Pub Date : 2024-08-01Epub Date: 2024-07-30DOI: 10.21037/qims-23-1597
Hai Du, Feng Chen, Hao Li, Kaifeng Wang, Jian Zhang, Jian Meng, Huiwen Li, Xia Xu, Junpu Qu, Rong Wu, Jing Li, Meilan Zhang, Fengxiang Zhang, Xuelin Zhu
Background: The incidence rate of thyroid nodules has reached 65%, but only 5-15% of these modules are malignant. Therefore, accurately determining the benign and malignant nature of thyroid nodules can prevent unnecessary treatment. We aimed to develop a deep-learning (DL) radiomics model based on ultrasound (US), explore its diagnostic efficacy for benign and malignant thyroid nodules, and verify whether it improved the diagnostic level of physicians.
Methods: We retrospectively included 1,076 thyroid nodules from 817 patients at three institutions. The radiomics and DL features of the US images were extracted and used to construct radiomics signature (Rad_sig) and deep-learning signature (DL_sig). A Pearson correlation analysis and least absolute shrinkage and selection operator (LASSO) regression analysis were used for feature selection. Clinical US semantic signature (C_US_sig) was constructed based on clinical information and US semantic features. Next, a combined model was constructed based on the above three signatures in the form of a nomogram. The model was constructed using a development set (institution 1: 719 nodules), and the model was evaluated using two external validation sets (institution 2: 74 nodules, and institution 3: 283 nodules). The performance of the model was assessed using decision curve analysis (DCA) and calibration curves. Furthermore, the C_US_sigs of junior physicians, senior physicians, and expers were constructed. The DL radiomics model was used to assist the physicians with different levels of experience in the interpretation of thyroid nodules.
Results: In the development and validation sets, the combined model showed the highest performance, with areas under the curve (AUCs) of 0.947, 0.917, and 0.929, respectively. The DCA results showed that the comprehensive nomogram had the best clinical utility. The calibration curves indicated good calibration for all models. The AUCs for distinguishing between benign and malignant thyroid nodules by junior physicians, senior physicians, and experts were 0.714-0.752, 0.740-0.824, and 0.891-0.908, respectively; however, with the assistance of DL radiomics, the AUCs reached 0.858-0.923, 0.888-0.944, and 0.912-0.919, respectively.
Conclusions: The nomogram based on DL radiomics had high diagnostic efficacy for thyroid nodules, and DL radiomics could assist physicians with different levels of experience to improve their diagnostic level.
背景:甲状腺结节的发病率已达 65%,但其中只有 5-15% 是恶性的。因此,准确判断甲状腺结节的良恶性可避免不必要的治疗。我们旨在开发一种基于超声(US)的深度学习(DL)放射组学模型,探索其对甲状腺结节良性和恶性的诊断效果,并验证其是否能提高医生的诊断水平:我们回顾性地纳入了三家机构 817 名患者的 1,076 个甲状腺结节。提取 US 图像的放射组学特征和深度学习特征,用于构建放射组学特征(Rad_sig)和深度学习特征(DL_sig)。特征选择采用了皮尔逊相关分析和最小绝对收缩与选择算子(LASSO)回归分析。临床 US 语义特征(C_US_sig)是根据临床信息和 US 语义特征构建的。接下来,根据上述三个特征以提名图的形式构建了一个组合模型。该模型使用一个开发集(机构 1:719 个结节)构建,并使用两个外部验证集(机构 2:74 个结节和机构 3:283 个结节)进行评估。利用决策曲线分析(DCA)和校准曲线对模型的性能进行了评估。此外,还构建了初级医师、高级医师和外科医生的 C_US_sigs。DL放射组学模型用于帮助不同经验水平的医生解释甲状腺结节:在开发集和验证集中,综合模型的性能最高,曲线下面积(AUC)分别为 0.947、0.917 和 0.929。DCA 结果显示,综合提名图的临床实用性最好。校准曲线显示所有模型都具有良好的校准性。初级医师、高级医师和专家区分甲状腺结节良性和恶性的AUC分别为0.714-0.752、0.740-0.824和0.891-0.908;但在DL放射组学的辅助下,AUC分别达到0.858-0.923、0.888-0.944和0.912-0.919:基于DL放射组学的提名图对甲状腺结节有很高的诊断效果,DL放射组学可以帮助不同经验水平的医生提高诊断水平。
{"title":"Deep-learning radiomics based on ultrasound can objectively evaluate thyroid nodules and assist in improving the diagnostic level of ultrasound physicians.","authors":"Hai Du, Feng Chen, Hao Li, Kaifeng Wang, Jian Zhang, Jian Meng, Huiwen Li, Xia Xu, Junpu Qu, Rong Wu, Jing Li, Meilan Zhang, Fengxiang Zhang, Xuelin Zhu","doi":"10.21037/qims-23-1597","DOIUrl":"10.21037/qims-23-1597","url":null,"abstract":"<p><strong>Background: </strong>The incidence rate of thyroid nodules has reached 65%, but only 5-15% of these modules are malignant. Therefore, accurately determining the benign and malignant nature of thyroid nodules can prevent unnecessary treatment. We aimed to develop a deep-learning (DL) radiomics model based on ultrasound (US), explore its diagnostic efficacy for benign and malignant thyroid nodules, and verify whether it improved the diagnostic level of physicians.</p><p><strong>Methods: </strong>We retrospectively included 1,076 thyroid nodules from 817 patients at three institutions. The radiomics and DL features of the US images were extracted and used to construct radiomics signature (Rad_sig) and deep-learning signature (DL_sig). A Pearson correlation analysis and least absolute shrinkage and selection operator (LASSO) regression analysis were used for feature selection. Clinical US semantic signature (C_US_sig) was constructed based on clinical information and US semantic features. Next, a combined model was constructed based on the above three signatures in the form of a nomogram. The model was constructed using a development set (institution 1: 719 nodules), and the model was evaluated using two external validation sets (institution 2: 74 nodules, and institution 3: 283 nodules). The performance of the model was assessed using decision curve analysis (DCA) and calibration curves. Furthermore, the C_US_sigs of junior physicians, senior physicians, and expers were constructed. The DL radiomics model was used to assist the physicians with different levels of experience in the interpretation of thyroid nodules.</p><p><strong>Results: </strong>In the development and validation sets, the combined model showed the highest performance, with areas under the curve (AUCs) of 0.947, 0.917, and 0.929, respectively. The DCA results showed that the comprehensive nomogram had the best clinical utility. The calibration curves indicated good calibration for all models. The AUCs for distinguishing between benign and malignant thyroid nodules by junior physicians, senior physicians, and experts were 0.714-0.752, 0.740-0.824, and 0.891-0.908, respectively; however, with the assistance of DL radiomics, the AUCs reached 0.858-0.923, 0.888-0.944, and 0.912-0.919, respectively.</p><p><strong>Conclusions: </strong>The nomogram based on DL radiomics had high diagnostic efficacy for thyroid nodules, and DL radiomics could assist physicians with different levels of experience to improve their diagnostic level.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-26DOI: 10.21037/qims-24-257
Aiguo Zhang, Zhen Chen, Shengxiang Mei, Yunfan Ji, Yiqi Lin, Hua Shi
Background: Axillary lymph node (ALN) status is a crucial prognostic indicator for breast cancer metastasis, with manual interpretation of whole slide images (WSIs) being the current standard practice. However, this method is subjective and time-consuming. Recent advancements in deep learning-based methods for medical image analysis have shown promise in improving clinical diagnosis. This study aims to leverage these technological advancements to develop a deep learning model based on features extracted from primary tumor biopsies for preoperatively identifying ALN metastasis in early-stage breast cancer patients with negative nodes.
