Differences In Tissue Volume Research Articles

Intra-individual comparison of epicardial adipose tissue characteristics on coronary CT angiography between photon-counting detector and energy-integrating detector CT systems

PurposeTo explore the potential differences in epicardial adipose tissue (EAT) volume and attenuation measurements between photon-counting detector (PCD) and energy-integrating detector (EID)-CT systems. MethodsFifty patients (mean age 69 ± 8 years, 41 male [82 %]) were prospectively enrolled for a research coronary CT angiography (CCTA) on a PCD-CT within 30 days after clinical EID-based CCTA. EID-CT acquisitions were reconstructed using a Bv40 kernel at 0.6 mm slice thickness. The PCD-CT acquisition was reconstructed at a down-sampled resolution (0.6 mm, Bv40; [PCD-DS]) and at ultra-high resolutions (PCD-UHR) with a 0.2 mm slice thickness and Bv40, Bv48, and Bv64 kernels. EAT segmentation was performed semi-automatically at about 1 cm intervals and interpolated to cover the whole epicardium within a threshold of −190 to −30 HU. A subgroup analysis was performed based on quartile groups created from EID-CT data and PCD-UHRBv48 data. Differences were measured using repeated-measures ANOVA and the Friedman test. Correlations were tested using Pearson’s and Spearman’s rho, and agreement using Bland-Altman plots. ResultsEAT volumes significantly differed between some reconstructions (e.g. EID-CT: 138 ml [IQR 100, 188]; PCD-DS: 147 ml [110, 206]; P<0.001). Overall, correlations between PCD-UHR and EID-CT EAT volumes were excellent, e.g. PCD-UHRBv48: r: 0.976 (95 % CI: 0.958, 0.987); P<0.001; with good agreement (mean bias: −9.5 ml; limits of agreement [LoA]: −40.6, 21.6). On the other hand, correlations regarding EAT attenuation was moderate, e.g. PCD-UHRBV48: r: 0.655 (95 % CI: 0.461, 0.790); P<0.001; mean bias: 6.5 HU; LoA: −2.0, 15.0. ConclusionEAT attenuation and volume measurements demonstrated different absolute values between PCD-UHR, PCD-DS as well as EID-CT reconstructions, but showed similar tendencies on an intra-individual level. New protocols and threshold ranges need to be developed to allow comparison between PCD-CT and EID-CT data.

Volumetric assessment of volume stable collagen matrix in maxillary single implant site development: A randomized controlled clinical trial.

The stability of soft tissue volume around dental implants is an important factor for the final esthetic outcome. The main objective of this study was to compare volume stable collagen matrix (VCMX) versus connective tissue graft (CTG) in the augmentation of soft tissue profiles in single implant sites with a class I Siebert ridge defect. Twenty patients (14 females and 6 males) were enrolled in the present study. After implant placement and augmentation of the buccal defect by VCMX or CTG, post-operative evaluation of the volumetric changes at the augmented implant site was carried out at 3, 6, and 9 months as primary outcome, clinical and radiographic soft tissue thickness were carried out at baseline and 9-month intervals, visual analog scale (VAS) and oral health impact profile-14 (OHIP14) were recorded 2 weeks after the surgery. A statistically significant difference in soft tissue volume was found between baseline and 3, 6, and 9 months postoperatively in both groups with the highest value at 9 months (136.33 ± 86.80) (mm3) in VCMX and (186.38 ± 57.52) (mm3) in CTG. Soft tissue thickness was significantly increased in both groups at 9 months in comparison to baseline. However, there was a significantly higher increase in soft tissue thickness at 9 months in CTG (3.87 ± 0.91) than in VCMX (2.94 ± 0.31). Regarding the radiographic soft tissue thickness, there was a statistically significant increase in both groups at 9 months in comparison to baseline. However, there was a statistically higher increase in the radiographic soft tissue thickness at 9 months in CTG (3.08 ± 0.97) than in VCMX (2.37 ± 0.29). VAS showed a statistically lower value in VCMX (0.4 ± 0.7) than CTG (2.8 ± 1.48). The OHIP recorded lower values in the VCMX group than the CTG group with no statistical significance. In addition, there was no difference in the PES between the two groups. The present study showed that CTG and VCMX were both effective in soft tissue augmentation around implants in the esthetic zone. However, CTG proved more efficient in increasing peri-implant soft tissue volume and mucosal thickness around single implants at a 9-month follow-up period. VCMX was associated with less pain or discomfort and reduced patient morbidity, as reflected by the significantly reduced VAS value in the VCMX group.

3D extraoral morphometric changes after implant surgery: an exploratory pilot study using stereophotogrammetry.

