Background: Chylopericardium refers to the accumulation of chylous fluid in the pericardial cavity. Non-enhanced magnetic resonance lymphangiography (MRL) can show neck and thoracic lymphatic abnormalities in the primary chylopericardium. It is not clear whether there is a relationship between neck and thoracic lymphatic abnormalities in primary chylopericardium and thoracic duct terminal release surgery. This study aimed to explore the correlation between the severity of neck and thoracic lymphatic abnormalities observed in non-enhanced MRL and the surgical outcomes in primary chylopericardium.
Methods: This is a retrospective cohort study. A retrospective analysis was conducted on fifty-six patients diagnosed with primary chylopericardium between January 2016 and December 2021, all of whom underwent thoracic duct terminal release surgery. Ultrasonography, chest computed tomography (CT) and non-enhanced MRL were performed prior to the surgical intervention. Patients were categorized into four types based on the severity of neck and thoracic lymphatic abnormalities observed in the non-enhanced MRL. Clinical and laboratory examinations and surgical outcomes were compared across different types using χ2-test or Fisher's exact test, t-test, and Kruskal-Wallis H-test. Additionally, independent factors influencing surgical outcomes were analyzed.
Results: Among primary chylopericardium cases (n=56), 22 (39.2%) were classified as type I or II, 17 (30.4%) as type III, and 17 (30.4%) as type IV. Surgical outcomes were more favorable for type I or II patients than those with type III or IV, accompanied by a reduction in postoperative primary chylopericardium volume (P=0.002). Postoperative chest CT scans indicated that type I or II patients had fewer instances of large grid shadows, small grid shadows, and bronchovascular bundle thickening compared to preoperative scans (P=0.001, P=0.02, P=0.03). Age and bronchomediastinal trunk dilation emerged as independent factors influencing surgical outcomes [odds ratio (OR) 0.03, 95% confidence interval (CI): 0.003-0.220, P=0.001; OR 11.10, 95% CI: 1.70-72.39, P=0.01, respectively].
Conclusions: A more severe degree of neck and thoracic lymphatic abnormalities is associated with worse surgical outcomes. Moreover, age and bronchomediastinal trunk dilatation are independent predictors of surgical outcomes. Preoperative utilization of non-enhanced MRL for severity of lymphatic abnormalities classification in primary chylopericardium patients offers a noninvasive means of assessing surgical risk.
背景:乳糜心包指的是心包腔内乳糜液的积聚。非增强磁共振淋巴管造影(MRL)可显示原发性乳糜心包炎的颈部和胸部淋巴异常。目前尚不清楚原发性乳糜胸的颈部和胸部淋巴异常与胸导管末端释放手术之间是否存在关系。本研究旨在探讨非增强型 MRL 观察到的颈部和胸部淋巴异常的严重程度与原发性乳糜胸手术结果之间的相关性:这是一项回顾性队列研究。对2016年1月至2021年12月期间诊断为原发性乳糜尿的56例患者进行了回顾性分析,所有患者均接受了胸导管末端释放手术。手术前进行了超声波检查、胸部计算机断层扫描(CT)和非增强型 MRL 检查。根据非增强 MRL 观察到的颈部和胸部淋巴异常的严重程度,将患者分为四种类型。采用χ 2检验或费雪精确检验、t检验和Kruskal-Wallis H检验比较不同类型患者的临床和实验室检查结果以及手术结果。此外,还分析了影响手术结果的独立因素:在原发性乳糜心包积液病例(n=56)中,22 例(39.2%)为 I 型或 II 型,17 例(30.4%)为 III 型,17 例(30.4%)为 IV 型。与 III 型或 IV 型患者相比,I 型或 II 型患者的手术效果更佳,术后原发性乳糜心包体积也有所减少(P=0.002)。术后胸部 CT 扫描显示,与术前扫描相比,I 型或 II 型患者出现大网格阴影、小网格阴影和支气管血管束增厚的情况较少(P=0.001、P=0.02、P=0.03)。年龄和支气管-纵隔干扩张是影响手术结果的独立因素[几率比(OR)分别为0.03,95%置信区间(CI):0.003-0.220,P=0.001;OR 11.10,95% CI:1.70-72.39,P=0.01]:颈部和胸部淋巴异常程度越严重,手术效果越差。此外,年龄和支气管-纵隔干扩张也是手术效果的独立预测因素。术前利用非增强型 MRL 对原发性乳糜胸患者的淋巴异常严重程度进行分类,为评估手术风险提供了一种无创手段。
{"title":"Association between lymphatic abnormalities in the neck and thorax in primary chylopericardium and surgical outcomes evaluated by non-enhanced magnetic resonance (MR) lymphangiography.","authors":"Yimeng Zhang, Xiaoli Sun, Mengke Liu, Xingpeng Li, Mingxia Zhang, Yongli Duan, Rengui Wang","doi":"10.21037/qims-24-144","DOIUrl":"10.21037/qims-24-144","url":null,"abstract":"<p><strong>Background: </strong>Chylopericardium refers to the accumulation of chylous fluid in the pericardial cavity. Non-enhanced magnetic resonance lymphangiography (MRL) can show neck and thoracic lymphatic abnormalities in the primary chylopericardium. It is not clear whether there is a relationship between neck and thoracic lymphatic abnormalities in primary chylopericardium and thoracic duct terminal release surgery. This study aimed to explore the correlation between the severity of neck and thoracic lymphatic abnormalities observed in non-enhanced MRL and the surgical outcomes in primary chylopericardium.</p><p><strong>Methods: </strong>This is a retrospective cohort study. A retrospective analysis was conducted on fifty-six patients diagnosed with primary chylopericardium between January 2016 and December 2021, all of whom underwent thoracic duct terminal release surgery. Ultrasonography, chest computed tomography (CT) and non-enhanced MRL were performed prior to the surgical intervention. Patients were categorized into four types based on the severity of neck and thoracic lymphatic abnormalities observed in the non-enhanced MRL. Clinical and laboratory examinations and surgical outcomes were compared across different types using <i>χ</i> <sup>2</sup>-test or Fisher's exact test, <i>t</i>-test, and Kruskal-Wallis H-test. Additionally, independent factors influencing surgical outcomes were analyzed.</p><p><strong>Results: </strong>Among primary chylopericardium cases (n=56), 22 (39.2%) were classified as type I or II, 17 (30.4%) as type III, and 17 (30.4%) as type IV. Surgical outcomes were more favorable for type I or II patients than those with type III or IV, accompanied by a reduction in postoperative primary chylopericardium volume (P=0.002). Postoperative chest CT scans indicated that type I or II patients had fewer instances of large grid shadows, small grid shadows, and bronchovascular bundle thickening compared to preoperative scans (P=0.001, P=0.02, P=0.03). Age and bronchomediastinal trunk dilation emerged as independent factors influencing surgical outcomes [odds ratio (OR) 0.03, 95% confidence interval (CI): 0.003-0.220, P=0.001; OR 11.10, 95% CI: 1.70-72.39, P=0.01, respectively].</p><p><strong>Conclusions: </strong>A more severe degree of neck and thoracic lymphatic abnormalities is associated with worse surgical outcomes. Moreover, age and bronchomediastinal trunk dilatation are independent predictors of surgical outcomes. Preoperative utilization of non-enhanced MRL for severity of lymphatic abnormalities classification in primary chylopericardium patients offers a noninvasive means of assessing surgical risk.</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/PMC11320522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983958","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: 2024-01-19DOI: 10.21037/qims-23-1028
