Incremental diagnostic value of virtual non-contrast dual-energy CT for the diagnosis of choledocholithiasis over conventional unenhanced CT.

PURPOSE: The purpose of this study was to evaluate the incremental diagnostic value of virtual non-contrast (VNC) images derived from unenhanced dual-energy computed tomography (CT) for the diagnosis of choledocholithiasis by comparison with conventional unenhanced CT. MATERIALS AND METHODS: Eighty-nine patients with gallbladder stones who had undergone both abdominal unenhanced dual-energy CT and magnetic resonance cholangiopancreatography (MRCP) were retrospectively included. There were 53 men and 36 women, with a mean age of 54 ± 13 (standard deviation) years (age range: 41-67 years). VNC and conventional CT images were generated. Two independent radiologists evaluated the presence of choledocholithiasis in three reading sessions (session 1, conventional unenhanced CT images; session 2, VNC images; session 3, conventional unenhanced CT plus VNC images). The reading time to identify choledocholithiasis was recorded. Inter-reader agreement was measured by using the Cohen kappa (κ) test. Incremental diagnostic value of VNC imaging when combined with conventional unenhanced CT was assessed based on discrimination (area under the curve [AUC]) and clinical utility (decision curve analysis). The diagnostic performance of dual-energy CT and that of MRCP were compared using DeLong test. RESULTS: Using the standard of reference, 39 patients (39/89; 44%) had choledocholithiasis. The diagnosis of choledocholithiasis was improved using VNC images in combination with conventional unenhanced CT (AUC, 0.877; 95% confidence interval [CI]: 0.808, 0.947) by comparison with conventional unenhanced CT alone (AUC, 0.789; 95% CI: 0.718, 0.877) (P = 0.033) and achieved almost perfect inter-reader agreement (κ = 0.88; 95% CI: 0.72, 1.00) for the diagnosis of choledocholithiasis, without lengthening the median reading time (16.2 s for the combination of conventional CT and VNC images vs. 14.7 s for conventional CT alone; P= 0.325). Based on decision curve analysis, adding VNC imaging to conventional unenhanced CT resulted in a higher net benefit among most of decision thresholds. No differences in diagnostic performance were found between the combination of conventional unenhanced CT and VNC imaging (AUC, 0.877; 95% CI: 0.808, 0.947) and MRCP (AUC, 0.913; 95% CI: 0.852, 0.974) (P= 0.458). CONCLUSIONS: VNC images derived from dual-energy unenhanced CT have incremental diagnostic value for the diagnosis of choledocholithiasis. Unenhanced CT in a dual-energy mode may be a useful tool for the diagnosis of choledocholithiasis.

Decoding tumor stage by peritumoral and intratumoral radiomics in resectable esophageal squamous cell carcinoma.

PURPOSE: To evaluate the potential application of radiomics in predicting Tumor-Node-Metastasis (TNM) stage in patients with resectable esophageal squamous cell carcinoma (ESCC). METHODS: This retrospective study included 122 consecutive patients (mean age, 57 years; 27 women). Corresponding tumor of interest was identified on axial arterial-phase CT images with manual annotation. Radiomics features were extracted from intra- and peritumoral regions. Features were pruned to train LASSO regression model with 93 patients to construct a radiomics signature, whose performance was validated in a test set of 29 patients. Prognostic value of radiomics-predicted TNM stage was estimated by survival analysis in the entire cohort. RESULTS: The radiomics signature incorporating one intratumoral and four peritumoral features was significantly associated with TNM stage. This signature discriminated tumor stage with an area under curve (AUC) of 0.823 in the training set, with similar performance in the test set (AUC 0.813). Recurrence-free survival (RFS) was significantly different between different radiomics-predicted TNM stage groups (Low-risk vs high-risk, log-rank P = 0.004). Univariate and multivariate Cox regression analyses revealed that radiomics-predicted TNM stage was an independent preoperative factor for RFS. CONCLUSIONS: The proposed radiomics signature combing intratumoral and peritumoral features was predictive of TNM stage and associated with prognostication in ESCC.

[Observation of the effect of early fluid resuscitation on hepatic fatty degeneration in rats after severe scald].

OBJECTIVE: To investigate the efficacy of early fluid resuscitation on hepatic steatosis in rats after severe scald. METHODS: One hundred and forty-four Sprague-Dawley rats were enrolled in the study. In thirty-six rats skin of 30% TBSA was treated with cold water to serve as sham injury group. All other rats were inflicted with 30% full-thickness scald, and they were subdivided into 3 groups, i. e. scald group(S, without resuscitation), delayed resuscitation group ( DR, with Ringer's solution at 6 post-scald hour(PSH) ) and early resuscitation group( ER, with Ringer's solution immediately after scald). The hepatic tissues of the rats were harvested at 0.5, 1.0,2.0,3.0,7.0 post-scald hour( PSH) and on 21.0 PSD for the observation of pathological changes with light-microscope and transmission electron microscope. The serum contents of TC, TG, HDL, ALP were determined at the same time-points. Body weight of each rat was measured before blood sampling, and total liver weight after blood sampling. Liver weight/body weight ratio was recorded. RESULTS: Compared with sham injury group, the fat denaturation degree of hepatic tissue in ER group was obviously less than that in S and DR group . The serum level of high density lipoprotein (TC) , triglyceride ( TG) , and alkaline phosphatase (ALP) after scald increased ranking as S > DR > ER, while the level of HDL decreased in that order. The liver weight/body weight ratio of the rats in DR group on 1.0 PSD was obviously elevated compared with that in ER group( P <0. 05) , and there exhibited significant difference of liver weight/body weight ratio between DR and ER groups on 7. 0 PSD ( P < 0. 01). The liver steatosis had obvious negative correlation with HDL content after scald( r = -0. 37, P <0.01) , but it had positive correlation with the ALP content( r = 0. 45, P <0. 01), TG content( r = 0. 25, P <0. 01) and liver weight/body weight ratio( r = 0. 440, P <0. 01). The remaining parameters showed no correlation with the liver steatosis. CONCLUSION: Fluid resuscitation immediately after scald can ameliorate hepatic fatty degeneration, reduce its incidence, and beneficial to recovery of liver damage to a certain extent.