This pilot study aimed to evaluate, for the first time, the changes in facial tissues following the placement of a single dental implant. Patients were scanned with a 3D facial scanner (3dMD) before implant surgery, immediately after surgery (T1), at 7 days postoperatively (T2), and at the impression stage (T3). Acquired images were processed using the 3dMDvultus (3dMD) software program and volume differences and linear depth measurements were calculated to determine the morphometric changes over time. A total of 11 patients were included in the analyses. Descriptive statistics were employed to analyze the data. The volumetric changes and maximum depth differences indicated an initial increase, followed by a progressive decrease in tissue volume after implant placement in the area of the surgery. The volume change values ranged between 2.5 and 3.9 cm3 for T1, whereas for T2, the volume change decreased to a range of 0.8 to 1.8 cm3. Maximum depth differences ranged between 2.06 and 2.80 mm in the soft tissues immediately after the implant surgery and reduced to around 2.01 to 0.55 mm at the impression stage. The amount of painkiller used was not related to the magnitude of linear depth measurements at any assessed time point. There was a longitudinal decrease in soft tissue volume and depth difference in extraoral soft tissues in the region of implant placement after surgery up to 6 weeks. The use of a facial scanner is a promising noninvasive method to monitor 3D morphometric changes after implant surgery.

Body composition impacts outcome of bronchoscopic lung volume reduction in patients with severe emphysema: a fully automated CT-based analysis

Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive and irreversible airflow limitation, with individual body composition influencing disease severity. Severe emphysema worsens symptoms through hyperinflation, which can be relieved by bronchoscopic lung volume reduction (BLVR). To investigate how body composition, assessed through CT scans, impacts outcomes in emphysema patients undergoing BLVR. Fully automated CT-based body composition analysis (BCA) was performed in patients with end-stage emphysema receiving BLVR with valves. Post-interventional muscle and adipose tissues were quantified, body size-adjusted, and compared to baseline parameters. Between January 2015 and December 2022, 300 patients with severe emphysema underwent endobronchial valve treatment. Significant improvements were seen in outcome parameters, which were defined as changes in pulmonary function, physical performance, and quality of life (QoL) post-treatment. Muscle volume remained stable (1.632 vs. 1.635 for muscle bone adjusted ratio (BAR) at baseline and after 6 months respectively), while bone adjusted adipose tissue volumes, especially total and pericardial adipose tissue, showed significant increase (2.86 vs. 3.00 and 0.16 vs. 0.17, respectively). Moderate to strong correlations between bone adjusted muscle volume and weaker correlations between adipose tissue volumes and outcome parameters (pulmonary function, QoL and physical performance) were observed. Particularly after 6-month, bone adjusted muscle volume changes positively corresponded to improved outcomes (ΔForced expiratory volume in 1 s [FEV1], r = 0.440; ΔInspiratory vital capacity [IVC], r = 0.397; Δ6Minute walking distance [6MWD], r = 0.509 and ΔCOPD assessment test [CAT], r = −0.324; all p < 0.001). Group stratification by bone adjusted muscle volume changes revealed that groups with substantial muscle gain experienced a greater clinical benefit in pulmonary function improvements, QoL and physical performance (ΔFEV1%, 5.5 vs. 39.5; ΔIVC%, 4.3 vs. 28.4; Δ6MWDm, 14 vs. 110; ΔCATpts, −2 vs. −3.5 for groups with ΔMuscle, BAR% < –10 vs. > 10, respectively). BCA results among patients divided by the minimal clinically important difference for forced expiratory volume of the first second (FEV1) showed significant differences in bone-adjusted muscle and intramuscular adipose tissue (IMAT) volumes and their respective changes after 6 months (ΔMuscle, BAR% −5 vs. 3.4 and ΔIMAT, BAR% −0.62 vs. 0.60 for groups with ΔFEV1 ≤ 100 mL vs > 100 mL). Altered body composition, especially increased muscle volume, is associated with functional improvements in BLVR-treated patients.

Preterm Formula, Fortified or Unfortified Human Milk for Very Preterm Infants, the PREMFOOD Study: A Parallel Randomised Feasibility Trial

Objective: Uncertainty exists regarding optimal supplemental diet for very preterm infants if the mother’s own milk (MM) is insufficient. We evaluated feasibility for a randomised controlled trial (RCT) powered to detect important differences in health outcomes. Methods: In this open, parallel, feasibility trial, we randomised infants 25+0–31+6 weeks of gestation by opt-out consent to one of three diets: unfortified human milk (UHM) (unfortified MM and/or unfortified pasteurised human donor milk (DM) supplement), fortified human milk (FHM) (fortified MM and/or fortified DM supplement), and unfortified MM and/or preterm formula (PTF) supplement from birth to 35+0 weeks post menstrual age. Feasibility outcomes included opt-outs, adherence rates, and slow growth safety criteria. We also obtained anthropometry, and magnetic resonance imaging body composition data at term and term plus 6 weeks (opt-in consent). Results: Of 35 infants randomised to UHM, 34 to FHM, and 34 to PTF groups, 21, 19, and 24 infants completed imaging at term, respectively. Study entry opt-out rate was 38%; 6% of parents subsequently withdrew from feeding intervention. Two infants met predefined slow weight gain thresholds. There were no significant between-group differences in term total adipose tissue volume (mean [SD]: UHM: 0.870 L [0.35 L]; FHM: 0.889 L [0.31 L]; PTF: 0.809 L [0.25 L], p = 0.66), nor in any other body composition measure or anthropometry at either timepoint. Conclusions: Randomisation to UHM, FHM, and PTF diets by opt-out consent was acceptable to parents and clinical teams, associated with safe growth profiles and no significant differences in body composition. Our data provide justification to proceed to a larger RCT.

