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One novel transfer learning-based CLIP model combined with self-attention mechanism for differentiating the tumor-stroma ratio in pancreatic ductal adenocarcinoma. 一种基于迁移学习的新型 CLIP 模型与自我注意机制相结合,用于区分胰腺导管腺癌中的肿瘤-间质比例。
IF 9.7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-11-01 Epub Date: 2024-10-16 DOI: 10.1007/s11547-024-01902-y
Hongfan Liao, Jiang Yuan, Chunhua Liu, Jiao Zhang, Yaying Yang, Hongwei Liang, Haotian Liu, Shanxiong Chen, Yongmei Li

Purpose: To develop a contrastive language-image pretraining (CLIP) model based on transfer learning and combined with self-attention mechanism to predict the tumor-stroma ratio (TSR) in pancreatic ductal adenocarcinoma on preoperative enhanced CT images, in order to understand the biological characteristics of tumors for risk stratification and guiding feature fusion during artificial intelligence-based model representation.

Material and methods: This retrospective study collected a total of 207 PDAC patients from three hospitals. TSR assessments were performed on surgical specimens by pathologists and divided into high TSR and low TSR groups. This study developed one novel CLIP-adapter model that integrates the CLIP paradigm with a self-attention mechanism for better utilizing features from multi-phase imaging, thereby enhancing the accuracy and reliability of tumor-stroma ratio predictions. Additionally, clinical variables, traditional radiomics model and deep learning models (ResNet50, ResNet101, ViT_Base_32, ViT_Base_16) were constructed for comparison.

Results: The models showed significant efficacy in predicting TSR in PDAC. The performance of the CLIP-adapter model based on multi-phase feature fusion was superior to that based on any single phase (arterial or venous phase). The CLIP-adapter model outperformed traditional radiomics models and deep learning models, with CLIP-adapter_ViT_Base_32 performing the best, achieving the highest AUC (0.978) and accuracy (0.921) in the test set. Kaplan-Meier survival analysis showed longer overall survival in patients with low TSR compared to those with high TSR.

Conclusion: The CLIP-adapter model designed in this study provides a safe and accurate method for predicting the TSR in PDAC. The feature fusion module based on multi-modal (image and text) and multi-phase (arterial and venous phase) significantly improves model performance.

目的:开发一种基于迁移学习并结合自我注意机制的对比语言-图像预训练(CLIP)模型,用于预测术前增强CT图像上胰腺导管腺癌的肿瘤-间质比(TSR),以了解肿瘤的生物学特征,从而进行风险分层,并在基于人工智能的模型表示过程中指导特征融合:这项回顾性研究共收集了三家医院的 207 例 PDAC 患者。病理学家对手术标本进行了 TSR 评估,并将其分为高 TSR 组和低 TSR 组。本研究开发了一种新型 CLIP 适配器模型,该模型将 CLIP 范式与自我注意机制相结合,能更好地利用多相成像的特征,从而提高肿瘤-基质比预测的准确性和可靠性。此外,还构建了临床变量、传统放射组学模型和深度学习模型(ResNet50、ResNet101、ViT_Base_32、ViT_Base_16)进行比较:结果:这些模型在预测PDAC的TSR方面显示出明显的功效。基于多相特征融合的 CLIP-adapter 模型的性能优于基于任何单相(动脉或静脉相)的模型。CLIP-adapter模型的表现优于传统的放射组学模型和深度学习模型,其中CLIP-adapter_ViT_Base_32表现最佳,在测试集中获得了最高的AUC(0.978)和准确率(0.921)。Kaplan-Meier生存分析显示,与高TSR患者相比,低TSR患者的总生存期更长:结论:本研究设计的 CLIP-adapter 模型为预测 PDAC 的 TSR 提供了一种安全、准确的方法。基于多模态(图像和文本)和多阶段(动脉和静脉阶段)的特征融合模块显著提高了模型的性能。
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引用次数: 0
Correction: What the urologist needs to know before radical prostatectomy: MRI effective support to pre‑surgery planning. 更正:泌尿科医生在根治性前列腺切除术前需要了解什么?磁共振成像为手术前规划提供有效支持。
IF 9.7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-11-01 DOI: 10.1007/s11547-024-01887-8
Ludovica Laschena, Emanuele Messina, Rocco Simone Flammia, Antonella Borrelli, Simone Novelli, Daniela Messineo, Costantino Leonardo, Alessandro Sciarra, Antonio Ciardi, Carlo Catalano, Valeria Panebianco
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引用次数: 0
Conceptual review of outcome metrics and measures used in clinical evaluation of artificial intelligence in radiology. 对用于放射学人工智能临床评估的成果指标和衡量标准进行概念性审查。
IF 9.7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-11-01 Epub Date: 2024-09-03 DOI: 10.1007/s11547-024-01886-9
Seong Ho Park, Kyunghwa Han, June-Goo Lee

