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OBJECTIVES: To evaluate the robustness of radiomics features among photon-counting detector CT (PCD-CT) and dual-energy CT (DECT) systems. METHODS: A texture phantom consisting of twenty-eight materials was scanned with one PCD-CT and four DECT systems (dual-source, rapid kV-switching, dual-layer, and sequential scanning) at three dose levels twice. Thirty sets of virtual monochromatic images at 70 keV were reconstructed. Regions of interest were delineated for each material with a rigid registration. Ninety-three radiomics were extracted per PyRadiomics. The test-retest repeatability between repeated scans was assessed by Bland-Altman analysis. The intra-system reproducibility between dose levels, and inter-system reproducibility within the same dose level, were evaluated by intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC). Inter-system variability among five scanners was assessed by coefficient of variation (CV) and quartile coefficient of dispersion (QCD). RESULTS: The test-retest repeatability analysis presented that 97.1% of features were repeatable between scan-rescans. The mean ± standard deviation ICC and CCC were 0.945 ± 0.079 and 0.945 ± 0.079 for intra-system reproducibility, respectively, and 86.0% and 85.7% of features were with ICC > 0.90 and CCC > 0.90, respectively, between different dose levels. The mean ± standard deviation ICC and CCC were 0.157 ± 0.174 and 0.157 ± 0.174 for inter-system reproducibility, respectively, and none of the features were with ICC > 0.90 or CCC > 0.90 within the same dose level. The inter-system variability suggested that 6.5% and 12.8% of features were with CV < 10% and QCD < 10%, respectively, among five CT systems. CONCLUSION: The radiomics features were non-reproducible with significant variability in values among different CT techniques. CLINICAL RELEVANCE STATEMENT: Radiomics features are non-reproducible with significant variability in values among photon-counting detector CT and dual-energy CT systems, necessitating careful attention to improve the cross-system generalizability of radiomic features before implementation of radiomics analysis in clinical routine. KEY POINTS: CT radiomics stability should be guaranteed before the implementation in the clinical routine. Radiomics robustness was on a low level among photon-counting detectors and dual-energy CT techniques. Limited inter-system robustness of radiomic features may impact the generalizability of models.
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A series of genipin derivatives were designed and synthesized as potential inhibitors targeted KRAS G12D mutation. The majority of these compounds demonstrated potential antiproliferative effects against KRAS G12D mutant tumor cells (CT26 and A427). Notably, seven compounds exhibited the anticancer effects with IC50 values ranging from 7.06 to 9.21 µM in CT26 (KRASG12D) and A427 (KRASG12D) cells and effectively suppressed the colony formation of CT26 cells. One representative compound SK12 was selected for further investigation into biological activity and action mechanisms. SK12 markedly induced apoptosis in CT26 cells in a concentration-dependent manner. Moreover, SK12 elevated the levels of reactive oxygen species (ROS) in tumor cells and exhibited a modulatory effect on the KRAS signaling pathway, thereby inhibiting the activation of downstream phosphorylated proteins. The binding affinity of SK12 to KRAS G12D protein was further confirmed by the surface plasmon resonance (SPR) assay with a binding KD of 157 µM. SK12 also exhibited notable anticancer efficacy in a nude mice tumor model. The relative tumor proliferation rate (T/C) of the experimental group (50 mg/kg) was 31.04 % (P < 0.05), while maintaining a commendable safety profile.