Xiaohui Yao, Yuan Zhu, Zhenxing Huang, Yue Wang, Shan Cong, Liwen Wan, Ruodai Wu, Long Chen, Zhanli Hu
Background: Non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor-sensitizing (EGFR-sensitizing) mutations exhibit a positive response to tyrosine kinase inhibitors (TKIs). Given the limitations of current clinical predictive methods, it is critical to explore radiomics-based approaches. In this study, we leveraged deep-learning technology with multimodal radiomics data to more accurately predict EGFR-sensitizing mutations.
Methods: A total of 202 patients who underwent both flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans and EGFR sequencing prior to treatment were included in this study. Deep and shallow features were extracted by a residual neural network and the Python package PyRadiomics, respectively. We used least absolute shrinkage and selection operator (LASSO) regression to select predictive features and applied a support vector machine (SVM) to classify the EGFR-sensitive patients. Moreover, we compared predictive performance across different deep models and imaging modalities.
Results: In the classification of EGFR-sensitive mutations, the areas under the curve (AUCs) of ResNet-based deep-shallow features and only shallow features from different multidata were as follows: RES_TRAD, PET/CT vs. CT-only vs. PET-only: 0.94 vs. 0.89 vs. 0.92; and ONLY_TRAD, PET/CT vs. CT-only vs. PET-only: 0.68 vs. 0.50 vs. 0.38. Additionally, the receiver operating characteristic (ROC) curves of the model using both deep and shallow features were significantly different from those of the model built using only shallow features (P<0.05).
Conclusions: Our findings suggest that deep features significantly enhance the detection of EGFR-sensitizing mutations, especially those extracted with ResNet. Moreover, PET/CT images are more effective than CT-only and PET-only images in producing EGFR-sensitizing mutation-related signatures.
背景:表皮生长因子受体致敏(EGFR-致敏)突变的非小细胞肺癌(NSCLC)患者对酪氨酸激酶抑制剂(TKIs)呈阳性反应。鉴于目前临床预测方法的局限性,探索基于放射组学的方法至关重要。在这项研究中,我们将深度学习技术与多模态放射组学数据相结合,以更准确地预测表皮生长因子受体(EGFR)致敏突变:本研究共纳入了202名患者,他们在治疗前均接受了面粉碱-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(18F-FDG PET/CT)扫描和表皮生长因子受体测序。深层和浅层特征分别由残差神经网络和 Python 软件包 PyRadiomics 提取。我们使用最小绝对收缩和选择算子(LASSO)回归来选择预测特征,并应用支持向量机(SVM)对表皮生长因子受体敏感的患者进行分类。此外,我们还比较了不同深度模型和成像模式的预测性能:在表皮生长因子受体敏感突变的分类中,基于 ResNet 的深层-浅层特征和仅来自不同多数据的浅层特征的曲线下面积(AUC)如下:RES_TRAD,PET/CT vs. 仅 CT vs. 仅 PET:0.94 vs. 0.89 vs. 0.92;ONLY_TRAD,PET/CT vs. 仅 CT vs. 仅 PET:0.68 vs. 0.50 vs. 0.38。此外,使用深层和浅层特征的模型的接收器操作特征曲线(ROC)与仅使用浅层特征的模型的接收器操作特征曲线(PConclusions:我们的研究结果表明,深度特征能显著提高表皮生长因子受体敏感突变的检测能力,尤其是使用 ResNet 提取的深度特征。此外,在生成表皮生长因子受体敏感突变相关特征方面,PET/CT 图像比纯 CT 图像和纯 PET 图像更有效。
{"title":"Fusion of shallow and deep features from <sup>18</sup>F-FDG PET/CT for predicting EGFR-sensitizing mutations in non-small cell lung cancer.","authors":"Xiaohui Yao, Yuan Zhu, Zhenxing Huang, Yue Wang, Shan Cong, Liwen Wan, Ruodai Wu, Long Chen, Zhanli Hu","doi":"10.21037/qims-23-1028","DOIUrl":"10.21037/qims-23-1028","url":null,"abstract":"<p><strong>Background: </strong>Non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor-sensitizing (EGFR-sensitizing) mutations exhibit a positive response to tyrosine kinase inhibitors (TKIs). Given the limitations of current clinical predictive methods, it is critical to explore radiomics-based approaches. In this study, we leveraged deep-learning technology with multimodal radiomics data to more accurately predict EGFR-sensitizing mutations.</p><p><strong>Methods: </strong>A total of 202 patients who underwent both flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography (<sup>18</sup>F-FDG PET/CT) scans and EGFR sequencing prior to treatment were included in this study. Deep and shallow features were extracted by a residual neural network and the Python package PyRadiomics, respectively. We used least absolute shrinkage and selection operator (LASSO) regression to select predictive features and applied a support vector machine (SVM) to classify the EGFR-sensitive patients. Moreover, we compared predictive performance across different deep models and imaging modalities.</p><p><strong>Results: </strong>In the classification of EGFR-sensitive mutations, the areas under the curve (AUCs) of ResNet-based deep-shallow features and only shallow features from different multidata were as follows: RES_TRAD, PET/CT <i>vs</i>. CT-only <i>vs</i>. PET-only: 0.94 <i>vs</i>. 0.89 <i>vs</i>. 0.92; and ONLY_TRAD, PET/CT <i>vs</i>. CT-only <i>vs</i>. PET-only: 0.68 <i>vs</i>. 0.50 <i>vs</i>. 0.38. Additionally, the receiver operating characteristic (ROC) curves of the model using both deep and shallow features were significantly different from those of the model built using only shallow features (P<0.05).</p><p><strong>Conclusions: </strong>Our findings suggest that deep features significantly enhance the detection of EGFR-sensitizing mutations, especially those extracted with ResNet. Moreover, PET/CT images are more effective than CT-only and PET-only images in producing EGFR-sensitizing mutation-related signatures.</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/PMC11320501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983966","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: Programmed death ligand-1 (PD-L1) expression serves a predictive biomarker for the efficacy of immune checkpoint inhibitors (ICIs) in the treatment of patients with early-stage lung adenocarcinoma (LA). However, only a limited number of studies have explored the relationship between PD-L1 expression and spectral dual-layer detector-based computed tomography (SDCT) quantification, qualitative parameters, and clinical biomarkers. Therefore, this study was conducted to clarify this relationship in stage I LA and to develop a nomogram to assist in preoperative individualized identification of PD-L1-positive expression.
