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Cao J, Mu Y, Xu X, Li H, Liu Z, Cao M, Wang P, Sun W, Cui L. Cerebral perfusion changes of the basal ganglia and thalami in full-term neonates with hypoxic-ischaemic encephalopathy: a three-dimensional pseudo continuous arterial spin labelling perfusion magnetic resonance imaging study. Pediatr Radiol 2022; 52:1559-67. [PMID: 35357515 DOI: 10.1007/s00247-022-05344-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the common causes of neurological injury in full-term neonates following perinatal asphyxia. The conventional magnetic resonance technique has low sensitivity in detecting variations in cerebral blood flow in patients with HIE. OBJECTIVE This article evaluates the clinical diagnostic value of three-dimensional pseudo-continuous arterial spin labelling (3-D pcASL) perfusion magnetic resonance imaging (MRI) for early prediction of neurobehavioral outcomes in full-term neonates with HIE. MATERIALS AND METHODS All neonates diagnosed with HIE underwent MRI (conventional and 3-D pcASL perfusion MRI). Cerebral blood flow values were measured in the basal ganglia (caudate nuclei, lenticular nuclei), thalami and white matter regions (frontal lobes, corona radiata). After 1-month follow-up, the Neonatal Behavioral Neurological Assessment scores were used to divide patients into favourable outcome group versus adverse outcome group. RESULTS Twenty-three patients were enrolled in this study. There were no statistical differences between the symmetrical cerebral blood flow values of bilateral basal ganglia, thalami and white matter regions. However, the cerebral blood flow values of grey matter nuclei were higher than the white matter regions. The average value of cerebral blood flow in the basal ganglia and thalami in the adverse outcome group was 37.28±6.42 ml/100 g/min, which is greater than the favourable outcome group (22.55 ± 3.21 ml/100 g/min) (P<0.01). The area under the curve (AUC) of 3-D pcASL perfusion MRI was 0.992 with a cutoff value of 28.75 ml/100 g/min, with a Youden's index of 0.9231. The sensitivity and specificity were 92.3% and 100%, respectively. CONCLUSION The 3-D pcASL demonstrated higher perfusion alteration in the basal ganglia and thalami of neonatal HIE with adverse outcomes. The 3-D pcASL perfusion MRI has the potential to predict neurobehavioral outcomes of neonates with HIE.
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Tang S, Nie L, Liu X, Chen Z, Zhou Y, Pan Z, He L. Application of Quantitative Magnetic Resonance Imaging in the Diagnosis of Autism in Children. Front Med (Lausanne) 2022; 9:818404. [PMID: 35646984 PMCID: PMC9133426 DOI: 10.3389/fmed.2022.818404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the application of quantitative magnetic resonance imaging in the diagnosis of autism in children. Methods Sixty autistic children aged 2–3 years and 60 age- and sex-matched healthy children participated in the study. All the children were scanned using head MRI conventional sequences, 3D-T1, diffusion kurtosis imaging (DKI), enhanced T2*- weighted magnetic resonance angiography (ESWAN) and 3D-pseudo continuous Arterial Spin-Labeled (3D-pcASL) sequences. The quantitative susceptibility mapping (QSM), cerebral blood flow (CBF), and brain microstructure of each brain area were compared between the groups, and correlations were analyzed. Results The iron content and cerebral blood flow in the frontal lobe, temporal lobe, hippocampus, caudate nucleus, substantia nigra, and red nucleus of the study group were lower than those in the corresponding brain areas of the control group (P < 0.05). The mean kurtosis (MK), radial kurtosis (RK), and axial kurtosis (AK) values of the frontal lobe, temporal lobe, putamen, hippocampus, caudate nucleus, substantia nigra, and red nucleus in the study group were lower than those of the corresponding brain areas in the control group (P < 0.05). The mean diffusivity (MD) and fractional anisotropy of kurtosis (FAK) values of the frontal lobe, temporal lobe and hippocampus in the control group were lower than those in the corresponding brain areas in the study group (P < 0.05). The values of CBF, QSM, and DKI in frontal lobe, temporal lobe and hippocampus could distinguish ASD children (AUC > 0.5, P < 0.05), among which multimodal technology (QSM, CBF, DKI) had the highest AUC (0.917) and DKI had the lowest AUC (0.642). Conclusion Quantitative magnetic resonance imaging (including QSM, 3D-pcASL, and DKI) can detect abnormalities in the iron content, cerebral blood flow and brain microstructure in young autistic children, multimodal technology (QSM, CBF, DKI) could be considered as the first choice of imaging diagnostic technology. Clinical Trial Registration [http://www.chictr.org.cn/searchprojen.aspx], identifier [ChiCTR2000029699].