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Antineoplásicos , Proliferação de Células , Relação Dose-Resposta a Droga , Ensaios de Seleção de Medicamentos Antitumorais , Iridoides , Camundongos Nus , Proteínas Proto-Oncogênicas p21(ras) , Humanos , Iridoides/farmacologia , Iridoides/química , Animais , Proteínas Proto-Oncogênicas p21(ras)/antagonistas & inibidores , Proteínas Proto-Oncogênicas p21(ras)/genética , Proteínas Proto-Oncogênicas p21(ras)/metabolismo , Antineoplásicos/farmacologia , Antineoplásicos/química , Antineoplásicos/síntese química , Proliferação de Células/efeitos dos fármacos , Relação Estrutura-Atividade , Camundongos , Estrutura Molecular , Apoptose/efeitos dos fármacos , Descoberta de Drogas , Linhagem Celular Tumoral , Mutação , Camundongos Endogâmicos BALB C , Neoplasias Experimentais/tratamento farmacológico , Neoplasias Experimentais/patologia , Neoplasias Experimentais/metabolismoRESUMO
BACKGROUND: To assess the improvement of image quality and diagnostic acceptance of thinner slice iodine maps enabled by deep learning image reconstruction (DLIR) in abdominal dual-energy CT (DECT). METHODS: This study prospectively included 104 participants with 136 lesions. Four series of iodine maps were generated based on portal-venous scans of contrast-enhanced abdominal DECT: 5-mm and 1.25-mm using adaptive statistical iterative reconstruction-V (Asir-V) with 50% blending (AV-50), and 1.25-mm using DLIR with medium (DLIR-M), and high strength (DLIR-H). The iodine concentrations (IC) and their standard deviations of nine anatomical sites were measured, and the corresponding coefficient of variations (CV) were calculated. Noise-power-spectrum (NPS) and edge-rise-slope (ERS) were measured. Five radiologists rated image quality in terms of image noise, contrast, sharpness, texture, and small structure visibility, and evaluated overall diagnostic acceptability of images and lesion conspicuity. RESULTS: The four reconstructions maintained the IC values unchanged in nine anatomical sites (all p > 0.999). Compared to 1.25-mm AV-50, 1.25-mm DLIR-M and DLIR-H significantly reduced CV values (all p < 0.001) and presented lower noise and noise peak (both p < 0.001). Compared to 5-mm AV-50, 1.25-mm images had higher ERS (all p < 0.001). The difference of the peak and average spatial frequency among the four reconstructions was relatively small but statistically significant (both p < 0.001). The 1.25-mm DLIR-M images were rated higher than the 5-mm and 1.25-mm AV-50 images for diagnostic acceptability and lesion conspicuity (all P < 0.001). CONCLUSIONS: DLIR may facilitate the thinner slice thickness iodine maps in abdominal DECT for improvement of image quality, diagnostic acceptability, and lesion conspicuity.
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Meios de Contraste , Aprendizado Profundo , Interpretação de Imagem Radiográfica Assistida por Computador , Radiografia Abdominal , Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Tomografia Computadorizada por Raios X , Humanos , Estudos Prospectivos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Tomografia Computadorizada por Raios X/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia Abdominal/métodos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Adulto , Iodo , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: The best settings of deep learning image reconstruction (DLIR) algorithm for abdominal low-kiloelectron volt (keV) virtual monoenergetic imaging (VMI) have not been determined. PURPOSE: To determine the optimal settings of the DLIR algorithm for abdominal low-keV VMI. MATERIAL AND METHODS: The portal-venous phase computed tomography (CT) scans of 109 participants with 152 lesions were reconstructed into four image series: VMI at 50 keV using adaptive statistical iterative reconstruction (Asir-V) at 50% blending (AV-50); and VMI at 40 keV using AV-50 and DLIR at medium (DLIR-M) and high strength (DLIR-H). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of nine anatomical sites were calculated. Noise power spectrum (NPS) using homogenous region of liver, and edge rise slope (ERS) at five edges were measured. Five radiologists rated image quality and diagnostic acceptability, and evaluated the lesion conspicuity. RESULTS: The SNR and CNR values, and noise and noise peak in NPS measurements, were significantly lower in DLIR images than AV-50 images in all anatomical sites (all P < 0.001). The ERS values were significantly higher in 40-keV images than 50-keV images at all edges (all P < 0.001). The differences of the peak and average spatial frequency among the four reconstruction algorithms were significant but relatively small. The 40-keV images were rated higher with DLIR-M than DLIR-H for diagnostic acceptance (P < 0.001) and lesion conspicuity (P = 0.010). CONCLUSION: DLIR provides lower noise, higher sharpness, and more natural texture to allow 40 keV to be a new standard for routine VMI reconstruction for the abdomen and DLIR-M gains higher diagnostic acceptance and lesion conspicuity rating than DLIR-H.
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OBJECTIVES: In Chinese culture, family members are the main decision maker on end-of-life (EoL) issues for patients with advanced cancer. Yet little is known about Chinese families' confidence in making EoL decisions and its associated factors. This study aims to investigate the status and associated factors of Chinese family members' confidence in making EoL decisions for patients with advanced cancer. METHODS: This cross-sectional study used a convenience sample of 147 family members of patients with stage III or stage IV cancer from a tertiary cancer center in Guangzhou, China. The questionnaires included demographic information of patients and their family members, patients' EoL preferences, and the Chinese version of the Family Decision-Making Self-Efficacy (FDMSE) Scale. RESULTS: A total of145 family members (98.64%) completed the questionnaires. The average score of FDMSE was 3.92 ± 0.53. A multiple regression analysis showed that the factors associated with FDMSE included patients' duration of disease, health insurance, participation in EoL decision-making, the expression of unfilled wishes, and family members' employment status. SIGNIFICANCE OF RESULTS: Chinese family members were not confident enough in making EoL decisions for patients with advanced cancer. It is recommended to develop cultural-tailored advanced care planning models to clarify patient preferences and to enhance the family members' self-efficacy in making EoL decisions with or for patients with advanced cancer.
