The value of machine learning based on CT radiomics in the preoperative identification of peripheral nerve invasion in colorectal cancer: a two-center study.

BACKGROUND: We aimed to explore the application value of various machine learning (ML) algorithms based on multicenter CT radiomics in identifying peripheral nerve invasion (PNI) of colorectal cancer (CRC). METHODS: A total of 268 patients with colorectal cancer who underwent CT examination in two hospitals from January 2016 to December 2022 were considered. Imaging and clinicopathological data were collected through the Picture Archiving and Communication System (PACS). The Feature Explorer software (FAE) was used to identify the peripheral nerve invasion of colorectal patients in center 1, and the best feature selection and classification channels were selected. Finally, the best feature selection and classifier pipeline were verified in center 2. RESULTS: The six-feature models using RFE feature selection and GP classifier had the highest AUC values, which were 0.610, 0.699, and 0.640, respectively. FAE generated a more concise model based on one feature (wavelet-HLL-glszm-LargeAreaHighGrayLevelEmphasis) and achieved AUC values of 0.614 and 0.663 on the validation and test sets, respectively, using the "one standard error" rule. Using ANOVA feature selection, the GP classifier had the best AUC value in a one-feature model, with AUC values of 0.611, 0.663, and 0.643 on the validation, internal test, and external test sets, respectively. Similarly, when using the "one standard error" rule, the model based on one feature (wave-let-HLL-glszm-LargeAreaHighGrayLevelEmphasis) achieved AUC values of 0.614 and 0.663 on the validation and test sets, respectively. CONCLUSIONS: Combining artificial intelligence and radiomics features is a promising approach for identifying peripheral nerve invasion in colorectal cancer. This innovative technique holds significant potential for clinical medicine, offering broader application prospects in the field. CRITICAL RELEVANCE STATEMENT: The multi-channel ML method based on CT radiomics has a simple operation process and can be used to assist in the clinical screening of patients with CRC accompanied by PNI. KEY POINTS: • Multi-channel ML in the identification of peripheral nerve invasion in CRC. • Multi-channel ML method based on CT-radiomics can detect the PNI of CRC. • Early preoperative identification of PNI in CRC is helpful to improve the formulation of treatment strategies and the prognosis of patients.

Individualized driver amplitude in liver MR elastography: a linear regression study.

BACKGROUND: Current liver magnetic resonance elastography (MRE) scans often require adjustments to driver amplitude to produce acceptable images. This could lead to time wastage and the potential loss of an opportunity to capture a high-quality image. PURPOSE: To construct a linear regression model of individualized driver amplitude to improve liver MRE image quality. MATERIAL AND METHODS: Data from 95 liver MRE scans of 61 participants, including abdominal missing volume ratio (AMVR), breath-holding status, the distance from the passive driver on the skin surface to the liver edge (Dd-l), body mass index (BMI), and lateral deflection of the passive driver with respect to the human sagittal plane (Angle α), were continuously collected. The Spearman correlation analysis and lasso regression were conducted to screen the independent variables. Multiple linear regression equations were developed to determine the optimal amplitude prediction model. RESULTS: The optimal formula for linear regression models: driver amplitude (%) = -16.80 + 78.59 × AMVR - 11.12 × breath-holding (end of expiration = 1, end of inspiration = 0) + 3.16 × Dd-l + 1.94 × BMI + 0.34 × angle α, with the model passing the F test (F = 22.455, P <0.001) and R2 value of 0.558. CONCLUSION: The individualized amplitude prediction model based on AMVR, breath-holding status, Dd-l, BMI, and angle α is a valuable tool in liver MRE examination.

Non-invasive Assessment of Axillary Lymph Node Metastasis Risk in Early Invasive Breast Cancer Adopting Automated Breast Volume Scanning-Based Radiomics Nomogram: A Multicenter Study.

