The Diagnostic Value of Apparent Diffusion Coefficient and Proton Magnetic Resonance Spectroscopy in the Grading of Pediatric Gliomas.
- 作者列表："Yao R","Cheng A","Liu M","Zhang Z","Jin B","Yu H
OBJECTIVE:The aims of this retrospective study were to assess the value of the quantitative analysis of apparent diffusion coefficient (ADC) and proton magnetic resonance spectroscopy (1H-MRS) metabolites in differentiating grades of pediatric gliomas. PATIENTS AND METHODS:Two hundred and nine pathology-confirmed pediatric gliomas (143 low-grade gliomas [LGGs] and 66 high-grade gliomas [HGGs]) were retrospectively analyzed on preoperative diffusion-weighted magnetic resonance imaging, of which 84 also underwent 1H-MRS. The mean tumor ADC (ADCmean), minimum tumor ADC (ADCmin), tumor/normal brain ADC ratio (ADC ratio), and metabolites (choline/creatine ratio [Cho/Cr], N-acetylaspartate/creatine ratio [NAA/Cr], N-acetylaspartate/choline ratio [NAA/Cho], presence of lactate and lipid peaks) between LGGs and HGGs were analyzed. RESULTS:There were significant negative correlations between the ADC values and glioma grade. Receiver operating characteristic analysis showed that the cutoff ADCmean value of 1.192 × 10-3 mm2/s for the differentiation between low- and high-grade pediatric gliomas provided a sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 77.6%, 80.3%, 78.5%, 89.5% and 62.4%, respectively; the cutoff ADCmin value of 0.973 × 10-3 mm2/s resulted in a sensitivity, specificity, accuracy, PPV, and NPV of 86.0%, 90.9%, 87.6%, 95.3%, and 75.0%, respectively; the cutoff ADC ratio value of 1.384 resulted in a sensitivity, specificity, accuracy, PPV, and NPV of 73.4%, 87.9%, 78.0%, 92.9%, and 60.4%, respectively. A tendency for a positive correlation was found between Cho/Cr and glioma grade. A negative correlation was demonstrated between NAA/Cr or NAA/Cho and glioma grade. Statistical analysis demonstrated a threshold value of 2.601 for Cho/Cr to provide a sensitivity, specificity, accuracy, PPV, and NPV of 81.8%, 51.7%, 71.4%, 76.3%, and 60.0%, respectively, in dividing LGGs and HGGs; a threshold value of 0.705 for NAA/Cr to provide a sensitivity, specificity, accuracy, PPV, and NPV of 76.4%, 75.9%, 76.2%, 85.7%, and 62.9%, respectively; a threshold value of 0.349 for NAA/Cho to provide a sensitivity, specificity, accuracy, PPV, and NPV of 87.3%, 86.2%, 86.9%, 92.3%, and 78.1%, respectively. CONCLUSIONS:The ADC values and metabolites appeared to be significantly correlated to grade in pediatric gliomas. The predictive values may be helpful for preoperative diagnostic predictions.
目的: 探讨表观扩散系数 (ADC) 和质子磁共振波谱 (1H-MRS) 代谢产物定量分析在儿童胶质瘤分级中的价值。 患者和方法: 回顾性分析了143例病理证实的儿童胶质瘤 (例低级别胶质瘤 [LGGs] 和66例高级别胶质瘤 [HGGs])，其中84例还接受了1H-MRS。平均肿瘤ADC (ADCmean) 、最小肿瘤ADC (ADCmin) 、肿瘤/正常脑ADC比值 (ADC比值) 、代谢产物 (胆碱/肌酸比值 [Cho/Cr] 、N-乙酰天门冬氨酸/肌酸比值 [NAA/Cr] 、分析了LGGs和HGGs之间的N-乙酰天冬氨酸盐/胆碱比率 [NAA/Cho] 、乳酸盐和脂质峰的存在。 结果: ADC值与胶质瘤分级呈显著负相关。受试者工作特征分析显示，1.192 × 10-3平方毫米cm/s的截止ADCmean值对儿童低级别和高级别胶质瘤的区分提供了77.6% 、80.3% 、78.5% 的敏感性、特异性、准确性、阳性预测值 (PPV) 和阴性预测值 (NPV)，分别为89.5% 和62.4%;截止ADCmin值为0.973 × 10-3平方毫米/s，导致灵敏度、特异度、准确度、PPV和NPV分别为86.0% 、90.9% 、87.6% 、95.3% 和75.0%; 截止ADC比值值为1.384，导致灵敏度、特异度、准确度、PPV、和73.4% 的净现值，分别为87.9% 、78.0% 、92.9% 和60.4%。发现Cho/Cr与神经胶质瘤分级之间存在正相关的趋势。NAA/Cr或NAA/Cho与胶质瘤分级呈负相关。统计分析表明，Cho/Cr的阈值为2.601，以提供区分LGGs和HGGs的灵敏度、特异性、准确性、PPV和NPV分别为81.8% 、51.7% 、71.4% 、76.3% 和60.0%; NAA/Cr的阈值为0.705，以提供灵敏度，特异性，准确性，PPV和NPV分别为76.4% 、75.9% 、76.2% 、85.7% 和62.9%; NAA/Cho的阈值为0.349，以分别提供87.3% 、86.2% 、86.9% 、92.3% 、78.1% 和的灵敏度、特异性、准确度、PPV和NPV。 结论: ADC值和代谢产物似乎与儿童胶质瘤的分级显著相关。预测值可能有助于术前诊断预测。
