Quantitative Imaging in Medicine and Surgery最新文献

Background: Intravertebral cleft (IVC) is a linear intravertebral imaging characteristic in fractured vertebrae filled with liquid or gas, once considered specific to Kummell's disease but now also observed in acute traumatic fractures, and its risk factors and relationship with bone cement leakage after percutaneous vertebroplasty (PVP)/percutaneous kyphoplasty (PKP) remain to be explored. The study aims to identify IVC risk factors in acute vertebral fractures (AVFs) patients and assess its link to bone cement leakage post-PVP/PKP.

Methods: A total of 1,612 patients diagnosed with AVF at two medical centres were retrospectively included. The diagnostic criterion for IVC was the presence of linear intravertebral lesions filled with liquid or gas in computed tomography (CT) and magnetic resonance imaging (MRI). A total of 126 patients (127 vertebrae) were diagnosed with intravertebral fissures and included in the IVC group, while 125 age- and sex-matched patients (134 vertebrae) without IVC were included in the control group. Clinical and imaging characteristics, including demography, osteoporosis severity, and vertebral fracture line involvement, were compared between the two groups. In patients who underwent PKP or PVP within three months, the incidence and types of bone cement leakage were analysed.

Results: The compression severity and vertebral fracture line involvement of the inferior endplate, posterior wall, and basivertebral foramen significantly differed between the IVC and control groups (P<0.05). Vertebral fracture line involvement of the basivertebral foramen was a risk factor for IVC [95% confidence interval (CI): 2.297 (1.303-4.048), P=0.004]. An interaction effect between vertebral fracture line involvement of the basivertebral foramen and the posterior wall was observed (P<0.05). Within 3 months, 64 vertebrae underwent PKP or PVP in the IVC group, and 15 cases (23.438%) exhibited leakage. Sixty-one vertebrae in the control group underwent PKP or PVP, with 6 cases (10.000%) exhibiting leakage. There was a significant difference between the two groups (P=0.042). C-type leakage was the most common type in the IVC group, accounting for 86.7% (13/15) of all cases.

Conclusions: A basivertebral foramen fracture is an IVC risk factor for AVF. AVF with IVC significantly increases bone cement leakage risk after PVP/PKP.

Background: Histopathological grading is a key prognostic marker for hepatocellular carcinoma (HCC). However, the clinical application of deep learning models (DLMs) for predicting HCC grading from medical imaging is limited by their black-box nature. We aimed to develop an interpretable DLM, interpretable HCC grading network (iHCG-Net), to predict HCC grading preoperatively using multi-phase contrast-enhanced magnetic resonance imaging (CEMRI).

Methods: This study retrospectively enrolled 370 HCC patients who underwent preoperative CEMRI before curative resection. Based on postoperative pathology, the patients were categorized into high-grade (n=136) and low-grade (n=234) HCC groups. They were then stratified into a training cohort (n=259) and a time-independent validation cohort (n=111). Twenty-three clinical-radiological features were collected for all patients. The iHCG-Net, based on the Concept Bottleneck Model (CBM) framework, first encodes CEMRI images using a DenseNet-121 backbone and then leverages a concept regressor to predict the twenty-three clinical-radiological features for final prediction of HCC histological grade. A feature importance score plot was generated to assess the contribution of each feature to the differential diagnosis. Nine baseline predictive models were developed for comparison. The models were evaluated using receiver operating characteristic (ROC) curve analysis and DeLong's test.

Results: iHCG-Net demonstrated strong predictive performance for HCC grading, achieving areas under the receiver operating characteristic curve (AUCs) of 0.893 in the training cohort and 0.802 in the validation cohort. The model significantly outperformed conventional models, including the clinical-radiological model (CM), radiomics models (RMs), and a clinical-radiomic combined model (CRM) (AUCs: 0.675-0.778, 0.617-0.723; P<0.05). Furthermore, iHCG-Net exhibited performance comparable to that of the DLM (AUCs: 0.920, 0.774; P>0.05), while providing inherent interpretability and mitigating the risk of overfitting. Feature importance analysis identified intratumoral arteries as the most influential feature for predicting HCC grading, with an importance score of 0.213.

