Cerebral small vessel disease (CSVD) is a series of diseases originating from pathological changes in cerebral microvessels, with a high prevalence in the population of advanced age. CSVD may significantly increase the risk of various neurological disorders, including cognitive impairment and stroke. With the development and application of advanced imaging techniques such as functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), there has been a deeper understanding of the brain function and microstructural changes in patients with CSVD. This article reviews some new indicators and analysis methods of fMRI and DTI in CSVD research, and elaborates on their correlation with patient clinical manifestations.

Objective:To construct radiomics models of micro-calcification in carotid plaques, and compare their diagnostic values.Methods:Fifty-two patients with large atherosclerotic cerebral infarction admitted to Department of Neurology, Third Affiliated Hospital of Soochow University from May 2017 to November 2019 were enrolled. All patients underwent conventional carotid artery Doppler ultrasound to detect carotid plaques and Micropure? ultrasound to detect micro-calcifications in the plaques. A cross-section image with maximum numbers of micro-calcifications was chosen when there were micro-calcifications in carotid plaques; otherwise, a cross-section image with the largest area of the plaque was chosen. After all images were normalized by Photoshop software, the plaques were delineated as regions of interest using MaZda 4.6 software and 283 texture features of the plaques were automatically extracted. The texture features with the strongest predictive value were selected through consistency analysis (intrclass correlation coefficient [ICC]>0.75), two-sample t-test, Least absolute shrinkage and selection operator (Lasso) regression. The predictive models were constructed by RandomForest (RF) and Support vector machine (SVM) classifiers. The training set and test set were divided by 7: 3 to analyze the classification accuracy. Receiver operating characteristic (ROC) curves were used to calculate the area under the curve (AUC) to evaluate the diagnostic values of the models. Delong test was used to compare the difference between the diagnostic values of the 2 classifiers in test set. Results:A total of 148 plaque images from 52 patients were enrolled, including 104 plaques with micro-calcification and 44 plaques without micro-calcification. Nine texture features were finally selected after ICC analysis, T test and Lasso regression: 5 image gray histogram features were mean, variance, skewness, kurtosis and 99 th percentile (Perc. 99%); 1 autoregressive model feature was Teta3, and 3 wavelet transform features were WavEnLH_s-3, WavEnLH_s-4, and WavEnLH_s-6. With RF classifier, accuracy of the diagnostic model was 0.93, enjoying AUC of 0.92; with SVM classifier, that was 0.91, enjoying AUC of 0.90; Delong test showed that the diagnostic values of the 2 classifiers in test set were significantly different ( Z=1.000, P=0.320). Conclusion:Radiomic models constructed by RF and SVM classifiers can identify micro-calcification in carotid plaques, and the 2 classifiers share equivalent diagnostic values.

Objective:To investigate the correlation between the Type D personality and the severity of white matter hyperintensities (WMHs) in patients with cerebral small vessel disease (CSVD).Methods:Consecutive patients with CSVD admitted to the Changzhou First People's Hospital between November 2020 and June 2021 were enrolled prospectively. The patients were scored on the Type D Personality Scale at admission; the scores of negative affectivity (NA) and social inhibition (SI) dimension were calculated respectively. The general data, laboratory examination data and imaging data of the patients were collected. Periventricular and deep WMHs were scored using the Fazekas visual scoring method. The total score 0-2 was defined as low-WMHs (L-WMHs), and 3-6 was defined as high-WMHs (H-WMHs). Multivariate logistic regression analysis was used to determine the independent influencing factor of WMHs. Results:A total of 100 patients with CSVD were enrolled, including 51 males (51%), aged 67.21±9.38 years, 29 (29%) had Type D personality; 56 (56%) were in the L-WMHs group and 44 (44%) were in the H-WMHs group. Univariate analysis showed that the proportion of Type D personality, NA dimension score, the proportion of hypertension, diastolic blood pressure, triglyceride and homocysteine in the H-WMHs group were significantly higher than those in the L-WMHs group (all P<0.05). Multivariate logistic regression analysis showed that NA dimension score (odds ratio [ OR] 18.351, 95% confidence interval [ CI] 2.780-121.135; P=0.003), age ( OR 1.134, 95% CI 1.039-1.238; P=0.005) and hypertension ( OR 7.771, 95% CI 1.525-39.607; P=0.014) were significantly positively correlated with the severity of WMHs, while triglycerides were significantly negatively correlated with the severity of WMHs ( OR 0.306, 95% CI 0.130-0.722; P=0.007). Conclusion:Type D personality is closely associated with the severity of WMHs in patients with CSVD.