Methods: We present DLCNBC-SA, a deep learning-based network specifically tailored for core needle biopsy and clinical data feature extraction, which integrates a self-attention mechanism (CNBC-SA). The proposed model consists of a feature extractor based on convolutional neural network (CNN) and an improved self-attention mechanism module, which can preserve the independence of features in WSIs for analysis and enhancement to provide rich feature representation. To validate the performance of the proposed model, we conducted comparative experiments and ablation studies using publicly available datasets, and verification was performed through quantitative analysis.
Results: The comparative experiment illustrates the superior performance of the proposed model in the task of binary classification of ALNs, as compared to alternative methods. Our method achieved outstanding performance [area under the curve (AUC): 0.882] in this task, significantly surpassing the state-of-the-art (SOTA) method on the same dataset (AUC: 0.862). The ablation experiment reveals that incorporating RandomRotation data augmentation technology and utilizing Adadelta optimizer can effectively enhance the performance of the proposed model.
Conclusions: The experimental results demonstrate that the model proposed in this paper outperforms the SOTA model on the same dataset, thereby establishing its reliability as an assistant for pathologists in analyzing WSIs of breast cancer. Consequently, it significantly enhances both the efficiency and accuracy of doctors during the diagnostic process.
背景:腋窝淋巴结(ALN)状态是乳腺癌转移的重要预后指标,目前的标准做法是人工解读全切片图像(WSI)。然而,这种方法既主观又耗时。最近,基于深度学习的医学图像分析方法取得了进展,有望改善临床诊断。本研究旨在利用这些技术进步,开发一种基于从原发肿瘤活检中提取的特征的深度学习模型,用于术前识别结节阴性的早期乳腺癌患者的 ALN 转移:我们提出了 DLCNBC-SA,这是一种基于深度学习的网络,专门为核心针活检和临床数据特征提取量身定制,其中集成了自我注意机制(CNBC-SA)。该模型由一个基于卷积神经网络(CNN)的特征提取器和一个改进的自我注意机制模块组成,可以保持 WSI 中特征的独立性,从而为分析和增强提供丰富的特征表示。为验证所提模型的性能,我们利用公开数据集进行了对比实验和消融研究,并通过定量分析进行了验证:对比实验表明,与其他方法相比,所提出的模型在 ALN 的二元分类任务中表现出色。我们的方法在这一任务中取得了出色的性能[曲线下面积(AUC):0.882],大大超过了同一数据集上最先进的(SOTA)方法(AUC:0.862)。消融实验表明,采用 RandomRotation 数据增强技术和利用 Adadelta 优化器可以有效提高所提模型的性能:实验结果表明,本文提出的模型在同一数据集上的表现优于 SOTA 模型,从而确立了其作为病理学家分析乳腺癌 WSI 的助手的可靠性。因此,它大大提高了医生在诊断过程中的效率和准确性。
{"title":"DLCNBC-SA: a model for assessing axillary lymph node metastasis status in early breast cancer patients.","authors":"Aiguo Zhang, Zhen Chen, Shengxiang Mei, Yunfan Ji, Yiqi Lin, Hua Shi","doi":"10.21037/qims-24-257","DOIUrl":"10.21037/qims-24-257","url":null,"abstract":"<p><strong>Background: </strong>Axillary lymph node (ALN) status is a crucial prognostic indicator for breast cancer metastasis, with manual interpretation of whole slide images (WSIs) being the current standard practice. However, this method is subjective and time-consuming. Recent advancements in deep learning-based methods for medical image analysis have shown promise in improving clinical diagnosis. This study aims to leverage these technological advancements to develop a deep learning model based on features extracted from primary tumor biopsies for preoperatively identifying ALN metastasis in early-stage breast cancer patients with negative nodes.</p><p><strong>Methods: </strong>We present DLCNBC-SA, a deep learning-based network specifically tailored for core needle biopsy and clinical data feature extraction, which integrates a self-attention mechanism (CNBC-SA). The proposed model consists of a feature extractor based on convolutional neural network (CNN) and an improved self-attention mechanism module, which can preserve the independence of features in WSIs for analysis and enhancement to provide rich feature representation. To validate the performance of the proposed model, we conducted comparative experiments and ablation studies using publicly available datasets, and verification was performed through quantitative analysis.</p><p><strong>Results: </strong>The comparative experiment illustrates the superior performance of the proposed model in the task of binary classification of ALNs, as compared to alternative methods. Our method achieved outstanding performance [area under the curve (AUC): 0.882] in this task, significantly surpassing the state-of-the-art (SOTA) method on the same dataset (AUC: 0.862). The ablation experiment reveals that incorporating RandomRotation data augmentation technology and utilizing Adadelta optimizer can effectively enhance the performance of the proposed model.</p><p><strong>Conclusions: </strong>The experimental results demonstrate that the model proposed in this paper outperforms the SOTA model on the same dataset, thereby establishing its reliability as an assistant for pathologists in analyzing WSIs of breast cancer. Consequently, it significantly enhances both the efficiency and accuracy of doctors during the diagnostic process.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Persistent challenges associated with misdiagnosis and underdiagnosis of coronary microvascular disease (CMVD) necessitate the exploration of noninvasive imaging techniques to enhance diagnostic accuracy. Therefore, we aimed to integrate multimodal imaging approaches to achieve a higher diagnostic rate for CMVD using high-quality myocardial metabolism imaging (MMI) and myocardial contrast echocardiography (MCE). This combination diagnostic strategy may help address the urgent need for improved CMVD diagnosis.
