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Radiomics analysis with three-dimensional and two-dimensional segmentation to predict survival outcomes in pancreatic cancer. 三维和二维分割放射组学分析预测胰腺癌的生存结果。
IF 2.5 Pub Date : 2023-11-28 DOI: 10.4329/wjr.v15.i11.304
Mohammed Saleh, Mayur Virarkar, Hagar S Mahmoud, Vincenzo K Wong, Carlos Ignacio Gonzalez Baerga, Miti Parikh, Sherif B Elsherif, Priya R Bhosale

Background: Radiomics can assess prognostic factors in several types of tumors, but considering its prognostic ability in pancreatic cancer has been lacking.

Aim: To evaluate the performance of two different radiomics software in assessing survival outcomes in pancreatic cancer patients.

Methods: We retrospectively reviewed pretreatment contrast-enhanced dual-energy computed tomography images from 48 patients with biopsy-confirmed pancreatic ductal adenocarcinoma who later underwent neoadjuvant chemoradiation and surgery. Tumors were segmented using TexRad software for 2-dimensional (2D) analysis and MIM software for 3D analysis, followed by radiomic feature extraction. Cox proportional hazard modeling correlated texture features with overall survival (OS) and progression-free survival (PFS). Cox regression was used to detect differences in OS related to pretreatment tumor size and residual tumor following treatment. The Wilcoxon test was used to show the relationship between tumor volume and the percent of residual tumor. Kaplan-Meier analysis was used to compare survival in patients with different tumor densities in Hounsfield units for both 2D and 3D analysis.

Results: 3D analysis showed that higher mean tumor density [hazard ratio (HR) = 0.971, P = 0.041)] and higher median tumor density (HR = 0.970, P = 0.037) correlated with better OS. 2D analysis showed that higher mean tumor density (HR = 0.963, P = 0.014) and higher mean positive pixels (HR = 0.962, P = 0.014) correlated with better OS; higher skewness (HR = 3.067, P = 0.008) and higher kurtosis (HR = 1.176, P = 0.029) correlated with worse OS. Higher entropy correlated with better PFS (HR = 0.056, P = 0.036). Models determined that patients with increased tumor size greater than 1.35 cm were likely to have a higher percentage of residual tumors of over 10%.

Conclusion: Several radiomics features can be used as prognostic tools for pancreatic cancer. However, results vary between 2D and 3D analyses. Mean tumor density was the only variable that could reliably predict OS, irrespective of the analysis used.

背景:放射组学可以评估多种类型肿瘤的预后因素,但尚未考虑其在胰腺癌中的预后能力。目的:评价两种不同的放射组学软件在评估胰腺癌患者生存预后方面的性能。方法:我们回顾性分析了48例活检证实的胰腺导管腺癌患者的预处理对比增强双能计算机断层扫描图像,这些患者后来接受了新辅助放化疗和手术。使用TexRad软件进行二维(2D)分析,使用MIM软件进行三维分析,然后进行放射学特征提取。Cox比例风险模型将纹理特征与总生存期(OS)和无进展生存期(PFS)相关联。采用Cox回归检测肿瘤大小与治疗后残余肿瘤相关的OS差异。采用Wilcoxon检验显示肿瘤体积与残余肿瘤百分比之间的关系。采用Kaplan-Meier分析比较Hounsfield单元中不同肿瘤密度患者的生存率,并进行二维和三维分析。结果:三维分析显示,较高的平均肿瘤密度[风险比(HR) = 0.971, P = 0.041)]和较高的中位肿瘤密度(HR = 0.970, P = 0.037)与较好的OS相关。二维分析显示,高平均肿瘤密度(HR = 0.963, P = 0.014)和高平均阳性像元(HR = 0.962, P = 0.014)与较好的OS相关;偏度越高(HR = 3.067, P = 0.008),峰度越高(HR = 1.176, P = 0.029), OS越差。熵越大,PFS越好(HR = 0.056, P = 0.036)。模型确定,肿瘤大小大于1.35 cm的患者可能有更高的残余肿瘤百分比,超过10%。结论:几种放射组学特征可作为胰腺癌的预后工具。然而,二维和三维分析的结果有所不同。无论采用何种分析,平均肿瘤密度是唯一能够可靠预测OS的变量。
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引用次数: 0
Imaging assessment of photosensitizer emission induced by radionuclide-derived Cherenkov radiation using charge-coupled device optical imaging and long-pass filters. 利用电荷耦合器件光学成像和长通滤光片对放射性核素衍生切伦科夫辐射引起的光敏剂发射进行成像评估。
IF 2.5 Pub Date : 2023-11-28 DOI: 10.4329/wjr.v15.i11.315
Winn Aung, Atsushi B Tsuji, Kazuaki Rikiyama, Fumihiko Nishikido, Satoshi Obara, Tatsuya Higashi

Background: Radionuclides produce Cherenkov radiation (CR), which can potentially activate photosensitizers (PSs) in phototherapy. Several groups have studied Cherenkov energy transfer to PSs using optical imaging; however, cost-effectively identifying whether PSs are excited by radionuclide-derived CR and detecting fluorescence emission from excited PSs remain a challenge. Many laboratories face the need for expensive dedicated equipment.

Aim: To cost-effectively confirm whether PSs are excited by radionuclide-derived CR and distinguish fluorescence emission from excited PSs.