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Affiliation(s)
- Shilong Tang
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lisha Nie
- GE Healthcare, MR Research China, Beijing, China
| | - Xianfan Liu
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhuo Chen
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yu Zhou
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhengxia Pan
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- *Correspondence: Zhengxia Pan,
| | - Ling He
- Department of Radiology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Ling He,
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Kerner DM, Nikam R, Kandula VVR, Averill LW. Pearls and Pitfalls in Arterial Spin Labeling Perfusion-Weighted Imaging in Clinical Pediatric Imaging. Semin Ultrasound CT MR 2022; 43:19-30. [PMID: 35164906 DOI: 10.1053/j.sult.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Characteristic arterial spin labeling (ASL) perfusion patterns are seen in a wide variety of pediatric brain pathologies, highlighting the potential added value and prognostic role of this magnetic resonance imaging (MRI) perfusion-weighted imaging modality. Our objective is to review the basic clinical physics, technical underpinnings, and artifacts and challenges as we highlight some of the most clinically relevant pathologies to the application of ASL in the pediatric setting.
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Affiliation(s)
- David M Kerner
- Department of Radiology, Nemours Children's Health System, Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Rahul Nikam
- Department of Radiology, Nemours Children's Health System, Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Vinay V R Kandula
- Department of Radiology, Nemours Children's Health System, Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Lauren W Averill
- Department of Radiology, Nemours Children's Health System, Alfred I. duPont Hospital for Children, Wilmington, DE.
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Fahlström M, Wikström J, Borota L, Enblad P, Lewén A. Variable Temporal Cerebral Blood Flow Response to Acetazolamide in Moyamoya Patients Measured Using Arterial Spin Labeling. Front Neurol 2021; 12:615017. [PMID: 34168605 PMCID: PMC8217767 DOI: 10.3389/fneur.2021.615017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/07/2021] [Indexed: 11/13/2022] Open
Abstract
Cerebrovascular reserve capacity (CVR), an important predictor of ischaemic events and a prognostic factor for patients with moyamoya disease (MMD), can be assessed by measuring cerebral blood flow (CBF) before and after administration of acetazolamide (ACZ). Often, a single CBF measurement is performed between 5 and 20 min after ACZ injection. Assessment of the temporal response of the vasodilation secondary to ACZ administration using several repeated CBF measurements has not been studied extensively. Furthermore, the high standard deviations of the group-averaged CVRs reported in the current literature indicate a patient-specific dispersion of CVR values over a wide range. This study aimed to assess the temporal response of the CBF and derived CVR during ACZ challenge using arterial spin labeling in patients with MMD. Eleven patients with MMD were included before or after revascularisation surgery. CBF maps were acquired using pseudo-continuous arterial spin labeling before and 5, 15, and 25 min after an intravenous ACZ injection. A vascular territory template was spatially normalized to patient-specific space, including the bilateral anterior, middle, and posterior cerebral arteries. CBF increased significantly post-ACZ injection in all vascular territories and at all time points. Group-averaged CBF and CVR values remained constant throughout the ACZ challenge in most patients. The maximum increase in CBF occurred most frequently at 5 min post-ACZ injection. However, peaks at 15 or 25 min were also present in some patients. In 68% of the affected vascular territories, the maximum increase in CBF did not occur at 15 min. In individual cases, the difference in CVR between different time points was between 1 and 30% points (mean difference 8% points). In conclusion, there is a substantial variation in CVR between different time points after the ACZ challenge in patients with MMD. Thus, there is a risk that the use of a single post-ACZ measurement time point overestimates disease progression, which could have wide implications for decision-making regarding revascularisation surgery and the interpretation of the outcome thereof. Further studies with larger sample sizes using multiple CBF measurements post-ACZ injection in patients with MMD are encouraged.
