Magnetic resonance shoulder imaging using deep learning-based algorithm.

OBJECTIVE: To investigate the feasibility of deep learning-based MRI (DL-MRI) in its application in shoulder imaging and compare its performance with conventional MR imaging (non-DL-MRI). METHODS: This retrospective study was approved by the local ethics committee. Seventy consecutive patients who had been examined with both DL-MRI and non-DL-MRI were enrolled for the image quality and lesion diagnosis comparison. Another 400 patients had been examined only with DL-MRI. Their images' quality was assessed by 20 radiologists using a satisfaction survey. The Kendall W test was performed to assess interobserver agreement. The Wilcoxon test was performed to compare the image quality. For lesion diagnosis, the interobserver and interstudy agreement were evaluated by kappa analysis. RESULTS: The scan time of DL-MRI (6 min 1 s) was nearly 50% decreased compared with that of non-DL-MRI (11 min 25 s). The image quality was higher in both PDWI (4.85 ± 0.31 for DL, and 4.73 ± 0.29 for non-DL) and T2WI (4.95 ± 0.2 for DL, and 4.74 ± 0.41 for non-DL) of DL-MRI. Good interobserver agreement was found for the image quality of all the MR sequences on both DL-MRI (Kendall W: 0.588~0.902) and non-DL-MRI (Kendall W: 0751~0.865). Both the SNRs and |CNR| were significantly higher in PDWI and T2WI of DL-MRI. High interobserver and interstudy agreements for the lesions in non-DL-MRI and DL-MRI (kappa value = 0.913 to 1.000) were observed. The results of the image quality satisfaction survey in 400 patients receiving DL-MRI in the shoulder obtained 5 scores among all the radiologists. CONCLUSION: Shoulder DL-MRI can greatly reduce the scan time, while improve imaging quality of PDWI and T2WI compared to non-DL-MRI. KEY POINTS: • Shoulder 2D DL-MRI can greatly reduce the whole scan time and improve imaging quality of both PDWI and T2WI compared to conventional parallel MRI. • Shoulder 2D DL-MRI could be a clinical routine with greatly improved work efficiency in the future.

Predicting the image quality of respiratory-gated and breath-hold 3D MRCP from the breathing curve: a prospective study.

OBJECTIVES: To compare the image quality of breath-hold magnetic resonance cholangiopancreatography (BH-MRCP) and respiratory-gating MRCP (RG-MRCP), and to explore breathing curve-based factors and patient-related data affecting image quality. METHODS: A total of 126 participants who underwent RG-MRCP and BH-MRCP on a 3-T magnetic resonance (MR) scanner were enrolled from May to December 2021. The images were evaluated by three radiologists on a 5-point scale. Respiratory parameters were extracted from the breathing curves. The Wilcoxon test was used to compare the image quality between the two MRCPs. Logistic regression analyzes were performed to identify age, sex, abdominal pain, and breathing predictor variables of better image quality. RESULTS: BH-MRCP performed better in visualizing intrahepatic bile ducts and overall image quality than RG-MRCP (p < 0.01). Factors predicting relatively good image quality included lower standard deviation of the respiratory amplitude (SDamp)-minimum-peak (odds ratio = 0.16, p < 0.01) for RG-MRCP and lower SDamp (OR = 0.69, p < 0.01) for BH-MRCP. CONCLUSIONS: BH-MRCP had significantly better overall image quality than RG-MRCP. Respiratory conditions exerted a significant impact on MRCP image quality, and parameters derived from the breathing curve could help predict the image quality of both sequences. KEY POINTS: • Both breath-hold (BH) and respiratory-gating (RG) MRCP demonstrate satisfying image quality. • BH-GRASE-MRCP is significantly better than RG-MRCP at the group level, but not for every individual. • Respiratory conditions exert a significant impact on the image quality, and the breathing curve can help predict the image quality.

Maltol ameliorates intervertebral disc degeneration through inhibiting PI3K/AKT/NF-κB pathway and regulating NLRP3 inflammasome-mediated pyroptosis.