Objective:To evaluate the efficacy of stem cell transplantation in treatment of ischemic stroke.Methods:Randomized controlled studies about stem cell transplantation in the treatment of ischemic stroke were searched from Pubmed, Cochrane Library, Embase, Ovid, China National Knowledge Infrastructure (CNKI), Wanfang and VIP database from database establishment to March 2021. The literature was screened according to the inclusion and exclusion criteria and the clinical data of the stem cell transplantation patients and conventional treatment patients were extracted. The differences of baseline value and final value of National Institutes of Health Stroke Scale (NIHSS) scores, Function Independent Measurement (FIM) scores, Fugl-Meyer Measurement (FMA) scores, Barthel index (BI), Activity of Daily Living (ADL) scale scores, modified Rankin scale (mRS) scores between the two groups were combined for Meta analysis.Results:Eighteen articles were included in the study, including 1334 patients; 668 patients were from the stem cell transplantation group and 666 patients were from the conventional treatment group. The results showed that NIHSS scores (difference in means [ MD]=3.510, 95%CI: 2.540-4.480, P=0.000], FIM scores ( MD=11.380, 95%CI: 5.470-17.280, P=0.000), FMA scores ( MD=13.830, 95%CI: 12.590-15.070, P=0.000), BI ( MD=22.100, 95%CI: 19.430-24.770, P=0.000), ADL scores ( MD=9.290, 95%CI: 3.530-15.050, P=0.002), and mRS scores ( P=0.004) in the stem cell transplantation group were significantly higher as compared with those in the conventional treatment group ( P<0.05). Conclusion:Stem cell transplantation on the basis of conventional treatment has good clinical efficacy in the recovery of neurological function, improvement of activity of daily living, and improvement of limb motor function in patients with ischemic stroke.

Objective:To explore the correlations of micro-calcification load in carotid plaques and plaque vulnerability scores detected by Micropure? ultrasonic technology with 18F-sodium fluoride ( 18F-NaF) uptake ratio (tissue-background ratio [TBR]) in positron emission tomography-computed tomography (PET-CT). Methods:Baseline data of patients with carotid atherosclerotic plaques admitted to our hospital from March 2017 to November 2020 were collected. Carotid arteries of these patients simultaneously positive on Micropure? ultrasound examination and 18F-NaF PET-CT were included. The number of spots in carotid plaques detected by Micropure? ultrasonic technology was defined as load of micro-calcification: they were divided into large number of micro-calcifications group (≥5 spots) and small number of micro-calcifications group (1-4 spots). The scores of carotid plaque vulnerability were evaluated according to carotid atherosclerosis scores in Diagnostic Value of Carotid Atherosclerosis Score for Ischemic Stroke. Correlations of TBR with micro-calcification load and plaque vulnerability scores in these 39 carotid arteries were analyzed. Results:Thirty-nine carotid arteries from 28 patients were enrolled: 24 carotid arteries were classified into the large number of micro-calcifications group and 15 carotid arteries were classified into the small number of micro-calcifications group. TBR of the large number of micro-calcifications group (2.61±0.73) was significantly increased as cpmpared with that of the small number of micro-calcifications group (1.93±0.43, t=-3.657, P=0.001). In the 39 carotid arteries, micro-calcification load was 5(3, 5), while the carotid plaque vulnerability scores were 2 (2, 3); micro-calcification load was positively correlated with TBR (2.35±0.71, r s=0.519, P=0.001), but no correlation was noted between TBR and carotid plaque vulnerability scores ( r s=0.086, P=0.602). Conclusion:Carotid plaque micro-calcification load detected by Micropure? ultrasound examination is associated with 18F-NaF uptake ratio; the larger the micro-calcification load, the more obvious the uptake of 18F-NaF.

