Objective
To present the International Parkinson and Movement Disorder Society (MDS) Clinical Diagnostic Criteria for Parkinson9s disease.
Background
Although several diagnostic criteria for Parkinson9s disease have been proposed, none have been officially adopted by an official Parkinson society. Moreover, the commonest-used criteria, the UK brain bank, were created more than 25 years ago. In recognition of the lack of standard criteria, the MDS initiated a task force to design new diagnostic criteria for clinical Parkinson9s disease.
Methods/Results
The MDS-PD Criteria are intended for use in clinical research, but may also be used to guide clinical diagnosis. The benchmark is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise. Although motor abnormalities remain central, there is increasing recognition of non-motor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the MDS-PD Criteria retain motor parkinsonism as the core disease feature, defined as bradykinesia plus rest tremor and/or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies upon three categories of diagnostic features; absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of PD diagnosis). Two levels of certainty are delineated: Clinically-established PD (maximizing specificity at the expense of reduced sensitivity), and Probable PD (which balances sensitivity and specificity).
Conclusion
The MDS criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, criteria will need continuous revision to accommodate these advances. Disclosure: Dr. Postuma has received personal compensation for activities with Roche Diagnostics Corporation and Biotie Therapies. Dr. Berg has received research support from Michael J. Fox Foundation, the Bundesministerium fur Bildung und Forschung (BMBF), the German Parkinson Association and Novartis GmbH.

MDS Clinical Diagnostic Criteria for Parkinson's Disease (S19.001)

Objective To establish a national body mass index (BMI) reference norm for the
purpose of screening and more active prevention and cure on overwight and obesity in Chinese children and
adolescente. Methods The 2000 Chinese National Survey on Students Constitution and Health was used as
reference population. In total there were more than 244.2 thousands of primary and secondary Han
nationality students aged 7 through 18 years old included in this study. The BMI distribution of various
Chinese children and adolescent groups were compared with the NCHS international norm, the percentage
values and with advanced ages, were calculated. In the beginning, three temporary norms were set up,
using the different combination of P85, P90 and P95 BMI percentages. Based on the intersect testing and
varifying of physiological, lipidemia biochemical and body composition measures, the best norm was then
selected. B-spline smoothing method was used to correct the curves, both for males and females, composed
by cut-off points at different ages. Results Using samples from the costal developed metropolis, the BMI
curves successfully overcame the shortcomings of low and depressive phenomenon of the total population, in
particular after the mid--adolescent period. The temporary Norm Ⅱ, composed by cut-off points of P85 for
overweight and P95 for obesity, was found to be the best among the three temporary norms, both shown by
its sensitivity and specificity. 24 and 28 were used as cut-off points for overweight and obesity in this norm,
both for males and females aged 18 years. These two cut-off points were consistent with those shown in the
Body Mass Index Reference Norm for Screening Overweight and Obesity in Chinese Adults. Three Samples
from Beijing, Henan and Sichuan, used as representatives of upper, middle and relative low levels of
physical growth of children and adolescents in China, were used for extra tests. The screening results
showed that among the male and female subjects aged 7 through 18 years, the prevalence rates were
17. 00% and 9. 46% for overweight, 9. 99% and 6. 47% for obesity in Beijing while 10. 86% and 6. 64%
for overweight, 4.27% and 3.07% for obesity in Henan, and 6.95% and 4.23% for overweight and
2. 84 % and 2. 09 % for obesity in Sichuan, respectively. Data clearly showed that the results were in
 accordance with the actural situation seen in the Chinese studens in 2000. Conclusion The newly
established reference norm seemed to be good for prospective studies as it considered the facts regarding the
rapid and strong tendency of secular growth changes seen in the Chinese children and adolesconts. It also
decreased the difference of growth levels between the Chinese children and adolescents and those of the
international norms. Ths norm was particularly developed for the Chinese which was also in consistent with
the Eastern Asia ethnic charcteristics so could be promoted in China.

Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents

American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD).

This guidance provides a data-supported approach to the diagnostic, therapeutic, and preventive aspects of NAFLD care. A "Guidance" document is different from a "Guideline." Guidelines are developed by a multidisciplinary panel of experts and rate the quality (level) of the evidence and the strength of each recommendation using the Grading of Recommendations, Assessment Development, and Evaluation (GRADE) system. A guidance document is developed by a panel of experts in the topic, and guidance statements, not recommendations, are put forward to help clinicians understand and implement the most recent evidence. This article is protected by copyright. All rights reserved.

The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance from the American Association for the Study of Liver Diseases

In view of the epidemic obesity in childhood, facing the disease and its associated morbidities early at this age becomes crucial for public health researchers and care givers The present review focuses on pediatric Non Alcoholic Fatty Liver Disease (NAFLD) among co-morbidities, being the disease yet under diagnosed and under treated despite a prevalence growing exponentially Evidences suggest that the environmental background for the development of NAFLD may be established in early life, and that the duration of the disease affects probably the likelihood of progression to more severe disease (necro-inflammation or Non Alcoholic SteatoHepatitis, also termed, NASH; fibrosis and cirrhosis) NAFLD associates with abdominal obesity, insulin resistance and features of metabolic syndrome In genetically prone individuals, malnutrition (ie, excessive consumption of saturated fats and refined sugars) leads to the derangement of the adipose tissue architecture and homeostasis, the peripheral and hepatic resistance to insulin-stimulated glucose uptake, thus favoring a condition of chronic low-grade inflammation Excessive nutrients cannot be stored in the adipose tissue and overflow elsewhere, mainly to the muscle tissue and liver Fat deposition in both sites enhances insulin resistance and further deposition of fats in a vicious manner What is of special interest comparing NAFLD in children and adults is that the histological appearance of the disease differs significantly, likely representing a yet physiological response to environmental stressors in children and a long-term adaptation in adults In this article, we review the current concepts about paediatric NAFLD, its pathogenesis, diagnosis and treatment, with particular regard to lifestyle and foods habits

Nonalcoholic fatty liver disease in children

BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is currently the outstanding cause of chronic liver disease in children and adolescents, especially in overweight and obese groups. Liver biopsy is the reference standard to diagnose NAFLD but invasive, thus it is not the best choice in clinical diagnosis and follow-up. Magnetic resonance (MR) is widely used in clinical trials to noninvasively quantify liver fat content in adults and children in foreign countries. While currently, it is rarely used in Chinese children and adolescents. We postulated that quantifying hepatic steatosis by MR could be extended to children and adolescents in China. AIM To investigate the accuracy of MR imaging (MRI) in quantifying liver fat with MR spectroscopy (MRS) as a reference. A secondary goal was to assess the prevalence of NAFLD in overweight and obese Chinese children and adolescents. METHODS There were 86 children and adolescents enrolled in this study, including 65 overweight and obese children and 21 healthy children. The participants underwent MRI and MRS. MRI and MRS were performed using multi-echo Dixon and HISTO sequences, respectively, to calculate hepatic proton density fat fraction (PDFF). Hepatic steatosis was diagnosed using MRS-PDFF > 5% as the threshold. Spearman's analysis was used to evaluate the correlation between MRI and MRS. The agreement between these two methods was assessed by Bland-Altman analysis. RESULTS The MRI-PDFF in the MRS region of interest and the entire liver was 9.9% ± 10.3% with a range of 0.3%-39.9%, and 10.6% ± 9.4% with a range of 1.9%-38.9%, respectively. The MRS-PDFF was 9.1% ± 10.0%, with a range of 0.5%-37.8%. The incidence of hepatic steatosis detected by MRS-PDFF was 46.5% (40/86) of all participants, all of whom belonged to the overweight and obese group. Spearman's analysis indicated an excellent correlation between multi-echo Dixon and MRS (r > 0.9, P < 0.01). Bland-Altman analysis also demonstrated a good agreement between these two methods. CONCLUSION Multi-echo Dixon shows an excellent correlation and agreement with MRS in quantifying liver fat content and could be a potential tool to detect hepatic steatosis in Chinese children and adolescents.

