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Marzi C, Giannelli M, Barucci A, Tessa C, Mascalchi M, Diciotti S. Efficacy of MRI data harmonization in the age of machine learning: a multicenter study across 36 datasets. Sci Data 2024; 11:115. [PMID: 38263181 PMCID: PMC10805868 DOI: 10.1038/s41597-023-02421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/27/2023] [Indexed: 01/25/2024] Open
Abstract
Pooling publicly-available MRI data from multiple sites allows to assemble extensive groups of subjects, increase statistical power, and promote data reuse with machine learning techniques. The harmonization of multicenter data is necessary to reduce the confounding effect associated with non-biological sources of variability in the data. However, when applied to the entire dataset before machine learning, the harmonization leads to data leakage, because information outside the training set may affect model building, and potentially falsely overestimate performance. We propose a 1) measurement of the efficacy of data harmonization; 2) harmonizer transformer, i.e., an implementation of the ComBat harmonization allowing its encapsulation among the preprocessing steps of a machine learning pipeline, avoiding data leakage by design. We tested these tools using brain T1-weighted MRI data from 1740 healthy subjects acquired at 36 sites. After harmonization, the site effect was removed or reduced, and we showed the data leakage effect in predicting individual age from MRI data, highlighting that introducing the harmonizer transformer into a machine learning pipeline allows for avoiding data leakage by design.
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Affiliation(s)
- Chiara Marzi
- Department of Statistics, Computer Science and Applications "Giuseppe Parenti", University of Florence, 50134, Florence, Italy
- "Nello Carrara" Institute of Applied Physics (IFAC), National Research Council (CNR), 50019, Sesto Fiorentino, Florence, Italy
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", 56126, Pisa, Italy
| | - Andrea Barucci
- "Nello Carrara" Institute of Applied Physics (IFAC), National Research Council (CNR), 50019, Sesto Fiorentino, Florence, Italy
| | - Carlo Tessa
- Radiology Unit Apuane e Lunigiana, Azienda USL Toscana Nord Ovest, 54100, Massa, Italy
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50139, Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and netwoRk in Oncology (ISPRO), 50139, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, 47522, Cesena, Italy.
- Alma Mater Research Institute for Human-Centered Artificial Intelligence, University of Bologna, 40121, Bologna, Italy.
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Alfano F, Cesari F, Gori AM, Berteotti M, Salvadori E, Giusti B, Bertelli A, Kura A, Barbato C, Formelli B, Pescini F, Fainardi E, Chiti S, Marzi C, Diciotti S, Marcucci R, Poggesi A. The Role of Extracellular Matrix and Inflammation in the Stratification of Bleeding and Thrombotic Risk of Atrial Fibrillation on Oral Anticoagulant Therapy: Insights from Strat-Af Study. J Clin Med 2023; 12:6866. [PMID: 37959331 PMCID: PMC10647302 DOI: 10.3390/jcm12216866] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/26/2023] [Revised: 10/20/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
In anticoagulated atrial fibrillation (AF) patients, the validity of models recommended for the stratification of the risk ratio between benefits and hemorrhage risk is limited. We hypothesize that both circulating and neuroimaging-based markers might improve the prediction of bleeding and thrombotic risk in anticoagulated AF patients. The Strat-AF study is an observational, prospective, single-center study enrolling 170 patients with AF; recruited patients are evaluated by means of a comprehensive protocol, with clinical, cerebral magnetic resonance imaging and circulating biomarkers assessment. The main outcome is the evaluation of cerebral microangiopathy related to the levels of circulating biomarkers of inflammation and extracellular matrix (ECM) remodeling. At multivariate logistic regression analysis adjusted for age, sex, CHA2DS2-VASc, HAS-BLED and type of anticoagulant, matrix metalloproteinases (MMP)-2 levels were significantly and positively associated with the presence of cerebral microbleeds (CMBs). A significant association between MMP-2, tissue inhibitor of metalloproteinases (TIMP)-1,-2,-4 levels and white matter hyperintensity was also found. Concerning the small vessel disease (SVD) score, MMP-2 and TIMP-1,-2 levels were associated with the presence of two and three or more signs of SVD, whereas TIMP-4 levels were associated with the presence of three signs of SVD with respect to patients with no instrumental signs of SVD. As regarding the presence of enlarged perivascular spaces (EPVS), a significant association was found for high levels of interleukin (IL)-8 and TIMP 1-2-3. These results demonstrate that patients with AF have evidence of impaired ECM degradation, which is an independent risk factor for thrombotic complications of AF patients on oral anticoagulant therapy. The incorporation of these markers in the prognostic schemes might improve their clinical capability in predicting stroke risk and thrombotic complications.
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Affiliation(s)
- Francesco Alfano
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Francesca Cesari
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Martina Berteotti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (E.S.); (C.B.); (B.F.); (A.P.)
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Alessia Bertelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
| | - Ada Kura
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Carmen Barbato
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (E.S.); (C.B.); (B.F.); (A.P.)
| | - Benedetta Formelli
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (E.S.); (C.B.); (B.F.); (A.P.)
| | | | - Enrico Fainardi
- Neuroradiology Unit, Careggi University Hospital, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy;
| | - Stefano Chiti
- Health Physics Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Chiara Marzi
- Institute of Applied Physics “Nello Carrara” (IFAC), National Research Council of Italy (CNR), 50019 Sesto Fiorentino, Italy;
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, 40126 Bologna, Italy;
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (E.S.); (C.B.); (B.F.); (A.P.)
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy;
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Marzi C, Scheda R, Salvadori E, Giorgio A, De Stefano N, Poggesi A, Inzitari D, Pantoni L, Mascalchi M, Diciotti S. Fractal dimension of the cortical gray matter outweighs other brain MRI features as a predictor of transition to dementia in patients with mild cognitive impairment and leukoaraiosis. Front Hum Neurosci 2023; 17:1231513. [PMID: 37822707 PMCID: PMC10562576 DOI: 10.3389/fnhum.2023.1231513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023] Open
Abstract
Background The relative contribution of changes in the cerebral white matter (WM) and cortical gray matter (GM) to the transition to dementia in patients with mild cognitive impairment (MCI) is not yet established. In this longitudinal study, we aimed to analyze MRI features that may predict the transition to dementia in patients with MCI and T2 hyperintensities in the cerebral WM, also known as leukoaraiosis. Methods Sixty-four participants with MCI and moderate to severe leukoaraiosis underwent baseline MRI examinations and annual neuropsychological testing over a 2 year period. The diagnosis of dementia was based on established criteria. We evaluated demographic, neuropsychological, and several MRI features at baseline as predictors of the clinical transition. The MRI features included visually assessed MRI features, such as the number of lacunes, microbleeds, and dilated perivascular spaces, and quantitative MRI features, such as volumes of the cortical GM, hippocampus, T2 hyperintensities, and diffusion indices of the cerebral WM. Additionally, we examined advanced quantitative features such as the fractal dimension (FD) of cortical GM and WM, which represents an index of tissue structural complexity derived from 3D-T1 weighted images. To assess the prediction of transition to dementia, we employed an XGBoost-based machine learning system using SHapley Additive exPlanations (SHAP) values to provide explainability to the machine learning model. Results After 2 years, 18 (28.1%) participants had transitioned from MCI to dementia. The area under the receiving operator characteristic curve was 0.69 (0.53, 0.85) [mean (90% confidence interval)]. The cortical GM-FD emerged as the top-ranking predictive feature of transition. Furthermore, aggregated quantitative neuroimaging features outperformed visually assessed MRI features in predicting conversion to dementia. Discussion Our findings confirm the complementary roles of cortical GM and WM changes as underlying factors in the development of dementia in subjects with MCI and leukoaraiosis. FD appears to be a biomarker potentially more sensitive than other brain features.
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Affiliation(s)
- Chiara Marzi
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti, " University of Florence, Florence, Italy
| | - Riccardo Scheda
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi, " University of Bologna, Cesena, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Antonio Giorgio
- Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Domenico Inzitari
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio, " University of Florence, Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and Network in Oncology (ISPRO), Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi, " University of Bologna, Cesena, Italy
- Alma Mater Research Institute for Human-Centered Artificial Intelligence, University of Bologna, Bologna, Italy
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D'Andrea C, Cazzaniga FA, Bistaffa E, Barucci A, de Angelis M, Banchelli M, Farnesi E, Polykretis P, Marzi C, Indaco A, Tiraboschi P, Giaccone G, Matteini P, Moda F. Impact of seed amplification assay and surface-enhanced Raman spectroscopy combined approach on the clinical diagnosis of Alzheimer's disease. Transl Neurodegener 2023; 12:35. [PMID: 37438825 DOI: 10.1186/s40035-023-00367-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/21/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The current diagnosis of Alzheimer's disease (AD) is based on a series of analyses which involve clinical, instrumental and laboratory findings. However, signs, symptoms and biomarker alterations observed in AD might overlap with other dementias, resulting in misdiagnosis. METHODS Here we describe a new diagnostic approach for AD which takes advantage of the boosted sensitivity in biomolecular detection, as allowed by seed amplification assay (SAA), combined with the unique specificity in biomolecular recognition, as provided by surface-enhanced Raman spectroscopy (SERS). RESULTS The SAA-SERS approach supported by machine learning data analysis allowed efficient identification of pathological Aβ oligomers in the cerebrospinal fluid of patients with a clinical diagnosis of AD or mild cognitive impairment due to AD. CONCLUSIONS Such analytical approach can be used to recognize disease features, thus allowing early stratification and selection of patients, which is fundamental in clinical treatments and pharmacological trials.
