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BACKGROUND: To develop and validate a nomogram model based on Gd-EOB-DTPA enhanced MRI for differentiation between hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) showing iso- or hyperintensity in the hepatobiliary phase (HBP). METHODS: A total of 75 patients with 49 HCCs and 26 FNHs randomly divided into a training cohort (n = 52: 34 HCC; 18 FNH) and an internal validation cohort (n = 23: 15 HCC; 8 FNH). A total of 37 patients (n = 37: 25 HCC; 12 FNH) acted as an external test cohort. The clinical and imaging characteristics between HCC and FNH groups in the training cohort were compared. The statistically significant parameters were included into the FAE software, and a multivariate logistic regression classifier was used to identify independent predictors and establish a nomogram model. Receiver operating characteristic (ROC) curves were used to evaluate the prediction ability of the model, while the calibration and decision curves were used for model validation. Subanalysis was used to compare qualitative and quantitative characteristics of patients with chronic hepatitis and cirrhosis between the HCC and FNH groups. RESULTS: In the training cohort, gender, age, enhancement rate in the arterial phase (AP), focal defects in uptake were significant predictors for HCC showing iso- or hyperintensity in the HBP. In the training cohort, area under the curve (AUC), sensitivity and specificity of the nomogram model were 0.989(95%CI: 0.967-1.000), 97.1% and 94.4%. In the internal validation cohort, the above three indicators were 0.917(95%CI: 0.782-1.000), 93.3% and 87.5%. In the external test cohort, the above three indicators were 0.960(95%CI: 0.905-1.000), 84.0% and 100.0%. The results of subanalysis showed that age was the independent predictor in the patients with chronic hepatitis and cirrhosis between HCC and FNH groups. CONCLUSIONS: Gd-EOB-DTPA enhanced MRI nomogram model may be useful for discriminating HCC and FNH showing iso- or hyperintensity in the HBP before surgery.
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Carcinoma Hepatocelular , Meios de Contraste , Hiperplasia Nodular Focal do Fígado , Gadolínio DTPA , Neoplasias Hepáticas , Imageamento por Ressonância Magnética , Nomogramas , Humanos , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Feminino , Masculino , Hiperplasia Nodular Focal do Fígado/diagnóstico por imagem , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética/métodos , Diagnóstico Diferencial , Adulto , Idoso , Estudos Retrospectivos , Curva ROCRESUMO
BACKGROUND: To develop and test a Prostate Imaging Stratification Risk (PRISK) tool for precisely assessing the International Society of Urological Pathology Gleason grade (ISUP-GG) of prostate cancer (PCa). METHODS: This study included 1442 patients with prostate biopsy from two centres (training, n = 672; internal test, n = 231 and external test, n = 539). PRISK is designed to classify ISUP-GG 0 (benign), ISUP-GG 1, ISUP-GG 2, ISUP-GG 3 and ISUP GG 4/5. Clinical indicators and high-throughput MRI features of PCa were integrated and modelled with hybrid stacked-ensemble learning algorithms. RESULTS: PRISK achieved a macro area-under-curve of 0.783, 0.798 and 0.762 for the classification of ISUP-GGs in training, internal and external test data. Permitting error ±1 in grading ISUP-GGs, the overall accuracy of PRISK is nearly comparable to invasive biopsy (train: 85.1% vs 88.7%; internal test: 85.1% vs 90.4%; external test: 90.4% vs 94.2%). PSA ≥ 20 ng/ml (odds ratio [OR], 1.58; p = 0.001) and PRISK ≥ GG 3 (OR, 1.45; p = 0.005) were two independent predictors of biochemical recurrence (BCR)-free survival, with a C-index of 0.76 (95% CI, 0.73-0.79) for BCR-free survival prediction. CONCLUSIONS: PRISK might offer a potential alternative to non-invasively assess ISUP-GG of PCa.