Methods: We analyzed SDCT parameters and PD-L1 expression in patients diagnosed with invasive nonmucinous LA through postoperative pathology. Patients were categorized into PD-L1-positive and PD-L1-negative expression groups based on a threshold of 1%. A retrospective set (N=356) was used to develop and internally validate the radiological and biomarker features collected from predictive models. Univariate analysis was employed to reduce dimensionality, and logistic regression was used to establish a nomogram for predicting PD-L1 expression. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves, and external validation was performed in an independent set (N=80).
Results: The proportions of solid components and pleural indentations were higher in the PD-L1-positive group, as indicated by the computed tomography (CT) value, CT at 40 keV (CT40keV; a/v), electron density (ED; a/v), and thymidine kinase 1 (TK1) exhibiting a positive correlation with PD-L1 expression. In contrast, the effective atomic number (Zeff; a/v) showed a negative correlation with PD-L1 expression [r=-0.4266 (Zeff.a), -0.1131 (Zeff.v); P<0.05]. After univariate analysis, 18 parameters were found to be associated with PD-L1 expression. Multiple regression analysis was performed on significant parameters with an area under the curve (AUC) >0.6, and CT value [AUC =0.627; odds ratio (OR) =0.993; P=0.033], CT40keV.a (AUC =0.642; OR =1.006; P=0.025), arterial Zeff (Zeff.a) (AUC =0.756; OR =0.102; P<0.001), arterial ED (ED.a) (AUC =0.641; OR =1.158, P<0.001), venous ED (ED.v) (AUC =0.607; OR =0.864; P<0.001), TK1 (AUC =0.601; OR =1.245; P=0.026), and diameter of solid components (Dsolid) (AUC =0.632; OR =1.058; P=0.04) were found to be independent risk factors for PD-L1 expression in stage I LA. These seven predictive factors were integrated into the development of an SDCT parameter-clinical nomogram, which demonstrated satisfactory discrimination ability in the training set [AUC =0.853; 95% confidence interval (CI): 0.76-0.947], internal validation set (AUC =0.824; 95% CI: 0.775-0.874), and external validation set (AUC =0.825; 95% CI: 0.733-0.918). Decision curve analys
{"title":"Predictive value of spectral dual-detector computed tomography for <i>PD-L1</i> expression in stage I lung adenocarcinoma: development and validation of a novel nomogram.","authors":"Tong Wang, Zheng Fan, Yong Yue, Xiaomei Lu, Xiaoxu Deng, Yang Hou","doi":"10.21037/qims-24-15","DOIUrl":"10.21037/qims-24-15","url":null,"abstract":"<p><strong>Background: </strong>Programmed death ligand-1 (<i>PD-L1</i>) expression serves a predictive biomarker for the efficacy of immune checkpoint inhibitors (ICIs) in the treatment of patients with early-stage lung adenocarcinoma (LA). However, only a limited number of studies have explored the relationship between <i>PD-L1</i> expression and spectral dual-layer detector-based computed tomography (SDCT) quantification, qualitative parameters, and clinical biomarkers. Therefore, this study was conducted to clarify this relationship in stage I LA and to develop a nomogram to assist in preoperative individualized identification of <i>PD-L1</i>-positive expression.</p><p><strong>Methods: </strong>We analyzed SDCT parameters and <i>PD-L1</i> expression in patients diagnosed with invasive nonmucinous LA through postoperative pathology. Patients were categorized into <i>PD-L1</i>-positive and <i>PD-L1</i>-negative expression groups based on a threshold of 1%. A retrospective set (N=356) was used to develop and internally validate the radiological and biomarker features collected from predictive models. Univariate analysis was employed to reduce dimensionality, and logistic regression was used to establish a nomogram for predicting <i>PD-L1</i> expression. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves, and external validation was performed in an independent set (N=80).</p><p><strong>Results: </strong>The proportions of solid components and pleural indentations were higher in the <i>PD-L1</i>-positive group, as indicated by the computed tomography (CT) value, CT at 40 keV (CT40keV; a/v), electron density (ED; a/v), and thymidine kinase 1 (TK1) exhibiting a positive correlation with <i>PD-L1</i> expression. In contrast, the effective atomic number (Zeff; a/v) showed a negative correlation with <i>PD-L1</i> expression [r=-0.4266 (Zeff.a), -0.1131 (Zeff.v); P<0.05]. After univariate analysis, 18 parameters were found to be associated with <i>PD-L1</i> expression. Multiple regression analysis was performed on significant parameters with an area under the curve (AUC) >0.6, and CT value [AUC =0.627; odds ratio (OR) =0.993; P=0.033], CT40keV.a (AUC =0.642; OR =1.006; P=0.025), arterial Zeff (Zeff.a) (AUC =0.756; OR =0.102; P<0.001), arterial ED (ED.a) (AUC =0.641; OR =1.158, P<0.001), venous ED (ED.v) (AUC =0.607; OR =0.864; P<0.001), TK1 (AUC =0.601; OR =1.245; P=0.026), and diameter of solid components (Dsolid) (AUC =0.632; OR =1.058; P=0.04) were found to be independent risk factors for PD-L1 expression in stage I LA. These seven predictive factors were integrated into the development of an SDCT parameter-clinical nomogram, which demonstrated satisfactory discrimination ability in the training set [AUC =0.853; 95% confidence interval (CI): 0.76-0.947], internal validation set (AUC =0.824; 95% CI: 0.775-0.874), and external validation set (AUC =0.825; 95% CI: 0.733-0.918). Decision curve analys","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/PMC11320513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984294","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 : 2024-07-01Epub Date: 2024-06-27DOI: 10.21037/qims-23-1407
Lekang Yin, Cheng Yan, Weifeng Guo, Chun Yang, Hao Dong, Yang Zhang, Shijie Xu, Mengsu Zeng
Background: Epicardial adipose tissue (EAT) is unique type of visceral adipose tissue, sharing the same microcirculation with myocardium. This study aimed to assess the imaging features of EAT in patients with acute myocarditis (AM) and explore the relationships with clinical characteristics.