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Affiliation(s)
- Cristiano D'Andrea
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Federico Angelo Cazzaniga
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Edoardo Bistaffa
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Andrea Barucci
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Marella de Angelis
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Martina Banchelli
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Edoardo Farnesi
- Institute of Physical Chemistry (IPC) and Abbe Center of Photonics (ACP), Friedrich Schiller University Jena, 07743, Jena, Germany
- Leibniz Institute of Photonic Technology, 07745, Jena, Germany
| | - Panagis Polykretis
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Chiara Marzi
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy
| | - Antonio Indaco
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Pietro Tiraboschi
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Giorgio Giaccone
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Paolo Matteini
- Institute of Applied Physics "Nello Carrara", National Research Council, 50019, Sesto Fiorentino, Italy.
| | - Fabio Moda
- Division of Neurology 5 and Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy.
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Mascalchi M, Romei C, Marzi C, Diciotti S, Picozzi G, Pistelli F, Zappa M, Paci E, Carozzi F, Gorini G, Falaschi F, Deliperi AL, Camiciottoli G, Carrozzi L, Puliti D. Pulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial. Eur Radiol 2023; 33:3115-3123. [PMID: 36854875 PMCID: PMC10121526 DOI: 10.1007/s00330-023-09504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES Cardiovascular disease (CVD), lung cancer (LC), and respiratory diseases are main causes of death in smokers and former smokers undergoing low-dose computed tomography (LDCT) for LC screening. We assessed whether quantification of pulmonary emphysematous changes at baseline LDCT has a predictive value concerning long-term mortality. METHODS In this longitudinal study, we assessed pulmonary emphysematous changes with densitometry (volume corrected relative area below - 950 Hounsfield units) and coronary artery calcifications (CAC) with a 0-3 visual scale in baseline LDCT of 524 participants in the ITALUNG trial and analyzed their association with mortality after 13.6 years of follow-up using conventional statistics and a machine learning approach. RESULTS Pulmonary emphysematous changes were present in 32.3% of subjects and were mild (6% ≤ RA950 ≤ 9%) in 14.9% and moderate-severe (RA950 > 9%) in 17.4%. CAC were present in 67% of subjects (mild in 34.7%, moderate-severe in 32.2%). In the follow-up, 81 (15.4%) subjects died (20 of LC, 28 of other cancers, 15 of CVD, 4 of respiratory disease, and 14 of other conditions). After adjusting for age, sex, smoking history, and CAC, moderate-severe emphysema was significantly associated with overall (OR 2.22; 95CI 1.34-3.70) and CVD (OR 3.66; 95CI 1.21-11.04) mortality. Machine learning showed that RA950 was the best single feature predictive of overall and CVD mortality. CONCLUSIONS Moderate-severe pulmonary emphysematous changes are an independent predictor of long-term overall and CVD mortality in subjects participating in LC screening and should be incorporated in the post-test calculation of the individual mortality risk profile. KEY POINTS • Densitometry allows quantification of pulmonary emphysematous changes in low-dose CT examinations for lung cancer screening. • Emphysematous lung density changes are an independent predictor of long-term overall and cardio-vascular disease mortality in smokers and former smokers undergoing screening. • Emphysematous changes quantification should be included in the post-test calculation of the individual mortality risk profile.
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Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental, Biomedical Sciences "Mario Serio, " University of Florence, Viale Pieraccini, 50134, Florence, Italy.
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy.
- Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Chiara Romei
- Division of Radiology, Cisanello Hospital, Pisa, Italy
| | - Chiara Marzi
- "Nello Carrara" Institute of Applied Physics, National Research Council of Italy, Sesto Fiorentino, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Bologna, Italy
| | - Giulia Picozzi
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Marco Zappa
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | - Eugenio Paci
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | - Francesca Carozzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giuseppe Gorini
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | | | | | - Gianna Camiciottoli
- Department of Clinical and Experimental, Biomedical Sciences "Mario Serio, " University of Florence, Viale Pieraccini, 50134, Florence, Italy
| | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Donella Puliti
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
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Salvadori E, Barucci E, Barbato C, Formelli B, Cesari F, Chiti S, Diciotti S, Giusti B, Gori AM, Marzi C, Pescini F, Pracucci G, Fainardi E, Marcucci R, Poggesi A. Cognitive phenotypes and factors associated with cognitive decline in a cohort of older patients with atrial fibrillation: The Strat-AF study. Eur J Neurol 2023; 30:849-860. [PMID: 36692890 DOI: 10.1111/ene.15701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE The multifactorial relationship between atrial fibrillation (AF) and cognitive impairment needs to be elucidated. The aim of this study was to assess, in AF patients on oral anticoagulants (OACs), the prevalence of cognitive impairment, defined according to clinical criteria or data-driven phenotypes, the prevalence of cognitive worsening, and factors associated with cognitive outcomes. METHODS The observational prospective Strat-AF study enrolled AF patients aged ≥ 65 years who were receiving OACs. The baseline and 18-month protocol included clinical, functional, and cognitive assessment, and brain magnetic resonance imaging. Cognitive outcomes were: empirically derived cognitive phenotypes; clinical diagnosis of cognitive impairment; and longitudinal cognitive worsening. RESULTS Out of 182 patients (mean age 77.7 ± 6.7 years, 63% males), 82 (45%) received a cognitive impairment diagnosis, which was associated with lower education level and functional status, and higher level of atrophy. Cluster analysis identified three cognitive profiles: dysexecutive (17%); amnestic (25%); and normal (58%). Compared to the normal group, the dysexecutive group was older, and had higher CHA2 DS2 -VASc scores, while the amnestic group had worse cognitive and functional abilities, and medial temporal lobe atrophy (MTA). Out of 128 followed-up patients, 35 (27%) had cognitive worsening that was associated with lower education level, worse cognitive efficiency, CHA2 DS2 -VASc score, timing of OAC intake, history of stroke, diabetes, non-lacunar infarcts, white matter hyperintensities and MTA. In multivariate models, belonging to the dysexecutive or amnestic group was a main predictor of cognitive worsening. CONCLUSIONS In our cohort of older AF patients, CHA2 DS2 -VASc score, timing of OAC intake, and history of stroke influenced presence, type and progression of cognitive impairment. Empirically derived cognitive classification identified three groups with different clinical profiles and better predictive ability for cognitive worsening compared to conventional clinical diagnosis.
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Affiliation(s)
| | | | - Carmen Barbato
- NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Francesca Cesari
- Atherothrombotic Diseases Centre, Careggi University Hospital, Florence, Italy
| | - Stefano Chiti
- Health Physics Unit, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Betti Giusti
- Atherothrombotic Diseases Centre, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Maria Gori
- Atherothrombotic Diseases Centre, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chiara Marzi
- Institute of Applied Physics "Nello Carrara" (IFAC), National Research Council of Italy (CNR), Florence, Italy
| | | | | | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- Atherothrombotic Diseases Centre, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, University of Florence, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
- Don Carlo Gnocchi Foundation, Florence, Italy
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7
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De Rosa AP, Esposito F, Valsasina P, d'Ambrosio A, Bisecco A, Rocca MA, Tommasin S, Marzi C, De Stefano N, Battaglini M, Pantano P, Cirillo M, Tedeschi G, Filippi M, Gallo A. Correction to: Resting-state functional MRI in multicenter studies on multiple sclerosis: a report on raw data quality and functional connectivity features from the Italian Neuroimaging Network Initiative. J Neurol 2023; 270:2815. [PMID: 36913040 PMCID: PMC10129912 DOI: 10.1007/s00415-023-11646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Alessandro Pasquale De Rosa
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy.
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alessandro d'Ambrosio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Chiara Marzi
- Institute of Applied Physics "Nello Cararra" (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, Sesto Fiorentino, 50019, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
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8
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De Rosa AP, Esposito F, Valsasina P, d'Ambrosio A, Bisecco A, Rocca MA, Tommasin S, Marzi C, De Stefano N, Battaglini M, Pantano P, Cirillo M, Tedeschi G, Filippi M, Gallo A. Resting-state functional MRI in multicenter studies on multiple sclerosis: a report on raw data quality and functional connectivity features from the Italian Neuroimaging Network Initiative. J Neurol 2023; 270:1047-1066. [PMID: 36350401 PMCID: PMC9886598 DOI: 10.1007/s00415-022-11479-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
The Italian Neuroimaging Network Initiative (INNI) is an expanding repository of brain MRI data from multiple sclerosis (MS) patients recruited at four Italian MRI research sites. We describe the raw data quality of resting-state functional MRI (RS-fMRI) time-series in INNI and the inter-site variability in functional connectivity (FC) features after unified automated data preprocessing. MRI datasets from 489 MS patients and 246 healthy control (HC) subjects were retrieved from the INNI database. Raw data quality metrics included temporal signal-to-noise ratio (tSNR), spatial smoothness (FWHM), framewise displacement (FD), and differential variation in signals (DVARS). Automated preprocessing integrated white-matter lesion segmentation (SAMSEG) into a standard fMRI pipeline (fMRIPrep). FC features were calculated on pre-processed data and harmonized between sites (Combat) prior to assessing general MS-related alterations. Across centers (both groups), median tSNR and FWHM ranged from 47 to 84 and from 2.0 to 2.5, and median FD and DVARS ranged from 0.08 to 0.24 and from 1.06 to 1.22. After preprocessing, only global FC-related features were significantly correlated with FD or DVARS. Across large-scale networks, age/sex/FD-adjusted and harmonized FC features exhibited both inter-site and site-specific inter-group effects. Significant general reductions were obtained for somatomotor and limbic networks in MS patients (vs. HC). The implemented procedures provide technical information on raw data quality and outcome of fully automated preprocessing that might serve as reference in future RS-fMRI studies within INNI. The unified pipeline introduced little bias across sites and appears suitable for multisite FC analyses on harmonized network estimates.
