Cardiovascular-specific mortality and risk factors in colorectal Cancer patients: A cohort study based on registry data of over 500,000 individuals in the US.

BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers worldwide, and recent studies have found that CRC patients are at increased risk for cardiovascular disease (CVD). This study aimed to investigate competing causes of death and prognostic factors among a large cohort of CRC patients and to describe cardiovascular-specific mortality in relation to the US standard population. METHODS: This registry-based cohort study identified patients diagnosed with CRC between 1973 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database in the US. Cumulative mortality functions, conditional standardized mortality ratios, and cause-specific hazard ratios were calculated. RESULTS: Of the 563,298 eligible CRC patients included in this study, 407,545 died during the follow-up period. CRC was the leading cause of death, accounting for 49.8% of all possible competing causes of death. CVD was the most common non-cancer cause of death, accounting for 17.8% of total mortality. This study found that CRC patients have a significantly increased risk of cardiovascular-specific mortality compared to the US standard population, with the risk increasing with age and extended survival time. CONCLUSION: This study highlights the need to develop multidisciplinary prevention and management strategies for CRC and CVD to improve CRC patients' survival and quality of life.

Whole-tumor histogram analysis of postcontrast T1-weighted and apparent diffusion coefficient in predicting the grade and proliferative activity of adult intracranial ependymomas.

PURPOSE: To investigate the value of histogram analysis of postcontrast T1-weighted (T1C) and apparent diffusion coefficient (ADC) images in predicting the grade and proliferative activity of adult intracranial ependymomas. METHODS: Forty-seven adult intracranial ependymomas were enrolled and underwent histogram parameters extraction (including minimum, maximum, mean, 1st percentile (Perc.01), Perc.05, Perc.10, Perc.25, Perc.50, Perc.75, Perc.90, Perc.95, Perc.99, standard deviation (SD), variance, coefficient of variation (CV), skewness, kurtosis, and entropy of T1C and ADC) using FireVoxel software. Differences in histogram parameters between grade 2 and grade 3 adult intracranial ependymomas were compared. Receiver operating characteristic curves and logistic regression analyses were conducted to evaluate the diagnostic performance. Spearman's correlation analysis was used to evaluate the relationship between histogram parameters and Ki-67 proliferation index. RESULTS: Grade 3 intracranial ependymomas group showed significantly higher Perc.95, Perc.99, SD, variance, CV, and entropy of T1C; lower minimum, mean, Perc.01, Perc.05, Perc.10, Perc.25, Perc.50 of ADC; and higher CV and entropy of ADC than grade 2 intracranial ependymomas group (all p < 0.05). Entropy (T1C) and Perc.10 (ADC) had a higher diagnostic performance with AUCs of 0.805 and 0.827 among the histogram parameters of T1C and ADC, respectively. The diagnostic performance was improved by combining entropy (T1C) and Perc.10 (ADC), with an AUC of 0.857. Significant correlations were observed between significant histogram parameters of T1C (r = 0.296-0.417, p = 0.001-0.044) and ADC (r = -0.428-0.395, p = 0.003-0.038). CONCLUSION: Whole-tumor histogram analysis of T1C and ADC may be a promising approach for predicting the grade and proliferative activity of adult intracranial ependymomas.

Prediction of O(6)-methylguanine-DNA methyltransferase promoter methylation status in IDH-wildtype glioblastoma using MRI histogram analysis.

To evaluate the utility of magnetic resonance imaging (MRI) histogram parameters in predicting O(6)-methylguanine-DNA methyltransferase promoter (pMGMT) methylation status in IDH-wildtype glioblastoma (GBM). From November 2021 to July 2023, forty-six IDH-wildtype GBM patients with known pMGMT methylation status (25 unmethylated and 21 methylated) were enrolled in this retrospective study. Conventional MRI signs (including location, across the midline, margin, necrosis/cystic changes, hemorrhage, and enhancement pattern) were assessed and recorded. Histogram parameters were extracted and calculated by Firevoxel software based on contrast-enhanced T1-weighted images (CET1). Differences and diagnostic performance of conventional MRI signs and histogram parameters between the pMGMT-unmethylated and pMGMT-methylated groups were analyzed and compared. No differences were observed in the conventional MRI signs between pMGMT-unmethylated and pMGMT-methylated groups (all p > 0.05). Compared with the pMGMT-methylated group, pMGMT-unmethylated showed a higher minimum, mean, Perc.01, Perc.05, Perc.10, Perc.25, Perc.50, and coefficient of variation (CV) (all p < 0.05). Among all significant CET1 histogram parameters, minimum achieved the best distinguishing performance, with an area under the curve of 0.836. CET1 histogram parameters could provide additional value in predicting pMGMT methylation status in patients with IDH-wildtype GBM, with minimum being the most promising parameter.