OBJECTIVES: As one of the major causes of low back pain, intervertebral disc degeneration (IDD) has caused a huge problem for humans. Increasing evidence indicates that NLRP3 inflammasome-mediated pyroptosis of NP cells displays an important role in the progression of IDD. Maltol (MA) is a flavoring agent extracted from red ginseng. Due to its anti-inflammatory and antioxidant effects, MA has been widely considered by researchers. Therefore, we hypothesized that MA may be a potential IVD protective agent by regulating NP cells and their surrounding microenvironment. METHODS: In vitro, qRT-PCR, and Western blot were used to explore the effect of MA on the transcription and protein expression of the anabolic protein (ADAMTS5, MMP3, MMP9) catabolic protein (Aggrecan), and pro-inflammatory factor (iNOS COX-2). Next, the effects of MA on PI3K/AKT/NF-κB pathway and pyroptosis pathway were analyzed by Western blot and immunofluorescence. Molecular docking was used to investigate the relationship between PI3K and MA. Moreover, ELISA was also used to detect the effects of MA on inflammatory factors (TNF-α, PGE2, IL-1ß, and IL-18). In vivo, the effects of MA on the vertebral structure of IDD mice were studied by HE and SO staining and the effects of MA on ECM and PI3K/AKT/NF-κB and pyroptosis pathway of IDD mice were studied by immunohistochemical staining. RESULTS: MA can ameliorate intervertebral disc degeneration in vivo and in vitro. Specifically, the molecular docking results showed that the binding degree of MA and PI3K was significant. Second, in vitro studies showed that MA inhibited the degradation of ECM and inflammatory response by inhibiting the PI3K/AKT/NF-κB pathway and the pyroptosis mediated by NLRP3 inflammasome, which increased the expression of anabolic proteins, decreased the expression of catabolic proteins, and decreased the secretion of inflammatory mediators such as IL-18 and IL-1ß. In addition, according to the study results of the mouse lumbar instability model, MA also improved the tissue disorder and degradation of the intervertebral disc, reduced the loss of proteoglycan and glycosaminoglycan, and inhibited intervertebral disc inflammation, indicating that MA has a protective effect on the intervertebral disc to intervertebral disc in mice. CONCLUSIONS: Our results suggest that MA slowed IDD development through the PI3K/AKT/NF-κB signaling pathway and NLRP3 inflammasome-mediated pyroptosis, indicating that MA appeared to be a viable medication for IDD treatment.

An Investigation of 2D Spine Magnetic Resonance Imaging (MRI) with Compressed Sensing (CS).

OBJECTIVE: To investigate the feasibility of compressed sensing MRI (CS-MRI) in the application of 2D spinal imaging and compare its performance with conventional MR imaging (non-CS-MRI). METHODS: The CS imaging protocol was optimized on 5 volunteers. Non-CS-MRI and CS-MRI of 2D sagittal T1 weighted imaging (WI), Sag T2WI, and axial T2WI were performed for 71 patients (22 cervical, 8 thoracic, 41 lumbar MRI). Paired t tests were conducted to compare the total scan time. Three radiologists assessed image quality and lesion diagnosis independently. A Kendall W test was performed to assess interobserver agreement of the image quality scores and lesion diagnosis between readers. A nonparametric test (Wilcoxon test) was performed to compare the image quality. For lesion diagnosis, the interobserver and interstudy agreements were evaluated by kappa analysis. Paired t tests were conducted for SNR and CNR comparison. RESULTS: The mean scan time for spine CS-MRI (4 min 28.7 s ± 34.6 s) was significantly shorter than that with non-CS-MRI (7 min 21.3 s ± 38.7 s, t = - 47.464, P < 0.0001). CS-MRI achieved higher SNR and CNR than Non-CS-MRI in image quality assessment. Interobserver agreements of lesion diagnosis were excellent between non-CS-MRI and CS-MRI (kappa value from 0.913 to 1.000, P < 0.001). Interstudy agreements of lesion assessments were also excellent (kappa value = 1.000, with P < 0.001). CONCLUSION: CS-MRI spine imaging can significantly reduce the scan time, while maintaining comparable imaging quality to non-CS-MRI.

A severe case of human coronavirus 229E pneumonia in an elderly man with diabetes mellitus: a case report.