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Affiliation(s)
- Alessandro Pasquale De Rosa
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy.
| | - Paola Valsasina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alessandro d'Ambrosio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Chiara Marzi
- Institute of Applied Physics "Nello Cararra" (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, Sesto Fiorentino, 50019, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università, 30, 00185, Rome, Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Naples, Italy
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9
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Borgheresi R, Barucci A, Colantonio S, Aghakhanyan G, Assante M, Bertelli E, Carlini E, Carpi R, Caudai C, Cavallero D, Cioni D, Cirillo R, Colcelli V, Dell’Amico A, Di Gangi D, Erba PA, Faggioni L, Falaschi Z, Gabelloni M, Gini R, Lelii L, Liò P, Lorito A, Lucarini S, Manghi P, Mangiacrapa F, Marzi C, Mazzei MA, Mercatelli L, Mirabile A, Mungai F, Miele V, Olmastroni M, Pagano P, Paiar F, Panichi G, Pascali MA, Pasquinelli F, Shortrede JE, Tumminello L, Volterrani L, Neri E. NAVIGATOR: an Italian regional imaging biobank to promote precision medicine for oncologic patients. Eur Radiol Exp 2022; 6:53. [PMID: 36344838 PMCID: PMC9640522 DOI: 10.1186/s41747-022-00306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/21/2022] [Indexed: 11/09/2022] Open
Abstract
NAVIGATOR is an Italian regional project boosting precision medicine in oncology with the aim of making it more predictive, preventive, and personalised by advancing translational research based on quantitative imaging and integrative omics analyses. The project’s goal is to develop an open imaging biobank for the collection and preservation of a large amount of standardised imaging multimodal datasets, including computed tomography, magnetic resonance imaging, and positron emission tomography data, together with the corresponding patient-related and omics-related relevant information extracted from regional healthcare services using an adapted privacy-preserving model. The project is based on an open-source imaging biobank and an open-science oriented virtual research environment (VRE). Available integrative omics and multi-imaging data of three use cases (prostate cancer, rectal cancer, and gastric cancer) will be collected. All data confined in NAVIGATOR (i.e., standard and novel imaging biomarkers, non-imaging data, health agency data) will be used to create a digital patient model, to support the reliable prediction of the disease phenotype and risk stratification. The VRE that relies on a well-established infrastructure, called D4Science.org, will further provide a multiset infrastructure for processing the integrative omics data, extracting specific radiomic signatures, and for identification and testing of novel imaging biomarkers through big data analytics and artificial intelligence.
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10
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Marzi C, d'Ambrosio A, Diciotti S, Bisecco A, Altieri M, Filippi M, Rocca MA, Storelli L, Pantano P, Tommasin S, Cortese R, De Stefano N, Tedeschi G, Gallo A. Prediction of the information processing speed performance in multiple sclerosis using a machine learning approach in a large multicenter magnetic resonance imaging data set. Hum Brain Mapp 2022; 44:186-202. [PMID: 36255155 PMCID: PMC9783441 DOI: 10.1002/hbm.26106] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/26/2022] [Revised: 06/02/2022] [Accepted: 09/24/2022] [Indexed: 02/05/2023] Open
Abstract
Many patients with multiple sclerosis (MS) experience information processing speed (IPS) deficits, and the Symbol Digit Modalities Test (SDMT) has been recommended as a valid screening test. Magnetic resonance imaging (MRI) has markedly improved the understanding of the mechanisms associated with cognitive deficits in MS. However, which structural MRI markers are the most closely related to cognitive performance is still unclear. We used the multicenter 3T-MRI data set of the Italian Neuroimaging Network Initiative to extract multimodal data (i.e., demographic, clinical, neuropsychological, and structural MRIs) of 540 MS patients. We aimed to assess, through machine learning techniques, the contribution of brain MRI structural volumes in the prediction of IPS deficits when combined with demographic and clinical features. We trained and tested the eXtreme Gradient Boosting (XGBoost) model following a rigorous validation scheme to obtain reliable generalization performance. We carried out a classification and a regression task based on SDMT scores feeding each model with different combinations of features. For the classification task, the model trained with thalamus, cortical gray matter, hippocampus, and lesions volumes achieved an area under the receiver operating characteristic curve of 0.74. For the regression task, the model trained with cortical gray matter and thalamus volumes, EDSS, nucleus accumbens, lesions, and putamen volumes, and age reached a mean absolute error of 0.95. In conclusion, our results confirmed that damage to cortical gray matter and relevant deep and archaic gray matter structures, such as the thalamus and hippocampus, is among the most relevant predictors of cognitive performance in MS.
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Affiliation(s)
- Chiara Marzi
- MS Center and 3T‐MRI Research Unit, Department of Advanced Medical and Surgical Sciences (DAMSS)University of Campania “Luigi Vanvitelli”NapoliItaly,Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi” – DEIAlma Mater Studiorum – University of BolognaBolognaItaly
| | - Alessandro d'Ambrosio
- MS Center and 3T‐MRI Research Unit, Department of Advanced Medical and Surgical Sciences (DAMSS)University of Campania “Luigi Vanvitelli”NapoliItaly
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi” – DEIAlma Mater Studiorum – University of BolognaBolognaItaly,Alma Mater Research Institute for Human‐Centered Artificial IntelligenceUniversity of BolognaBolognaItaly
| | - Alvino Bisecco
- MS Center and 3T‐MRI Research Unit, Department of Advanced Medical and Surgical Sciences (DAMSS)University of Campania “Luigi Vanvitelli”NapoliItaly
| | - Manuela Altieri
- MS Center and 3T‐MRI Research Unit, Department of Advanced Medical and Surgical Sciences (DAMSS)University of Campania “Luigi Vanvitelli”NapoliItaly,Department of PsychologyUniversity of Campania “Luigi Vanvitelli”NapoliItaly
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of NeuroscienceVita‐Salute San Raffaele University, IRCCS San Raffaele Scientific InstituteMilanItaly,Neurology and Neurophysiology UnitVita‐Salute San Raffaele University, IRCCS San Raffaele Scientific InstituteMilanItaly
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of NeuroscienceVita‐Salute San Raffaele University, IRCCS San Raffaele Scientific InstituteMilanItaly,Neurology and Neurophysiology UnitVita‐Salute San Raffaele University, IRCCS San Raffaele Scientific InstituteMilanItaly
| | - Loredana Storelli
- Neuroimaging Research Unit, Division of NeuroscienceVita‐Salute San Raffaele University, IRCCS San Raffaele Scientific InstituteMilanItaly
| | - Patrizia Pantano
- Department of Human NeurosciencesSapienza University of RomeRomeItaly,IRCCS NeuromedPozzilliItaly
| | - Silvia Tommasin
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Rosa Cortese
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - Nicola De Stefano
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - Gioacchino Tedeschi
- MS Center and 3T‐MRI Research Unit, Department of Advanced Medical and Surgical Sciences (DAMSS)University of Campania “Luigi Vanvitelli”NapoliItaly
| | - Antonio Gallo
- MS Center and 3T‐MRI Research Unit, Department of Advanced Medical and Surgical Sciences (DAMSS)University of Campania “Luigi Vanvitelli”NapoliItaly
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11
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Marfisi D, Tessa C, Marzi C, Del Meglio J, Linsalata S, Borgheresi R, Lilli A, Lazzarini R, Salvatori L, Vignali C, Barucci A, Mascalchi M, Casolo G, Diciotti S, Traino AC, Giannelli M. Image resampling and discretization effect on the estimate of myocardial radiomic features from T1 and T2 mapping in hypertrophic cardiomyopathy. Sci Rep 2022; 12:10186. [PMID: 35715531 PMCID: PMC9205876 DOI: 10.1038/s41598-022-13937-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/21/2022] [Indexed: 12/24/2022] Open
Abstract
Radiomics is emerging as a promising and useful tool in cardiac magnetic resonance (CMR) imaging applications. Accordingly, the purpose of this study was to investigate, for the first time, the effect of image resampling/discretization and filtering on radiomic features estimation from quantitative CMR T1 and T2 mapping. Specifically, T1 and T2 maps of 26 patients with hypertrophic cardiomyopathy (HCM) were used to estimate 98 radiomic features for 7 different resampling voxel sizes (at fixed bin width), 9 different bin widths (at fixed resampling voxel size), and 7 different spatial filters (at fixed resampling voxel size/bin width). While we found a remarkable dependence of myocardial radiomic features from T1 and T2 mapping on image filters, many radiomic features showed a limited sensitivity to resampling voxel size/bin width, in terms of intraclass correlation coefficient (> 0.75) and coefficient of variation (< 30%). The estimate of most textural radiomic features showed a linear significant (p < 0.05) correlation with resampling voxel size/bin width. Overall, radiomic features from T2 maps have proven to be less sensitive to image preprocessing than those from T1 maps, especially when varying bin width. Our results might corroborate the potential of radiomics from T1/T2 mapping in HCM and hopefully in other myocardial diseases.
