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The main classification systems of sleep disorders are based on the subjective self-reported criteria. Objective measures are essential to characterize the nocturnal sleep disturbance, identify daytime impairment, and determine the course of these symptoms. The aim of this study was to establish a resting-state fMRI-based support vector machine (SVM) classifier to diagnose insomnia disorder.We enrolled 20 patients with insomnia disorder and 21 healthy controls, and obtained their simultaneous polysomnographic electroencephalography and functional magnetic resonance imaging (EEG-fMRI) recordings. The SVM classifiers were trained to capture insomnia. Classifier performance was quantified by a 5-fold cross validation and on independent test dataset.The fMRI-based SVM classifier was able to diagnose insomnia with an accuracy of 89.3% (sensitivity of 90.9%, specificity of 87.7%). The robustness of SVM classifier was encouraging.We established an encouraging resting-state fMRI-based SVM classifier to automatically diagnose insomnia disorder. As an objective measure for assessing insomnia disorder, it would be of additional value to the current self-reported subjective criteria.

Blood oxygenation level-dependent (BOLD) signals in the white matter (WM) have been demonstrated to encode neural activities by showing structure-specific temporal correlations during resting-state and task-specific imaging of fiber pathways with various degrees of correlations in strength and time delay. Previous neuroimaging studies have shown state-dependent functional connectivity and regional amplitude of signal fluctuations in brain gray matter across wakefulness and nonrapid eye movement (NREM) sleep cycles. However, the functional characteristics of WM during sleep remain unknown. Using simultaneous electroencephalography and functional magnetic resonance imaging data during wakefulness and NREM sleep collected from 66 healthy participants, we constructed 10 stable WM functional networks using clustering analysis. Functional connectivity between these WM functional networks and regional amplitude of WM signal fluctuations across multiple low-frequency bands were evaluated. In general, decreased WM functional connectivity between superficial and middle layer WM functional networks was observed from wakefulness to sleep. In addition, functional connectivity between the deep and cerebellar networks was higher during light sleep and lower during both wakefulness and deep sleep. The regional fluctuation amplitude was always higher during light sleep and lower during deep sleep. Importantly, slow-wave activity during deep sleep negatively correlated with functional connectivity between WM functional networks but positively correlated with fluctuation strength in the WM. These observations provide direct physiological evidence that neural activities in the WM are modulated by the sleep-wake cycle. This study provided the initial mapping of functional changes in WM during sleep.

Cognitive-behavioral therapy for insomnia (CBT-I) has been recommended as the first-line therapy for this condition. However, insomnia disorder with objective short sleep duration (ISS) phenotype is a distinct subtype from insomnia with normal sleep duration (INS) phenotype, and it may have a differential therapeutic response. We searched PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov using the PICOS principle for studies that examined the efficacy of cognitive-behavioral therapy for those with the ISS phenotype versus the INS phenotype, and identified nine studies with 612 patients with insomnia disorder. This included 270 patients with the ISS phenotype and 342 patients with the INS phenotype. The main outcome was that CBT-I had a better efficacy for the INS phenotype compared with the ISS phenotype, with about 30% higher response and about 20% higher remission. Similar results were indicated in the secondary outcomes. The therapeutic response of the ISS phenotype was significantly different from that of the INS phenotype. In the future, research is needed to clarify how to optimally treat insomnia disorder with the ISS phenotype in prospective randomized clinical trials, and to understand whether decreasing physiologic arousal will be necessary to improve results.