Methods: The absorbance and fluorescence spectra of PSs were measured using a microplate reader and fluorescence spectrometer to examine the photo-physical properties of PSs. To mitigate the need for expensive dedicated equipment and achieve the aim of the study, we developed a method that utilizes a charge-coupled device optical imaging system and appropriate long-pass filters of different wavelengths (manual sequential application of long-pass filters of 515, 580, 645, 700, 750, and 800 nm). Tetrakis (4-carboxyphenyl) porphyrin (TCPP) was utilized as a model PS. Different doses of copper-64 (64CuCl2) (4, 2, and 1 mCi) were used as CR-producing radionuclides. Imaging and data acquisition were performed 0.5 h after sample preparation. Differential image analysis was conducted by using ImageJ software (National Institutes of Health) to visually evaluate TCPP fluorescence.

Results: The maximum absorbance of TCPP was at 390-430 nm, and the emission peak was at 670 nm. The CR and CR-induced TCPP emissions were observed using the optical imaging system and the high-transmittance long-pass filters described above. The emission spectra of TCPP with a peak in the 645-700 nm window were obtained by calculation and subtraction based on the serial signal intensity (total flux) difference between 64CuCl2 + TCPP and 64CuCl2. Moreover, the differential fluorescence images of TCPP were obtained by subtracting the 64CuCl2 image from the 64CuCl2 + TCPP image. The experimental results considering different 64CuCl2 doses showed a dose-dependent trend. These results demonstrate that a bioluminescence imaging device coupled with different long-pass filters and subtraction image processing can confirm the emission spectra and differential fluorescence images of CR-induced TCPP.

Conclusion: This simple method identifies the PS fluorescence emission generated by radionuclide-derived CR and can contribute to accelerating the development of Cherenkov energy transfer imaging and the discovery of new PSs.

背景:放射性核素产生切伦科夫辐射(Cherenkov radiation, CR),在光疗中可能激活光敏剂(PSs)。几个研究小组利用光学成像研究了切伦科夫能量转移到ps;然而,经济有效地确定放射性核素衍生的CR是否激发ps并检测激发ps的荧光发射仍然是一个挑战。许多实验室都需要昂贵的专用设备。目的:经济有效地确认核素衍生的CR是否激发了ps,并区分激发后的ps的荧光发射。方法:采用微孔板阅读器和荧光光谱仪对ps的吸光度和荧光光谱进行测定,检测ps的光物理性质。为了减少对昂贵的专用设备的需求并实现研究的目的,我们开发了一种利用电荷耦合器件光学成像系统和适当的不同波长的长通滤波器的方法(手动顺序应用515、580、645、700、750和800 nm的长通滤波器)。以四(4-羧基苯基)卟啉(TCPP)作为模型PS,以不同剂量的铜-64 (64CuCl2)(4,2和1 mCi)作为产cr的放射性核素。样品制备后0.5 h进行成像和数据采集。采用ImageJ软件(美国国立卫生研究院)进行差分图像分析,直观评价TCPP荧光。结果:TCPP的最大吸光度在390 ~ 430 nm处,发射峰在670 nm处。利用光学成像系统和上述高透射率长通滤光片观察了CR和CR诱导的TCPP发射。根据64CuCl2 + TCPP与64CuCl2的串行信号强度(总通量)差值进行计算和相减,得到645 ~ 700 nm窗口内峰值的TCPP发射光谱。此外,在64CuCl2 + TCPP图像中减去64CuCl2图像,得到TCPP的差异荧光图像。考虑不同64CuCl2剂量的实验结果呈现剂量依赖趋势。这些结果表明,结合不同长通滤波器和减法图像处理的生物发光成像装置可以确定cr诱导的TCPP的发射光谱和差分荧光图像。结论:该方法可识别放射性核素衍生CR产生的PS荧光发射,有助于加速Cherenkov能量转移成像技术的发展和新PS的发现。
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引用次数: 0
Does the use of computed tomography scenogram alone enable diagnosis in cases of bowel obstruction? 单独使用计算机断层扫描能诊断肠梗阻吗?
IF 2.5 Pub Date : 2023-10-28 DOI: 10.4329/wjr.v15.i10.281
Ozlem Kadirhan, Volkan Kızılgoz, Sonay Aydin, Esra Bilici, Ekrem Bayat, Mecit Kantarci

Background: Ileus is a pathological condition of the abdomen that presents as a medical emergency. It is characterized by potential complications such as perforation and ischemia, which can lead to significant morbidity and mortality if not promptly addressed. The successful management of ileus relies heavily on the timely and precise identification of the condition. While conventional radiography (CR) is commonly used as the primary diagnostic tool, its accuracy in identifying obstructions ranges from 46% to 80%. Furthermore, the diagnostic accuracy of identifying the location and etiology of intestinal obstruction by CR is limited, therefore making computed tomography (CT) the ideal imaging modality in this regard.

Aim: To determine the presence of acute bowel obstruction (BO) on abdominal CT scenogram images and the accuracy of determining its possible location, taking into account the experience of the observers.

Methods: A retrospective screening was conducted on an ensemble of 46 individuals who presented to the emergency department between January 2021 and January 2022 with severe abdominal pain and were subsequently monitored for suspected ileus. The abdominal CT scans of these patients were assessed by three radiologists with varying levels of experience (1, 3, and 10 years) at different intervals (1 mo apart). The evaluation focused on determining the presence or absence of BO, as well as identifying the potential location of the obstruction (small bowel or large bowel). The study employed Kappa statistics to assess inter-observer variances, while the McNamer test was used to evaluate obstruction and segmentation discrepancies between observations. A significance level of P < 0.05 was determined to indicate statistical significance.

