Radiomics model of dual-time 2-[18F]FDG PET/CT imaging to distinguish between pancreatic ductal adenocarcinoma and autoimmune pancreatitis.

OBJECTIVES: Pancreatic ductal adenocarcinoma (PDAC) and autoimmune pancreatitis (AIP) are diseases with a highly analogous visual presentation that are difficult to distinguish by imaging. The purpose of this research was to create a radiomics-based prediction model using dual-time PET/CT imaging for the noninvasive classification of PDAC and AIP lesions. METHODS: This retrospective study was performed on 112 patients (48 patients with AIP and 64 patients with PDAC). All cases were confirmed by imaging and clinical follow-up, and/or pathology. A total of 502 radiomics features were extracted from the dual-time PET/CT images to develop a radiomics decision model. An additional 12 maximum intensity projection (MIP) features were also calculated to further improve the radiomics model. The optimal radiomics feature set was selected by support vector machine recursive feature elimination (SVM-RFE), and the final classifier was built using a linear SVM. The performance of the proposed dual-time model was evaluated using nested cross-validation for accuracy, sensitivity, specificity, and area under the curve (AUC). RESULTS: The final prediction model was developed from a combination of the SVM-RFE and linear SVM with the required quantitative features. The multimodal and multidimensional features performed well for classification (average AUC: 0.9668, accuracy: 89.91%, sensitivity: 85.31%, specificity: 96.04%). CONCLUSIONS: The radiomics model based on 2-[18F]fluoro-2-deoxy-D-glucose (2-[18F]FDG) PET/CT dual-time images provided promising performance for discriminating between patients with benign AIP and malignant PDAC lesions, which shows its potential for use as a diagnostic tool for clinical decision-making. KEY POINTS: • The clinical symptoms and imaging visual presentations of PDAC and AIP are highly similar, and accurate differentiation of PDAC and AIP lesions is difficult. • Radiomics features provided a potential noninvasive method for differentiation of AIP from PDAC. • The diagnostic performance of the proposed radiomics model indicates its potential to assist doctors in making treatment decisions.

IgG4-Related Tumefactive Lesions at the Pulmonary Artery Causing Stenosis of Bilateral Primary Branches and Resultant Pulmonary Hypertension.

IgG4-related disease (IgG4-RD) is a newly recognized but rare entity involving multiple organs, with autoimmune pancreatitis, retroperitoneal mass, and the inflammation of glands being typical in most cases. IgG4-related perivascular lesions, although uncommon, have been increasingly reported in recent years. Diagnosis of IgG4-RD relies on comprehensive consideration of characteristic histopathological and immunostaining results, clinical and imaging findings, and serological results according to several widely recognized diagnostic criteria. This benign disorder frequently presenting tumefactive lesions should be distinguished from malignancy and other inflammatory mimics. Here we report a case of tumefactive mass at the bifurcation of the pulmonary trunk causing stenosis of the proximal left and right pulmonary artery (PA) and resultant pulmonary hypertension (PH). Bypass from the PA trunk to the right branch distal to stenosis was performed to resolve the obstructive hemodynamic disturbance and PH. Glucocorticoid monotherapy was performed after a diagnosis of definite IgG4-RD. Longitudinal disease activity assessment via imaging modalities, serological parameters, and IgG4-RD responder index verified no relapse during follow-up and the validity of the treatment strategy.

[Differentiation of autoimmune pancreatitis and pancreatic ductal adenocarcinoma based on multi-modality texture features in 18F-FDG PET/CT].