BACKGROUND: With pandemic of coronavirus disease 2019 (COVID-19), human coronaviruses (HCoVs) have recently attached worldwide attention as essential pathogens in respiratory infection. HCoV-229E has been described as a rare cause of lower respiratory infection in immunocompetent adults. CASE PRESENTATION: We reported a 72-year-old man infected by HCoV-229E with rapid progression to acute respiratory distress syndrome, in conjunction with new onset atrial fibrillation, intensive care unit acquired weakness, and recurrent hospital acquired pneumonia. Clinical and radiological data were continuously collected. The absolute number of peripheral T cells and the level of complement components diminished initially and recovered after 2 months. The patient was successfully treated under intensive support care and discharged from the hospital after 3 months and followed. CONCLUSION: HCoV-229E might an essential causative agent of pulmonary inflammation and extensive lung damage. Supportive treatment was essential to HCoVs infection on account of a long duration of immunological recovery in critical HCoV-229E infection.

Subretinal echinococcosis: a case report.

BACKGROUND: Echinococcosis is a dangerous zoonotic parasitic disease. Ocular echinococcosis is very rare, especially the hydatid cysts in subretinal space. We present a case of subretinal echinococcosis and management. CASE PRESENTATION: A 37-year-old man with subretinal echinococcosis who developed panuveitis and visual impairment. The patient lives on agriculture and animal husbandry, which made him susceptible to parasitic infection. He had severe panuveitis and blurred vision on arrival at hospital. According to his ocular examination and systemic review, the subretinal echinococcosis diagnosis was made. The patient received pars plana lensectomy and pars plana vitrectomy. The lesion underneath his retina was removed, and histopathology examination confirmed the subretinal echinococcosis diagnosis. CONCLUSIONS: Echinococcosis is a dangerous zoonotic parasitic disease in pastoral areas. Ocular echinococcosis is usually secondary to systemic infection. Although the incidence is rare, the disease could lead to destructive visual function impairment.

Value of additional strain analysis with feature tracking in dobutamine stress cardiovascular magnetic resonance for detecting coronary artery disease.

BACKGROUND: Dobutamine stress cardiovascular magnetic resonance (DS-CMR) has been established for the detection of coronary artery disease (CAD). The novel technique feature tracking (FT) analyses left ventricular circumferential strain (Ecc) thus offering detailed information about myocardial deformation. The purpose of this study was to evaluate FT based Ecc for the detection of myocardial ischemia during DS-CMR. METHODS: A total of 25 patients (18 males; mean age 64 ± 10 years) with suspected or known CAD underwent a standardized high-dose DS-CMR protocol at 1.5 T. For FT analysis cine short axis (SAX) views (apical, medial, basal) at rest and during maximum dobutamine stress were used. None of the patients had wall motion abnormalities (WMAs) or impaired left ventricular function at rest or scar tissue. For analysis of Ecc the three SAX planes were divided into 16 segments (n = 400 segments). During stress 15 patients (34 segments) developed WMAs as assessed by visual analysis. All patients underwent x-ray coronary angiography for clinical reasons which served as the reference standard. Patients without WMAs during DS-CMR and exclusion of stenotic CAD were defined as normal (10 patients, 160 segments). In patients with significant CAD segments that were supplied by a vessel of >70% narrowing were defined as stenotic (n = 64). The remaining segments in patients with significant CAD were considered as remote (n = 176). RESULTS: At rest no differences in Ecc were observed between normal, stenotic and remote segments. High-dose dobutamine stress revealed highly significant differences between Ecc of normal and stenotic segments (p < 0.001), as well as between remote and stenotic segments (p < 0.001). The same observation took place for the absolute change of Ecc (p < 0.001 and p = 0.01). ROC analysis of Ecc during maximum DS-CMR differentiated normal from stenotic segments with a sensitivity of 75% and specificity of 67% using a cutoff -33.2% with an area under the curve of 0.78. Additional analysis of intermediate-dose dobutamine also showed a significant difference between normal and stenotic segments (p = 0.001). CONCLUSION: FT based analysis of Ecc during intermediate- and high-dose DS-CMR was feasible and differentiated between stenotic, remote and normal segments. Quantitative assessment of Ecc with FT may improve the diagnostic accuracy of DS-CMR for detection of ischemia.

Investigation of renal perfusion and pathological changes in patients with acute kidney disease and tubulointerstitial nephritis using intravoxel incoherent motion and arterial spin labelling MRI: a prospective, observational study protocol.