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Affiliation(s)
- Daniela Marfisi
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Via Roma 67, 56126, Pisa, Italy
| | - Carlo Tessa
- Unit of Radiology, Azienda USL Toscana Nord Ovest, Apuane Hospital, 54100, Massa, Italy
| | - Chiara Marzi
- Institute of Applied Physics "Nello Carrara", Italian National Research Council, 50019, Sesto Fiorentino, Italy
| | - Jacopo Del Meglio
- Unit of Cardiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Stefania Linsalata
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Via Roma 67, 56126, Pisa, Italy
| | - Rita Borgheresi
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Via Roma 67, 56126, Pisa, Italy
| | - Alessio Lilli
- Unit of Cardiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Riccardo Lazzarini
- Unit of Radiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Luca Salvatori
- Unit of Radiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Claudio Vignali
- Unit of Radiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Andrea Barucci
- Institute of Applied Physics "Nello Carrara", Italian National Research Council, 50019, Sesto Fiorentino, Italy
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50121, Florence, Italy
| | - Giancarlo Casolo
- Unit of Cardiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, 55041, Lido di Camaiore, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 47522, Cesena, Italy
| | - Antonio Claudio Traino
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Via Roma 67, 56126, Pisa, Italy
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Via Roma 67, 56126, Pisa, Italy.
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12
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Bianconi E, Del Freo G, Salvadori E, Barbato C, Formelli B, Pescini F, Pracucci G, Sarti C, Cesari F, Chiti S, Diciotti S, Gori AM, Marzi C, Fainardi E, Giusti B, Marcucci R, Bertaccini B, Poggesi A. Can CHA 2DS 2-VASc and HAS-BLED Foresee the Presence of Cerebral Microbleeds, Lacunar and Non-Lacunar Infarcts in Elderly Patients With Atrial Fibrillation? Data From Strat-AF Study. Front Neurol 2022; 13:883786. [PMID: 35645956 PMCID: PMC9135961 DOI: 10.3389/fneur.2022.883786] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/25/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Anticoagulants reduce embolic risk in atrial fibrillation (AF), despite increasing hemorrhagic risk. In this context, validity of congestive heart failure, hypertension, age ≥ 75 years, diabetes, stroke, vascular disease, age 65-74 years and sex category (CHA2DS2-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly (HAS-BLED) scales, used to respectively evaluate thrombotic and hemorrhagic risks, is incomplete. In patients with AF, brain MRI has led to the increased detection of "asymptomatic" brain changes, particularly those related to small vessel disease, which also represent the pathologic substrate of intracranial hemorrhage, and silent brain infarcts, which are considered risk factors for ischemic stroke. Routine brain MRI in asymptomatic patients with AF is not yet recommended. Our aim was to test predictive ability of risk stratification scales on the presence of cerebral microbleeds, lacunar, and non-lacunar infarcts in 170 elderly patients with AF on oral anticoagulants. Ad hoc developed R algorithms were used to evaluate CHA2DS2-VASc and HAS-BLED sensitivity and specificity on the prediction of cerebrovascular lesions: (1) Maintaining original items' weights; (2) augmenting weights' range; (3) adding cognitive, motor, and depressive scores. Accuracy was poor for each outcome considering both scales either in phase 1 or phase 2. Accuracy was never improved by the addition of cognitive scores. The addition of motor and depressive scores to CHA2DS2-VASc improved accuracy for non-lacunar infarcts (sensitivity = 0.70, specificity = 0.85), and sensitivity for lacunar-infarcts (sensitivity = 0.74, specificity = 0.61). Our results are a very first step toward the attempt to identify those elderly patients with AF who would benefit most from brain MRI in risk stratification.
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Affiliation(s)
- Elisa Bianconi
- Department of Statistics, Computer Science, Applications ≪ G. Parenti ≫, University of Florence, Florence, Italy
| | - Giulia Del Freo
- Department of Statistics, Computer Science, Applications ≪ G. Parenti ≫, University of Florence, Florence, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Carmen Barbato
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
- Don Carlo Gnocchi Foundation, Milan, Italy
| | - Benedetta Formelli
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | | | - Giovanni Pracucci
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Cristina Sarti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Francesca Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - Stefano Chiti
- Department Health Professions, U.O. Research and Development, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Cesena, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Chiara Marzi
- Institute of Applied Physics “Nello Carrara” (IFAC), National Research Council of Italy (CNR), Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Bruno Bertaccini
- Department of Statistics, Computer Science, Applications ≪ G. Parenti ≫, University of Florence, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
- Don Carlo Gnocchi Foundation, Milan, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
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13
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Bertelli E, Mercatelli L, Marzi C, Pachetti E, Baccini M, Barucci A, Colantonio S, Gherardini L, Lattavo L, Pascali MA, Agostini S, Miele V. Machine and Deep Learning Prediction Of Prostate Cancer Aggressiveness Using Multiparametric MRI. Front Oncol 2022; 11:802964. [PMID: 35096605 PMCID: PMC8792745 DOI: 10.3389/fonc.2021.802964] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 10/27/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer (PCa) is the most frequent male malignancy and the assessment of PCa aggressiveness, for which a biopsy is required, is fundamental for patient management. Currently, multiparametric (mp) MRI is strongly recommended before biopsy. Quantitative assessment of mpMRI might provide the radiologist with an objective and noninvasive tool for supporting the decision-making in clinical practice and decreasing intra- and inter-reader variability. In this view, high dimensional radiomics features and Machine Learning (ML) techniques, along with Deep Learning (DL) methods working on raw images directly, could assist the radiologist in the clinical workflow. The aim of this study was to develop and validate ML/DL frameworks on mpMRI data to characterize PCas according to their aggressiveness. We optimized several ML/DL frameworks on T2w, ADC and T2w+ADC data, using a patient-based nested validation scheme. The dataset was composed of 112 patients (132 peripheral lesions with Prostate Imaging Reporting and Data System (PI-RADS) score ≥ 3) acquired following both PI-RADS 2.0 and 2.1 guidelines. Firstly, ML/DL frameworks trained and validated on PI-RADS 2.0 data were tested on both PI-RADS 2.0 and 2.1 data. Then, we trained, validated and tested ML/DL frameworks on a multi PI-RADS dataset. We reported the performances in terms of Area Under the Receiver Operating curve (AUROC), specificity and sensitivity. The ML/DL frameworks trained on T2w data achieved the overall best performance. Notably, ML and DL frameworks trained and validated on PI-RADS 2.0 data obtained median AUROC values equal to 0.750 and 0.875, respectively, on unseen PI-RADS 2.0 test set. Similarly, ML/DL frameworks trained and validated on multi PI-RADS T2w data showed median AUROC values equal to 0.795 and 0.750, respectively, on unseen multi PI-RADS test set. Conversely, all the ML/DL frameworks trained and validated on PI-RADS 2.0 data, achieved AUROC values no better than the chance level when tested on PI-RADS 2.1 data. Both ML/DL techniques applied on mpMRI seem to be a valid aid in predicting PCa aggressiveness. In particular, ML/DL frameworks fed with T2w images data (objective, fast and non-invasive) show good performances and might support decision-making in patient diagnostic and therapeutic management, reducing intra- and inter-reader variability.
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Affiliation(s)
- Elena Bertelli
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Laura Mercatelli
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Chiara Marzi
- "Nello Carrara" Institute of Applied Physics (IFAC), National Research Council of Italy (CNR), Sesto Fiorentino, Italy
| | - Eva Pachetti
- "Alessandro Faedo" Institute of Information Science and Technologies (ISTI), National Research Council of Italy (CNR), Pisa, Italy.,Department of Information Engineering (DII), University of Pisa, Pisa, Italy
| | - Michela Baccini
- "Giuseppe Parenti" Department of Statistics, Computer Science, Applications(DiSIA), University of Florence, Florence, Italy.,Florence Center for Data Science, University of Florence, Florence, Italy
| | - Andrea Barucci
- "Nello Carrara" Institute of Applied Physics (IFAC), National Research Council of Italy (CNR), Sesto Fiorentino, Italy
| | - Sara Colantonio
- "Alessandro Faedo" Institute of Information Science and Technologies (ISTI), National Research Council of Italy (CNR), Pisa, Italy
| | - Luca Gherardini
- "Giuseppe Parenti" Department of Statistics, Computer Science, Applications(DiSIA), University of Florence, Florence, Italy
| | - Lorenzo Lattavo
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Maria Antonietta Pascali
- "Alessandro Faedo" Institute of Information Science and Technologies (ISTI), National Research Council of Italy (CNR), Pisa, Italy
| | - Simone Agostini
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy
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14
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Yagis E, Atnafu SW, García Seco de Herrera A, Marzi C, Scheda R, Giannelli M, Tessa C, Citi L, Diciotti S. Effect of data leakage in brain MRI classification using 2D convolutional neural networks. Sci Rep 2021; 11:22544. [PMID: 34799630 PMCID: PMC8604922 DOI: 10.1038/s41598-021-01681-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
In recent years, 2D convolutional neural networks (CNNs) have been extensively used to diagnose neurological diseases from magnetic resonance imaging (MRI) data due to their potential to discern subtle and intricate patterns. Despite the high performances reported in numerous studies, developing CNN models with good generalization abilities is still a challenging task due to possible data leakage introduced during cross-validation (CV). In this study, we quantitatively assessed the effect of a data leakage caused by 3D MRI data splitting based on a 2D slice-level using three 2D CNN models to classify patients with Alzheimer's disease (AD) and Parkinson's disease (PD). Our experiments showed that slice-level CV erroneously boosted the average slice level accuracy on the test set by 30% on Open Access Series of Imaging Studies (OASIS), 29% on Alzheimer's Disease Neuroimaging Initiative (ADNI), 48% on Parkinson's Progression Markers Initiative (PPMI) and 55% on a local de-novo PD Versilia dataset. Further tests on a randomly labeled OASIS-derived dataset produced about 96% of (erroneous) accuracy (slice-level split) and 50% accuracy (subject-level split), as expected from a randomized experiment. Overall, the extent of the effect of an erroneous slice-based CV is severe, especially for small datasets.
