1
|
Zheng L, Jiang P, Lin D, Chen X, Zhong T, Zhang R, Chen J, Song Y, Xue Y, Lin L. Histogram analysis of mono-exponential, bi-exponential and stretched-exponential diffusion-weighted MR imaging in predicting consistency of meningiomas. Cancer Imaging 2023; 23:117. [PMID: 38053183 DOI: 10.1186/s40644-023-00633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The consistency of meningiomas is critical to determine surgical planning and has a significant impact on surgical outcomes. Our aim was to compare mono-exponential, bi-exponential and stretched exponential MR diffusion-weighted imaging in predicting the consistency of meningiomas before surgery. METHODS Forty-seven consecutive patients with pathologically confirmed meningiomas were prospectively enrolled in this study. Two senior neurosurgeons independently evaluated tumour consistency and classified them into soft and hard groups. A volume of interest was placed on the preoperative MR diffusion images to outline the whole tumour area. Histogram parameters (mean, median, 10th percentile, 90th percentile, kurtosis, skewness) were extracted from 6 different diffusion maps including ADC (DWI), D*, D, f (IVIM), alpha and DDC (SEM). Comparisons between two groups were made using Student's t-Test or Mann-Whitney U test. Parameters with significant differences between the two groups were included for Receiver operating characteristic analysis. The DeLong test was used to compare AUCs. RESULTS DDC, D* and ADC 10th percentile were significantly lower in hard tumours than in soft tumours (P ≤ 0.05). The alpha 90th percentile was significantly higher in hard tumours than in soft tumours (P < 0.02). For all histogram parameters, the alpha 90th percentile yielded the highest AUC of 0.88, with an accuracy of 85.10%. The D* 10th percentile had a relatively higher AUC value, followed by the DDC and ADC 10th percentile. The alpha 90th percentile had a significantly greater AUC value than the ADC 10th percentile (P ≤ 0.05). The D* 10th percentile had a significantly greater AUC value than the ADC 10th percentile and DDC 10th percentile (P ≤ 0.03). CONCLUSION Histogram parameters of Alpha and D* may serve as better imaging biomarkers to aid in predicting the consistency of meningioma.
Collapse
Affiliation(s)
- Lingmin Zheng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Peirong Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Danjie Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Xiaodan Chen
- Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Tianjin Zhong
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Rufei Zhang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Jing Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Yang Song
- MR Scientific Marketing, Healthineers Ltd, Siemens, Shanghai, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
| | - Lin Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
- School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, 350004, China.
| |
Collapse
|
2
|
Ahmed ANA. Preoperative Magnetic Resonance Elastography (MRE) of Skull Base Tumours: A Review. Indian J Otolaryngol Head Neck Surg 2023; 75:4173-4178. [PMID: 37974805 PMCID: PMC10645913 DOI: 10.1007/s12070-023-03955-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
Conventional magnetic resonance imaging (MRI) can detect tumors consistency, but it can't predict tumor stiffness or adherence of the tumor to nearby structures. Magnetic resonance elastography (MRE) is a known non-invasive MRI based imaging technique used to assess the viscoelasticity of the tissues particularly liver fibrosis. This study discussed the importance of preoperative MRE in skull base tumors and the future implications of this new imaging modality. We did review of the English literature (by searching PubMed) regarding the use of MRE in preoperative assessment of skull base tumours stiffness and adherence to surrounding tissues. Recent research demonstrated that MRE can detect the stiffness and adherence of skull base tumors to surrounding structures by recording the spread of mechanical waves in the different tissues. In addition to non-radiation exposure, this technique is fast and can be incorporated into the conventional (MRI) study. MRE can palpate skull base tumours by imaging, allowing the stiffness of the tumour to be assessed. Preoperative assessment of brain tumours consistency, stiffness, and adherence to surrounding tissues is critical to avoid injury of important nearby structures and better preoperative patient counselling regarding surgical approach (endoscopic or open), operative time, and suspected surgical complications. However, the accuracy of MRE is less in small and highly vascular tumors. Also, MRE can't accurately detect tumour-brain adherence, but the new modality (slip-interface imaging) can. Hence, adding MRE to the conventional MRI study may help in preoperative diagnosis and treatment of skull base tumours.