Artificial intelligence (AI) has numerous applications in radiology. Clinical research studies to evaluate the AI models are also diverse. Consequently, diverse outcome metrics and measures are employed in the clinical evaluation of AI, presenting a challenge for clinical radiologists. This review aims to provide conceptually intuitive explanations of the outcome metrics and measures that are most frequently used in clinical research, specifically tailored for clinicians. While we briefly discuss performance metrics for AI models in binary classification, detection, or segmentation tasks, our primary focus is on less frequently addressed topics in published literature. These include metrics and measures for evaluating multiclass classification; those for evaluating generative AI models, such as models used in image generation or modification and large language models; and outcome measures beyond performance metrics, including patient-centered outcome measures. Our explanations aim to guide clinicians in the appropriate use of these metrics and measures.

人工智能(AI)在放射学中应用广泛。评估人工智能模型的临床研究也多种多样。因此,在人工智能的临床评估中采用的结果指标和测量方法也多种多样,这给临床放射科医生带来了挑战。本综述旨在从概念上直观地解释临床研究中最常用的结果指标和测量方法,特别是针对临床医生。虽然我们简要讨论了人工智能模型在二元分类、检测或分割任务中的性能指标,但我们主要关注的是已发表文献中较少涉及的主题。其中包括评估多类分类的指标和测量方法;评估生成型人工智能模型的指标和测量方法,如用于图像生成或修改的模型和大型语言模型;以及性能指标以外的结果测量方法,包括以患者为中心的结果测量方法。我们的解释旨在指导临床医生正确使用这些指标和测量方法。
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引用次数: 0
Development and validation of survival prediction models for patients with hepatocellular carcinoma treated with transcatheter arterial chemoembolization plus tyrosine kinase inhibitors. 经导管动脉化疗栓塞加酪氨酸激酶抑制剂治疗肝细胞癌患者生存预测模型的开发与验证。
IF 9.7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-11-01 Epub Date: 2024-10-14 DOI: 10.1007/s11547-024-01890-z
Kun Huang, Haikuan Liu, Yanqin Wu, Wenzhe Fan, Yue Zhao, Miao Xue, Yiyang Tang, Shi-Ting Feng, Jiaping Li

Background: Due to heterogeneity of molecular biology and microenvironment, therapeutic efficacy varies among hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE) and tyrosine kinase inhibitors (TKIs). We examined combined models using clinicoradiological characteristics, mutational burden of signaling pathways, and radiomics features to predict survival prognosis.

Methods: Two cohorts comprising 111 patients with HCC were used to build prognostic models. The training and test cohorts included 78 and 33 individuals, respectively. Mutational burden was calculated based on 17 cancer-associated signaling pathways. Radiomic features were extracted and selected from computed tomography images using a pyradiomics system. Models based on clinicoradiological indicators, mutational burden, and radiomics score (rad-score) were built to predict overall survival (OS) and progression-free survival (PFS).