OBJECTIVE: The aim of the work described here was to develop a non-invasive tool based on the radiomics and ultrasound features of automated breast volume scanning (ABVS), clinicopathological factors and serological indicators to evaluate axillary lymph node metastasis (ALNM) in patients with early invasive breast cancer (EIBC). METHODS: We retrospectively analyzed 179 ABVS images of patients with EIBC at a single center from January 2016 to April 2022 and divided the patients into training and validation sets (ratio 8:2). Additionally, 97 ABVS images of patients with EIBC from a second center were enrolled as the test set. The radiomics signature was established with the least absolute shrinkage and selection operator. Significant ALNM predictors were screened using univariate logistic regression analysis and further combined to construct a nomogram using the multivariate logistic regression model. The receiver operating characteristic curve assessed the nomogram's predictive performance. DISCUSSION: The constructed radiomics nomogram model, including ABVS radiomics signature, ultrasound assessment of axillary lymph node (ALN) status, convergence sign and erythrocyte distribution width (standard deviation), achieved moderate predictive performance for risk probability evaluation of ALNs in patients with EIBC. Compared with ultrasound, the nomogram model was able to provide a risk probability evaluation tool not only for the ALNs with positive ultrasound features but also for micrometastatic ALNs (generally without positive ultrasound features), which benefited from the radiomics analysis of multi-sourced data of patients with EIBC. CONCLUSION: This ABVS-based radiomics nomogram model is a pre-operative, non-invasive and visualized tool that can help clinicians choose rational diagnostic and therapeutic protocols for ALNM.

The value of the signal intensity of peritumoral tissue on Gd-EOB-DTPA dynamic enhanced MRI in assessment of microvascular invasion and pathological grade of hepatocellular carcinoma.

ABSTRACT: The aim of the study was to assess the potential role of preoperative gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) dynamic enhanced MR imaging for diagnosing microvascular invasion (MVI) and pathological grade of hepatocellular carcinoma (HCC).A total of 113 consecutive HCC patients confirmed by histopathology underwent preoperative Gd-EOB-DTPA dynamic enhanced MRI were included. Signal intensity (SI) of peritumoral, normal liver tissue and tumor parenchyma during arterial phase and hepatobiliary phase (HBP) were analyzed. The receiver operating characteristic (ROC) curves were performed to assess the potential diagnostic capability for MVI and pathological grade of HCC. Kaplan-Meier method was performed to estimate the recurrence-free survival rate and compared using the log rank test.SI ratio of peritumoral tissue to normal liver in arterial phase (SIAp/Al) was independently associated with MVI [odds ratio (OR) = 3.115, 95% confidence interval (CI): 1.867-5.198] and pathological grades (OR = 1.437, 95% CI: 1.042-1.981). The area under the curve (AUC) of SIAp/Al was equivalent to the SI of tumor parenchyma on arterial phase (SIAt) in distinguishing low and high pathological grades. However, the AUC of SIAp/Al (0.851) was larger than peritumoral hypointensity on HBP (0.668) for distinguishing MVI. The recurrence-free survival rate of HCC patients with SIAp/Al<1.1 was higher than HCC with SIAp/Al≥1.1(P = .025).The SIAp/Al in preoperative Gd-EOB-DTPA dynamic enhanced MR imaging is a potential diagnosis marker for MVI and pathological grade of HCC noninvasively. The higher SIAp/Al may predict the poor prognosis of HCC after surgery.

Invasive thymoma extending into the superior vena cava and right atrium: The value of multimodal cardiac magnetic resonance.

The purpose of this case report is to describe the multimodal cardiac magnetic resonance (CMR) imaging features of an invasive thymoma extending into the superior vena cava and right atrium. This unusual case indicates that multimodal CMR can not only reveal the morphological features of thymoma but also enable the identification of histological types, which provides a reasonable surgical plan in the perioperative management. .

Solitary fibrous tumor of the mesentery: a case report and review of the literature.

Solitary fibrous tumors are rare mesenchymal tumors that typically arise from the pleura and rarely originate from the mesentery. We herein report a case involving a 66-year-old patient who presented with a mass on the left abdomen. This mass had been incidentally noticed 10 years earlier. The patient sometimes experienced abdominal pain. Physical examination revealed an irregular mass, which was resected. A biopsy of the mass revealed that it was a solitary fibrous tumor originating from the mesentery of the small intestine. The patient was discharged 1 week after surgery and had an uneventful clinical course throughout the 4-month postoperative follow-up.

[Assessment of efficacy of acupuncture combined with hyperbaric oxygen therapy for patients with delayed encephalopathy of CO intoxication by magnetic resonance voxel incoherent motion imaging].