Collapse
Affiliation(s)
- Ahmed Nabil Abdelhamid Ahmed
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, 6th Nile Valley Street, Hadayek Alkoba, Cairo, 11331 Egypt
| |
Collapse
|
3
|
Takamura T, Hara S, Nariai T, Ikenouchi Y, Suzuki M, Taoka T, Ida M, Ishigame K, Hori M, Sato K, Kamagata K, Kumamaru K, Oishi H, Okamoto S, Araki Y, Uda K, Miyajima M, Maehara T, Inaji M, Tanaka Y, Naganawa S, Kawai H, Nakane T, Tsurushima Y, Onodera T, Nojiri S, Aoki S. Effect of Temporal Sampling Rate on Estimates of the Perfusion Parameters for Patients with Moyamoya Disease Assessed with Simultaneous Multislice Dynamic Susceptibility Contrast-enhanced MR Imaging. Magn Reson Med Sci 2023; 22:301-312. [PMID: 35296610 PMCID: PMC10449549 DOI: 10.2463/mrms.mp.2021-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/19/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The effect of temporal sampling rate (TSR) on perfusion parameters has not been fully investigated in Moyamoya disease (MMD); therefore, this study evaluated the influence of different TSRs on perfusion parameters quantitatively and qualitatively by applying simultaneous multi-slice (SMS) dynamic susceptibility contrast-enhanced MR imaging (DSC-MRI). METHODS DSC-MRI datasets were acquired from 28 patients with MMD with a TSR of 0.5 s. Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and time to maximum tissue residue function (Tmax) were calculated for eight TSRs ranging from 0.5 to 4.0 s in 0.5-s increments that were subsampled from a TSR of 0.5 s datasets. Perfusion measurements and volume for chronic ischemic (Tmax ≥ 2 s) and non-ischemic (Tmax < 2 s) areas for each TSR were compared to measurements with a TSR of 0.5 s, as was visual perfusion map analysis. RESULTS CBF, CBV, and Tmax values tended to be underestimated, whereas MTT and TTP values were less influenced, with a longer TSR. Although Tmax values were overestimated in the TSR of 1.0 s in non-ischemic areas, differences in perfusion measurements between the TSRs of 0.5 and 1.0 s were generally minimal. The volumes of the chronic ischemic areas with a TSR ≥ 3.0 s were significantly underestimated. In CBF and CBV maps, no significant deterioration was noted in image quality up to 3.0 and 2.5 s, respectively. The image quality of MTT, TTP, and Tmax maps for the TSR of 1.0 s was similar to that for the TSR of 0.5 s but was significantly deteriorated for the TSRs of ≥ 1.5 s. CONCLUSION In the assessment of MMD by SMS DSC-MRI, application of TSRs of ≥ 1.5 s may lead to deterioration of the perfusion measurements; however, that was less influenced in TSRs of ≤ 1.0 s.