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Affiliation(s)
- Markus Fahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Johan Wikström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Ljubisa Borota
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Per Enblad
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Anders Lewén
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
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Sleight E, Stringer MS, Marshall I, Wardlaw JM, Thrippleton MJ. Cerebrovascular Reactivity Measurement Using Magnetic Resonance Imaging: A Systematic Review. Front Physiol 2021; 12:643468. [PMID: 33716793 PMCID: PMC7947694 DOI: 10.3389/fphys.2021.643468] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022] Open
Abstract
Cerebrovascular reactivity (CVR) magnetic resonance imaging (MRI) probes cerebral haemodynamic changes in response to a vasodilatory stimulus. CVR closely relates to the health of the vasculature and is therefore a key parameter for studying cerebrovascular diseases such as stroke, small vessel disease and dementias. MRI allows in vivo measurement of CVR but several different methods have been presented in the literature, differing in pulse sequence, hardware requirements, stimulus and image processing technique. We systematically reviewed publications measuring CVR using MRI up to June 2020, identifying 235 relevant papers. We summarised the acquisition methods, experimental parameters, hardware and CVR quantification approaches used, clinical populations investigated, and corresponding summary CVR measures. CVR was investigated in many pathologies such as steno-occlusive diseases, dementia and small vessel disease and is generally lower in patients than in healthy controls. Blood oxygen level dependent (BOLD) acquisitions with fixed inspired CO2 gas or end-tidal CO2 forcing stimulus are the most commonly used methods. General linear modelling of the MRI signal with end-tidal CO2 as the regressor is the most frequently used method to compute CVR. Our survey of CVR measurement approaches and applications will help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.
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Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom,*Correspondence: Michael S. Stringer
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom,UK Dementia Research Institute, Edinburgh, United Kingdom
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Rava RA, Podgorsak AR, Waqas M, Snyder KV, Levy EI, Davies JM, Siddiqui AH, Ionita CN. Use of a convolutional neural network to identify infarct core using computed tomography perfusion parameters. Proc SPIE Int Soc Opt Eng 2021; 11596. [PMID: 33707811 DOI: 10.1117/12.2579753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Purpose Computed tomography perfusion (CTP) is used to diagnose ischemic strokes through contralateral hemisphere comparisons of various perfusion parameters. Various perfusion parameter thresholds have been utilized to segment infarct tissue due to differences in CTP software and patient baseline hemodynamics. This study utilized a convolutional neural network (CNN) to eliminate the need for non-universal parameter thresholds to segment infarct tissue. Methods CTP data from 63 ischemic stroke patients was retrospectively collected and perfusion parameter maps were generated using Vitrea CTP software. Infarct ground truth labels were segmented from diffusion-weighted imaging (DWI) and CTP and DWI volumes were registered. A U-net based CNN was trained and tested five separate times using each CTP parameter (cerebral blood flow (CBF), cerebral blood volume (CBV), time-to-peak (TTP), mean-transit-time (MTT), delay time). 8,352 infarct slices were utilized with a 60:30:10 training:testing:validation split and Monte Carlo cross-validation was conducted using 20 iterations. Infarct volumes were reconstructed following segmentation from each CTP slice. Infarct spatial and volumetric agreement was compared between each CTP parameter and DWI. Results Spatial agreement metrics (Dice coefficient, positive predictive value) for each CTP parameter in predicting infarct volumes are: CBF=(0.67, 0.76), CBV=(0.44, 0.62), TTP=(0.60, 0.67), MTT=(0.58, 0.62), delay time=(0.57, 0.60). 95% confidence intervals for volume differences with DWI infarct are: CBF=14.3±11.5 mL, CBV=29.6±21.2 mL, TTP=7.7±15.2 mL, MTT=-10.7±18.6 mL, delay time=-5.7±23.6 mL. Conclusions CBF is the most accurate CTP parameter in segmenting infarct tissue. Segmentation of infarct using a CNN has the potential to eliminate non-universal CTP contralateral hemisphere comparison thresholds.