The role of apparent diffusion coefficient in the grading of adult isocitrate dehydrogenase-mutant astrocytomas: relationship with the Ki-67 proliferation index.

BACKGROUND: The grading of adult isocitrate dehydrogenase (IDH)-mutant astrocytomas is a crucial prognostic factor. PURPOSE: To investigate the value of conventional magnetic resonance imaging (MRI) features and apparent diffusion coefficient (ADC) in the grading of adult IDH-mutant astrocytomas, and to analyze the correlation between ADC and the Ki-67 proliferation index. MATERIAL AND METHODS: The clinical and MRI data of 82 patients with adult IDH-mutant astrocytoma who underwent surgical resection and molecular genetic testing with IDH and 1p/19q were retrospectively analyzed. The conventional MRI features, ADCmin, ADCmean, and nADC of the tumors were compared using the Kruskal-Wallis single factor ANOVA and chi-square tests. Receiver operating characteristic (ROC) curves were drawn to evaluate conventional MRI and ADC accuracy in differentiating tumor grades. Pearson correlation analysis was performed to determine the correlation between ADC and the Ki-67 proliferation index. RESULTS: The difference in enhancement, ADCmin, ADCmean, and nADC among WHO grade 2, 3, and 4 tumors was statistically significant (all P <0.05). ADCmin showed the preferable diagnostic accuracy for grading WHO grade 2 and 3 tumors (AUC=0.724, sensitivity=63.4%, specificity=80%, positive predictive value (PPV)=62.0%; negative predictive value (NPV)=82.5%), and distinguishing grade 3 from grade 4 tumors (AUC=0.764, sensitivity=70%, specificity=76.2%, PPV=75.0%, NPV=71.4%). Enhancement + ADC model showed an optimal predictive accuracy (grade 2 vs. 3: AUC = 0.759; grade 3 vs. 4: AUC = 0.799). The Ki-67 proliferation index was negatively correlated with ADCmin, ADCmean, and nADC (all P <0.05), and positively correlated with tumor grade. CONCLUSION: Conventional MRI features and ADC are valuable to predict pathological grading of adult IDH-mutant astrocytomas.

The learning curve for minimally invasive Achilles repair using the "lumbar puncture needle and oval forceps" technique.

INTRODUCTION: An acute Achilles tendon rupture represents a common tendon injury, and its operative methods have been developed over the years. This study aimed to quantify the learning curve for the minimally invasive acute Achilles tendon rupture repair. METHODS: From May 2020 to June 2022, sixty-seven patient cases who received minimally invasive tendon repair were reviewed. Baseline data and operative details were collected. The cumulative summation (CUSUM) control chart was used for the learning curve analyses. Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score, and visual analog scale (VAS) at 3/6/9/12 months were calculated to assess the clinical outcomes. RESULTS: Thirty-six cases underwent at least a year of follow up and were enrolled in this study. The gender ratio and average age were 80.5% and 32.5 years. The linear equation fitted well (R2 = 0.95), and CUSUM for operative time peaked in the 12th case, which was divided into the learning phase (n = 12) and master phase (n = 24). No significant difference was detected between the two groups in clinical variables, except for the operative time (71.1 ± 13.2 min vs 45.8 ± 7.2 min, p = 0.004). Moreover, we detected one case with a suture reaction and treated it properly. CONCLUSION: Minimally invasive Achilles repair provides an opportunity for early rehabilitation. Notably, the learning curve showed that the "lumbar puncture needle and oval forceps" technique was accessible to surgeons.

Comparison between screw fixation and plate fixation via sinus tarsi approach for displaced intra-articular calcaneal fractures: a systematic review and meta-analysis.