Results: Out of the total sample size of 46 patients, 15 individuals (32.6%) were identified as female, while the remaining 31 individuals (67.4%) were identified as male. The ultimate diagnosis of 42 instances (91.3%) indicated ileus resulting from mechanical obstruction (MO). Among these patients, 14 (33%) experienced obstruction in the large bowel (LB), while 28 (66%) experienced obstruction in the small bowel (SB). The initial evaluation yielded sensitivity rates of 76.19%, 83.31%, and 83.33%, and diagnostic accuracy rates of 69.56%, 76.08%, and 80.43% for the detection of BO among the three observers. The initial study revealed that the average sensitivity of three observers in detecting the presence of ileus caused by MO was 80.94%, while the diagnostic accuracy was 75.35%. Based on the first evaluation, the senior observer demonstrated the highest sensitivity (85.71%), negative predictive value (92.60%), and diagnostic accuracy (80.43%) when accurately estimating the thick and thin segmentation, as per the final diagnosis. There was no statistically significant disparity observed in the sensitivities pertai

背景:肠梗阻是一种腹部病理状况,表现为医学紧急情况。它的特点是潜在的并发症,如穿孔和缺血,如果不及时处理,可导致显著的发病率和死亡率。肠梗阻的成功治疗在很大程度上依赖于病情的及时和准确的识别。虽然常规x线摄影(CR)通常被用作主要诊断工具,但其识别阻塞的准确率在46%至80%之间。此外,通过CR识别肠梗阻的位置和病因的诊断准确性有限,因此计算机断层扫描(CT)是这方面的理想成像方式。目的:结合观察者的经验,探讨急性肠梗阻(BO)在腹部CT场景图上是否存在,以及判断其可能位置的准确性。方法:对2021年1月至2022年1月期间因严重腹痛就诊于急诊科并随后监测疑似肠梗阻的46例患者进行回顾性筛查。这些患者的腹部CT扫描由三名具有不同经验水平(1年、3年和10年)的放射科医生在不同的时间间隔(间隔1个月)进行评估。评估的重点是确定BO的存在与否,以及确定梗阻的潜在位置(小肠或大肠)。本研究采用Kappa统计评估观察者间方差,采用McNamer检验评估观察间的阻塞和分割差异。以P < 0.05为差异有统计学意义。结果:在46例患者的总样本量中,女性15例(32.6%),男性31例(67.4%)。42例(91.3%)最终诊断为机械性梗阻(MO)引起的肠梗阻。其中14例(33%)发生大肠梗阻,28例(66%)发生小肠梗阻。初步评估结果显示,三名观察者对BO的敏感度分别为76.19%、83.31%和83.33%,诊断准确率分别为69.56%、76.08%和80.43%。初步研究发现,三名观察者对MO致肠梗阻的平均敏感度为80.94%,诊断准确率为75.35%。在第一次评价的基础上,根据最终诊断,高级观察员在准确估计厚分割和薄分割时灵敏度最高(85.71%),阴性预测值最高(92.60%),诊断准确率最高(80.43%)。在第二次评估中,在识别肠梗阻的敏感性上,以及在LB或SB内节段水平的精确测定上,比较第二和第三个观察者时,没有观察到统计学上的显著差异。然而,虽然第一观察者对肠梗阻的检出率没有统计学意义上的变化,但段估计的准确率明显上升(73.91%)。与其他评估者相比,高级评估者在评估肠梗阻和分割是否存在方面具有更高的准确性。结论:我们的研究结果表明,腹部CT扫描在诊断急性MO的敏感性和准确率与CR相似或更高。此外,研究表明,经验丰富的放射科医生比经验不足的放射科医生更有可能准确预测MO的存在和潜在定位。
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引用次数: 0
Two-point Dixon and six-point Dixon magnetic resonance techniques in the detection, quantification and grading of hepatic steatosis. 两点Dixon和六点Dixon磁共振技术在肝脂肪变性的检测、定量和分级中的应用。
IF 2.5 Pub Date : 2023-10-28 DOI: 10.4329/wjr.v15.i10.293
Mohamed Elfaal, Alanna Supersad, Craig Ferguson, Stephanie Locas, Florin Manolea, Mitchell P Wilson, Medica Sam, Wendy Tu, Gavin Low

Background: Hepatic steatosis is a very common problem worldwide.

Aim: To assess the performance of two- and six-point Dixon magnetic resonance (MR) techniques in the detection, quantification and grading of hepatic steatosis.

Methods: A single-center retrospective study was performed in 62 patients with suspected parenchymal liver disease. MR sequences included two-point Dixon, six-point Dixon, MR spectroscopy (MRS) and MR elastography. Fat fraction (FF) estimates on the Dixon techniques were compared to the MRS-proton density FF (PDFF). Statistical tests used included Pearson's correlation and receiver operating characteristic.

Results: FF estimates on the Dixon techniques showed excellent correlation (≥ 0.95) with MRS-PDFF, and excellent accuracy [area under the receiver operating characteristic (AUROC) ≥ 0.95] in: (1) Detecting steatosis; and (2) Grading severe steatosis, (P < 0.001). In iron overload, two-point Dixon was not evaluable due to confounding T2* effects. FF estimates on six-point Dixon vs MRS-PDFF showed a moderate correlation (0.82) in iron overload vs an excellent correlation (0.97) without iron overload, (P < 0.03). The accuracy of six-point Dixon in grading mild steatosis improved (AUROC: 0.59 to 0.99) when iron overload cases were excluded. The excellent correlation (> 0.9) between the Dixon techniques vs MRS-PDFF did not change in the presence of liver fibrosis (P < 0.01).