Previous studies have shown that placebo repetitive transcranial magnetic stimulation (rTMS) was effective on post-stroke motor rehabilitation. However, the placebo effect has not been systematically assessed. Therefore, this meta-analysis was conducted to resolve this issue and explore potential influencing factors further. PubMed, Embase, web of science and the Cochrane Library were searched for published randomised controlled trials (RCTs) with placebo rTMS treatment of stroke recovery until May 2019. The placebo effect size (Hedges’ g) was estimated using the motor outcome of pre- and post- placebo rTMS treatment. Meta-regression analysis was also performed to explore potential influencing factors for the placebo effect. Twenty-six placebo-controlled trials (including 381 patients in placebo group) were selected. Effect size results (Hedges’ g = 0.466, 95% CI 0.207–0.726; P

The association of mortality risk and insomnia disorder with daytime impairments has been plausible. The purpose of this study was to evaluate the strength of evidence for this relationship. We performed a comprehensive literature search for clinical Cohort trials including annual cumulative time-to-event data that evaluated the risk of mortality in insomnia disorder patients with daytime impairments. We used pooled hazard ratio (HR) as the main outcome measure and Kaplan-Meier survive curve to display outcome measures. The weighted cumulative mortality of 4.5% for patients with insomnia disorder was higher than that of 2.6% for those without insomnia (p

Background Repetitive transcranial magnetic stimulation (rTMS) has been considered a promising technique for the treatment of primary insomnia. However, its efficacy and placebo response remains unclear due to limited clinical data. Therefore, we conducted a systematic review to examine the efficacy and placebo response of rTMS. Methods We performed a comprehensive literature search for clinical trials evaluating the efficacy of rTMS addressing primary insomnia. To pool effect size estimates (Hedges' g) of active rTMS and sham rTMS across studies for outcome measures, a meta-analysis was done according to the Cochrane guideline. Results In sum, rTMS significantly improved insomnia symptoms in the active rTMS group, and the pooled effect size of Pittsburgh Sleep Quality Index (PSQI) was −0.98 (95% CI: −1.28, −0.68) for treatment duration of 10 days, −1.16 (95% CI: −1.51, −0.82) for 20 days, and −2.14 (95% CI: −2.45, −1.83) for 30 days, respectively. However, the placebo response was also significant, reducing insomnia symptoms in the sham rTMS group. Furthermore, 73.5% (95% CI: 50.8%, 96.2%) of the effect size of active rTMS was actually produced by sham rTMS. Conclusion The rTMS was effective in the treatment of primary insomnia, yet, the placebo effect of sham stimulation was highly significant. This new evidence may alter rTMS regimen for insomnia from a clinical and methodological point of view. Finally, in future research more objective data and multicenter double-blinded controlled studies should be encouraged.

Background Pharmacotherapy, psychotherapy, and complementary therapy have been used for primary insomnia. However, the efficacy and placebo response are not exactly clear because of limited clinical data. We therefore conducted a systematic review to examine the efficacy and placebo response of multimodal treatments. Methods We performed a comprehensive literature search for randomized placebo-controlled clinical trials evaluating the efficacy of multimodal treatments addressing primary insomnia. To pool effect size estimates (Hedges' g) of active and placebo conditions across studies for outcome measures, a meta-analysis was done according to the Cochrane guideline. Results The results of network meta-analysis for sleep efficiency showed that orexin receptor antagonists had the maximum effect size of 1.35 (95% confidence interval [CI], 0.88-1.82), followed by γ-aminobutyric acid agonists of 1.28 (95% CI, 0.85-1.71), cognitive behavioral therapy for insomnia of 1.07 (95% CI, 0.10-2.05), acupuncture of 0.64 (95% CI, -0.17 to 2.36), and repetitive transcranial magnetic stimulation of 0.61 (95% CI, -0.52 to 1.75), respectively. However, the placebo response was also significant and robust to improve insomnia symptoms, and 65.9% (95% CI, 49.3%-82.5%) of the effect size of multimodal treatments was actually produced by placebo conditions. Conclusions The pharmacotherapy seems the most effective in improving sleep efficiency. However, the optimal therapeutic regimen is still uncertain. In addition, the placebo response is significant and robust in treatments of primary insomnia.