BACKGROUND: Optimal surgical fixation for displaced intra-articular calcaneal fractures (DIACF) remains a subject of debate, particularly regarding the superiority between screw fixation and plate fixation via the sinus tarsi approach (STA). This review aims to determine the preferred treatment for DIACF and compare the outcomes of minimally invasive surgery options. METHODS: Our study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on distal intra-articular fractures of the calcaneus (DIACFs) that were fixed using cannulated screws or plates via STA. Through a comprehensive meta-analysis, we evaluated several outcomes, including post-operative function, radiological measurements, and complications. RESULT: A total of 728 patients from 7 studies met the inclusion criteria. Among them, 435 patients underwent screw fixation via STA, and 373 patients underwent plate fixation via STA. The study found no statistically significant differences between the screw fixation and the plate fixation via sinus tarsi approach (STA) in terms of AOFAS scores, Bohler's angle, Gissane's angle, sural nerve injury, secondary subtalar arthrodesis and reoperation. Compared with screw fixation, plate fixation via STA can reduce reduction loss of Bohler's angle (WMD = - 1.64, 95% CI = [- 2.96, - 0.31], P = 0.06, I2 = 59%), lower the incidence of fixation failure (OR = 0.32, 95% CI = [0.13, 0.81], P = 0.78, I2 = 0%), and decrease intra-articular step-off (WMD = - 0.52, 95% CI = [- 0.87, - 0.17], P = 0.66, I2 = 0%). CONCLUSIONS: Plate fixation demonstrates superior capability in restoring calcaneal width, maintaining Bohler's angle, and minimizing intra-articular step-off, thereby maintaining better reduction of the subtalar articular surface. In addition, plate fixation exhibits the modest complication rate and a low incidence of fixation failure. Therefore, we recommend the use of plate fixation through the STA, especially for complex and comminuted intra-articular calcaneal fractures.

Comparison between anterior-to-posterior screw fixation versus posterolateral approach plate fixation for posterior malleous fracture: A systematic review and meta-analysis.

PURPOSE: There are two main surgical fixation methods for the posterior malleolar fractures (PMFs), the anterior-to-posterior (AP) screws or via the posterolateral (PL) approach utilizing a buttress plate. This review aims to compare the clinical outcome between the AP screw fixation and the PL plate fixation for treating PMFs. METHODS: We searched all relevant publications about PMFs treated with AP screws or PL plates through electronic databases including the PubMed, the Cochrane Library, the Embase, the Wiley online library and the Web of Science. The meta-analysis was conducted to evaluated clinical outcomes including reduction quality, post-operative function and complications. RESULTS: Six studies (one single randomized controlled trial and five retrospective cohort studies) were enrolled. 172 patients underwent AP screw fixation and 214 patients underwent PL plate fixation with a total of 386 patients (169 males and 217 females). The PL plating group yielded better AOFAS scores(MD = 6.97, 95 % CI=[4.68, 9.27], P＜0.00001, I2 =0 %) and was more likely to achieve excellent anatomical reduction(OR=5.49, 95 % CI=[1.06, 28.42], P = 0.04, I2 =80 %). No differences were found in the bad reduction quality, incidences of complications (arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees. CONCLUSION: We suggest that the PL plate fixation method has the clinical benefit of achieving anatomical reduction and better AOFAS scores over the AP screw fixation for treating PMFs. No differences were found in the incidences of complications ( arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees. The posterior approach and the direct reduction are recommended for the treatment of the PMFs. LEVEL OF CONFIDENCE: Ⅱb.

Development of an MRI-Based Comprehensive Model Fusing Clinical, Radiomics and Deep Learning Models for Preoperative Histological Stratification in Intracranial Solitary Fibrous Tumor.

BACKGROUND: Accurate preoperative histological stratification (HS) of intracranial solitary fibrous tumors (ISFTs) can help predict patient outcomes and develop personalized treatment plans. However, the role of a comprehensive model based on clinical, radiomics and deep learning (CRDL) features in preoperative HS of ISFT remains unclear. PURPOSE: To investigate the feasibility of a CRDL model based on magnetic resonance imaging (MRI) in preoperative HS in ISFT. STUDY TYPE: Retrospective. POPULATION: Three hundred and ninety-eight patients from Beijing Tiantan Hospital, Capital Medical University (primary training cohort) and 49 patients from Lanzhou University Second Hospital (external validation cohort) with ISFT based on histopathological findings (237 World Health Organization [WHO] tumor grade 1 or 2, and 210 WHO tumor grade 3). FIELD STRENGTH/SEQUENCE: 3.0 T/T1-weighted imaging (T1) by using spin echo sequence, T2-weighted imaging (T2) by using fast spin echo sequence, and T1-weighted contrast-enhanced imaging (T1C) by using two-dimensional fast spin echo sequence. ASSESSMENT: Area under the receiver operating characteristic curve (AUC) was used to assess the performance of the CRDL model and a clinical model (CM) in preoperative HS in the external validation cohort. The decision curve analysis (DCA) was used to evaluate the clinical net benefit provided by the CRDL model. STATISTICAL TESTS: Cohen's kappa, intra-/inter-class correlation coefficients (ICCs), Chi-square test, Fisher's exact test, Student's t-test, AUC, DCA, calibration curves, DeLong test. A P value <0.05 was considered statistically significant. RESULTS: The CRDL model had significantly better discrimination ability than the CM (AUC [95% confidence interval, CI]: 0.895 [0.807-0.912] vs. 0.810 [0.745-0.874], respectively) in the external validation cohort. The CRDL model can provide a clinical net benefit for preoperative HS at a threshold probability >20%. DATA CONCLUSION: The proposed CRDL model holds promise for preoperative HS in ISFT, which is important for predicting patient outcomes and developing personalized treatment plans. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