Autoimmune pancreatitis (AIP) is a unique subtype of chronic pancreatitis, which shares many clinical presentations with pancreatic ductal adenocarcinoma (PDA). The misdiagnosis of AIP often leads to unnecessary pancreatic resection. 18F-FDG positron emission tomography/ computed tomography (PET/CT) could provide comprehensive information on the morphology, density, and functional metabolism of the pancreas at the same time. It has been proved to be a promising modality for noninvasive differentiation between AIP and PDA. However, there is a lack of clinical analysis of PET/CT image texture features. Difficulty still remains in differentiating AIP and PDA based on commonly used diagnostic methods. Therefore, this paper studied the differentiation of AIP and PDA based on multi-modality texture features. We utilized multiple feature extraction algorithms to extract the texture features from CT and PET images at first. Then, the Fisher criterion and sequence forward floating selection algorithm (SFFS) combined with support vector machine (SVM) was employed to select the optimal multi-modality feature subset. Finally, the SVM classifier was used to differentiate AIP from PDA. The results prove that texture analysis of lesions helps to achieve accurate differentiation of AIP and PDA.

(18)F-FDG-PET/CT findings in pancreatic metastasis.

PURPOSE: This study aimed to evaluate the fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) findings and pattern of FDG uptake in pancreatic metastases. MATERIALS AND METHODS: A total of 19 consecutive patients (26 lesions) with histologically or clinically confirmed pancreatic metastases who had undergone (18)F-FDG-PET/CT were enrolled in this retrospective study. Among the 19 patients, 14 patients underwent abdominal contrast-enhanced CT (ceCT). The location, size and FDG uptake patterns of the pancreatic lesions were recorded. Metabolic activity by means of maximum standardised uptake value (SUVmax) was measured by drawing regions of interest at the site of pancreatic lesions. Twenty pancreatic cancer patients were included in this study as comparative data analysis. The difference of SUVmax between pancreatic metastases and primary pancreatic cancer were compared using the Mann-Whitney U test. P < 0.05 was considered significant. RESULTS: Three different patterns of FDG uptake could be distinguished in the pancreatic metastatic lesions, including focal nodule or mass, multiple foci and segmental lesion with high FDG uptake. The average SUVmax in pancreatic metastases was 7.8 ± 6.9 versus 7.4 ± 3.9 in primary pancreatic cancer (P = 0.987 > 0.05). Four intrapancreatic isodense nodules in three patients were undetected on ceCT. CONCLUSION: The described patterns of FDG uptake findings may be helpful for a better characterisation of pancreatic metastases although semiquantitative analysis using SUVmax could not be used as a criterion for differentiating pancreatic metastases from primary pancreatic cancer. FDG-PET/CT has also an advantage in detecting unsuspected pancreatic metastases which cannot be detected by ceCT imaging. Thus, it is a useful adjunct to the described features on CT.

The role of 18F-FDG PET/CT in differentiating malignant from benign portal vein thrombosis.

AIMS: In this retrospective study, we evaluated the role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in differentiating malignant from benign portal vein thrombosis (PVT) in patients with known malignant tumors. METHODS: Seventy-two patients with histologically or clinically confirmed PVT and who had undergone (18)F-FDG PET/CT were included. Visual and semiquantitative analyses of PET/CT scans were performed. Metabolic activity was measured using the maximum standardized uptake value (SUVmax) by drawing the region of interest at the site of thrombosis. Receiver operating characteristic analysis was conducted to identify the optimal cutoff of SUVmax for detecting neoplastic thrombosis. Malignancy was defined using the following criteria: (1) visual analysis and (2) SUVmax >3.35. PET/CT results were confirmed with histopathological results and clinical and imaging follow-up. RESULTS: The SUVmax of tumor thrombus (6.37 ± 2.67) was significantly higher than that of bland thrombus (2.87 ± 1.47; P < 0.01). The sensitivities, specificities, and accuracies for the two criteria were 91.5 % and 93.6; 64.0 and 80.0 %; and 81.9 % and 88.9 %, respectively. CONCLUSION: (18)F-FDG PET/CT is a promising new method for distinguishing between portal venous neoplastic thrombosis and bland thrombosis using semiquantitative analysis, with the optimal cutoff value of SUVmax >3.35 as a criterion.

Comparative analysis of the analgesic effects of intercostal nerve block, ultrasound-guided paravertebral nerve block, and epidural block following single-port thoracoscopic lung surgery.

