Objectives: This study aimed to evaluate the diagnostic performance of magnetic resonance perfusion-weighted imaging (PWI) as a noninvasive method to assess post-treatment radiation effect and tumor progression in patients with glioma. Methods: A systematic literature search was performed in the PubMed, Cochrane Library, and Embase databases up to March 2020. The quality of the included studies was assessed by the quality assessment of diagnostic accuracy studies 2. Data were extracted to calculate sensitivity, specificity, and diagnostic odds ratio (DOR), 95% Confidence interval (CI) and analyze the heterogeneity of the studies (Spearman correlation coefficient, I 2 test). We performed meta-regression and subgroup analyses to identify the impact of study heterogeneity. Results: Twenty studies were included, with available data for analysis on 939 patients and 968 lesions. All included studies used dynamic susceptibility contrast (DSC) PWI, four also used dynamic contrast-enhanced PWI, and three also used arterial spin marker imaging PWI. When DSC was considered, the pooled sensitivity and specificity were 0.83 (95% CI, 0.79 to 0.86) and 0.83 (95% CI, 0.78 to 0.87), respectively; pooled DOR, 21.31 (95% CI, 13.07 to 34.73); area under the curve (AUC), 0.887; Q∗, 0.8176. In studies using dynamic contrast-enhanced, the pooled sensitivity and specificity were 0.73 (95% CI, 0.66 to 0.80) and 0.80 (95% CI, 0.69 to 0.88), respectively; pooled DOR, 10.83 (95% CI, 2.01 to 58.43); AUC, 0.9416; Q∗, 0.8795. In studies using arterial spin labeling, the pooled sensitivity and specificity were 0.79 (95% CI, 0.69 to 0.87) and 0.78 (95% CI, 0.67 to 0.87), respectively; pooled DOR, 15.63 (95% CI, 4.61 to 53.02); AUC, 0.8786; Q∗, 0.809. Conclusions: Perfusion magnetic resonance imaging displays moderate overall accuracy in identifying post-treatment radiation effect and tumor progression in patients with glioma. Based on the current evidence, DSC-PWI is a relatively reliable option for assessing tumor progression after glioma radiotherapy.

PurposeCOPD is a heterogeneous disease, and the available prognostic indexes are therefore limited. This study aimed to identify the factors associated with acute exacerbation leading to hospitalization.Patients and methodsThis was a retrospective study of consecutive patients with COPD (meeting the Global Initiative for Chronic Obstructive Lung Disease [GOLD] diagnostic criteria) hospitalized at the Ninth Hospital of Xi’an Affiliated Hospital of Xi’an Jiaotong University between October 2014 and September 2016. During follow-up after first hospitalization, the patients who had been rehospitalized within 1 year for acute exacerbation were grouped into the frequent exacerbation (FE) group, while the others were grouped into the infrequent exacerbation (IE) group. The baseline demographic, clinical, laboratory, pulmonary function, and imaging data were compared between the two groups.ResultsCompared with the IE group, the FE group had lower forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) (P=0.005), FEV1%pred (P=0.002), maximal mid-expiratory flow (MMEF25–75%pred) (P=0.003), and ratio of carbon monoxide diffusion capacity to alveolar ventilation (DLCO/VA) (P=0.03) and higher resonant frequency (Fres; P=0.04). According to generations of bronchi, the percentage of the wall area (%WA) of lobes was found to be higher in the FE group. Emphysema index (EI), mean emphysema density (MED)whole and MEDleft lung in the FE group were significantly worse than in the IE group (P<0.05). Using logistic regression, exacerbation hospitalizations in the past year (odds ratio [OR] 14.4, 95% CI 6.1–34.0, P<0.001) and EI >10% (OR 2.9, 95% CI 1.2–7.1, P=0.02) were independently associated with frequent acute exacerbation of COPD (AECOPD) hospitalization.ConclusionExacerbation hospitalizations in the past year and imaging features of emphysema (EI) were independently associated with FE hospitalization.

Objective To investigate the association between different smoking statuses and survival and emphysema in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This retrospective study included patients admitted from October 2014 to September 2017. Demographic, clinical, laboratory, imaging, impulse oscillometry, and traditional pulmonary function data were collected. The relationship between smoking and EI was analyzed via binary logistic regression after adjusting for other factors. Survival was analyzed using the Kaplan–Meier method and the log rank test. Results The patients with AECOPD (357 cases) were identified (and stratified into three groups: never smoked (NS; n=83), former smokers (FS, n=118), and current smokers (CS; n=156). Compared with CS, NS were older and predominantly female. No differences were observed in respiratory symptoms and acute exacerbation between CS and NS. NS had higher resistance and reaction in the central and peripheral airways, while CS exhibited more severe diffuse dysfunction. CS demonstrated more severe and extensive emphysema. Smoking was an independent risk factor for emphysema after adjusting for age, forced expiratory volume in the first second over predicted value, BMI, leukocyte count, and carbon monoxide transfer coefficient. No difference in 5-year survival rates between NS and CS was established. Conclusion CS has the worst pulmonary function, suggesting a more important destruction of the lung parenchyma, while AECOPD without smoking risk factors mostly affects the airways. Impulse oscillometry can be used for imaging airway-dominant AECOPD. There was no difference in the 5-year survival rate.

In terms of airway wall area and emphysema index, patients with chronic bronchitis with PRISm were essentially no different than those with chronic bronchitis without abnormal spirometry, whereas for symptoms, they are more like GOLD 1 and 2 patients. Our findings show that it is not yet clear whether it constitutes an intermediate stage of chronic bronchitis with normal lung function that progression to early COPD.

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