Quantitative Imaging in Medicine and Surgery最新文献

Background: Over the past few decades, left ventricular (LV) dysfunction in ST-segment elevation myocardial infarction (STEMI) patients has been the focus of research. Recently, co-occurring right ventricular (RV) dysfunction has received more attention in clinical practice. We aimed to assess RV function using cardiac magnetic resonance (CMR) imaging and identify factors that may contribute to RV dysfunction in STEMI patients.

Methods: We retrospectively studied 189 patients with STEMI who underwent CMR 1-7 days after successful percutaneous coronary intervention (PCI). The ejection fraction (EF), wall thickening rate (WTR), peak radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) of the LV, interventricular septum (IVS) and RV were measured with cine images. The location and extent of the infarct were determined using late gadolinium enhancement (LGE) imaging. The differences of function between STEMI patients with right ventricular ejection fraction (RVEF) <50% and those with RVEF ≥50% were compared using an independent-sample t-test. Linear regression analyses were used to determine independent predictors of RVEF.

Results: RVEF <50% was observed in 32.28%% STEMI patients, who also demonstrated significantly lower left ventricular ejection fraction (LVEF), WTR, RS, CS, LS and larger infarct sizes than those with RVEF ≥50%. Patients with RVEF <50% also demonstrated a higher incidence of RV infarction, higher RV end-systolic volume (ESV) index, and lower RV RS and CS. Multivariable linear regression analysis revealed LV EF, IVS WTR and IVS RS as significant predictors for RVEF, while male gender, the culprit lesion in the right coronary artery (RCA), peak troponin were negative predictors for RVEF. Notably, peak troponin, LV EF, LV RS, LV CS, LV WTR, and IVS WTR demonstrated higher area under the curve (AUC) values for predicting RV dysfunction.

Conclusions: RV dysfunction was detected in 32.28% of STEMI patients. Patients with acute STEMI and RVEF <50% had impaired LV and IVS functions. Systolic function of the LV and IVS, peak troponin, and culprit lesions in the RCA were independent predictors of RV dysfunction in STEMI patients.

Background: Evaluation of mitral (MA) and tricuspid annuli (TA) in the same healthy subject in a non-invasive way in real-life clinical settings makes an opportunity to compare their dimensions and derived functional properties. The purpose of the present cohort study was to investigate whether there are any differences in the three-dimensional speckle-tracking echocardiography- (3DSTE-) measured size and derived functional characteristics of the MA and TA in the same healthy adults.

Methods: The study comprised 248 healthy adults, in which 3DSTE was performed to determine MA and TA dimensions and functional properties. Due to insufficient image quality, 89 cases were excluded, therefore the remaining population consisted of 159 subjects (age: 35.6±12.9 years, 76 males). Subjects were enrolled on a voluntary basis consecutively between January 2011 and November 2017 in the outpatient clinic of the tertiary cardiology center at the Department of Medicine, University of Szeged, Hungary. Data were analyzed by Student's t-test, analysis of variance (ANOVA) test, Fischer's exact test, Pearsons' correlations, interclass correlations and Bland-Altman tests.

Results: Same-side MA/TA end-diastolic annular dilation is associated with simultaneous MA/TA end-systolic dilation and vice versa. MA dilation in end-diastole and end-systole results in MA functional improvement/deterioration. Dilation of end-diastolic TA dimensions does not obviously entail differences in TA function. However, similar to MA, more dilated TA in end-systole is associated with impaired TA function. Dilated MA dimensions (end-diastolic MA area: 4.31±0.62 vs. 10.89±1.18 cm², P<0.05) are not obviously associated with dilated end-diastolic TA dimensions (area: 7.05±1.42 vs. 7.81±1.48 cm², P=ns) and functional improvement/impairment (fractional area change: 27.5%±10.8% vs. 25.2%±10.6%, P=ns).

Conclusions: Dilation of MA and TA is associated with different contralateral responses in morphology and function.