Conclusion: Dixon techniques performed satisfactorily for the evaluation of hepatic steatosis but with exceptions.

背景:肝脂肪变性是世界范围内非常普遍的问题。目的:评价二点和六点迪克森磁共振(MR)技术在肝脂肪变性的检测、定量和分级中的应用价值。方法:对62例疑似实质性肝病患者进行单中心回顾性研究。MR序列包括两点Dixon、六点Dixon、MR光谱(MRS)和MR弹性成像。将Dixon技术估计的脂肪分数(FF)与mrs质子密度FF (PDFF)进行比较。使用的统计检验包括皮尔逊相关和接受者工作特征。结果:Dixon技术的FF估计值与MRS-PDFF具有良好的相关性(≥0.95),并且在以下方面具有良好的准确性[受试者工作特征下面积(AUROC)≥0.95]:(1)检测脂肪变性;(2)重度脂肪变性分级(P < 0.001)。在铁超载时,由于混淆T2*效应,两点Dixon不能评估。6点Dixon与MRS-PDFF的FF估计显示,铁超载的中度相关性(0.82)与无铁超载的极好相关性(0.97)(P < 0.03)。当排除铁超载病例时,6点Dixon分级轻度脂肪变性的准确性提高(AUROC: 0.59至0.99)。Dixon技术与MRS-PDFF之间的极好相关性(> 0.9)在肝纤维化存在时没有改变(P < 0.01)。结论:Dixon技术对肝脂肪变性的评价令人满意,但也有例外。
{"title":"Two-point Dixon and six-point Dixon magnetic resonance techniques in the detection, quantification and grading of hepatic steatosis.","authors":"Mohamed Elfaal, Alanna Supersad, Craig Ferguson, Stephanie Locas, Florin Manolea, Mitchell P Wilson, Medica Sam, Wendy Tu, Gavin Low","doi":"10.4329/wjr.v15.i10.293","DOIUrl":"https://doi.org/10.4329/wjr.v15.i10.293","url":null,"abstract":"<p><strong>Background: </strong>Hepatic steatosis is a very common problem worldwide.</p><p><strong>Aim: </strong>To assess the performance of two- and six-point Dixon magnetic resonance (MR) techniques in the detection, quantification and grading of hepatic steatosis.</p><p><strong>Methods: </strong>A single-center retrospective study was performed in 62 patients with suspected parenchymal liver disease. MR sequences included two-point Dixon, six-point Dixon, MR spectroscopy (MRS) and MR elastography. Fat fraction (FF) estimates on the Dixon techniques were compared to the MRS-proton density FF (PDFF). Statistical tests used included Pearson's correlation and receiver operating characteristic.</p><p><strong>Results: </strong>FF estimates on the Dixon techniques showed excellent correlation (≥ 0.95) with MRS-PDFF, and excellent accuracy [area under the receiver operating characteristic (AUROC) ≥ 0.95] in: (1) Detecting steatosis; and (2) Grading severe steatosis, (<i>P</i> < 0.001). In iron overload, two-point Dixon was not evaluable due to confounding T2* effects. FF estimates on six-point Dixon <i>vs</i> MRS-PDFF showed a moderate correlation (0.82) in iron overload <i>vs</i> an excellent correlation (0.97) without iron overload, (<i>P</i> < 0.03). The accuracy of six-point Dixon in grading mild steatosis improved (AUROC: 0.59 to 0.99) when iron overload cases were excluded. The excellent correlation (> 0.9) between the Dixon techniques <i>vs</i> MRS-PDFF did not change in the presence of liver fibrosis (<i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>Dixon techniques performed satisfactorily for the evaluation of hepatic steatosis but with exceptions.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Distinctive magnetic resonance imaging features in primary central nervous system lymphoma: A case report. 原发性中枢神经系统淋巴瘤的独特磁共振成像特征:一例报告。
IF 2.5 Pub Date : 2023-09-28 DOI: 10.4329/wjr.v15.i9.274
Li-Hong Liu, Han-Wen Zhang, Hong-Bo Zhang, Xiao-Lei Liu, Hua-Zhen Deng, Fan Lin, Biao Huang

Background: Primary central nervous system lymphoma (PCNSL) is a rare malignant tumor originating from the lymphatic hematopoietic system. It exhibits unique imaging manifestations due to its biological characteristics.

Case summary: Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and magnetic resonance spectroscopy was performed. The imaging findings showed multiple space-occupying lesions with low signal on T1-weighted imaging, uniform high signal on T2-weighted imaging, and obvious enhancement on contrast-enhanced scans. DWI revealed diffusion restriction, PWI demonstrated hypoperfusion, and spectroscopy showed elevated choline peak and decreased N-acetylaspartic acid. The patient's condition significantly improved after hormone shock therapy.

Conclusion: This case highlights the distinctive imaging features of PCNSL and their importance in accurate diagnosis and management.