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Aprendizado Profundo , Neoplasias da Próstata , Masculino , Humanos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Gradação de Tumores , Próstata/diagnóstico por imagem , Próstata/cirurgia , Próstata/patologia , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: Dual-phenotype hepatocellular carcinoma (DPHCC) is highly aggressive and difficult to distinguish from hepatocellular carcinoma (HCC). PURPOSE: To develop and validate clinical and radiomics models based on contrast-enhanced MRI for the preoperative diagnosis of DPHCC. STUDY TYPE: Retrospective. POPULATION: A total of 87 patients with DPHCC and 92 patients with non-DPHCC randomly divided into a training cohort (n = 125: 64 non-DPHCC; 61 DPHCC) and a validation cohort (n = 54: 28 non-DPHCC; 26 DPHCC). FIELD STRENGTH/SEQUENCE: A 3.0 T; dynamic contrast-enhanced MRI with time-resolved T1-weighted imaging sequence. ASSESSMENT: In the clinical model, the maximum tumor diameter and hepatitis B virus (HBV) were independent risk factors of DPHCC. In the radiomics model, a total of 1781 radiomics features were extracted from tumor volumes of interest (VOIs) in the arterial phase (AP) and portal venous phase (PP) images. For feature reduction and selection, Pearson correlation coefficient (PCC) and recursive feature elimination (RFE) were used. Clinical, AP, PP, and combined radiomics models were established using machine learning algorithms (support vector machine [SVM], logistic regression [LR], and logistic regression-least absolute shrinkage and selection operator [LR-LASSO]) and their discriminatory efficacy assessed and compared. STATISTICAL TESTS: The independent sample t test, Mann-Whitney U test, Chi-square test, regression analysis, receiver operating characteristic curve (ROC) analysis, Pearson correlation analysis, the Delong test. A P value < 0.05 was considered statistically significant. RESULTS: In the validation cohort, the combined radiomics model (area under the curve [AUC] = 0.908, 95% confidence interval [CI]: 0.831-0.985) showed the highest diagnostic performance. The AUCs of the PP (AUC = 0.879, 95% CI: 0.779-0.979) and combined radiomics models were significantly higher than that of clinical model (AUC = 0.685, 95% CI: 0.526-0.844). There were no significant differences in AUC between AP or PP radiomics model and combined radiomics model (P = 0.286, 0.180 and 0.543). CONCLUSION: MRI radiomics models may be useful for discriminating DPHCC from non-DPHCC before surgery. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 2.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética/métodos , Fenótipo , Estudos RetrospectivosRESUMO
OBJECTIVES: To analyze myocardial fibrosis in dilated cardiomyopathy (DCM) patients with no late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) using T1 mapping and extracellular volume (ECV) and investigate the potential correlation with left ventricular (LV) dilation and dysfunction. METHODS: The study included 41 DCM patients without LGE and 79 healthy controls. T1 and ECV were compared between the two groups using multivariable logistic regression analysis. The correlations between histological and functional parameters were evaluated using Pearson's correlation. RESULTS: Mean native myocardial T1 and ECV were significantly higher in the DCM group compared to controls (p ≤ 0.001, respectively). Multivariable logistic regression revealed that ECV (mean, minimum), LV ejection fraction (LVEF), and LV end-diastolic diameter (LVEDD) were independent discriminators for LGE-negative DCM; the area under the curve (AUC) of LVEF, LVEDD, ECV mean, and ECV minimum were 0.97, 0.96, 0.88, and 0.68, respectively. In the DCM group, LVEDD and LVEF were positively and negatively correlated with ECV, respectively. LVEDV index and LV end-systolic volume (LVESV) index were positively correlated with native-T1 and ECV, and the absolute value of LV global strain had a negative correlation with ECV. CONCLUSIONS: Early myocardial fibrosis in DCM could be detected by prolonged native T1 and elevated ECV despite the absence of LGE on CMR. Moreover, the change of histological characteristics of myocardium in DCM was correlated with LV dilation and dysfunction. KEY POINTS: ⢠At an early stage, patients with DCM may have myocardial fibrosis despite the absence of LGE. ⢠T1 mapping and ECV are efficient methods for early detection of potential myocardial fibrosis. ⢠Increased native T1 and ECV are correlated with left ventricular dilation and dysfunction in LGE-negative DCM patients.