Background: Follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA) present diagnostic challenges due to overlapping clinical and ultrasound features. Improving the diagnosis of FTC can enhance patient prognosis and effectiveness in clinical management. This study seeks to develop a predictive model for FTC based on ultrasound features using machine learning (ML) algorithms and assess its diagnostic effectiveness.

Methods: Patients diagnosed with FTA or FTC based on surgical pathology between January 2009 and February 2023 at Zhejiang Provincial Cancer Hospital and Zhejiang Provincial People's Hospital were retrospectively included. A total of 562 patients from Zhejiang Provincial Cancer Hospital comprised the training set, and 218 patients from Zhejiang Provincial People's Hospital constituted the validation set. Subsequently, clinical parameters and ultrasound characteristics of the patients were collected. The diagnostic parameters were analyzed using the least absolute shrinkage and selection operator and multivariate logistic regression screening methods. Next, a comparative analysis was performed using seven ML models. The area under the receiver operating characteristic (ROC) curve (AUC), accuracy, sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), precision, recall, and comprehensive evaluation index (F-score) were calculated to compare the diagnostic efficacy among the seven models and determine the optimal model. Further, the optimal model was validated, and the SHapley Additive ExPlanations (SHAP) approach was applied to explain the significance of the model variables. Finally, an individualized risk assessment was conducted.

Results: Age, echogenicity, thyroglobulin antibody (TGAb), echotexture, composition, triiodothyronine (T3), thyroglobulin (TG), margin, thyroid-stimulating hormone (TSH), calcification, and halo thickness >2 mm were influential factors for diagnosing FTC. The XGBoost model was identified as the optimal model after a comprehensive evaluation. The AUC of this model in the validation set was 0.969 [95% confidence interval (CI), 0.946-0.992], while its precision sensitivity, specificity, and accuracy were 0.791, 0.930, 0.913 and 0.917, respectively.

Conclusions: XGBoost model based on ultrasound features was constructed and interpreted using the SHAP method, providing evidence for the diagnosis of FTC and guidance for the personalized treatment of patients.

Background: Viral pneumonia (VP) often leads to the development of deep vein thrombosis (DVT) in hospitalized patients. The aim of the study was to investigate the incidence of DVT in discharged patients with VP, and whether new and old DVT differ in transverse relaxation time.

Methods: In this prospective cohort study in Wuhan, China, 338 consecutive discharged VP patients from February 2021 to March 2023 who underwent T2 weighted Sampling Perfection with Application Optimized Contrast Evolution (SPACE) were recruited to detect DVT. T2 mapping and T2* mapping were performed for the patients with DVT detected by magnetic resonance imaging (MRI). The minimum, maximum, mean of T2 time and T2* time of DVT were recorded as T2min, T2max, T2mean, T2*min, T2*max, and T2*mean, respectively. Clinical data and laboratory findings were compared between new and old DVT cases, which were defined based on the examination results before and after discharge. A Mann-Whitney test was used to compare transverse relaxation time parameters between new and old DVT.

Results: Twelve percent of VP patients (40/338) developed new DVT after discharge. Thirty-three out of 104 DVTs did not resolve after discharge. Compared with patients with new DVT, patients with old DVT were older (67 vs. 59 years, P=0.003); and had a higher proportion of bedridden time >72 hours (72.7% vs. 37.0%, P<0.001). Patients with old DVT had a lower lymphocyte count (0.67×10⁹/L vs. 0.97×10⁹/L, P=0.01), higher C-reactive protein (59 vs. 35 mg/L, P=0.019), and higher levels of D-dimer (6.7 vs. 0.9 µg/mL, P<0.001) than patients with new DVT. Patients with old DVT received more invasive mechanical ventilation (30.3% vs. 7.4%, P<0.001) and had a higher proportion of acute respiratory distress syndrome (75.8% vs. 51.9%, P<0.001), and a higher proportion of cardiac injury (39.4% vs. 14.8%, P=0.033) than patients with new DVT. T2min, T2max, T2mean, and T2*max of new DVT were significantly greater than old DVT (17.6±10.4 vs. 13.2±5.9 ms, 94.9±44.9 vs. 42.3±23.6 ms, 46.8±24.0 vs. 25.0±12.6 ms, 22.5±12.4 vs. 10.7±3.5 ms, P<0.05 for all). There was no significant difference in T2*min or T2*mean between new and old DVT (3.2±0.4 vs. 3.1±0.4 ms, 8.2±4.9 vs. 5.5±1.5 ms, P>0.05 for both).