OBJECTIVE: In this study, we compared the analgesic effects of intercostal nerve block (ICNB), ultrasound-guided paravertebral nerve block (PVB), and epidural block (EB) following single-port thoracoscopic lung surgery. METHOD: A total of 120 patients who underwent single-hole thoracoscopic lung surgery were randomly and equally divided into three groups: ICNB group, the PVB group, and the EB group. ICNB was performed under direct thoracoscopic visualization before the conclusion of the surgery in the ICNB group, while PVB and EB were performed after general anesthesia in the PVB and EB groups, respectively. Patient-controlled intravenous analgesia (PCIA) was used following the surgery in all the groups. The following indicators were recorded: Intraoperative sufentanil dosage, anesthesia awakening time, postoperative intubation time, nerve block operation time, postoperative visual analog scale (VAS) pain scores during resting and coughing at regular intervals of 0, 2, 4, 8, 24, and 48 h, the time until first PCIA, number of effective compressions within 24 h postoperatively, number of rescue analgesia interventions, and the side effects. RESULTS: In comparison to the ICNB group, the PVB and EB groups had a lower intraoperative sufentanil dosage, significantly shorter anesthesia awakening time, and postoperative intubation time, but longer nerve block operation time, lower VAS scores when resting and coughing within 24 h postoperatively (all p-values less than 0.05). Conversely, there were no statistically significant differences in VAS scores during resting and coughing after 24 h (all p-values greater than 0.05). Time to first PCIA, number of effective compressions and number of rescue analgesia at the 24-hour mark postoperatively were significantly better in the PVB and EB groups than that in the ICNB group (P < 0.05). However, there was a higher incidence of side effects observed in the EB group (P < 0.05). CONCLUSION: The analgesic effect of PVB and EB following single-port thoracoscopic lung surgery is better than that of ICNB. PVB causes fewer side effects and complications and is safer and more effective.

Autoimmune pancreatitis: whole-body 18F-FDG PET/CT findings.

PURPOSE: The study aimed to investigate the function of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in diagnosing of autoimmune pancreatitis (AIP) and whole-body evaluation. METHODS: Seven AIP patients who underwent (18)F-FDG PET/CT systemic examination in our hospital from August 2010 to March 2012 were analyzed retrospectively. Systemic PET/CT routine scanning and pancreatic delayed scanning were performed in all patients. RESULTS: The mean age of 7 AIP patients (6 male and 1 female) was 54.2 years (range from 42 to 71 years). The pancreas showed diffuse enlargement in 6 cases, and segmental enlargement in 1 case. Fluorodeoxyglucose (FDG) uptake was increased in diseased region. The maximum standardized uptake value (SUVmax) was 4.38 ± 0.90 and increased to 5.31 ± 1.08 after delayed scanning, of which small amounts of inflammatory exudate around pancreas was observed in 4 cases. Extrapancreatic lesions (EPLs) were observed in all 7 cases: lymphadenectasis (n = 5), lymphadenectasis with increased FDG uptake (n = 4); associated sialosis with metabolism enlargement (n = 4); associated cholangitis (n = 4); associated interstitial pneumonia (n = 3); inverted "V" shaped high FDG uptake foci in prostate (n = 5). CONCLUSIONS: AIP is a systemic disease. (18)F-FDG PET/CT can exhibit the characteristics of AIP pancreatic lesions, and also better reflect the changes and metabolic characteristics of extrapancreatic organs. It plays a distinct role in diagnosis, differentiating of AIP and whole-body evaluation.

68Ga-FAPI-04 PET/MR Versus 18F-FDG PET/CT in the Detection of Ovarian Cancer.

ABSTRACT: A 75-year-old woman presented with right lower abdominal pain. Pelvic ultrasound showed a cystic solid mass in the right adnexa. Painless enlarged lymph nodes on the left supraclavicular side with biopsy were suggestive of metastatic cancer. 18F-FDG PET/CT performed to evaluate the primary tumor showed intense uptake in both regions of the right adnexa and the gastric sinus, but 68Ga-FAPI PET/MRI showed uptake only in the right adnexal region. A subsequent gastroscopic biopsy confirmed atrophic inflammation. Finally, surgery histopathology revealed ovarian cancer. This case demonstrated that 68Ga-FAPI PET/MRI may help exclude suspected primary gastric carcinoma with false-positive 18F-FDG uptake.

