% vs. -10.14 ± 4.01%, P = 0.397), whereas the HFpEF group had more severely impaired LA phasic strain (ε : 27.40 [22.60, 35.80] vs. 18.15 [11.98, 25.90]; ε : 13.80 [9.20, 18.90] vs. 7.95 [4.30, 14.35]; ε : 13.50 [9.90, 17.10] vs. 7.90 [5.40, 14.15]). LA total EF (37.91 [29.54, 47.94] vs. 47.49 [39.18, 55.01]), passive EF (14.70 [7.41, 21.49] vs. 18.07 [9.32, 24.78]), and active EF (27.19 [17.79, 36.60] vs. 36.64 [26.63, 42.71]) were all significantly decreased in HFpEF patients compared with non-HF patients. LA reservoir (β = 0.90 [0.85, 0.96]), conduit (β = 0.93 [0.87, 0.99]), and booster (β = 0.86 [0.78, 0.95]) strain were independently associated with HFpEF in HCM patients. The model including reservoir strain (Net Reclassification Index [NRI]: 0.260) or booster strain (NRI: 0.325) improved the reclassification of HFpEF based on LV GLS and minimum left atrial volume index (LAVI ).

Data Conclusion: LA phasic function was severely impaired in HCM patients with HFpEF, whereas LV function was not further impaired compared with non-HF patients.

Level Of Evidence: 4 TECHNICAL EFFICACY: Stage 3.
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http://dx.doi.org/10.1002/jmri.28000DOI Listing
November 2021

Lymph node ratio-based the ypTNrM staging system for gastric cancer after neoadjuvant therapy: a large population-based study.

Surg Today 2022 May 1;52(5):783-794. Epub 2021 Nov 1.

Department of Surgery, Qingyang People's Hospital, No. 608 South Road, Qingyang, 745000, Gansu Province, China.

Purposes: The lymph node ratio (LNR) has been considered a better prognostic factor than traditional N staging in patients with gastric cancer (GC), but its accuracy is unclear for those who receive neoadjuvant therapy (NAT). We aimed to compare the node ratio (Nr) staging with the ypN staging and to thereby develop a modified staging system incorporating Nr staging.

Methods: A total of 1791 patients who underwent gastrectomy after NAT in the Surveillance, Epidemiology, and End Results database were retrospectively analyzed. ypTNrM staging was established based on the overall survival (OS).

Results: The Nr staging was generated using 0.2 and 0.5 as the cutoff values of LNR and represented patients with more homogeneous OS compared with ypN staging. The 5-year OS rates for ypTNrM stages IA, IB, II, IIIA, and IIIB were 70.2%, 54.2%, 36.0%, 21.2%, and 6.6%, respectively, compared with 58.8%, 39.1%, and 21.6% for ypTNM stages I, II, and III, respectively. Compared with the ypTNM staging system, the ypTNrM staging system had a lower misclassification rate (3.0% vs. 50.9%) and better prognostic predictive power (C-index: 0.645 vs. 0.589, P < 0.001).

Conclusions: The ypTNrM staging system incorporating Nr staging may provide a more accurate assessment in the clinical decision-making process for GC after NAT.
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http://dx.doi.org/10.1007/s00595-021-02386-3DOI Listing
May 2022

[Early Assessment of Myocardial Fibrosis of Hypertrophic Cardiomyopathy with Native-T1-Mapping-Based Deep Learning: A Preliminary Study].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Sep;52(5):819-824

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To explore the diagnostic performance of deep learning (DL) model in early detection of the interstitial myocardial fibrosis using native T1 maps of hypertrophic cardiomyopathy (HCM) without late gadolinium enhancement (LGE).

Methods: Sixty HCM patients and 44 healthy volunteers who underwent cardiac magnetic resonance were enrolled in this study. Each native T1 map was labeled according to its LGE status. Then, native T1 maps of LGE (-) and those of the controls were preprocessed and entered in the SE-ResNext-50 model as the matrix for the DL model for training, validation and testing.

Results: A total of 241 native T1 maps were entered in the SE-ResNext-50 model. The model achieved a specificity of 0.87, sensitivity of 0.79, and area under curve ( ) of 0.83 ( <0.05) in distinguishing native T1 maps of LGE (-) from those of the controls in the testing set.

Conclusion: The DL model based on SE-ResNext-50 could be used for identifying native T1 maps of LGE (-) with relatively high accuracy. It is a promising approach for early detection of myocardial fibrosis in HCM without the use of contrast agent.
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http://dx.doi.org/10.12182/20210960506DOI Listing
September 2021

[Application of Deep Learning Reconstruction Algorithm in Low-Dose Thin-Slice Liver CT of Healthy Volunteers].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Sep;52(5):807-812

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To explore the clinical feasibility of applying deep learning (DL) reconstruction algorithm in low-dose thin-slice liver CT examination of healthy volunteers by comparing the reconstruction algorithm based on DL, filtered back projection (FBP) reconstruction algorithm and iterative reconstruction (IR) algorithm.