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BACKGROUND: Quantitative diffusion metrics provide additional microstructural information of diseases. The robustness of quantitative diffusion metrics should be established before clinical application. PURPOSE: To evaluate the variability and reproducibility of quantitative diffusion MRI metrics. STUDY TYPE: Prospective. POPULATION: 14 volunteers (7 men; median age, range, 28, 26-59 years). FIELD STRENGTH/SEQUENCE: 3.0-T/Diffusion spectrum imaging. ASSESSMENT: Brain MRI studies were performed four times per subject: involving different combinations of coil types and voxel sizes. Regions of interest of 13 brain anatomical sites were drawn by one observer twice and another observer once to allow interobserver and intraobserver reproducibility assessment. Twenty-five quantitative metrics were calculated using four diffusion models. STATISTICAL TESTS: The variability was evaluated with coefficients of variation (CV), and quartile coefficient of dispersion (QCD). The reproducibility was assessed with intraclass correlation coefficient (ICC), and concordance correlation coefficient (CCC). Wilcoxon signed rank test was used to compare the influence of factors on robustness of quantitative diffusion metrics. A two-tailed P < 0.05 was considered statistically significant. RESULTS: The variability of quantitative diffusion metrics showed CV of 2.4%-68.2%, and QCD of 0.6%-48.2%, respectively. The reproducibility of scans using 20-channel coils with voxels of 2 × 2 × 2 mm3 and 3 × 3 × 3 mm3 , respectively (ICC 0.03-0.84, CCC 0.03-0.84) was significantly worse than that of repeated scans using a 20-channel coil with a voxel size of 2 × 2 × 2 mm3 (ICC of 0.74-0.97, CCC 0.74-0.97) and that of scans using 20- and 64-channel coils, respectively, with a voxel size of 2 × 2 × 2 mm3 (ICC 0.59-0.95, CCC 0.59-0.95). The intraobserver reproducibility (ICC 0.49-0.94, CCC 0.49-0.94) was significantly better than the interobserver reproducibility (ICC 0.28-0.91, CCC 0.28-0.91). DATA CONCLUSION: Our study indicated that the voxel size has a greater influence on the reproducibility of quantitative diffusion metrics than scan-rescans and coils. The reproducibility within one observer was higher than that between two observers. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 1.
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Bone is a kind of meat processing by-product with high nutritional value but low in calorie, which is a typical food in China and parts of East Asian countries. Microbial fermentation by lactic acid bacteria showed remarkable advantages to increase the absorption of nutrients from bone cement by human body. Streptococcus thermophilus CICC 20372 is proven to be a good starter for bone cement fermentation. No genes encoding virulence traits or virulence factors were found in the genome of S. thermophilus CICC 20372 by a thorough genomic analysis. Its notable absence of antibiotic resistance further solidifies the safety. Furthermore, the genomic analysis identified four types of gene clusters responsible for the synthesis of antimicrobial metabolites. A comparative metabolomic analysis was performed by cultivating the strain in bone cement at 37 °C for 72 h, with the culture in de Man, Rogosa, and Sharpe (MRS) medium as control. Metabolome analysis results highlighted the upregulation of pathways involved in 2-oxocarboxylic acid metabolism, ATP-binding cassette (ABC) transporters, amino acid synthesis, and nucleotide metabolism during bone cement fermentation. S. thermophilus CICC 20372 produces several metabolites with health-promoting function during bone cement fermentation, including indole-3-lactic acid, which is demonstrated ameliorative effects on intestinal inflammation, tumor growth, and gut dysbiosis. In addition, lots of nucleotide and organic acids were accumulated at higher levels, which enriched the fermented bone cement with a variety of nutrients. Collectively, these features endow S. thermophilus CICC 20372 a great potential strain for bone food processing.