Results: Eastern Cooperative Oncology Group performance status, Child-Pugh class, peritumoral enhancement, PI3K_AKT and hypoxia mutational burden, and rad-score were used to create a combined model predicting OS. C-indices were 0.805 (training cohort) and 0.768 (test cohort). The areas under the curve (AUCs) were 0.889, 0.900, and 0.917 for 1-year, 2-year, and 3-year OS, respectively. To predict PFS, alpha-fetoprotein level, tumor enhancement pattern, hypoxia and receptor tyrosine kinase mutational burden, and rad-score were used. C-indices were 0.782 (training cohort) and 0.766 (test cohort). AUCs were 0.885 and 0.925 for 6-month and 12-month PFS, respectively. Calibration and decision curve analyses supported the model's accuracy and clinical potential.

Conclusions: The nomogram models are hopeful to predict OS and PFS in patients with intermediate-advanced HCC treated with TACE plus TKIs, offering a promising tool for treatment decisions and monitoring patient progress.

背景:由于分子生物学和微环境的异质性,接受经导管动脉化疗栓塞(TACE)和酪氨酸激酶抑制剂(TKIs)治疗的肝细胞癌(HCC)患者的疗效各不相同。我们研究了利用临床放射学特征、信号通路突变负荷和放射组学特征预测生存预后的组合模型:方法:由 111 名 HCC 患者组成的两个队列用于建立预后模型。训练队列和测试队列分别包括 78 人和 33 人。根据 17 种癌症相关信号通路计算突变负荷。使用放射组学系统从计算机断层扫描图像中提取和选择放射组学特征。根据临床放射学指标、突变负荷和放射组学评分(rad-score)建立了预测总生存期(OS)和无进展生存期(PFS)的模型:结果:东部合作肿瘤学组表现状态、Child-Pugh分级、瘤周增强、PI3K_AKT和缺氧突变负荷以及放射组学评分被用于创建预测OS的综合模型。C指数为0.805(训练队列)和0.768(测试队列)。1年、2年和3年OS的曲线下面积(AUC)分别为0.889、0.900和0.917。预测PFS时,使用了甲胎蛋白水平、肿瘤强化模式、缺氧和受体酪氨酸激酶突变负荷以及rad-score。C指数为0.782(训练队列)和0.766(测试队列)。6个月和12个月PFS的AUC分别为0.885和0.925。校准和决策曲线分析证实了模型的准确性和临床潜力:提名图模型有望预测接受TACE加TKIs治疗的中晚期HCC患者的OS和PFS,为治疗决策和监测患者进展提供了一种有前途的工具。
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引用次数: 0
The continuous improvement of digital assistance in the radiation oncologist's work: from web-based nomograms to the adoption of large-language models (LLMs). A systematic review by the young group of the Italian association of radiotherapy and clinical oncology (AIRO). 不断改进放射肿瘤学家工作中的数字辅助工具:从基于网络的提名图到采用大型语言模型(LLM)。意大利放射治疗和临床肿瘤学协会(AIRO)青年小组的系统回顾。
IF 9.7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-11-01 Epub Date: 2024-10-13 DOI: 10.1007/s11547-024-01891-y
Antonio Piras, Ilaria Morelli, Riccardo Ray Colciago, Luca Boldrini, Andrea D'Aviero, Francesca De Felice, Roberta Grassi, Giuseppe Carlo Iorio, Silvia Longo, Federico Mastroleo, Isacco Desideri, Viola Salvestrini

Purpose: Recently, the availability of online medical resources for radiation oncologists and trainees has significantly expanded, alongside the development of numerous artificial intelligence (AI)-based tools. This review evaluates the impact of web-based clinical decision-making tools in the clinical practice of radiation oncology.

Material and methods: We searched databases, including PubMed, EMBASE, and Scopus, using keywords related to web-based clinical decision-making tools and radiation oncology, adhering to PRISMA guidelines.

Results: Out of 2161 identified manuscripts, 70 were ultimately included in our study. These papers all supported the evidence that web-based tools can be transversally integrated into multiple radiation oncology fields, with online applications available for dose and clinical calculations, staging and other multipurpose intents. Specifically, the possible benefit of web-based nomograms for educational purposes was investigated in 35 of the evaluated manuscripts. As regards to the applications of digital and AI-based tools to treatment planning, diagnosis, treatment strategy selection and follow-up adoption, a total of 35 articles were selected. More specifically, 19 articles investigated the role of these tools in heterogeneous cancer types, while nine and seven articles were related to breast and head & neck cancers, respectively.