背景:原发性中枢神经系统淋巴瘤(PCNSL)是一种罕见的起源于淋巴造血系统的恶性肿瘤。由于其生物学特性,它表现出独特的影像学表现。病例总结:进行磁共振成像(MRI)、弥散加权成像(DWI)、灌注加权成像(PWI)和磁共振波谱。影像学表现为多个占位性病变,T1加权成像低信号,T2加权成像均匀高信号,增强扫描明显增强。DWI显示扩散受限,PWI显示低灌注,光谱显示胆碱峰升高,N-乙酰天冬氨酸降低。激素休克治疗后,患者的病情明显好转。结论:本病例突出了PCNSL的独特影像学特征及其在准确诊断和治疗中的重要性。
{"title":"Distinctive magnetic resonance imaging features in primary central nervous system lymphoma: A case report.","authors":"Li-Hong Liu,&nbsp;Han-Wen Zhang,&nbsp;Hong-Bo Zhang,&nbsp;Xiao-Lei Liu,&nbsp;Hua-Zhen Deng,&nbsp;Fan Lin,&nbsp;Biao Huang","doi":"10.4329/wjr.v15.i9.274","DOIUrl":"10.4329/wjr.v15.i9.274","url":null,"abstract":"<p><strong>Background: </strong>Primary central nervous system lymphoma (PCNSL) is a rare malignant tumor originating from the lymphatic hematopoietic system. It exhibits unique imaging manifestations due to its biological characteristics.</p><p><strong>Case summary: </strong>Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and magnetic resonance spectroscopy was performed. The imaging findings showed multiple space-occupying lesions with low signal on T1-weighted imaging, uniform high signal on T2-weighted imaging, and obvious enhancement on contrast-enhanced scans. DWI revealed diffusion restriction, PWI demonstrated hypoperfusion, and spectroscopy showed elevated choline peak and decreased N-acetylaspartic acid. The patient's condition significantly improved after hormone shock therapy.</p><p><strong>Conclusion: </strong>This case highlights the distinctive imaging features of PCNSL and their importance in accurate diagnosis and management.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/8f/WJR-15-274.PMC10563853.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41214414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of pulmonary perfusion magnetic resonance imaging for the diagnosis of pulmonary hypertension: A review. 肺灌注磁共振成像在肺动脉高压诊断中的作用:综述。
IF 2.5 Pub Date : 2023-09-28 DOI: 10.4329/wjr.v15.i9.256
Miriam Lacharie, Adriana Villa, Xenios Milidonis, Hadeer Hasaneen, Amedeo Chiribiri, Giulia Benedetti

Among five types of pulmonary hypertension, chronic thromboembolic pulmonary hypertension (CTEPH) is the only curable form, but prompt and accurate diagnosis can be challenging. Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH, however these are limited by radiation exposure, subjective qualitative bias, and lack of cardiac functional assessment. This review aims to assess the methodology, diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages, limitations and future research scope.

在五种类型的肺动脉高压中,慢性血栓栓塞性肺动脉高压(CTEPH)是唯一可治愈的形式,但及时准确的诊断可能具有挑战性。计算机断层扫描和基于核医学的技术是非侵入性诊断CTEPH的标准成像模式,但这些技术受到辐射暴露、主观定性偏差和缺乏心脏功能评估的限制。本文旨在评估现有文献中肺灌注成像的方法学、诊断准确性,并讨论其优点、局限性和未来的研究范围。
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引用次数: 0
Appearance of aseptic vascular grafts after endovascular aortic repair on [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography. 血管内主动脉修复后无菌血管移植物在[(18)F]氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描上的表现
IF 2.5 Pub Date : 2023-08-28 DOI: 10.4329/wjr.v15.i8.241
Paige Bennett, Maria Bernadette Tomas, Christopher F Koch, Kenneth J Nichols, Christopher J Palestro

Background: Diagnosis of prosthetic vascular graft infection with [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) allows for early detection of functional changes associated with infection, based on increased glucose utilization by activated macrophages and granulocytes. Aseptic vascular grafts, like all foreign bodies, can stimulate an inflammatory response, which can present as increased activity on 18F-FDG PET/CT. Consequently, distinguishing aseptic inflammation from graft infection, though important, can be difficult. In the case of endovascular aneurysm repair (EVAR), a minimally invasive procedure involving the transfemoral insertion of an endoprosthetic stent graft, the normal postoperative appearance of these grafts on 18F-FDG PET/CT can vary over time, potentially confounding study interpretation.

Aim: To investigate the visual, semiquantitative, and temporal characteristics of aseptic vascular grafts in patients status post EVAR.

Methods: In this observational retrospective cohort study, patients with history of EVAR who underwent 18F-FDG PET/CT for indications other than infection were identified retrospectively. All patients were asymptomatic for graft infection - no abdominal pain, fever of unknown origin, sepsis, or leukocytosis - at the time of imaging and for ≥ 2 mo after each PET/CT. Imaging studies such as CT for each patient were also reviewed, and any patients with suspected or confirmed vascular graft infection were excluded. One hundred two scans performed on 43 patients (34 males; 9 females; age = 77 ± 8 years at the time of the final PET/CT) were retrospectively reviewed. All 43 patients had an abdominal aortic (AA) vascular graft, 40 patients had a right iliac (RI) limb graft, and 41 patients had a left iliac (LI) limb graft. Twenty-two patients had 1 PET/CT and 21 patients had from 2 to 9 PET/CTs. Grafts were imaged between 2 mo to 168 mo (about 14 years) post placement. Eight grafts were imaged within 6 mo of placement, including three that were imaged within three months of placement. The mean interval between graft placement and PET/CT for all 102 scans was 51 ± 39 mo. PET/CT data was reconstructed with region-of-interest analysis of proximal, mid and distal portions of the grafts and background ascending aorta. Maximum standardized uptake value (SUVmax) was recorded for each region. SUVmax-to-background uptake ratios (URs) were calculated. Visual assessment was performed using a 2-pattern grading scale: Diffuse (homogeneous uptake less than liver uptake) and focal (one or more areas of focal uptake in any part of the graft). Statistical analysis was performed.