An unsupervised image registration method employing chest computed tomography images and deep neural networks

BackgroundDeformable image registration is crucial for multiple radiation therapy applications. Fast registration of computed tomography (CT) lung images is challenging because of the large and nonlinear deformation between inspiration and expiration. With advancements in deep learning techniques, learning-based registration methods are considered efficient alternatives to traditional methods in terms of accuracy and computational cost. MethodIn this study, an unsupervised lung registration network (LRN) with cycle-consistent training is proposed to align two acquired CT-derived lung datasets during breath-holds at inspiratory and expiratory levels without utilizing any ground-truth registration results. Generally, the LRN model uses three loss functions: image similarity, regularization, and Jacobian determinant. Here, LRN was trained on the CT datasets of 705 subjects and tested using 10 pairs of public CT DIR-Lab datasets. Furthermore, to evaluate the effectiveness of the registration technique, target registration errors (TREs) of the LRN model were compared with those of the conventional algorithm (sum of squared tissue volume difference; SSTVD) and a state-of-the-art unsupervised registration method (VoxelMorph). ResultsThe results showed that the LRN with an average TRE of 1.78 ± 1.56 mm outperformed VoxelMorph with an average TRE of 2.43 ± 2.43 mm, which is comparable to that of SSTVD with an average TRE of 1.66 ± 1.49 mm. In addition, estimating the displacement vector field without any folding voxel consumed less than 2 s, demonstrating the superiority of the learning-based method with respect to fiducial marker tracking and the overall soft tissue alignment with a nearly real-time speed. ConclusionsTherefore, this proposed method shows significant potential for use in time-sensitive pulmonary studies, such as lung motion tracking and image-guided surgery.

Regional shape alteration of left thalamus associated with late chronotype in young adults

ABSTRACT Chronotype reflects individual differences in circadian rhythms and influences individual psychology and behavior. Previous studies found altered subcortical structures are closely related to individual chronotypes. However, these studies have been conducted mainly using voxel-based morphometry and traditional volume measurement methods with certain limitations. This study aimed to investigate subcortical aberrant volume and shape patterns in late chronotypes (LC) young adults compared to early chronotypes (EC) young adults. Magnetic resonance imaging (MRI) scanning and chronotype assessment were performed once for all participants, including 49 LC young adults and 49 matched EC young adults. The morningness and eveningness preferences were assessed using the Chronotype Questionnaire. A vertex-wise shape analysis was conducted to analyze structural MRI data. There were no significant differences in brain tissue volume and subcortical structural volume between groups. LC young adults showed significant regional shape atrophy in the left ventral posterior thalamus compared to EC individuals. A significant correlation was found between the regional shape atrophy of left ventral posterior thalamus and the score of Chronotype Questionnaire in LC young adults. Regional shape alteration of left thalamus was closely related to the chronotype, and LC may be a potential risk factor for sleep-related behavioral and mental problems in young adults. However, the predominantly female sample and the failure to investigate the effect of chronotype on the subcortical structure-function network are limitations of this study. Further prospective studies are needed to investigate the temporal characteristics of thalamic shape changes and consequent behavioral and psychiatric problems in adults with LC.

The association of prediabetes and type 2 diabetes with hippocampal subfields volume: The Maastricht study