Radioiodine-131-Labeled Theranostic Nanoparticles for Transarterial Radioembolization and Chemoembolization Combination Therapy of VX2 Liver Tumor.

In interventional treatment, materials are administered into the blood supply artery and directly delivered to tumors, offering proper scenarios for nanomedicine potential clinical applications. Transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) are effective treatment methods for hepatocellular carcinoma (HCC), but postoperative residual tumor may result in intrahepatic recurrence and distant metastasis. The combination therapy of TACE and TARE based on multifunctional nanoparticles (NPs) is expected to overcome the drug resistance in hypoxic tumors and improve the therapeutic effect. Herein, BaGdF5 NPs are synthesized and then coated with polydopamine (PDA), conjugated with the chemotherapeutic drug cis-diamminedichloride platinum (CDDP), radio-labeled with therapeutic radionuclide 131 I, yielding 131 I-BaGdF5 @PDA-CDDP NPs. The in vitro anti-cancer effects of 131 I-BaGdF5 @PDA-CDDP NPs are confirmed using CCK-8 and γ-H2AX assays in Huh7 cells. Mixed with Lipiodol, 131 I-BaGdF5 @PDA-CDDP NPs are injected into the hepatic artery via a microcatheter to realize the TACE and TARE combination therapy in a rabbit VX2 liver tumor model. The results indicate that glucose metabolism is clearly decreased based on 18 F-FDG PET imaging and the apoptosis of tumor cells is increased. Furthermore, 131 I and BaGdF5 NPs can be used for SPECT imaging and CT/MR imaging respectively, facilitating real-time monitoring of the in vivo biodistribution of 131 I-BaGdF5 @PDA-CDDP NPs.

Cohort profile: The Xinjiang Multiethnic Cohort (XMC) study.

PURPOSE: To investigate the potential causal link between heredity, geographical environment, diet and other lifestyle factors with long-term health consequences, we established the Xinjiang Multiethnic Cohort Study (XMC), the first large-scale prospective cohort in Xinjiang, China. PARTICIPANTS: XMC commenced in 2018 and enrolled participants from three study sites (Urumqi, Hotan and Ili) in Xinjiang, China. Data collected include standard baseline questionnaire, physical measurement, biological specimen. In addition, about one-third of participants were assessed habitual diet by a more detailed semiquantitative food frequency questionnaire which included 127 foods items at baseline FINDINGS TO DATE: Finally, a total of 30 949 participants, with 32.37% from Urumqi, 41.75% from Hotan, and 25.88% from Ili were recruited in XMC. The average age of participants was 56.21 years for men, and 54.75 years for women. More than 60% of participants in all three survey sites reported an average consumption of fruit and vegetable three or more times per week. In Hotan and Ili, the staple food was wheaten food, whereas, in Urumqi, rice and wheaten food was the food staples. Consumption of white meat, such as fish and poultry, was lower in the three survey locations. Based on self-reported disease from study participants, the five most common chronic diseases among participants across all three survey locations were dyslipidaemia, hypertension, cholecystitis, diabetes, ischaemic heart disease. FUTURE PLANS: First, we will collect all health-related records of the study participants in January each year for the previous year. Second, 10% of subjects were randomly selected for telephone follow-up in the final year of cohort building. Finally, as planned, we will revisit the study subjects on site every 2-3 years. Again, we will conduct face-to-face questionnaires and collect biological specimens such as blood and urine from the study subjects.

99mTc-methylene diphosphonate SPECT/CT imaging of gout spondylitis: a case report.