Conclusions: The iHCG-Net can be a promising interpretable artificial intelligence tool for the preoperative prediction of HCC grading.

Background: Tricuspid valve (TV) replacement with surgical bioprosthetic, surgical mechanical, or transcatheter prostheses is a critical intervention for severe tricuspid regurgitation or stenosis. However, comprehensive echocardiographic comparisons of hemodynamic performance across these prosthesis types remain limited, especially for novel transcatheter prostheses. This study aimed to systematically analyze the transthoracic echocardiographic (TTE) Doppler parameters of three types of tricuspid prostheses with normal function to provide accurate references for the management of patients following clinical TV replacement (TVR).

Methods: This retrospective study included 62 patients with surgical bioprosthetic valves, 52 with surgical mechanical valves, and 25 with transcatheter valves. Clinical data, along with comprehensive two-dimensional (2D) and Doppler echocardiographic parameters, were collected from normal tricuspid prostheses. Doppler parameters were measured at the TV position, including peak early tricuspid diastolic velocity (E velocity), mean gradient (MG_TV), velocity-time integral (VTI_TV), pressure half-time (PHT_TV), the ratio of VTI_TV to the VTI of the left ventricular outflow tract (VTI ratio), the effective orifice area (EOA_TV), and the indexed effective orifice area (IEOA_TV).

Results: The normal ranges (95% confidence interval) of transthoracic Doppler echocardiographic parameters for the three types of tricuspid prostheses were established for surgical bioprosthetic valves (E velocity, 1.40-1.59 m/s; MG_TV, 3.90-4.93 mmHg; VTI_TV, 41.8-47.2 cm; PHT_TV, 135.8-157.8 ms; VTI ratio, 2.03-2.31; EOA_TV, 1.44-1.69 cm²; IEOA_TV, 0.92-1.09 cm2/m²), surgical mechanical valves (E velocity, 1.40-1.58 m/s; MG_TV, 3.08-3.93 mmHg; VTI_TV, 34.6-39.9 cm; PHT_TV, 106.7-122.8 ms; VTI ratio, 1.70-2.04; EOA_TV, 1.73-2.10 cm²; IEOA_TV, 1.08-1.31 cm²/m²), and transcatheter valves (E velocity, 1.21-1.51 m/s; MG_TV, 2.58-4.83 mmHg; VTI_TV, 32.7-40.4 cm; PHT_TV, 107.5-132.2 ms; VTI ratio, 1.60-1.99; EOA_TV, 1.80-2.44 cm²; IEOA_TV, 1.15-1.54 cm²/m²).

Conclusions: This study established prosthesis-specific echocardiographic reference values for normal tricuspid prostheses. Values outside these ranges may indicate dysfunction, although the clinical correlation remains to be determined. These findings can enhance the postoperative monitoring of tricuspid prostheses.

Background: Hepatocellular carcinoma (HCC) represents a major global health burden. Despite lenvatinib's established role as first-line therapy for advanced HCC, the optimal sequential strategy after its failure remains uncertain. This study compared the efficacy and safety of lenvatinib continuation versus switching to regorafenib following first-line lenvatinib progression.

Methods: A retrospective analysis was conducted on 107 consecutive HCC patients treated with lenvatinib. Patients were divided into two groups based on their second-line treatment: the regorafenib group (LEN-RG, 49 patients) and the lenvatinib continuation group (LEN-CON, 58 patients). Baseline characteristics were collected, and overall survival (OS), post-progression survival (PPS), total progression-free survival (TPFS), and post-second-line progression-free survival (PFS) were assessed.