Results: In total, there were 306 AA grafts, 285 LI grafts, 282 RI grafts, and 306 ascending aorta background SUVmax measurements. For all 102 scans, mean SUVmax values for AA grafts we

背景:使用[(18)F]氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(18F-FDG PET/CT)诊断假体血管移植感染可以早期发现与感染相关的功能变化,这是基于活化的巨噬细胞和粒细胞对葡萄糖的利用增加。无菌血管移植物,像所有异物一样,可以刺激炎症反应,在18F-FDG PET/CT上表现为活性增加。因此,区分无菌性炎症和移植物感染,虽然重要,但可能是困难的。在血管内动脉瘤修复(EVAR)的情况下,一种微创手术涉及经股插入内假支架,这些移植物在18F-FDG PET/CT上的正常术后外观可能会随着时间的推移而变化,这可能会混淆研究的解释。目的:探讨EVAR后无菌血管移植的视觉、半定量和时间特征。方法:在这项观察性回顾性队列研究中,回顾性识别有EVAR病史的患者,这些患者因感染以外的适应症接受了18F-FDG PET/CT检查。所有患者在成像时和每次PET/CT后≥2个月均无移植物感染症状,无腹痛、不明原因发热、败血症或白细胞增多。我们还回顾了每位患者的CT等影像学检查,排除了任何怀疑或证实血管移植感染的患者。对43例患者进行了102次扫描(男性34例;9雌性;年龄= 77±8岁(PET/CT终末扫描时)。43例患者均行腹主动脉(AA)血管移植,40例患者行右髂(RI)肢体移植,41例患者行左髂(LI)肢体移植。1次PET/CT 22例,2 ~ 9次PET/CT 21例。移植物放置后2个月至168个月(约14年)成像。8个移植物在植入后6个月内成像,其中3个在植入后3个月内成像。所有102次扫描中,移植物放置和PET/CT之间的平均间隔为51±39个月。PET/CT数据通过移植物近端、中端和远端以及背景升主动脉的兴趣区分析进行重建。记录每个区域的最大标准化吸收值(SUVmax)。计算suvmax -background摄取比(URs)。视觉评估采用两种模式分级量表:弥漫性(均匀摄取小于肝脏摄取)和局灶性(移植物任何部位的一个或多个局灶性摄取区域)。进行统计学分析。结果:共有306例AA片,285例LI片,282例RI片,306例升主动脉背景SUVmax测量。在所有102次扫描中,AA移植物近端、中端和远端段的平均SUVmax值为2.8-3.0。LI接枝和RI接枝的平均SUVmax值为2.7 ~ 2.8。背景平均SUVmax值为2.5±0.5。平均URs为1.1 ~ 1.2。扫描的视觉分析反映了定量分析的结果。在目视检查中,98%显示弥漫性,均匀的18F-FDG摄取少于肝脏。AA型、LI型和RI型分别与移植URs (f比= 21.5,P 0.001)、LI型(f比= 20.4,P 0.001)和RI型(f比= 30.4,P 0.001)有显著相关性。因此,18F-FDG摄取的视觉模式与半定量URs在统计学上显著对应。病灶型移植物的年龄大于弥漫性移植物,分别为87±89和50±37个月(P = 0.02)。AA移植的URs与移植年龄显著相关(r = 0.19, P = 0.001)。URs也与LI移植的移植年龄(r = 0.25, P < 0.0001)和RI移植的移植年龄(r = 0.31, P < 0.001)显著相关。按移植年龄分组的相似数量的四分位数(n = 25-27)表明,第4四分位数的URs明显高于第2四分位数(f比= 19.5,P < 0.001)。在评估URs时,在升主动脉10%-20%范围内的移植物SUVmax值在无菌移植物中是明显的,除了最老四分位数的移植物。在这项研究中,最老四分之一(EVAR后> 7年)的移植物SUVmax比升主动脉SUVmax高出30%。结论:在18F-FDG PET/CT上,主动脉和髂血管内无菌血管支架的SUVmax值在升主动脉背景SUVmax值的10%-20%之间。年龄较大的无菌移植物的SUVmax可高达背景以上的30%。在98%的无菌血管移植物中可见弥漫性、均匀性摄取少于肝脏的视觉摄取模式,这使临床医生特别放心。
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引用次数: 0
Rare portal hypertension caused by Abernethy malformation (Type IIC): A case report. 罕见的由阿伯内蒂畸形(IIC型)引起的门静脉高压1例。
IF 2.5 Pub Date : 2023-08-28 DOI: 10.4329/wjr.v15.i8.250
Xin Yao, Yang Liu, Li-Dan Yu, Jian-Ping Qin

Background: Abernethy malformation is a rare congenital vascular malformation with a portosystemic shunt that may clinically manifest as cholestasis, dyspnea, or hepatic encephalopathy, among other conditions. Early diagnosis and classification are very important to further guide treatment. Typically, patients with congenital portosystemic shunts have no characteristics of portal hypertension. Herein, we report an 18-year-old female with prominent portal hypertension that manifested mainly as rupture and bleeding of esophageal varices. Imaging showed a thin main portal vein, no portal vein branches in the liver, and bleeding of the esophageal and gastric varices caused by the collateral circulation upwards from the proximal main portal vein. Patients with Abernethy malformation type I are usually treated with liver transplantation, and patients with type II are treated with shunt occlusion, surgery, or transcatheter coiling. Our patient was treated with endoscopic surgery combined with drug therapy and had no portal hypertension and good hepatic function for 24 mo of follow-up.