OBJECTIVE: To observe the effect of acupuncture plus hyperbaric oxygen (HBO) on cerebral blood perfusion in patients with delayed encephalopathy after carbon monoxide poisoning (DEACMP). METHODS: Twenty-eight patients with DEACMP were randomly divided into acupuncture group (n=14 cases) and control group (n=14 cases). Patients of the acupuncture group were treated by using "Xingnao Kaiqiao" needling technique (specific set of acupuncture points as Yintang ï¼»EX-HN3ï¼½, Shangxing ï¼»GV23ï¼½, Baihui ï¼»GV20ï¼½, Sishenchong ï¼»EX-HN1ï¼½, Fengchi ï¼»GB20ï¼½, Taichong ï¼»LR3ï¼½, etc., and strong stimulation) combined with HBO in an air pressurized tank, and those of the control group treated by simple HBO. The treatment was conducted once a day, 5 days a week for 6 weeks. All the patients underwent head routine magnetic resonance imaging (MRI) and intravoxel incoherent motion imaging(IVIM) scan before and after the treatment. The values of pseudo-diffusion coefficient D (D*) and perfusion fraction (f) of the bilateral semi-oval centers were measured by using MITK software package to calculate the ave-rage fD* value (f×D*). The Barthel index (BI) score was used to assess the patients' daily living ability, and the correlation between parameter values was evaluated by Pearson method. RESULTS: After the treatment, the values of f, fD* and BI scores were significantly increased in both acupuncture group and control groups (P<0.05). The values of the 3 indexes were significantly higher in the acupuncture group than those in the control group (P<0.05). The values of f and fD* were positively correlated with BI score (P<0.05), with the correlation coefficients being 0.822, 0.636 and 0.601, respectively between the fD* and f, BI and f, and BI and fD*. CONCLUSION: Acupuncture combined with HBO can significantly improve the low-perfusion of bilate-ral semi-oval center and daily living ability in patients with DEACMP, being significantly superior to simple HBO therapy in the curative effect.

[Evaluation of the efficacy of acupuncture combined with hyperbaric oxygen on delayed neuropathological sequelae after carbon monoxide poisoning by using mTI-ASL imaging].

OBJECTIVE: Quantitative assessment of white blood flow in semi-oval center of patients with delayed neuropathological sequelae (DNS) after carbon monoxide poisoning treated with acupuncture combined with hyperbaric oxygen (HBO) based on magnetic resonance multi-inversion time arterial spin labeling imaging (mTI-ASL), and to evaluate its efficacy indirectly. METHODS: Twenty-six patients with clinically diagnosed DNS were randomly divided into an observation group (13 cases) and a control group (13 cases). The conventional therapy combined with HBO were given in the control group. In the observation group,on the base of the treatment, Xingnao Kaiqiao acupuncture was applied, the main acupoints were Shuigou (GV 26), Neiguan (PC 6), Baihui (GV 20), Shangxing (GV 23), Yintang (GV 29), Sanyinjiao (SP 6) on the affected side, Sishencong (EX-HN 1), Fenglong (ST 40), Lianquan (CV 23) and Jinjin (EX-HN12) for slurred speech, Jianyu (LI 15), Waiguan (TE 5) and Shousanli (LI 10) for upper limb pain, Huantiao (GB 30), Yanglingquan (GB 34), Yinlingquan (SP 9) for lower limb pain, the treatment was given once every day, 5 days as one course, with an interval of 2 days between the course. The treatment for 6 courses was required. The conventional head MR scan, mTI-ASL and diffusion tensor imaging (DTI) scans before and 1 week after treatment were adopted, Matlab (R2014b), Mricron and Syngo.via software were adopted to measure the cerebral blood flow (CBF) and anisotropy (FA) values of the semi-oval center. The correlation between the parameters was evaluated by Pearson method. And the simple intelligent mental state examination scale (MMSE) was uesd to assess cognitive function. RESULTS: After treatment, the CBF, MMSE scores in both groups and FA values in the observation group were higher than those before treatment (P<0.05). After treatment, the CBF, FA and MMSE scores in the observation group were significantly higher than those in the control group (P<0.05). There was a positive correlation between CBF, FA and MMSE scores (P<0.05), and the correlation between CBF and MMSE was the best (r =0.822). CONCLUSION: Acupuncture combined with hyperbaric oxygen can significantly improved early white matter hypoperfusion and improved cognitive function score in patients with DNS. The curative effect is better than that of hyperbaric oxygen therapy alone. The mTI-ASL imaging can quantitatively evaluate its curative effect.