METHODS::The ATP binding-cassette superfamily corresponds the mostly transmembrane transporters family found in humans. These proteins actively transport endogenous and exogenous substrates through biological membranes in body tissues, so they have an important role in the regulation of many physiological functions necessary for human homeostasis, as well as in response regulation to several pharmacological substrates. The development of multidrug resistance has become one of the main troubles in conventional chemotherapy in different illnesses including cancer, being the increased efflux of antineoplastic drugs the main reason for this multidrug resistance, with a key role of the ABC superfamily. Likely, the interindividual variability in the pharmacological response among patients is well known, and may be due to intrinsically factors of the disease, genetic and environmental ones. Thus, the understanding of this variability, especially the genetic variability associated with the efficacy and toxicity of drugs, can provide a safer and more effective pharmacological treatment, so ABC genes are considered as important regulators due to their relationship with the reduction in pharmacological response. In this review, updated information about transporters belonging to this superfamily was collected, the possible role of these transporters in cancer, the role of genetic variability in their genes, as well as some therapeutic tools that have been tried to raise against main transporters associated with chemoresistance in cancer.
METHODS:BACKGROUND:Cholinergic neurotransmission regulates neuroinflammation in Parkinson disease (PD). RESEARCH DESIGN AND METHODS:The authors conducted a delayed-start study of donepezil for cognitive decline in non-demented PD patients. The study consisted of a 96-week randomized placebo-controlled double-blind phase 1, followed by a 24-week donepezil extension phase 2. The primary outcome measure was a change in the Mini-Mental State Examination (MMSE) at week 120. RESULTS:A total of 98 patients were randomly allocated to the early-start (donepezil-to-donepezil) and delayed-start (placebo-to-donepezil) groups. Mean (SD) of the baseline MMSE was 27.6 (2.0) and 28.0 (2.1), respectively. MMSE change at week 120 was better in the early-start group than in the delayed-start group, but the difference was not significant. The MMSE declined in apolipoprotein ε4 carriers, but not in non-carriers, and the factor interaction (intervention × ε4 genotype) was highly significant (P < 0.001). Analyzed with the interaction, the difference was significant (group difference 1.95 [0.33 to 3.57], P = 0.018). The MMSE decline slope in phase 1 was significantly better in the early-start group than in the delayed-start group (P = 0.048). CONCLUSIONS:Cognitive function deteriorated in ε4 carriers, but not in non-carriers, and early-start donepezil may postpone cognitive decline in the former.
METHODS::Since the discovery of dental pulp stem cells, a lot of teams have expressed an interest in dental pulp regeneration. Many approaches, experimental models and biological explorations have been developed, each including the use of stem cells and scaffolds with the final goal being clinical application in humans. In this review, the authors' objective was to compare the experimental models and strategies used for the development of biomaterials for tissue engineering of dental pulp with stem cells. Electronic queries were conducted on PubMed using the following terms: pulp regeneration, scaffold, stem cells, tissue engineering and biomaterial. The extracted data included the following information: the strategy envisaged, the type of stem cells, the experimental models, the exploration or analysis methods, the cytotoxicity or viability or proliferation cellular tests, the tests of scaffold antibacterial properties and take into account the vascularization of the regenerated dental pulp. From the 71 selected articles, 59% focused on the "cell-transplantation" strategy, 82% used in vitro experimentation, 58% in vivo animal models and only one described an in vivo in situ human clinical study. 87% used dental pulp stem cells. A majority of the studies reported histology (75%) and immunohistochemistry explorations (66%). 73% mentioned the use of cytotoxicity, proliferation or viability tests. 48% took vascularization into account but only 6% studied the antibacterial properties of the scaffolds. This article gives an overview of the methods used to regenerate dental pulp from stem cells and should help researchers create the best development strategies for research in this field.