Methods: A standard water phantom with a diameter of 180 mm was scanned, using the 160 slice multi-detector CT scanning of United Imaging Healthcare, to compare the noise power spectrums of DL, FBP and IR algorithms. 100 healthy volunteers were prospectively enrolled, with 50 assigned to the normal dose group (ND) and 50 to the low dose group (LD). IR algorithm was used in the ND group to reconstruct images, while DL, FBP and IR algorithms were used in the LD group to reconstruct images. One-way analysis of variance was used to compare the liver CT values, the liver noise, liver signal-to-noise ratio (SNR), contrast noise ratio (CNR) and figure of merit (FOM) of the images of ND-IR, LD-FBP, LD-IR and LD-DL. The Kruskal-Wallis test was used to analyse subjective scores of anatomical structures.

Results: The DL algorithm had the lowest average peak value of noise power spectrum, and its shape was similar to that of medium-level IR algorithm. Liver CT values of ND-IR, LD-FBP, LD-IR and LD-DL did not show statistically significant difference. The noise of LD-DL was lower than that of LD-FBP, LD-IR and ND-IR ( <0.05), and the SNR, CNR and FOM of LD-DL were higher than those of LD-FBP, LD-IR and ND-IR ( <0.05). The subjective scores of anatomical structures of LD-DL did not show significant difference compared to those of ND-IR ( >0.05), and were higher than those of LD-FBP and LD-IR. The radiation dose of the LD group was reduced by about 50.2% compared with that of the ND group.

Conclusion: The DL algorithm with noise shape similar to the medium iterative grade IR commonly used in clinical practice showed higher noise reduction ability than IR did. Compared with FBP, the DL algorithm had smoother noise shape, but much better noise reduction ability. The application of DL algorithm in low-dose thin-slice liver CT of healthy volunteers can help achieve the standard image quality of liver CT.
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http://dx.doi.org/10.12182/20210660103DOI Listing
September 2021

Automatic machine learning based on native T1 mapping can identify myocardial fibrosis in patients with hypertrophic cardiomyopathy.

Eur Radiol 2022 Feb 3;32(2):1044-1053. Epub 2021 Sep 3.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Objectives: To investigate the feasibility of automatic machine learning (autoML) based on native T1 mapping to predict late gadolinium enhancement (LGE) status in hypertrophic cardiomyopathy (HCM).

Methods: Ninety-one HCM patients and 44 healthy controls who underwent cardiovascular MRI were enrolled. The native T1 maps of HCM patients were classified as LGE ( +) or LGE (-) based on location-matched LGE images. An autoML pipeline was implemented using the tree-based pipeline optimization tool (TPOT) for 3 binary classifications: LGE ( +) and LGE (-), LGE (-) and control, and HCM and control. TPOT modeling was repeated 10 times to obtain the optimal model for each classification. The diagnostic performance of the best models by slice and by case was evaluated using sensitivity, specificity, accuracy, and microaveraged area under the curve (AUC).

Results: Ten prediction models were generated by TPOT for each of the 3 binary classifications. The diagnostic accuracy obtained with the best pipeline in detecting LGE status in the testing cohort of HCM patients was 0.80 by slice and 0.79 by case. In addition, the TPOT model also showed discriminability between LGE (-) patients and control (accuracy: 0.77 by slice; 0.78 by case) and for all HCM patients and controls (accuracy: 0.88 for both).

Conclusions: Native T1 map analysis based on autoML correlates with LGE ( +) or (-) status. The TPOT machine learning algorithm could be a promising method for predicting myocardial fibrosis, as reflected by the presence of LGE in HCM patients without the need for late contrast-enhanced MRI sequences.

Key Points: • The tree-based pipeline optimization tool (TPOT) is a machine learning algorithm that could help predict late gadolinium enhancement (LGE) status in patients with hypertrophic cardiomyopathy. • The TPOT could serve as an adjuvant method to detect LGE by using information from native T1 maps, thus avoiding the need for contrast agent. • The TPOT also detects native T1 map alterations in LGE-negative patients with hypertrophic cardiomyopathy.
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http://dx.doi.org/10.1007/s00330-021-08228-7DOI Listing
February 2022

[Application of Automated Machine Learning Based on Radiomics Features of T2WI and RS-EPI DWI to Predict Preoperative T Staging of Rectal Cancer].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Jul;52(4):698-705

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

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 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 ( ) 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, , 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 for the training set reaching 0.810, 0.875, and 0.893, respectively. The sensitivity, specificity and for the test set were 0.810, 0.813, and 0.810, respectively. The sensitivity, specificity and 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.
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http://dx.doi.org/10.12182/20210460201DOI Listing
July 2021

Increased oxygenation is associated with myocardial inflammation and adverse regional remodeling after acute ST-segment elevation myocardial infarction.

Eur Radiol 2021 Dec 18;31(12):8956-8966. Epub 2021 May 18.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Objectives: To explore the relationships between oxygenation signal intensity (SI) with myocardial inflammation and regional left ventricular (LV) remodeling in reperfused acute ST-segment elevation myocardial infarction (STEMI) using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR).

Methods: Thirty-three STEMI patients and 22 age- and sex-matched healthy volunteers underwent CMR. The protocol included cine function, OS imaging, precontrast T1 mapping, T2 mapping, and late gadolinium enhancement (LGE) imaging. A total of 880 LV segments were included for analysis based on the American Heart Association 16-segment model. For validation, 15 pigs (10 myocardial infarction (MI) model animals and 5 controls) received CMR and were sacrificed for immunohistochemical analysis.