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Affiliation(s)
- Ryan A Rava
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY, 14260.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203
| | - Alexander R Podgorsak
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY, 14260.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Medical Physics, University at Buffalo, Buffalo NY, 14260
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
| | - Kenneth V Snyder
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
| | - Jason M Davies
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY, 14260.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Medical Physics, University at Buffalo, Buffalo NY, 14260.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
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Rava RA, Podgorsak AR, Waqas M, Snyder KV, Mokin M, Levy EI, Davies JM, Siddiqui AH, Ionita CN. Investigation of convolutional neural networks using multiple computed tomography perfusion maps to identify infarct core in acute ischemic stroke patients. J Med Imaging (Bellingham) 2021; 8:014505. [PMID: 33585662 PMCID: PMC7874969 DOI: 10.1117/1.jmi.8.1.014505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/19/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: To assess acute ischemic stroke (AIS) severity, infarct is segmented using computed tomography perfusion (CTP) software, such as RAPID, Sphere, and Vitrea, relying on contralateral hemisphere thresholds. Since this approach is potentially patient dependent, we investigated whether convolutional neural networks (CNNs) could achieve better performances without the need for contralateral hemisphere thresholds. Approach: CTP and diffusion-weighted imaging (DWI) data were retrospectively collected for 63 AIS patients. Cerebral blood flow (CBF), cerebral blood volume (CBV), time-to-peak, mean-transit-time (MTT), and delay time maps were generated using Vitrea CTP software. U-net shaped CNNs were developed, trained, and tested for 26 different input CTP parameter combinations. Infarct labels were segmented from DWI volumes registered with CTP volumes. Infarct volumes were reconstructed from two-dimensional CTP infarct segmentations. To remove erroneous segmentations, conditional random field (CRF) postprocessing was applied and compared with prior results. Spatial and volumetric infarct agreement was assessed between DWI and CTP (CNNs and commercial software) using median infarct difference, median absolute error, dice coefficient, positive predictive value. Results: The most accurate combination of parameters for CNN segmenting infarct using CRF postprocessing was CBF, CBV, and MTT (4.83 mL, 10.14 mL, 0.66, 0.73). Commercial software results are: RAPID = (2.25 mL, 21.48 mL, 0.63, 0.70), Sphere = (7.57 mL, 17.74 mL, 0.64, 0.70), Vitrea = (6.79 mL, 15.28 mL, 0.63, 0.72). Conclusions: Use of CNNs with multiple input perfusion parameters has shown to be accurate in segmenting infarcts and has the ability to improve clinical workflow by eliminating the need for contralateral hemisphere comparisons.
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Affiliation(s)
- Ryan A. Rava
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
| | - Alexander R. Podgorsak
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Medical Physics, Buffalo New York, United States
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Kenneth V. Snyder
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Maxim Mokin
- University of South Florida, Department of Neurosurgery, Tampa, Florida, United States
| | - Elad I. Levy
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Jason M. Davies
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
- University at Buffalo, Department of Bioinformatics, Buffalo, New York, United States
| | - Adnan H. Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Ciprian N. Ionita
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Medical Physics, Buffalo New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