Objective To investigate the association between heme oxygenase-1 (HO-1) gene rs2071746 polymorphism and long-term clinical outcome in patients with ischemic stroke.Methods Between July 2015 and June 2017,consecutive patients with acute ischemic stroke admitted to the Department of Neurology,the Third Affiliated Hospital of Soochow University were enrolled prospectively.TOAST classification was performed for all patients.Genotyping of the HO-1 gene rs2071746 polymorphism was performed using a modified multiplex ligase detection reaction technique.The patients were followed up.The primary endpoint events included ischemic stroke,vascular death,and myocardial infarction.Multivariate Cox proportional hazard regression model was used to analyze the independent influencing factors for primary endpoint events.Results A total of 1 698 patients with successful genotyping and follow-up information were enrolled.Genotyping showed that the frequency of rs2071746 A allelewas 44.91％.They were followed up for 15.21 ± 7.39 months,and 168 patients (9.89％) had primary endpoint events.The incidence of primary endpoint events in A allele carriers was significantly lower than that in non-A allele carriers (8.80％ vs.12.40％;P =0.018).Multivariate Cox proportional risk regression model showed that after adjusting for age,gender,hypertension,diabetes mellitus,smoking,alcohol consumption,and genotype,A allele was an independent protective factor for primary endpoint events in patients with acute ischemic stroke (hazard risk [HR] 0.693,95％ confidence interval [CI]0.506-0.949;P=0.022).Subgroup analysis showed that carrying the A allele was an independent protective factor for primary endpoint events in patients with large atherosclerotic stroke (HR 0.651,95％ CI 0.425-0.997;P=0.048),while rs2071746 polymorphism was not associated with long-term outcome in other etiological subtypes.Conclusion The HO-1 gene rs2071746 A allele may be a protective factor for the long-term outcome in patients with acute ischemic stroke and large atherosclerotic stroke.

It has been previously thought that calcification is a feature of the stability of atherosclerotic plaques. However, recent studies have shown that microcalcification in atherosclerotic plaques is significantly associated with plaque vulnerability. The relationship between atherosclerotic plaques and calcification is unclear, and the specific role of calcification in atherosclerotic plaques remains controversial.

Objective To explore the relationship between carotid plaque microcalcifcation and ischemic stroke (including transient ischemic attack) and the value of carotid microcalcification in predicting ischemic stroke.Methods Twenty-six patients in accordance with atherothrombosis models classified by Korean modified TOAST classification were enrolled in this study from November 2016 to March 2017.The microcalcification of the bilateral carotid was detected by Micropure imaging and the severity of intracranial ischemic focal lesions was evaluated by Alberta stroke programme early CT scale (ASPECT).The relation of ASPECT scores with microcalcification of the bilateral carotid was analyzed,and the value of carotid microcalcification in predicting ischemic stroke was analyzed by receiver operating characteristic curve method.Results Microcalcifition was detected in 27 of the total 52 carotids (51.92％) in 19 patients,which localized in the fibrous cap in 23 carotids (85.19％) and the basilar part of the plaque in 4 carotids (14.81％).The microcalcification surrounded the macrocalcifiation in 14 carotids (51.85％).The ASPECT scores were 10.85±1.43 in the microcalcifition side,which were significantly higher than those in the side without microcalcifition (11.80±1.19,t=2.584,P=0.013).The area under the curve was 0.673,with sensitivity of 0.667 and specificity of 0.680.Conclusion Micropure imaging maybe a new approach to detect the carotid microcalcification,and plaques with microcalcifition mav easilv cause ipsilateral ischemic stroke.

Objective To study the value of expanded-National Institutes of Health Stroke Scale (e-NIHSS) in evaluating the neurological signs of medullary infarction.Methods One hundred and thirteen patients with primary medullary infarction proved by magnetic resonance imaging were enrolled and divided into medial medullary infarction (MMI) group (n=41) and lateral medullary infarction (LMI) group (n=72).Risk factors of stroke and neurological signs evaluated by NIHSS and e-NIHSS were recorded and compared between the two groups.Results The age and prevalence of diabetes in MMI group were significantly older/higher than those in LMI group (P＜0.05).The major neurological signs of MMI were limb weakness (95.12％),dysphagia (36.59％),facial plasy (34.15％) and dysarthria (31.71％).And the major neurological signs of LMI were dysphagia (63.89％),truncal ataxia (54.17％),sensory dysfunction (50.00％) and dysarthia (48.61％).All the patients had significantly higher e-NIHSS scores than NIHSS scores (5.40±2.74 vs.2.96±2.22,P=0.000),which was similar in MMI group (e-NIHSS:5.34±3.20 vs.NIHSS:4.07±2.55,P=0.000) and in LMI group (e-NIHSS:5.43±2.47 vs.NIHSS:2.33±1.74,P=0.000).The e-NIHSS scores increased 2.57±1.99 than NIHSS scores in all the patients,which were 1.63±2.25 in MMI group and 3.10±1.62 in LMI higher than NIHSS scores;the differences were statistically significant (P＜0.05).Conclusion The e-NIHSS could improve the sensitivity of NIHSS in evaluating the neurological signs of medullary infarction,which is better in evaluating LMI than in evaluating MMI.

Cerebral Hemorrhage ; drug therapy ; Humans ; Thrombolytic Therapy