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Cimentos Ósseos , Streptococcus thermophilus , Humanos , Fermentação , Streptococcus thermophilus/genética , Streptococcus thermophilus/metabolismo , Cimentos Ósseos/metabolismo , Metaboloma , Nucleotídeos/metabolismoRESUMO
OBJECTIVE: To evaluate the study quality and clinical value of radiomics studies on chondrosarcoma. METHODS: PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang Data were searched for articles on radiomics for evaluating chondrosarcoma as of January 31, 2022. The study quality was assessed according to Radiomics Quality Score (RQS), Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) checklist, Image Biomarker Standardization Initiative (IBSI) guideline, and modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The level of evidence supporting clinical use of radiomics on chondrosarcoma differential diagnosis was determined based on meta-analyses. RESULTS: Twelve articles were included. The median RQS was 10.5 (range, -3 to 15), with an adherence rate of 36%. The adherence rate was extremely low in domains of high-level evidence (0%), open science and data (17%), and imaging and segmentation (35%). The adherence rate of the TRIPOD checklist was 61%, and low for section of title and abstract (13%), introduction (42%), and results (56%). The reporting rate of pre-processing steps according to the IBSI guideline was 60%. The risk of bias and concern of application were mainly related to the index test. The meta-analysis on differential diagnosis of enchondromas vs. chondrosarcomas showed a diagnostic odds ratio of 43.90 (95% confidential interval, 25.33-76.10), which was rated as weak evidence. CONCLUSIONS: The current scientific and reporting quality of radiomics studies on chondrosarcoma was insufficient. Radiomics has potential in facilitating the optimization of operation decision-making in chondrosarcoma. KEY POINTS: ⢠Among radiomics studies on chondrosarcoma, although differential diagnostic models showed promising performance, only pieces of weak level of evidence were reached with insufficient study quality. ⢠Since the RQS rating, the TRIPOD checklist, and the IBSI guideline have largely overlapped with each other, it is necessary to establish one widely acceptable methodological and reporting guideline for radiomics research. ⢠The TRIPOD model typing, the phase classification of image mining studies, and the level of evidence category are useful tools to assess the gap between academic research and clinical application, although their modifications for radiomics studies are needed.
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Condrossarcoma , Diagnóstico por Imagem , Humanos , Prognóstico , Biomarcadores , Diagnóstico Diferencial , Condrossarcoma/diagnóstico por imagemRESUMO
OBJECTIVES: To evaluate image quality, diagnostic acceptability, and lesion conspicuity in abdominal dual-energy CT (DECT) using deep learning image reconstruction (DLIR) compared to those using adaptive statistical iterative reconstruction-V (Asir-V) at 50% blending (AV-50), and to identify potential factors impacting lesion conspicuity. METHODS: The portal-venous phase scans in abdominal DECT of 47 participants with 84 lesions were prospectively included. The raw data were reconstructed to virtual monoenergetic image (VMI) at 50 keV using filtered back-projection (FBP), AV-50, and DLIR at low (DLIR-L), medium (DLIR-M), and high strength (DLIR-H). A noise power spectrum (NPS) was generated. CT number and standard deviation values of eight anatomical sites were measured. Signal-to-noise (SNR), and contrast-to-noise ratio (CNR) values were calculated. Five radiologists assessed image quality in terms of image contrast, image noise, image sharpness, artificial sensation, and diagnostic acceptability, and evaluated the lesion conspicuity. RESULTS: DLIR further reduced image noise (p < 0.001) compared to AV-50 while better preserved the average NPS frequency (p < 0.001). DLIR maintained CT number values (p > 0.99) and improved SNR and CNR values compared to AV-50 (p < 0.001). DLIR-H and DLIR-M showed higher ratings in all image quality analyses than AV-50 (p < 0.001). DLIR-H provided significantly better lesion conspicuity than AV-50 and DLIR-M regardless of lesion size, relative CT attenuation to surrounding tissue, or clinical purpose (p < 0.05). CONCLUSIONS: DLIR-H could be safely recommended for routine low-keV VMI reconstruction in daily contrast-enhanced abdominal DECT to improve image quality, diagnostic acceptability, and lesion conspicuity. KEY POINTS: ⢠DLIR is superior to AV-50 in noise reduction, with less shifts of the average spatial frequency of NPS towards low frequency, and larger improvements of NPS noise, noise peak, SNR, and CNR values. ⢠DLIR-M and DLIR-H generate better image quality in terms of image contrast, noise, sharpness, artificial sensation, and diagnostic acceptability than AV-50, while DLIR-H provides better lesion conspicuity than AV-50 and DLIR-M. ⢠DLIR-H could be safely recommended as a new standard for routine low-keV VMI reconstruction in contrast-enhanced abdominal DECT to provide better lesion conspicuity and better image quality than the standard AV-50.
