Diagnostic performance of CT densities in selected gray- and white-matter regions for the clinical diagnosis of brain death: A retrospective study in a tertiary-level general hospital

Diagnostic Performance of Selected MRI-Derived Radiomics Able to Discriminate Progression-Free and Overall Survival in Patients with Midline Glioma and the H3F3AK27M Mutation

BACKGROUND

Radiomics refers to a recent area of knowledge that studies features extracted from different imaging techniques and subsequently transformed into high-dimensional data that can be associated with biological events. Diffuse midline gliomas (DMG) are one of the most devastating types of cancer, with a median survival of approximately 11 months after diagnosis and 4-5 months after radiological and clinical progression.

METHODS

A retrospective study. From a database of 91 patients with DMG, only 12 had the H3.3K27M mutation and brain MRI DICOM files available. Radiomic features were extracted from MRI T1 and T2 sequences using LIFEx software. Statistical analysis included normal distribution tests and the Mann-Whitney U test, ROC analysis, and calculation of cut-off values.

RESULTS

A total of 5760 radiomic values were included in the analyses. AUROC demonstrated 13 radiomics with statistical significance for progression-free survival (PFS) and overall survival (OS). Diagnostic performance tests showed nine radiomics with specificity for PFS above 90% and one with a sensitivity of 97.2%. For OS, 3 out of 4 radiomics demonstrated between 80 and 90% sensitivity.

CONCLUSIONS

Several radiomic features demonstrated statistical significance and have the potential to further aid DMG diagnostic assessment non-invasively. The most significant radiomics were first- and second-order features with GLCM texture profile, GLZLM_GLNU, and NGLDM_Contrast.

Evolution and current circumstances of heart transplants: Global and Mexican perspective

A cardiac transplant is an irreplaceable alternative for patients with terminal chronic heart failure refractive to treatment. Heart failure results from an imbalance between cardiac output and organic demand, the prominent etiology is ischemic heart disease and arterial hypertension. In developed countries, it has a prevalence of 4.2%, reaching over 11.8% in adults over 65. It affects around 64.3 million people worldwide, with 9 cases for every 1000 people. This syndrome has a death rate of 56% in 5 years, making heart transplants relevant. The procedure has dramatically evolved from the beginning of animal experimentation in the early 20^th century to now, where significant advances are still being made. The purpose of this review is to compile the central aspects of international and Mexico's local heart transplant history and current status, as well as a general view of what this procedure entails and possible prospective outcomes for this practice.

Utility of brain parenchyma density measurement and computed tomography perfusion imaging in predicting brain death

Purpose

To assess the utility of brain parenchyma density measurement on unenhanced computed tomography (CT) in predicting brain death (BD), in order to evaluate the added value of CT perfusion (CTP).

Material and methods

A total of 77 patients who were clinically diagnosed as BD and had both CT angiography (CTA) and CTP imaging in the same session were retrospectively reviewed. On unenhanced phase of CTA, density measurement was performed from 23 regions of interests (ROIs) which were located in the following areas: level of basal ganglia (caudate nucleus, putamen, corpus callosum, posterior limb of internal capsule), level of brainstem, grey- white matters on levels of centrum semiovale (CS), high convexity (HC), and cerebellum. CTP images were evaluated qualitatively and independently. Grey matter (GM), white matter (WM), density, and GM/WM density ratio of BD patients were compared with control subjects.

Results

Comparing with the normal control group, the GM and WM density at each level and GM/WM density ratio of CS, HC, and cerebellum level were significantly lower in brain-dead patients (p = 0.019 for HC-WM, p < 0.001 for other areas). Using ROC analysis, the highest value of area under curve (AUC) for the GM/WM density ratio was found at the HC level (AUC = 0.907). The sensitivity of the GM/WM density ratio at the HC level was found to be 90% when the cut-off value of 1.25 was identified. Evaluating the GM/WM density ratio together with the CTP results increased the sensitivity further to 98%.

Conclusions

The GM/WM density ratio at the HC level on unenhanced CT may be a useful finding to predict BD. Also, the addition of CTP increases the sensitivity of this method.