Quantitative Imaging in Medicine and Surgery最新文献

Background: Magnetic resonance cholangiopancreatography (MRCP) is a widely used noninvasive imaging technique for evaluating the pancreaticobiliary ductal system, but its image quality is often affected by respiratory motion and background signal. The purpose of this study was evaluating the performance of contrast-enhanced single breath-hold three-dimensional variable flip-angle fast spin-echo breath-hold MRCP (3D SPACE BH MRCP) in examining patients with suspected pancreaticobiliary disease, with a specific focus on the resulting image quality.

Methods: Forty patients prospectively underwent pre- and postcontrast (intravenous gadolinium) 3D SPACE BH MRCP during the portal venous and equilibrium phases. Quantitative analysis measured signal intensity [common bile duct (CBD), liver, and background], signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and contrast ratio (CR). Two radiologists independently scored subjective image quality on a four-point scale. Statistical analyses included Wilcoxon signed-rank tests and kappa statistics.

Results: As compared to precontrast sequences, postcontrast sequences demonstrated significant reductions in liver signal (-12.77%; P<0.05) and background noise (-17.98%; P<0.05), with increased CR (+2.17%, P<0.05). CBD signal, SNR, and CNR showed no significant differences between precontrast and postcontrast sequences (P>0.05). Subjective scores indicated a preference for postcontrast images over precontrast ones (Z =-2.714; P=0.007). Interobserver agreement was excellent (precontrast: κ =0.76; postcontrast: κ =0.79; P<0.01).

Conclusions: Postcontrast 3D SPACE BH MRCP acquired during the venous phase enhances background suppression and overall image quality without compromising biliary duct visualization, potentially improving diagnostic accuracy for pancreaticobiliary pathologies.

Background: Insulin resistance (IR) elevates the risk of coronary artery disease (CAD). The triglyceride-glucose (TyG) index is a reliable substitute indicator for IR. Computed tomography-derived fractional flow reserve (CT-FFR) and coronary flow reserve (CFR) effectively assess coronary vascular function. This study aimed to investigate the relationship between the TyG index and coronary vascular function assessed by CT-FFR and CFR in suspected CAD patients.

Methods: We enrolled 293 patients who underwent single-photon emission computed tomography (SPECT) along with coronary computed tomography angiography (CCTA), and analyzed the relationships among the CT-FFR, myocardial blood flow (MBF), CFR, and the TyG index.

Results: Among the patients, those with a higher TyG index exhibited a relatively lower CT-FFR (0.80 vs. 0.85; P=0.02), rest-MBF (0.80 vs. 0.83; P=0.01), stress-MBF (1.92 vs. 2.26; P=0.01), and CFR (2.49 vs. 2.72; P=0.42). The TyG index was weakly and negatively correlated with the left ventricular (LV) CFR (r=-0.153; P=0.009). Among the patients without obstructive CAD, those with a high TyG index had a significantly lower CFR than those with a low TyG index (2.54 vs. 2.95; P=0.01), but no such significant difference was found in relation to the CT-FFR (0.91 vs. 0.93; P=0.72). Of the 879 vessels examined, 448 (51%) exhibited a reduced CFR. Compared with the vessels with a normal CFR, those with a decreased CFR exhibited a significantly increased obstructive CAD rate (40% vs. 29%; P<0.001), a lower CT-FFR (0.90 vs. 0.93; P<0.001), and a higher TyG index (8.81 vs. 8.67; P<0.001). In the vessels without obstructive CAD, the TyG index was higher in those with a reduced CFR compared with those with a normal CFR (8.80 vs. 8.59; P<0.001). The patient-level analysis revealed that male sex, the TyG index, obstructive CAD, and the CT-FFR were independently associated with the LV-CFR. The TyG index remained associated with the LV-CFR after adjustment for conventional risk factors. The TyG index remained independently associated with a reduced CFR in the patients without obstructive CAD.

Conclusions: The TyG index was independently associated with coronary vascular function, including both epicardial artery and microcirculatory function. The patients without obstructive CAD and those with a decreased CFR exhibited an increased TyG index, indicating a relationship between the TyG index and microcirculatory dysfunction. The TyG index, as a marker of metabolic health, was also related to microvascular injury. Our results provide insights into the association between the TyG index and coronary vascular function, which may inform clinical risk assessment.

[This corrects the article DOI: 10.21037/qims-2024-2962.].