Methods: In this study, we established five distinct pretreatment groups, each consisting of nine male rabbit: a fasted group, a nonfasted group, a sugar load group, an acipimox group, and a combination group of nonfasted rabbits administered insulin. Moreover, positron emission tomography-computed tomography (PET/CT) scan windows were established at 30-, 60-, and 90-minute intervals. We developed 10 CMVD models and conducted a diagnosis of CMVD through an integrated analysis of MMI and MCE, including image acquisition and processing. For each heart segment, we calculated the standardized uptake value (SUV) based on body weight (SUVbw), as well as certain ratios of SUV including SUV of the heart (SUVheart) to that of the liver (SUVliver) and SUVheart to SUV of the lung (SUVlung). Additionally, we obtained three coronary SUVbw uptake values. To clarify the relationship between SUVbw uptake values and echocardiographic parameters of the myocardial contrast agent more thoroughly, we conducted a comprehensive analysis across different pretreatment protocols. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of each parameter in the context of CMVD.
Results: In the context of MMI, the nonfasted-plus-insulin group, as observed during the 60-minute examination, exhibited a noteworthy total 18F-fluorodeoxyglucose (18F-FDG) uptake of 47.44±6.53 g/mL, which was found to be statistically different from the other groups. To ascertain the reliability of the results, two double-blind investigators independently assessed the data and achieved a good level of agreement, according to the intraclass correlation coefficient (ICC) (0.957). The SUVbw of the nonfasted-plus-insulin group exhibited a moderate correlation with the microvascular blood flow reserve (MBFR) parameters derived from the MCE examination, as evidenced by a r value of 0.686. For the diagnosis of CMVD disease, the diagnostic accuracy of the combined diagnostic method [area under the curve (AUC) =0.789; 95% confidence interval (CI): 0.705-0.873] was significantly higher than that of the MBFR (AUC =0.697; 95% CI: 0.597-0.797) and SUVbw (AUC =0.715; 95% CI: 0.622-0.807) methods (P<0.05).
{"title":"Integrating myocardial metabolic imaging and stress myocardial contrast echocardiography to improve the diagnosis of coronary microvascular diseases in rabbits.","authors":"Guodong Wang, Xiaohong Li, Jiaxin Zhao, Shangke Chen, Yongde Qin, Lina Guan, Yuming Mu","doi":"10.21037/qims-23-1630","DOIUrl":"10.21037/qims-23-1630","url":null,"abstract":"<p><strong>Background: </strong>Persistent challenges associated with misdiagnosis and underdiagnosis of coronary microvascular disease (CMVD) necessitate the exploration of noninvasive imaging techniques to enhance diagnostic accuracy. Therefore, we aimed to integrate multimodal imaging approaches to achieve a higher diagnostic rate for CMVD using high-quality myocardial metabolism imaging (MMI) and myocardial contrast echocardiography (MCE). This combination diagnostic strategy may help address the urgent need for improved CMVD diagnosis.</p><p><strong>Methods: </strong>In this study, we established five distinct pretreatment groups, each consisting of nine male rabbit: a fasted group, a nonfasted group, a sugar load group, an acipimox group, and a combination group of nonfasted rabbits administered insulin. Moreover, positron emission tomography-computed tomography (PET/CT) scan windows were established at 30-, 60-, and 90-minute intervals. We developed 10 CMVD models and conducted a diagnosis of CMVD through an integrated analysis of MMI and MCE, including image acquisition and processing. For each heart segment, we calculated the standardized uptake value (SUV) based on body weight (SUV<sub>bw</sub>), as well as certain ratios of SUV including SUV of the heart (SUV<sub>heart</sub>) to that of the liver (SUV<sub>liver</sub>) and SUV<sub>heart</sub> to SUV of the lung (SUV<sub>lung</sub>). Additionally, we obtained three coronary SUV<sub>bw</sub> uptake values. To clarify the relationship between SUV<sub>bw</sub> uptake values and echocardiographic parameters of the myocardial contrast agent more thoroughly, we conducted a comprehensive analysis across different pretreatment protocols. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of each parameter in the context of CMVD.</p><p><strong>Results: </strong>In the context of MMI, the nonfasted-plus-insulin group, as observed during the 60-minute examination, exhibited a noteworthy total <sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>F-FDG) uptake of 47.44±6.53 g/mL, which was found to be statistically different from the other groups. To ascertain the reliability of the results, two double-blind investigators independently assessed the data and achieved a good level of agreement, according to the intraclass correlation coefficient (ICC) (0.957). The SUV<sub>bw</sub> of the nonfasted-plus-insulin group exhibited a moderate correlation with the microvascular blood flow reserve (MBFR) parameters derived from the MCE examination, as evidenced by a <i>r</i> value of 0.686. For the diagnosis of CMVD disease, the diagnostic accuracy of the combined diagnostic method [area under the curve (AUC) =0.789; 95% confidence interval (CI): 0.705-0.873] was significantly higher than that of the MBFR (AUC =0.697; 95% CI: 0.597-0.797) and SUV<sub>bw</sub> (AUC =0.715; 95% CI: 0.622-0.807) methods (P<0.05).</p><p><strong>Conclusions: </strong>Our study demonst","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Preoperative grading gliomas is essential for therapeutic clinical decision-making. Current non-invasive imaging modality for glioma grading were primarily focused on magnetic resonance imaging (MRI) or positron emission tomography (PET) of the tumor region. However, these methods overlook the peritumoral region (PTR) of tumor and cannot take full advantage of the biological information derived from hybrid-imaging. Therefore, we aimed to combine multiparameter from hybrid 18F-fluorodeoxyglucose (18F-FDG) PET/MRI of the solid component and PTR were combined for differentiating high-grade glioma (HGG) from low-grade glioma (LGG).
Methods: A total of 76 patients with pathologically confirmed glioma (41 HGG and 35 LGG) who underwent simultaneous 18F-FDG PET, arterial spin labelling (ASL), and diffusion-weighted imaging (DWI) with hybrid PET/MRI were retrospectively enrolled. The relative maximum standardized uptake value (rSUVmax), relative cerebral blood flow (rCBF), and relative minimum apparent diffusion coefficient (rADCmin) for the solid component and PTR at different distances outside tumoral border were compared. Receiver operating characteristic (ROC) curves were applied to assess the grading performance. A nomogram for HGG prediction was constructed.
Results: HGGs displayed higher rSUVmax and rCBF but lower rADCmin in the solid component and 5 mm-adjacent PTR, lower rADCmin in 10 mm-adjacent PTR, and higher rCBF in 15- and 20-mm-adjacent PTR. rSUVmax in solid component performed best [area under the curve (AUC) =0.865] as a single parameter for grading. Combination of rSUVmax in the solid component and adjacent 20 mm performed better (AUC =0.881). Integration of all 3 indicators in the solid component and adjacent 20 mm performed the best (AUC =0.928). The nomogram including rSUVmax, rCBF, and rADCmin in the solid component and 5-mm-adjacent PTR predicted HGG with a concordance index (C-index) of 0.906.