Methods: For this retrospective case-control study, totally 38 AM patients and 52 controls were screened retrospectively from January 2019 to December 2022, and the EAT volume was measured from coronary computed tomography (CT) angiography imaging. Histogram analysis was performed to calculate parameters like the mean, standard deviation, interquartile range and percentiles of EAT attenuation. Whether EAT features change was assessed when clinical characteristics including symptoms, T wave abnormalities, pericardial effusion (PE), impairment of systolic function, and the need for intensive care presented.
Results: The EAT volume (75.2±22.8 mL) and mean EAT attenuation [-75.8±4.4 Hounsfield units (HU)] of the AM group was significantly larger than the control group (64.7±26.0 mL, P=0.049; -77.9±5.0 HU, P=0.044). Among the clinical characteristics, only the presence of PE was associated with changes in EAT features. Patients with PE showed significantly changes in EAT attenuation including mean attenuation [analysis of variance (ANOVA) P=0.001] and quantitative histogram parameters. The mean attenuation of patients with PE (-71.9±4.0 HU) was significantly larger than controls (-77.9±5.0 HU, Bonferroni corrected P<0.001) and patients without PE (-77.4±3.5 HU, Bonferroni corrected P=0.003). Observed in histogram, the overall increase in EAT attenuation could lead to decrease in EAT volume, which resulted in no statistically significant difference in EAT volume between the AM patients with PE and controls (64.7±26.0 vs. 72.2±28.3 mL, Bonferroni corrected P>0.99).
Conclusions: Compared to controls, EAT volume was significantly larger in AM, and EAT attenuation increased notably in the presence of PE. We recommend evaluating EAT volume and attenuation simultaneously when quantifying EAT using CT attenuation thresholds.
{"title":"Correlation between clinical characteristics and epicardial adipose tissue features in acute myocarditis patients using coronary computed tomography (CT) vascular imaging: a case-control study with retrospective data collection.","authors":"Lekang Yin, Cheng Yan, Weifeng Guo, Chun Yang, Hao Dong, Yang Zhang, Shijie Xu, Mengsu Zeng","doi":"10.21037/qims-23-1407","DOIUrl":"10.21037/qims-23-1407","url":null,"abstract":"<p><strong>Background: </strong>Epicardial adipose tissue (EAT) is unique type of visceral adipose tissue, sharing the same microcirculation with myocardium. This study aimed to assess the imaging features of EAT in patients with acute myocarditis (AM) and explore the relationships with clinical characteristics.</p><p><strong>Methods: </strong>For this retrospective case-control study, totally 38 AM patients and 52 controls were screened retrospectively from January 2019 to December 2022, and the EAT volume was measured from coronary computed tomography (CT) angiography imaging. Histogram analysis was performed to calculate parameters like the mean, standard deviation, interquartile range and percentiles of EAT attenuation. Whether EAT features change was assessed when clinical characteristics including symptoms, T wave abnormalities, pericardial effusion (PE), impairment of systolic function, and the need for intensive care presented.</p><p><strong>Results: </strong>The EAT volume (75.2±22.8 mL) and mean EAT attenuation [-75.8±4.4 Hounsfield units (HU)] of the AM group was significantly larger than the control group (64.7±26.0 mL, P=0.049; -77.9±5.0 HU, P=0.044). Among the clinical characteristics, only the presence of PE was associated with changes in EAT features. Patients with PE showed significantly changes in EAT attenuation including mean attenuation [analysis of variance (ANOVA) P=0.001] and quantitative histogram parameters. The mean attenuation of patients with PE (-71.9±4.0 HU) was significantly larger than controls (-77.9±5.0 HU, Bonferroni corrected P<0.001) and patients without PE (-77.4±3.5 HU, Bonferroni corrected P=0.003). Observed in histogram, the overall increase in EAT attenuation could lead to decrease in EAT volume, which resulted in no statistically significant difference in EAT volume between the AM patients with PE and controls (64.7±26.0 <i>vs.</i> 72.2±28.3 mL, Bonferroni corrected P>0.99).</p><p><strong>Conclusions: </strong>Compared to controls, EAT volume was significantly larger in AM, and EAT attenuation increased notably in the presence of PE. We recommend evaluating EAT volume and attenuation simultaneously when quantifying EAT using CT attenuation thresholds.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635665","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 : 2024-07-01Epub Date: 2024-06-27DOI: 10.21037/qims-24-417
Wei-Chieh Diau, Chiu-Yang Lee, I-Ming Chen, Tzu-Ting Kuo
Background: No recommendations have been made regarding the puncture position during tunnelled dialysis catheter (TDC) insertion from right internal jugular vein (RIJV). We investigated the effect of puncture positioning along with other characteristics and clinical factors associated with TDCs to determine their correlation with catheter patency rate.