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Cardiomiopatias , Cardiomiopatia Dilatada , Humanos , Meios de Contraste , Imagem Cinética por Ressonância Magnética , Gadolínio , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/patologia , Cardiomiopatia Dilatada/patologia , Miocárdio/patologia , Função Ventricular Esquerda , Fibrose , Valor Preditivo dos TestesRESUMO
OBJECTIVES: To investigate the incremental prognostic value of left ventricular (LV) entropy in a large multi-center population with coronary atherosclerotic heart disease (CAD). BACKGROUND: Current risk stratification of patients with CAD is imprecise and not accurate enough. METHODS: A total of 314 CAD patients who underwent cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) at two medical centers in China between October 2015 and July 2022 were included in this study. Additionally, the 193 patients under 3.0-T field also underwent CMR T1 mapping. LV entropy and extracellular volume (ECV) were calculated from the LGE image of LV myocardium, and major adverse cardiac events (MACEs) were analyzed. RESULTS: Among 314 patients, 110 experienced MACE during a median follow-up of 13 months. The risk of MACE was significantly increased in the high entropy group (log-rank p < 0.001). Entropy maintained an independent association with MACE in a multivariable model including left ventricular ejection fraction (LVEF) and LGE (HR = 1.78; p = 0.001). In addition, the primary endpoint events prognostic value was significantly improved by adding LV entropy to the baseline multivariable model (C-statistic improvement: 0.785-0.818, Delong test: p = 0.001). Similarly, among 193 3.0-T field patients, adding LV entropy to the multivariable baseline model significantly improved the prognostic value of the model for MACE (C-statistic improvement: 0.820-0.898, Delong test: p = 0.004). CONCLUSION: CMR-assessed LV entropy is a powerful independent predictor of MACE in patients with CAD, incremental to common clinical and CMR risk factors, including LVEF, LGE, Native T1, and ECV. CLINICAL RELEVANCE STATEMENT: Left ventricular entropy is a powerful independent predictor of major adverse cardiac events in patients with coronary atherosclerotic heart disease, incremental to common clinical and cardiac magnetic resonance risk factors. KEY POINTS: ⢠Left ventricular entropy, a novel cardiac magnetic resonance parameter of myocardial heterogeneity, demonstrated a robust prognostic association with major adverse cardiac events beyond guideline-based, clinical risk markers. ⢠Entropy can have an important role in the primary prevention of major adverse cardiac events in patients with coronary atherosclerotic heart disease. ⢠Compared with late gadolinium enhancement, extracellular volume, and native T1, entropy could be used to more comprehensively characterize the heterogeneity of left ventricular myocardium.
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OBJECTIVES: Time from onset to reperfusion affects mortality and favorable outcomes in patients with acute ischemic stroke (AIS). To evaluate effects of a real-time feedback mobile application on critical time intervals and functional outcomes in stroke emergency management. METHODS: We recruited patients with clinically suspected acute stroke from December 1st, 2020 until July 30st, 2022. All Patients had a non-contrast computed tomography (CT) and were included only if they had AIS. We divided the patients into two groups based on the date of availability on mobile application: pre-APP group and post-APP group. Onset to Door time (ODT), Door to Imaging Time (DIT), Door to Needle Time (DNT), Door to Puncture Time (DPT), Door to Recanalization Time (DRT), National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were compared between two groups. RESULTS: We retrospectively enrolled 312 AIS patients who were assigned into the pre-APP group (n = 159) and post-APP group (n = 153). The median ODT time and median admission NIHSS score were not significantly different between the two groups at baseline assessment. The median (IQR) DIT [44 (30-60) min vs 28 (20-36) min, P < 0.01] and DNT [44 (36.25-52) min vs 39 (29-45) min, P = 0.02] both decreased significantly in two groups. However, median DPT and DRT time showed no significant differences. The proportion of mRS score of 0 to 2 at day 90 was significantly higher in the post-App group than in the pre-App group, at 82.4% and 71.7%, respectively (dominance ratio OR=1.84, 95% CI: 1.07 to 3.16, P = 0.03). CONCLUSION: The present findings indicate that the real-time feedback of stroke emergency management used by a mobile application have potential for shortening the DIT and DNT time and improve the prognosis of stroke patients.
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AVC Isquêmico , Aplicativos Móveis , Acidente Vascular Cerebral , Humanos , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/terapia , Estudos Retrospectivos , Retroalimentação , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Terapia Trombolítica/efeitos adversos , Tempo para o Tratamento , Fibrinolíticos/efeitos adversosRESUMO
AIM: A prenatal diagnosis of coarctation of the aorta (CoA) is challenging. This study aimed to develop a coarctation probability model incorporating prenatal cardiac sonographic markers to estimate the probability of an antenatal diagnosis of CoA. METHODS: We reviewed 89 fetuses as an investigation cohort with prenatal suspicion for CoA and categorized them into three subgroups: severe CoA: symptomatic CoA and surgery within the first 3 months; mild CoA: surgery within 4 months to 1 year (29); and false-positive CoA: not requiring surgery (45). Logistic regression was used to create a multiparametric model, and a validation cohort of 86 fetuses with suspected CoA was used to validate the model. RESULTS: The prediction model had an optimal criterion >0.25 (sensitivity of 97.7%; specificity of 59.1%), and the area under the receiver operator curve was 0.85. The parameters and their cut-off values were as follows: left common carotid artery to left subclavian artery distance/distal transverse arch (LCCA-LSCA)/DT Index >1.77 (sensitivity 62%, specificity 88%, 95% confidence interval [CI]: 0.6-0.8), and z-score of AAo peak Doppler > -1.7 (sensitivity 77%, specificity 56%, 95% CI: 0.6-0.8). The risk assessment demonstrated that fetuses with a model probability >60% should have inpatient observation for a high risk of CoA, whereas fetuses with a model probability <15% should not undergo clinical follow-up. CONCLUSION: The probability model performs well in predicting CoA outcomes postnatally and can also improve the accuracy of risk assessment. The objectivity of its parameters may allow its implementation in multicenter studies of fetal cardiology.
