Background This pilot study was designed to develop a fully automatic and quantitative scoring system of B-lines (QLUSS: quantitative lung ultrasound score) involving the pleural line and to compare it with previously described semi-quantitative scores in the measurement of extravascular lung water as determined by standard thermo-dilution. Methods This was a prospective observational study of 12 patients admitted in the intensive care unit with acute respiratory distress and each provided with 12 lung ultrasound (LUS) frames. Data collected from each patient consisted in five different scores, four semi-quantitative (nLUSS, cLUSS, qLUSS, %LUSS) and quantitative scores (QLUSS). The association between LUS scores and extravascular lung water (EVLW) was determined by simple linear regression (SLR) and robust linear regression (RLR) methods. A correlation analysis between the LUS scores was performed by using the Spearman rank test. Inter-observer variability was tested by computing intraclass correlation coefficient (ICC) in two-way models for agreement, basing on scores obtained by different raters blinded to patients’ conditions and clinical history. Results In the SLR, QLUSS showed a stronger association with EVLW ( R 2 = 0.57) than cLUSS ( R 2 = 0.45) and nLUSS ( R 2 = 0.000), while a lower association than qLUSS ( R 2 = 0.85) and %LUSS ( R 2 = 0.72) occurred. By applying RLR, QLUSS showed an association for EVLW ( R 2 = 0.86) comparable to qLUSS ( R 2 = 0.85) and stronger than %LUSS ( R 2 = 0.72) . QLUSS was significantly correlated with qLUSS ( r = 0.772; p = 0.003) and %LUSS ( r = 0.757; p = 0.005), but not with cLUSS ( r = 0.561; p = 0.058) and nLUSS ( r = 0.105; p = 0.744). Moreover, QLUSS showed the highest ICC (0.998; 95%CI from 0.996 to 0.999) among the LUS scores. Conclusions This study demonstrates that computer-aided scoring of the pleural line percentage affected by B-lines has the potential to assess EVLW. QLUSS may have a significant impact, once validated with a larger dataset composed by multiple real-time frames. This approach has the potentials to be advantageous in terms of faster data analysis and applicability to large sets of data without increased costs. On the contrary, it is not useful in pleural effusion or consolidations. Electronic supplementary material ...

Discriminating acute respiratory distress syndrome (ARDS) from acute cardiogenic pulmonary edema (CPE) may be challenging in critically ill patients. Aim of this study was to investigate if gray-level co-occurrence matrix (GLCM) analysis of lung ultrasound (LUS) images can differentiate ARDS from CPE. The study population consisted of critically ill patients admitted to intensive care unit (ICU) with acute respiratory failure and submitted to LUS and extravascular lung water monitoring, and of a healthy control group (HCG). A digital analysis of pleural line and subpleural space, based on the GLCM with second order statistical texture analysis, was tested. We prospectively evaluated 47 subjects: 16 with a clinical diagnosis of CPE, 8 of ARDS, and 23 healthy subjects. By comparing ARDS and CPE patients’ subgroups with HCG, the one-way ANOVA models found a statistical significance in 9 out of 11 GLCM textural features. Post-hoc pairwise comparisons found statistical significance within each matrix feature for ARDS vs. CPE and CPE vs. HCG (P ≤ 0.001 for all). For ARDS vs. HCG a statistical significance occurred only in two matrix features (correlation: P = 0.005; homogeneity: P = 0.048). The quantitative method proposed has shown high diagnostic accuracy in differentiating normal lung from ARDS or CPE, and good diagnostic accuracy in differentiating CPE and ARDS. Gray-level co-occurrence matrix analysis of LUS images has the potential to aid pulmonary edemas differential diagnosis.

Study Objectives Increased phase synchronization in electroencephalography (EEG) bands might reflect the activation of compensatory mechanisms of cognitive decline in people with neurodegenerative diseases. Here, we investigated whether altered large-scale couplings of brain oscillations could be linked to the balancing of cognitive decline in a longitudinal cohort of people with idiopathic rapid eye-movement sleep behavior disorder (iRBD). Methods We analyzed 18 patients (17 males, 69.7±7.5 years) with iRBD undergoing high-density EEG (HD-EEG), presynaptic dopaminergic imaging, and clinical and neuropsychological assessments at two time points (time interval 24.2±5.9 months). We thus quantified the HD-EEG power distribution, orthogonalized amplitude correlation and weighted phase lag index at both time points and correlated them with clinical, neuropsychological and imaging data. Results Four patients phenoconverted at follow-up (three cases of parkinsonism and one of dementia). At the group level, neuropsychological scores decreased over time, without reaching statistical significance. However, alpha phase synchronization increased and delta amplitude correlations decreased significantly at follow-up compared to baseline. Both large-scale network connectivity metrics were significantly correlated with neuropsychological scores but not with sleep quality indices or presynaptic dopaminergic imaging data. Conclusions These results suggest that increased alpha phase synchronization and reduced delta amplitude correlation may be considered electrophysiological signs of an active compensatory mechanism of cognitive impairment in people with iRBD. Large-scale functional modifications may be helpful biomarkers in the characterization of prodromal stages of alpha-synucleinopathies.