Brain-derived neurotrophic factor (BDNF) plays an important role in neuronal plasticity and in the pathophysiology of various brain disorders. Repetitive transcranial magnetic stimulation (rTMS) has been widely used in neuropsychiatric disease. It is presumed that BDNF mediates the therapeutic benefits of rTMS, but previous results are contradictory. We therefore conducted a meta-analysis to examine the efficacy of rTMS to increase serum BDNF.We performed a comprehensive literature search for clinical trials evaluating the efficacy of rTMS and addressing serum BDNF level. To pool effect size estimate (Hedges' g) of serum BDNF across studies, a meta-analysis was performed according to the Cochrane guideline.rTMS failed to increase serum BDNF level with effect size of -0.12 (95% CI: -0.30, 0.06) (P=0.193). Multilevel mixed-effects models analysis showed that overall effect of rTMS on BDNF levels was influenced by group of participants (healthy vs. disease) (P0.001), stimulation frequency (low-frequency vs. high-frequency) of rTMS (P=0.007), treatment duration (P0.001) of rTMS, and population age (P0.001).Repetitive rTMS fails to increase serum BDNF, and it seems that serum BDNF level is related to frequency and duration of rTMS, as well as age and health status of population.

Objective. To investigate the functional reorganization of the motor network after repetitive transcranial magnetic stimulation (rTMS) in stroke patients with motor dysfunction and the distinction between high-frequency rTMS (HF-rTMS) and low-frequency rTMS (LF-rTMS). Methods. Thirty-three subcortical stroke patients were enrolled and assigned to the HF-rTMS group, LF-rTMS group, and sham group. Each patient of rTMS groups received either 10.0 Hz rTMS over the ipsilesional primary motor cortex (M1) or 1.0 Hz rTMS over the contralesional M1 for 10 consecutive days. A resting-state functional magnetic resonance imaging (fMRI) scan and neurological examinations were performed at baseline and after rTMS. The motor network and functional connectivities intramotor network with the core brain regions including the bilateral M1, premotor area (PMA), and supplementary motor area (SMA) were calculated. Comparisons of functional connectivities and Pearson correlation analysis between functional connectivity changes and behavioral improvement were calculated. Results. Significant motor improvement was found after rTMS in all groups which was larger in two rTMS groups than in the sham group. The functional connectivities of the motor network were significantly increased in bilateral M1, SMA, and contralesional PMA after real rTMS. These changes were only detected in the regions of the ipsilesional hemisphere in the HF-rTMS group and in the regions of the contralesional hemisphere in the LF-rTMS group. Significantly changed functional connectivities of the intramotor network were found between the ipsilesional M1 and SMA and contralesional PMA, between contralesional M1 and contralesional SMA, between contralesional SMA and ipsilesional SMA and contralesional PMA in the HF-rTMS group in which the changed connectivity between ipsilesional M1 and contralesional PMA was obviously correlated with the motor improvement. In addition, the functional connectivity of the intramotor network between ipsilesional M1 and contralesional PMA was significantly higher in the HF-rTMS group than in the LF-rTMS group. Conclusion. Both HF-rTMS and LF-rTMS have a positive effect on motor recovery in patients with subcortical stroke and could promote the reorganization of the motor network. HF-rTMS may contribute more to the functional connectivity reorganization of the ipsilesional motor network and realize greater benefit to the motor recovery.

Objective. To investigate whether and how the working memory impairment induced by sleep deprivation (SD) could be recovered by using repetitive transcranial magnetic stimulation (rTMS), as well as to clarify the corresponding brain activity changes. Methods. Seventeen healthy adults received one session of 5.0 Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) following 24 hours of SD. Resting state functional magnetic resonance imaging (fMRI) and working memory test were performed during a rested waking period, after SD and rTMS. The amplitude of low-frequency fluctuations (ALFF) was used to detect the spontaneous neural activity changes after both SD and rTMS. The relationship between ALFF and the performance of working memory was also assessed by using correlation analysis. Results. After SD, the participants exhibited lower response accuracies and longer reaction times on the working memory tests of letters and numbers. The decreased response accuracy of numbers was significantly improved after rTMS similarly to the state of the rested waking period after a normal night of sleep. ALFF values decreased from the rested waking period state to the state of SD in the brain regions involving the frontal gyrus, precuneus, angular gyrus, and parietal lobe which showed significantly increased ALFF after rTMS. Furthermore, significantly positive correlations were observed between changes of response accuracy and the changes of ALFF value of the inferior frontal gyrus and supramarginal gyrus. Conclusion. These results indicate that high-frequency rTMS applied over left DLPFC may contribute to the recovery of the impaired working memory after SD by modulating the neural activity of related brain regions.