Results: In the patient study, the acute oxygenation SI showed a stepwise rise among remote, salvaged, and infarcted segments compared with healthy myocardium. At convalescence, all oxygenation SI values besides those in infarcted segments with microvascular obstruction decreased to similar levels. Acute oxygenation SI was associated with early myocardial injury (T1: r = 0.38; T2: r = 0.41; all p < 0.05). Segments with higher acute oxygenation SI values exhibited thinner diastolic walls and decreased wall thickening during follow-up. Multivariable regression modeling indicated that acute oxygenation SI (β = 2.66; p < 0.05) independently predicted convalescent segment adverse remodeling (LV wall thinning). In the animal study, alterations in oxygenation SI were correlated with histological inflammatory infiltrates (r = 0.59; p < 0.001).

Conclusions: Myocardial oxygenation by OS-CMR could be used as a quantitative imaging biomarker to assess myocardial inflammation and predict convalescent segment adverse remodeling after STEMI.

Key Points: • Oxygenation signal intensity (SI) may be an imaging biomarker of inflammatory infiltration that could be used to assess the response to anti-inflammatory therapies in the future. • Oxygenation SI early after myocardial infarction (MI) was associated with left ventricular segment injury at acute phase and could predict regional functional recovery and adverse remodeling late after acute MI. • Oxygenation SI demonstrated a stepwise increase among remote, salvaged, and infarcted segments. Infarcted zones with microvascular obstruction demonstrated a higher oxygenation SI than those without. However, the former showed less pronounced changes over time.
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http://dx.doi.org/10.1007/s00330-021-08032-3DOI Listing
December 2021

Estimation of stature from radiographically determined lower limb bone length in modern Chinese.

J Forensic Leg Med 2021 Apr 22;79:101779. Epub 2019 Feb 22.

Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, PR China; Department of Forensic Pathology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, PR China. Electronic address:

To develop population - specific stature prediction equations from measurements of the lower limb bone in a contemporary Chinese. 303 individuals of Han group in Western China, including 201 females and 102 males were collected. The study sample was randomly divided into two subgroups. A calibration sample, which consisted of 171 females and 87 males, was used to develop the regression formula. A validation sample comprising the remaining 30 female and 15 male individuals was then used to test the predictive accuracy of the established formula. The regression equations were developed from intact bones and fragments of the femur, tibia and fibula, the maximum lengths of femur, tibia, and fibula were highly correlated with the stature. The maximum length of femur provide the most accurate result with the prediction accuracy of 3.84 cm for unknown sex, 4.00 cm in the male group, 3.45 cm in the female group, 3.61 cm in the group with age no more than 45, 3.45 cm in the group with age above 45. Moreover, the multiple regression equations were developed, and they portray a more accurate stature in instances in which the femur, tibia and fibula are available. This paper provides indications that the femur, tibia and fibula are important bones for stature estimation and they could be effectively used in forensic cases.
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http://dx.doi.org/10.1016/j.jflm.2019.02.012DOI Listing
April 2021

[Application of MRI-based Radiomics Models in the Assessment of Hepatic Metastasis of Rectal Cancer].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Mar;52(2):311-318

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Obejective: To explore the clinical value of using radiomics models based on different MRI sequences in the assessment of hepatic metastasis of rectal cancer.

Methods: 140 patients with pathologically confirm edrectal cancer were included in the study. They underwent baseline magnetic resonance imaging (MRI) between April 2015 and May 2018 before receiving any treatment. According to the results of liver biopsy, surgical pathology, and imaging, patients were put into two groups, the patients with hepatic metastasis and those without. T2 weighted images (T2WI), diffusion weighted images (DWI) and apparent diffusion coefficient (ADC) images were used to draw the region of interest (ROI) of primary lesions on consecutive slices on ITK-SNAP. 3-D ROIs were generated and loaded into Artificial Intelligent Kit for extraction of radiomics features and 396 features were extracted for each sequence. The feature data were preprocessed on Python and the samples were oversampled, using Support Vector Machine-Synthetic Minority Over-Sampling Technique (SVM-SMOTE) to balance the number of samples in the group with liver metastasis and the group with no liver metastasis at the end of the follow-up. Then, the samples were divided into the training cohort and the test cohort at a ratio of 2∶1. The logistic regression models were developed with selected radionomic features on R software. The receiver operating characteristics (ROC) curves and calibration curves were used to evaluate the performance of the models.

Results: In total, 52 patients with liver metastasis and 88 patients without liver metastasis at the end of follow-up were enrolled. Carcinoembryonic antigen (CEA) and T stage and N stage evaluated on the MRI images showed statistically significant difference between the two groups ( <0.05). After data preprocessing and selecting, except for 17 non-radiomic features, the model combining T2WI, DWI and ADC features, the model of T2WI features alone, the model of DWI features alone and the model of ADC features alone were developed with 32 features, 10 features, 30 features and 15 features, respectively. The combined model (T2WI+DWI+ADC), the T2WI model, and the ADC model can assess hepatic metastasis accurately, with the area under curve ( ) on the train set reaching 93.5%, 89.2%, 90.6% and that of the test set reaching 80.8%, 80.5%, 81.4%, respectively. The combined model did not show a higher than those of the T2WI and ADC alone models. Model based on DWI features has a slightly insufficient of 90.3% in the train set and 75.1% in the test set. The calibration curve showed the smallest fluctuation in the combined model, which is closest fit to the diagonal reference line. The fluctuation in the three independent data set models were similar. The calibration curves of all the four models showed that as the risk increased, the prediction of the models turned from an underestimation to an overestimating the risk. In brief, the combined model showed the best performance, with the best fit to the diagonal reference line in calibration curve and high comparable to the of the T2WI model and ADC model. The performance of T2WI and ADC alone models were second to that of the combined model, while the DWI alone model showed relatively poor performance.