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Aprendizado Profundo , Humanos , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos , Processamento de Imagem Assistida por Computador/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Algoritmos , Doses de RadiaçãoRESUMO
BACKGROUND: Complete reporting is essential for clinical research. However, the endorsement of reporting guidelines in radiological journals is still unclear. Further, as a field extensively utilizing artificial intelligence (AI), the adoption of both general and AI reporting guidelines would be necessary for enhancing quality and transparency of radiological research. This study aims to investigate the endorsement of general reporting guidelines and those for AI applications in medical imaging in radiological journals, and explore associated journal characteristic variables. METHODS: This meta-research study screened journals from the Radiology, Nuclear Medicine & Medical Imaging category, Science Citation Index Expanded of the 2022 Journal Citation Reports, and excluded journals not publishing original research, in non-English languages, and instructions for authors unavailable. The endorsement of fifteen general reporting guidelines and ten AI reporting guidelines was rated using a five-level tool: "active strong", "active weak", "passive moderate", "passive weak", and "none". The association between endorsement and journal characteristic variables was evaluated by logistic regression analysis. RESULTS: We included 117 journals. The top-five endorsed reporting guidelines were CONSORT (Consolidated Standards of Reporting Trials, 58.1%, 68/117), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 54.7%, 64/117), STROBE (STrengthening the Reporting of Observational Studies in Epidemiology, 51.3%, 60/117), STARD (Standards for Reporting of Diagnostic Accuracy, 50.4%, 59/117), and ARRIVE (Animal Research Reporting of In Vivo Experiments, 35.9%, 42/117). The most implemented AI reporting guideline was CLAIM (Checklist for Artificial Intelligence in Medical Imaging, 1.7%, 2/117), while other nine AI reporting guidelines were not mentioned. The Journal Impact Factor quartile and publisher were associated with endorsement of reporting guidelines in radiological journals. CONCLUSIONS: The general reporting guideline endorsement was suboptimal in radiological journals. The implementation of reporting guidelines for AI applications in medical imaging was extremely low. Their adoption should be strengthened to facilitate quality and transparency of radiological study reporting.
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Inteligência Artificial , Publicações Periódicas como Assunto , Humanos , Lista de Checagem , Editoração , Padrões de ReferênciaRESUMO
This study is aimed to evaluate effects of deep learning image reconstruction (DLIR) on image quality in single-energy CT (SECT) and dual-energy CT (DECT), in reference to adaptive statistical iterative reconstruction-V (ASIR-V). The Gammex 464 phantom was scanned in SECT and DECT modes at three dose levels (5, 10, and 20 mGy). Raw data were reconstructed using six algorithms: filtered back-projection (FBP), ASIR-V at 40% (AV-40) and 100% (AV-100) strength, and DLIR at low (DLIR-L), medium (DLIR-M), and high strength (DLIR-H), to generate SECT 120kVp images and DECT 120kVp-like images. Objective image quality metrics were computed, including noise power spectrum (NPS), task transfer function (TTF), and detectability index (d'). Subjective image quality evaluation, including image noise, texture, sharpness, overall quality, and low- and high-contrast detectability, was performed by six readers. DLIR-H reduced overall noise magnitudes from FBP by 55.2% in a more balanced way of low and high frequency ranges comparing to AV-40, and improved the TTF values at 50% for acrylic inserts by average percentages of 18.32%. Comparing to SECT 20 mGy AV-40 images, the DECT 10 mGy DLIR-H images showed 20.90% and 7.75% improvement in d' for the small-object high-contrast and large-object low-contrast tasks, respectively. Subjective evaluation showed higher image quality and better detectability. At 50% of the radiation dose level, DECT with DLIR-H yields a gain in objective detectability index compared to full-dose AV-40 SECT images used in daily practice.
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Aprendizado Profundo , Humanos , Algoritmos , Processamento de Imagem Assistida por Computador , Imagens de Fantasmas , Doses de Radiação , Tomografia Computadorizada por Raios X , Interpretação de Imagem Radiográfica Assistida por ComputadorRESUMO
BACKGROUND: Rare sugars have become promising 'sugar alternatives' because of their low calories and unique physiological functions. Among the family of rare sugars, d-allulose is one of the sugars attracting interest. Ketose 3-epimerases (KEase), including d-tagatose 3-epimerase (DTEase) and d-allulose 3-epimerase (DAEase), are mainly used for d-allulose production. RESULTS: In this study, a putative xylose isomerase from Caballeronia insecticola was characterized and identified as a novel DAEase. Caballeronia insecticola DAEase displayed prominent enzymatic properties, and 150 g L-1 d-allulose was produced from 500 g L-1 d-fructose in 45 min with a conversion rate of 30% and high productivity of 200 g L-1 h-1 . Furthermore, DAEase was employed in a phosphorylation-dephosphorylation cascade reaction, which significantly increased the conversion rate of d-allulose. Under optimized conditions, the conversion rate of d-allulose was approximately 100% when the concentration of d-fructose was 50 mmol L-1 . CONCLUSION: This research described a very beneficial and facile approach for d-allulose production based on C. insecticola DAEase. © 2022 Society of Chemical Industry.