Conclusions: Multiparametric 18F-FDG PET/MRI from the solid component and PTR performed excellently in differentiating HGGs from LGGs. It can be used as a non-invasive and effective tool for preoperative grade stratification of patients with glioma, and can be considered in clinical practice.
{"title":"Multiparametric simultaneous hybrid <sup>18</sup>F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (<sup>18</sup>F-FDG PET/MRI) incorporating intratumoral and peritumoral regions for grading of glioma.","authors":"Ping Liu, Yu-Ping Zeng, Hong Qu, Wan-Yi Zheng, Tian-Xing Zhou, Li-Feng Hang, Gui-Hua Jiang","doi":"10.21037/qims-24-280","DOIUrl":"10.21037/qims-24-280","url":null,"abstract":"<p><strong>Background: </strong>Preoperative grading gliomas is essential for therapeutic clinical decision-making. Current non-invasive imaging modality for glioma grading were primarily focused on magnetic resonance imaging (MRI) or positron emission tomography (PET) of the tumor region. However, these methods overlook the peritumoral region (PTR) of tumor and cannot take full advantage of the biological information derived from hybrid-imaging. Therefore, we aimed to combine multiparameter from hybrid <sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>F-FDG) PET/MRI of the solid component and PTR were combined for differentiating high-grade glioma (HGG) from low-grade glioma (LGG).</p><p><strong>Methods: </strong>A total of 76 patients with pathologically confirmed glioma (41 HGG and 35 LGG) who underwent simultaneous <sup>18</sup>F-FDG PET, arterial spin labelling (ASL), and diffusion-weighted imaging (DWI) with hybrid PET/MRI were retrospectively enrolled. The relative maximum standardized uptake value (rSUV<sub>max</sub>), relative cerebral blood flow (rCBF), and relative minimum apparent diffusion coefficient (rADC<sub>min</sub>) for the solid component and PTR at different distances outside tumoral border were compared. Receiver operating characteristic (ROC) curves were applied to assess the grading performance. A nomogram for HGG prediction was constructed.</p><p><strong>Results: </strong>HGGs displayed higher rSUV<sub>max</sub> and rCBF but lower rADC<sub>min</sub> in the solid component and 5 mm-adjacent PTR, lower rADC<sub>min</sub> in 10 mm-adjacent PTR, and higher rCBF in 15- and 20-mm-adjacent PTR. rSUV<sub>max</sub> in solid component performed best [area under the curve (AUC) =0.865] as a single parameter for grading. Combination of rSUV<sub>max</sub> in the solid component and adjacent 20 mm performed better (AUC =0.881). Integration of all 3 indicators in the solid component and adjacent 20 mm performed the best (AUC =0.928). The nomogram including rSUV<sub>max</sub>, rCBF, and rADC<sub>min</sub> in the solid component and 5-mm-adjacent PTR predicted HGG with a concordance index (C-index) of 0.906.</p><p><strong>Conclusions: </strong>Multiparametric <sup>18</sup>F-FDG PET/MRI from the solid component and PTR performed excellently in differentiating HGGs from LGGs. It can be used as a non-invasive and effective tool for preoperative grade stratification of patients with glioma, and can be considered in clinical practice.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-16DOI: 10.21037/qims-24-288
Yongguang Ban, Di Lan, Shanshan Wang, Wei Liu, Xiaoqing Fu, Li Hou, Lingfei Guo, Jianbo Teng, Qinhua Luan
Background: Extravaginal testicular torsion has profound clinical implications in neonates, but its ultrasound characteristics may vary at different disease stages. The purpose of this study was to identify the ultrasound characteristics of neonatal extravaginal testicular torsion and their diagnostic value at different disease stages.
Methods: A retrospective analysis of the clinical and ultrasound examination data of 20 infants aged 1-75 days with surgically and pathologically confirmed unilateral extravaginal testicular torsion (10 right, 10 left) was conducted. The infants were divided into three stages based on the ultrasound characteristics: double-ring effusion, calcification of the tunica vaginalis, and testicular atrophy.
Results: In the double-ring effusion stage, the affected testicles were enlarged with axial abnormalities, with the parenchymal testicular blood flow signal significantly reduced or absent. Twisted paratesticular masses and a "double-ring effusion sign" were visible. In the tunica vaginalis calcification stage, the affected testicles were slightly smaller, with axial abnormalities, absent blood flow signals in the testicular parenchyma, and strong echogenicity of the tunica vaginalis. In the testicular atrophy stage, the affected testicles were markedly smaller, with enhanced echogenicity in the tunica vaginalis and parenchyma, and absent blood flow signal in the testicular parenchyma. The volumes of the affected testicles gradually decreased from the stage of double-ring effusion to that of tunica vaginalis calcification, and then to testicular atrophy (P<0.05).
Conclusions: Neonatal extravaginal testicular torsion at different disease stages has distinct ultrasound features, and color doppler ultrasound plays an important role in the diagnosis and treatment of extravaginal testicular torsion.