Conclusion: Radiomics models based on MRI could be effectively used in assessing liver metastasis in rectal cancer, which may help determine clinical staging and treatment.
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http://dx.doi.org/10.12182/20210360202DOI Listing
March 2021

[The Clinical Effectiveness of Neural Network-based Boundary Recognition of Upper Abdominal Organs on CT Images].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Mar;52(2):306-310

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To assess the clinical effectiveness of boundary recognition of upper abdomen organs on CT images based on neural network model and the combination of different slices.

Methods: A total of 2 000 patients who underwent upper abdomen enhanced CT scans from March 2018 to March 2019 were included in the study. The quality of the CT images met the requirements for clinical diagnosis. Eight boundary layers (the upper and lower edge of liver, the upper and lower edge of spleen, the lower edge of left kidney, the lower edge of right kidney, the lower edge of the stomach and the lower edge of the gallbladder) of the main organs in the upper abdomen were labeled. The model training (training set, verification set and test set) based on different neural network methods and combinations of different slices were then performed to assess the accuracy of boundary recognition. Furthermore, clinical data from 50 cases were used as test group for assessing the accuracy and clinical effectiveness of this model.

Results: The fusion model created by integrating the two models according to different weight ratios yielded the highest accuracy, and then followed the EfficientNet-b3 model, with the Xception model showing the lowest accuracy. In each model, the boundary recognition accuracy of 5-slice image is higher than that of 3-silce image, and that of 1-slice image is the lowest. The recognition accuracy of fusion model of the 5-continuous-slice image for upper edge of liver, lower edge of liver, upper edge of spleen, lower edge of spleen, lower edge of left kidney, lower edge of right kidney, lower edge of stomach and lower edge of gallbladder was 91%, 87%, 92%, 85%, 92%, 95%, 76% and 74%, respectively. The fusion model was checked with the effectiveness data of 50 cases, yielding 88%, 86%, 88%, 80%, 82%, 80%, 69%, and 65% accuracy for 8-slice image, respectively, and the accuracy of meeting clinical application requirement was as high as 98%, 98%, 95%, 98%, 99%, 98%, 80% and 77%, respectively.

Conclusion: By increasing boundary change logics in the continuous slices, the fusion model integrating different weight proportions demonstrates the highest accuracy for identifying the boundary of upper abdominal organs on CT images, achieving high examination effectiveness in clinical practice.
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http://dx.doi.org/10.12182/20210360201DOI Listing
March 2021

[A Preliminary Study of Applying Geometric Deep Learning in Brain Morphometry for Diagnosis of Alzheimer's Disease].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Mar;52(2):300-305

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: A predictive model of Alzheimer's disease (AD) was established based on brain surface meshes and geometric deep learning, and its performance was evaluated.

Methods: Seventy-six clinically diagnosed AD patients and 83 healthy older adults were enrolled and randomly assigned to the training set and the test set according to a 4-to-1 ratio. Brain surface mesh was constructed from 3-D T1-weighted high-resolution structural MR volumes of each participant. After applying a series of simplification to the surface meshes, the training set was fed into the geometric deep neural network for training. The performance of the prediction model was evaluated with the test set, and the evaluation metrics included accuracy, sensitivity and specificity.

Results: The prediction model trained on the right brain surface meshes with 6 000 faces achieved the best performance, with accuracy reaching 93.8%, sensitivity, 91.7%, and specificity, 94.1%. The evolution of the brain surface meshes during convolution and pooling revealed that AD patients had diffuse brain tissue loss compared with healthy older adults.

Conclusion: Morphological brain analysis based on mesh data and geometric deep learning has great potential in the differential diagnosis of AD.
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http://dx.doi.org/10.12182/20210360103DOI Listing
March 2021

[The Application Value of Artificial Intelligence-based Filtering and Interpolated Image Reconstruction Algorithm in Abdominal Magnetic Resonance Image Denoising].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Mar;52(2):293-299

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To compare the noise reduction performance of conventional filtering and artificial intelligence-based filtering and interpolation (AIFI) and to explore for optimal parameters of applying AIFI in the noise reduction of abdominal magnetic resonance imaging (MRI).

Methods: Sixty patients who underwent upper abdominal MRI examination in our hospital were retrospectively included. The raw data of T1-weighted image (T1WI), T2-weighted image (T2WI), and dualecho sequences were reconstructed with two image denoising techniques, conventional filtering and AIFI of different levels of intensity. The difference in objective image quality indicators, peak signal-to-noise ratio (pSNR) and image sharpness, of the different denoising techniques was compared. Two radiologists evaluated the image noise, contrast, sharpness, and overall image quality. Their scores were compared and the interobserver agreement was calculated.