Single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging of the gouty spine is rare. We describe a 66-year-old man who presented with pain and numbness in the right lower leg; he reported a 2-month history of intermittent low back pain. Imaging revealed neoplastic lesions of the spine, which were initially regarded as tumors. Thus, the patient underwent surgical removal of the lumbar lesion. However, the postoperative pathological diagnosis was gout spondylitis. In this report, we show multimodal images of advanced gout spondylitis. The metabolic information provided by SPECT/CT, combined with the microscopic changes in bone structure revealed by dual-source thin-layer CT and the anatomical localization information provided by magnetic resonance imaging, can help clinicians to more fully understand the pathophysiological mechanisms and imaging manifestations of gout from multiple perspectives, thereby reducing the rate of misdiagnosis.

Low expression of IL6R predicts poor prognosis for lung adenocarcinoma.

BACKGROUND: Interleukin 6 (IL6) is both a pleiotropic cytokine and an immune-related gene. Interleukin 6 receptor (IL6R) is the receptor for IL6. It may be closely connected to the development of lung cancer. This research aims to explore the prognostic value of IL6R and prevent overtreatment of patients with lung adenocarcinoma (LUAD). METHODS: In this study, the expression of IL6R in tumor tissues and surrounding tissues was first analyzed by immunohistochemistry in the Affiliated Hospital of Nantong University (NTU) cohort. Secondly, we downloaded information from The Cancer Genome Atlas (TCGA) for the TCGA cohort and used this information to explore the messenger RNA (mRNA) level of IL6R. We then used Kaplan-Meier survival analyses, univariate and multivariate Cox analyses, nomogram models, and decision curve analyses to assess the prognostic value of IL6R. In addition, we also analyzed immune cell infiltration and the signaling pathways related to IL6R through Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Enrichment Analysis (GSEA). RESULTS: Through the data analysis of the NTU cohort and the TCGA cohort, it was found that the expression of IL6R in normal tissues around the tumor was higher than that in tumor tissue, and was positively correlated with the overall survival (OS) of LUAD patients. Additionally, low expression of IL6R was found to be an independent predictor of poor prognosis among the patients in these two research cohorts. Next, using GO, KEGG, and GSEA analyses, we found that partially infiltrated tumor immune cells might be related to earlier staging and better prognosis of patients with LUAD. Finally, the study of the 3-5-year survival rate of LUAD patients through the nomogram showed that the expression of IL6R could improve the accuracy of prediction to prevent the overtreatment of some LUAD patients. CONCLUSIONS: In summary, our study indicated that the low expression of IL6R was associated with poor prognosis among LUAD patients and that low expression of IL6R is a potential independent risk factor that could provide a basis for strengthening postoperative classification management of such patients.

Curcumin Complex Analogues as Near-Infrared Fluorescent Probes for Monitoring all Aß Species in the Early Alzheimer's Disease Model.

Aggregation of amyloid ß-peptide (Aß) is closely related to the pathology of Alzheimer's disease (AD). In this pathology, the beginning stage is characterized by excessive accumulation of Aß monomers due to imbalanced Aß in the process of clearance. The Aß peptide exists in many forms such as soluble and insoluble Aß species, both of which coexist during the progression of AD and contribute to AD pathology. Thus, probes capable of monitoring all Aß species are highly desirable. While there are several fluorescent probes for detecting insoluble Aß, it is still challenging to monitor all Aß forms by using probes. Here, we describe a near-infrared fluorescent chemical probe, termed AD-1, developed through complexation of curcumin analogues with a stabilizer, which has good photophysical properties and shows high binding to all Aß species in solution tests. Furthermore, AD-1 exhibited good blood-brain barrier penetrating ability and low cytotoxicity. More importantly, it was successfully applied to 4-month-young APP/PS1 mice imaging noninvasively.

Suppression of LINC00460 mediated the sensitization of HCT116 cells to ionizing radiation by inhibiting epithelial-mesenchymal transition.