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Rava RA, Snyder KV, Mokin M, Waqas M, Zhang X, Podgorsak AR, Allman AB, Senko J, Shiraz Bhurwani MM, Hoi Y, Davies JM, Levy EI, Siddiqui AH, Ionita CN. Assessment of computed tomography perfusion software in predicting spatial location and volume of infarct in acute ischemic stroke patients: a comparison of Sphere, Vitrea, and RAPID. J Neurointerv Surg 2020; 13:130-135. [PMID: 32457224 DOI: 10.1136/neurintsurg-2020-015966] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND CT perfusion (CTP) infarct and penumbra estimations determine the eligibility of patients with acute ischemic stroke (AIS) for endovascular intervention. This study aimed to determine volumetric and spatial agreement of predicted RAPID, Vitrea, and Sphere CTP infarct with follow-up fluid attenuation inversion recovery (FLAIR) MRI infarct. METHODS 108 consecutive patients with AIS and large vessel occlusion were included in the study between April 2019 and January 2020 . Patients were divided into two groups: endovascular intervention (n=58) and conservative treatment (n=50). Intervention patients were treated with mechanical thrombectomy and achieved successful reperfusion (Thrombolysis in Cerebral Infarction 2b/2 c/3) while patients in the conservative treatment group did not receive mechanical thrombectomy or intravenous thrombolysis. Intervention and conservative treatment patients were included to assess infarct and penumbra estimations, respectively. It was assumed that in all patients treated conservatively, penumbra converted to infarct. CTP infarct and penumbra volumes were segmented from RAPID, Vitrea, and Sphere to assess volumetric and spatial agreement with follow-up FLAIR MRI. RESULTS Mean infarct differences (95% CIs) between each CTP software and FLAIR MRI for each cohort were: intervention cohort: RAPID=9.0±7.7 mL, Sphere=-0.2±8.7 mL, Vitrea=-7.9±8.9 mL; conservative treatment cohort: RAPID=-31.9±21.6 mL, Sphere=-26.8±17.4 mL, Vitrea=-15.3±13.7 mL. Overlap and Dice coefficients for predicted infarct were (overlap, Dice): intervention cohort: RAPID=(0.57, 0.44), Sphere=(0.68, 0.60), Vitrea=(0.70, 0.60); conservative treatment cohort: RAPID=(0.71, 0.56), Sphere=(0.73, 0.60), Vitrea=(0.72, 0.64). CONCLUSIONS Sphere proved the most accurate in patients who had intervention infarct assessment as Vitrea and RAPID overestimated and underestimated infarct, respectively. Vitrea proved the most accurate in penumbra assessment for patients treated conservatively although all software overestimated penumbra.
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Affiliation(s)
- Ryan A Rava
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, Buffalo, New York, USA
| | - Kenneth V Snyder
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA.,Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Maxim Mokin
- Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA.,Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Xiaoliang Zhang
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA
| | - Alexander R Podgorsak
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, Buffalo, New York, USA.,Medical Physics, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Ariana B Allman
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, Buffalo, New York, USA
| | - Jillian Senko
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, Buffalo, New York, USA
| | - Mohammad Mahdi Shiraz Bhurwani
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA.,Canon Stroke and Vascular Research Center, Buffalo, New York, USA
| | - Yiemeng Hoi
- Canon Medical Systems USA Inc, Tustin, California, USA
| | - Jason M Davies
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA.,Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Biomedical Informatics, University at Buffalo,The State University of New York, Buffalo, New York, USA
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA.,Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, New York, USA.,Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Ciprian N Ionita
- Biomedical Engineering, University at Buffalo-The State University of New York, Buffalo, New York, USA .,Canon Stroke and Vascular Research Center, Buffalo, New York, USA.,Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Medical Physics, University at Buffalo - The State University of New York, Buffalo, New York, USA
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Abstract
Perfusion imaging using arterial spin labeling noninvasively evaluates cerebral blood flow utilizing arterial blood water as endogenous tracer. It does not require the need of radiotracer or intravenous contrast and offers unique complimentary information in the imaging of pediatric brain. Common clinical applications include neonatal hypoxic ischemic encephalopathy, pediatric stroke and vascular malformations, epilepsy and brain tumors. Future applications may include evaluation of silent ischemia in sickle cell patients, monitor changes in intracranial pressure in hydrocephalus, provide additional insights in nonaccidental trauma and chronic traumatic brain injury (TBI) and in functional Magnetic resonance imaging (MRI). The purpose of this review article is to evaluate the technical considerations including pitfalls, physiological variations, clinical applications and future directions of arterial spin labeling imaging.