[Current state of researches on mechanisms of acupuncture in improvement of hypoxia-ischemic diseases of the central nervous system].

Acupuncture is widely used in the treatment of ischemic diseases of the central nervous system in different clinical stages and has achieved a good clinical effect. The current research showed that acupuncture can improve cerebral blood flow perfusion via increasing blood flow volume, blood flow velocity, the levels of vasomotor substances and reduction of blood viscosity and erythrocyte aggregation index. In recent years, many studies focused on the pathophysiological mechanism of acupuncture in improving cerebral ischemia via triggering the cholinergic vasodilatation, up-regulation of expression of vascular-related proteins and genes，attenuation of inflammatory reaction, etc. Currently, the methods for evaluating the effect of acupuncture are mostly noninvasive functional magnetic resonance imaging in healthy subjects. Future studies should include united selection of acupoints and acupuncture needle manipulations, more reasonable combination of different acupoints, united outcome evaluative standards, better repeatability, employment of big data, etc.

The CNPY2 enhances epithelial-mesenchymal transition via activating the AKT/GSK3ß pathway in non-small cell lung cancer.

The survival of non-small cell lung cancer (NSCLC) is poor due to high metastasis, and the indispensable step of metastasis includes epithelial-mesenchymal transition (EMT). In the study, by analyzing the dataset of the Cancer Genome Atlas (TCGA), we found that the expression of Canopy homolog 2 (CNPY2) is increased both in adenocarcinoma and squamous cell carcinoma, which is further confirmed in NSCLC tissues. Not only that, there is a negative correlation between CNPY2 and E-cadherin expression at mRNA level. Wound healing and transwell matrix penetration assay showed that overexpression of CNPY2 promotes the capability for invasion and metastasis of NSCLC cells. Further analysis uncovered that overexpression of CNPY2 can activate the AKT/GSK3ß pathway, which leads to the inactivation of GSK-3ß. The inactivation of GSK-3ß increases the level of Snail, and then decreases the expression of E-cadherin to promote EMT. Eventually, inhibition of AKT suppresses the malignant transformation of CNPY2-upregulated cells. The above results suggest that CNPY2 may be served as a novel therapeutic target to therapy the NSCLC.

[Evaluation of the association between left coronary artery stenosis degree and myocardial perfusion by 64 multi-slice].

OBJECTIVE: To evaluate the association between left coronary artery stenosis degree and myocardial perfusion by 64 multi-slice CT. METHODS: A total of 223 patients underwent 64 multi-slice CT coronary artery images (CTA) were included and divided into normal group (91 cases), mild stenosis group (72 cases), moderate stenosis group (36 cases) and severe stenosis group (24 cases). Myocardial density was measured at apical, septal and lateral segments. Myocardial density in infarcted segments was compared to non-infarct segments in 11 patients with old myocardial infarction (all from severe stenosis group). RESULTS: Myocardial density was significantly lower at apical segments [(55.8 ± 21.4) HU vs. (75.3 ± 7.5) HU], at septal segment [(87.8 ± 3.3) HU vs. (98.2 ± 5.2) HU] and at lateral segment [(86.8 ± 7.9) HU vs. (95.6 ± 11.6) HU] in severe stenosis group than in normal group (all P < 0.05). Myocardial density of patients with old myocardial infarction was significantly reduced in non-infarct segment [(70.9 ± 8.3) HU vs.(98.7 ± 7.3) HU, P < 0.01] and increased in infarct segment [(42.5 ± 15.7) HU vs. (17.8 ± 4.1) HU, P < 0.01] post contrast enhancement. CONCLUSION: CTA could be used to evaluate the severity of the left coronary artery stenosis based on myocardial density measurement. Myocardial delayed enhancement derived from CTA could be used to identify infarct segments.

[Evaluation of pulmonary arterial hypertension in chronic obstructive pulmonary disease by multislice spiral CT].