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Affiliation(s)
- Ekin Yagis
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | - Selamawet Workalemahu Atnafu
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Via dell'Università 50, 47521, Cesena, Italy
| | | | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Via dell'Università 50, 47521, Cesena, Italy
| | - Riccardo Scheda
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Via dell'Università 50, 47521, Cesena, Italy
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Carlo Tessa
- Division of Radiology, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore, LU, Italy
| | - Luca Citi
- School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Via dell'Università 50, 47521, Cesena, Italy.
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15
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Capuano R, Bisecco A, D'Ambrosio A, Altieri M, Docimo R, Cirillo M, Trojsi F, Russo A, Marzi C, Diciotti S, Tedeschi G, Gallo A. Multiple sclerosis functional composite predicts thalamic atrophy in multiple sclerosis. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Harding IH, Chopra S, Arrigoni F, Boesch S, Brunetti A, Cocozza S, Corben LA, Deistung A, Delatycki M, Diciotti S, Dogan I, Evangelisti S, França MC, Göricke SL, Georgiou-Karistianis N, Gramegna LL, Henry PG, Hernandez-Castillo CR, Hutter D, Jahanshad N, Joers JM, Lenglet C, Lodi R, Manners DN, Martinez ARM, Martinuzzi A, Marzi C, Mascalchi M, Nachbauer W, Pane C, Peruzzo D, Pisharady PK, Pontillo G, Reetz K, Rezende TJR, Romanzetti S, Saccà F, Scherfler C, Schulz JB, Stefani A, Testa C, Thomopoulos SI, Timmann D, Tirelli S, Tonon C, Vavla M, Egan GF, Thompson PM. Brain Structure and Degeneration Staging in Friedreich Ataxia: Magnetic Resonance Imaging Volumetrics from the ENIGMA-Ataxia Working Group. Ann Neurol 2021; 90:570-583. [PMID: 34435700 PMCID: PMC9292360 DOI: 10.1002/ana.26200] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 01/24/2023]
Abstract
Objective Friedreich ataxia (FRDA) is an inherited neurological disease defined by progressive movement incoordination. We undertook a comprehensive characterization of the spatial profile and progressive evolution of structural brain abnormalities in people with FRDA. Methods A coordinated international analysis of regional brain volume using magnetic resonance imaging data charted the whole‐brain profile, interindividual variability, and temporal staging of structural brain differences in 248 individuals with FRDA and 262 healthy controls. Results The brainstem, dentate nucleus region, and superior and inferior cerebellar peduncles showed the greatest reductions in volume relative to controls (Cohen d = 1.5–2.6). Cerebellar gray matter alterations were most pronounced in lobules I–VI (d = 0.8), whereas cerebral differences occurred most prominently in precentral gyri (d = 0.6) and corticospinal tracts (d = 1.4). Earlier onset age predicted less volume in the motor cerebellum (rmax = 0.35) and peduncles (rmax = 0.36). Disease duration and severity correlated with volume deficits in the dentate nucleus region, brainstem, and superior/inferior cerebellar peduncles (rmax = −0.49); subgrouping showed these to be robust and early features of FRDA, and strong candidates for further biomarker validation. Cerebral white matter abnormalities, particularly in corticospinal pathways, emerge as intermediate disease features. Cerebellar and cerebral gray matter loss, principally targeting motor and sensory systems, preferentially manifests later in the disease course. Interpretation FRDA is defined by an evolving spatial profile of neuroanatomical changes beyond primary pathology in the cerebellum and spinal cord, in line with its progressive clinical course. The design, interpretation, and generalization of research studies and clinical trials must consider neuroanatomical staging and associated interindividual variability in brain measures. ANN NEUROL 2021;90:570–583
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Affiliation(s)
- Ian H Harding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Sidhant Chopra
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Filippo Arrigoni
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Sylvia Boesch
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Louise A Corben
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.,Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Andreas Deistung
- University Clinic and Outpatient Clinic for Radiology, Department for Radiation Medicine, University Hospital Halle (Saale), Halle (Saale), Germany.,Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Delatycki
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi,", University of Bologna, Bologna, Italy
| | - Imis Dogan
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Stefania Evangelisti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marcondes C França
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Sophia L Göricke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Laura L Gramegna
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Pierre-Gilles Henry
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Carlos R Hernandez-Castillo
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada.,CONACYT-Institute of Neuroethology, University of Veracruz, Xalapa, Mexico
| | - Diane Hutter
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
| | - James M Joers
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Christophe Lenglet
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - David N Manners
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alberto R M Martinez
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Andrea Martinuzzi
- Scientific Institute, IRCCS Eugenio Medea, Conegliano-Pieve di Soligo Research Center, Conegliano, Italy
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi,", University of Bologna, Bologna, Italy
| | - Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio,", University of Florence, Florence, Italy.,Clinical Epidemiology Unit, ISPRO, Oncological Network, Prevention and Research Institute, Florence, Italy
| | | | - Chiara Pane
- NSRO Department, University of Naples Federico II, Naples, Italy
| | - Denis Peruzzo
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Pramod K Pisharady
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.,Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Thiago J R Rezende
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Sandro Romanzetti
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Francesco Saccà
- NSRO Department, University of Naples Federico II, Naples, Italy
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN Institute, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudia Testa
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Stefania Tirelli
- Neuroimaging Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - Marinela Vavla
- Scientific Institute, IRCCS Eugenio Medea, Conegliano-Pieve di Soligo Research Center, Conegliano, Italy
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
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Trajkovic J, Di Gregorio F, Ferri F, Marzi C, Diciotti S, Romei V. Publisher Correction: Resting state alpha oscillatory activity is a valid and reliable marker of schizotypy. Sci Rep 2021; 11:13487. [PMID: 34162949 PMCID: PMC8222399 DOI: 10.1038/s41598-021-92571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jelena Trajkovic
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum - Università di Bologna, Campus di Cesena, 47521, Cesena, Italy
| | - Francesco Di Gregorio
- UO Medicina Riabilitativa e Neuroriabilitazione, Azienda Unità Sanitaria Locale, 40139, Bologna, Italy
| | - Francesca Ferri
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy.,Alma Mater Research Institute for Human‑Centered Artificial Intelligence, University of Bologna, Bologna, Italy
| | - Vincenzo Romei
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum - Università di Bologna, Campus di Cesena, 47521, Cesena, Italy. .,IRCCS Fondazione Santa Lucia, 00179, Rome, Italy.
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18
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Trajkovic J, Di Gregorio F, Ferri F, Marzi C, Diciotti S, Romei V. Resting state alpha oscillatory activity is a valid and reliable marker of schizotypy. Sci Rep 2021; 11:10379. [PMID: 34001914 PMCID: PMC8129121 DOI: 10.1038/s41598-021-89690-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/30/2021] [Indexed: 12/20/2022] Open
Abstract
Schizophrenia is among the most debilitating neuropsychiatric disorders. However, clear neurophysiological markers that would identify at-risk individuals represent still an unknown. The aim of this study was to investigate possible alterations in the resting alpha oscillatory activity in normal population high on schizotypy trait, a physiological condition known to be severely altered in patients with schizophrenia. Direct comparison of resting-state EEG oscillatory activity between Low and High Schizotypy Group (LSG and HSG) has revealed a clear right hemisphere alteration in alpha activity of the HSG. Specifically, HSG shows a significant slowing down of right hemisphere posterior alpha frequency and an altered distribution of its amplitude, with a tendency towards a reduction in the right hemisphere in comparison to LSG. Furthermore, altered and reduced connectivity in the right fronto-parietal network within the alpha range was found in the HSG. Crucially, a trained pattern classifier based on these indices of alpha activity was able to successfully differentiate HSG from LSG on tested participants further confirming the specific importance of right hemispheric alpha activity and intrahemispheric functional connectivity. By combining alpha activity and connectivity measures with a machine learning predictive model optimized in a nested stratified cross-validation loop, current research offers a promising clinical tool able to identify individuals at-risk of developing psychosis (i.e., high schizotypy individuals).
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Affiliation(s)
- Jelena Trajkovic
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum - Università di Bologna, Campus di Cesena, 47521, Cesena, Italy
| | - Francesco Di Gregorio
- UO Medicina Riabilitativa e Neuroriabilitazione, Azienda Unità Sanitaria Locale, 40139, Bologna, Italy
| | - Francesca Ferri
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy.,Alma Mater Research Institute for Human-Centered Artificial Intelligence, University of Bologna, Bologna, Italy
| | - Vincenzo Romei
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum - Università di Bologna, Campus di Cesena, 47521, Cesena, Italy. .,IRCCS Fondazione Santa Lucia, 00179, Rome, Italy.