Conclusions: T2 weighted SPACE magnetic resonance (MR) is valuable in the follow-up of thrombosis of discharged VP patients. T2 mapping distinguishes between new and old DVT.

Background: Assessing the age of deep vein thrombosis (DVT) is crucial for guiding treatment approaches. Two-dimensional shear-wave elastography (2D-SWE) and super-microvascular imaging (SMI), as emerging techniques for tissue elasticity assessment and intrathrombus microvascular analysis, are pivotal for accurate thrombus age determination. This research endeavors to classify DVT into acute, subacute, and chronic ages utilizing these imaging methods.

Methods: The study is a prospective, single-center, inpatient investigation that utilized convenience sampling for participant recruitment. Patients with a symptom duration of <6 months who were found to have lower-extremity DVT on ultrasound (US) between January 2021 and March 2022 after craniocerebral trauma (CT) or bone injury (BI) operations were included in this study. Participants were divided into three groups based on the duration of DVT, measured from the first diagnosis of thrombosis by US to the follow-up with 2D-SWE and SMI: acute (≤14 days), subacute (15-30 days), and chronic (31 days to 6 months) All patients underwent 2D-SWE and SMI using an Aplio i700 Ultrasound System equipped with a PLT-1005BT line array probe. Diagnostic performance was assessed using the area under the receiver operating characteristic (ROC) curve.

Results: The maximum value of the elastic modulus for DVT (DVT_Emax), the mean value of the elastic modulus for DVT (DVT_Emean), and SMI's flow distribution scoring pattern for DVT (SMI_scoring) emerged as significant predictors for acute and chronic, with high area under the ROC curve (AUC) of acute [AUC (95% confidential interval): 0.95 (0.89-0.97), 0.96 (0.91-0.98), 0.93 (0.88-0.97) in 39 patients] and chronic [AUC (95% confidential interval): 0.88 (0.81-0.93), 0.94 (0.88-0.97), 0.91 (0.84-0.95) in 51 patients], respectively. However, these indices had lower efficacy for subacute prediction [AUC (95% confidential interval): 0.51 (0.42-0.60), 0.54 (0.46-0.63), 0.53 (0.44-0.62), in 47 patients]. Combining DVT_Emean with SMI_scoring improved performance in predicting subacute: 0.90 (0.83-0.94) than related features alone.

Conclusions: Both 2D-SWE and SMI can be used to assess acute and chronic DVT in patients with CT and BI after surgeries. This combination is a promising adjunctive technique for identifying the subacute phase of DVT in these patients.

Background: Compared with older Caucasians, older Chinese have remarkably lower prevalence and lower severity of spine degenerative changes. There have been few studies on Southeast East populations. This study aims to compare radiographic spine degeneration features among older Hong Kong (HK) Chinese, older Thais, and older Indonesians.

Methods: This study included 195 Thai women (mean: 73.6 years), 202 Thai men (mean: 73.7 years), 227 Indonesian women (mean: 70.5 years), and 174 Indonesian men (mean: 70.2 years), as well as same number of gender- and age-matched HK Chinese. The recruitment plan was that the participants would represent the general older population of their respective communities. With spine radiograph, spine hyper-kyphosis, osteoarthritic wedging (OAw), acquired short vertebrae (SVa), general osteophyte formation, lumbar disc space narrowing, and lumbar spondylolisthesis were assessed.