Methods: We retrospectively reviewed TDC insertion procedures performed between January 2018 and December 2020 at a single institution. Patients were monitored for at least 1 year or until TDC removal or replacement. The distance on the post-operative chest radiography were measured to determine the height of puncture position. End points were freedom from catheter dysfunction.
Results: Total 949 catheters met the eligibility criteria. Catheter dysfunction occurred in 233 patients and catheter infection in 127 patients. By multivariate analysis, female sex [hazard ratio (HR) =1.497, 95% confidence interval (CI): 1.119-2.002; P=0.007] and split-tip catheter (HR =1.453, 95% CI: 1.087-1.944; P=0.012) were associated with an increased rate of catheter dysfunction. Every 10-year increment in age (HR =1.243, 95% CI: 1.123-1.376; P<0.001) and every 1-cm increase in the height of the catheter insertion site (HR =1.270, 95% CI: 1.096-1.473; P=0.001) were also associated with an increased rate of catheter dysfunction. After classifying the height of puncture position into 3 groups, significant worse patency was observed in the catheter with puncture height more than 4 cm (P=0.025). No immediate complications were observed.
Conclusions: TDC insertion at a high puncture site correlates with an increased risk of catheter dysfunction. Puncturing the RIJV close to the clavicle is safe and enhances catheter patency.
{"title":"Effect of puncture position on catheter patency rate during tunnelled dialysis catheter insertion from the right internal jugular vein.","authors":"Wei-Chieh Diau, Chiu-Yang Lee, I-Ming Chen, Tzu-Ting Kuo","doi":"10.21037/qims-24-417","DOIUrl":"10.21037/qims-24-417","url":null,"abstract":"<p><strong>Background: </strong>No recommendations have been made regarding the puncture position during tunnelled dialysis catheter (TDC) insertion from right internal jugular vein (RIJV). We investigated the effect of puncture positioning along with other characteristics and clinical factors associated with TDCs to determine their correlation with catheter patency rate.</p><p><strong>Methods: </strong>We retrospectively reviewed TDC insertion procedures performed between January 2018 and December 2020 at a single institution. Patients were monitored for at least 1 year or until TDC removal or replacement. The distance on the post-operative chest radiography were measured to determine the height of puncture position. End points were freedom from catheter dysfunction.</p><p><strong>Results: </strong>Total 949 catheters met the eligibility criteria. Catheter dysfunction occurred in 233 patients and catheter infection in 127 patients. By multivariate analysis, female sex [hazard ratio (HR) =1.497, 95% confidence interval (CI): 1.119-2.002; P=0.007] and split-tip catheter (HR =1.453, 95% CI: 1.087-1.944; P=0.012) were associated with an increased rate of catheter dysfunction. Every 10-year increment in age (HR =1.243, 95% CI: 1.123-1.376; P<0.001) and every 1-cm increase in the height of the catheter insertion site (HR =1.270, 95% CI: 1.096-1.473; P=0.001) were also associated with an increased rate of catheter dysfunction. After classifying the height of puncture position into 3 groups, significant worse patency was observed in the catheter with puncture height more than 4 cm (P=0.025). No immediate complications were observed.</p><p><strong>Conclusions: </strong>TDC insertion at a high puncture site correlates with an increased risk of catheter dysfunction. Puncturing the RIJV close to the clavicle is safe and enhances catheter patency.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635759","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 : 2024-07-01Epub Date: 2024-06-21DOI: 10.21037/qims-24-223
Attila Nemes, Árpád Kormányos, Gergely Rácz, Nóra Ambrus, Csaba Lengyel
Background: There is a close relationship between volumes of the right atrium (RA) and dimensions and derived functional sphincter-like features of the tricuspid annulus (TA). However, its relation to longitudinal TA motion is not clear, which can even be considered to be a characteristic of the longitudinal shortening of the right ventricle (RV) and represented by TA plane systolic excursion (TAPSE). Therefore, the aim of this cohort study was to perform a detailed analysis of the relationship of three-dimensional speckle-tracking echocardiography (3DSTE)-derived RA volumes and RV longitudinal shortening in healthy individuals. These parameters were also examined in case of average values and larger/smaller than mean values.
Methods: The present study comprised 93 healthy adults (mean age: 27.7±6.3 years, 46 men), who participated in a complete medical investigation including two-dimensional, TAPSE, Doppler and 3DSTE-derived RA volumetric echocardiographic assessments.
Results: RA volumes, stroke volumes and emptying fractions were not related to TAPSE. In case of low, mean and high TAPSE, maximum [50.4±22.4 vs. 49.5±15.5 vs. 49.0±15.8 mL, P= not significant (ns)], preatrial contraction (36.9±16.8 vs. 34.5±10.4 vs. 35.6±10.5 mL, P= ns) and minimum (28.7±13.6 vs. 27.2±9.4 vs. 26.6±9.3 mL, P= ns) RA volumes did not differ. Higher RA volumes showed no associations with TAPSE either.
Conclusions: 3DSTE-derived RA volumes and M-mode echocardiography-derived TAPSE representing RV longitudinal shortening are not associated in healthy adults. None of the RA volumes showed correlations with TAPSE.