INTRODUCTION: Acute kidney injury (AKI) is a critical condition with a complex aetiology and different outcomes, where haemodynamic dysfunction, renal hypoperfusion and inflammation serve as key contributors to its development and progression. Early and accurate diagnosis is vital for initiating targeted treatments like fluid resuscitation, vasoactive agents or steroid therapy, which are essential for improving patient outcomes. Intravoxel incoherent motion (IVIM) MRI assesses both capillary perfusion and tissue water diffusion, while arterial spin labelling (ASL) MRI measures renal blood flow without the need for contrast. Research on combined use of IVIM and ASL MRI in patients with AKI is rare. This study aims to investigate the MRI characteristics of IVIM and ASL in patients with tubulointerstitial nephritis (TIN) and to explore their relationship with pathological findings and renal recovery. METHODS AND ANALYSIS: Single-centre, prospective, observational cohort study of 30 patients with biopsy-proven TIN. Participants will undergo renal IVIM and ASL MRI within 7 days post-biopsy. The pathological assessments of active and chronic tubulointerstitial injuries will be semiscored using modified Banff criteria. The estimated glomerular filtration rate (eGFR) during follow-up and prevalence of chronic kidney disease at 3 and 6 months will be reported. An eGFR below 45 mL/min is considered a poor renal outcome. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Ethics Committee of Peking University First Hospital and written informed consent will be obtained from all participants (2022Y503). The study results will be disseminated through publication in a relevant peer-reviewed journal and presentation at academic meetings to increase awareness and share findings with the scientific community.

Magnetic Resonance Imaging in Atherosclerotic Renal Artery Stenosis: The Update and Future Directions from Interventional Perspective.

Background: Atherosclerotic renal artery stenosis (ARAS) is a condition where the renal arteries become narrowed due to atherosclerosis, leading to reduced blood flow to the kidneys and various renal complications. The effectiveness of interventional treatments, such as renal artery angioplasty and stenting, remains debated, making patient selection for these procedures challenging. Summary: This review focuses on the diagnosis and management of ARAS, with a particular emphasis on the potential role of functional magnetic resonance imaging (MRI) in evaluating renal function and mechanisms. By summarizing current diagnostic approaches and outcomes of interventional treatments, the review highlights the importance of informed clinical decision-making in ARAS management. Functional MRI emerges as a promising noninvasive tool to assess renal function, aiding in patient stratification and treatment planning. Key Messages: The efficacy of interventional treatments for ARAS requires further investigation and careful patient selection. Functional MRI holds promise as a noninvasive means to assess renal function and mechanisms, potentially guiding more effective clinical decisions in ARAS management. Advancing research in diagnostic methods, particularly functional MRI, can enhance our understanding and improve the treatment outcomes for ARAS patients.

CT-based radiomics: predicting early outcomes after percutaneous transluminal renal angioplasty in patients with severe atherosclerotic renal artery stenosis.

This study aimed to comprehensively evaluate non-contrast computed tomography (CT)-based radiomics for predicting early outcomes in patients with severe atherosclerotic renal artery stenosis (ARAS) after percutaneous transluminal renal angioplasty (PTRA). A total of 52 patients were retrospectively recruited, and their clinical characteristics and pretreatment CT images were collected. During a median follow-up period of 3.7 mo, 18 patients were confirmed to have benefited from the treatment, defined as a 20% improvement from baseline in the estimated glomerular filtration rate. A deep learning network trained via self-supervised learning was used to enhance the imaging phenotype characteristics. Radiomics features, comprising 116 handcrafted features and 78 deep learning features, were extracted from the affected renal and perirenal adipose regions. More features from the latter were correlated with early outcomes, as determined by univariate analysis, and were visually represented in radiomics heatmaps and volcano plots. After using consensus clustering and the least absolute shrinkage and selection operator method for feature selection, five machine learning models were evaluated. Logistic regression yielded the highest leave-one-out cross-validation accuracy of 0.780 (95%CI: 0.660-0.880) for the renal signature, while the support vector machine achieved 0.865 (95%CI: 0.769-0.942) for the perirenal adipose signature. SHapley Additive exPlanations was used to visually interpret the prediction mechanism, and a histogram feature and a deep learning feature were identified as the most influential factors for the renal signature and perirenal adipose signature, respectively. Multivariate analysis revealed that both signatures served as independent predictive factors. When combined, they achieved an area under the receiver operating characteristic curve of 0.888 (95%CI: 0.784-0.992), indicating that the imaging phenotypes from both regions complemented each other. In conclusion, non-contrast CT-based radiomics can be leveraged to predict the early outcomes of PTRA, thereby assisting in identifying patients with ARAS suitable for this treatment, with perirenal adipose tissue providing added predictive value.