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Orsolini S, Marzi C, Gavazzi G, Bianchi A, Salvadori E, Giannelli M, Donnini I, Rinnoci V, Pescini F, Pantoni L, Mascalchi M, Diciotti S. Altered Regional Brain Homogeneity of BOLD Signal in CADASIL: A Resting State fMRI Study. J Neuroimaging 2020; 31:348-355. [PMID: 33314416 DOI: 10.1111/jon.12821] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND PURPOSE The cognitive decline in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is assumed to be due to a cortical-subcortical disconnection secondary to damage to the cerebral white matter (WM). Using resting state functional MRI (rsfMRI) and analysis of the regional homogeneity (ReHo), we examined a group of CADASIL patients and a group of healthy subjects in order to: (1) explore possible differences between the two groups; and (2) to assess, in CADASIL patients, whether any ReHo abnormalities correlate with individual burdens of WM T2 -weighted hyperintensity and diffusion tensor imaging (DTI)-derived index of mean diffusivity (MD) of the cerebral WM, an index reflecting microstructural damage in CADASIL. METHODS Twenty-three paucisymptomatic CADASIL patients (13 females; age mean ± standard deviation = 43.6 ± 11.1 years; three symptomatic and 20 with no or few symptoms) and 16 healthy controls (nine females; age 46.6 ± 11.0 years) were examined with T1 -weighted, T2 -weighted fluid attenuated inversion recovery images, DTI, and rsfMRI. RESULTS When compared to controls, CADASIL patients showed four clusters of significantly lower ReHo values in cortical areas belonging to networks involved in inhibition and attention, including the right insula, the left superior frontal gyrus, and the bilateral anterior cingulated cortex. ReHo changes did not correlate with an individual patient's lesion burden or MD. CONCLUSIONS This study reveals decreased ReHo of rsfMRI signals in cortical areas involved in inhibition and attention processes, suggesting a potential role for these functional cortical changes in CADASIL.
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Affiliation(s)
- Stefano Orsolini
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Gioele Gavazzi
- Department of Integrated Imaging, IRCCS SDN, Naples, Italy
| | - Andrea Bianchi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | | | | | | | - Leonardo Pantoni
- Stroke and Dementia Laboratory, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
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Salvadori E, Galmozzi F, Uda F, Barbato C, Camilleri E, Cesari F, Chiti S, Diciotti S, Donnini S, Formelli B, Galora S, Giusti B, Gori AM, Marzi C, Melone A, Mistri D, Pescini F, Pracucci G, Rinnoci V, Sarti C, Fainardi E, Marcucci R, Poggesi A. Association Between Motor and Cognitive Performances in Elderly With Atrial Fibrillation: Strat-AF Study. Front Neurol 2020; 11:571978. [PMID: 33281708 PMCID: PMC7691488 DOI: 10.3389/fneur.2020.571978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/30/2020] [Indexed: 01/22/2023] Open
Abstract
Background/Objective: Growing evidence suggests a close relationship between motor and cognitive abilities, but possible common underlying mechanisms are not well-established. Atrial fibrillation (AF) is associated with reduced physical performance and increased risk of cognitive decline. The study aimed to assess in a cohort of elderly AF patients: (1) the association between motor and cognitive performances, and (2) the influence and potential mediating role of cerebral lesions burden. Design: Strat-AF is a prospective, observational study investigating biological markers for cerebral bleeding risk stratification in AF patients on oral anticoagulants. Baseline cross-sectional data are presented here. Setting: Thrombosis outpatient clinic (Careggi University Hospital). Participants: One-hundred and seventy patients (mean age 77.7 ± 6.8; females 35%). Measurements: Baseline protocol included: neuropsychological battery, motor assessment [Short Physical Performance Battery (SPPB), and walking speed], and brain magnetic resonance imaging (MRI) used for the visual assessment of white matter hyperintensities, lacunar and non-lacunar infarcts, cerebral microbleeds, and global cortical and medial temporal atrophies. Results: Mean Montreal Cognitive Assessment (MoCA) total score was 21.9 ± 3.9, SPPB total score 9.5 ± 2.2, and walking speed 0.9 ± 0.2. In univariate analyses, both SPPB and walking speed were significantly associated with MoCA (r = 0.359, r = 0.372, respectively), visual search (r = 0.361, r = 0.322), Stroop (r = −0.272, r = −0.263), short story (r = 0.263, r = 0.310), and semantic fluency (r = 0.311, r = 0.360). In multivariate models adjusted for demographics, heart failure, physical activity, and either stroke history (Model 1) or neuroimaging markers (Model 2), both SPPB and walking speed were confirmed significantly associated with MoCA (Model 1: β = 0.256, β = 0.236; Model 2: β = 0.276, β = 0.272, respectively), visual search (Model 1: β = 0.350, β = 0.313; Model 2: β = 0.344, β = 0.307), semantic fluency (Model 1: β = 0.223, β = 0.261), and short story (Model 2: β = 0.245, β = 0.273). Conclusions: In our cohort of elderly AF patients, a direct association between motor and cognitive functions consistently recurred using different evaluation of the performances, without an evident mediating role of cerebral lesions burden.
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Affiliation(s)
| | - Francesco Galmozzi
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Francesca Uda
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Carmen Barbato
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Eleonora Camilleri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Francesca Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - Stefano Chiti
- Department Health Professions, U.O. Research and Development, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Bologna, Italy
| | - Samira Donnini
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Benedetta Formelli
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Silvia Galora
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Bologna, Italy
| | - Anna Melone
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Damiano Mistri
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Giovanni Pracucci
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Cristina Sarti
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy.,Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy.,Stroke Unit, Careggi University Hospital, Florence, Italy
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Marzi C, Giannelli M, Tessa C, Mascalchi M, Diciotti S. Toward a more reliable characterization of fractal properties of the cerebral cortex of healthy subjects during the lifespan. Sci Rep 2020; 10:16957. [PMID: 33046812 PMCID: PMC7550568 DOI: 10.1038/s41598-020-73961-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023] Open
Abstract
The cerebral cortex manifests an inherent structural complexity of folding. The fractal geometry describes the complexity of structures which show self-similarity in a proper interval of spatial scales. In this study, we aimed at evaluating in-vivo the effect of different criteria for selecting the interval of spatial scales in the estimation of the fractal dimension (FD) of the cerebral cortex in T1-weighted magnetic resonance imaging (MRI). We compared four different strategies, including two a priori selections of the interval of spatial scales, an automated selection of the spatial scales within which the cerebral cortex manifests the highest statistical self-similarity, and an improved approach, based on the search of the interval of spatial scales which presents the highest rounded R2adj coefficient and, in case of equal rounded R2adj coefficient, preferring the widest interval in the log–log plot. We employed two public and international datasets of in-vivo MRI scans for a total of 159 healthy subjects (age range 6–85 years). The improved approach showed strong associations of FD with age and yielded the most accurate machine learning models for individual age prediction in both datasets. Our results indicate that the selection of the interval of spatial scales of the cerebral cortex is thus critical in the estimation of FD.
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Affiliation(s)
- Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Viale del Risorgimento 2, 40136, Bologna, Italy
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Carlo Tessa
- Division of Radiology, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore (Lu), Italy
| | - Mario Mascalchi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Viale del Risorgimento 2, 40136, Bologna, Italy.
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Poggesi A, Barbato C, Galmozzi F, Camilleri E, Cesari F, Chiti S, Diciotti S, Galora S, Giusti B, Gori AM, Marzi C, Melone A, Mistri D, Pescini F, Pracucci G, Rinnoci V, Sarti C, Fainardi E, Marcucci R, Salvadori E. Role of Biological Markers for Cerebral Bleeding Risk STRATification in Patients with Atrial Fibrillation on Oral Anticoagulants for Primary or Secondary Prevention of Ischemic Stroke (Strat-AF Study): Study Design and Methodology. Medicina (Kaunas) 2019; 55:E626. [PMID: 31548494 PMCID: PMC6843419 DOI: 10.3390/medicina55100626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/09/2019] [Accepted: 09/19/2019] [Indexed: 01/31/2023]
Abstract
Background and Objectives: In anticoagulated atrial fibrillation (AF) patients, the validity of models recommended for the stratification of the risk ratio between benefits and hemorrhage risk is limited. Cerebral small vessel disease (SVD) represents the pathologic substrate for primary intracerebral hemorrhage and ischemic stroke. We hypothesize that biological markers-both circulating and imaging-based-and their possible interaction, might improve the prediction of bleeding risk in AF patients under treatment with any type of oral anticoagulant. Materials and Methods: The Strat-AF study is an observational, prospective, single-center hospital-based study enrolling patients with AF, aged 65 years or older, and with no contraindications to magnetic resonance imaging (MRI), referring to Center of Thrombosis outpatient clinic of our University Hospital for the management of oral anticoagulation therapy. Recruited patients are evaluated by means of a comprehensive protocol, with clinical, cerebral MRI, and circulating biomarkers assessment at baseline and after 18 months. The main outcome is SVD progression-particularly microbleeds-as a selective surrogate marker of hemorrhagic complication. Stroke occurrence (ischemic or hemorrhagic) and the progression of functional, cognitive, and motor status will be evaluated as secondary outcomes. Circulating biomarkers may further improve predictive potentials. Results: Starting from September 2017, 194 patients (mean age 78.1 ± 6.7, range 65-97; 61% males) were enrolled. The type of AF was paroxysmal in 93 patients (48%), and persistent or permanent in the remaining patients. Concerning the type of oral anticoagulant, 57 patients (29%) were on vitamin K antagonists, and 137 (71%) were on direct oral anticoagulants. Follow-up clinical evaluation and brain MRI are ongoing. Conclusions: The Strat-AF study may be an essential step towards the exploration of the role of a combined clinical biomarker or multiple biomarker models in predicting stroke risk in AF, and might sustain the incorporation of such new markers in the existing stroke prediction schemes by the demonstration of a greater incremental value in predicting stroke risk and improvement in clinical outcomes in a cost-effective fashion.
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Affiliation(s)
- Anna Poggesi
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy.
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
- IRCCS Don Carlo Gnocchi, 50143 Florence, Italy.
| | - Carmen Barbato
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | - Francesco Galmozzi
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | - Eleonora Camilleri
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
| | - Francesca Cesari
- Central Laboratory, Careggi University Hospital, 50134 Florence, Italy.
| | - Stefano Chiti
- Department Health Professions, U.O.c Research and Development, 50134 Careggi University Hospital, 50134 Florence, Italy.