背景:右心房(RA)的体积与三尖瓣环(TA)的尺寸和衍生的括约肌样功能特征之间存在密切关系。然而,其与三尖瓣环纵向运动的关系并不明确,甚至可以认为三尖瓣环纵向运动是右心室(RV)纵向缩短的一个特征,并以三尖瓣环平面收缩期偏移(TAPSE)为代表。因此,这项队列研究的目的是详细分析三维斑点追踪超声心动图(3DSTE)得出的健康人右心室容积与右心室纵向缩短的关系。这些参数还检查了平均值和大于/小于平均值的情况:本研究包括 93 名健康成年人(平均年龄:27.7±6.3 岁,46 名男性),他们参加了完整的医学调查,包括二维、TAPSE、多普勒和 3DSTE 导出的 RA 容积超声心动图评估:RA 容量、搏出量和排空分数与 TAPSE 无关。在低TAPSE、平均TAPSE和高TAPSE的情况下,最大[50.4±22.4 vs. 49.5±15.5 vs. 49.0±15.8 mL,P=无显著性(ns)]、心房前收缩(36.9±16.8 vs. 34.5±10.4 vs. 35.6±10.5 mL,P= ns)和最小(28.7±13.6 vs. 27.2±9.4 vs. 26.6±9.3 mL,P= ns)RA 容量没有差异。较高的 RA 容量与 TAPSE 也没有关联:结论:在健康成年人中,3DSTE 导出的 RA 容量与 M 型超声心动图导出的代表 RV 纵向缩短的 TAPSE 无关。没有一种 RA 容量与 TAPSE 呈相关性。
{"title":"Right ventricular longitudinal shortening and right atrial volumes are not associated in healthy adults-detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study.","authors":"Attila Nemes, Árpád Kormányos, Gergely Rácz, Nóra Ambrus, Csaba Lengyel","doi":"10.21037/qims-24-223","DOIUrl":"10.21037/qims-24-223","url":null,"abstract":"<p><strong>Background: </strong>There is a close relationship between volumes of the right atrium (RA) and dimensions and derived functional sphincter-like features of the tricuspid annulus (TA). However, its relation to longitudinal TA motion is not clear, which can even be considered to be a characteristic of the longitudinal shortening of the right ventricle (RV) and represented by TA plane systolic excursion (TAPSE). Therefore, the aim of this cohort study was to perform a detailed analysis of the relationship of three-dimensional speckle-tracking echocardiography (3DSTE)-derived RA volumes and RV longitudinal shortening in healthy individuals. These parameters were also examined in case of average values and larger/smaller than mean values.</p><p><strong>Methods: </strong>The present study comprised 93 healthy adults (mean age: 27.7±6.3 years, 46 men), who participated in a complete medical investigation including two-dimensional, TAPSE, Doppler and 3DSTE-derived RA volumetric echocardiographic assessments.</p><p><strong>Results: </strong>RA volumes, stroke volumes and emptying fractions were not related to TAPSE. In case of low, mean and high TAPSE, maximum [50.4±22.4 <i>vs.</i> 49.5±15.5 <i>vs.</i> 49.0±15.8 mL, P= not significant (ns)], preatrial contraction (36.9±16.8 <i>vs.</i> 34.5±10.4 <i>vs.</i> 35.6±10.5 mL, P= ns) and minimum (28.7±13.6 <i>vs.</i> 27.2±9.4 <i>vs.</i> 26.6±9.3 mL, P= ns) RA volumes did not differ. Higher RA volumes showed no associations with TAPSE either.</p><p><strong>Conclusions: </strong>3DSTE-derived RA volumes and M-mode echocardiography-derived TAPSE representing RV longitudinal shortening are not associated in healthy adults. None of the RA volumes showed correlations with TAPSE.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635766","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 American College of Radiology (ACR) developed the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for pure blood contrast agents, but Sonazoid was not included. Modifications to LI-RADS have been proposed for Sonazoid. The purpose of this meta-analysis was to identify and compare the diagnostic efficacy of the two LI-RADS algorithms of Sonazoid.
Methods: We searched the PubMed, MEDLINE, Web of Science, Embase, and Cochrane Library databases from databases inception to August 31, 2023, to find original studies on the ACR LI-RADS and/or modified LI-RADS algorithm with Sonazoid used as the contrast agent in patients with high-risk hepatocellular carcinoma (HCC). A bivariate random-effects model was used. Data pooling, meta-regression, and sensitivity analysis were performed for meta-analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the methodological quality, and the Deeks funnel plot asymmetry test was used to evaluate the publication bias.
Results: A meta-analysis of 10 studies with 1,611 observations was conducted. The pooled data for ACR LI-RADS category 5 (LR-5) and modified LR-5 were respectively as follows: pooled sensitivity, 0.70 [95% confidence interval (CI): 0.64-0.75] and 0.81 (95% CI: 0.76-0.86) (P<0.05); pooled specificity, 0.90 (95% CI: 0.82-0.94) and 0.87 (95% CI: 0.81-0.91) (P>0.05); and pooled area under the summary receiver operating characteristic curve, 0.84 and 0.91. The diagnostic performance of LI-RADS category M (LR-M) of the two algorithms was comparable. Study heterogeneity was observed.
Conclusions: The results indicated that modified LR-5 algorithm demonstrated improved diagnostic sensitivity compared with the ACR LR-5 algorithm of Sonazoid, with differences observed between the different versions. Further research is needed to validate and explore the optimal diagnostic criteria for HCC using Sonazoid. Before the database search was conducted, this study was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42023455220).