Integration of Multiparameter MRI into Conventional Pretreatment Risk Factors to Predict Positive Surgical Margins After Radical Prostatectomy.

INTRODUCTION/BACKGROUND: Positive surgical margins (PSMs) after radical prostatectomy (RP) can increase the risk of biochemical recurrence in prostate cancer (PCa) patients. However, the prediction of the likelihood of PSMs in patients undergoing similar surgical procedures remains a challenge. We aim to develop a predictive model for PSMs in patients undergoing non-nerve-sparing RP. PATIENTS AND METHODS: In this retrospective study, we analyzed data from PCa patients who underwent minimally invasive non-nerve-sparing RP at our hospital between June 2017 and June 2021. We identified independent risk factors associated with PSMs using clinical and MRI-based parameters in univariate and multivariate logistic regression analyzes. These factors were then used to develop a nomogram for predicting the probability of PSMs. The predictive performance was validated using calibration and receiver operating characteristic curve, area under the curve ,and decision curve analysis. RESULTS: Multivariate analyzes revealed prostate-specific antigen density, tumor size, tumor location at the apex, tumor contact length, extracapsular extension (ECE) level, and apparent diffusion coefficient value as independent risk factors. A nomogram was developed and validated with high accuracy (C-index = 0.78). Furthermore, we found that 44.2% of patients diagnosed with organ-confined disease had ECE after surgery, and 29.1% of patients with Gleason scores ≤7 had higher pathological scores. Interestingly, the tumor burden calculated from PCa biopsy cores was overestimated when compared to postoperative PCa specimens. CONCLUSION: We developed a reliable nomogram for predicting the risk of PSMs in PCa patients undergoing non-nerve-sparing RP. The study highlights the importance of incorporating these parameters in personalized surgical management.

SEU2-Net: multi-scale U2-Net with SE attention mechanism for liver occupying lesion CT image segmentation.

Liver occupying lesions can profoundly impact an individual's health and well-being. To assist physicians in the diagnosis and treatment of abnormal areas in the liver, we propose a novel network named SEU2-Net by introducing the channel attention mechanism into U2-Net for accurate and automatic liver occupying lesion segmentation. We design the Residual U-block with Squeeze-and-Excitation (SE-RSU), which is to add the Squeeze-and-Excitation (SE) attention mechanism at the residual connections of the Residual U-blocks (RSU, the component unit of U2-Net). SEU2-Net not only retains the advantages of U2-Net in capturing contextual information at multiple scales, but can also adaptively recalibrate channel feature responses to emphasize useful feature information according to the channel attention mechanism. In addition, we present a new abdominal CT dataset for liver occupying lesion segmentation from Peking University First Hospital's clinical data (PUFH dataset). We evaluate the proposed method and compare it with eight deep learning networks on the PUFH and the Liver Tumor Segmentation Challenge (LiTS) datasets. The experimental results show that SEU2-Net has state-of-the-art performance and good robustness in liver occupying lesions segmentation.

Low-contrast agent dose dual-energy CT monochromatic imaging in pulmonary angiography versus routine CT.

OBJECTIVE: This study aimed to retrospectively evaluate the feasibility and reliability of low-contrast agent dose dual-energy computed tomography (DECT) monochromatic imaging in pulmonary angiography. METHODS: Computed tomography pulmonary angiography was performed in 86 patients, 41 in 120-kVp computed tomography (CT) and 45 in DECT with low-contrast agent dose. The images in DECT were reconstructed at optimal kiloelectron-voltage (keV), demonstrating the best contrast-to-noise ratio between pulmonary artery and soft tissue, and at 70 keV. Image quality was compared by quantitative and subjective indexes. The radiation doses were recorded. RESULTS: Compared with 120-kVp CT, optimal keV showed superior quantitative indexes with inferior subjective image quality, whereas 70 keV demonstrated no statistical difference in quantitative indexes with superior subjective image quality. All suspicious pulmonary embolisms in DECT were diagnosed confidently by combination of 2 kinds of monochromatic imaging. The radiation dose in DECT is almost twice as 120-kVp CT. CONCLUSIONS: Low-contrast agent dose DECT monochromatic imaging in pulmonary angiography accommodates superior intravascular enhancement and contrast in pulmonary arteries, and improves diagnostic confidence with compatible radiation dose.