{"title":"Ultrasound characteristics of extravaginal testicular torsion at different stages of disease progression.","authors":"Yongguang Ban, Di Lan, Shanshan Wang, Wei Liu, Xiaoqing Fu, Li Hou, Lingfei Guo, Jianbo Teng, Qinhua Luan","doi":"10.21037/qims-24-288","DOIUrl":"10.21037/qims-24-288","url":null,"abstract":"<p><strong>Background: </strong>Extravaginal testicular torsion has profound clinical implications in neonates, but its ultrasound characteristics may vary at different disease stages. The purpose of this study was to identify the ultrasound characteristics of neonatal extravaginal testicular torsion and their diagnostic value at different disease stages.</p><p><strong>Methods: </strong>A retrospective analysis of the clinical and ultrasound examination data of 20 infants aged 1-75 days with surgically and pathologically confirmed unilateral extravaginal testicular torsion (10 right, 10 left) was conducted. The infants were divided into three stages based on the ultrasound characteristics: double-ring effusion, calcification of the tunica vaginalis, and testicular atrophy.</p><p><strong>Results: </strong>In the double-ring effusion stage, the affected testicles were enlarged with axial abnormalities, with the parenchymal testicular blood flow signal significantly reduced or absent. Twisted paratesticular masses and a \"double-ring effusion sign\" were visible. In the tunica vaginalis calcification stage, the affected testicles were slightly smaller, with axial abnormalities, absent blood flow signals in the testicular parenchyma, and strong echogenicity of the tunica vaginalis. In the testicular atrophy stage, the affected testicles were markedly smaller, with enhanced echogenicity in the tunica vaginalis and parenchyma, and absent blood flow signal in the testicular parenchyma. The volumes of the affected testicles gradually decreased from the stage of double-ring effusion to that of tunica vaginalis calcification, and then to testicular atrophy (P<0.05).</p><p><strong>Conclusions: </strong>Neonatal extravaginal testicular torsion at different disease stages has distinct ultrasound features, and color doppler ultrasound plays an important role in the diagnosis and treatment of extravaginal testicular torsion.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-26DOI: 10.21037/qims-24-68
Peixi Liao, Xucan Zhang, Yaoyao Wu, Hu Chen, Wenchao Du, Hong Liu, Hongyu Yang, Yi Zhang
Background: Low-dose computed tomography (LDCT) is a diagnostic imaging technique designed to minimize radiation exposure to the patient. However, this reduction in radiation may compromise computed tomography (CT) image quality, adversely impacting clinical diagnoses. Various advanced LDCT methods have emerged to mitigate this challenge, relying on well-matched LDCT and normal-dose CT (NDCT) image pairs for training. Nevertheless, these methods often face difficulties in distinguishing image details from nonuniformly distributed noise, limiting their denoising efficacy. Additionally, acquiring suitably paired datasets in the medical domain poses challenges, further constraining their applicability. Hence, the objective of this study was to develop an innovative denoising framework for LDCT images employing unpaired data.
Methods: In this paper, we propose a LDCT denoising network (DNCNN) that alleviates the need for aligning LDCT and NDCT images. Our approach employs generative adversarial networks (GANs) to learn and model the noise present in LDCT images, establishing a mapping from the pseudo-LDCT to the actual NDCT domain without the need for paired CT images.
Results: Within the domain of weakly supervised methods, our proposed model exhibited superior objective metrics on the simulated dataset when compared to CycleGAN and selective kernel-based cycle-consistent GAN (SKFCycleGAN): the peak signal-to-noise ratio (PSNR) was 43.9441, the structural similarity index measure (SSIM) was 0.9660, and the visual information fidelity (VIF) was 0.7707. In the clinical dataset, we conducted a visual effect analysis by observing various tissues through different observation windows. Our proposed method achieved a no-reference structural sharpness (NRSS) value of 0.6171, which was closest to that of the NDCT images (NRSS =0.6049), demonstrating its superiority over other denoising techniques in preserving details, maintaining structural integrity, and enhancing edge contrast.
Conclusions: Through extensive experiments on both simulated and clinical datasets, we demonstrated the superior efficacy of our proposed method in terms of denoising quality and quantity. Our method exhibits superiority over both supervised techniques, including block-matching and 3D filtering (BM3D), residual encoder-decoder convolutional neural network (RED-CNN), and Wasserstein generative adversarial network-VGG (WGAN-VGG), and over weakly supervised approaches, including CycleGAN and SKFCycleGAN.
{"title":"Weakly supervised low-dose computed tomography denoising based on generative adversarial networks.","authors":"Peixi Liao, Xucan Zhang, Yaoyao Wu, Hu Chen, Wenchao Du, Hong Liu, Hongyu Yang, Yi Zhang","doi":"10.21037/qims-24-68","DOIUrl":"10.21037/qims-24-68","url":null,"abstract":"<p><strong>Background: </strong>Low-dose computed tomography (LDCT) is a diagnostic imaging technique designed to minimize radiation exposure to the patient. However, this reduction in radiation may compromise computed tomography (CT) image quality, adversely impacting clinical diagnoses. Various advanced LDCT methods have emerged to mitigate this challenge, relying on well-matched LDCT and normal-dose CT (NDCT) image pairs for training. Nevertheless, these methods often face difficulties in distinguishing image details from nonuniformly distributed noise, limiting their denoising efficacy. Additionally, acquiring suitably paired datasets in the medical domain poses challenges, further constraining their applicability. Hence, the objective of this study was to develop an innovative denoising framework for LDCT images employing unpaired data.</p><p><strong>Methods: </strong>In this paper, we propose a LDCT denoising network (DNCNN) that alleviates the need for aligning LDCT and NDCT images. Our approach employs generative adversarial networks (GANs) to learn and model the noise present in LDCT images, establishing a mapping from the pseudo-LDCT to the actual NDCT domain without the need for paired CT images.</p><p><strong>Results: </strong>Within the domain of weakly supervised methods, our proposed model exhibited superior objective metrics on the simulated dataset when compared to CycleGAN and selective kernel-based cycle-consistent GAN (SKFCycleGAN): the peak signal-to-noise ratio (PSNR) was 43.9441, the structural similarity index measure (SSIM) was 0.9660, and the visual information fidelity (VIF) was 0.7707. In the clinical dataset, we conducted a visual effect analysis by observing various tissues through different observation windows. Our proposed method achieved a no-reference structural sharpness (NRSS) value of 0.6171, which was closest to that of the NDCT images (NRSS =0.6049), demonstrating its superiority over other denoising techniques in preserving details, maintaining structural integrity, and enhancing edge contrast.</p><p><strong>Conclusions: </strong>Through extensive experiments on both simulated and clinical datasets, we demonstrated the superior efficacy of our proposed method in terms of denoising quality and quantity. Our method exhibits superiority over both supervised techniques, including block-matching and 3D filtering (BM3D), residual encoder-decoder convolutional neural network (RED-CNN), and Wasserstein generative adversarial network-VGG (WGAN-VGG), and over weakly supervised approaches, including CycleGAN and SKFCycleGAN.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-30DOI: 10.21037/qims-24-272
Danyi Liu, Qiuxia Jiang, Ziwei Xu, Liya Li, Guorong Lyu
Background: Noninvasive evaluation of fetal lung development is a critical area of study. Two-dimensional shear-wave elastography (2D-SWE) provides valuable insights into tissue stiffness, potentially correlating with different stages of lung development. This study aims to explore the potential of the 2D-SWE technique for assessing the maturity of fetal lung development.
Methods: This prospective cohort study included pregnant women undergoing routine antenatal ultrasound examinations at the Second Affiliated Hospital of Fujian Medical University and Quanzhou Women's and Children's Hospital from September 2022 to September 2023. The study consecutively recruited 300 pregnant women with normal pregnancies and 15 who opted for induced labor. Among those with normal pregnancies, the study assessed the differences in fetal pulmonary and hepatic elasticity measurements across different gestational weeks (GW) using one-way analysis of variance (ANOVA). Furthermore, regression analyses using linear, quadratic, and cubic equations were conducted to investigate the relationship between fetal parameters and GW. For those who opted for induced labor, elasticity measurements were taken before induction, and fetal lung tissue specimens were collected for post-induction observation.