Late gadolinium enhancement (LGE) on cardiac MRI indicates the myocardial fibrosis in hypertrophic cardiomyopathy (HCM), and the prognostic value of LGE in HCM has been described in several studies, but controversy exists given the limited power of these studies to predict future adverse cardiac events. The objective of this study was to perform a meta-analysis to systematically evaluate the predictive value of LGE on cardiac magnetic resonance (CMR) for future adverse cardiac events.We systematically searched multiple database including PubMed, EMBASE, and Cochrane Library for cohort studies of the effects of LGE on clinical outcomes (sudden cardiac death (SCD)/aborted SCD, all cardiac death, and all-cause mortality) in patients with HCM. We performed a meta-analysis to determine pooled odds ratios (OR), weighted average annualized event rates, and summary receiver-operating characteristic (SROC) curves for these clinical events.We identified nine clinical studies, examining 1734 patients with LGE and 2036 without LGE, and an average follow-up of 2.9 years. The weighted average annualized event rates of SCD/aborted SCD in patients with HCM (positive LGE versus negative LGE) was 1.28% versus 0.32% (p 0.001), and the pooled OR was 3.40 (95% CI: 1.90, 6.08; p 0.001). The sensitivity and specificity of predicting future cardiac events were 0.83 (95% CI: 0.66, 0.93) and 0.45 (95% CI: 0.31, 0.59), respectively. The 5-year risk of SCD/aborted SCD was 6.4% in patients with LGE. The all cardiac death and all-cause mortality were also significantly increased in patients with LGE. However, the extent of LGE was not significantly related to the risk of SCD/aborted SCD.LGE is significantly associated with SCD/aborted SCD risk, all cardiac death and all-cause mortality in patients with HCM. Implantable cardioverter defibrillators (ICD) can be considered for those patients with LGE.

Recently, several functional neuroimaging studies have been conducted in patients with persistent insomnia disorder, but these studies have yielded diverse findings. We aimed to identify convergence in function across the heterogeneity of patients, modalities, and methods for insomnia disorder by performing a quantitative coordinate-based meta-analysis. We performed a quantitative, voxel-wise meta-analysis of resting-state fMRI studies using seed-based d mapping to find convergence of functional alterations in persistent insomnia disorder. We included 28 studies comprising 287 peak foci involving 951 patients with insomnia disorder and 884 healthy controls. Patients with persistent insomnia disorder showed that increased activity was more frequently reported in right parahippocampal gyrus (p

Objectives The placebo response to orexin receptor antagonists in primary insomnia is little-known. Our aim was, therefore, to conduct a systematic review of placebo-controlled randomized clinical trials to characterize placebo response. Methods We performed a comprehensive literature search for randomized, placebo-controlled, double-blind clinical trials evaluating the efficacy of orexin receptor antagonists addressing primary insomnia. To pool effect size estimates (Cohen’s d) of placebo and orexin receptor antagonists across trials for outcome measures, a meta-analysis was done according to the Cochrane guideline. Results The placebo response was significant and robust to improve the symptoms of insomnia in terms of objective and subjective measures, and the effects (0.70 ± 0.51) in subjective measures were smaller than that (1.10 ± 1.14) in objective measures (p = 0.027). The biphasic feature of placebo response showed an initial short-term increase of placebo effect and subsequent changeless long-term effect. Conclusion The biphasic feature of placebo response is clinically useful, and neuroimaging is essential to clarify the long-term mechanism in the future.