Conclusions: Our analysis suggests that employing web-based and AI tools offers promising potential to enhance the personalization of cancer treatment.

目的:最近,随着大量基于人工智能(AI)的工具的开发,放射肿瘤学家和受训人员可获得的在线医疗资源显著增加。本综述评估了基于网络的临床决策工具对放射肿瘤学临床实践的影响:我们使用与基于网络的临床决策工具和放射肿瘤学相关的关键词检索了包括PubMed、EMBASE和Scopus在内的数据库,并遵守了PRISMA指南:在2161篇已确认的手稿中,有70篇最终纳入了我们的研究。这些论文均支持网络工具可横向整合到多个放射肿瘤学领域的证据,其在线应用可用于剂量和临床计算、分期及其他多用途目的。具体而言,35 篇受评稿件研究了基于网络的提名图在教育方面可能带来的益处。关于数字和人工智能工具在治疗计划、诊断、治疗策略选择和后续治疗中的应用,共有 35 篇文章入选。更具体地说,19 篇文章研究了这些工具在不同癌症类型中的作用,9 篇和 7 篇文章分别与乳腺癌和头颈部癌症有关:我们的分析表明,采用基于网络和人工智能的工具有望提高癌症治疗的个性化程度。
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引用次数: 0
Adjuvant modern radiotherapy in resected pN2 NSCLC patients: results from a multicentre retrospective analysis on acute and late toxicity on behalf of AIRO thoracic oncology study group: the RAC-TAC study. 切除的 pN2 NSCLC 患者的现代辅助放疗:代表 AIRO 胸部肿瘤学研究小组进行的急性和晚期毒性多中心回顾性分析结果:RAC-TAC 研究。
IF 9.7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-11-01 Epub Date: 2024-08-31 DOI: 10.1007/s11547-024-01885-w
Valerio Nardone, Alessio Bruni, Davide Franceschini, Beatrice Marini, Stefano Vagge, Patrizia Ciammella, Matteo Sepulcri, Anna Cappelli, Elisa D'Angelo, Giuseppina De Marco, Antonio Angrisani, Mattia Manetta, Melissa Scricciolo, Cesare Guida, Dario Aiello, Paolo Borghetti, Salvatore Cappabianca

Background: Recently, the PORT-C and LUNG-ART trials, which evaluated the role of postoperative radiation therapy (PORT), have significantly altered the treatment landscape for NSCLC pN2 patients who previously underwent surgery. In response, the Italian Association of Radiotherapy and Oncology Thoracic Oncology study group has initiated an observational multicenter trial to assess both acute and late toxicities of PORT in pN2 NSCLC patients treated with modern techniques.

Methods: Data on NSCLC patients submitted to PORT after radical surgery treated between 2015 and 2020 in six Italian Centers were collected. Heart, lung, and esophageal acute and late toxicities have been retrospectively analyzed and related to radiation therapy dosimetric parameters. Furthermore, loco-regional control, distant metastasis and overall survival have been analyzed.

Results: A total of 212 patients with a median age of 68 years from six different centers were included in this analysis (142 males and 70 females). Prior to undergoing PORT, 96 patients (45.8%) had a history of heart disease, 110 patients (51.9%) had hypertension, and 51 patients (24%) had COPD. Acute toxicity was observed in 147 patients (69.3%), with lung toxicity occurring in 93 patients (G1 in 70 patients, G2 in 17 patients, and G3 in 4 patients), esophageal toxicity in 114 patients (G1 in 89 patients, G2 in 23 patients, and G3 in 1 patient), and cardiac toxicity in 4 patients (G1 in 2 patients and G3 in 2 patients). Late side effects were found in 60 patients (28.3%), predominantly involving the lungs (51 patients: 32 G1, 11 G2, and 1 G3) and the esophagus (11 patients: 8 G1 and 3 G2), with no reported late cardiac side effects. Various clinical and dosimetric parameters were found to correlate with both acute and chronic toxicities. Over a median follow-up period of 54 months, 48 patients (22.6%) showed locoregional disease relapse, 106 patients (50%) developed distant metastases, and 66 patients (31.1%) died.