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Silvia Galora
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Anna Melone
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | - Damiano Mistri
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | | | - Giovanni Pracucci
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | - Valentina Rinnoci
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy.
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
- IRCCS Don Carlo Gnocchi, 50143 Florence, Italy.
| | - Cristina Sarti
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy.
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Careggi University Hospital, 50134 Florence, Italy.
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
| | - Emilia Salvadori
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy.
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
- IRCCS Don Carlo Gnocchi, 50143 Florence, Italy.
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Giannelli M, Marzi C, Mascalchi M, Diciotti S, Tessa C. Can Trace-Weighted Images Be Used to Estimate Diffusional Kurtosis Imaging-Derived Indices of Non-Gaussian Water Diffusion in Head and Neck Cancer? AJNR Am J Neuroradiol 2019; 40:E44-E45. [PMID: 31467244 DOI: 10.3174/ajnr.a6167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M Giannelli
- Unit of Medical Physics Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana" Pisa, Italy
| | - C Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" University of Bologna Cesena, Italy
| | - M Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio" University of Florence Florence, Italy
| | - S Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" University of Bologna Cesena, Italy
| | - C Tessa
- Unit of Radiology Versilia Hospital Lido di Camaiore, Italy
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Pantoni L, Marzi C, Poggesi A, Giorgio A, De Stefano N, Mascalchi M, Inzitari D, Salvadori E, Diciotti S. Fractal dimension of cerebral white matter: A consistent feature for prediction of the cognitive performance in patients with small vessel disease and mild cognitive impairment. Neuroimage Clin 2019; 24:101990. [PMID: 31491677 PMCID: PMC6731209 DOI: 10.1016/j.nicl.2019.101990] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 11/17/2022]
Abstract
Patients with cerebral small vessel disease (SVD) frequently show decline in cognitive performance. However, neuroimaging in SVD patients discloses a wide range of brain lesions and alterations so that it is often difficult to understand which of these changes are the most relevant for cognitive decline. It has also become evident that visually-rated alterations do not fully explain the neuroimaging correlates of cognitive decline in SVD. Fractal dimension (FD), a unitless feature of structural complexity that can be computed from high-resolution T1-weighted images, has been recently applied to the neuroimaging evaluation of the human brain. Indeed, white matter (WM) and cortical gray matter (GM) exhibit an inherent structural complexity that can be measured through the FD. In our study, we included 64 patients (mean age ± standard deviation, 74.6 ± 6.9, education 7.9 ± 4.2 years, 53% males) with SVD and mild cognitive impairment (MCI), and a control group of 24 healthy subjects (mean age ± standard deviation, 72.3 ± 4.4 years, 50% males). With the aim of assessing whether the FD values of cerebral WM (WM FD) and cortical GM (GM FD) could be valuable structural predictors of cognitive performance in patients with SVD and MCI, we employed a machine learning strategy based on LASSO (least absolute shrinkage and selection operator) regression applied on a set of standard and advanced neuroimaging features in a nested cross-validation (CV) loop. This approach was aimed at 1) choosing the best predictive models, able to reliably predict the individual neuropsychological scores sensitive to attention and executive dysfunctions (prominent features of subcortical vascular cognitive impairment) and 2) identifying a features ranking according to their importance in the model through the assessment of the out-of-sample error. For each neuropsychological test, using 1000 repetitions of LASSO regression and 5000 random permutations, we found that the statistically significant models were those for the Montreal Cognitive Assessment scores (p-value = .039), Symbol Digit Modalities Test scores (p-value = .039), and Trail Making Test Part A scores (p-value = .025). Significant prediction of these scores was obtained using different sets of neuroimaging features in which the WM FD was the most frequently selected feature. In conclusion, we showed that a machine learning approach could be useful in SVD research field using standard and advanced neuroimaging features. Our study results raise the possibility that FD may represent a consistent feature in predicting cognitive decline in SVD that can complement standard imaging. White matter fractal dimension is altered in small vessel disease patients with MCI. White matter complexity's decrease consistently predicts worse cognitive performance. Fractal dimension may be a new marker of white matter damage in small vessel disease.
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Affiliation(s)
- Leonardo Pantoni
- 'L. Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Cesena, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Antonio Giorgio
- Department of Medicine, Surgery, and Neuroscience, University of Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery, and Neuroscience, University of Siena, Italy
| | - Mario Mascalchi
- 'Mario Serio' Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Domenico Inzitari
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Cesena, Italy
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Mascalchi M, Marzi C, Giannelli M, Ciulli S, Bianchi A, Ginestroni A, Tessa C, Nicolai E, Aiello M, Salvatore E, Soricelli A, Diciotti S. Histogram analysis of DTI-derived indices reveals pontocerebellar degeneration and its progression in SCA2. PLoS One 2018; 13:e0200258. [PMID: 30001379 PMCID: PMC6042729 DOI: 10.1371/journal.pone.0200258] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/24/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To assess the potential of histogram metrics of diffusion-tensor imaging (DTI)-derived indices in revealing neurodegeneration and its progression in spinocerebellar ataxia type 2 (SCA2). MATERIALS AND METHODS Nine SCA2 patients and 16 age-matched healthy controls, were examined twice (SCA2 patients 3.6±0.7 years and controls 3.3±1.0 years apart) on the same 1.5T scanner by acquiring T1-weighted and diffusion-weighted (b-value = 1000 s/mm2) images. Cerebrum and brainstem-cerebellum regions were segmented using FreeSurfer suite. Histogram analysis of DTI-derived indices, including mean diffusivity (MD), fractional anisotropy (FA), axial (AD) / radial (RD) diffusivity and mode of anisotropy (MO), was performed. RESULTS At baseline, significant differences between SCA2 patients and controls were confined to brainstem-cerebellum. Median values of MD/AD/RD and FA/MO were significantly (p<0.001) higher and lower, respectively, in SCA2 patients (1.11/1.30/1.03×10(-3) mm2/s and 0.14/0.19) than in controls (0.80/1.00/0.70×10(-3) mm2/s and 0.20/0.41). Also, peak location values of MD/AD/RD and FA were significantly (p<0.001) higher and lower, respectively, in SCA2 patients (0.91/1.11/0.81×10(-3) mm2/s and 0.12) than in controls (0.71/0.91/0.63×10(-3) mm2/s and 0.18). Peak height values of FA and MD/AD/RD/MO were significantly (p<0.001) higher and lower, respectively, in SCA2 patients (0.20 and 0.07/0.06/0.07×10(-3) mm2/s/year /0.07) than in controls (0.15 and 0.14/0.11/0.12/×10(-3) mm2/s/year /0.09). The rate of change of MD median values was significantly (p<0.001) higher (i.e., increased) in SCA2 patients (0.010×10(-3) mm2/s/year) than in controls (-0.003×10(-3) mm2/s/year) in the brainstem-cerebellum, whereas no significant difference was found for other indices and in the cerebrum. CONCLUSION Histogram analysis of DTI-derived indices is a relatively straightforward approach which reveals microstructural changes associated with pontocerebellar degeneration in SCA2 and the median value of MD is capable to track its progression.
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Affiliation(s)
- Mario Mascalchi
- “Mario Serio” Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
- * E-mail:
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Cesena, Italy
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital “Azienda Ospedaliero-Universitaria Pisana”, Pisa, Italy
| | - Stefano Ciulli
- “Mario Serio” Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Andrea Bianchi
- “Mario Serio” Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Andrea Ginestroni
- Neuroradiology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Carlo Tessa
- Department of Radiology and Nuclear Medicine, Versilia Hospital, AUSL 12 Viareggio, Lido di Camaiore (Lu), Italy
| | | | | | - Elena Salvatore
- Department of Neurological Sciences, University of Naples Federico II, Naples, Italy
| | | | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Cesena, Italy
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Marzi C, Ciulli S, Giannelli M, Ginestroni A, Tessa C, Mascalchi M, Diciotti S. Structural Complexity of the Cerebellum and Cerebral Cortex is Reduced in Spinocerebellar Ataxia Type 2. J Neuroimaging 2018; 28:688-693. [PMID: 29975004 DOI: 10.1111/jon.12534] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 04/05/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Fractal dimension (FD) is an index of structural complexity of cortical gray matter (GM) and white matter (WM). Application of FD to pontocerebellar degeneration has revealed cerebellar changes. However, so far, possible concurrent cerebral changes and progression of changes in brain complexity have not been investigated. METHODS We computed FD of cerebellar and cerebral cortex and WM derived from longitudinal brain MRI of patients with spinocerebellar ataxia type 2 (SCA2), which is an inherited cause of pontocerebellar degeneration. Nine SCA2 patients and 16 age-matched healthy controls were examined twice (3.6 ± .7 and 3.3 ± 1.0 years apart, respectively) on the same 1.5T MR scanner with T1-weighted imaging. Cortical GM and WM of the cerebrum and cerebellum were segmented using FreeSurfer and FD of these segmentations were computed. RESULTS At baseline, FD values of cerebellar GM and WM were significantly (P < .001) lower in SCA2 patients (2.48 ± .04 for GM and 1.74 ± .09 for WM) than in controls (2.56 ± .02 for GM and 2.22 ± .19 for WM). Also, FD values of cerebral GM were significantly (P < .05) lower in SCA2 patients (2.39 ± .03) than in controls (2.43 ± .02). No significant differences were observed for FD of the cerebral WM. The rate of change of FD values was not significantly different between SCA2 patients and controls. CONCLUSIONS The structural complexity of the cerebellum and cerebral cortex is reduced in SCA2 patients. Fractal analysis seems not to be able to demonstrate progression of changes associated with degeneration in SCA2.