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Coartação Aórtica , Feminino , Humanos , Recém-Nascido , Gravidez , Aorta Torácica/diagnóstico por imagem , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Feto , Modelos Estatísticos , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia Pré-NatalRESUMO
BACKGROUND: There is a requirement for a personalized strategy to make MRI more accessible to men with suspicion of clinically significant prostate cancer (CSPC). PURPOSE: To evaluate an optimized (Op)-MRI compared with biparametric (Bp)-MRI and multiparametric (Mp)-MRI for the diagnosis of CSPC. STUDY TYPE: Two-center, retrospective. SUBJECTS: A total of 346 patients from center 1 and 292 patients from center 2. FIELD STRENGTH/SEQUENCE: 3.0T scanners, T2 -weighted imaging (T2 WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) imaging. ASSESSMENT: Four radiologists interpreted the Bp-MRI (T2 WI and DWI) and Mp-MRI (T2 WI, DWI, and DCE) independently according to the Prostate Imaging Reporting and Data System (PI-RADS). For Op-MRI, two radiologists used an adjusted decision rule on Bp-MRI-assessed PI-RADS 3 lesions by determining early enhancement of DCE. Pathologies at biopsy and/or prostatectomy specimens were used as standard references. STATISTICAL TESTS: Performance was assessed using receiver operating characteristic (ROC) curves. Kappa statistics were used to assess interobserver variability. RESULTS: Interreader agreement was excellent for all three MRI assessments (all κ values >0.80). Op-MRI had comparable sensitivity (senior/junior: 90.9% [261/287] / 91.6% [263/287]) and higher specificity (78.1% [274/351] /74.4% [261/351]) compared with Mp-MRI (sensitivity: 92.3% [265/287] / 93.7% [269/287]; specificity: 67.8% [238/351] / 68.1% [239/351]) and Bp-MRI (sensitivity: 91.6% [263/287] / 93.4% [268/287]; specificity: 71.2% [250/351] / 70.1% [246/351]) for the diagnosis of CSPC. Compared to Mp-MRI, Op-MRI spared biopsy in 80.7% (515/638) of DCE scans with similar performance accuracy. Compared to Bp-MRI, Op-MRI downgraded 25.2% (31/123) of lesions at a cost of missing 6.5% (3/46) of malignancies, and upgraded 45.5% (56/123) of lesions with a positive predictive value of 62.5% (35/56) in 123 equivocal findings. DATA CONCLUSION: The Op-MRI, using an adjusted PI-RADS decision rule, did not compromise diagnostic accuracy with sparing biopsy in 80.7% of DCE scans compared to Mp-MRI, and outperformed Bp-MRI by regrading PI-RADS lesions. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 2.
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Neoplasias da Próstata , Imagem de Difusão por Ressonância Magnética , Humanos , Imageamento por Ressonância Magnética , Masculino , Prostatectomia , Neoplasias da Próstata/diagnóstico por imagem , Estudos RetrospectivosRESUMO
Nitrogen-doped flower-like carbon superstructures (NPC-F) are prepared via carbonizing self-assembled polyimide nanosheets. SEM, TEM, XPS, and N2 sorption methods are adopted to characterize the flower-like structure. NPC-F exhibits adsorption selectivity for hemoglobin (Hb) because the specific pyridinic N groups of NPC-F could coordinate with the sixth vacancy of ferrous ion in hemoglobin. The adsorption behavior fits well with Langmuir model with a maximum adsorption capacity of 360.0 mg g-1 and the adsorbed Hb could be lightly stripped from the NPC-F nanospheres surface by 0.5 wt% CTAB solution. Circular dichroism spectra indicate no obvious conformation changing of Hb during purification process by NPC-F nanospheres. Five cycles of a continuous adsorption/desorption experiment demonstrate the reusability of NPC-F as adsorbent for Hb. The prepared NPC-F superstructures are then employed for the isolation of Hb from human whole blood sample, obtaining high-purity Hb as demonstrated by sodium dodecyl sulfate polyacrylamide gel electrophoresis assays. Graphical abstractNitrogen-doped flower-like carbon superstructure (NPC-F) is used to isolate target protein. NPC-F exhibits highly selective capture capacity towards hemoglobin because the specific pyridinic N groups of NPC-F could coordinate with the sixth vacant coordinating position of Fe2+ in hemoglobin.