Background: It has been accepted knowledge that placebo effects have been significant in insomnia randomized clinical trials. However, the dynamic features of placebo effects have not been clarified. Our aim was therefore to conduct a meta-analysis of placebo-controlled randomized clinical trials to characterize the dynamic features of placebo effects addressing primary insomnia. Methods: We performed a comprehensive literature search for randomized, placebo-controlled, double-blind clinical trials evaluating the efficacy of therapeutic regimens addressing primary insomnia. We pooled separate effect size estimates (Hedge's g) of placebo and regimen conditions across trials for outcome measures, and multilevel mixed-effects models was used to explore potential sources of heterogeneity. Findings: The placebo effects were significant and robust to reduce the symptoms of insomnia, and subjective measures were significantly smaller than objective measures (p

Objective This study aims to perform a metaanalysis to assess the diagnostic performance and clinical utility of the dynamic magnetic resonance imaging (MRI) in discrimination of benign and malignant pulmonary nodules. Materials and methods We searched PubMed, EMBASE, and Cochrane Library from January 1995 to May 2015 for studies evaluating the diagnostic accuracy of dynamic MRI in discriminating benign from malignant pulmonary nodules. Methodological quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) were calculated. Potential publication bias was investigated. Results Twelve studies with 524 malignant and 284 benign nodules were included in this metaanalysis. The publication bias was not significant. Summary receiver operating characteristic curve showed that AUC was 0.94 [95% confidence interval (CI), 0.83–0.98], with pooled sensitivity of 0.95 (95% CI: 0.90, 0.97), specificity of 0.87 (95% CI: 0.72, 0.95), PLR of 7.6 (95% CI: 3.2, 18.0), NLR of 0.06 (95% CI: 0.03, 0.11), and DOR of 133 (95% CI: 45, 393), respectively. Conclusion Dynamic contrast-enhanced MRI is valuable for discrimination of benign from malignant pulmonary nodules and is especially useful for exclusion of malignant pulmonary nodules.

Rationale and Objectives To evaluate the clinical utility of three-dimensional (3D) computed tomography (CT) for predicting pleural invasion by peripheral lung cancer. Materials and Methods CT findings (tumor size, vertical diameter, length and area of the interface between tumor and the pleura, ratios of length and area [R area ] of interface between tumor and the pleura to tumor size, angle between the tumor and adjacent pleura, presence or absence of pleural thickening, and originally developed 3D pleural patterns) in 201 consecutive patients with lung cancer of ≤3 cm in contact with pleural surface were correlated with pathologic findings. Logistic modeling was used for determining the significant factors for prediction of pleural invasion, and receiver operating characteristic (ROC) curves were used for investigating diagnostic capability of significant factors, resulting in a recommendation to the optimal criteria for predicting pleural invasion and to the optimal threshold for differentiating parietal from visceral invasion. Results Sixty-one (30%) of the 201 patients had pathologically verified pleural invasion. Logistic modeling revealed that the 3D pleural pattern was the only significant factor ( P area was optimal for differentiating parietal from visceral pleural invasion, and the highest accuracy of 77% was obtained with a cut-off value of 13.4 for this criterion. Conclusions Computer-aided 3D CT analysis of the pleura was useful for predicting pleural invasion.

Background and purpose It is not conclusive that magnetic resonance (MR)-based carotid atherosclerotic plaque assessment identifies high-risk features associated with cerebrovascular events. We aimed to systematically summarize the association of MR imaging (MRI)-determined intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thinning/rupture of the fibrous cap (TRFC) with subsequent ischemic events. Materials and methods We performed a comprehensive literature search evaluating the association of MRI-based carotid plaque composition with ischemic outcomes. We included cohort studies examining IPH, LRNC, or TRFC with mean follow-up of ≥ 6 months and an outcome measure of ipsilateral ischemic events. A meta-analysis was done according to the Cochrane guideline. Results We identified 13 studies including 1.150 patients and 1.208 analyzed carotid arteries, with mean follow-up of 21.1 months. The hazard ratios (HR) for IPH, LRNC, and TRFC as predictors of subsequent ischemic events were 4.41 (95% CI: 2.87, 6.79), 3.00 (95% CI: 1.51, 5.95), and 5.94 (95% CI: 2.66, 13.28), respectively. The predictive value of carotid plaque MRI for ischemic events was acceptable, with sensitivity of 0.80 (95% CI: 0.66, 0.90) and specificity of 0.63 (95% CI: 0.57, 0.68). However, it was limited to confirm or exclude future ischemic events in clinical context, with positive likelihood ratio (LR) of 2.2 (95% CI: 1.9, 2.5) and negative LR of 0.31 (95% CI: 0.18, 0.55). No statistically significant heterogeneity or publication bias was observed. Conclusion The presence of IPH, LRNC, and TRFC determined by MRI is associated with increased risk of future ischemic events, but its predictive value is moderate and should not be used for confirmation or exclusion of future ischemic events in clinical context.