Results: Compared with the original images, improvement of varying degrees were shown in the pSNR and the sharpness of the images of the three sequences, T1W1, T2W2, and dual echo sequence, after denoising filtering and AIFI were used (all <0.05). In addition, compared with conventional filtering, the objective quality scores of the reconstructed images were improved when conventional filtering was combined with AIFI reconstruction methods in T1WI sequence, AIFI level≥3 was used in T2WI and echo1 sequence, and AIFI level≥4 was used in echo2 sequence (all <0.05). The subjective scores given by the two radiologists for the image noise, contrast, sharpness, and overall image quality in each sequence of conventional filtering reconstruction, AIFI reconstruction (except for AIFI level=1), and two-method combination reconstruction were higher than those of the original images (all <0.05). However, the image contrast scores were reduced for AIFI level=5. There was good interobserver agreement between the two radiologists (all >0.75, <0.05). After multidimensional comparison, the optimal parameters of using AIFI technique for noise reduction in abdominal MRI were conventional filtering+AIFI level=3 in the T1WI sequence and AIFI level=4 in the T2WI and dualecho sequences.

Conclusion: AIFI is superior to filtering in imaging denoising at medium and high levels. It is a promising noise reduction technique. The optimal parameters of using AIFI for abdominal MRI are Filtering+AIFI level=3 in the T1WI sequence and AIFI level=4 in T2WI and dualecho sequences.
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http://dx.doi.org/10.12182/20210360104DOI Listing
March 2021

[Noise Reduction Effect of Deep-learning-based Image Reconstruction Algorithms in Thin-section Chest CT].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Mar;52(2):286-292

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To evaluate the noise reduction effect of deep learning-based reconstruction algorithms in thin-section chest CT images by analyzing images reconstructed with filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR), and deep learning image reconstruction (DLIR) algorithms.

Methods: The chest CT scan raw data of 47 patients were included in this study. Images of 0.625 mm were reconstructed using six reconstruction methods, including FBP, ASIR hybrid reconstruction (ASIR50%, ASIR70%), and deep learning low, medium and high modes (DL-L, DL-M, and DL-H). After the regions of interest were outlined in the aorta, skeletal muscle and lung tissue of each group of images, the CT values, SD values and signal-to-noise ratio (SNR) of the regions of interest were measured, and two radiologists evaluated the image quality.

Results: CT values, SD values and SNR of the images obtained by the six reconstruction methods showed statistically significant difference ( <0.001). There were statistically significant differences in the image quality scores of the six reconstruction methods ( <0.001). Images reconstruced with DL-H have the lowest noise and the highest overall quality score.

Conclusion: The model based on deep learning can effectively reduce the noise of thin-section chest CT images and improve the image quality. Among the three deep-learning models, DL-H showed the best noise reduction effect.
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http://dx.doi.org/10.12182/20210360506DOI Listing
March 2021

Characterization of infarcted myocardium by T1-mapping and its association with left ventricular remodeling.

Eur J Radiol 2021 Apr 12;137:109590. Epub 2021 Feb 12.

Department of Radiology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, China; Department of Radiology, West China Hospital, Sichuan University, China. Electronic address:

Purpose: Acutely infarcted native T1 (native T1) and extracellular volume (ECV) could quantify myocardial injury after acute myocardial infarction (AMI). Therefore, we sought to further explore their association with left ventricular (LV) remodeling during follow-up.

Methods: 56 ST-segment-elevation MI patients were prospectively recruited and completed acute and 3-month cardiac magnetic resonance scans. T1 mapping, late gadolinium enhancement and cine imaging were performed to measure native T1, ECV, infarct size and LV global function, respectively. LV remodeling was evaluated as the change in LV end-diastolic volume index (△EDV) at follow-up scan compared with baseline.

Results: In acute scan, 37 patients (66.07 %) had microvascular obstruction (MVO). The native T1 did not significantly differ between patients with or without MVO (1482.0 ± 80.6 ms vs. 1469.0 ± 71.6 ms, P =  0.541). However, ECV in patients without MVO was lower than that in patients with MVO (49.60 ± 8.57 % vs. 58.53 ± 8.62 %, P = 0.001). The native T1 only correlated with △EDV in patients without MVO (r = 0.495, P = 0.031); while ECV was associated with △EDV in all patients (r = 0.665, P =  0.002; r = 0.506, P =  0.001; r = 0.570, P <  0.001). Furthermore, ECV was independently associated with LV remodeling in multivariable linear regression analysis (β = 0.490, P =  0.002).

Conclusion: As a promising parameter for early risk stratification after AMI, ECV is associated with LV remodeling during follow-up; while native T1 may be feasible when MVO is absent.
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http://dx.doi.org/10.1016/j.ejrad.2021.109590DOI Listing
April 2021

Cdc42 Facilitates Axonogenesis by Enhancing Microtubule Stabilization in Primary Hippocampal Neurons.

Cell Mol Neurobiol 2021 Oct 11;41(7):1599-1610. Epub 2021 Feb 11.

Department of Histology and Embryology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China.