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Carbono/química , Hemoglobinas/química , Nitrogênio/química , Adsorção , HumanosRESUMO
BACKGROUND: This retrospective study was undertaken to analyze the effectiveness and safety of surgery combined with postoperative 125 I seed brachytherapy in the treatment of mucoepidermoid carcinoma (MEC) of the parotid gland with risk factors in pediatric patients. PROCEDURE: From September 2002 to January 2012, 24 patients, ages 5-16 years (mean, 13.2 years; median, 12.3 years), with MEC of the parotid gland were included. Patients with high risk factors received 125 I seed brachytherapy (median actuarial D90, 97 Gy) within 4 weeks following surgery. Radioactivity was 18.5-33.3 MBq per seed and the prescription dose was 60-120 Gy. Overall and disease-free survival rates, local control rate, and distant metastasis were recorded. Radiation-associated late side effects, including dermatitis, hearing loss, thyroid nodules, and secondary malignancy, were also evaluated. RESULTS: During the follow-up period of 5-13.4 years (median, 7.2 years), the overall and disease-free survival rates were all 100%. No patients developed local recurrence, regional/distant metastasis, and no severe radiation-associated complications including the second malignancy were noted. CONCLUSION: Surgery combined with postoperative 125 I seed brachytherapy is effective and safe in the treatment of MEC of the parotid gland in pediatric patients, with no evidence of severe late radiation-related complications. More patients and longer follow-up data are still needed to prove the efficacy of 125 I brachytherapy.
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Braquiterapia , Carcinoma Mucoepidermoide/terapia , Radioisótopos do Iodo/uso terapêutico , Neoplasias Parotídeas/terapia , Cuidados Pós-Operatórios , Adolescente , Carcinoma Mucoepidermoide/patologia , Criança , Pré-Escolar , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias Parotídeas/patologia , Prognóstico , Dosagem Radioterapêutica , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
BACKGROUND: To investigate the potential mechanism of splenic enlargement in Ang II/APOE model and the associations between the spleen volume and the indices of abdominal aortic aneurysm (AAA) in human. METHODS: To investigate the changes of spleen volume on AAA formation, apolipoprotein E knockout (Apo E-/-) mice were treated with Ang II (1000 ng/kg/min) up to 28 days to generate AAA. We used Magnetic Resonance Imaging (MRI), liquid measurement, H&E and immunohistochemistry to analyze the morphological or pathological changes of spleen. To investigate the changes of spleen volume in human, a retrospective case-control study involving 30 male AAA patients and 25 male controls were performed. Spleen volume was measured on computed tomography images. Univariate analysis and multivariable sequential logistic regression analyses were used to analyze the association between spleen volume and maximal diameter (Dmax). RESULTS: In Ang II/APOE model, we found splenic enlargement in mice with AAA compared with the sham group. Histopathological investigations revealed hypertrophies of splenic follicles and increased populations of CD3+ T cells. In clinic cohort study, univariate analysis revealed higher values in large AAA (Dmax > 5.5 cm,n = 15) compared with the small (Dmax < 5.5 cm,n = 15) for spleen volume (230.6 ± 64.5 cm3 vs. 170.0 ± 32.8 cm3; P = 0.0030). Regression analysis revealed a statistically significant positive linear correlation of spleen volume and Dmax of AAA (r = 0.3611;P = 0.0423). CONCLUSIONS: Mimicking the splenic pathology observed in murine AAA model, there is a strong positive correlation between spleen volume and the Dmax in male AAA patients. As Dmax is a valuable predictor of AAA rupture, the spleen enlargement may be another indicator.