Aims/hypothesisWe investigated whether prediabetes, type 2 diabetes, and continuous measures of hyperglycemia are associated with tissue volume differences in specific subfields of the hippocampus. MethodsWe used cross-sectional data from 4,724 participants (58.7 ± 8.5 years, 51.5% women) of The Maastricht Study, a population-based prospective cohort. Glucose metabolism status was assessed with an oral glucose tolerance test, and defined as type 2 diabetes (n = 869), prediabetes (n = 671), or normal glucose metabolism (n = 3184). We extracted 12 hippocampal subfield volumes per hemisphere with FreeSurfer v6.0 using T1w and FLAIR 3T MRI images. We used multiple linear regression and linear trend analysis, and adjusted for total intracranial volume, demographic, lifestyle, and cardiovascular risk factors. ResultsType 2 diabetes was significantly associated with smaller volumes in the hippocampal subfield fimbria (standardized beta coefficient ± standard error (β ± SE) = -0.195 ± 0.04, p-value < 0.001), the hippocampus proper, i.e. Cornu Ammonis (CA) 1, CA2/3, CA4, dentate gyrus, subiculum and presubiculum (β ± SE < -0.105 ± 0.04, p-value < 0.006); as well as the hippocampal tail (β ± SE = -0.162 ± 0.04, p-value < 0.001). Prediabetes showed no significant associations. However, linear trend analysis indicated a dose–response relation from normal glucose metabolism, to prediabetes, to type 2 diabetes. Multiple continuous measures of hyperglycemia were associated with smaller volumes of the subfields fimbria (β ± SE < -0.010 ± 0.011, p-value < 0.001), dentate gyrus (β ± SE < -0.013 ± 0.010, p-value < 0.002), CA3 (β ± SE < -0.014 ± 0.011, p-value < 0.001), and tail (β ± SE < -0.006 ± 0.012, p-value < 0.003). Conclusions/interpretationType 2 diabetes and measures of hyperglycemia are associated with hippocampal subfield atrophy, independently of lifestyle and cardiovascular risk factors. We found evidence for a dose–response relationship from normal glucose metabolism, to prediabetes, to type 2 diabetes. Prediabetes stages could give a window of opportunity for the early prevention of brain disease.

Abstract P224: Perivascular Adipose Tissue May Contribute To Disparate Blood Pressure Responses To Lifetime High Fat Feeding In Dahl Salt-sensitive And Salt-resistant Rats

Dahl salt-sensitive (SS) and salt-resistant (SR) rats show dramatically different blood pressure (BP) responses to being raised on a high fat, but normal salt, diet starting at weaning. Virtually no effect on BP is seen in SR rats, whereas in SS rats mean arterial pressure (MAP) reaches over 160 mmHg by adulthood. The BP difference is similar in female and male rats. The cellular and physiological mechanisms responsible have not been completely elucidated in either sex. Dysfunctional perivascular adipose tissue (PVAT) is proposed to contribute to obesity-associated hypertension through actions on other components of the vascular wall. Here we used female rats to test the hypothesis that differences in adipose tissue amount or function in SS and SR rats play a part in the distinct BP effects of high fat diet in the two strains. Rats (n=8 per strain) were fed a high fat diet (60% kcal fat) from weaning. BP was measured with telemetry. At 18 weeks of age, MAPs (mmHg) were 108±1 and 180±4 in SR and SS rats. Body weights (g) were 274±4 and 323±4. Total and visceral adipose volumes (mm3) measured by μCT were higher in SS rats versus SR rats (visceral: 22372±927 versus 14112±1495; total: 17208±732 versus 10234±984). PVAT volume around the thoracic aorta was larger in SS rats (0.228±0.017 versus 0.167±0.006). Subcutaneous adipose tissue volumes did not differ. Plasma triglycerides and cholesterol were modestly but significantly higher in SS rats. The well-known anticontractile effect of PVAT was compared in thoracic aorta from both strains. Removal of PVAT increased the AUC of the tension/PE contraction in SR rats by 1484±226 units and by a significantly smaller amount (946±162.5 units) in SS rats. Finally, aortic stiffness was estimated from pulse wave velocity measured via Doppler in a subset (n=4 each) of rats from each strain. Pulse wave velocity (M/sec) was markedly higher in SS than SR rats (11.5±1.0 versus 6.4±0.3). We conclude that differences in adipose tissue volume, location or function could account in part for the distinct BP responses of female SS and SR rats to high fat feeding.

Retinal ganglion cell endowment is correlated with optic tract fiber cross section, not density

There is substantial variation between healthy individuals in the number of retinal ganglion cells (RGC) in the eye, with commensurate variation in the number of axons in the optic tracts. Fixel-based analysis of diffusion MR produces estimates of fiber density (FD) and cross section (FC). Using these fixel measurements along with retinal imaging, we asked if individual differences in RGC tissue volume are correlated with individual differences in FD and FC measurements obtained from the optic tracts, and subsequent structures along the cortical visual pathway. We find that RGC endowment is correlated with optic tract FC, but not with FD. RGC volume had a decreasing relationship with measurements from subsequent regions of the visual system (LGN volume, optic radiation FC/FD, and V1 surface area). However, we also found that the variations in each visual area were correlated with the variations in its immediately adjacent visual structure. We only observed these serial correlations when FC is used as the measure of interest for the optic tract and radiations, but no significant relationship was found when FD represented these white matter structures. From these results, we conclude that the variations in RGC endowment, LGN volume, and V1 surface area are better predicted by the overall cross section of the optic tract and optic radiations as compared to the intra-axonal restricted signal component of these white matter pathways. Additionally, the presence of significant correlations between adjacent, but not distant, anatomical structures suggests that there are multiple, local sources of anatomical variation along the visual pathway.