Radiation resistance is the most common challenge for improving radiotherapy. The mechanisms underlying the development of radioresistance remain poorly understood. This study aims to explore the role of LINC00460 in ionizing radiation-induced radioresistance as well as the mechanisms by which LINC00460 is regulated by radiation exposure. The expression of LINC00460 was measured. Cell proliferation and colony formation were measured in HCT116 cells after treatment by radiation. The development of epithelial-mesenchymal transition (EMT) was determined with or without knockdown LINC00460 expression using western blot analysis. Transcription activity was determined using a series of LINC00460-promoter luciferase reporter gene vectors. LINC00460 expression was significantly higher in HCT116 cells, relative to other cell types, with LINC00460 expression significantly affecting HCT116 cell proliferation. Suppression of LINC00460 inhibits EMT development in HCT116 cells via regulation of ZEB1 expression. Furthermore, LINC00460 expression was induced by irradiation via the activation of c-jun transcription factor-binding element located on the LINC00460 promoter. LINC00460 was shown to play a crucial role in EMT-associated progression of colorectal cancer, indicating that LINC00460 may be an indicator or new potential therapeutic target for colorectal cancer radiosensitization.

Diagnostic Performance of Theranostic Radionuclides Used in Transarterial Radioembolization for Liver Cancer.

Primary liver tumor with hepatocellular carcinoma accounting for 75-80% of all such tumors, is one of the global leading causes of cancer-related death, especially in cirrhotic patients. Liver tumors are highly hypervascularized via the hepatic artery, while normal liver tissues are mainly supplied by the portal vein; consequently, intra-arterially delivered treatment, which includes transarterial chemoembolization (TACE) and transarterial radioembolization (TARE), is deemed as a palliative treatment. With the development of nuclear technology and radiochemistry, TARE has become an alternative for patients with hepatic cancer, especially for patients who failed other therapies, or for patients who need tumor downstaging treatment. In practice, some radionuclides have suitable physicochemical characteristics to act as radioactive embolism agents. Among them, 90Y emits ß rays only and is suitable for bremsstrahlung single photon emission computed tomography (BS SPECT) and positron emission tomography (PET); meanwhile, some others, such as 131I, 153Sm, 166Ho, 177Lu, 186Re, and 188Re, emit both ß and γ rays, enabling embolism beads to play a role in both therapy and single photon emission computed tomography (SPECT) imaging. During TARE, concomitant imaging provide additive diagnostic information and help to guide the course of liver cancer treatment. Therefore, we review the theranostic radionuclides that have been used or could potentially be used in TARE for liver cancer and focus on the clinical benefits of diagnostic applications, including real-time monitoring of embolism beads, evaluating irradiation dose, predicting therapy effects, and corresponding adjustments to TARE.

Comparison of revised EWGSOP criteria and four other diagnostic criteria of sarcopenia in Chinese community-dwelling elderly residents.

OBJECTIVES: To compare the prevalence and associated factors of sarcopenia defined by the revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria with the initial European Working Group on Sarcopenia in Older People (EWGSOP1) criteria, the Asia Working Group for Sarcopenia (AWGS), the International Working Group on Sarcopenia (IWGS), and the National Institutes of Health (FNIH) Sarcopenia Project criteria among Chinese community-dwelling older adults. DESIGN: A cross-sectional study. SETTING: Two community health centers in Urumqi, China. PARTICIPANTS: A total of 483 participants aged 60 years and older from the community. MEASUREMENT: Anthropometry, skeletal muscle mass, handgrip strength, 4-m walking speed, and biochemical markers. Questionnaire collected information included demographics, lifestyle, and quality of life. RESULTS: The prevalence of EWGSOP2-defined sarcopenia (men: 6.5%; women: 3.3%) was lower than that defined by the EWGSOP1 (men: 22.3%; women 11.7%), AWGS (men: 10.9%; women: 8.0%), and IWGS (men: 24.5%; women: 11.0%) criteria, but higher than FNIH criteria (men: 6.0%; women: 1.7%). The positive percent agreement was lower (men: 15.6%-63.6%; women: 15.2%-40.0%), while negative percent agreement was higher (men: 96.4%-100.0%; women: 97.3%-99.6%). Sex (OR 0.31, 95% CI 0.12-0.81), education level (OR 0.49, 95% CI 0.29-0.83), and body mass index (BMI, OR 0.73, 95% CI 0.62-0.86) were associated with sarcopenia defined by the EWGSOP2 criteria. No consistent pattern of risk factors associated with sarcopenia in EWGSOP2 and four other diagnostic criteria was present. CONCLUSIONS AND IMPLICATIONS: The EWGSOP2 criteria did not agree with the EWGSOP1, AWGS, IWGA, and FNIH criteria defining sarcopenia. Risk factors associated with the EWGSOP2-defined sarcopenia have no consistent patterns with the EWGSOP1, AWGS, IWGA, and FNIH criteria. Therefore, the validity of the EWGSOP2 consensus needs to be confirmed in further prospective studies.