{"title":"The American College of Radiology contrast-enhanced ultrasound Liver Imaging Reporting and Data System and its modified version in diagnosing hepatocellular carcinoma via Sonazoid: a meta-analysis.","authors":"Jiazhi Cao, Hong Wang, Xiaomiao Ruan, Jingwen Yang, Youxiang Ren, Wenwu Ling","doi":"10.21037/qims-23-1459","DOIUrl":"10.21037/qims-23-1459","url":null,"abstract":"<p><strong>Background: </strong>The American College of Radiology (ACR) developed the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for pure blood contrast agents, but Sonazoid was not included. Modifications to LI-RADS have been proposed for Sonazoid. The purpose of this meta-analysis was to identify and compare the diagnostic efficacy of the two LI-RADS algorithms of Sonazoid.</p><p><strong>Methods: </strong>We searched the PubMed, MEDLINE, Web of Science, Embase, and Cochrane Library databases from databases inception to August 31, 2023, to find original studies on the ACR LI-RADS and/or modified LI-RADS algorithm with Sonazoid used as the contrast agent in patients with high-risk hepatocellular carcinoma (HCC). A bivariate random-effects model was used. Data pooling, meta-regression, and sensitivity analysis were performed for meta-analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the methodological quality, and the Deeks funnel plot asymmetry test was used to evaluate the publication bias.</p><p><strong>Results: </strong>A meta-analysis of 10 studies with 1,611 observations was conducted. The pooled data for ACR LI-RADS category 5 (LR-5) and modified LR-5 were respectively as follows: pooled sensitivity, 0.70 [95% confidence interval (CI): 0.64-0.75] and 0.81 (95% CI: 0.76-0.86) (P<0.05); pooled specificity, 0.90 (95% CI: 0.82-0.94) and 0.87 (95% CI: 0.81-0.91) (P>0.05); and pooled area under the summary receiver operating characteristic curve, 0.84 and 0.91. The diagnostic performance of LI-RADS category M (LR-M) of the two algorithms was comparable. Study heterogeneity was observed.</p><p><strong>Conclusions: </strong>The results indicated that modified LR-5 algorithm demonstrated improved diagnostic sensitivity compared with the ACR LR-5 algorithm of Sonazoid, with differences observed between the different versions. Further research is needed to validate and explore the optimal diagnostic criteria for HCC using Sonazoid. Before the database search was conducted, this study was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42023455220).</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635769","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 : 2024-07-01Epub Date: 2024-05-21DOI: 10.21037/qims-23-1860
Xinru Deng, Xinlan Xiao
{"title":"Intracranial granulomatous inflammation caused by cryptococcal infection: a case study and literature analysis.","authors":"Xinru Deng, Xinlan Xiao","doi":"10.21037/qims-23-1860","DOIUrl":"10.21037/qims-23-1860","url":null,"abstract":"","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635784","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 : 2024-07-01Epub Date: 2024-06-17DOI: 10.21037/qims-24-202
Luni Zhang, Caixia Jia, Shiyao Gu, Jing Chen, Rong Wu
Background: Intraplaque neovascularization (IPN) is a biomarker for vulnerable atherosclerotic plaques and can be effectively visualized via contrast-enhanced ultrasound (CEUS). Plaque elasticity is influenced by elements such as lipid core and fibrosis and can be quantitatively assessed on shear wave elastography (SWE). Studies combining the use of CEUS and SWE for the assessment of stroke risk are currently lacking. Our study thus aimed to determine the predictive value of IPN combined with plaque elasticity among patients with asymptomatic carotid plaque.
Methods: Consecutive patients with mild carotid stenosis who underwent CEUS and SWE were retrospectively analyzed. IPN was graded according to the presence and location of microbubbles within the plaque, while plaque elasticity was measured in terms of mean shear wave velocity (SWV). All patients were followed up for 6 months to monitor the development of ischemic stroke. The predictive values of IPN and SWV, individually and in combination, were assessed.
Results: A total of 121 patients were included, of whom 95 (78.5%) were male. The mean age was 63.1±10.7 years. Both grade 2 IPN [hazard ratio (HR) =2.37, 95% confidence interval (CI): 1.58-9.65; P=0.039] and SWV (HR =0.43, 95% CI: 0.20-0.95; P=0.038) were independently associated with future ischemic stroke events. The combined model demonstrated a significantly better predictive performance (HR =3.243, 95% CI: 1.87-6.17; P=0.027).
Conclusions: The combination of IPN and SWV demonstrated significantly better predictive value for the risk of stroke. Our combined model thereby has the potential to guide the clinical stratification and management of patients with asymptomatic mild carotid stenosis.
{"title":"Intraplaque neovascularization combined with plaque elasticity for predicting ipsilateral stroke in patients with asymptomatic mild carotid stenosis.","authors":"Luni Zhang, Caixia Jia, Shiyao Gu, Jing Chen, Rong Wu","doi":"10.21037/qims-24-202","DOIUrl":"10.21037/qims-24-202","url":null,"abstract":"<p><strong>Background: </strong>Intraplaque neovascularization (IPN) is a biomarker for vulnerable atherosclerotic plaques and can be effectively visualized via contrast-enhanced ultrasound (CEUS). Plaque elasticity is influenced by elements such as lipid core and fibrosis and can be quantitatively assessed on shear wave elastography (SWE). Studies combining the use of CEUS and SWE for the assessment of stroke risk are currently lacking. Our study thus aimed to determine the predictive value of IPN combined with plaque elasticity among patients with asymptomatic carotid plaque.</p><p><strong>Methods: </strong>Consecutive patients with mild carotid stenosis who underwent CEUS and SWE were retrospectively analyzed. IPN was graded according to the presence and location of microbubbles within the plaque, while plaque elasticity was measured in terms of mean shear wave velocity (SWV). All patients were followed up for 6 months to monitor the development of ischemic stroke. The predictive values of IPN and SWV, individually and in combination, were assessed.</p><p><strong>Results: </strong>A total of 121 patients were included, of whom 95 (78.5%) were male. The mean age was 63.1±10.7 years. Both grade 2 IPN [hazard ratio (HR) =2.37, 95% confidence interval (CI): 1.58-9.65; P=0.039] and SWV (HR =0.43, 95% CI: 0.20-0.95; P=0.038) were independently associated with future ischemic stroke events. The combined model demonstrated a significantly better predictive performance (HR =3.243, 95% CI: 1.87-6.17; P=0.027).</p><p><strong>Conclusions: </strong>The combination of IPN and SWV demonstrated significantly better predictive value for the risk of stroke. Our combined model thereby has the potential to guide the clinical stratification and management of patients with asymptomatic mild carotid stenosis.</p>","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635785","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: Osteoporosis remains substantially underdiagnosed and undertreated worldwide. Chest low-dose computed tomography (LDCT) may provide a valuable and popular opportunity for osteoporosis screening. This study sought to evaluate the feasibility of the screening of low bone mineral density (BMD) and osteoporosis with mean attenuation values of the lower thoracic compared to upper lumbar vertebrae. The cutoff thresholds of the mean attenuation values in Hounsfield units (HU) were derived to facilitate implementation of opportunistic screening using chest LDCT.