PLOSL: Population learning followed by one shot learning pulmonary image registration using tissue volume preserving and vesselness constraints.

This paper presents the Population Learning followed by One Shot Learning (PLOSL) pulmonary image registration method. PLOSL is a fast unsupervised learning-based framework for 3D-CT pulmonary image registration algorithm based on combining population learning (PL) and one-shot learning (OSL). The PLOSL image registration has the advantages of the PL and OSL approaches while reducing their respective drawbacks. The advantages of PLOSL include improved performance over PL, substantially reducing OSL training time and reducing the likelihood of OSL getting stuck in local minima. PLOSL pulmonary image registration uses tissue volume preserving and vesselness constraints for registration of inspiration-to-expiration and expiration-to-inspiration pulmonary CT images. A coarse-to-fine convolution encoder-decoder CNN architecture is used to register large and small shape features. During training, the sum of squared tissue volume difference (SSTVD) compensates for intensity differences between inspiration and expiration computed tomography (CT) images and the sum of squared vesselness measure difference (SSVMD) helps match the lung vessel tree. Results show that the PLOSL (SSTVD+SSVMD) algorithm achieved subvoxel landmark error while preserving pulmonary topology on the SPIROMICS data set, the public DIR-LAB COPDGene and 4DCT data sets.

Dental Tissue Volumes in Mice with Osteogenesis Imperfecta

Osteogenesis imperfecta (OI), commonly known as brittle bone disease, has long been known to cause significant dental problems that affect patients over the course of their lives, including increased dental fractures, discolored teeth, and malocclusion.At the molecular level, OI is a disorder of the type I collagen protein. Insufficient amounts or misshapen forms of this protein lead to disruptions in the microstructure of bone and teeth tissues.Dentin, the hard tissue which comprises the bulk of the tooth and absorbs shock forces during chewing, develops on a matrix of type I collagen. Thus, collagen abnormalities in OI lead to less organized and less stable dentin.Further, the teeth in people with OI tend to exhibit dentin hypertrophy, in which increased amounts of dentin are deposited at the interior of the tooth. In humans with OI, dentin hypertrophy tends to develop shortly after the eruption of teeth into the oral cavity.Enamel, unlike dentin, develops on a matrix of non‐collagenous proteins, and is thought to develop normally in OI. However, abnormalities in the underlying dentin in OI can frequently lead to enamel fractures. Finally, the teeth in people with OI have often been noted to be smaller than those of people without OI.Mice are the most commonly used animal model for dental development. However, differences in dental tissue volumes in OI have not yet been studied in mice.The objective of this study is to compare dental tissue volumes at different developmental stages in teeth from mice with and without OI. We hypothesize that both juvenile and young adult mice with OI will have smaller dental tissue volumes than mice without OI.To test this hypothesis, three‐dimensional models of teeth from OI mice (n = 10) and wild type mice (n = 10) were created from microCT scans taken at weaning age (week 4 after birth) and young adulthood (week 16 after birth). Dental tissue volumes were measured using 3D Slicer.Mann‐Whitney U tests showed that at week 16, mice with OI had significantly lower dental volumes compared to mice without OI for upper molars, lower molars, upper incisors, and lower incisors (p &lt; 0.05). Additionally, at week 4, mice with OI had significantly smaller lower molars, upper incisors, and lower incisors (p &lt; 0.05). There was no significant difference between the two groups in upper molar size among the week 4 mice.At week 16, the OI mice had significantly lower volumes of dentin compared to the mice without OI in the upper and lower molars (p &lt; 0.05), but not in the upper or lower incisors. At week 4, the OI mice had significantly lower volumes of dentin compared to the mice without OI in the upper and lower incisors and lower molars (p &lt;0.05), but not the upper molars.There were no significant differences between the two groups in enamel volume at either timepoint.These results demonstrate that mice with OI have smaller overall dental volumes compared to mice without OI, consistent with the human OI phenotype of smaller teeth.This research will provide important insights into the development of the dental phenotype in OI. The use of a mouse model to investigate dental tissue volumes represents a novel direction for OI research. Establishing the validity of the mouse model will allow future researchers to further characterize the effects of this disease on early dental development using methods, such as CT scans, that cannot be practically or ethically performed in young human patients.

Default-Mode Network Connectivity Changes Correlate with Attention Deficits in ALL Long-Term Survivors Treated with Radio- and/or Chemotherapy.