Case summary: This case report describes our experience in the diagnosis and treatment of an 18-year-old female with Abernethy malformation type IIC and portal hypertension. This condition was initially diagnosed as cirrhosis combined with portal hypertension. The patient was ultimately diagnosed using liver histology and subsequent imaging, and the treatment was highly effective. To publish this case report, written informed consent was obtained from the patient, including the attached imaging data.

Conclusion: Abernethy malformation type IIC may develop portal hypertension, and traditional nonselective beta-blockers combined with endoscopic treatment can achieve high efficacy.

背景:Abernethy畸形是一种罕见的先天性血管畸形,伴有门静脉系统分流,临床表现为胆汁淤积、呼吸困难或肝性脑病等。早期诊断和分类对进一步指导治疗非常重要。通常,先天性门静脉分流患者没有门静脉高压的特征。在此,我们报告一位18岁的女性,她有明显的门静脉高压,主要表现为食管静脉曲张破裂和出血。影像学显示门静脉主干细,肝脏内无门静脉分支,由门静脉主干近端上行侧枝循环引起食管和胃静脉曲张出血。Abernethy畸形I型患者通常采用肝移植治疗,II型患者采用分流闭塞、手术或经导管盘绕治疗。患者经内镜手术联合药物治疗,随访24个月无门静脉高压症,肝功能良好。病例总结:本病例报告描述了我们对一名18岁女性IIC型阿伯内蒂畸形合并门静脉高压症的诊断和治疗经验。这种情况最初被诊断为肝硬化合并门静脉高压。患者最终通过肝脏组织学和随后的影像学诊断,治疗非常有效。为了发表本病例报告,获得了患者的书面知情同意,包括所附的影像学数据。结论:IIC型Abernethy畸形可发展为门静脉高压症,传统非选择性β受体阻滞剂联合内镜治疗可取得较高疗效。
{"title":"Rare portal hypertension caused by Abernethy malformation (Type IIC): A case report.","authors":"Xin Yao,&nbsp;Yang Liu,&nbsp;Li-Dan Yu,&nbsp;Jian-Ping Qin","doi":"10.4329/wjr.v15.i8.250","DOIUrl":"https://doi.org/10.4329/wjr.v15.i8.250","url":null,"abstract":"<p><strong>Background: </strong>Abernethy malformation is a rare congenital vascular malformation with a portosystemic shunt that may clinically manifest as cholestasis, dyspnea, or hepatic encephalopathy, among other conditions. Early diagnosis and classification are very important to further guide treatment. Typically, patients with congenital portosystemic shunts have no characteristics of portal hypertension. Herein, we report an 18-year-old female with prominent portal hypertension that manifested mainly as rupture and bleeding of esophageal varices. Imaging showed a thin main portal vein, no portal vein branches in the liver, and bleeding of the esophageal and gastric varices caused by the collateral circulation upwards from the proximal main portal vein. Patients with Abernethy malformation type I are usually treated with liver transplantation, and patients with type II are treated with shunt occlusion, surgery, or transcatheter coiling. Our patient was treated with endoscopic surgery combined with drug therapy and had no portal hypertension and good hepatic function for 24 mo of follow-up.</p><p><strong>Case summary: </strong>This case report describes our experience in the diagnosis and treatment of an 18-year-old female with Abernethy malformation type IIC and portal hypertension. This condition was initially diagnosed as cirrhosis combined with portal hypertension. The patient was ultimately diagnosed using liver histology and subsequent imaging, and the treatment was highly effective. To publish this case report, written informed consent was obtained from the patient, including the attached imaging data.</p><p><strong>Conclusion: </strong>Abernethy malformation type IIC may develop portal hypertension, and traditional nonselective beta-blockers combined with endoscopic treatment can achieve high efficacy.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5d/51/WJR-15-250.PMC10473916.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10150822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Progress of magnetic resonance imaging radiomics in preoperative lymph node diagnosis of esophageal cancer. 磁共振影像放射组学在食管癌术前淋巴结诊断中的应用进展。
IF 2.5 Pub Date : 2023-07-28 DOI: 10.4329/wjr.v15.i7.216
Yan-Han Xu, Peng Lu, Ming-Cheng Gao, Rui Wang, Yang-Yang Li, Jian-Xiang Song

Esophageal cancer, also referred to as esophagus cancer, is a prevalent disease in the cardiothoracic field and is a leading cause of cancer-related mortality in China. Accurately determining the status of lymph nodes is crucial for developing treatment plans, defining the scope of intraoperative lymph node dissection, and ascertaining the prognosis of patients with esophageal cancer. Recent advances in diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging (MRI) have improved the effectiveness of MRI for assessing lymph node involvement, making it a beneficial tool for guiding personalized treatment plans for patients with esophageal cancer in a clinical setting. Radiomics is a recently developed imaging technique that transforms radiological image data from regions of interest into high-dimensional feature data that can be analyzed. The features, such as shape, texture, and waveform, are associated with the cancer phenotype and tumor microenvironment. When these features correlate with the clinical disease outcomes, they form the basis for specific and reliable clinical evidence. This study aimed to review the potential clinical applications of MRI-based radiomics in studying the lymph nodes affected by esophageal cancer. The combination of MRI and radiomics is a powerful tool for diagnosing and treating esophageal cancer, enabling a more personalized and effectual approach.