Results: The median OS for the LEN-CON group was 34.4 months [95% confidence interval (CI): 22.4-46.4], compared to 21.8 months (95% CI: 18.56-25.05) in the LEN-RG group [hazard ratio (HR) 0.64, 95% CI: 0.40-1.02, P=0.058]. The median PPS was 25.87 months (95% CI: 15.35-36.38) in the LEN-CON group, compared to 15.33 months (95% CI: 7.39-23.28) in the LEN-RG group (HR 0.58, 95% CI: 0.37-0.93, P=0.019). No significant differences were observed between the groups in TPFS or Post-Second-Line PFS. Multivariate analysis identified Eastern Cooperative Oncology Group (ECOG), extrahepatic metastasis, combined programmed cell death 1 (PD-1) therapy, nodule number, and treatment strategy as independent prognostic factors for PPS. Subgroup analysis indicated clinical benefits in PPS for LEN-CON patients with ECOG 0, Child-Pugh A, male gender, combined PD-1 therapy, multiple tumors, and alpha-fetoprotein (AFP) ≤400 ng/mL. Common adverse events (AEs) were similar between the two groups, with elevated ALT more frequent in the LEN-RG group.

Conclusions: Continuing lenvatinib as second-line therapy after failure may offer sustained survival benefits and demonstrate favorable efficacy and safety in real-world clinical practice.

Background: Cervical cancer remains a significant global health challenge, requiring improved diagnostic and prognostic tools to enhance treatment planning and outcomes. Noninvasive medical imaging offers a promising route for precision diagnostics. This study aimed to develop and evaluate a predictive model for cervical cancer treatment response during radiation therapy using features extracted from multimodal medical imaging.

Methods: This study evaluated the use of multimodal medical imaging, including apparent diffusion coefficient (ADC), dynamic contrast-enhanced (DCE), and positron emission tomography (PET), across different treatment stages (pre-, mid-, and post-stage) in 22 patients with cervical cancer. From these images, we extracted and assessed the predictive performance of various feature types, including zero-order, first-order, second-order, and higher-order features.

Results: Texture features, particularly those derived from the Gray Level Co-occurrence Matrix (GLCM) in two-dimensional (2D) plane, were more effective compared to other image features, achieving an area under the curve (AUC) of 0.73±0.12. Combining GLCM with shape features further increased the AUC to 0.75. Among the GLCM features, "contrast" was identified as the most predictive for treatment response (AUC of 0.74 for the top five contrast features). Among single-modality analyses, ADC demonstrated the best prediction compared to PET/computed tomography (CT) (15% AUC increase) and DCE (12% AUC increase). The combination of imaging modalities and texture analysis further enhanced patient stratification, yielding an average 8% AUC increase compared to single-modality models. Using only post-stage GLCM2D features resulted in an AUC only 4% lower than using all time points, suggesting that reduced imaging time points and modalities may still retain strong predictive power.

Conclusions: Integrating texture features from multimodal imaging can improve cervical cancer prognostication and guide personalized treatment strategies. These findings support the potential of imaging biomarkers in optimizing therapy and reducing the diagnostic burden, contributing to more efficient and tailored cancer care.

Background: Early tumor shrinkage (ETS) is a superior parameter for assessing treatment responses. Our study hypothesized that an ETS with an optimal cut-off value was an imaging biomarker for advanced esophageal squamous cell carcinoma (ESCC) treated with first-line immunotherapy.

Methods: We retrospectively enrolled 129 patients with unresectable locally advanced ESCC treated with first-line immunotherapy between 2019 and 2021. ETS was defined as the relative change in the longest diameters at the first evaluation compared with that at baseline. Multivariate analyses were conducted to identify the significant prognostic variables in progression-free survival (PFS) and overall survival (OS).

Results: The median value of ETS was 29.5%. An ETS with a 10% cut-off value was statistically significantly associated with PFS in the univariate analysis [hazard ratio (HR): 2.26; 95% confidence interval (CI): 1.21-4.24; P=0.009]. Besides, in the univariate analysis, the longest diameter, maximum invasive depth, central necrosis on enhanced computed tomography, enhanced pattern, and ETS values were statistically significant predictive factors for OS. In the multivariate analysis, the maximum invasive depth and ETS with a 10% cut-off value were independently predictive factors for OS (HR: 0.22; 95% CI: 0.09-0.52; P=0.001, HR: 2.93; 95% CI: 1.41-6.06; P=0.004).