Simple SummaryBoth chemotherapy and radiotherapy play a role in the neurocognitive impairment of long-term survivors from acute lymphoblastic leukemia, but it is unknown if similar mechanisms are involved. We assessed neurocognitive alterations, brain tissue volumes, and functional connectivity of the main hubs of the default-mode network, in 13 patients treated with chemotherapy and radiotherapy (Group A) and in 13 treated with chemotherapy only (Group B). Correlations with neuropsychological scores, independent of group, were assessed for regions that showed significant differences between the two groups at neuroimaging. Compared to Group B, Group A performed significantly worse at the digit span and digit symbol tests and showed increased functional connectivity between the medial prefrontal cortex and the rolandic operculi, along with the absence of differences in regional brain tissue volumes. Functional connectivity in these regions correlated inversely with speed of processing in both groups, suggesting that similar mechanisms may be involved in the neurocognitive deficits in both groups.Whether chemotherapy (ChT) and radiotherapy (RT) determine neurocognitive impairment in acute lymphoblastic leukemia long-term survivors (ALL LTSs) through similar mechanisms affecting the same brain regions is still unknown. We compared neurocognitive alterations, regional brain tissue volumes (by voxel-based morphometry), and functional connectivity of the main default-mode network hubs (by seed-based analysis of resting state functional MRI data), in 13 ALL LTSs treated with RT and ChT (Group A) and 13 treated with ChT only (Group B). Group A performed significantly worse than Group B at the digit span and digit symbol tests (p = 0.023 and 0.013, respectively). Increased connectivity between the medial prefrontal cortex (the main anterior hub of the default-mode network) and the rolandic operculi was present in Group A compared to Group B, along with the absence of significant differences in regional brain tissue volumes. In these regions, the functional connectivity correlated inversely with the speed of processing scores, independent of treatment group. These results suggest that similar mechanisms may be involved in the neurocognitive deficits in ALL LTS patients, regardless of the treatment group. Further studies are needed to clarify whether these changes represent a direct expression of the mechanisms underlying the cognitive deficits or ineffective compensatory phenomena.

Monopolar Transurethral Resection of the Prostate Versus Holmium Laser Enucleation in Men with Prostate Volume Greater than 100 mL

Purpose: The surgical treatment for severe benign prostatic hyperplasia is challenging. The aim of our study was to compare the safety and efficacy of monopolar transurethral resection of the prostate (M-TURP) and holmium laser enucleation of the prostate (HOLEP) for prostate size &gt;100 ml. Materials and Methods: We retrospectively evaluated our database of two groups of patients. Thirteen patients underwent M-TURP (group 1), and 27 underwent HOLEP (group 2). Results: The mean prostate size was 163.1 ± 49.0 ml in group 1 and 143.4 ± 40.9 ml in group 2 (P = 0.19). There was no significant difference in resected tissue volume, days of catheter removal, admission days, and postoperative serum hemoglobin between treatment groups. However, in group 1, mean postoperative serum sodium dropped from 137.1 mmol/L to 131.4 mmol/L, which was significantly lower than postoperative serum sodium in group 2 (P &lt; 0.0001). There were more complications in group 1 than group 2, especially for patients undergoing transfusion (76.9% in group 1 and 22.2% in group 2) and with hyponatremia (15.4% in group 1 and 0% in group 2). At 3-month follow-up, the international prostate symptom score, quality of life score, and residual urine volume revealed no significant differences between groups. Conclusion: M-TURP and HOLEP in men with prostate volume greater 100 ml had similar operative time, admission days and postoperative functional outcomes. However, higher transfusion rates and postoperative hyponatremia were noted in the M-TURP group comparing to the HOLEP group.

Paradoxical Temporal Enlargement: An Expansion of Superficial Temporal Fat Pad Following Interfacial Technique for Pterional Craniotomy.

Contour irregularities in the temporal region have been reported previously after procedures involving temporal dissection. In this study, we report paradoxical temporal enlargement (PTE) following interfascial pterional craniotomy. A retrospective review of patients who underwent a unilateral transcranial procedure with frontotemporal approach at our institution between September 2013 and December 2017 was performed. Patients with a previous craniotomy or bilateral craniotomy were excluded. Radiological imaging series including computed tomography and magnetic resonance imaging were utilized to calculate temporal soft tissue volumes both preoperatively and postoperatively by using advanced software technology. Relative soft tissue volume differences between the operative side and the contralateral side were calculated at different time-points including preoperative, 3-months follow-up (3M), 12-months (12M) follow-up, and the last follow-up (LFU, over 1-year). Forty-three patients were included. Mean age was 52.7 ± 4.5 years. Mean follow-up was 27.9 ± 15.8 months. Significant changes of temporal fat pad relative-volume difference were observed between the preoperative and the corresponding 3M (t [82] = -2.8865, P = 0.0050); 12M (t [77] = -4.4321, P < 0.0001), and LFU (t [74] = -4.9862, P < 0.0001) postoperative time points. No significant change of the temporalis muscle was observed between the preoperative and the corresponding 3M (P = 0.3629), 12M (P = 0.1553), or LFU (P = 0.0715). Soft tissue volume showed a significant increase on the operative side between the preoperative and the corresponding LFU (t [74] = -2.5866, P = 0.0117). Paradoxical temporal enlargement with more than 10% volumetric change was observed in 24% of the patients at their LFU (>1-year). This change was not due to temporalis muscle changes. Paradoxical temporal enlargement was due to hypertrophy of the superficial temporal fat pad. Before surgical correction of postoperative temporal contour changes, it is important to obtain imaging and characterize the etiology of the deformity.