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Affiliation(s)
- Srikala Narayanan
- Children's Hospital of Pittsburgh of UPMC, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Vincent Schmithorst
- Children's Hospital of Pittsburgh of UPMC, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ashok Panigrahy
- John F. Caffey Endowed Chair in Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
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10
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Rava RA, Mokin M, Snyder KV, Waqas M, Siddiqui AH, Davies JM, Levy EI, Ionita CN. Performance of angiographic parametric imaging in locating infarct core in large vessel occlusion acute ischemic stroke patients. J Med Imaging (Bellingham) 2020; 7:016001. [PMID: 32064301 PMCID: PMC7012174 DOI: 10.1117/1.jmi.7.1.016001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/27/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose: Biomarkers related to hemodynamics can be quantified using angiographic parametric imaging (API), which is a quantitative imaging method that uses digital subtraction angiography (DSA). We aimed to assess the accuracy of API in locating infarct core within large vessel occlusion (LVO) acute ischemic stroke (AIS) patients. Approach: Data were retrospectively collected for 25 LVO AIS patients who achieved successful recanalization. DSA data from lateral and anteroposterior (AP) views were loaded into API software to generate hemodynamic parameter maps. Relative differences in hemispherical regions for each API parameter were calculated. Ground truth infarct core locations were obtained using 24-h follow-up fluid-attenuation inversion recovery (FLAIR) MRI imaging. FLAIR MRI infarct locations were registered with DSA images to determine infarct regions in API parameter maps. Relative differences across hemispheres for each API parameter were plotted against each other. A support vector machine was used to determine the optimal hyperplane for classifying regions as infarct or healthy tissue. Results: For the lateral and AP views, respectively, the most accurate classification of infarct regions came from plotting mean transit time (MTT) versus peak height (PH) [ accuracy = 0.8125 ± 0.0012 (95%)], the area under the receiver operator characteristic curve ( AUROC ) = 0.8946 ± 0.0000 (95%), and plotting MTT versus the area under the curve (AUC) [ accuracy = 0.7957 ± 0.0011 (95%), AUROC = 0.8759 ± 0.0000 (95%)]. Conclusions: API provides accurate assessment of locating ischemic core in AIS LVO patients and has the potential for clinical benefit by determining infarct core location and growth in real time for intraoperative decision making.
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Affiliation(s)
- Ryan A. Rava
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
| | - Maxim Mokin
- University of South Florida, Department of Neurosurgery, Tampa, Florida, United States
| | - Kenneth V. Snyder
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Adnan H. Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Jason M. Davies
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
- University at Buffalo, Department of Bioinformatics, Buffalo, New York, United States
| | - Elad I. Levy
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Ciprian N. Ionita
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
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Greer JS, Wang X, Wang Y, Pinho MC, Maldjian JA, Pedrosa I, Madhuranthakam AJ. Robust pCASL perfusion imaging using a 3D Cartesian acquisition with spiral profile reordering (CASPR). Magn Reson Med 2019; 82:1713-1724. [PMID: 31231894 PMCID: PMC6743738 DOI: 10.1002/mrm.27862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To improve the robustness of arterial spin-labeled measured perfusion using a novel Cartesian acquisition with spiral profile reordering (CASPR) 3D turbo spin echo (TSE) in the brain and kidneys. METHODS The CASPR view ordering followed a pseudo-spiral trajectory on a Cartesian grid, by sampling the center of k-space at the beginning of each echo train of a segmented 3D TSE acquisition. With institutional review board approval and written informed consent, 14 normal subjects (9 brain and 5 kidneys) were scanned with pCASL perfusion imaging using 3D CASPR and compared against 3D linear TSE (brain and kidneys), the established 2D EPI and 3D gradient and spin echo perfusion (brain), and 2D single-shot turbo spin-echo perfusion (kidneys). The SNR and the quantitative perfusion values were compared among different acquisitions. RESULTS 3D CASPR TSE achieved robust perfusion across all slices compared to 3D linear TSE in the brain and kidneys. Compared to 2D EPI, 3D CASPR TSE showed higher SNR across the brain (P < 0.01), and exhibited good agreement (36.4 ± 4.7 and 36.9 ± 5.3 mL/100 g/min with 2D EPI and 3D CASPR, respectively), and with 3D gradient and spin echo (27.9 ± 7.2 mL/100 g/min). Compared to a single slice 2D single-shot turbo spin-echo acquisition, 3D CASPR TSE achieved robust perfusion across the entire kidneys in similar scan time with comparable quantified perfusion values (154.1 ± 74.6 and 151.7 ± 70.6 mL/100 g/min with 2D single-shot turbo spin-echo and 3D CASPR, respectively). CONCLUSION The CASPR view ordering with 3D TSE achieves robust arterial spin-labeled perfusion in the brain and kidneys because of the sampling of the center of k-space at the beginning of each echo train.