Background Many studies have reported that transverse computed tomography (CT) imaging findings correlate with prognosis of patients with small peripheral lung neoplasm with lepidic growth. However, no studies have examined this correlation with the aid of three-dimensional (3D) CT data. Purpose To determine the most efficacious imaging factor for differentiation of lepidic growth type lung neoplasms with good prognosis from those with poor prognosis. Material and Methods We evaluated CT findings, nodule patterns, SUVmax on FDG-PET/CT, as well as nodule volume and ratios of solid parts to nodule volume that were semi-automatically measured on CT images of 64 pulmonary nodules of ≤2 cm in 60 consecutive patients (24 men and 36 women; mean age, 65 years). For logistic modeling, we used all of the significant factors observed between the neoplasms with good and with poor prognosis as independent variables to estimate the statistically significant factors for discriminating invasive adenocarcinomas with lepidic growth (lesions with poor prognosis, n = 42) from the other neoplasms, including preinvasive lesions (lesions with good prognosis, n = 22), resulting in a recommendation for the optimal criterion for predicting lesions with poor prognosis. Results The logistic regression model identified the ratio of the solid part to the whole volume of a pulmonary nodule as the only significant factor ( P = 0.04) for differentiating lepidic growth type lung neoplasms with good prognosis from those with poor prognosis. A ratio of 0.238 or more showed the highest discriminatory accuracy of 84% with 91% sensitivity and 76% specificity. Conclusion Computer-aided analyses of pulmonary nodules proved most useful for establishing the optimal criterion for differentiation of lepidic growth type lung neoplasms with good prognosis from those with poor prognosis.

Hypericin has been widely studied as a potent photosensitizer for photodynamic therapy in both preclinical and clinical settings. Recently, hypericin has also been discovered to have a specific avidity for necrotic tissue. This affinity is also observed in a series of radiolabeled derivatives of hypericin, including [(123)I]iodohypericin, [(124)I]iodohypericin, and [(131)I]iodohypericin. Hypericin, along with other necrosis-avid contrast agents, has been investigated for use in noninvasively targeting necrotic tissues in numerous disorders. Potential clinical applications of hypericin include the identification of acute myocardial infarction, evaluation of tissue viability, assessment of therapeutic responses to treatments, and interventional procedures for solid tumors. The mechanisms of necrosis avidity in hypericin remain to be fully elucidated, although several hypotheses have been suggested. In particular, it has been proposed that the necrosis avidity of hypericin is compound specific; for instance, cholesterol, phosphatidylserine, or phosphatidylethanolamine components in the phospholipid bilayer of cellular membranes may be the major targets for its observed selectivity. Further investigations are needed to identify the specific binding moiety that is responsible for the necrosis avidity of hypericin.

