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Background: The early stages of chronic kidney disease (CKD) are often undetectable on traditional non-contrast computed tomography (NCCT) images through visual assessment by radiologists. This study aims to evaluate the potential of radiomics-based quantitative features extracted from NCCT, combined with machine learning techniques, in differentiating CKD stages 1–3 from healthy controls. Methods: This retrospective study involved 1099 CKD patients (stages 1–3) and 1099 healthy participants who underwent NCCT. Bilateral kidney volumes of interest were automatically segmented using a deep learning-based segmentation approach (VB-net) on CT images. Radiomics models were constructed using the mean values of features extracted from both kidneys. Key features were selected through Relief, MRMR, and LASSO regression algorithms. A machine learning classifier was trained to differentiate CKD from healthy kidneys and compared with the radiologist assessments. Model performance was evaluated using the area under the curve (AUC) of receiver operating characteristic analysis. Results: In the training set, the AUCs for the Gaussian process (GP) classifier model and radiologist assessments were 0.849 and 0.570, respectively. In the testing set, the AUC values were 0.790 for the GP model and 0.575 for radiologist assessments. Conclusions: The NCCT-based radiomics model demonstrates significant clinical utility by enabling non-invasive, early diagnosis of CKD stages 1–3, outperforming radiologist assessments.

Background/Objectives: To evaluate and compare the qualitative and quantitative image performance of multiplexed sensitivity-encoding diffusion-weighted imaging (MUSE-DWI) against conventional single-shot (ss-DWI) and high-resolution single-shot (HR-ssDWI) sequences in patients with esophageal cancer. Methods: Twenty patients who underwent esophagus MRI, including ss-DWI, HR-ssDWI and MUSE-DWI, were retrospectively enrolled. Image quality, esophageal contour, lesion conspicuity and image distortion were independently graded by two radiologists using a five-point scale and compared between the three sequences. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of esophageal tissue were measured and compared between the three sequences. Results: After Bonferroni correction (p < 0.017), MUSE-DWI had significantly higher scores than HR-ssDWI in image quality, esophageal contour delineation and lesion conspicuity, and all three sequences had statistically significant differences in image distortion scores with MUSE-DWI performing the best. Quantitative analysis revealed that MUSE-DWI had the highest SNR and CNR values; significant differences were found in SNR between ss-DWI and HR-ssDWI (p < 0.001), and in both SNR and CNR between HR-ssDWI and MUSE-DWI (p < 0.001), while no significant differences were observed in SNR and CNR between ss-DWI and MUSE-DWI (p > 0.017). Conclusions: MUSE-DWI outperforms ss-DWI and HR-ssDWI in reducing image distortion, with comparable quantitative image quality metrics to ss-DWI. It represents a valuable optimized DWI technique for esophageal clinical imaging.

Depression is one of the common incidental symptoms in end-stage renal disease (ESRD) patients, empirically overlooked. Reproducible results observed that altered interregional white matter (WM) connections between depression-related brain regions (thalamus, amygdala, and prefrontal cortex (PFC)) in the human brain were closely associated with depression. Whether the depressive tendency of ESRD patients is also association with the WM connections is remains unknown. To address this problem, 56 ESRD patients before dialysis initiation and 56 healthy controls (HCs) were scanned with diffusion tensor imaging. According to the diagnostic and statistical manual of mental disorders, ESRD patients were separated into with and without depressive tendency groups. Twenty-five essential metabolites were tested in ESRD. The tractography atlas-based analysis and multiple regression analysis were implemented to gain features which could map the depressive tendency variability across ESRD. For metabolites, the levels of thrombocytes and calcium have significant differences between with and without depressive tendency groups. For WM microstructure, depressive tendency ESRD patients had abnormal WM diffusion properties along the fiber tracts of the amygdala-PFC. Compared with the features which were extracted from the group-difference of WM or metabolites, only WM features combinations (1000 bootstrap samples; 5000 permutation tests) along the fiber tract of the amygdala-PFC was a significant predictor of either with or without depressive tendency. Our findings suggested that the advanced neuroprotection may be planned before dialysis initiation, and the WM characteristics of amygdala-PFC may be a potential neuromarkers for the early diagnosis of depressive tendency in ESRD patients before dialysis initiation.