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Affiliation(s)
- Joshua S. Greer
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Xinzeng Wang
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Yiming Wang
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Marco C. Pinho
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX
| | - Joseph A. Maldjian
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX
| | - Ivan Pedrosa
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX
| | - Ananth J. Madhuranthakam
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX
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Tang S, Liu X, He L, Liu B, Qin B, Feng C. Application of a 3D pseudocontinuous arterial spin-labeled perfusion MRI scan combined with a postlabeling delay value in the diagnosis of neonatal hypoxic-ischemic encephalopathy. PLoS One 2019; 14:e0219284. [PMID: 31283776 DOI: 10.1371/journal.pone.0219284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 06/20/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Currently, there are many studies on the application of the 3D pseudocontinuous arterial spin-labeled (3D-pcASL) perfusion MRI technique for adult brain examinations, but few studies exist on the application of the technique for child brain examinations. PURPOSE To explore the application of a 3D-pcASL perfusion MRI scan combined with postlabeling delay (PLD) for assessing neonatal hypoxic-ischemic encephalopathy (HIE). MATERIALS AND METHODS Two-hundred neonates diagnosed with neonatal HIE were equally divided into five groups (40/group): 0- to <24-hour-old HIE group, 1- to <3-day-old HIE group, 3- to <7-day-old HIE group, 7- to <15-day-old HIE group and 15- to 28-day-old HIE group; 200 healthy neonates were equivalently divided. All 10 groups received a conventional and a 3D-pcASL perfusion MRI scan. For groups <3 days old, PLD values for the 3D-pcASL cerebral perfusion MRI scan were preset at 1025 ms; in all other groups, PLD values were preset at 1525 ms. CBF values for the 3D-pcASL cerebral perfusion MRI were compared between the HIE and corresponding control groups to determine the distinguishing characteristics of CBF values in HIE neonates. RESULTS On the 3D-pcASL cerebral perfusion MRI scan, in the 1- to <3-day-old groups, HIE neonate CBF values were higher than those of controls in all brain regions (excluding the frontal lobe); in the 0- to <24-hour-old and 3- to <7-day-old groups, HIE neonate CBF values were lower than those of corresponding controls in all brain regions; in the 7- to <15-day-old and 15- to 28-day-old groups, there were no significant differences in the CBF values between groups in any brain regions. CONCLUSIONS The 3D-pcASL perfusion MRI scan combined with a PLD can assist in the early diagnosis of neonatal HIE, as this method more comprehensively reflects the HIE pathological process.
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Tang S, Liu X, He L, Liu B, Qin B, Feng C. Application of Postlabeling Delay Time in 3-Dimensional Pseudocontinuous Arterial Spin-Labeled Perfusion Imaging in Normal Children: . J Comput Assist Tomogr 2019; 43:697-707. [DOI: 10.1097/rct.0000000000000911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Robison RK, Li Z, Wang D, Ooi MB, Pipe JG. Correction of B
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eddy current effects in spiral MRI. Magn Reson Med 2018; 81:2501-2513. [DOI: 10.1002/mrm.27583] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/05/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Ryan K. Robison
- Phoenix Children's Hospital Phoenix Arizona
- Barrow Neurological Institute Phoenix Arizona
| | - Zhiqiang Li
- Barrow Neurological Institute Phoenix Arizona
| | | | - Melvyn B. Ooi
- Barrow Neurological Institute Phoenix Arizona
- Philips Healthcare Gainesville Florida
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Young AMH, Guilfoyle MR, Donnelly J, Smielewski P, Agarwal S, Czosnyka M, Hutchinson PJ. Multimodality neuromonitoring in severe pediatric traumatic brain injury. Pediatr Res 2018; 83:41-9. [PMID: 29084196 DOI: 10.1038/pr.2017.215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 08/31/2017] [Indexed: 12/18/2022]
Abstract
Each year, the annual hospitalization rates of traumatic brain injury (TBI) in children in the United States are 57.7 per 100K in the <5 years of age and 23.1 per 100K in the 5-14 years age group. Despite this, little is known about the pathophysiology of TBI in children and how to manage it most effectively. Historically, TBI management has been guided by clinical examination. This has been assisted progressively by clinical imaging, intracranial pressure (ICP) monitoring, and finally a software that can calculate optimal brain physiology. Multimodality monitoring affords clinicians an early indication of secondary insults to the recovering brain including raised ICP and decreased cerebral perfusion pressure. From variables such as ICP and arterial blood pressure, correlations can be drawn to determine parameters of cerebral autoregulation (pressure reactivity index) and "optimal cerebral perfusion pressure" at which the vasculature is most reactive. More recently, significant advances using both direct and near-infrared spectroscopy-derived brain oxygenation plus cerebral microdialysis to drive management have been described. Here in, we provide a perspective on the state-of-the-art techniques recently implemented in clinical practice for pediatric TBI.