Accuracy of multi-echo Dixon sequence in quantification of hepatic steatosis in Chinese children and adolescents.

Background and Purpose Mean apparent propagator (MAP) MRI is a novel diffusion imaging method to map tissue microstructure. The purpose of this study was to evaluate the diagnostic value of the MAP MRI in Parkinson's disease (PD) in comparison with conventional diffusion tensor imaging (DTI). Methods 23 PD patients and 22 age- and gender-matched healthy controls were included. MAP MRI and DTI were performed on a 3T MR scanner with a 20-channel head coil. The MAP metrics including mean square displacement (MSD), return to the origin probability (RTOP), return to the axis probability (RTAP), and return to the plane probability (RTPP), and DTI metrics including fractional anisotropy (FA), and mean diffusivity (MD), were measured in subcortical gray matter and compared between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic performance of all the metrics. The association between the diffusion metrics and disease severity was assessed by Pearson correlation analysis. Results For MAP MRI, the mean values of MSD in the bilateral caudate, pallidum, putamen, thalamus and substantia nigra (SN) were higher in PD patients than in healthy controls (pFDR ≤ 0.001); the mean values of the zero displacement probabilities (RTOP, RTAP, and RTPP) in the bilateral caudate, pallidum, putamen and thalamus were lower in PD patients (pFDR < 0.001). For DTI, only FA in the bilateral SN was significantly higher in PD patients than those in the controls (pFDR < 0.001). ROC analysis showed that the areas under the curves of MAP MRI metrics (MSD, RTOP, RTAP, and RTPP) in the bilateral caudate, pallidum, putamen and thalamus (range, 0.85-0.94) were greater than those of FA and MD of DTI (range, 0.55-0.69) in discriminating between PD patients and healthy controls. RTAP in the ipsilateral pallidum (r = -0.56, pFDR = 0.027), RTOP in the bilateral and contralateral putamen (r = -0.58, pFDR = 0.019; r = -0.57, pFDR = 0.024) were negatively correlated with UPDRS III motor scores. Conclusion MAP MRI outperformed the conventional DTI in the diagnosis of PD and evaluation of the disease severity.

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Mean Apparent Propagator MRI Is Better Than Conventional Diffusion Tensor Imaging for the Evaluation of Parkinson's Disease: A Prospective Pilot Study.

To compare the diagnostic performance of neurite orientation dispersion and density imaging (NODDI), mean apparent propagator magnetic resonance imaging (MAP-MRI), diffusion kurtosis imaging (DKI), diffusion tensor imaging (DTI) and diffusion-weighted imaging (DWI) in distinguishing high-grade gliomas (HGGs) from solitary brain metastases (SBMs). Patients with previously untreated, histopathologically confirmed HGGs (n = 20) or SBMs (n = 21) appearing as a solitary and contrast-enhancing lesion on structural MRI were prospectively recruited to undergo diffusion-weighted MRI. DWI data were obtained using a q-space Cartesian grid sampling procedure and were processed to generate parametric maps by fitting the NODDI, MAP-MRI, DKI, DTI and DWI models. The diffusion metrics of the contrast-enhancing tumor and peritumoral edema were measured. Differences in the diffusion metrics were compared between HGGs and SBMs, followed by receiver operating characteristic (ROC) analysis and the Hanley and McNeill test to determine their diagnostic performances. NODDI-based isotropic volume fraction (Viso) and orientation dispersion index (ODI); MAP-MRI-based mean-squared displacement (MSD) and q-space inverse variance (QIV); DKI-generated radial, mean diffusivity and fractional anisotropy (RDk, MDk and FAk); and DTI-generated radial, mean diffusivity and fractional anisotropy (RD, MD and FA) of the contrast-enhancing tumor were significantly different between HGGs and SBMs (p < 0.05). The best single discriminative parameters of each model were Viso, MSD, RDk and RD for NODDI, MAP-MRI, DKI and DTI, respectively. The AUC of Viso (0.871) was significantly higher than that of MSD (0.736), RDk (0.760) and RD (0.733) (p < 0.05). NODDI outperforms MAP-MRI, DKI, DTI and DWI in differentiating between HGGs and SBMs. NODDI-based Viso has the highest performance.