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Frutose , Racemases e Epimerases , Racemases e Epimerases/genética , Concentração de Íons de Hidrogênio , Frutose/químicaRESUMO
PURPOSE: Our purposes were (1) to explore the methodologic quality of the studies on the deep learning in knee imaging with CLAIM criterion and (2) to offer our vision for the development of CLAIM to assure high-quality reports about the application of AI to medical imaging in knee joint. MATERIALS AND METHODS: A Checklist for Artificial Intelligence in Medical Imaging systematic review was conducted from January 1, 2015, to June 1, 2020, using PubMed, EMBASE, and Web of Science databases. A total of 36 articles discussing deep learning applications in knee joint imaging were identified, divided by imaging modality, and characterized by imaging task, data source, algorithm type, and outcome metrics. RESULTS: A total of 36 studies were identified and divided into: X-ray (44.44%) and MRI (55.56%). The mean CLAIM score of the 36 studies was 27.94 (standard deviation, 4.26), which was 66.53% of the ideal score of 42.00. The CLAIM items achieved an average good inter-rater agreement (ICC 0.815, 95% CI 0.660-0.902). In total, 32 studies performed internal cross-validation on the data set, while only 4 studies conducted external validation of the data set. CONCLUSIONS: The overall scientific quality of deep learning in knee imaging is insufficient; however, deep learning remains a promising technology for diagnostic or predictive purpose. Improvements in study design, validation, and open science need to be made to demonstrate the generalizability of findings and to achieve clinical applications. Widespread application, pre-trained scoring procedure, and modification of CLAIM in response to clinical needs are necessary in the future. KEY POINTS: ⢠Limited deep learning studies were established in knee imaging with mean score of 27.94, which was 66.53% of the ideal score of 42.00, commonly due to invalidated results, retrospective study design, and absence of a clear definition of the CLAIM items in detail. ⢠A previous trained data extraction instrument allowed reaching moderate inter-rater agreement in the application of the CLAIM, while CLAIM still needs improvement in scoring items and result reporting to become a wide adaptive tool in reviews of deep learning studies.
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Inteligência Artificial , Aprendizado Profundo , Lista de Checagem , Humanos , Articulação do Joelho , Radiografia , Estudos RetrospectivosRESUMO
OBJECTIVES: To implement a pipeline to automatically segment the ROI and to use a nomogram integrating the MRI-based radiomics score and clinical variables to predict responses to neoadjuvant chemotherapy (NAC) in osteosarcoma patients. METHODS: A total of 144 osteosarcoma patients treated with NAC were separated into training (n = 101) and test (n = 43) groups. After normalisation, ROIs for the preoperative MRI were segmented by a deep learning segmentation model trained with nnU-Net by using two independent manual segmentations as labels. Radiomics features were extracted using automatically segmented ROIs. Feature selection was performed in the training dataset by five-fold cross-validation. The clinical, radiomics, and clinical-radiomics models were built using multiple machine learning methods with the same training dataset and validated with the same test dataset. The segmentation model was evaluated by the Dice coefficient. AUC and decision curve analysis (DCA) were employed to illustrate the model performance and clinical utility. RESULTS: 36/144 (25.0%) patients were pathological good responders (pGRs) to NAC, while 108/144 (75.0%) were non-pGRs. The segmentation model achieved a Dice coefficient of 0.869 on the test dataset. The clinical and radiomics models reached AUCs of 0.636 with a 95% confidence interval (CI) of 0.427-0.860 and 0.759 (95% CI, 0.589-0.937), respectively, in the test dataset. The clinical-radiomics nomogram demonstrated good discrimination, with an AUC of 0.793 (95% CI, 0.610-0.975), and accuracy of 79.1%. The DCA suggested the clinical utility of the nomogram. CONCLUSION: The automatic nomogram could be applied to aid radiologists in identifying pGRs to NAC. KEY POINTS: ⢠The nnU-Net trained by manual labels enables the use of an automatic segmentation tool for ROI delineation of osteosarcoma. ⢠A pipeline using automatic lesion segmentation and followed by a radiomics classifier could aid the evaluation of NAC response of osteosarcoma. ⢠A predictive nomogram composed of clinical variables and MRI-based radiomics score provides support for individualised treatment planning.