Pregnancy-Associated Renal Cortical Necrosis and Nonenhanced Functional Magnetic Resonance Imaging: A Case Series.

Rationale & Objective: Pregnancy-associated renal cortical necrosis is a critical illness with a poor prognosis. We aimed to describe the clinical and magnetic resonance imaging (MRI) characteristics of a case series of patients with acute kidney injury in the setting of pregnancy-associated renal cortical necrosis. Study Design: Case series. Setting & Participants: Seventeen patients from a single center diagnosed by nonenhanced functional MRI and/or kidney pathology. Results: All patients presented with postpartum acute kidney injury stage 3. Of the 17 patients, 15 (88%) had pregnancy-associated atypical hemolytic uremic syndrome, 11 (65%) had postpartum hemorrhage, 7 (41%) had preeclampsia/hemolysis elevated liver enzymes low platelet count syndrome, and 4 (24%) had disseminated intravascular coagulation. On T2-weighted MRI, the diffuse phenotype showed outer cortex swelling in the early phase, with a dark signal rim involving the inner cortex and Bertin column, which became more apparent over time along with cortical thinning, substantially decreasing T2 signal intensity. The focal phenotype showed focally distributed hypointense signals in the cortex. After 8-101 (median: 60) months of follow-up, 4 individuals had estimated glomerular filtration rates ≥60 mL/min/1.73 m2, 6 had estimated glomerular filtration rates of 15-60 mL/min/1.73 m2, and 7 had kidney failure requiring kidney replacement therapy. The diffuse phenotype was present in all of the individuals who remained kidney replacement therapy dependent. Limitations: Retrospective study; small sample size. Conclusions: Different forms of pregnancy-associated thrombotic microangiopathy were the major causative diseases in our pregnancy-associated renal cortical necrosis case series. Nonenhanced functional MRI may provide valuable data for establishing diagnosis and kidney prognosis.

Analysis of the sensitivity and specificity of compressed sensing magnetic resonance imaging in the diagnosis of heart failure.

Background: Magnetic resonance imaging (MRI) is a powerful tool for predicting heart failure (HF) patient prognosis (including death), but it adversely affecting clinical diagnosis and work efficiency. Compressed sensing technology reconstructs and recovers signals using sampling points that are far below the requirement of traditional sampling laws, which can shorten the signal acquisition time without affecting the image quality of MRI. This study aimed to apply compressed sensing technology to the MRI images of patients with HF to evaluate its effectiveness in the diagnosis of HF. Although compressed sensing MRI technology has not yet been widely adopted in clinical practice, it has demonstrated favorable application prospects. Through continuous updating and optimization, it is expected to become a research hotspot in medical imaging, providing more valuable information for clinical work. Methods: In this study, 66 patients with acute ischemic stroke admitted to hospital were selected for the experimental group, and 20 patients with normal cardiac function who underwent physical examinations during the same period were selected for the control group. An MRI image reconstruction algorithm based on compressed sensing was developed and used in the cardiac MRI image processing. Results: The results showed that the e' and heart rate of the experimental group were significantly higher than those of the control group, and the E/e' ratio was significantly lower than that of the control group (P<0.05). The early peak filling rate (PFR1), the PFR1/the late peak filling rate (PFR2), the early filling volume (FV1), and the FV1/the filling volume (FV) of the experimental group were significantly higher than those of the control group, and the PFR2 and the late filling volume (FV2) of the experimental group were significantly lower than those of the control group (P<0.05). The diagnostic sensitivity, specificity, and the area under the curve (AUC) for the concentration-time of the PFR2 were 0.891, 0.788, and 0.904, respectively. The diagnostic sensitivity, specificity, and AUC for the FV2 were 0.902, 0.878, and 0.925, respectively. The peak signal to noise ratio and structural similarity of the images reconstructed using the oral contraceptives algorithm were significantly higher than those determined by the sensitivity coding algorithm and the orthogonal matching pursuit algorithm (P<0.05). Conclusions: The imaging algorithm based on compressed sensing had excellent processing effect on cardiac MRI and improved the image quality. Cardiac MRI imaging had good diagnostic performance for HF and had the value of clinical popularization.