Conclusions: RAC-TAC retrospective multicentric study showed the low toxicity of PORT when advanced technology is used. At the same time, it's noteworthy to underline that 50% of the patients develop distant recurrences in the follow up.

背景:最近,评估术后放疗(PORT)作用的 PORT-C 和 LUNG-ART 试验极大地改变了之前接受过手术的 NSCLC pN2 患者的治疗格局。为此,意大利放疗和肿瘤协会胸部肿瘤学研究小组发起了一项多中心观察性试验,以评估采用现代技术治疗的 pN2 NSCLC 患者术后放疗的急性和晚期毒性:收集了2015年至2020年间在意大利6个中心接受根治术后PORT治疗的NSCLC患者的数据。对心脏、肺部和食管的急性和晚期毒性进行了回顾性分析,并将其与放疗剂量参数联系起来。此外,还分析了局部区域控制、远处转移和总生存率:本次分析共纳入了来自六个不同中心的 212 名患者(男性 142 人,女性 70 人),中位年龄为 68 岁。在接受 PORT 治疗前,96 名患者(45.8%)有心脏病史,110 名患者(51.9%)有高血压,51 名患者(24%)有慢性阻塞性肺病。147 名患者(69.3%)出现急性毒性,其中 93 名患者出现肺部毒性(70 名患者为 G1,17 名患者为 G2,4 名患者为 G3),114 名患者出现食道毒性(89 名患者为 G1,23 名患者为 G2,1 名患者为 G3),4 名患者出现心脏毒性(2 名患者为 G1,2 名患者为 G3)。60例患者(28.3%)出现了晚期副作用,主要涉及肺部(51例患者:32例G1、11例G2和1例G3)和食道(11例患者:8例G1和3例G2),没有晚期心脏副作用的报道。研究发现,各种临床和剂量参数与急性和慢性毒性相关。中位随访期为54个月,48名患者(22.6%)出现局部疾病复发,106名患者(50%)出现远处转移,66名患者(31.1%)死亡:RAC-TAC回顾性多中心研究表明,在采用先进技术的情况下,PORT的毒性较低。结论:RAC-TAC 多中心回顾性研究显示,在使用先进技术的情况下,PORT 的毒性较低,但值得注意的是,50% 的患者在随访期间会出现远处复发。
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引用次数: 0
Dual-energy CT late arterial phase iodine maps for the diagnosis of acute non-occlusive mesenteric ischemia. 用于诊断急性非闭塞性肠系膜缺血的双能 CT 晚期动脉相碘图。
IF 9.7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-11-01 Epub Date: 2024-10-15 DOI: 10.1007/s11547-024-01898-5
Tommaso D'Angelo, Giuseppe M Bucolo, Ibrahim Yel, Vitali Koch, Leon D Gruenewald, Simon S Martin, Leona S Alizadeh, Thomas J Vogl, Giorgio Ascenti, Ludovica R M Lanzafame, Silvio Mazziotti, Alfredo Blandino, Christian Booz

Purpose: To evaluate the diagnostic accuracy of dual-energy CT (DECT) iodine maps in comparison to conventional CT series for the assessment of non-occlusive mesenteric ischemia (NOMI).

Material and methods: We evaluated data from 142 patients (72 men; 50.7%) who underwent DECT between 2018 and 2022, with surgically confirmed diagnosis of NOMI. One board-certified radiologist performed region of interest (ROI) measurements in bowel segments on late arterial (LA) and portal venous (PV) phase DECT iodine maps as well as LA conventional series, in both ischemic and non-ischemic bowel loops, using surgical reports as reference standard, and in a control group of 97 patients. Intra- and inter-reader agreement with a second board-certified radiologist was also evaluated. Receiver operating characteristic (ROC) curve analysis was performed to calculate the optimal threshold for discriminating ischemic from non-ischemic bowel segments. Subjective image rating of LA and PV iodine maps was performed.