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Affiliation(s)
- Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Stefano Ciulli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Andrea Ginestroni
- Neuroradiology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Carlo Tessa
- Department of Radiology and Nuclear Medicine, Versilia Hospital, Lido di Camaiore (Lu), Italy
| | - Mario Mascalchi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
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Giannelli M, Marzi C, Mascalchi M, Diciotti S, Tessa C. Toward a Standardized Approach to Estimate Kurtosis in Body Applications of a Non-Gaussian Diffusion Kurtosis Imaging Model of Water Diffusion. Radiology 2017; 285:329-331. [DOI: 10.1148/radiol.2017170995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital “Azienda Ospedaliero-Universitaria Pisana”, Pisa, Italy
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Via Venezia 52, 47521 Cesena, Italy
| | - Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Via Venezia 52, 47521 Cesena, Italy
| | - Carlo Tessa
- Unit of Radiology, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore (LU), Italy
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Krüger J, Scholz M, Gross A, Krause K, Marzi C, Grallert H, Ladenvall C, Schleinitz D, Kirsten H, Heyne H, Laurila E, Kriebel J, Thorand B, Rathmann W, Groop L, Prokopenko I, Isomaa B, Beutner F, Kratzsch J, Thiery J, Klöting N, Fischer-Rosinský A, Pfeiffer A, Spranger J, Gieger C, Blüher M, Stumvoll M, Kovacs P, Tönjes A. Genome wide meta-analysis identifies novel regulators of circulating serum progranulin. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tamietto M, Cauda F, Corazzini LL, Savazzi S, Marzi C, Goebel R, Weiskrantz L, de Gelder B. Collicular vision guides non-conscious behavior. J Vis 2010. [DOI: 10.1167/8.6.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fuggetta G, Silvanto J, Muggleton N, Pavone E, Feurra M, Sartori L, Marzi C, Walsh V. Electrophysiological evidence for the role of extrastriate visual cortex in visual awareness. J Vis 2010. [DOI: 10.1167/8.6.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Grallert H, Herder C, Marzi C, Meisinger C, Wichmann HE, Rathmann W, Illig T. Association of genetic variation in KCNQ1 with type 2 diabetes in the KORA surveys. Horm Metab Res 2010; 42:149-51. [PMID: 19798621 DOI: 10.1055/s-0029-1241170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H Grallert
- Helmholtz Zentrum München, National Research Centre for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
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Marzi C, Huth C, Kolz M, Grallert H, Meisinger C, Wichmann HE, Rathmann W, Herder C, Illig T. Variants of the transcription factor 7-like 2 gene (TCF7L2) are strongly associated with type 2 diabetes but not with the metabolic syndrome in the MONICA/KORA surveys. Horm Metab Res 2007; 39:46-52. [PMID: 17226113 DOI: 10.1055/s-2007-957345] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Recently, significant associations between common variants of the transcription factor 7-like 2 gene ( TCF7L2) and type 2 diabetes have been reported. This study was designed to replicate the reported associations of the two highly correlated (r (2)=0.86) TCF7L2 single nucleotide polymorphisms rs12255372 and rs7903146 with type 2 diabetes in a case-control study of 2369 MONICA/KORA participants (678 cases/1691 controls from Augsburg, Germany). To further investigate the pathogenic mechanism underlying these associations, we extended our analyses to the metabolic syndrome (IDF, NCEP definitions) and its components in a population-based study comprising 1404 male and female KORA participants aged 55-74 years. Results of our analyses strongly confirmed the minor T alleles as risk variants for type 2 diabetes (rs7903146: OR (TvsC) [95% CI]=1.36 [1.18;1.58], p=0.00003, and rs12255372: OR (TvsG) [95% CI]=1.31 [1.13;1.51], p=0.0003). Moreover, the T allele at rs7903146 was inversely associated with log-transformed, HOMA-%B (beta=-0.07, p=0.005) as a measure of basal insulin secretion, and log-transformed fasting insulin (beta=-0.06, p=0.02). No association was found with insulin resistance (HOMA-IR) and the metabolic syndrome. These findings support replication evidence that TCF7L2 variants increase type 2 diabetes risk. TCF7L2 may primarily affect pancreatic beta cell function.
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Affiliation(s)
- C Marzi
- GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany
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Calzolari E, Aiello V, Palazzi P, Sensi A, Calzolari S, Orrico D, Calliari L, Holler H, Marzi C, Belli S, Bernardi F, Patracchini P. Psychiatric disorder in a familial 15;18 translocation and sublocalization of myelin basic protein of 18q22.3. Am J Med Genet 1996; 67:154-61. [PMID: 8723042 DOI: 10.1002/(sici)1096-8628(19960409)67:2<154::aid-ajmg5>3.0.co;2-s] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Two related patients with similar clinical features consisting of a few dysmorphic signs and psychiatric disturbance were reported to have a partial trisomy of chromosomes 15(pter-q13.3) and 18(q23-qter) deriving from a familial translocation t(15;18). One patient is affected by bipolar disorder and the other by schizoaffective disorder. Both cases have a predominantly affective course; nevertheless, a clear diagnosis is difficult in the first patient, who is 15 years of age, and only a longitudinal course will allow us to establish a definite diagnosis. The possibility that these two pathologies belong to a single category is discussed, and the presence of a susceptibility locus on chromosome 18 is hypothesized. Cytogenetic data, FISH, and DNA studies indicate that the myelin basic protein (MPB) gene is not involved in the translocation, and localize it centromeric to the breakpoint on chromosome 18(q22.3). Thus, it is unlikely to be involved in the disease.
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Affiliation(s)
- E Calzolari
- Istituto di Genetica Medica, Universitá Ferrara, Universitá Ferrara, Italy
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Raguse T, Klinge U, Baron U, Marzi C. [Breast cancer of the male. Analysis of our patient sample and the literature]. Chirurg 1985; 56:784-8. [PMID: 3002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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35
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Collin NG, Cowey A, Latto R, Marzi C. The role of frontal eye-fields and superior colliculi in visual search and non-visual search in rhesus monkeys. Behav Brain Res 1982; 4:177-93. [PMID: 7059375 DOI: 10.1016/0166-4328(82)90071-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Rhesus monkeys were tested on a visual search task in which they had to find and retrieve a peanut from a display of visually similar but inedible objects. The speed with which they did so was measured. Animals in which the superior colliculi or frontal eye-fields had been removed took longer to find the peanut than two operated control groups. Animals with collicular lesions had longer latencies than those with frontal eye-fields removed. These two groups were also tested on a second task, non-visual search, in which a peanut was concealed in each of 25 identical holes. The animals' task was to retrieve all 25 peanuts as quickly as possible. The group with frontal eye-fields removed made significantly more return errors, i.e. returning to a hole already sampled, than the control group but, in contrast to the first task, the animals with collicular lesions were not impaired. The results are related to the physiological properties of frontal eye-fields and superior colliculi and to the effects of frontal cortical brain damage in man. It is suggested that the frontal eye-fields are concerned with internally organized, i.e. voluntary, eye scanning whereas the superior colliculi are concerned with the detection and location of targets which are then fixated involuntarily.
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Marzi C, Jotti D. [Not Available]. Riv Stor Med 1971; 15:225-46. [PMID: 11626751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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37
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Marzi C, Jotti D. [Work of Vittorio Marchi from Novellara in the neurological field. (Value and modern characteristics of his research and method in histology, anatomy and pathology of the nervous system. consideration of his activity in the context of a tormented life)]. Riv Stor Med 1971; 15:225-46. [PMID: 4948752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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38
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Marzi C, Jotti D, Manini L. [Clinico-therapeutic observations on the association of diabetes and tuberculosis in adult, presenile and senile subjects]. Acta Gerontol (Milano) 1970; 20:42-56. [PMID: 5478831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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39
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Corato P, Bassi A, Jotti D, Rossi G, Marzi C. [Observations on the early symptomatology of chronic miliary pulmonary tuberculosis in adult, middle aged and aged patients]. Acta Gerontol (Milano) 1969; 19:90-4. [PMID: 5374867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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40
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Marzi C, Jotti D. [Application of chemoprophylaxis in homes for the aged]. Acta Gerontol (Milano) 1969; 19:95-100. [PMID: 5374868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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41
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Marzi C, Jotti D, Russo G. [Relationship between diabetes and tuberculosis in the aged]. Acta Gerontol (Milano) 1968; 18:164-73. [PMID: 5737974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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42
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Jotti D, Marzi C. [Pleuro-pulmonary tuberculosis in the aged. Survey on a random population group in 1951 to 1966]. Acta Gerontol (Milano) 1968; 18:127-30. [PMID: 5753357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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43
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Jotti D, Pietranera M, Marzi C. [18 years of activity of the chest x-ray unit of the Antitubercular Provincial Association of Reggio Emilia]. Lotta Tuberc 1968; 38:Suppl:225-33. [PMID: 5253526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Leoncini G, Marzi C, Silingardi P. [Behavior of the leukosedimentation index compared with others biological tests in aged and presenile subjects]. Acta Gerontol (Milano) 1968; 18:23-7. [PMID: 5715917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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45
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Marzi C, Russo G, Iotti D. [Determination of blood sugar by the simplified potassium cyanide method]. Acta Gerontol (Milano) 1967; 17:187-92. [PMID: 5608432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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46
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Corradini E, Gori F, Marzi C. [Histological modifications of the temporal lobe within the limits of the encephalic pathologic blood circulation of the immature infant. Contribution to the pathogenesis of some types of epilepsy]. Arch De Vecchi Anat Patol 1967; 48:701-34. [PMID: 5606324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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