The establishment of polarity is an essential process in early neuronal development. Cdc42, a GTPase of the Rho family, is a key regulator of cytoskeletal dynamics and neuronal polarity. However, the mechanisms underlying the action of cdc42 in regulating axonogenesis have not been elucidated. Here, we expressed wild-type cdc42, a constitutively active cdc42 mutant (cdc42F28L) and a dominant negative cdc42 mutant (cdc42N17), respectively, in the primary hippocampal neurons to alter the activity of cdc42. We found that cdc42 activities were paralleled with the capacities to promote axonogenesis in the cultured neurons. Cdc42 also enhanced microtubule stability in the cultured neurons. Pharmacologically stabilizing microtubules significantly abrogated the defective axonogenesis induced by cdc42 inhibition. Moreover, cdc42 promoted the dephosphorylation of collapsing response mediator protein-2 (CRMP-2) at Thr514 by increasing GSK-3β phosphorylation at Ser9 in the cultured neurons. These findings suggest that cdc42 may facilitate axonogenesis by promoting microtubule stabilization in rat primary hippocampal neurons.
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http://dx.doi.org/10.1007/s10571-021-01051-0DOI Listing
October 2021

[Application of 3.0T Time-of-flight Magnetic Resonance Angiography with Sparse Undersampling and Iterative Reconstruction in the Diagnosis of Unruptured Intracranial Aneurysms].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Jan;52(1):92-97

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To evaluate the diagnostic value of 3.0T time-of-flight MR angiography with sparse undersampling and iterative reconstruction (TOFu-MRA) for unruptured intracranial aneurysms (UIAs) on the basis of using digital subtraction angiography (DSA) as the reference standard.

Methods: A total of 65 patients with suspected UIAs were prospectively enrolled and all patients underwent TOFu-MRA and DSA. Relying on DSA as the reference standard, the sensitivity (SEN), specificity (SPE), positive predictive value (PPV) and negative predictive value (NPV) of using TOFu-MRA in UIA diagnosis were calculated, and the inter-observer agreement between two doctors was determined. Comparison of maximum intensity projection (MIP) and volume rendering (VR) image datasets was made to evaluate the agreement between DSA results and TOFu-MRA in the measurement of UIA morphological parameters, including the neck width (D ), height (H) , and width (D ) of UIAs.

Results: The study covered 55 UIAs from 46 patients. The SEN, SPE, PPV and NPV of the two doctors using TOFu-MRA in UIA diagnosis were as follows: (95.7%, 95.7%), (94.7%, 94.7%), (97.8%, 97.8%) and (90.0%, 90.0%), respectively for patient-based assessment; (96.4%, 94.5%), (94.7%, 94.7%), (98.1%, 98.1%) and (90.0%, 85.7%), respectively, for aneurysm-based assessment. There is a strong inter-observer agreement (Kappa=0.93 for patient-based assessment and 0.96 for aneurysm-based assessment) between the two doctors. Moreover, Bland-Altman analysis showed that more than 95% points fell within the limits of agreement (LoA), suggesting strong agreement between the two examination methods for the measurement of UIAs morphological parameters.

Conclusion: TOFu-MRA showed good diagnostic efficacy for UIAs and the results were in good agreement with those of DSA, the reference standard, for assessing UIA morphological parameter. TOFu-MRA can be used as a first choice for noninvasive diagnostic evaluation of UIAs.
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http://dx.doi.org/10.12182/20210160602DOI Listing
January 2021

Noninvasive oxygenation assessment after acute myocardial infarction with breathing maneuvers-induced oxygenation-sensitive magnetic resonance imaging.

J Magn Reson Imaging 2021 07 12;54(1):284-289. Epub 2021 Jan 12.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.

The safety profiles when performing stress oxygenation-sensitive magnetic resonance imaging (OS-MRI) have raised concerns in clinical practice. Adenosine infusion can cause side effects such as chest pain, dyspnea, arrhythmia, and even cardiac death. The aim of this study was to investigate the feasibility of breathing maneuvers-induced OS-MRI in acute myocardial infarction (MI). This was a prospective study, which included 14 healthy rabbits and nine MI rabbit models. This study used 3 T MRI/modified Look-Locker inversion recovery sequence for native T mapping, balanced steady-state free precession sequence for OS imaging, and phase-sensitive inversion recovery sequence for late gadolinium enhancement. The changes in myocardial oxygenation (ΔSI) were assessed under two breathing maneuvers protocols in healthy rabbits: a series of extended breath-holding (BH), and a combined maneuver of hyperventilation followed by the extended BH (HVBH). Subsequently, OS-MRI with HVBH in acute MI rabbits was performed, and the ΔSI was compared with that of adenosine stress protocol. Student's t-test, Wilcoxon rank test, and Friedman test were used to compare ΔSI in different subgroups. Pearson and Spearman correlation was used to obtain the association of ΔSI between breathing maneuvers and adenosine stress. Bland-Altman analysis was used to assess the bias of ΔSI between HVBH and adenosine stress. In healthy rabbits, BH maneuvers from 30 to 50 s induced significant increase in SI compared with the baseline (all p < 0.05). By contrast, hyperventilation for 60 s followed by 10 s-BH (HVBH 10 s) exhibited a comparable ΔSI to that of stress test (p = 0.07). In acute MI rabbits, HVBH 10 s-induced ΔSIs among infarcted, salvaged, and the remote myocardial area were no less effectiveness than adenosine stress when performing OS-MRI (r = 0.84; p < 0.05). Combined breathing maneuvers with OS-MRI have the potential to be used as a nonpharmacological alternative for assessing myocardial oxygenation in patients with acute MI. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.
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http://dx.doi.org/10.1002/jmri.27509DOI Listing
July 2021

[Application Value of CT Metal Artifact Correction Technology (MAC ) in CT Review after Total Hip Replacement].

Sichuan Da Xue Xue Bao Yi Xue Ban 2020 Nov;51(6):828-833

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To evaluate the application value of CT metal artifact correction technology (MAC ) in CT review after total hip replacement.