Background In clinical assessment of Pectus Excavatum (PE), the indication to surgery is based not only on symptoms but also on quantitative markers calculated from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scans. According to clinical routine, these indexes are measured manually by radiologists with limited computer support. This process is time consuming and potentially subjected to inaccuracy and individual variability in measurements. Moreover, the existing indexes have limitations, since they are based on linear measurements performed on single slices rather than on volumetric data derived from all the thoracic scans. Results In this paper we present an image processing pipeline aimed at providing radiologists with a computer-aid tool in support of diagnosis of PE patients developed in MATLAB® and conceived for MRI images. This framework has a dual purpose: (i) to automatize computation of clinical indexes with a view to ease and standardize pre-operative evaluation; (ii) to propose a new marker of pathological severity based on volumetric analysis and overcoming the limitations of existing axial slice-based indexes. Final designed framework is semi-automatic, requiring some user interventions at crucial steps: this is realized through a Graphical User Interface (GUI) that simplifies the interaction between the user and the tools. We tested our pipeline on 50 pediatric patients from Gaslini Children’s Hospital and performed manual computation of indexes, comparing the results between the proposed tool and gold-standard clinical practice. Automatic indexes provided by our algorithm have shown good agreement with manual measurements by two independent readers. Moreover, the new proposed Volumetric Correction Index (VCI) has exhibited good correlation with standardized markers of pathological severity, proving to be a potential innovative tool for diagnosis, treatment, and follow-up. Conclusions Our pipeline represents an innovative image processing in PE evaluation, based on MRI images (radiation-free) and providing the clinician with a quick and accurate tool for automatically calculating the classical PE severity indexes and a new more comprehensive marker: the Volumetric Correction Index.

Idiopathic/isolated REM sleep behavior disorder (iRBD) is considered a prodromal stage of alpha-synucleinopathies. Cortical and sub-cortical brain modifications begin years before the emergence of overt neurodegenerative symptoms. To better understand the pathophysiological process impacting the brain from the prodromal to the overt stage of alpha-synucleinopathy, it is essential to assess iRBD patients over time. Recent evidence suggests that the human brain operates at an operating point near a critical phase transition between subcritical and supercritical phases in the system′s state space to maintain cognitive and physiological performance. In contrast, a deviation from the critical regime leading to altered oscillatory dynamics has been observed in several pathologies. Here, we investigated if the alpha-synucleinopathy produces a deviation of the operating point already evident in the prodromal phase and if this shift correlates with biological and clinical disease severity. We analyzed a dataset of 59 patients with iRBD (age 69.61 +/- 6.98, 50 male) undergoing resting-state high-density EEG, presynaptic dopaminergic imaging, and clinical evaluations. Thirty-one patients (age 72.41 +/- 7.05, 31 male) also underwent clinical and instrumental follow-up (mean follow-up period 25.85 +/- 10.20 months). To localize the individual operating points along the excitation-inhibition (EI) continuum, we assessed both measures of neuronal EI balance and measures of critical brain dynamics such as long-range temporal correlation (LRTCs) and neuronal bistability in spontaneous narrow-band oscillations. Finally, we correlated critical brain dynamics and EI balance metrics with phase synchronization, nigro-striatal dopaminergic functioning, and clinical performances. Compared to 48 healthy subjects (age 70.25 +/- 10.15, 23 male), iRBD patients showed higher values of LRTCs and bistability in the 2-7 Hz band at diagnosis. Patients who eventually phenoconverted to overt alpha-synucleinopathy exhibited a more excitation-dominated (fEI > 1) condition than stable iRBD patients in 5-7 Hz. This higher excitation also directly correlated with phase synchronization in 2-7 Hz, further suggesting a shift of the operating point toward a supercritical state with the disease progression. Moreover, excitation-dominated state and low bistability were associated with deterioration of the nigro-striatal dopaminergic function and tended to correlate with stronger clinical symptoms. In conclusion, this study shows for the first time a deviation of the working point from inhibition- to excitation-dominated states along the continuum from prodromal to overt phases of the disease. These cortical brain dynamics modifications are associated with nigro-striatal dopaminergic impairment. These results increase our knowledge of the physiopathological process underlying alpha-synucleinopathies since prodromal stages, possibly providing new clues on disease-modifying strategies.