Results: DECT-based iodine concentration (IC) measurements showed significant differences in LA phase iodine maps between ischemic (median:0.72; IQR 0.52-0.91 mg/mL) and non-ischemic bowel loops (5.16; IQR 3.45-6.31 mg/ml) (P <.0001). IC quantification on LA phase revealed an AUC of 0.966 for the assessment of acute bowel ischemia, significantly higher compared to both IC quantification based on PV phase (0.951) and attenuation values evaluated on LA conventional CT series (0.828). Excellent intra-observer and strong inter-observer agreements were observed for the quantification of iodine concentration. Conversely, weak inter-observer agreement was noted for conventional HU assessments. The optimal LA phase-based IC threshold for assessing bowel ischemia was 1.34 mg/mL, yielding a sensitivity of 100% and specificity of 96.48%.

Conclusion: Iodine maps based on LA phase significantly improve the diagnostic accuracy for the assessment of NOMI compared to conventional CT series and PV phase iodine maps.

目的:评估双能 CT(DECT)碘图与传统 CT 系列在评估非闭塞性肠系膜缺血(NOMI)方面的诊断准确性:我们评估了2018年至2022年期间接受DECT检查、经手术确诊为NOMI的142名患者(72名男性;50.7%)的数据。一名经委员会认证的放射科医生以手术报告为参考标准,在缺血和非缺血肠襻的晚期动脉(LA)和门静脉(PV)相DECT碘图以及LA常规系列上对肠段进行了感兴趣区(ROI)测量,并对97名患者组成的对照组进行了测量。此外,还评估了与第二位经委员会认证的放射科医生的读片者内部和读片者之间的一致性。进行了接收者操作特征(ROC)曲线分析,以计算出区分缺血和非缺血肠段的最佳阈值。对 LA 和 PV 碘图进行了主观图像评级:结果:基于 DECT 的碘浓度(IC)测量显示,缺血肠段(中位数:0.72;IQR 0.52-0.91 mg/mL)和非缺血肠段(5.16;IQR 3.45-6.31 mg/ml)的 LA 相碘图存在显著差异(P 结论:缺血肠段和非缺血肠段的 LA 相碘图之间存在显著差异:与传统的 CT 系列和 PV 相碘图相比,基于 LA 相的碘图可显著提高评估 NOMI 的诊断准确性。
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引用次数: 0
From twilight to starlight? Debating the role of chemoradiotherapy in gastric cancer in the D2 dissection era. 从黄昏到星光?讨论 D2 切开术时代化放疗在胃癌中的作用。
IF 9.7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-11-01 Epub Date: 2024-10-01 DOI: 10.1007/s11547-024-01892-x
Mauro Loi, Marcel Verheij, Joost Nuyttens, Marta Scorsetti, Lorenzo Livi, Maria A Hawkins, Florence Huguet

Patients affected by resectable locally advanced gastric cancer (GC) should receive perioperative chemotherapy as a standard of care. However, an additional benefit of adjuvant chemoradiation (CRT) has been negated by modern trials in the era of extended surgical dissection, and CRT is currently only considered on an individual basis in case of suboptimal resection. However, the dismal prognosis of GC and the modest treatment completion rates of perioperative chemotherapy have pushed to reconsider CRT, particularly as a preoperative treatment, in light of modern treatment techniques, advances in the understanding of the immune landscape and development of targeted agents. The aim of this review is to critically assess the historical role of CRT, the limitations of current evidence and to debate its potential role in an integrated neoadjuvant strategy for patients with resectable GC.