Ultrasound-guided interlaminar approach for nusinersen administration in patients with spinal muscular atrophy with spinal fusion or severe scoliosis.

BACKGROUND: Intrathecal injection of medications can be challenging in spinal muscular atrophy (SMA) patients with severe scoliosis or after spine surgery. Here we report our experience with real-time ultrasound (US)-guided intrathecal administration of nusinersen in patients with SMA. METHODS: Seven patients (six children and one adult) with either spinal fusion or severe scoliosis were enrolled. We performed intrathecal injections of nusinersen under US guidance. The efficacy and safety of US-guided injection were explored. RESULTS: Five patients had undergone spinal fusion, while the other two presented severe scoliosis. Success was achieved in 19/20 lumbar punctures (95%), 15 of which were performed through the near-spinous process approach. The intervertebral space with a designated channel was selected for the five postoperative patients, while the interspaces with the smallest rotation angle were chosen for the other two patients with severe scoliosis. In 89.5% (17/19) of the punctures, the number of insertions was no more than two. No major adverse events were observed. CONCLUSION: Given its safety and efficacy, real-time US guidance is recommended for SMA patients with spine surgery or severe scoliosis, and the near-spinous process view can be used as a interlaminar puncture approach for US guidance.

Integrating radiomics with the vesical imaging-reporting and data system to predict muscle invasion of bladder cancer.

PURPOSE: To develop predictive models based on the integration of radiomics with the Vesical Imaging-Reporting and Data System (VI-RADS) for determining muscle invasion of bladder cancer. MATERIALS AND METHODS: One hundred ninety-one patients were retrospectively included in this study from January 2015 to March 2022. Of these, 121 data were randomly divided into training and validation sets at a ratio of 7:3. The remaining data (n = 70) served as the independent testing set. The radiomics features were extracted from bladder cancer on high-b-value DWI images. The pipelines of radiomics models were trained in the training set. One optimal model was selected based on the performance in the validation set. Then, the selected model was tested in the independent testing set. Two radiologists evaluated the VI-RADS based on T2WI and DWI. Reader 1 was an experienced reader, and Reader 2 was an inexperienced reader. A clinical-radiomics model was built by integrating the radiomics signature and VI-RADS. The performance was assessed using receiver operating characteristic curve analysis. The histopathological results were used as the standard reference to assess the diagnostic accuracy of muscle invasion. RESULTS: The radiomics model had area under the curve (AUC) values of 0.801, 0.867, and 0.806 in the training, validation, and testing sets, respectively. The VI-RADS scores of Readers 1/2 yielded AUC values of 0.831/0.781, 0.909/0.815, and 0.871/0.776 in the training, validation, and testing sets, respectively. The clinical-radiomics model for Readers 1/2 revealed AUC values of 0.889/0.854, 0.961/0.919, and 0.881/0.844 in the training, validation, and testing sets, respectively. The performance of the clinical-radiomics model was improved compared to the VI-RADS score for inexperienced Reader 2 (P < 0.05). CONCLUSION: The radiomics model was useful in the diagnosis of muscle invasion of bladder cancer. The clinical-radiomics model integrating radiomics and VI-RADS further improved the performance compared to VI-RADS alone, which was helpful for readers with less diagnostic experience.

Early diagnostic and prognostic value of myocardial strain derived from cardiovascular magnetic resonance in patients with cardiac amyloidosis.