Background: Microvascular invasion (MVI) is an independent risk factor for postoperative recurrence in hepatocellular carcinoma (HCC), making preoperative prediction clinically critical. This study aimed to identify factors associated with MVI and develop a clinically applicable predictive model using patient-derived variables, including serological markers, tumor morphology, and magnetic resonance imaging (MRI) features.

Methods: A retrospective analysis was conducted on 236 patients with HCC who underwent surgical resection between January 1, 2019, and December 31, 2022, at the Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Guangdong Medical University. Patients were randomly assigned to training and validation cohorts at a 1:1 ratio. Significant factors identified through univariate analysis with P values adjusted via the Benjamini-Hochberg method (adjusted P<0.05) were subjected to binary logistic regression to determine the independent risk factors for MVI in HCC. These factors were used to develop a nomogram for MVI prediction, with its diagnostic performance assessed through receiver operating characteristic (ROC) curves. Additionally, k-fold cross-validation (k=5) was performed to evaluate model stability.

Results: There were 236 patients included, with 118 in each cohort. Logistic regression identified four independent risk factors for MVI: arterial phase edge enhancement [odds ratio (OR) =4.610, P=0.011], incomplete tumor capsule (OR =4.513, P=0.013), alpha-fetoprotein (AFP) >800 ng/mL (OR =3.407, P=0.035), and intratumoral vascular enhancement (OR =6.300, P=0.022). In the training cohort, the area under the curve (AUC), sensitivity, specificity and Youden index (YI) of the nomogram were 0.871 (P<0.001), 78.8%, 80.0% and 0.645, respectively; while in the validation cohort, they were 0.878 (P<0.001), 83.9%, 86.2% and 0.689, respectively, with both cohorts' AUC results consistent with the average AUC of 0.860 from k-fold cross-validation. Decision curve analysis and calibration curve results confirmed high model accuracy and clinical benefit.

Conclusions: AFP >800 ng/mL, intratumoral vascular enhancement, arterial phase enhancement, and incomplete tumor capsule are independent risk factors for MVI in HCC. Combining serological, morphological, and MRI characteristics offers robust utility and accuracy in predicting MVI in HCC.

Background: Facial anthropometric analysis is a valuable tool for assessing growth and development in children. It allows for continuous patient monitoring, facilitates the identification of morphological variations and asymmetries, supports diagnostic processes, contributes to the planning and predictability of therapeutic interventions, and aids in evaluating treatment outcomes. This study aimed to evaluate Vectra H2^® stereophotogrammetry system for facial anthropometry analysis in children.

Methods: Thirty participants were selected, ranging from 5 to 12 years old. Prior to the acquisition of facial images, nineteen anatomical landmarks were marked with a black eyeliner pen on the participants' faces, so that 14 linear measurements could be quantified. The three-dimensional (3D) image of the facial surface was captured using the stereophotogrammetry equipment. First, linear measurements were quantified directly on the participant's face using a digital caliper. In the second phase of the anthropometric analysis, the same linear measurements were taken on the 3D image using stereophotogrammetry system software. Intraclass correlation coefficient (ICC) test was applied to evaluate intra- and inter-examiner errors. For data analysis, Pearson's and Spearman's correlation coefficient tests were applied. The mean absolute difference (MAD) was used to describe the differences. Data were presented as mean/standard deviation and median/interquartile deviation.

Results: All 14 facial measurements showed statistically significant difference (P<0.05). The measurements Tr-G, G-Pn, G-Sn, Ene-Che, and End-Chd demonstrated very strong correlation (r values between 0.9485 and 0.9026), while Ald-Ale, Exe-Che, Sn-Ls, Sn-Pg, Ls-Li, Exd-Chd, and Chd-Che measurements exhibited strong correlation (r values between 0.8821 and 0.7094). Acd-Ace and Cphe-Cphd measurements showed moderate correlation (r=0.5790 and r=0.6982). The measurements Sn-Ls and Ene-Che presented a lower MAD value (0.53), and the measurements Ald-Ale showed the highest value (5.38).

Conclusions: Vectra H2^® facial stereophotogrammetry system proved to be a validated and reliable method for facial anthropometry analysis in children.

Background: The value of hemodynamics in intracranial atherosclerotic stenosis (ICAS) patients has not been fully studied. The purpose of this study was to analyze the correlation between fractional flow (FF) and hypoperfusion in patients with ICAS of the anterior circulation, and compare the performance differences between FF and diameter stenosis (DS) in distinguishing hypoperfusion.