Different phenotypes of neuropsychiatric systemic lupus erythematosus are related to a distinct pattern of structural changes on brain MRI

ObjectivesThe underlying structural brain correlates of neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) remain unclear, thus hindering correct diagnosis.We compared brain tissue volumes between a clinically well-defined cohort of patients with NPSLE and SLE patients with neuropsychiatric syndromes not attributed to SLE (non-NPSLE). Within the NPSLE patients, we also examined differences between patients with two distinct disease phenotypes: ischemic and inflammatory.MethodsIn this prospective (May 2007 to April 2015) cohort study, we included 38 NPSLE patients (26 inflammatory and 12 ischemic) and 117 non-NPSLE patients. All patients underwent a 3-T brain MRI scan that was used to automatically determine white matter, grey matter, white matter hyperintensities (WMH) and total brain volumes. Group differences in brain tissue volumes were studied with linear regression analyses corrected for age, gender, and total intracranial volume and expressed as B values and 95% confidence intervals.ResultsNPSLE patients showed higher WMH volume compared to non-NPSLE patients (p = 0.004). NPSLE inflammatory patients showed lower total brain (p = 0.014) and white matter volumes (p = 0.020), and higher WMH volume (p = 0.002) compared to non-NPSLE patients. Additionally, NPSLE inflammatory patients showed lower white matter (p = 0.020) and total brain volumes (p = 0.038) compared to NPSLE ischemic patients.ConclusionWe showed that different phenotypes of NPSLE were related to distinct patterns of underlying structural brain MRI changes. Especially the inflammatory phenotype of NPSLE was associated with the most pronounced brain volume changes, which might facilitate the diagnostic process in SLE patients with neuropsychiatric symptoms.Key Points• Neuropsychiatric systemic lupus erythematosus (NPSLE) patients showed a higher WMH volume compared to SLE patients with neuropsychiatric syndromes not attributed to SLE (non-NPSLE).• NPSLE patients with inflammatory phenotype showed a lower total brain and white matter volume, and a higher volume of white matter hyperintensities, compared to non-NPSLE patients.• NPSLE patients with inflammatory phenotype showed lower white matter and total brain volumes compared to NPSLE patients with ischemic phenotype.

Decreased task‐evoked functional connectivity in the descending pain modulatory network in Alzheimer’s disease

AbstractBackgroundPeople with Alzheimer’s disease (AD) may suffer from alterations in the descending pain modulatory network (DPMN). Adults with AD receive fewer analgesic pain medications and report pain less frequently than healthy controls. This study examines possible alterations in task‐evoked functional connectivity (TEFC) in response to thermal pain in several structures comprising the DPMN. We hypothesize that adults with AD will demonstrate decreased TEFC between DPMN regions.MethodThe sample consisted of 61 adults, 31 people with Alzheimer’s disease (AD; Mage = 77) and 30 healthy controls (HC; Mage = 73). The groups did not differ on socioeconomic status, current or average pain, or state or trait anxiety scores. Age and depression scores differed between groups and were controlled. Participants completed 4 pseudorandomized fMRI sessions using a passive thermal pain induction task consisting of warmth, mild pain, and moderate pain temperature thresholds. Regions of interest were selected a priori: bilateral primary somatosensory cortex (S1), bilateral anterior insula (aINS), bilateral posterior insula (pINS), anterior cingulate cortex (ACC), and the periaqueductal gray (PAG). Psychophysiological interactions (PPI) analysis was completed using CONN v18.b. Motion correction was performed using Artifact Detection Tools and fMRI sessions for which greater than 20% of the timeseries exceeded 2 mm normalized motion were excluded from the analysis. Age and AD‐related differences in cerebral tissue volume were controlled. Contrasts for this analysis were chosen to be mild pain &gt; warmth and moderate pain &gt; warmth to subtract innocuous stimulus from noxious stimuli.ResultCompared to healthy controls, adults with AD exhibited decreased TEFC between the R S1 and L S1 for mild pain &gt; warmth (T = ‐2.03, p = 0.047), and decreased TEFC between the PAG and ACC for moderate pain &gt; warmth (T = ‐2.18, p = 0.033).ConclusionFindings suggest that in people with AD, decreased connectivity between left and right S1 may indicate altered sensory processing of neural input. Evidence of decreased connectivity between the PAG and ACC in adults with AD may indicate an inability to modulate endogenous opioid systems within the brain and may lead to increased suffering from pain.

The effect of immediate implant placement on alveolar ridge preservation compared to spontaneous healing after tooth extraction: Soft tissue findings from a randomized controlled clinical trial.