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Aneurisma da Aorta Abdominal/patologia , Apolipoproteínas E/genética , Baço/metabolismo , Idoso , Animais , Estudos de Casos e Controles , Humanos , Imageamento por Ressonância Magnética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: To investigate the feasibility of low-dose whole pancreas CT perfusion in the clinical practice. METHODS: Sixty-one patients suspected pancreatic disease underwent low-dose whole pancreas CT perfusion scan (by body weight, group A: 70 kV, 120 mAs; group B: 80 kV, 100 mAs) and the individualized pancreas scan. Forty-six patients were enrolled. Perfusion characteristics, such as, blood flow, blood volume and permeability, were analyzed. The effective radiation dose of the whole pancreas CT perfusion and the total CT scan protocol were recorded. CT findings were histologically confirmed by surgical intervention or diagnostic puncture. RESULTS: Of the 46 cases, 33 were pancreatic adenocarcinoma, 5 were solid-pseudo-papillary tumors of pancreas, 8 cases of pancreatic endocrine tumors on the perfusion study. There was significant interobserver agreement on the measurement of normal pancreatic CT perfusion parameters of group A (n = 28)and group B (n = 18), respectively (p > 0.05). For the normal pancreas, there was no significant difference on CT perfusion parameters between group A and group B (p > 0.05). There were significant differences on blood flow as well as blood volume between the pancreatic adenocarcinomas and the normal pancreas (p < 0.001), whereas no difference on the permeability (p > 0.05). The time to peak of the normal pancreas is 28.94 ± 4.37 s (range from 24 to 38 s). Different pancreatic tumors had different types of time attenuation curve (TAC). TACs were different between pancreatic adenocarcinomas and normal pancreas. The effective radiation dose of the whole pancreas CT perfusion of Group A and Group B were 3.60 and 4.88 mSv (DLP 246 and 325 mGy cm), respectively, and the total radiation dose was around 8.01-16.22 mSv. CONCLUSIONS: Low-dose whole pancreatic CT perfusion can effectively reduce radiation dose, and provide the best phase for the individualized pancreas scan, which has great value in the clinical practice.
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Adenocarcinoma/fisiopatologia , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/fisiopatologia , Imagem de Perfusão/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Fluxo Sanguíneo Regional , Adulto JovemRESUMO
This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies, namely chatting while under local anesthesia (Chat-LA), total intravenous anesthesia (TIVA), and general anesthesia with laryngeal mask airway (GA-LMA), employed in transperineal magnetic resonance imaging (MRI)/ultrasound (US) fusion prostate biopsy (TP-MUF-PB). A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University (Suzhou, China). Clinical data and outcomes, including total costs, complications, and quality-adjusted life years (QALYs), were compared. Probability sensitivity and subgroup analyses were also performed. Chat-LA was found to be the most cost-effective option, outperforming both TIVA and GA-LMA. However, subgroup analyses revealed that in younger patients (under 65 years old) and those with smaller prostate volumes (<40 ml), TIVA emerged as a more cost-effective strategy. While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB, personalization of anesthesia strategies is crucial, considering specific patient demographics such as age and prostate volume.
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Análise Custo-Benefício , Biópsia Guiada por Imagem , Próstata , Neoplasias da Próstata , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Próstata/patologia , Próstata/diagnóstico por imagem , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/economia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Imageamento por Ressonância Magnética/economia , Imageamento por Ressonância Magnética/métodos , Anestesia Local/economia , Anestesia Local/métodos , Anos de Vida Ajustados por Qualidade de Vida , Anestesia Geral/economia , Análise de Custo-EfetividadeRESUMO
Objective: Acute stroke care is a highly complex type of emergency medical service (EMS) involving patient-centered care in a highly unpredictable and stressful environment with the help of several busy providers. The ability of primary healthcare providers (PHPs) to identify stroke onset early and further manage referrals to higher-level hospitals becomes critical. Methods: We conducted a cross-sectional survey about stroke knowledge and awareness among PHPs in China from September 2021 to December 2021. A total of 289 PHPs were divided into two groups, the stroke treatment window (STW) Aware group vs. the STW Unaware group according to their knowledge on the time window for acute ischemic stroke (AIS) management. Logistic regression analysis was performed to explore the predictors associated with knowledge of the time window for acute stroke management. Results: Of 289 PHPs surveyed during the study period, 115 (39.7%) participants were aware of the time window for stroke management and were in the STW Aware group, while 174 (60.2%) were in the STW Unaware group. Forty percent of PHPs in the STW Aware group were familiar with the secondary stroke prevention goal of <140/90 mmHg, compared with 27.01% in the Unaware group (P < 0.05). PHPs were not sufficiently aware of loss of consciousness also a symptom of stroke in two groups (75.7 vs. 62.6%, P < 0.05). A higher proportion of PHPs in the STW Aware group believed that thrombolysis was an effective treatment for AIS (96.5 vs. 79.9%, P < 0.01). Endovascular therapy is indicated for AIS was perceived by a higher proportion of PHPs in the STW Aware group than that in the Unaware group (62.6 vs. 6.9%, P < 0.01). Eighty percent of PHPs in the STW Aware group reported attending training on stroke management compared with 58.1% in the Unaware group (P < 0.01). Logistic regression results showed that the predictors of stroke knowledge and awareness among PHPs included sex (OR: 2.3, 95% CI, 1.2-4.6), received training (OR: 2.9, 95% CI, 1.60-5.1), and times of training per year (OR: 0.70, 95% CI, 0.6-0.9). Conclusions: PHPs present with a mild to moderate level of stroke management knowledge in northwest China. Strategies to help increase stroke knowledge and awareness among PHPs should be considered in order to help improve the stroke related health service system.