Methods: This study included patients with anterior circulation artery stenosis. The determination of cerebral perfusion stages and the calculation of perfusion parameters were based on the magnetic resonance imaging (MRI) perfusion images. The patients were divided into a normal perfusion group and a hypoperfusion group (stages I and II). DS and FF values were calculated on the basis of digital subtraction angiography images.

Results: We analyzed 58 patients. FF was negatively correlated with relative time to peak (r=-0.41, P=0.002) and relative mean transit time (r=-0.27, P=0.037). In groups with a larger time to maximum tissue residue function, FF had a lower distribution interval. FF was significantly different between normal perfusion patients and hypoperfusion patients (0.71±0.17 vs. 0.52±0.18, P<0.05), while DS was not (0.66±0.17 vs. 0.54±0.13, P=0.087). Multivariate analysis indicated FF (odds ratio, 0.08; 95% confidence interval: 0.01-0.80) was the only independent factor. Receiver operating characteristic analysis revealed the area under the curve for differentiating hypoperfusion from normal perfusion. The areas under the curve were 0.739 (0.597-0.850) for DS and 0.772 (0.632-0.876) for FF. The accuracy, sensitivity and specificity at the optimal cutoff (FF=0.61) were 76.6% (58.8-92.1%), 76.4% (56.5-93.3%) and 78.7% (58.3-95.8%), respectively.

Conclusions: There is a correlation between MRI perfusion and FF in patients with anterior circulation ICAS. A low FF may indicate a higher time to maximum tissue residue function and a poorer hypoperfusion stage. FF provides hemodynamic information that is distinct from and complementary to the anatomical assessment of DS. The ability to compute FF intraoperatively could, in the future, provide real-time feedback on physiological improvement following revascularization.

Background: With the increasing use of coronary computed tomography angiography (CCTA), isolated coronary artery fistulas (ICAFs) are increasingly identified during routine or non-targeted imaging, but the large-scale epidemiological and anatomical data remain limited. This study aims to explore the prevalence, anatomical features, and clinical manifestations of ICAFs in adults who underwent CCTA.

Methods: A retrospective analysis was performed on 378,556 consecutive adult patients who underwent CCTA at Fuwai Hospital between 2010 and 2022. Two experienced radiologists independently reviewed CCTA images to confirm the presence of ICAFs and assess their anatomical features, including origin, drainage site, and size. Demographic, clinical, and procedural data were analyzed to evaluate associations with symptoms and treatment strategies.

Results: A total of 252 adult patients with ICAFs were identified, yielding a prevalence of 0.07%. The mean age was 48.29±15.03 years, and 47.20% were male. The majority originated from the anterior descending artery (30.56%) and drained into the pulmonary artery (62.3%). The mean diameter of the fistula was 7.30±5.19 mm with 32.54% categorized as with large ICAFs. Symptomatic ICAFs patients were younger than asymptomatic patients (43.81±14.18 vs. 52.05±14.73 years, P=0.016). The average diameter of the draining site was larger in symptomatic ICAFs group (7.95 vs. 5.85 mm, P=0.033). Among the whole cohort, 70 patients underwent transcatheter closure and 28 patients underwent surgical closure, with no significant differences in baseline characteristics. The clinical efficacy was similar between both groups, however, transcatheter closure was infeasible in 15.71% of the attempted cases. Most untreated ICAFs patients maintained their physical activity levels and barely underwent follow-up assessments.

Conclusions: The prevalence of ICAFs was 0.07% among adult population who underwent CCTA. Large-sized ICAFs was the anatomical features significantly associated with clinical symptoms.

Background: Despite the high prevalence of hysterectomy, the procedure is associated with a significant risk of subsequent pelvic floor dysfunction (PFD). This study aimed to evaluate pelvic floor alterations following hysterectomy and bilateral adnexectomy using real-time shear wave elastography (SWE) and pelvic floor ultrasonography.