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Neoplasias Ósseas , Aprendizado Profundo , Osteossarcoma , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética/métodos , Terapia Neoadjuvante , Nomogramas , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/tratamento farmacológico , Estudos RetrospectivosRESUMO
BACKGROUND: Fabella is a sesamoid bone of knee that has potential biomechanical function. We aimed to examine the fabellar prevalence and parameters in Chinese population and test the hypothesis that fabellar presence and morphology were associated with meniscus tear or ligament injury. METHODS: A total of 1011 knee magnetic resonance imaging scans from 979 patients with knee pain were analyzed retrospectively. The exclusion criteria are postsurgical scans, difficulty in fabella discrimination, conditions not suitable for measurement, and unsatisfied image. The fabellar presence and its parameters (length, width and thickness) were documented. The association between fabellar presence and meniscus tear or ligament injury were assessed by chi-square test, in all knees and subgroups (age, gender, side, lesion part). The correlation of fabellar presence and parameters with advancing age was assessed by Spearman correlation analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to investigate whether factors related with meniscus tear or ligament injury. Diagnostic performance of risk factors was assessed by receiver operating characteristic (ROC) analysis. RESULTS: The overall prevalence of fabellae was 39.8% (402/1011 knees) and increased with the increasing age (r = 0.237, P < 0.001). The size of the fabellae differed according to genders, age, and presence of articulating grooves. Fabella presented more often in knees with medial meniscus (MM) tears (66.7% vs 33.8%; P < 0.001) with a multivariate OR of 2.960 (95% CI, 1.853-3.903). The association remained in all tear parts (anterior, middle, and posterior), and in younger (age < 50 years) and older patients (age ≥ 50 years). Age, fabellar length, width, length/thickness ratio and width/thickness ratio yielded an area under the ROC curve (AUC) of 0.604-0.766 to predict an MM tear. In combination with age, fabellar width and length/thickness ratio, the AUC was improved 0.791 (95% CI, 0.744-0.837), with a sensitivity of 73.0% and a specificity of 74.6%. CONCLUSION: The presence of fabellae, increased fabellar length and width as well as flatter fabellar morphology, are significantly associated with an increased risk for MM tear. These findings might aid clinicians in identifying patients at risk for a MM tear and informing them.
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Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Ossos Sesamoides , Lesões do Menisco Tibial , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Traumatismos do Joelho/complicações , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/epidemiologia , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/diagnóstico por imagem , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Lesões do Menisco Tibial/complicações , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/epidemiologiaRESUMO
OBJECTIVES: To assess the methodological quality and risk of bias in radiomics studies investigating diagnosis, therapy response, and survival of patients with osteosarcoma. METHODS: In this systematic review, literatures on radiomics in osteosarcoma were included and assessed for methodological quality through the radiomics quality score (RQS). The risk of bias and concern of application was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. A meta-analysis of studies focusing on predicting osteosarcoma response to neoadjuvant chemotherapy was performed. RESULTS: Twelve radiomics studies exploring osteosarcoma were identified, and five were included in meta-analysis. The RQS reached an average of 20.4% (6.92 of 36) with good inter-rater agreement (ICC 0.95, 95% CI 0.85-0.99). Four studies validated results with an internal dataset, none of which used external dataset; one study was prospectively designed, and another one shared part of the dataset. The risk of bias and concern of application were mainly related to index test aspect. The meta-analysis showed a diagnostic odds ratio of 43.68 (95%CI 13.5-141.31) for predicting response to neoadjuvant chemotherapy with high heterogeneity and low methodological quality. CONCLUSIONS: The overall scientific quality of included studies is insufficient; however, radiomics remains a promising technology for predicting treatment response, which might guide therapeutic decision-making and related to prognosis. Improvements in study design, validation, and open science needs to be made to demonstrate the generalizability of findings and to achieve clinical applications. Widespread application of RQS, pre-trained RQS scoring procedure, and modification of RQS in response to clinical needs are necessary. KEY POINTS: ⢠Limited radiomics studies were established in osteosarcoma with mean RQS of 20.4%, commonly due to unvalidated results, retrospective study design, and absence of open science. ⢠Meta-analysis of radiomics studies predicting osteosarcoma response to neoadjuvant chemotherapy showed high diagnostic odds ratio 43.68, while high heterogeneity and low methodological quality were the main concerns. ⢠A previously trained data extraction instrument allowed reaching moderate inter-rater agreement in RQS applications, while RQS still needs improvement to become a wide adaptive tool in reviews of radiomics studies, in routine self-check before manuscript submitting and in study design.