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Zhang Q, Shan W, Ai C, Chen Z, Zhou T, Lv X, Zhou X, Ye S, Ren L, Wang X. Construction of Multifunctional Fe 3O 4-MTX@HBc Nanoparticles for MR Imaging and Photothermal Therapy/Chemotherapy. Nanotheranostics 2018; 2:87-95. [PMID: 29291165 PMCID: PMC5743840 DOI: 10.7150/ntno.21942] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 11/10/2017] [Indexed: 01/23/2023] Open
Abstract
To accomplish effective cancer imaging and integrated therapy, the multifunctional nanotheranostic Fe3O4-MTX@HBc core-shell nanoparticles (NPs) were designed. A straightforward method was demonstrated for efficient encapsulation of magnetic NPs into the engineered virus-like particles (VLPs) through the affinity of histidine tags for the methotrexate (MTX)-Ni2+ chelate. HBc144-His VLPs shell could protect Fe3O4-MTX NPs from the recognition by the reticuloendothelial system as well as could increase their cellular uptake efficiency. Through our well-designed tactic, the photothermal efficiency of Fe3O4 NPs were obviously improved in vitro and in vivo upon near-infrared (NIR) laser irradiation. Moreover, Magnetic resonance imaging (MRI) results showed that the Fe3O4-MTX@HBc core-shell NPs were reliable T2-type MRI contrast agents for tumor imaging. Hence the Fe3O4-MTX@HBc core-shell NPs may act as a promising theranostic platform for multimodal cancer treatment.
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Affiliation(s)
- Qiang Zhang
- School of Pharmaceutical Sciences, Xiamen University, Xiamen 361002, Fujian, P. R. China
| | - Wenjun Shan
- Key Laboratory of Biomedical Engineering of Fujian Province University/Research Center of Biomedical Engineering of Xiamen, Department of Biomaterials, College of Materials, Xiamen University, Xiamen 361005, Fujian, P. R. China
| | - Chaochao Ai
- Key Laboratory of Biomedical Engineering of Fujian Province University/Research Center of Biomedical Engineering of Xiamen, Department of Biomaterials, College of Materials, Xiamen University, Xiamen 361005, Fujian, P. R. China
| | - Zhiwei Chen
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance Research, Xiamen University, Xiamen 361005, Fujian, P. R. China
| | - Tiantian Zhou
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance Research, Xiamen University, Xiamen 361005, Fujian, P. R. China
| | - Xiaolin Lv
- Key Laboratory of Biomedical Engineering of Fujian Province University/Research Center of Biomedical Engineering of Xiamen, Department of Biomaterials, College of Materials, Xiamen University, Xiamen 361005, Fujian, P. R. China
| | - Xi Zhou
- Key Laboratory of Biomedical Engineering of Fujian Province University/Research Center of Biomedical Engineering of Xiamen, Department of Biomaterials, College of Materials, Xiamen University, Xiamen 361005, Fujian, P. R. China
| | - Shefang Ye
- Key Laboratory of Biomedical Engineering of Fujian Province University/Research Center of Biomedical Engineering of Xiamen, Department of Biomaterials, College of Materials, Xiamen University, Xiamen 361005, Fujian, P. R. China
| | - Lei Ren
- Key Laboratory of Biomedical Engineering of Fujian Province University/Research Center of Biomedical Engineering of Xiamen, Department of Biomaterials, College of Materials, Xiamen University, Xiamen 361005, Fujian, P. R. China.,Fujian Collaborative Innovation Center for Exploitation and Utilization of Marine Biological Resources, Xiamen University, Xiamen 361005, Fujian, P. R. China.,State Key Lab of Physical Chemistry of Solid Surfaces, Xiamen University, Xiamen 361005, P. R. China
| | - Xiumin Wang
- School of Pharmaceutical Sciences, Xiamen University, Xiamen 361002, Fujian, P. R. China
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