食道癌,又称食道癌,是心胸外科的一种常见病,也是中国癌症相关死亡的主要原因。准确判断淋巴结状态对于制定治疗方案、确定术中淋巴结清扫范围、确定食管癌患者预后至关重要。弥散加权成像和动态对比增强磁共振成像(MRI)的最新进展提高了MRI评估淋巴结受累的有效性,使其成为指导食管癌患者个性化治疗计划的有益工具。放射组学是最近发展起来的一种成像技术,它将放射图像数据从感兴趣的区域转换成可以分析的高维特征数据。这些特征,如形状、纹理和波形,与癌症表型和肿瘤微环境有关。当这些特征与临床疾病结果相关联时,它们就构成了具体和可靠的临床证据的基础。本研究旨在综述mri放射组学在食管癌淋巴结研究中的潜在临床应用。MRI和放射组学的结合是诊断和治疗食管癌的有力工具,可以实现更加个性化和有效的方法。
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引用次数: 0
Invasive rhinocerebral mucormycosis: Imaging the temporal evolution of disease in post COVID-19 case with diabetes: A case report. 侵袭性鼻-脑毛霉菌病:新冠肺炎合并糖尿病患者疾病时间演变的影像学研究1例
IF 2.5 Pub Date : 2023-07-28 DOI: 10.4329/wjr.v15.i7.234
Ramakrishna Narra, Shravya Rayapati

Background: Rhinocerebral mucormycosis (RCM) is a rare, fatal, invasive fungal infection infecting mainly patients with immunocompromised conditions, such as diabetes mellitus, hematologic malignancies, and organ transplantations. Coronavirus disease 2019 (COVID-19) disease in these patients further weakens the immune system due to several factors, including hypoxia, corticosteroid usage (further increasing hyperglycemic status), mechanical ventilation, increased serum ferritin levels, endothelitis due to free radicals, and glucose receptor protein upregulation. Timely diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines in patients with coexisting COVID-19 disease can reduce complication rates and improve survival.

Case summary: A 75-year-old male patient with diabetes and hypertension diagnosed with COVID-19 presented to the emergency department. Laboratory examinations revealed elevated blood glucose levels, as well as ketone bodies in the urine. He was treated with oxygen and steroids, as well as insulin to correct blood glucose levels. He complained of a headache 10 d later, and imaging demonstrated mucosal thickening in bilateral sphenoidal, ethmoidal, and maxillary sinuses with hyperdense foci in the right maxillary sinus but without central nervous system involvement. Surgical debridement was performed, and a histopathological study revealed fungi hyphae. Systemic antifungals (amphotericin b and posaconazole) were administered. Subsequently, on 15th day he developed right lower limb weakness and left lateral rectus palsy. There was slow but steady progress, and he was discharged. However, he presented to emergency department 1mo later with altered sensorium and poor control of diabetes resulted in an intracranial spread of mucormycosis, which ultimately led to the patient's poor prognosis and slow recovery.

Conclusion: Prompt early diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines are necessary in patients with COVID-19 associated invasive RCM to reduce complication rates and improve patient survival.

背景:鼻脑毛霉菌病(RCM)是一种罕见的、致命的侵袭性真菌感染,主要感染免疫功能低下的患者,如糖尿病、血液系统恶性肿瘤和器官移植。这些患者的2019冠状病毒病(COVID-19)疾病由于多种因素进一步削弱了免疫系统,包括缺氧、皮质类固醇的使用(进一步增加高血糖状态)、机械通气、血清铁蛋白水平升高、自由基引起的内皮炎和葡萄糖受体蛋白上调。对合并COVID-19疾病的患者及时诊断、做出明智的治疗决策,并根据适当的治疗指南控制糖尿病,可降低并发症发生率,提高生存率。病例总结:一名75岁男性糖尿病高血压患者诊断为COVID-19就诊于急诊科。实验室检查显示血糖水平升高,尿液中也有酮体。他接受了氧气、类固醇和胰岛素治疗,以纠正血糖水平。10 d后主诉头痛,影像学显示双侧蝶窦、筛窦和上颌窦粘膜增厚,右侧上颌窦有高密度灶,但未累及中枢神经系统。进行手术清创,组织病理学检查发现真菌菌丝。给予全身抗真菌药物(两性霉素b和泊沙康唑)。随后,在第15天,他出现右下肢无力和左外侧直肌麻痹。病情进展缓慢但稳定,他出院了。但患者于1个月后因感觉改变及糖尿病控制不佳而就诊急诊科,导致毛霉菌病颅内扩散,最终导致患者预后差,恢复缓慢。结论:在新冠肺炎相关的侵袭性RCM患者中,及时早期诊断、明智的治疗决策、合理的治疗指南控制糖尿病是降低并发症发生率和提高患者生存率的必要措施。
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引用次数: 0
期刊
World journal of radiology
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