Insulin Inhibits Autophagy by Inhibiting the Binding of FoXO1 to the Promoter Region of GABARAPL1.

Hyperinsulinemia and insulin resistance in T2D have a potent suppressive effect on hepatic autophagy, however, the underlying mechanisms remain unclear. To explore the effect of insulin on hepatic autophagy and its possible signaling pathways, HL-7702 cells were treated with insulin with or without insulin signaling inhibitors. The interaction between insulin and the promoter region of GABARAPL1 was assessed through luciferase assay and EMSA. There were significant dose-dependent decreases in the number of intracellular autophagosomes and the protein levels of GABARAPL1 and beclin1 in insulin-treated HL-7702 cells. Insulin signaling inhibitors reversed the inhibitory effect of insulin on rapamycin-induced autophagy and autophagy-related gene upregulation. Insulin blocks the binding of FoxO1 to putative insulin response elements in GABARAPL1 gene promoter, leading to the repressed transcription of GABARAPL1 gene and the suppression of hepatic autophagy. Our study identified GABARAPL1 as a novel target of insulin in suppressing hepatic autophagy.

Assessment of Ki-67 expression levels in IDH-wildtype glioblastoma using logistic regression modelling of VASARI features.

To investigate the value of using VASARI signs preoperatively to assess Ki-67 proliferation index levels in patients with IDH-wildtype glioblastoma (GB).Pathological and imaging data of 154 patients with GB confirmed by surgical pathology were retrospectively analysed, and the level of Ki-67 proliferative index was assessed in tumour tissue samples from patients using immunohistochemistry (IHC) staining. Patients were divided into a high and low Ki-67 proliferation index expression group. Two radiologists analysed MRI images of patients with IDH-wildtype GB using the VASARI features system. VASARI parameters between the two groups were statistically analysed to identify characteristic parameters with significant differences and their predictive performance was determined using ROC curves.Among the obtained clinical and VASARI features of IDH-wildtype GB patients, the distribution of Maximum diameter, Proportion of necrosis and Hemorrhage was significantly different between the two groups (all p < 0.05). Multivariate logistic regression analysis showed that Maximum diameter and Hemorrhage were independent risk factors distinguishing the group with high and low expression of Ki-67 proliferative index. ROC curve analysis showed that the logistic regression model achieved an AUC value of 0.730 (95% CI: 0.639, 0.822), sensitivity of 0.628 and specificity of 0.756.Logistic regression modelling of preoperative VASARI features can be used as a reliable tool for predicting the level of Ki-67 proliferative index in IDH-wildtype GB patients, which can help in preoperative development of treatment and follow-up strategies for patients.

Postoperative progression of intracranial grade II-III solitary fibrous tumor/hemangiopericytoma: predictive value of preoperative magnetic resonance imaging semantic features.

BACKGROUND: Preoperative prediction of postoperative tumor progression of intracranial grade II-III hemangiopericytoma is the basis for clinical treatment decisions. PURPOSE: To use preoperative magnetic resonance imaging (MRI) semantic features for predicting postoperative tumor progression in patients with intracranial grade II-III solitary fibrous tumor/hemangiopericytoma (SFT/HPC). MATERIAL AND METHODS: We retrospectively analyzed the preoperative MRI data of 42 patients with intracranial grade II-III SFT/HPC, as confirmed by surgical resection and pathology in our hospital from October 2010 to October 2017, who were followed up for evaluation of recurrence, metastasis, or death. We applied strict inclusion and exclusion criteria and finally included 37 patients. The follow-up time was in the range of 8-120 months (mean = 57.1 months). RESULTS: Single-factor survival analysis revealed that tumor grade (log-rank, P = 0.024), broad-based tumor attachment to the dura mater (log-rank, P = 0.009), a blurred tumor-brain interface (log-rank, P = 0.008), skull invasion (log-rank, P = 0.002), and the absence of postoperative radiotherapy (log-rank, P = 0.006) predicted postoperative intracranial SFT/HPC progression. Multivariate survival analysis revealed that tumor grade (P = 0.009; hazard ratio [HR] = 11.42; 95% confidence interval [CI] = 1.832-71.150), skull invasion (P = 0.014; HR = 5.72; 95% CI = 1.421-22.984), and the absence of postoperative radiotherapy (P = 0.001; HR = 0.05; 95% CI = 0.008-0.315) were independent predictors of postoperative intracranial SFT/HPC progression. CONCLUSION: Broad-based tumor attachment to the dura mater, skull invasion, and blurring of the tumor-brain interface can predict postoperative intracranial SFT/HPC progression.