Collapse
Affiliation(s)
- Tomohiro Takamura
- Department of Radiology, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Department of Radiology, Juntendo University, Tokyo, Japan
| | - Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | - Toshiaki Taoka
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Masahiro Ida
- Department of Radiology, Mito Medical Center, Higashiibaraki, Ibaraki, Japan
| | - Keiichi Ishigame
- Department of Radiology, Kenshinkai Tokyo Medical Clinic, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University, Tokyo, Japan
- Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Kanako Sato
- Department of Radiology, Juntendo University, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University, Tokyo, Japan
| | | | - Hidenori Oishi
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | - Sho Okamoto
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University, Nagoya, Aichi, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Hisashi Kawai
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | - Toshiki Nakane
- Department of Radiology, Nagoya University, Nagoya, Aichi, Japan
| | | | - Toshiyuki Onodera
- Department of Radiology, Tokyo Metropolitan Cancer Detection Center, Tokyo, Japan
| | - Shuko Nojiri
- Clinical Research and Trial Center, Juntendo Hospital, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University, Tokyo, Japan
| |
Collapse
|
4
|
Hersh AM, Weber-Levine C, Jiang K, Young L, Kerensky M, Routkevitch D, Tsehay Y, Perdomo-Pantoja A, Judy BF, Lubelski D, Theodore N, Manbachi A. Applications of elastography in operative neurosurgery: A systematic review. J Clin Neurosci 2022; 104:18-28. [PMID: 35933785 PMCID: PMC11023619 DOI: 10.1016/j.jocn.2022.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
Elastography is an imaging technology capable of measuring tissue stiffness and consistency. The technology has achieved widespread use in the workup and management of diseases of the liver, breast, thyroid, and prostate. Although elastography is increasingly being applied in neurosurgery, it has not yet achieved widespread adoption and many clinicians remain unfamiliar with the technology. Therefore, we sought to summarize the range of applications and elastography modalities available for neurosurgery, report its effectiveness in comparison with conventional imaging methods, and offer recommendations. All full-text English-language manuscripts on the use of elastography for neurosurgical procedures were screened using the PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science databases. Thirty-two studies were included with 990 patients, including 21 studies on intracranial tumors, 5 on hydrocephalus, 4 on epilepsy, 1 on spinal cord compression, and 1 on adolescent scoliosis. Twenty studies used ultrasound elastography (USE) whereas 12 used magnetic resonance elastography (MRE). MRE studies were mostly used in the preoperative setting for assessment of lesion stiffness, tumor-brain adherence, diagnostic workup, and operative planning. USE studies were performed intraoperatively to guide resection of lesions, determine residual microscopic abnormalities, assess the tumor-brain interface, and study mechanical properties of tumors. Elastography can assist with resection of brain tissue, detection of microscopic lesions, and workup of hydrocephalus, among other applications under investigation. Its sensitivity often exceeds that of conventional MRI and ultrasound for identifying abnormal tissue and lesion margins.
Collapse
Affiliation(s)
- Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carly Weber-Levine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lisa Young
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Max Kerensky
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Denis Routkevitch
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yohannes Tsehay
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Amir Manbachi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
5
|
Chen J, Zhang Z, Li Y, Zeng H, Li Z, Wang C, Xu C, Deng Q, Wang Q, Yang X, Li Z. Precise fibrin decomposition and tumor mechanics modulation with hydroxyethyl starch-based smart nanomedicine for enhanced antitumor efficacy. J Mater Chem B 2022; 10:8193-8210. [PMID: 36172808 DOI: 10.1039/d2tb01812h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Chemotherapy is a conventional cancer treatment in clinical settings. Although numerous nano drug delivery systems have been developed, the chemotherapeutic effect is greatly limited by abnormal tumor mechanics in solid tumors. Tumor stiffening and accumulated solid stress compress blood vessels and inhibit drug delivery to tumor cells, becoming critical challenges for chemotherapy. By loading doxorubicin (DOX), tissue plasminogen activator (tPA), and fibrin targeting peptide CREKA (Cys-Arg-Glu-Lys-Ala) within pH responsive amphiphilic block polymers, pyridyldithio-hydroxyethyl starch-Schiff base-polylactic acid (PA-HES-pH-PLA), we report a smart nanomedicine, DOX@CREKA/tPA-HES-pH-PLA (DOX@CREKA/tPA-HP), which exhibits a potent antitumor efficacy. In triple-negative breast cancer (TNBC) 4T1 tumors, DOX@CREKA/tPA-HP precisely targeted and effectively decomposed fibrin matrix. By measuring Young's Modulus of tumor slices and quantifying tumor openings, we demonstrated that DOX@CREKA/tPA-HP remarkably reduced tumor stiffness and solid stress. Consequently, the alleviated tumor mechanics decompressed tumor blood vessels, promoted drug delivery, and led to amplified antitumor effect. Our work reveals that decomposing fibrin is a significant means for modulating tumor mechanics, and DOX@CREKA/tPA-HP is a promising smart nanomedicine for treating TNBC.