Conclusions: ETS is associated with survival outcomes in patients with advanced ESCC treated with immunotherapy. Early tumor size shrinkage of at least 10% can be regarded as a promising biomarker predictor for PFS and OS. ETS supports clinical decisions by identifying patients who can benefit from immunotherapy.

Background: Congenital hepatic hemangiomas (CHHs) represent a rare subset of vascular tumors that, despite often demonstrating a favorable natural history, can precipitate life-threatening complications in neonates. However, a comprehensive delineation of specific prenatal sonographic features that reliably predict the development of postnatal heart failure remains inadequately explored. This study aimed to identify and quantify key prenatal ultrasound risk factors associated with the onset of postnatal heart failure in fetuses diagnosed with CHHs, thereby facilitating early risk stratification and potential prenatal intervention.

Methods: Patients with CHHs who were diagnosed at or referred to our hospital by prenatal ultrasound between 2019 and 2023 were followed-up. The age of the pregnant women and the gestational age (GA) at the first detection of the mass, as well as the ultrasound characteristics, clinical manifestations, and outcomes of the children were collected. Patients were categorized into asymptomatic and concomitant heart failure groups according to their postpartum condition. Statistical methods were used to analyze the differences in prenatal ultrasound between the 2 groups.

Results: A cohort of 54 patients was finally included. Multiple prenatal parameters significantly predicted congestive heart failure (CHF). The heart failure group had a larger median tumor diameter (6.5 vs. 3.8 cm; P=0.001). Receiver operating characteristic (ROC) analysis identified a tumor diameter >4.85 cm as predictive of CHF (area under the curve =0.859, sensitivity 100%, specificity 70.2%). The cardiothoracic ratio was significantly elevated in the heart failure group (median 0.40 vs. 0.27; P<0.0001). The presence of portal-systemic venous shunts (PSVSs) (100% vs. 19.1%; P<0.0001), venous lakes (100% vs. 10.6%; P<0.0001), hepatic vein dilation (100% vs. 48.9%; P=0.013), and hepatic artery dilation (100% vs. 36.2%; P=0.002) were all significantly associated with CHF. A dual portal vein and hepatic artery blood supply was more frequent in the heart failure group (57.1% vs. 12.8%; P=0.017). Hepatic artery dilation was correlated with the hepatic artery blood supply, venous lakes, and hepatic vein dilation.

Conclusions: Children with CHHs who develop heart failure after birth were identified as having changed prenatal ultrasound characteristics. This information will aid in the early clinical management of such patients to improve their prognosis.

Background: Codeine-containing cough syrup (CCS) misuse has become a growing global concern, particularly among young people, due to its potential for dependence. This study aimed to evaluate the efficacy of a comprehensive treatment approach for patients with dependence on CCS and to assess treatment outcomes through single-photon emission computed tomography (SPECT).

Methods: This study included 29 patients with CCS dependence and 31 matched controls. SPECT imaging was performed using the radiopharmaceutical agent ^99mTc-TRODAT-1. Patients with CCS dependence underwent comprehensive treatment, and SPECT examinations were conducted both before and after the intervention. Dopamine transporter (DAT) availability in the striatum was measured, and the volume (V), weight (W), and uptake ratio of corpus striatum/the whole brain (Ra) of ^99mTc-TRODAT-1 in the striatum relative to the whole brain were calculated using mathematical models.

Results: Patients with CCS dependence exhibited significantly reduced DAT availability in the striatum, as well as decreased V (21.12±5.65 cm³), W (22.98±7.62 g), and Ra [(4.16±1.12)%] values, compared to the control group before treatment. Following treatment, clinical symptoms improved to varying degrees. DAT availability, along with V (30.90±9.14 cm³), W (32.44±9.60 g), and Ra [(7.06±1.84)%] values, increased significantly compared to pre-treatment levels (P<0.01) but remained lower than those observed in the control group.

Conclusions: The comprehensive treatment approach demonstrated effectiveness in improving clinical and imaging outcomes in patients with CCS dependence. However, complete recovery of striatal DAT availability and related parameters was not achieved for these patients. TRODAT SPECT brain imaging was proven to be a useful imaging modality for assessment of the effectiveness of treatment methods in CCS dependence.