OBJECTIVE: The objective of this study was to compare the efficacy and safety of radiofrequency ablation (RFA), cryoablation, and microwave ablation (MWA) for patients with lung malignancies. METHODS: We performed a network meta-analysis to identify both direct and indirect evidence from relevant trials by searching PubMed, Embase, and the Cochrane Library to December 31, 2017, for the treatment of malignant lung tumors with the use of RFA, MWA, or cryoablation. We extracted the relevant information from the published studies with a predefined data sheet and assessed the risk of bias with the Cochrane risk of bias tool. The primary outcomes were efficacy (local progression rate and overall survival rate) and safety (major complications rate). We did a random-effects network meta-analysis within a Bayesian framework as well as assessed the quality of evidence contributing to each network estimate using GRADE framework. RESULTS: We collected 34 studies eligible which included 1840 participants and 2520 lung malignancies (1318 primary lung cancer and 1202 pulmonary metastatic tumors). The quality of evidence was rated as very low in most comparisons. From the point of local progression rate, RFA and MWA were significantly more effective than cryoablation with odds ratio (OR) of 0.04 (95% confidence interval [CI]: 0.004, 0.38; P = 0.005) and 0.02 (95% CI: 0.002, 0.24; P = 0.001), respectively. No significant difference was found between MWA and RFA with an OR of 0.63 (95% CI: 0.04, 10.39; P = 0.745). Regarding the major complications, RFA, MWA, and cryoablation showed the comparable safety (P > 0.05). CONCLUSION: RFA and MWA offer an advantage over cryoablation for patients with malignant lung tumors.

Background Stress myocardial perfusion imaging is a noninvasive alternative to invasive fractional flow reserve for evaluating haemodynamically significant coronary artery disease. We aimed to systematically analyse the diagnostic performance and clinical utility of myocardial perfusion MRI for coronary artery disease (CAD) using fractional flow reserve (FFR) as the standard reference. Methods We searched PubMed, EMBASE, and Cochrane Library to July 2015 for studies using perfusion MR as a diagnostic test for CAD versus FFR. The meta-analysis was performed based on Cochrane guideline. Results We identified 20 studies with 1,570 patients. Pooled analyses were performed at per-patient level (1,041 patients) and per-territory level (2,690 coronary territories). The sensitivity, specificity, area under sROC curve were 0.88 (95% CI: 0.85, 0.91), 0.88 (95% CI: 0.84, 0.90), and 0.94 (95% CI: 0.92, 0.96) at per-patient level, and 0.86 (95% CI: 0.81, 0.90), 0.88 (95% CI: 0.84, 0.92), and 0.93 (95% CI: 0.91, 0.95) at per-territory level. Post-test probability was altered by positive (likelihood ratio) LR of 7.1 (95% CI: 5.6, 9.0) and negative LR of 0.13 (95% CI: 0.10, 0.17) based on Bayes' theorem. Conclusions Diagnostic accuracy of myocardial perfusion MRI for CAD is high and can alter the post-test probability of CAD.

The volumetry of the hippocampal subregion may provide additional information in the early investigation of amnestic mild cognitive impairment (aMCI) and the T2 signal intensity (T2-SI) of the hippocampal subregion has not been well studied quantitatively by magnetic resonance imaging (MRI) in aMCI.Using combined MRI-based hippocampal volumetry and T2-SI at the levels of the whole hippocampus and hippocampal subregion, 18 patients with aMCI and 18 age-matched controls were investigated.Significantly lower left whole hippocampal and hippocampal head volumes and higher T2-SI in the bilateral whole hippocampus and hippocampal head were shown, whereas atrophy of the right whole hippocampus and hippocampal subregion was not significant in aMCI. Additionally, correlations were found among the hippocampal volume, T2-SI and Mini-Mental State Examination (MMSE) scores for aMCI in the whole hippocampus and some hippocampal subregions and an almost perfect correlation was found between T2-SI of the left hippocampal head and MMSE scores regarding aMCI (r = -0.831, P = 0.000).Abnormalities of the hippocampal volume and T2-SI were documented in aMCI, whereas T2-SI was implied to be more susceptible than the volume in the pathohistological progression in aMCI. Additionally, T2-SI in the left hippocampal head may be a potential biomarker to facilitate the early diagnosis of aMCI.