Restless legs syndrome (RLS) is common in the end-stage renal disease (ESRD) population; however, their interrelationship remains largely unclear. In the current study, we aimed to investigate the brain structure variation in ESRD patients with RLS (ERSD-RLS) and its potential relation with the severity of RLS. Diffusion tensor imaging and T1-weighted imaging were obtained from 64 ERSD-RLS and 64 matched healthy controls. Voxel-based morphometry (VBM) analysis and tractography atlas-based analysis (TABS) were used to detect the alteration of gray matter (GM) volume and white matter (WM) microstructural characterization. The corticospinal tract (CST), which is a main motor-pathway, was selected as a fiber bundle of interest in the TABS analysis. The severity of RLS was evaluated by using the International RLS Study Group scale. Lastly, a correlation analysis was performed to explore the interrelationship between RLS rating scores and brain structure measurements. For the results, ERSD-RLS showed abnormal GM volume of motor-related brain regions located in the bilateral superior frontal gyri, precentral gyrus, and putamen. Significant differences in the diffusion properties were found at the posterior limb of the internal capsule. Furthermore, the severity of RLS was only significantly associated with the diffusion properties, which was not found in the motor-related regions of GM. Our results suggest that the motor-related brain structure was altered in ERSD-RLS. The abnormal WM microstructure of the CST may serve as an imaging marker correlated with the severity of motor dysfunction in ERSD-RLS, indicating that WM neuroprotection should be considered when improving motor function in ERSD-RLS.

Background End-stage renal disease (ESRD) patients are at a substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there isn’t an uncontested result whether cognition was improved or worsened during dialysis. Methods To explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), predialysis ESRD patients (predialysis group), and maintenance hemodialysis ESRD patients (HD group). All ESRD patients performed six blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K+, and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in the HD group and predialysis group. Results Neuropsychological analysis showed the HD group exhibited better cognitive function than the predialysis group, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the predialysis group and HD group than the HCs. Besides, a lower normalized clustering coefficient was found in the predialysis group relative to the HCs and HD group. For the GLM analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in the predialysis group. Conclusions Our study revealed that dialysis had a limited effect on cognitive improvement.

As a relay center between the cerebral cortex and various subcortical brain areas, the thalamus is repeatedly associated with the dysfunction of brain-gut interaction in patients with irritable bowel syndrome (IBS). However, the regional morphological alterations of the thalamus in IBS are not well defined. We acquired structural magnetic resonance data from 34 patients with IBS and 34 demographically similar healthy subjects. Data processing was performed using FMRIB’s Integrated Registration and Segmentation Tool (FIRST). Volumetric analysis and surface-based vertex analysis were both carried out to characterize the morphology of the thalamus and other subcortical structures. Our results suggested that the majority (31 cases) of the patients with IBS had diarrhea-predominant symptoms. Volumetric analysis revealed a larger normalized volume of the right thalamus and left caudate nucleus in patients with IBS than in healthy controls. Surface analysis indicated that the difference arose mainly from the laterodorsal nucleus of the right thalamus, and the body of the left caudate nucleus. In addition, patients with IBS had different hemispheric asymmetries of the thalamus (rightward) and caudate nucleus (leftward) from controls (leftward for the thalamus and rightward for the caudate nucleus). In general, our results indicated that patients with diarrhea-predominant IBS had enlarged thalamus and caudate nucleus volumes, as well as altered hemispheric asymmetries of these two structures, compared with healthy controls. The neuroimaging evidence of these structural alterations helps clarify the underlying pathophysiology of diarrhea-predominant IBS.

