A comparison of pseudo-continuous arterial spin labelling and dynamic susceptibility contrast MrI with and without contrast agent leakage correction in paediatric brain tumours

OBJECTIVE: To investigate correlations between MRI perfusion metrics measured by dynamic susceptibility contrast and arterial spin labelling in paediatric brain tumours. METHODS: 15 paediatric patients with brain tumours were scanned prospectively using pseudo-continuous arterial spin labelling (ASL) and dynamic susceptibility contrast (DSC-) MRI with a pre-bolus to minimise contrast agent leakage. Cerebral blood flow (CBF) maps were produced using ASL. Cerebral blood volume (CBV) maps with and without contrast agent leakage correction using the Boxerman technique and the leakage parameter, K2, were produced from the DSC data. Correlations between the metrics produced were investigated. RESULTS: Histology resulted in the following diagnoses: pilocytic astrocytoma (n = 7), glioblastoma (n = 1), medulloblastoma (n = 1), rosette-forming glioneuronal tumour of fourth ventricle (n = 1), atypical choroid plexus papilloma (n = 1) and pilomyxoid astrocytoma (n = 1). Three patients had a non-invasive diagnosis of low-grade glioma. DSC CBV maps of T1-enhancing tumours were difficult to interpret without the leakage correction. CBV values obtained with and without leakage correction were significantly different (p < 0.01). A significant positive correlation was observed between ASL CBF and DSC CBV (r = 0.516, p = 0.049) which became stronger when leakage correction was applied (r = 0.728, p = 0.002). K2 values were variable across the group (mean = 0.35, range = −0.49 to 0.64). CONCLUSION: CBV values from DSC obtained with and without leakage correction were significantly different. Large increases in CBV were observed following leakage correction in highly T1-enhancing tumours. DSC and ASL perfusion metrics were found to correlate significantly in a range of paediatric brain tumours. A stronger relationship between DSC and ASL was seen when leakage correction was applied to the DSC data. Leakage correction should be applied when analysing DSC data in enhancing paediatric brain tumours. ADVANCES IN KNOWLEDGE: We have shown that leakage correction should be applied when investigating enhancing paediatric brain tumours using DSC-MRI. A stronger correlation was found between CBF derived from ASL and CBV derived from DSC when a leakage correction was employed

An Insight into Application of Land Use Land Cover Analysis towards Sustainable Agriculture within Jhajjar District, Haryana

The increasing population, depletion of natural resources, semi-arid climatic and poor soil health conditions in Jhajjar district of Haryana have drawn major attention towards the changes in Land Use/Land Cover (LULC). The region's increasing population is mainly dependent upon the agrarian economy; thus, sustainable agricultural production is a major thrust area of research. The present study analyses the LULC changes in the area during two decades 2000 – 2020, using remote sensing and Geographic Information System (GIS). Landsat satellite images (Landsat-7 and Landsat-8 satellites) for 2000 and 2020 were analyzed for mixed classification based on unsupervised classification followed by supervised classification. The study area has experienced an increase in agricultural land, surface water bodies and built-up land by 16.89%, 79.73% and 56.41%, respectively. There is a decrease in barren land and fallow land by 48.53% and 36.97%, respectively, as per the five major LULC classes. The LULC analysis indicates an increase in built-up land, which is responsible for controlling agricultural productivity and unsustainable agricultural activities. The study provides a comprehensive understanding of the land use trajectory in a specific region in two decades and associated unsustainable changes in the agrarian economy through pressure on the increase in agricultural production and conversion of land mass into croplands. It also signifies climate-resilient agriculture and the management of sustainable agriculture

Classification of paediatric brain tumours by diffusion weighted imaging and machine learning

To determine if apparent diffusion coefficients (ADC) can discriminate between posterior fossa brain tumours on a multicentre basis. A total of 124 paediatric patients with posterior fossa tumours (including 55 Medulloblastomas, 36 Pilocytic Astrocytomas and 26 Ependymomas) were scanned using diffusion weighted imaging across 12 different hospitals using a total of 18 different scanners. Apparent diffusion coefficient maps were produced and histogram data was extracted from tumour regions of interest. Total histograms and histogram metrics (mean, variance, skew, kurtosis and 10th, 20th and 50th quantiles) were used as data input for classifiers with accuracy determined by tenfold cross validation. Mean ADC values from the tumour regions of interest differed between tumour types, (ANOVA P < 0.001). A cut off value for mean ADC between Ependymomas and Medulloblastomas was found to be of 0.984 × 10-3 mm2 s-1 with sensitivity 80.8% and specificity 80.0%. Overall classification for the ADC histogram metrics were 85% using Naïve Bayes and 84% for Random Forest classifiers. The most commonly occurring posterior fossa paediatric brain tumours can be classified using Apparent Diffusion Coefficient histogram values to a high accuracy on a multicentre basis

The management of diabetic ketoacidosis in children

The object of this review is to provide the definitions, frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes of permanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatric diabetes is 10%–70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomic circumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to prevent complications or, in the case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1–2 hours; an initial bolus of 10–20 mL/kg 0.9% saline is followed by 0.45% saline calculated to supply maintenance and replace 5%–10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated. The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates a committed team effort