Background: Cardiac amyloidosis (CA) is one of the causes of heart failure with preserved ejection fraction. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) and extracellular volume (ECV) fractions is a preferred method to identify CA. However, the requirement of contrast limits its use in renal deficiency patients. Myocardial strain is a promising method without contrast. We sought to assess the early diagnostic and prognostic value of strain. Methods: This retrospective study enrolled 31 patients with systemic amyloidosis (SA) in Peking University First Hospital from January 2014 to January 2019. The patients were categorized into three groups, including 11 CA patients with left ventricular hypertrophy (CA-LVH group), 9 CA patients without LVH (CA-NLVH group), and 11 patients with extracardiac SA (SA group). Strain analysis was performed with CMR images. A least absolute shrinkage and selection operator (LASSO) was used to generate strain score. The receiver operating characteristic (ROC) curve was used to evaluate the early diagnostic efficacy of strain score and other single strain parameter. The primary endpoint was defined as death from all cause or rehospitalization for heart failure. A Cox proportional hazards model was used to assess the index value on the prognosis. Results: In CA patients, as the left ventricular wall thickens, the global and regional strain decrease significantly. A new strain score (strain score = 0.00893 × mid-septal circumferential peak strain + 0.02285 × apical radial peak strain + 0.1541 × apical circumferential peak strain + 0.33097 × epicardial circumferential average peak strain + 0.42232 × endocardial longitudinal average peak strain) generated using LASSO showed that the area under the ROC curve was 0.909. All the patients with outcome events were in CA groups, four were in CA-LVH group and one in CA-NLVH group. New York Heart Association (NYHA) grade [hazard ratio (HR) =14.29, 95% confidence interval (CI): 2.34-87.34, P<0.01], brain natriuretic peptide (HR =20.05, 95% CI: 2.21-182.36, P=0.008), cardiac injury biomarker (HR =11.59, 95% CI: 1.03-130.36, P=0.047), E/E' (mitral inflow to mitral relaxation velocity ratio) (HR =1.09, 95% CI: 1.00-1.18, P=0.040), end-systolic left ventricular volume (HR =1.04, 95% CI: 1.00-1.18, P=0.039) and LGE volume (HR =1.11, 95% CI: 1.02-1.20, P=0.012) positively correlate with events. Better renal function (HR =0.92, 95% CI: 0.86-0.98, P=0.011) and ejection fraction (HR =0.94, 95% CI: 0.88-0.99, P=0.027) appear to be protective factors. Although with no statistical difference, the strain damage had a tendency to predict poor prognosis, i.e., mid-ventricular circumferential strain with HR of 1.25 (95% CI: 1.0-1.57, P=0.050) and strain score with HR of 1.30 (95% CI: 0.98-1.73, P=0.067). Conclusions: Myocardial strain decreased in CA patients. The integrated magnetic resonance imaging (MRI) strain score can serve as a useful tool to identify early myocardial involvement in amyloidosis. The strain damage had a tendency to predict poor prognosis.

The Predictive Value of Combining Symptoms, Residual Syntax Score and Non-Invasive Tests in the Diagnosis of Significant Coronary Artery Disease in Elderly Post-PCI Patients.

Purpose: To assess the diagnostic efficiency of a combination of symptoms, residual Syntax score (rSS) and non-invasive tests in elderly post-PCI patients. Patients and Methods: This was a retrospective study that consecutively enrolled patients ≥60 years old with chronic coronary syndrome and previous stent implantation without lesions requiring further revascularization between March 2013 and June 2020. The patients were scheduled for exercise ECG, CCTA and invasive coronary angiography within 4 weeks. The study then calculated rSS and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of symptoms, rSS, exercise ECG and CCTA, taking computational pressure-flow dynamics derived fractional flow reserve (caFFR) as the standard reference. Results: A total of 114 patients were enrolled in this study, including 75 patients with caFFR-positive and 39 patients with caFFR-negative. The caFFR-positive group had more patients with typical angina. Furthermore, the rSS in the caFFR-positive group was higher than that in the caFFR-negative category (7.33 ± 6.56 vs 3.34 ± 4.26, p < 0.001). There was no significant difference in exercise ECG results between the two groups. However, the rate of positive CCTA in the caFFR-positive group was higher than that in the caFFR-negative category (89.33% vs 46.15%, p < 0.001). In addition, after combining symptoms, rSS and CCTA, the sensitivity, specificity, PPV, NPV and accuracy for diagnose were 77.5%, 84.2%, 90.2%, 66.7% and 79.8%, respectively. Conclusion: The findings showed that exercise ECG had limited power to diagnose significant CAD in elderly post-PCI patients, but CCTA was more efficient. Moreover, combining symptoms, rSS and CCTA provided more accurate diagnostic performance with feasibility and safety.