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AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Estudos Transversais , Melhoria de Qualidade , Acidente Vascular Cerebral/terapia , Pessoal de SaúdeRESUMO
This study explored a new model of Prostate Imaging Reporting and Data System (PIRADS) and adjusted prostate-specific antigen density of peripheral zone (aPSADPZ) for predicting the occurrence of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). The demographic and clinical characteristics of 853 patients were recorded. Prostate-specific antigen (PSA), PSA density (PSAD), PSAD of peripheral zone (PSADPZ), aPSADPZ, and peripheral zone volume ratio (PZ-ratio) were calculated and subjected to receiver operating characteristic (ROC) curve analysis. The calibration and discrimination abilities of new nomograms were verified with the calibration curve and area under the ROC curve (AUC). The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves. The AUCs of PSA, PSAD, PSADPZ, aPSADPZ, and PZ-ratio were 0.669, 0.762, 0.659, 0.812, and 0.748 for PCa diagnosis, while 0.713, 0.788, 0.694, 0.828, and 0.735 for csPCa diagnosis, respectively. All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of PCa or csPCa. The new model significantly improved the diagnostic accuracy of PCa (0.945 vs 0.830, P < 0.01) and csPCa (0.937 vs 0.845, P < 0.01) compared with the base model. In addition, the number of patients with PCa and csPCa predicted by the new model was in good agreement with the actual number of patients with PCa and csPCa in high-risk threshold. This study demonstrates that aPSADPZ has a higher predictive accuracy for PCa diagnosis than the conventional indicators. Combining aPSADPZ with PIRADS can improve PCa diagnosis and avoid unnecessary biopsies.
Assuntos
Próstata , Neoplasias da Próstata , Masculino , Humanos , Próstata/diagnóstico por imagem , Próstata/patologia , Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico por imagem , Biópsia , Nomogramas , Estudos RetrospectivosRESUMO
Aim: Hyperuricemia (HUA) has received increased attention in the last few decades due to its global prevalence. Our previous study found that administration of a macroporous resin extract of Dendrobium officinale leaves (DoMRE) to rats with HUA that was induced by exposure to potassium oxazine combined with fructose and a high-purine diet led to a significant reduction in serum uric acid (SUA) levels. The aim of this study was to explore the effects of DoMRE on hyperuricemia induced by anthropomorphic unhealthy lifestyle and to elucidate its possible mechanisms of action. Methods: Dosages (5.0 and 10.0 g/kg/day) of DoMRE were administered to rats daily after induction of HUA by anthropomorphic unhealthy lifestyle for 12 weeks. The levels of UA in the serum, urine, and feces; the levels of creatinine (Cr) in the serum and urine; and the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in serum were all measured using an automatic biochemical analyzer. The activities of xanthine oxidase (XOD) and adenosine deaminase (ADA) in the serum, liver, and intestine tissue supernatant were measured using appropriate kits for each biological target. The expressions levels of UA transporters (ABCG2 and GLUT9), tight junction (TJ) proteins (ZO-1 and occludin), and inflammatory factors (IL-6, IL-8, and TNF-α) in the intestine were assayed by immunohistochemical (IHC) staining. Hematoxylin and eosin (H&E) staining was used to assess histological changes in the renal and intestinal tissues. Results: DoMRE treatment significantly reduced SUA levels and concomitantly increased fecal UA (FUA) levels and the fractional excretion of UA (FEUA) in HUA rats. Furthermore, DoMRE significantly reduced both the XOD activity in the serum, liver, and intestine and the ADA activity in the liver and intestine. DoMRE also effectively regulated the expression of GLUT9 and ABCG2 in the intestine, and it significantly upregulated the expression of the intestinal TJ proteins ZO-1 and occludin. Therefore, DoMRE reduced the damage to the intestinal barrier function caused by the increased production of inflammatory factors due to HUA to ensure normal intestinal UA excretion. Conclusion: DoMRE demonstrated anti-HUA effects in the HUA rat model induced by an anthropomorphic unhealthy lifestyle, and the molecular mechanism appeared to involve the regulation of urate transport-related transporters (ABCG2 and GLUT9) in the intestine, protection of the intestinal barrier function to promote UA excretion, and inhibition of XOD and ADA activity in the liver and intestine to inhibit UA production in the HUA-induced rats.