Collapse
Affiliation(s)
- Jitang Chen
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.
| | - Zhijie Zhang
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.
| | - Yining Li
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.
| | - Haowen Zeng
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.
| | - Zheng Li
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.
| | - Chong Wang
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.
| | - Chen Xu
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.
| | - Qingyuan Deng
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.
| | - Qiang Wang
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.
| | - Xiangliang Yang
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China. .,Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.,Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medical, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.,Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.,GBA Research Innovation Institute for Nanotechnology, Guangdong, 510530, P. R. China
| | - Zifu Li
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China. .,Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.,Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medical, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.,Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China.,Wuhan Institute of Biotechnology, High Tech Road 666, East Lake high tech Zone, Wuhan, 430040, P. R. China
| |
Collapse
|
6
|
Shi Y, Huo Y, Pan C, Qi Y, Yin Z, Ehman RL, Li Z, Yin X, Du B, Qi Z, Yang A, Hong Y. Use of magnetic resonance elastography to gauge meningioma intratumoral consistency and histotype. Neuroimage Clin 2022; 36:103173. [PMID: 36081257 PMCID: PMC9463601 DOI: 10.1016/j.nicl.2022.103173] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether tumor shear stiffness, as measured by magnetic resonance elastography, corresponds with intratumoral consistency and histotype. MATERIALS AND METHODS A total of 88 patients with 89 meningiomas (grade 1, 74 typical [13 fibroblastic, 61 non-fibroblastic]; grade 2, 12 atypical; grade 3, 3 anaplastic) were prospectively studied, each undergoing preoperative MRE in conjunction with T1-, T2- and diffusion-weighted imaging. Contrast-enhanced T1-weighted sequences were also obtained. Tumor consistency was evaluated as heterogeneous or homogenous, and graded on a 5-point scale intraoperatively. MRE-determined shear stiffness was associated with tumor consistency by surgeon's evaluation and whole-slide histologic analyses. RESULTS Mean tumor stiffness overall was 3.81+/-1.74 kPa (range, 1.57-12.60 kPa), correlating well with intraoperative scoring (r = 0.748; p = 0.001). MRE performed well as a gauge of tumor consistency (AUC = 0.879, 95 % CI: 0.792-0.938) and heterogeneity (AUC = 0.773, 95 % CI: 0.618-0.813), significantly surpassing conventional MR techniques (DeLong test, all p < 0.001 after Bonferroni adjustment). Shear stiffness was independently correlated with both fibrous content (partial correlation coefficient = 0.752; p < 0.001) and tumor cellularity (partial correlation coefficient = 0.547; p < 0.001). MRE outperformed other imaging techniques in distinguishing fibroblastic meningiomas from other histotypes (AUC = 0.835 vs 0.513 ∼ 0.634; all p < 0.05), but showed limited ability to differentiate atypical or anaplastic meningiomas from typical meningiomas (AUC = 0.723 vs 0.616 ∼ 0.775; all p > 0.05). Small (<2.5 cm, n = 6) and intraventricular (n = 2) tumors displayed inconsistencies between MRE and surgeon's evaluation. CONCLUSIONS The results of this prospective study provide substantial evidence that preoperative evaluation of meningiomas with MRE can reliably characterize tumor stiffness and spatial heterogeneity to aid neurosurgical planning.
Collapse
Affiliation(s)
- Yu Shi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Yunlong Huo
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Chen Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Yafei Qi
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Ziying Yin
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Zhenyu Li
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Xiaoli Yin
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Bai Du
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Ziyang Qi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Aoran Yang
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, PR China.
| | - Yang Hong
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, PR China.
| |
Collapse
|