Methods: The participants aged 30 years or older who underwent chest LDCT and quantitative computed tomography (QCT) examinations from August 2018 to October 2020 in our hospital were consecutively included in this retrospective study. A region of interest (ROI) was placed in the trabecular bone of each vertebral body to measure the HU values. The correlations of mean HU values of lower thoracic (T11-T12) and upper lumbar (L1-L2) vertebrae with age and lumbar BMD obtained with QCT were performed using the Pearson correlation coefficient, respectively. The area under the curve (AUC) of the receiver operator characteristic (ROC) curve was generated to determine the cutoff thresholds for distinguishing low BMD from normal and osteoporosis from non-osteoporosis.
Results: A total of 1,112 participants were included in the final study cohort (743 men and 369 women, mean age 58.2±8.9 years; range, 32-88 years). The mean HU values of T11-T12 and L1-L2 were significantly different among 3 QCT-defined BMD categories of osteoporosis, osteopenia, and normal (P<0.001). The differences in HU values between T11-T12 and L1-L2 in each category of bone status were statistically significant (P<0.001). The mean HU values of T11-T12 (r=-0.453, P<0.001) and L1-L2 (r=-0.498, P<0.001) had negative correlations with age. Positive correlations were observed between the mean HU values of T11-T12 (r=0.872, P<0.001) and L1-L2 (r=0.899, P<0.001) with BMD. The optimal cutoff thresholds for distinguishing low BMD from normal were average T11-T12 ≤157 HU [AUC =0.941, 95% confidence interval (CI): 0.925-0.954, P<0.001] and L1-L2 ≤138 HU (AUC =0.950, 95% CI: 0.935-0.962, P<0.001), as well as distinguishing osteoporosis from non-osteoporosis were average T11-T12 ≤125 HU (AUC =0.960, 95% CI: 0.947-0.971, P<0.001) and L1-L2 ≤107 HU (AUC =0.961, 95% CI: 0.948-0.972, P<0.001). There was no significant difference between the AUC values of T11-T12 and L1-L2 for low BMD (P=0.07) and osteoporosis (P=0.92) screening.
Conclusions: We have conducted a study on low BMD and osteoporosis screening using mean attenuation values of lower thoracic and upper lumbar vertebrae. Assessment of mean attenuation values of T11-T12 and L1-L2 can be used interchangeably for low BMD and osteoporosis screening using chest LDCT, and their cutoff thresholds were
{"title":"Opportunistic use of chest low-dose computed tomography (LDCT) imaging for low bone mineral density and osteoporosis screening: cutoff thresholds for the attenuation values of the lower thoracic and upper lumbar vertebrae.","authors":"Ya-Ling Pan, Yin-Bo Wu, Huo-Gen Wang, Tai-Hen Yu, Dong He, Xiang-Jun Lu, Fan-Fan Zhao, Hong-Feng Ma, Ya-Jie Wang, Yun-Kai Cai","doi":"10.21037/qims-24-59","DOIUrl":"10.21037/qims-24-59","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis remains substantially underdiagnosed and undertreated worldwide. Chest low-dose computed tomography (LDCT) may provide a valuable and popular opportunity for osteoporosis screening. This study sought to evaluate the feasibility of the screening of low bone mineral density (BMD) and osteoporosis with mean attenuation values of the lower thoracic compared to upper lumbar vertebrae. The cutoff thresholds of the mean attenuation values in Hounsfield units (HU) were derived to facilitate implementation of opportunistic screening using chest LDCT.</p><p><strong>Methods: </strong>The participants aged 30 years or older who underwent chest LDCT and quantitative computed tomography (QCT) examinations from August 2018 to October 2020 in our hospital were consecutively included in this retrospective study. A region of interest (ROI) was placed in the trabecular bone of each vertebral body to measure the HU values. The correlations of mean HU values of lower thoracic (T11-T12) and upper lumbar (L1-L2) vertebrae with age and lumbar BMD obtained with QCT were performed using the Pearson correlation coefficient, respectively. The area under the curve (AUC) of the receiver operator characteristic (ROC) curve was generated to determine the cutoff thresholds for distinguishing low BMD from normal and osteoporosis from non-osteoporosis.</p><p><strong>Results: </strong>A total of 1,112 participants were included in the final study cohort (743 men and 369 women, mean age 58.2±8.9 years; range, 32-88 years). The mean HU values of T11-T12 and L1-L2 were significantly different among 3 QCT-defined BMD categories of osteoporosis, osteopenia, and normal (P<0.001). The differences in HU values between T11-T12 and L1-L2 in each category of bone status were statistically significant (P<0.001). The mean HU values of T11-T12 (r=-0.453, P<0.001) and L1-L2 (r=-0.498, P<0.001) had negative correlations with age. Positive correlations were observed between the mean HU values of T11-T12 (r=0.872, P<0.001) and L1-L2 (r=0.899, P<0.001) with BMD. The optimal cutoff thresholds for distinguishing low BMD from normal were average T11-T12 ≤157 HU [AUC =0.941, 95% confidence interval (CI): 0.925-0.954, P<0.001] and L1-L2 ≤138 HU (AUC =0.950, 95% CI: 0.935-0.962, P<0.001), as well as distinguishing osteoporosis from non-osteoporosis were average T11-T12 ≤125 HU (AUC =0.960, 95% CI: 0.947-0.971, P<0.001) and L1-L2 ≤107 HU (AUC =0.961, 95% CI: 0.948-0.972, P<0.001). There was no significant difference between the AUC values of T11-T12 and L1-L2 for low BMD (P=0.07) and osteoporosis (P=0.92) screening.</p><p><strong>Conclusions: </strong>We have conducted a study on low BMD and osteoporosis screening using mean attenuation values of lower thoracic and upper lumbar vertebrae. Assessment of mean attenuation values of T11-T12 and L1-L2 can be used interchangeably for low BMD and osteoporosis screening using chest LDCT, and their cutoff thresholds were ","PeriodicalId":54267,"journal":{"name":"Quantitative Imaging in Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635804","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}