Assuntos
Neoplasias Ósseas , Osteossarcoma , Neoplasias Ósseas/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Osteossarcoma/diagnóstico por imagem , Prognóstico , Estudos RetrospectivosRESUMO
BACKGROUND: Chondromyxoid fibroma-like osteosarcoma (CMF-OS) is an exceedingly rare subtype of low-grade central osteosarcoma (LGCO), accounting for up to 10% of cases and making it difficult to diagnose. CMF-OS is frequently misdiagnosed on a radiological examination and biopsy, even after the initial operation. Its treatment is a controversial issue due to its low-grade classification and actual high-grade behavior. CASE PRESENTATION: We retrospectively reviewed the medical charts of more than 2000 osteosarcoma patients between 2008 and 2019; 11 patients with CMF-OS were identified, of which six patients were treated by our institution with complete clinical characteristics, including treatment and prognosis, radiological and pathological features were reviewed. Three males and three females with a median age of 46 (range 22-56) years were pathologically proven to have CMF-OS. The radiological presentation of CMF-OS is variable, thus radiological misdiagnoses are common. However, one must not ignore a malignant radiologic appearance. The most distinctive pathological feature conferring the diagnosis of CMF-OS is the presence of osteoid production directly by the tumor cells under a chondromyxoid fibroma (CMF)-like background. Differential diagnoses based on comprehensive data from CMF, LGCO, chondrosarcoma (CHS), conventional osteosarcoma (COS), etc., are needed. All patients were treated with an operation and chemotherapy, and one patient received additional radiotherapy. Nevertheless, recurrence and metastasis are common in CMF-OS patients. Relatively invasive biological behavior of CMF-OS is against the low-grade classification of this disease. CONCLUSIONS: It is important to recognize CMF-OS and distinguish it from CMF, CHS, COS and other LGCOs. CMF-OS has a relatively poor prognosis despite its low-grade classification.
Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Condrossarcoma/diagnóstico por imagem , Fibroma/diagnóstico por imagem , Osteossarcoma/diagnóstico por imagem , Adulto , Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Feminino , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/cirurgia , Fibroma/cirurgia , Humanos , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Maxila/diagnóstico por imagem , Maxila/cirurgia , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Osteossarcoma/cirurgia , Estudos Retrospectivos , Costelas/diagnóstico por imagem , Costelas/cirurgia , Adulto JovemRESUMO
Repetitive transcranial magnetic stimulation (rTMS) has been proposed as an experimental approach for the treatment of disorders of consciousness (DOC). To date, there has been little research into the use of rTMS in DOC and the therapeutic effects have been variously documented. This study aimed to examine the effects of 20 Hz rTMS on the electroencephalography (EEG) reactivity and clinical response in patients with DOC and to explore the neuromodulatory effects of high-frequency rTMS. In this randomized, sham-controlled, crossover study, real or sham 20 Hz rTMS was applied to the left primary motor cortex (M1) of patients with DOC for 5 consecutive days. Evaluations were blindly performed at the baseline (T0), immediately after the end of the 5 days of treatment (T1) and 1 week after the treatment (T2) using the JFK coma recovery scale-revised (CRS-R) and resting-state EEG. Only one patient, with a history of 2 months of traumatic brain injury, showed long-lasting (T1, T2) behavioral and neurophysiological modifications after the real rTMS stimulation. The 5 remaining patients presented brain reactivity localized at several electrodes, and the EEG modification was not significant. rTMS stimulation may improve awareness and arousal of DOC. Additionally, EEG represents a potential biomarker for the therapeutic efficacy of rTMS. This trial is registered with (NCT03385278).
Assuntos
Transtornos da Consciência/diagnóstico por imagem , Transtornos da Consciência/terapia , Eletroencefalografia/métodos , Descanso/fisiologia , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Adolescente , Adulto , Transtornos da Consciência/fisiopatologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
ε-Poly-l-lysine (ε-PL) is a natural homo-poly(amino acid) which can be produced by microorganisms. With the advantages in broad-spectrum antimicrobial activity, biodegradability, and biocompatibility, ε-PL has been widely used as a preservative in the food industry. Different molecular architectures endow ε-PL and ε-PL-based materials with versatile applications. However, the microbial synthesis of ε-PL is currently limited by low efficiencies in genetic engineering and molecular architecture modification. This review presents recent advances in ε-PL production and molecular architecture modification of microbial ε-PL, with a focus on the current challenges and solutions for the improvement of the productivity and diversity of ε-PL. In addition, we highlight recent examples where ε-PL has been applied to expand the versability of edible films and nanoparticles in various applications. Commercial production and the challenges and future research directions in ε-PL biosynthesis are also discussed. Currently, although the main use of ε-PL is as a food preservative, ε-PL and ε-PL-based polymers have shown excellent application potential in biomedical fields. With the development of synthetic biology, the design and synthesis of ε-PL with a customized molecular architecture are possible in the near future. ε-PL-based polymers with specific functions will be a new trend in biopolymer manufacturing.