Results: Fetal lung and liver elasticity values, along with the lung-to-liver elasticity ratio (LLE ratio), showed significant variations across different GW (P<0.05). Specifically, fetal lung elasticity values initially increased and then decreased as GW advanced (R2=0.41). Liver elasticity values continuously increased throughout GW, though the rate of increase diminished during the prenatal period (R2=0.37). The LLE ratio values increased and then decreased over GW, fluctuating overall between 0.8 and 0.9 (R2=0.14). A 71.4% concordance was observed between the predicted stage of lung development, based on lung elasticity values, and the histological stage of lung development in the induced fetuses.
Conclusions: 2D-SWE can depict the maturation of fetal lung development at various stages.
{"title":"Evaluating fetal lung development at various gestational weeks using two-dimensional shear wave elastography.","authors":"Danyi Liu, Qiuxia Jiang, Ziwei Xu, Liya Li, Guorong Lyu","doi":"10.21037/qims-24-272","DOIUrl":"10.21037/qims-24-272","url":null,"abstract":"<p><strong>Background: </strong>Noninvasive evaluation of fetal lung development is a critical area of study. Two-dimensional shear-wave elastography (2D-SWE) provides valuable insights into tissue stiffness, potentially correlating with different stages of lung development. This study aims to explore the potential of the 2D-SWE technique for assessing the maturity of fetal lung development.</p><p><strong>Methods: </strong>This prospective cohort study included pregnant women undergoing routine antenatal ultrasound examinations at the Second Affiliated Hospital of Fujian Medical University and Quanzhou Women's and Children's Hospital from September 2022 to September 2023. The study consecutively recruited 300 pregnant women with normal pregnancies and 15 who opted for induced labor. Among those with normal pregnancies, the study assessed the differences in fetal pulmonary and hepatic elasticity measurements across different gestational weeks (GW) using one-way analysis of variance (ANOVA). Furthermore, regression analyses using linear, quadratic, and cubic equations were conducted to investigate the relationship between fetal parameters and GW. For those who opted for induced labor, elasticity measurements were taken before induction, and fetal lung tissue specimens were collected for post-induction observation.</p><p><strong>Results: </strong>Fetal lung and liver elasticity values, along with the lung-to-liver elasticity ratio (LLE ratio), showed significant variations across different GW (P<0.05). Specifically, fetal lung elasticity values initially increased and then decreased as GW advanced (R2=0.41). Liver elasticity values continuously increased throughout GW, though the rate of increase diminished during the prenatal period (R2=0.37). The LLE ratio values increased and then decreased over GW, fluctuating overall between 0.8 and 0.9 (R2=0.14). A 71.4% concordance was observed between the predicted stage of lung development, based on lung elasticity values, and the histological stage of lung development in the induced fetuses.</p><p><strong>Conclusions: </strong>2D-SWE can depict the maturation of fetal lung development at various stages.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Barlow's disease (BD) is a common etiology of degenerative mitral valve (MV) disease, often causing significant mitral regurgitation (MR). The pathology of BD is challenging for surgeons performing MV repair (MVR). However, most MVR effectiveness studies have been based on survival and risk of reoperation. The aim of this study was to analyze the safety, efficacy, and durability of MVR in patients with BD and to identify factors that influence recurrent MR.
Methods: We retrospectively analyzed the clinical outcomes of 274 patients undergoing MVR for BD at a tertiary hospital (Guangdong People's Hospital, Guangzhou, China) between January 2010 and June 2022. To analyze the results of MVR and identify the risk factors for MR recurrence, we defined two groups: a total of 240 patients with MR grade <2+ (group A) and a total of 34 patients who had recurrent MR after MVR (group B; the patients with MR ≥2+). All patients were operated on using standard repair techniques. Recurrent MR was the primary outcome. Secondary outcomes were death and reoperation after MVR. Patients were followed up until March 2023. Patients were followed up by clinic visits, telephone calls, and postal or electronic questionnaires.
Results: The median [range] patient age was 46.00 [16-75] years and 186 (67.9%) patients were male. Concomitant procedures were performed in 123 patients: tricuspid valve repair 71 (25.9%), maze or pulmonary vein isolation (PVI) 12 (4.4%), atrial septal defect (ASD) repair 3 (1.1%), and left atrial appendage (LAA) closure 28 (10.2%). Hospital mortality was 0.4%. Long-term complications included radiofrequency ablation in 7 patients (2.6%), pacemaker implantation in 1 patient (0.4%), and stroke in 3 patients (1.1%). The median follow-up was 3.28 (range, 0-12.39) years. Considering the competing risk of mortality, the cumulative incidence of MR progression 2+ or more grades was 2.6%, 5.9%, 14.5%, and 27.7% at 1 month, 1, 5, and 10 years, respectively. Overall survival at 1, 5, and 10 years was 99.3%, 98.6%, and 98.6%, respectively. The immediate postoperative MR area [hazard ratio (HR) =1.723; 95% confidence interval (CI): 1.051-2.824; P=0.031], postoperative left ventricular end-diastolic dimension (LVEDD) (HR =1.149; 95% CI: 1.016-1.300; P=0.027), and postoperative MR grade {HR = Exp[4.500 - 0.544 × ln(t + 20)]; P=0.008} were associated with an increased risk of MR recurrence, whereas a higher left ventricular ejection fraction (LVEF) (HR =0.931; 95% CI: 0.868-0.999; P=0.049) was associated with a decreased risk.