可切除的局部晚期胃癌(GC)患者应接受围手术期化疗,这是一种标准的治疗方法。然而,在扩大手术切除范围的时代,辅助化放疗(CRT)的额外益处已被现代试验所否定,目前只有在切除效果不理想的情况下才考虑进行CRT治疗。然而,鉴于 GC 的预后不佳以及围手术期化疗的治疗完成率不高,现代治疗技术、对免疫环境认识的进步以及靶向药物的开发促使人们重新考虑 CRT,尤其是作为术前治疗。本综述旨在批判性地评估 CRT 的历史作用、当前证据的局限性,并讨论其在可切除 GC 患者综合新辅助策略中的潜在作用。
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引用次数: 0
Preoperative identification from occult leiomyosarcomas in laparoscopic hysterectomy and laparoscopic myomectomy: accuracy of the ultrasound scoring system (PRESS-US). 腹腔镜子宫切除术和腹腔镜子宫肌瘤切除术术前识别隐匿性子宫肌瘤:超声评分系统(PRESS-US)的准确性。
IF 9.7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-30 DOI: 10.1007/s11547-024-01903-x
Zhuolin Jiang, Shijun Jia, Jie Zhang, Chun Liu, Xinyi Luo, Yixin Tang, Guonan Zhang, Yi Zhu

Purpose: To assess the diagnostic performance and inter-observer agreement of a PREoperative sarcoma scoring based on ultrasound (PRESS-US) in differentiating uterine leiomyosarcoma (uLMS) from leiomyoma (LM).

Methods: We conducted a retrospective evaluation of patients who underwent surgery and received standardized ultrasound examinations due to the presence of uterine myoma-like masses. Histological diagnosis was used as the reference standard. The masses were analyzed using morphological uterus sonographic assessment criteria, and the diagnostic accuracy of PRESS-US was evaluated using ROC curve analysis. Kappa (κ) statistics were used to assess the inter-observer agreement between a less experienced and an expert radiologist.

Results: Among the 646 patients, 632 (97.8%) were diagnosed with LM, and 14 (2.2%) had uLMS. The malignancy rates for low-risk and high-risk patients were 0.35% and 13.48%, respectively. The optimal PRESS-US cutoff was 17.5, resulting in an AUC of 89.7% (95% CI, 0.79-1.00), with a sensitivity of 85.7% and a specificity of 87.8%. The inter-observer agreement between a less experienced and an expert radiologist was excellent (κ = 0.811, P < 0.001).

Conclusions: PRESS-US provides effective risk stratification for uLMS for radiologists with different levels of experience, with high reliability. Subgrouping high-risk patients helps in better risk stratification.

目的:评估基于超声的术前肉瘤评分(PRESS-US)在区分子宫肌瘤(uLMS)和子宫良性肌瘤(LM)方面的诊断性能和观察者之间的一致性:我们对因子宫肌瘤样肿块而接受手术和标准化超声检查的患者进行了回顾性评估。组织学诊断作为参考标准。采用形态学子宫超声评估标准对肿块进行分析,并通过 ROC 曲线分析评估 PRESS-US 的诊断准确性。Kappa(κ)统计用于评估经验较少的放射科医生和专家之间的观察者间一致性:在 646 例患者中,632 例(97.8%)被诊断为 LM,14 例(2.2%)为 uLMS。低风险和高风险患者的恶变率分别为 0.35% 和 13.48%。最佳 PRESS-US 临界值为 17.5,AUC 为 89.7%(95% CI,0.79-1.00),灵敏度为 85.7%,特异度为 87.8%。经验较少的放射科医生和专家的观察者之间的一致性非常好(κ = 0.811,P 结论:PRESS-US 能有效地进行风险分层:PRESS-US 能为不同经验水平的放射科医生提供有效的 uLMS 风险分层,可靠性高。对高风险患者进行分组有助于更好地进行风险分层。
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引用次数: 0
Cardiovascular magnetic resonance semi-automated threshold-based post-processing of right ventricular volumes in repaired tetralogy of Fallot. 心血管磁共振半自动阈值法洛四联症修复后右心室容积后处理。
IF 9.7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-10-30 DOI: 10.1007/s11547-024-01908-6
Lara Tondi, Stefano Figliozzi, Sara Boveri, Francesco Sturla, Giulia Pasqualin, Antonia Camporeale, Giandomenico Disabato, Andrea Attanasio, Gianpaolo Carrafiello, Pietro Spagnolo, Massimo Lombardi