Methods: This is a retrospective case-control study. A total of 133 patients who underwent hysterectomy and bilateral adnexectomy for benign or malignant pelvic conditions were included. Participants were categorized into three groups based on the time elapsed since surgery: less than 1 year (n=41), 1-3 years (n=45), and more than 3 years (n=47). Additionally, 45 healthy individuals without a history of hysterectomy or bilateral adnexectomy were enrolled as the control group. Pelvic floor ultrasonography was performed to assess parameters at rest and during the Valsalva maneuver. Real-time SWE was used to measure the elasticity of the anterior, middle, and posterior regions of the bilateral puborectalis (PR) muscle during rest, pelvic floor muscle contraction, and the Valsalva maneuver. Comparisons between two groups were conducted using independent t-tests, whereas multiple group comparisons were analyzed using analysis of variance (ANOVA). For intra-group comparisons, paired sample t-tests were used.

Results: Pelvic floor ultrasonography revealed that, compared to the control group, all postoperative groups exhibited a reduced urethral inclination angle at rest and an increased angle during the Valsalva maneuver (P<0.05). The levator hiatus area (LHA) was significantly larger during the Valsalva maneuver in all postoperative groups compared to the control group (P<0.05). Patients in the 1-3 years and more than 3 years post-surgery groups demonstrated reduced distance from the anterior urethrovesical junction to the reference line and posterior bladder wall distance during both rest and the Valsalva maneuver compared to the control group (P<0.05). Additionally, the more than 3 years post-surgery group indicated an increased bladder neck mobility during the Valsalva maneuver. Real-time SWE measurements showed that PR elasticity was highest during pelvic floor muscle contraction in the control group, followed by the Valsalva maneuver and rest. Among the postoperative groups, PR elasticity at rest was lower than it was in the control group (P<0.05), with further reductions observed during pelvic floor muscle contraction in the 1-3 years and more than 3 years post-surgery groups.

Conclusions: Real-time SWE and ultrasonography reveal that hysterectomy with bilateral adnexectomy leads to progressive, quantifiable declines in pelvic floor muscle elasticity and structural support. These findings provide objective biomarkers for postoperative assessment and potential targets for personalized rehabilitation.

Background: Hepatocellular carcinoma (HCC) and liver-dominant metastases remain major causes of cancer mortality, and yttrium-90 transarterial radioembolization (TARE) offers a vital treatment option for unresectable cases. Accurate dosimetry is critical for maximizing tumor control while minimizing lung toxicity, yet conventional planar scintigraphy may overestimate lung shunt and compromise therapeutic efficacy. This study evaluated the value of Q.Liver software in planning yttrium-90 TARE for liver cancer.

Methods: A total of 45 patients with liver cancer scheduled for treatment with yttrium-90 resin microspheres TARE were enrolled. Treatment planning was conducted via the partition model with two approaches for each case: the traditional method based on planar scintigraphy and the Q.Liver software based on single-photon emission computed tomography-computed tomography (SPECT/CT) imaging. Differences in liver and lung volume between the two methods were compared. Differences in lung shunt fraction (LSF) were analyzed in 43 patients, and yttrium-90-prescribed activity, liver-absorbed dose (D_Liver), and lung-absorbed dose (D_Lung) were compared between the two methods for the same patient. In the planar method, liver and lung volumes were obtained by enhanced CT, and LSF was obtained by planar scintigraphy; in the Q.Liver method, LSF, liver and lung volumes were obtained via SPECT/CT. The yttrium-90-prescribed activity, D_Liver, and D_Lung of each method were calculated.

Results: (I) The liver and lung volumes in the planar and Q.Liver methods were 1,809 and 1,820 mL (P=0.36), respectively, and 3,279 and 2,587 mL (P<0.05), respectively. (II) The LSF in the planar method was higher than that in the Q.Liver method (6.08% vs. 3.96%). (III) Yttrium-90-prescribed activity was higher in the planar method than in the Q.Liver method (2.02 vs. 1.82 GBq), The sum of D_Lung was 345.53 Gy in the planar method and 221.82 Gy in the Q.Liver method. (IV) With D_Lung being constant in the treatment planning system, the yttrium-90 prescribed activity, DTumor and D_Liver, were higher in the Q.Liver method than in the planar method. This led to changes in 44.19% (19/43) of the treatment plans.

Conclusions: SPECT/CT-based Q.Liver software was able to simplify yttrium-90 treatment. Planar scintigraphy overestimated LSF and D_Lung as compared to SPECT/CT imaging. If D_Lung remained constant, Q.Liver software increased DTumor and D_Liver, leading to changes in 44.19% of the treatment plans involving yttrium-90 resin microsphere TARE.