OBJECTIVE: To investigate the use of multislice spiral CT (MSCT) in the diagnosis of pulmonary arterial hypertension (PAH) in patients with chronic obstructive pulmonary disease (COPD). METHODS: The diameters and areas of the pulmonary artery were measured in 81 cases with COPD and 100 normal adults from January to November 2011. The ratios of the diameters of the main pulmonary artery (MPA) to ascending aorta (AA), descending aorta (DA), trachea, thoracic vertebra (ThV) were also calculated. Data analysis used the t test of the 2 samples compared, multi-rate compared by χ(2) test. RESULTS: There were significant differences in the measured parameters between the COPD group and the control group. The differences were also significant among groups of COPD patients aged < 40 y, 40 - 60 y, > 60 y, and the control group, among patients with different stages of COPD (stage I, II, III, IV) and the control group, and among patients with sPAP > 50 mm Hg (1 mm Hg = 0.133 kPa), sPAP ≤ 50 mm Hg and the control group. There were positive correlations between sPAP and the measured indexes such as MPA [(3.14 ± 0.63) cm] of pulmonary artery in COPD. There were negative correlations between FEV(1)% and some of the measured indexes such as MPA/T(d) (1.81 ± 0.48). Multi-indicators was no significant difference (χ(2) = 17.76, P > 0.05). CONCLUSIONS: MSCT is very useful in diagnosis of PAH in COPD. The diameter ratio of MPA to trachea, the area of MPA, and the diameter ratio of MPA to ThV can be used as diagnostic criteria for evaluation of PAH in COPD.

Diagnostic accuracy of first generation dual-source computed tomography in the assessment of coronary artery disease: a meta-analysis from 24 studies.

The objective of this study is to evaluate the diagnostic accuracy of the first generation dual-source computed tomography (DSCT) in the diagnosis of coronary artery disease (CAD). We selected articles from four databases (Pubmed, Embase, the Cochrane central register of controlled trials (CENTRAL) and Chinese biomedical literature database. The strict study selection was made, and two reviewers independently extracted data back-to-back from included studies. Meta-Disc version 1.4 was used to obtain the pooled results. 24 studies were included in meta-analysis. A cut off point of ≥50% stenosis was used in all the studies to define significant coronary artery stenosis. In patient-based analysis (n = 801), pooled sensitivity was 0.980 [95% confidence interval (CI):0.970-0.990], specificity 0.870 (95% CI: 0.830-0.900), median positive predictive value (PPV) across studies 0.876 (range from 0.741 to 0.943) and negative predictive value (NPV) 0.964 (range from 0.900 to 1.000). In vessel-based analysis (n = 3,620) DSCT pooled sensitivity was 0.957 (95% CI: 0.943-0.969), specificity 0.930 (95% CI: 0.910-0.940), median PPV across studies 0.838 (range from 0.534 to 0.964) and NPV 0.973 (range from 0.885 to 0.996). In segment-based analysis (n = 6,177) DSCT pooled sensitivity was 0.915 (95% CI: 0.901-0.928), specificity 0.959 (95% CI: 0.956-0.963), median PPV 0.782 (range from 0.320 to 0.927) and NPV 0.985 (range from 0.929 to 0.999). In subgroups analysis, pooled sensitivity and specificity in segment based analysis were 93.1 and 92.3% when heart rate (HR) is beyond 70 bpm; when HR was below 70 bpm, the sensitivity was similar (93%), but specificity increased a little from 92.3 to 94%. When analysed based on segment with a cut-off calcium score of 400, the sensitivity was slightly higher in the subgroup with a score over 400 than in the subgroup with a score below 400 (94 vs. 91%), while the specificity was much lower in the subgroup with the high calcium score than the subgroup with the low calcium score (85 vs. 96%). For subgroups with heart rate beyond and below 65 bpm in patient-based analysis, sensitivities were 0.95 (95% CI: 0.86-0.99) and 0.98 (95% CI 0.91-1.00), respectively, while the specificities were 0.88 (95% CI 0.81-0.94) and 0.85 (95% CI 0.77-0.91), respectively. The area under the receiver operating characteristic curve (AUC) in the two subgroups were 0.9608 and 0.9786, respectively. DSCT is highly sensitive for patient-based analysis of CAD and has high specificity and NPV for segment-based analysis of CAD. First generation DSCT may have a role in the evaluation of patients with chest pain as a simple non-invasive examination because of its ability to diagnose or exclude significant CAD.