/pdf/differentiation-between-high-grade-gliomas-and-solitary-2n6167h9cw.pdf

Differentiation between high-grade gliomas and solitary brain metastases: a comparison of five diffusion-weighted MRI models

Readout‐segmented echo‐planar diffusion‐weighted imaging (RS‐EPI) can improve image quality and signal‐to‐noise ratio, the resulting apparent diffusion coefficient (ADC) value acts as a more sensitive biomarker to characterize tumors. However, data regarding the differentiation of breast cancer (BC) receptor statuses using RS‐EPI are limited.

Readout‐Segmented Echo‐Planar Diffusion‐Weighted MR Imaging Improves the Differentiation of Breast Cancer Receptor Statuses Compared With Conventional Diffusion‐Weighted Imaging

Purpose This study aims to evaluate the accuracy of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in distinguishing malignant and benign solitary pulmonary nodules and masses. Methods Studies investigating the diagnostic accuracy of IVIM-DWI in lung lesions published through December 2020 were searched. The standardized mean differences (SMDs) of the apparent diffusion coefficient (ADC), tissue diffusivity (D), pseudo-diffusivity (D*), and perfusion fraction (f) were calculated. The sensitivity, specificity, area under the curve (AUC), publication bias, and heterogeneity were then summarized, and the source of heterogeneity and the reliability of combined results were explored by meta-regression and sensitivity analysis. Results A total of 16 studies including 714 malignant and 355 benign lesions were included. Significantly lower ADC, D, and f values were found in malignant pulmonary lesions compared to those in benign lesions. The D value showed the best diagnostic performance (sensitivity = 0.90, specificity = 0.71, AUC = 0.91), followed by ADC (sensitivity = 0.84, specificity = 0.75, AUC = 0.88), f (sensitivity = 0.70, specificity = 0.62, AUC = 0.71), and D* (sensitivity = 0.67, specificity = 0.61, AUC = 0.67). There was an inconspicuous publication bias in ADC, D, D* and f values, moderate heterogeneity in ADC, and high heterogeneity in D, D*, and f values. Subgroup analysis suggested that both ADC and D values had a significant higher sensitivity in “nodules or masses” than that in “nodules.” Conclusions The parameters derived from IVIM-DWI, especially the D value, could further improve the differential diagnosis between malignant and benign solitary pulmonary nodules and masses. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: CRD42021226664

/pdf/value-of-ivim-in-differential-diagnoses-between-benign-and-3tnv93so.pdf

Meng-Zhu Wang

Papers

Accuracy of multi-echo Dixon sequence in quantification of hepatic steatosis in Chinese children and adolescents.

Mean Apparent Propagator MRI Is Better Than Conventional Diffusion Tensor Imaging for the Evaluation of Parkinson's Disease: A Prospective Pilot Study.

Differentiation between high-grade gliomas and solitary brain metastases: a comparison of five diffusion-weighted MRI models

Readout‐Segmented Echo‐Planar Diffusion‐Weighted MR Imaging Improves the Differentiation of Breast Cancer Receptor Statuses Compared With Conventional Diffusion‐Weighted Imaging

Value of IVIM in Differential Diagnoses between Benign and Malignant Solitary Lung Nodules and Masses: A Meta-analysis