Results: Compared with Southeast Asians (Thais and Indonesian data together), Chinese women and men had a higher prevalence of hyper-kyphosis (24.9% vs. 16.4%), OAw (2.4% vs. 0.9%), general osteophyte formation (15.3% vs. 10.5%), lumber disc space narrowing (27.6% vs. 20.3%), and lumbar spondylolisthesis (20.7% vs. 15.3%). The trends were also consistent for sub-group data analyses. An even lower prevalence was noted among Indonesian women and men than among Thais in general osteophyte formation (5.9% vs. 14.1%), lumbar disc space narrowing (18.3% vs. 24.1%), and lumbar spondylolisthesis (11.4% vs. 19.3%).

Conclusions: This study showed a lower prevalence of spine degeneration changes among older Thais and older Indonesians than among older Chinese. Indonesians, who inhabit an even warmer climate, show even fewer spine degeneration changes than Thais.

Background: Prominent epicanthus could not only diminish the eyes' aesthetics but may be deceptive for its typical appearance of pseudo-esotropia. This study aims to apply a deep learning model to characterize the periocular morphology for preliminary identification.

Methods: This prospective study consecutively included 300 subjects visiting the ophthalmology department in a tertiary referral hospital. Children aged 7-18 years with simple epicanthus or concomitant esotropia and healthy volunteers who were age- and gender-matched were eligible for inclusion. Multiple metrics were extracted automatically and manually from facial images to characterize the periocular morphology and binocular symmetry. The dice coefficient (Dice), intraclass correlation coefficient (ICC), and Bland-Altman biases were calculated to evaluate their consistency. The receiver operating characteristic (ROC) curve determined the cut-off values of symmetry indexes (SIs) for distinguishing concomitant esotropia subjects from epicanthus ones.

Results: The Dice for eyelid and cornea segmentation were 0.949 and 0.944, respectively. The ICCs of the two measurements ranged from 0.898 to 0.983. Biases ranged from 0.16 to 0.74 mm. The periocular morphology of epicanthus eyes was significantly different from the normal ones, including palpebral fissure width (21.41±1.53 vs. 24.45±1.82 mm; P<0.01), and palpebral fissure height (8.91±1.37 vs. 9.60±1.25 mm; P<0.01). The ROC analysis yielded an area under the curve of 0.971 [95% confidence interval (CI): 0.950-0.991] with SI for distinguishing esotropia subjects. Its optimal cut-off value was 1.296 with 0.920 sensitivity and 0.910 specificity.

Conclusions: Our study established a standard deep learning system for characterizing the periocular morphology of epicanthus and esotropia eyes with great accuracy. This objective method could be generalized to other periocular morphological assessments for clinical care.

Background: At present, some common bile duct stones (CBDSs) cannot be removed by conventional endoscopic treatment. Percutaneous transhepatic papillary ballooning and extraction (PTPBE) is a promising treatment for CBDSs. This study aimed to evaluate the feasibility and efficacy of PTPBE for removing CBDSs.

Methods: From April 2013 to April 2021, 29 patients with CBDSs underwent PTPBE at The First Affiliated Hospital of Zhengzhou University; their clinical data were retrospectively analyzed. The technical success, clinical success, procedure time, radiation dose, 1-year CBDSs recurrence rate, and incidence of early/late complications were recorded, and white blood cell (WBC) counts and alanine aminotransferase (ALT), C-reactive protein (CRP), total bilirubin (TBIL), and carbohydrate antigen-199 (CA-199) levels were compared before the interventional procedure and 1 month later.

Results: The CBDSs were successfully removed in 29 patients (the CBDSs in 20 patients were resolved once, and in 9 patients, they were resolved twice). The mean procedure time and radiation dose were 56.38±13.56 minutes and 732.07±262.23 miligray (mGy), respectively. The technical and clinical success rates were both 100%. The incidence of early complications (including pancreatitis and bile duct bleeding) and late complications (reflux cholangitis) was 10.34% and 3.45%, respectively. The WBC (both P<0.01), ALT (both P<0.01), CRP (both P<0.01), CA-199 (both P<0.01), and TBIL (both P<0.01) significantly decreased before PTPBE and 1 month later.

Conclusions: PTPBE is a safe and effective alternative solution for elderly patients who cannot undergo or refuse traditional surgical and endoscopic treatments.