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Atypical triplication anterior cerebral artery is a rare entity and the variation is an important factor leading to aneurysm. A patient with aneurysm that arises from the bifurcation of the distal anterior cerebral arteries is presented. The contralateral anterior cerebral artery is also presented, and there is no communication between the left and the right anterior cerebral artery. The findings from multiple slice CT angiography in this case are illustrated and discussed. The recognition of this variant is important for the therapy planning.
Assuntos
Artéria Cerebral Anterior/anormalidades , Artéria Cerebral Anterior/diagnóstico por imagem , Angiografia Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Angiografia Digital/métodos , Embolização Terapêutica/métodos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/terapiaRESUMO
OBJECTIVE: To explore the application of prospective ECG-triggering dual-source CT (DSCT) angiography in infants and children with complex congenital heart disease (CHD) compared with transthoracic echocardiography (TTE). METHODS: Eighty-seven patients (mean age: 28 months, range 3 months to 6 years; male 46; mean weight: 15 kg) underwent prospective ECG-triggering DSCT angiography and TTE. Surgery was performed in 54 patients. The overall imaging quality was evaluated on a four-point scale. Inter-observer agreement in subjective image quality grading was assessed by kappa statistics. The accuracy of DSCT angiography and TTE was calculated based on the surgery findings in the 54 patients who were performed with surgery. RESULTS: A total of 267 cardiovascular deformities were diagnosed by DSCT angiography, and 231 deformities were diagnosed by TTE. There was a good agreement on overall image quality (kappa = 0.78). A total of 173 cardiovascular deformities were confirmed by surgery findings in 54 patients. The accuracy of DSCT angiography and TTE was 97.69% (169/173) and 82.08% (142/173). The mean effective dose was (0.40 ± 0.08) mSv. CONCLUSIONS: Prospective ECG-triggering DSCT angiography with a very low effective radiation dose allows the accurate diagnosis of anomalies in infants and children with complex CHD compared with TTE. It has great value for preoperative assessment of CHD.
Assuntos
Técnicas de Imagem de Sincronização Cardíaca , Cardiopatias Congênitas/diagnóstico por imagem , Criança , Pré-Escolar , Angiografia Coronária/métodos , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador , Cintilografia , Tomografia Computadorizada Espiral/métodosRESUMO
Acute multivessel occlusions generally have multisite clot burden with lower successful reperfusion rates, and cerebrovascular anatomical variants increase the challenge of endovascular clot retrieval. We report a case of acute anterior multivessel occlusions patient with duplicated middle cerebral artery. Combined balloon guide catheter with stent retriever and aspiration approach has gained complete revascularization and good functional outcomes at 3 months follow-up.
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BACKGROUND: Anterolateral thigh perforator (ALTP) flap is considered a versatile flap for soft tissue reconstruction. Computed tomography angiography (CTA) is used for mapping perforator in abdominal-based reconstruction; however, it is less commonly used in ALTP due to its poor imaging efficacy. In this study, we introduced a novel CTA technique for preoperative localization and design of ALTP flap and evaluated its value in directing surgical reconstruction. RESULTS: Thirty-five patients with soft tissue defects were consecutively enrolled. Modified CTA procedures, such as sharp convolution kernel, ADMIRE iterative reconstruction, 80 kV tube voltage, high flow contrast agent and cinematic rendering image reconstruction, were used to map ALTPs. A total of 287 perforators (including 884 sub-branches) were determined, with a mean of 5 perforators per thigh (range 2-11). The ALTPs were mainly concentrated in the "hot zone" (42%, 121/287) or the distal zone (41%, 118/287). Most perforators originated from the descending branch of the lateral circumflex femoral artery (76%, 219/287). Three perforator types, namely musculocutaneous (62%, 177/287), septocutaneous (33%, 96/287), and mixed pattern (5%, 14/287), were identified. The median pedicle length measured by two methods was 4.1 cm (range 0.7-20.3 cm) and 17.0 cm (range 4.7-33.9 cm), respectively, and the median diameter of the skin flap nourished by one perforator was 3.4 cm (IQR 2.1-5.7 cm). Twenty-eight ALTP flaps were obtained with the guidance of CTA, and 26 flaps survived after follow-up. CONCLUSIONS: The proposed CTA mapping technique is a useful tool for preoperative localization and design of ALTP flap.