Neurovascular (NV) decoupling is a potential neuropathologic mechanism of cognitive impairment in patients with end‐stage renal disease (ESRD). Hemodialysis improves cognitive impairment at 24 h post‐dialysis, which suggests a potential neuroprotective effect of hemodialysis treatment on the brain. We investigated the effects of hemodialysis treatment on the reversal of NV decoupling associated with cognitive improvement. A total of 39 patients with ESRD and 39 healthy controls were enrolled. All patients were imaged twice during a dialysis session: before hemodialysis (T1pre‐dialysis) and at 24 h after dialysis (T2post‐dialysis). The healthy controls were imaged once. NV coupling was characterized based on correlation coefficients between four types of blood oxygen level‐dependent signals and cerebral blood flow (CBF). A battery of neuropsychological and blood tests was performed before the imaging. Patients with ESRD showed improvements in memory and executive function at T2post‐dialysis compared with that at T1pre‐dialysis. At both T1pre‐dialysis and T2post‐dialysis, patients with ESRD had lower amplitude of low‐frequency fluctuation (ALFF)–CBF coupling than healthy controls. Additionally, patients with ESRD had higher ALFF–CBF coupling at T2post‐dialysis than at T1pre‐dialysis. Higher memory scores, higher hemoglobin level, lower total plasma homocysteine level, lower systolic blood pressure variance, and lower ultrafiltration volume were associated with higher ALFF–CBF coupling in patients with ESRD after a hemodialysis session. These findings indicate that partial correction of anemia and hyperhomocysteinemia, stable systolic blood pressure, and fluid restriction may be closely linked to the reversal of NV decoupling and improvement in cognition in patients with ESRD. We confirmed the reversibility of cognitive impairment and NV decoupling in patients with ESRD after a single hemodialysis session, highlighting the potential value of NV coupling as an objective and physiologic biomarker of brain dysfunction in ESRD. Anemia, hyperhomocysteinemia, ultrafiltration volume, and SBP variance could potentially play a critical role in the reversibility of NV decoupling and cognitive impairment.

End-stage kidney disease and mild cognitive impairment (ESKD-MCI) affect the quality of life and long-term treatment outcomes of patients affected by these diseases. Clarifying the morphological changes from brain injuries in ESKD-MCI and their relationship with clinical features is helpful for the early identification and intervention of MCI before it progresses to irreversible dementia. This study gathered data from 23 patients with ESKD-MCI, 24 patients with ESKD and non-cognitive impairment (NCI), and 27 health controls (HCs). Structural magnetic resonance studies, cognitive assessments, and general clinical data were collected from all participants. Voxel-based morphometry analysis was performed to compare grey matter (GM) volume differences between the groups. The patients’ GM maps and clinical features were subjected to univariate regression to check for possible correlations. Patients with ESKD-MCI displayed significantly more impairments in multiple cognitive domains, including global cognition, visuospatial and executive function, and memory, compared to patients with ESKD-NCI. Using a more liberal threshold ( P  < 0.001, uncorrected), we found that compared to patients with ESKD-NCI, patients with ESKD-MCI exhibited clusters of regions with lower GM volumes, including the right hippocampus (HIP), parahippocampal gyrus (PHG), Rolandic operculum, and supramarginal gyrus. The volumes of the right HIP and PHG were negatively correlated with serum calcium levels. ESKD-MCI was associated with a subtle volume reduction of GM in several brain areas known to be involved in memory, language, and auditory information processing. We speculate that these slight morphometric impairments may be associated with disturbed calcium metabolism.

Objective: To study neuromechanism for uremic restless syndrome (URLS), functional MRI (fMRI) analysis and were used to explor main activity. Methods: Resting state functional magnetic resonance imaging (MRI) was performed on 29 patients with uremic restless legs syndrome and 25 healthy controls. The values of the regional homogeneity (ReHo) of the two groups were calculated and analyzed statistically. Result As compared with the control group, patients with uremic restless legs syndrome showed emotional and mental abnormality. Increased ReHo values in bilateral supplementary motor area, bilateral thalamus, left insular lobe, left hippocampus (P<0.05), and decreased ReHo values in anterior cingulate gyrus, bilateral posterior central gyrus, right amygdala were found in patients with uremic restless legs syndrome (P<0.05). The severity score of RLS was respectively positively correlated with dialysis duration (r=0.57, P=0.002), PTH level (r=0.419, P=0.033) BAI (r=0.528, P=0.006), and BDI (r=0.567, P=0.003). Co