To compare soft tissue dimensional changes and relative differences in soft and hard tissue volumes 4months after single-tooth extraction and three different treatment modalities: spontaneous healing (SH) and alveolar ridge preservation by means of a deproteinized bovine bone mineral and a collagen matrix, with (IMPL/DBBM/CM) or without (DBBM/CM) immediate implant placement. STL files from study casts obtained at baseline and after 4months were matched to calculate buccal soft tissue linear and volumetric changes. DICOM files from CBCTs were superimposed to STL files allowing the evaluation of soft tissue thickness at baseline and 4months. Mean horizontal reduction accounted for 1.46±0.20 (SH), 0.85±0.38 (DBBM-CM) and 0.84±0.30 IMPL/DBBM-CM, with no statistical differences. Soft tissue thickness had a significant mean increase of 0.95 for SH group, compared to a non-significant mean decrease for DBBM-CM (0.20) and IMPL/DBBM-CM groups (0.07). A preservation technique with DBBM-CM, with or without immediate implant placement, did not reduce the horizontal linear and volumetric changes at the buccal soft tissue profile significantly at 4months after tooth extraction when compared to spontaneous healing. This is due to a significant increase in soft tissue thickness in spontaneously healing sites.

Neuroimaging of Cerebral Blood Flow and Sodium in Women with Lipedema.

Lipedema is characterized by pain, fatigue, and excessive adipose tissue and sodium accumulation of the lower extremities. This case-control study aims to determine whether sodium or vascular dysfunction is present in the central nervous system. Brain magnetic resonance imaging was performed at 3 T in patients with lipedema (n = 15) and control (n = 18) participants matched for sex, age, race, and BMI. Standard anatomical imaging and intracranial angiography were applied to evaluate brain volume and vasculopathy, respectively; arterial spin labeling and sodium magnetic resonance imaging were applied to quantify cerebral blood flow (CBF) (milliliters per 100 grams oftissue/minute) and brain tissue sodium content (millimoles per liter), respectively. A Mann-Whitney U test (significance criteria P < 0.05) was applied to evaluate group differences. No differences in tissue volume, white matter hyperintensities, intracranial vasculopathy, or tissue sodium content were observed between groups. Gray matter CBF was elevated (P = 0.03) in patients with lipedema (57.2 ± 9.6 mL per 100 g/min) versus controlparticipants (49.8 ± 9.1 mL per 100 g/min). Findings provide evidence that brain sodium and tissue fractions are similar between patients with lipedema and control participants and that patients with lipedema do not exhibit abnormal radiological indicators of intracranial vasculopathy or ischemic injury. Potential explanations for elevated CBF are discussed in the context of the growing literature on lipedema symptomatology and vascular dysfunction.

0562 Differences in Upper Airway Soft Tissue Volumes Between African American and Caucasian Patients with Obstructive Sleep Apnea Using Magnetic Resonance Imaging

Abstract Introduction Research suggests greater obstructive sleep apnea (OSA) severity in African-Americans than Caucasians. However, the underlying mechanisms causing this ethnic disparity are unknown. To evaluate possible mechanisms, we compared the size of the tongue between African American and Caucasian OSA patients using magnetic resonance imaging (MRI), controlling for age, body mass index (BMI) and apnea-hypoxia index (AHI). Given prior evidence of more severe OSA in African Americans, we hypothesized these patients would have larger soft tissue volumes compared to Caucasians. Methods Upper airway soft tissue volumes, (total tongue, tongue fat, lateral walls, pterygoids, total soft tissue) were quantified using MRI and compared between Caucasian (n=133) and African American (n=175) patients with moderate OSA. Analyses were conducted using regression models controlling for age, sex, BMI and AHI. Results Among all OSA patients, African Americans had higher BMI than Caucasians (40.0±8.6 vs. 37.1±8.1 kg/m2, p=0.0024) and a higher proportion of females (66.3% vs. 36.1%; p&amp;lt;0.0001). There were no significant differences in age (p=0.143) or AHI (p=0.314). Controlling for these covariates, there were no differences between African American and Caucasian OSA patients in tongue fat volume (mean [95% confidence interval] difference = 479 [-3156, 4115] mm3; p=0.794). However, African Americans had a 13,286 (6,439, 20,132) mm3 larger total tongue volume compared to Caucasians (p=0.0002). Larger volumes in African Americans were also observed for the soft palate (p&amp;lt;0.0001), retropalatal lateral walls (p=0.003), pterygoid (p=0.034) and total soft tissue volume (p=0.0003). Conclusion African Americans were observed to have larger volumes of the tongue, soft palate, retropalatal lateral walls, pterygoids and total soft tissue volume compared to Caucasians, although there were no differences in AHI and tongue fat volume. The study contributes to the overall understanding of ethnic-specific pathology of OSA and can potentially influence how African Americans and Caucasians are diagnosed and treated specifically for the disease. Support