Alterations in the gut microbiota of patients with silica-induced pulmonary fibrosis.

Silicosis resulting from silica exposure is a global occupational disease characterized by severe pathological changes in progressive pulmonary fibrosis. Previous evidence has indicated that dysbiosis of the gut microbiota occurs after environmental dust exposure and is associated with certain diseases. The aims of this study are to elucidate the compositional and functional characteristics of the gut microbiota in early-stage silicosis and to understand their influence on pulmonary fibrosis. We investigated the gut microbial composition of fecal samples from 18 patients and 21 healthy subjects using 16S rRNA gene sequencing technology. Compared with the healthy subjects, reductions in the levels of Firmicutes and Actinobacteria were noted in patients with silicosis and progressive pulmonary fibrosis, as well as lower levels of Devosia, Clostridiales, AlloprevotellaandRikenellaceae_RC9. Lachnospiraceae and Lachnoclostridium levels were increased in patients with silicosis. GOC and KEGG analyses were used to predict that certain bacteria taxa play critical roles in the development of pulmonary fibrosis, including posttranslational modification, amino acid transport and metabolism, nucleotide transport and metabolism, and ribosomal structure and biogenesis. KEGG analysis showed that certain taxa participate in various roles including cancer, endocrine metabolism, immune system, signaling molecules and interaction, and transcription. Collectively, in this pilot study, microbiota changes have been represented in the gut of patients with silicosis. Although this change in gut microbiota have been represented, caution is needed when interpreting the findings since this is observational finding, not necessarily causative. More studies should be performed in the expanding population to be verified and more studies underlying biological mechanisms for better understanding the relationship between gut microbiota and development of pulmonary fibrosis in patients with silicosis.

Metabolic tumor burden on postsurgical PET/CT predicts survival of patients with gastric cancer.

BACKGROUND: The prognostic value of postoperative 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to patients with gastric cancer remains unclear. This study aims to investigate the prognostic value of whole body (WB) metabolic tumor burden (MTBWB) on postsurgical 18F-FDG PET/CT to patients with gastric cancer. METHODS: A total of 376 patients with surgeries-confirmed gastric cancer were enrolled. Clinicopathologic information, overall survival (OS) and MTBWB parameters on postsurgical PET/CT, in terms of WB maximum standardized uptake value (SUVWBmax), WB metabolic tumor volume (MTVWB), and WB total lesion glycolysis (TLGWB) were collected. In-between differences of patient clinicopathologic characteristics, OS and MTBWB measurements were compared using chi-square test, Fisher's exact test, Student's t test or the Kaplan-Meier survival analysis. The optimal cutoffs of MTBWB measurements were calculated through the receiver operating characteristic (ROC) curve analysis. Univariable and multivariable Cox proportional hazard regression were performed to test the predictive value of the clinicopathologic factors and MTBWB measurements to patient survival. RESULTS: The PET-positive patients had significantly decreased OS based on either Kaplan-Meier survival analysis (P <  0.001) or univariable Cox regression (hazard ratio [HR] = 2.850, P <  0.001). In patients with PET-positive tumors, the associations between OS and SUVWBmax, MTVWB and TLGWB were significant, both in univariable analysis (P <  0.001, P <  0.001 and P = 0.001, respectively) and in multivariable analysis (P = 0.002, P <  0.001 and P = 0.005, respectively). Patient OS among groups dichotomized by cutoffs of SUVWBmax > 8.6, MTVWB > 91.5 cm3, and TLGWB > 477.6 cm3 were significantly different (P = 0.001, P <  0.001 and P = 0.001, respectively). CONCLUSIONS: MTBWB, in terms of SUVWBmax, MTVWB and TLGWB, on postsurgical 18F-FDG PET/CT provides prognostic value to patients with gastric cancer after curative resection.