Methods: A total of 72 patients who underwent CT re-examination after total hip replacement from December 2018 to March 2020 were enrolled, and the original data were reconstructed by filter backup projection (FBP) and MAC. Select three identical levels in the two sets of reconstructed images and place the same ROI. The selected levels were the initial level, central level, and lower edge of acetabulum. Measure the CT and noise (SD) of metal high and low density artifacts of the three levels area, as well as metal hip joint space, metal para-bone tissue, muscle, bladder and subcutaneous fat, and calculate the average value. Subcutaneous fat value was used as a reference to calculate the SNR and CNR of metal implant para-bone tissue, muscle and bladder. Two radiologists scored the two groups of reconstructed images using blinded method, Kappa's test was used to compare the homogeneity.

Results: There were differences between the two groups of reconstructed images in high- and low-density artifact areas, joint gap CT values, and image noise. Compared with the FBP group, the CT value of the high-density area and the joint space of the MAC group decreased, the CT value of the low-density area increased, and the noise value of each area decreased. The SNR and CNR of metal adjacent bone tissue, muscle and bladder were higher in the MAC group than those in the FBP group, and the difference was statistically significant ( <0.05). The difference in subjective scores between the two groups was statistically significant ( =-6.564, <0.05). 2 radiologists had moderate consistency with Kappa value of 0.72 on FBP group, and good consistency with Kappa value of 0.85 on MAC group.

Conclusion: MAC in CT review after total hip replacement can reduce metal artifacts, make the joint space more clear, and improve the quality of CT images.
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http://dx.doi.org/10.12182/20201160603DOI Listing
November 2020

Retraction Note: Prognostic value of heart failure in hemodialysis-dependent end-stage renal disease patients with myocardial fibrosis quantification by extracellular volume on cardiac magnetic resonance imaging.

BMC Cardiovasc Disord 2020 09 15;20(1):407. Epub 2020 Sep 15.

Department of Radiology, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12872-020-01688-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491183PMC
September 2020

Assessment of left ventricular deformation in patients with type 2 diabetes mellitus by cardiac magnetic resonance tissue tracking.

Sci Rep 2020 08 4;10(1):13126. Epub 2020 Aug 4.

Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China.

To quantify the global and regional left ventricular (LV) myocardial strain in type 2 diabetes mellitus (T2DM) patients using cardiac magnetic resonance (CMR) tissue-tracking techniques and to determine the ability of myocardial strain parameters to assessment the LV deformation. Our study included 98 adult T2DM patients (preserved LV ejection fraction [LVEF], 72; reduced LVEF, 26) and 35 healthy controls. Conventional LV function, volume-time curve parameters and LV remodeling index were measured using CMR. Global and regional LV myocardial strain parameters were measured using CMR tissue tracking and compared between the different sub-groups. Receiver operating characteristic analysis was used to assess the diagnostic accuracy. Regression analyses were conducted to determine the relationship between strain parameters and the LV remodeling index. The results show that global radial peak strain (PS) and circumferential PS were not significantly different between the preserved-LVEF group and control group (P > 0.05). However, longitudinal PS was significantly lower in the preserved-LVEF group than in the control group (P = 0.005). Multivariate linear and logistic regression analyses showed that global longitudinal PS was independently associated (β = 0.385, P < 0.001) with the LV remodeling index. In conclusion, early quantitative evaluation of cardiac deformation can be successfully performed using CMR tissue tracking in T2DM patients. In addition, global longitudinal PS can complement LVEF in the assessment of cardiac function.
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http://dx.doi.org/10.1038/s41598-020-69977-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403307PMC
August 2020

The combined effects of cardiac geometry, microcirculation, and tissue characteristics on cardiac systolic and diastolic function in subclinical diabetes mellitus-related cardiomyopathy.

Int J Cardiol 2020 Dec 15;320:112-118. Epub 2020 Jul 15.

Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China. Electronic address:

Background: Diabetes mellitus-related cardiomyopathy has recently been described as a distinct progression of left ventricular (LV) systolic and diastolic dysfunction. Pathological changes in the myocardium may explain the development of two different phenotypes. We evaluated the effects of LV geometry, myocardial microcirculation, and tissue characteristics on cardiac deformation in patients with subclinical type 2 diabetes mellitus (T2DM) utilizing multiparametric cardiac magnetic resonance (CMR) imaging.

Methods: A total of 135 T2DM patients and 55 matched controls were prospectively enrolled and performed multiparametric CMR examination. CMR-derived parameters including cardiac geometry, function, microvascular perfusion, T1 mapping, T2 mapping, and strain were analyzed and compared between T2DM patients and controls.

Results: The univariable and multivariable analysis of systolic and diastolic function revealed that longer duration of diabetes was associated with decreased longitudinal peak systolic strain rate (PSSR-L) (β = 0.195, p = .013), and higher remodeling index and higher extracellular volume (ECV) tended to correlate with decreased longitudinal peak diastolic strain rate (PDSR-L) (remodeling index, β = -0.339, p = .000; ECV, β = -0.172, p = .026), whereas microvascular perfusion index and T2 value affected both PSSR-L (perfusion index, β = -0.328, p = .000; T2 value, β = 0.306, p = .000) and PDSR-L (perfusion index, β = 0.209, p = .004; T2 value, β = -0.275, p = .000) simultaneously.