Objectives: The diagnostic accuracy of cardiac computed tomography angiography (CCTA) is well reported. The prognostic value of CCTA has been described in several studies, but many of these were underpowered and an update of the meta-analysis is necessary to increase the power to predict rare events. The purpose of this study was to perform a meta-analysis of the ability of CCTA to predict future cardiovascular events. Methods: We searched multiple databases for longitudinal studies of CCTA with a follow-up of at least 12 months of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), death, myocardial infarction and revascularization. Summary test parameters and receiver-operating characteristic curves were calculated. Results: Eighteen studies evaluated 29,243 patients with a median follow-up of 25 months. For MACE in patients with negative findings on CCTA, there was a pooled negative likelihood ratio (LR) of 0.01 [95% confidence interval (CI) 0.00-0.08], a positive LR of 1.72 (95% CI 1.54-1.91), a sensitivity of 1.00 (95% CI 0.97-1.00), a specificity of 0.42 (95% CI 0.36-0.48) and a diagnostic odds ratio of 159.07 (95% CI 22.20-1,139.80). The weighted average annualized MACE rate for positive versus negative CCTA findings was 3.49 versus 0.21%. Stratifying by no CAD, nonobstructive CAD or obstructive CAD, there were incrementally increasing adverse events. Conclusions: Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA.

Background Ground-glass opacity (GGO) is reported to be characteristic to lepidic growth of neoplasm in subsolid nodules. In solid nodules of lung cancer, however, there is no characteristic feature to be reported. Purpose To study if there are any thin-section CT findings characteristic to tumor histology or if they are only related to tumor size in solid nodules of the lung cancer. Material and Methods This study included 106 solid peripheral lung cancers of 3 cm or smaller (56 adenocarcinomas, 33 squamous cell carcinomas, and 17 small cell carcinomas) in which 16-slice CT with 1 mm collimation was performed before surgery. Six morphologic findings (presence or absence of lobulation, coarse spiculation, air bronchogram, cavity, pleural tag, and pleural-based lesion) and four measurements (ratio of the greatest transverse and vertical diameter to the shortest transverse diameter and density of lobulation and coarse spiculation) on thin-section CT images were evaluated. Density of lobulation (coarse spiculation) was defined as the ratio of lobulation (coarse spiculation) number to the greatest transverse diameter of a nodule. Results Air bronchogram ( P Conclusion Air bronchogram on thin-section CT is characteristic feature of solid adenocarcinoma of the lung. However, other thin-section CT findings are irrelevant to tumor histology and related only to tumor size.

a b s t r a c t Purpose: To investigate the clinicopathological features and prognosis in patients with adenocarcinoma of the lung with scattered consolidation (ALSC). Materials and methods: Between January 2006 and March 2010, 139 consecutive patients with lung adenocarcinoma of ≤3 cm, who underwent pulmonary resection for lung cancer, were investigated ret- rospectively. Radiologic classification was based on the findings of thin-section CT such as the presence of consolidation or ground-glass opacity (GGO). Type I (n = 15) and Type II (n = 14), showed a pure GGO and a mixed GGO with consolidation

The aim of this study is to assess the usefulness of computer-aided three-dimensional (3D) measurement of volume and computed tomography (CT) attenuation values of nodes for diagnosing nodal metastases of lung cancer.We measured three diameters, their ratios, volume, and CT values in 3D images of 191 nodes (64 malignant; 162 of1 cm in short diameter) in 26 consecutive patients who underwent contrast-enhanced, thin-section, multidetector row CT before surgery. We separately studied statistically significant factors in a group of all nodes and in another group of nodes of1 cm in short diameter with logistic modeling and evaluated their diagnostic accuracy.Significant factors were CT values (P .001) and short diameter (P = .001) for the total node group, and CT values (P = .030) and 3D volume (P = .035) for the1 cm node group. Optimal 83% accuracy was obtained with a criterion of short diameter of7.4 mm and CT values of103 Hounsfield unit (HU) for the total node group, whereas optimal 76% accuracy was obtained with a criterion of 3D volume of1282 mm(3) or CT values of103 HU for the1 cm node group.3D measurement may be useful for diagnosing nodal metastases.