Background: Cardiovascular magnetic resonance (CMR) is the gold-standard to estimate right ventricular (RV) volumes, which are key for clinical management of patients with repaired tetralogy of Fallot (rTOF). Semi-automated threshold-based methods (SAT) have been proposed for CMR post-processing as alternatives to fully manual standard tracing. We investigated the impact of SAT on RV analysis using different thresholds in rTOF patients.

Methods: RV volumes and mass were estimated using SAT and standard fully manual tracing methods in rTOF patients. Two threshold levels were set for SAT, i.e., default 50 (SAT-50) and 30 (SAT-30). RV stroke volumes (SV) were compared to main pulmonary artery forward flow (MPA-FF). Post-processing time, intra- and interobserver variabilities were compared across methods.

Results: Sixty-two CMRs of rTOF patients were analyzed. Compared to the standard fully manual tracing, no significant differences in RV mass, volumes and ejection fraction were observed using SAT-30, whereas SAT-50 significantly underestimated RV end-diastolic-volume index (EDVi) by 10.4% (mean difference of - 11.8 ± 6.2 ml/m2, p 0.03) and overestimated RV mass index by 21.8% (mean difference of 14.2 ± 11.9 g/m2, p 0.002). Compared to MPA-FF, RVSV by standard fully manual method and SAT-30 showed minor biases, respectively, 0.03 ml/m2 and 0.7 ml/m2, while SAT-50 underestimated RVSV by 6.86 ml/m2 (p < 0.001). In six patients, the degree of RV EDVi underestimation by SAT-50 determined a change of category from dilated to non-dilated RV. Intra- and interobserver variabilities were good to excellent for all methods. Post-processing duration was shorter for SAT compared to standard manual segmentation (5.5 ± 1.7 min vs. 19.5 ± 4.4 min, p < 0.001).

Conclusion: CMR SAT-30 post-processing is a precise, accurate and time-saving method for biventricular assessment of volumes, ejection fraction and mass in rTOF.

背景:心血管磁共振(CMR)是估算右心室容积的黄金标准,而右心室容积是法洛氏四联症(rTOF)修复患者临床管理的关键。有人提出了基于阈值的半自动方法(SAT)用于 CMR 后处理,以替代全手工标准描记。我们研究了 SAT 使用不同阈值对 rTOF 患者 RV 分析的影响:方法:使用 SAT 和标准全手动描记方法估算 rTOF 患者的 RV 容量和质量。为 SAT 设定了两个阈值水平,即默认值 50(SAT-50)和 30(SAT-30)。将 RV 搏出量(SV)与主肺动脉前向血流(MPA-FF)进行比较。比较了不同方法的后处理时间、观察者内部和观察者之间的差异:对 62 例 rTOF 患者的 CMR 进行了分析。与标准的全手动描记相比,使用 SAT-30 观察到的 RV 质量、容积和射血分数无明显差异,而 SAT-50 则明显低估了 RV 舒张末期容积指数(EDVi)10.4%(平均差异为 - 11.8 ± 6.2 ml/m2,P 0.03),高估了 RV 质量指数 21.8%(平均差异为 14.2 ± 11.9 g/m2,P 0.002)。与 MPA-FF 相比,标准全手工方法和 SAT-30 的 RVSV 偏差较小,分别为 0.03 ml/m2 和 0.7 ml/m2,而 SAT-50 则低估了 RVSV 6.86 ml/m2(p 结论:MPA-FF 和 SAT-30 的 RVSV 偏差较小,分别为 0.03 ml/m2 和 0.7 ml/m2:CMR SAT-30 后处理是在 rTOF 中评估双心室容积、射血分数和质量的一种精确、准确和省时的方法。
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Radiologia Medica
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