Conclusions: The LV concentric remodeling and myocardial fibrosis correlated with diastolic function, and perfusion function and myocardial edema were associated with both LV systolic and diastolic function.
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http://dx.doi.org/10.1016/j.ijcard.2020.07.013DOI Listing
December 2020

The prognostic value of right ventricular deformation derived from cardiac magnetic resonance tissue tracking for all-cause mortality in light-chain amyloidosis patients.

Cardiovasc Diagn Ther 2020 Apr;10(2):161-172

MR Collaboration, Siemens Healthcare Ltd., Shanghai 201318, China.

Background: Early detection of right ventricular (RV) dysfunction is vital for determining the prognosis of light-chain amyloidosis (AL) patients. While few studies focused on RV deformation due to the limitation of research methods. The aim of this study was to determine the prognostic significance of RV myocardial strain in AL patients assessed by cardiac magnetic resonance (CMR) tissue tracking.

Methods: Sixty-four AL patients (28 females and 36 males, mean age 58±12.8 years old; range 25-81 years old) were enrolled from 1 October 2014 through 31 March 2017 and compared with 20 age- and sex-matched controls. Fifty-one AL patients met the criteria for cardiac amyloidosis (CA). Deformation parameters of both RV and left ventricle (LV) were measured by the CMR tissue tracking technique including myocardial global radial peak strain (GRPS), global circumferential peak strain (GCPS), and global longitudinal peak strain (GLPS). The follow-up time was 20 months or until the occurrence of death.

Results: Thirty-two (50%) had preserved RV ejection fraction (RVEF ≥45%). AL patients had significantly lower RV-GRPS (20.3±2.12 31.31±7.61), GCPS (-2.12±0.88 -13.71±2.53), and GLPS (-5.33±0.64 -14.239±2.99) than controls even RVEF remain preserved (all P<0.001). Compared with controls and patients without CA, RV-GRPS (12.26±1.26 29.72±3.54, P<0.001) and RV-GLPS (-3.78±2.25 -5.66±2.08, P<0.05) were significantly lower in patients with CA. Cox multivariate analyses demonstrated that RV-GRPS [hazard ratio (HR) =0.93, 95% CI: 0.88-0.98, P=0.007] and Mayo stage were (HR =3.11, 95% CI: 1.30-7.41, P=0.01) predictors of mortality in AL patients.

Conclusions: CMR tissue tracking is a feasible and highly reproducible technique for the analysis of RV deformation and could aid in the early diagnosis of RV involvement in AL patients. RV-GRPS of RV strain and Mayo stage provides prognostic information about mortality in AL patients.
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http://dx.doi.org/10.21037/cdt.2020.01.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225432PMC
April 2020

The additive effects of obesity on myocardial microcirculation in diabetic individuals: a cardiac magnetic resonance first-pass perfusion study.

Cardiovasc Diabetol 2020 05 6;19(1):52. Epub 2020 May 6.

Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.

Background: The microvascular effects of obesity should be considered in diabetic individuals for elucidating underlying mechanisms and developing targeted therapies. This study aims to determine the effect of obesity on myocardial microvascular function in type 2 diabetes mellitus (T2DM) patients using cardiac magnetic resonance (CMR) first-pass perfusion imaging and assessed significant risk factors for microvascular dysfunction.

Materials And Methods: Between September 2016 and May 2018, 120 patients with T2DM (45.8% women [55 of 120]; mean age, 56.45 ± 11.97 years) and 79 controls (44.3% women [35 of 79]; mean age, 54.50 ± 7.79 years) with different body mass index (BMI) scales were prospectively enrolled and underwent CMR examination. CMR-derived perfusion parameters, including upslope, time to maximum signal intensity (TTM), maximum signal intensity (MaxSI), MaxSI (-baseline), and SI (baseline), and T2DM related risk factors were analyzed among groups/subgroups both in T2DM patients and controls. Univariable and multivariable linear and logistic regression analyses were performed to assess the potential additive effect of obesity on microvascular dysfunction in diabetic individuals.

Results: Compared with controls with comparable BMIs, patients with T2DM showed reduced upslope and MaxSI and increased TTM. For both T2DM and control subgroups, perfusion function gradually declined with increasing BMI, which was confirmed by all perfusion parameters, except for TTM (all P < 0.01). In multivariable linear regression analysis, BMI (β = - 0.516; 95% confidence interval [CI], - 0.632 to - 0.357; P < 0.001), female sex (β = 0.372; 95% CI, 0.215 to 0.475; P < 0.001), diabetes duration (β = - 0.169; 95% CI, - 0.319 to - 0.025; P = 0.022) and glycated haemoglobin (β = - 0.184; 95% CI, - 0.281 to - 0.039; P = 0.010) were significantly associated with global upslope in the T2DM group. Multivariable logistic regression analysis indicated that T2DM was an independent predictor of microvascular dysfunction in normal-weight (odds ratio[OR], 6.46; 95% CI, 2.08 to 20.10; P = 0.001), overweight (OR, 7.19; 95% CI, 1.67 to 31.07; P = 0.008) and obese participants (OR, 11.21; 95% CI, 2.38 to 52.75; P = 0.002).

Conclusions: Myocardial microvascular function gradually declined with increasing BMI in both diabetes and non-diabetes status. T2DM was associated with an increased risk of microvascular dysfunction, and obesity exacerbated the adverse effect of T2DM.
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http://dx.doi.org/10.1186/s12933-020-01028-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201945PMC
May 2020
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