Conclusions: MVR in patients with BD can be performed with low mortality and complications and is associated with superior long-term outcomes. However, MVR was associated with a certain risk of MR recurrence, especially in those with high postoperative LVEDD, residual MR >1+, and decreased postoperative LVEF. We recommend MVR for patients wit
{"title":"Recurrent mitral regurgitation after repair of Barlow's disease in a single-center retrospective cohort study.","authors":"Lishan Zhong, Yanyin Huang, Shuo Xiao, Zhenzhong Wang, Yuxin Li, Junfei Zhao, Dou Fang, Qiuji Wang, Zhaolong Zhang, Huanlei Huang","doi":"10.21037/qims-23-1768","DOIUrl":"10.21037/qims-23-1768","url":null,"abstract":"<p><strong>Background: </strong>Barlow's disease (BD) is a common etiology of degenerative mitral valve (MV) disease, often causing significant mitral regurgitation (MR). The pathology of BD is challenging for surgeons performing MV repair (MVR). However, most MVR effectiveness studies have been based on survival and risk of reoperation. The aim of this study was to analyze the safety, efficacy, and durability of MVR in patients with BD and to identify factors that influence recurrent MR.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical outcomes of 274 patients undergoing MVR for BD at a tertiary hospital (Guangdong People's Hospital, Guangzhou, China) between January 2010 and June 2022. To analyze the results of MVR and identify the risk factors for MR recurrence, we defined two groups: a total of 240 patients with MR grade <2+ (group A) and a total of 34 patients who had recurrent MR after MVR (group B; the patients with MR ≥2+). All patients were operated on using standard repair techniques. Recurrent MR was the primary outcome. Secondary outcomes were death and reoperation after MVR. Patients were followed up until March 2023. Patients were followed up by clinic visits, telephone calls, and postal or electronic questionnaires.</p><p><strong>Results: </strong>The median [range] patient age was 46.00 [16-75] years and 186 (67.9%) patients were male. Concomitant procedures were performed in 123 patients: tricuspid valve repair 71 (25.9%), maze or pulmonary vein isolation (PVI) 12 (4.4%), atrial septal defect (ASD) repair 3 (1.1%), and left atrial appendage (LAA) closure 28 (10.2%). Hospital mortality was 0.4%. Long-term complications included radiofrequency ablation in 7 patients (2.6%), pacemaker implantation in 1 patient (0.4%), and stroke in 3 patients (1.1%). The median follow-up was 3.28 (range, 0-12.39) years. Considering the competing risk of mortality, the cumulative incidence of MR progression 2+ or more grades was 2.6%, 5.9%, 14.5%, and 27.7% at 1 month, 1, 5, and 10 years, respectively. Overall survival at 1, 5, and 10 years was 99.3%, 98.6%, and 98.6%, respectively. The immediate postoperative MR area [hazard ratio (HR) =1.723; 95% confidence interval (CI): 1.051-2.824; P=0.031], postoperative left ventricular end-diastolic dimension (LVEDD) (HR =1.149; 95% CI: 1.016-1.300; P=0.027), and postoperative MR grade {HR = Exp[4.500 - 0.544 × ln(t + 20)]; P=0.008} were associated with an increased risk of MR recurrence, whereas a higher left ventricular ejection fraction (LVEF) (HR =0.931; 95% CI: 0.868-0.999; P=0.049) was associated with a decreased risk.</p><p><strong>Conclusions: </strong>MVR in patients with BD can be performed with low mortality and complications and is associated with superior long-term outcomes. However, MVR was associated with a certain risk of MR recurrence, especially in those with high postoperative LVEDD, residual MR >1+, and decreased postoperative LVEF. We recommend MVR for patients wit","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The contrasted-enhanced ultrasound thyroid imaging reporting and data system (CEUS TI-RADS) is the first international risk stratification system for thyroid nodules based on conventional ultrasound (US) and CEUS. This study aimed to evaluate the diagnostic efficacy of CEUS TI-RADS for benign and malignant thyroid nodules and to assess the related interobserver agreement.
Methods: The study recruited 433 patients who underwent thyroid US and CEUS between January 2019 and June 2023 at the Affiliated Hospital of Guangdong Medical University. A retrospective analysis of 467 thyroid nodules confirmed by fine-needle aspiration (FNA) and/or surgery was performed. Further, a CEUS TI-RADS classification was assigned to each thyroid nodule based on the CEUS TI-RADS scoring criteria for the US and CEUS features of the nodule. The nodules were grouped based on their sizes as follows: size ≤1 cm, group A; size >1 and ≤4 cm, group B; and size >4 cm, group C. Multivariate logistic regression was used to analyze independent risk factors for malignant thyroid nodules. Pathological assessment was the reference standard for establishing the sensitivity (SEN), specificity (SPE), accuracy (ACC), positive predictive value (PPV), and negative predictive value (NPV) of CEUS TI-RADS in diagnosing malignant thyroid nodules. The area under the curve (AUC) in the receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic efficacy of the scoring system in predicting malignancy in three groups of nodules. The intragroup correlation coefficient (ICC) was adopted to assess the interobserver agreement of the CEUS TI-RADS score.
Results: Out of the 467 thyroid nodules, 262 were malignant and 205 were benign. Logistic regression analysis revealed that the independent risk factors for malignant thyroid nodules included punctate echogenic foci (P<0.001), taller-than-wide shape (P=0.015), extrathyroidal invasion (P=0.020), irregular margins/lobulation (P=0.036), hypoechoicity on US (P=0.038), and hypoenhancement on CEUS (P<0.001). The AUC for the CEUS TI-RADS in diagnosing malignant thyroid nodules was 0.898 for all nodules, 0.795 for group A, 0.949 for group B, and 0.801 for group C, with the optimal cutoff values of the CEUS TI-RADS being 5 points, 6 points, 5 points, and 5 points, respectively. Among these groups of nodules, group B had the highest AUC, with the SEN, SPE, ACC, PPV, and NPV for diagnosing malignant nodules being 95.9%, 88.1%, 92.8%, 92.6%, and 93.2%, respectively. The ICC of the CEUS TI-RADS classification between senior and junior physicians was 0.862 (P<0.001).