Radiomics analysis for the differentiation of autoimmune pancreatitis and pancreatic ductal adenocarcinoma in 18 F-FDG PET/CT.

PURPOSE: To perform a radiomics analysis with comparisons of multidomain features and a variety of feature selection strategies and classifiers, with the goal of evaluating the value of quantified radiomics method for noninvasively differentiating autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC) in 18 F-fluorodeoxglucose positron emission tomography/computed tomography (18 F FDG PET/CT) images. METHODS: We extracted 251 expert-designed features from 2D and 3D PET/CT images of 111 patients, and recombined these features into five feature sets according to their modalities and dimensions. Among the five feature sets, the optimal one was found leveraging four feature selection strategies and four machine learning classifiers based on the area under the receiver operating characteristic curve (AUC). The feature selection strategies include spearman's rank correlation coefficient, minimum redundancy maximum relevance, support vector machine recursive feature elimination (SVM-RFE), and no feature selection, while the classifiers are random forest, adaptive boosting, support vector machine (SVM) with the Gaussian radial basis function, and SVM with the linear kernel function respectively. Based on the optimal feature set, these feature selection strategies and classifiers were comparatively studied to achieve the best differentiation. Finally, the quantified radiomics prediction model was developed based on the best combination of the feature selection strategy and classifier, and it was compared with two clinical factors based prediction models, and human doctors using nested cross-validation in terms of AUC, accuracy, sensitivity, and specificity. RESULTS: Comparison experiments demonstrated that CT features and three-dimensional (3D) features performed better than positron emission tomography (PET) features and three-dimensional (2D) features respectively, and multidomain features were superior to single domain features. In addition, the combination of SVM-RFE feature selection strategy and Linear SVM classifier had the highest diagnostic performance (i.e., AUC = 0.93 ± 0.01, ACC = 0.85 ± 0.02, SEN = 0.86 ± 0.03, SPE = 0.84 ± 0.03). The quantified radiomics model developed is significantly superior to both human doctors and clinical factors based prediction models in terms of accuracy and specificity. CONCLUSIONS: Our preliminary results confirmed that the quantified radiomics method could aid the noninvasive differentiation of AIP and PDAC in 18 F FDG PET/CT images and the integration of multidomain features is beneficial for the differentiation.

Intrapancreatic accessory spleen: Evaluation with CT and MRI.

The aim of the present study was to evaluate the characteristics of computed tomography (CT) and magnetic resonance imaging (MRI), particularly diffusion-weighted imaging (DWI), in the imaging of intrapancreatic accessory spleen (IPAS). The clinical and pathological records of 9 patients, including 8 patients with IPAS and 1 patient with splenosis, were reviewed. The patients had undergone plain and triple-phase enhanced CT scanning (n=9) and MRI scanning (n=8). The lesions of the 8 IPAS patients were located in the pancreatic tail, and were round (n=3), oval (n=4) or triangular (n=1) in shape. The CT and/or MRI densities, signal intensities and dynamic enhanced patterns of the lesions were similar to those of the orthotopic spleen. In DWI images (n=5), the IPAS regions presented high signal intensity (SI), and no significant difference in the apparent diffusion coefficient determined using a b-value of 600 sec/mm2 was identified between the IPAS and orthotopic spleen (P>0.05). One patient with splenosis complicated with cirrhosis had a nodule located in the pancreatic tail with an unenhanced CT value of 65 HU. In MRI examination, with the exception of the dynamic enhancement pattern, the T1-weighted, T2-weighted and DWI signals of splenosis were inconsistent with those of the normal spleen. In conclusion, in pre-contrast and post-contrast-enhanced CT and MRI images, IPAS exhibits similar characteristics to the orthotopic spleen. CT and MRI used in combination with DWI are important in the diagnosis of IPAS.