Conclusions: In summary, CEUS TI-RADS demonstrated significant efficacy in distinguishing thyroid nodules. Nonetheless, there were variations in its capacity to detect malignant nodules across diverse sizes, and it demonstrate optimal performance in 1- to 4-cm nodules. These
{"title":"Diagnostic efficacy of the contrast-enhanced ultrasound thyroid imaging reporting and data system classification for benign and malignant thyroid nodules.","authors":"Yu-Ping Yang, Guo-Li Zhang, Hong-Lian Zhou, Hai-Xia Dai, Xing Huang, Li-Juan Liu, Jun Xie, Jie-Xin Wang, Hua-Juan Li, Xin Liang, Qian Yuan, Yan-Hao Zeng, Xiao-Hong Xu","doi":"10.21037/qims-24-457","DOIUrl":"10.21037/qims-24-457","url":null,"abstract":"<p><strong>Background: </strong>The contrasted-enhanced ultrasound thyroid imaging reporting and data system (CEUS TI-RADS) is the first international risk stratification system for thyroid nodules based on conventional ultrasound (US) and CEUS. This study aimed to evaluate the diagnostic efficacy of CEUS TI-RADS for benign and malignant thyroid nodules and to assess the related interobserver agreement.</p><p><strong>Methods: </strong>The study recruited 433 patients who underwent thyroid US and CEUS between January 2019 and June 2023 at the Affiliated Hospital of Guangdong Medical University. A retrospective analysis of 467 thyroid nodules confirmed by fine-needle aspiration (FNA) and/or surgery was performed. Further, a CEUS TI-RADS classification was assigned to each thyroid nodule based on the CEUS TI-RADS scoring criteria for the US and CEUS features of the nodule. The nodules were grouped based on their sizes as follows: size ≤1 cm, group A; size >1 and ≤4 cm, group B; and size >4 cm, group C. Multivariate logistic regression was used to analyze independent risk factors for malignant thyroid nodules. Pathological assessment was the reference standard for establishing the sensitivity (SEN), specificity (SPE), accuracy (ACC), positive predictive value (PPV), and negative predictive value (NPV) of CEUS TI-RADS in diagnosing malignant thyroid nodules. The area under the curve (AUC) in the receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic efficacy of the scoring system in predicting malignancy in three groups of nodules. The intragroup correlation coefficient (ICC) was adopted to assess the interobserver agreement of the CEUS TI-RADS score.</p><p><strong>Results: </strong>Out of the 467 thyroid nodules, 262 were malignant and 205 were benign. Logistic regression analysis revealed that the independent risk factors for malignant thyroid nodules included punctate echogenic foci (P<0.001), taller-than-wide shape (P=0.015), extrathyroidal invasion (P=0.020), irregular margins/lobulation (P=0.036), hypoechoicity on US (P=0.038), and hypoenhancement on CEUS (P<0.001). The AUC for the CEUS TI-RADS in diagnosing malignant thyroid nodules was 0.898 for all nodules, 0.795 for group A, 0.949 for group B, and 0.801 for group C, with the optimal cutoff values of the CEUS TI-RADS being 5 points, 6 points, 5 points, and 5 points, respectively. Among these groups of nodules, group B had the highest AUC, with the SEN, SPE, ACC, PPV, and NPV for diagnosing malignant nodules being 95.9%, 88.1%, 92.8%, 92.6%, and 93.2%, respectively. The ICC of the CEUS TI-RADS classification between senior and junior physicians was 0.862 (P<0.001).</p><p><strong>Conclusions: </strong>In summary, CEUS TI-RADS demonstrated significant efficacy in distinguishing thyroid nodules. Nonetheless, there were variations in its capacity to detect malignant nodules across diverse sizes, and it demonstrate optimal performance in 1- to 4-cm nodules. These ","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Previous studies have indicated that despite adhering to current patient selection guidelines, there remains a 30% to 40% subset of patients who do not experience improvement in heart failure (HF) after receiving cardiac resynchronization therapy (CRT). We aim to utilize echocardiographic myocardial work parameters to serve as predictors of responsiveness to CRT in patients with heart failure and reduced ejection fraction (HFrEF).
Methods: We prospectively recruited patients who underwent CRT at Sun Yat-sen Memorial Hospital from June 2019 to September 2022. Comprehensive preoperative information, clinical laboratory data, conventional echocardiographic parameters and myocardial work were collected for all participants, as well as follow-up data 6 months after CRT.
Results: Twenty-five patients (67.6%) showed response to CRT treatment, while twelve patients (32.4%) had no response. Compared with the non-response group, the response group had larger region constructive work [RCW: the sum of constructive work (CW) in the 9 segments of the basal, mid, and apical segments of the anterior, lateral, and posterior walls], region wasted work [RWW: the sum of wasted work (WW) in the 6 segments of the basal and mid segments of the anterior septum, posterior septum and anterior walls], and the combination of RCW and RWW (RCW + RWW) in baseline (RCW: 9,695.68±2,955.40 vs. 5,219.50±2,207.68 mmHg%, P<0.001; RWW: 3,612.08±1,723.80 vs. 1,674.33±995.23 mmHg%, P=0.001; RCW + RWW: 13,307.76±3,857.71 vs. 6,893.83±2,592.83 mmHg%, P<0.001). Furthermore, global constructive work (GCW), global wasted work (GWW), GCW + GWW, RCW, RWW, and RCW + RWW had areas under the receiver operating characteristic curve (AUCs) of 0.870, 0.770, 0.860, 0.890, 0.870, and 0.910, respectively, for predicting CRT responsiveness.
Conclusions: The global and regional myocardial work parameters are associated with CRT response in CRT candidates. Particularly regional myocardial work parameters appear to be promising parameters to improve selection for CRT of patients with HFrEF.
{"title":"Investigating the clinical utility of global and regional myocardial work parameters in predicting response to cardiac resynchronization therapy in patients with heart failure and reduced ejection fraction.","authors":"Chaodi Tan, Zongjian Li, Yuping Zheng, Ying Chen, Boshui Huang, Shaoxin Zheng, Shuxian Zhou","doi":"10.21037/qims-24-393","DOIUrl":"10.21037/qims-24-393","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have indicated that despite adhering to current patient selection guidelines, there remains a 30% to 40% subset of patients who do not experience improvement in heart failure (HF) after receiving cardiac resynchronization therapy (CRT). We aim to utilize echocardiographic myocardial work parameters to serve as predictors of responsiveness to CRT in patients with heart failure and reduced ejection fraction (HFrEF).</p><p><strong>Methods: </strong>We prospectively recruited patients who underwent CRT at Sun Yat-sen Memorial Hospital from June 2019 to September 2022. Comprehensive preoperative information, clinical laboratory data, conventional echocardiographic parameters and myocardial work were collected for all participants, as well as follow-up data 6 months after CRT.</p><p><strong>Results: </strong>Twenty-five patients (67.6%) showed response to CRT treatment, while twelve patients (32.4%) had no response. Compared with the non-response group, the response group had larger region constructive work [RCW: the sum of constructive work (CW) in the 9 segments of the basal, mid, and apical segments of the anterior, lateral, and posterior walls], region wasted work [RWW: the sum of wasted work (WW) in the 6 segments of the basal and mid segments of the anterior septum, posterior septum and anterior walls], and the combination of RCW and RWW (RCW + RWW) in baseline (RCW: 9,695.68±2,955.40 <i>vs</i>. 5,219.50±2,207.68 mmHg%, P<0.001; RWW: 3,612.08±1,723.80 <i>vs</i>. 1,674.33±995.23 mmHg%, P=0.001; RCW + RWW: 13,307.76±3,857.71 <i>vs</i>. 6,893.83±2,592.83 mmHg%, P<0.001). Furthermore, global constructive work (GCW), global wasted work (GWW), GCW + GWW, RCW, RWW, and RCW + RWW had areas under the receiver operating characteristic curve (AUCs) of 0.870, 0.770, 0.860, 0.890, 0.870, and 0.910, respectively, for predicting CRT responsiveness.</p><p><strong>Conclusions: </strong>The global and regional myocardial work parameters are associated with CRT response in CRT candidates. Particularly regional myocardial work parameters appear to be promising parameters to improve selection for CRT of patients with HFrEF.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}