Differential diagnosis of atypical and anaplastic meningiomas based on conventional MRI features and ADC histogram parameters using a logistic regression model nomogram.

The purpose of the study was to determine the value of a logistic regression model nomogram based on conventional magnetic resonance imaging (MRI) features and apparent diffusion coefficient (ADC) histogram parameters in differentiating atypical meningioma (AtM) from anaplastic meningioma (AnM). Clinical and imaging data of 34 AtM and 21 AnM diagnosed by histopathology were retrospectively analyzed. The whole tumor delineation along the tumor edge on ADC images and ADC histogram parameters were automatically generated and comparisons between the two groups using the independent samples t test or Mann-Whitney U test. Univariate and multivariate logistic regression analyses were used to construct the nomogram of the AtM and AnM prediction model, and the model's predictive efficacy was evaluated using calibration and decision curves. Significant differences in the mean, enhancement, perc.01%, and edema were noted between the AtM and AnM groups (P < 0.05). Age, sex, location, necrosis, shape, max-D, variance, skewness, kurtosis, perc.10%, perc.50%, perc.90%, and perc.99% exhibited no significant differences (P > 0.05). The mean and enhancement were independent risk factors for distinguishing AtM from AnM. The area under the curve, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the nomogram were 0.871 (0.753-0.946), 80.0%, 81.0%, 79.4%, 70.8%, and 87.1%, respectively. The calibration curve demonstrated that the model's probability to predict AtM and AnM was in favorable agreement with the actual probability, and the decision curve revealed that the prediction model possessed satisfactory clinical availability. A logistic regression model nomogram based on conventional MRI features and ADC histogram parameters is potentially useful as an auxiliary tool for the preoperative differential diagnosis of AtM and AnM.

Apparent diffusion coefficient values effectively predict cell proliferation and determine oligodendroglioma grade.

This study aims to evaluate the value of conventional magnetic resonance imaging (MRI) features and apparent diffusion coefficient (ADC) values in differentiating oligodendroglioma of various grades and explore the correlation between ADC and Ki-67. The preoperative MRI data of 99 patients with World Health Organization (WHO) grades 2 (n = 42) and 3 (n = 57) oligodendroglioma confirmed by surgery and pathology were retrospectively analyzed. Conventional MRI features, ADCmean, ADCmin, and normalized ADC (nADC) were compared between the two groups. A receiver operating characteristic curve was used to evaluate each parameter's diagnostic efficacy in differentiating the two tumor types. Each tumor's Ki-67 proliferation index was also measured to explore its relationship with the ADC value. Compared with WHO2 grade tumors, WHO3 grade tumors had a larger maximum diameter and more significant cystic degeneration/necrosis, edema, and moderate/severe enhancement (all P < 0.05). The ADCmin, ADCmean, and nADC values of the WHO3 and WHO2 grade tumors were significantly different, and the ADCmin value most accurately distinguished the two tumor types, yielding an area under the curve value of 0.980. When 0.96 × 10-3 mm2/s was used as the differential diagnosis threshold, the sensitivity, specificity, and accuracy of the two groups were 100%, 93.00%, and 96.96%, respectively. The ADCmin (r = -0.596), ADCmean (r = - 0.590), nADC (r = - 0.577), and Ki-67 proliferation index values had significantly negative correlations (all P < 0.05). Conventional MRI features and ADC values are beneficial in the noninvasive prediction of the WHO grade and tumor proliferation rate of oligodendroglioma.

ADC histogram parameters differentiating atypical from transitional meningiomas: correlation with Ki-67 proliferation index.

BACKGROUND: Preoperative differentiation of atypical meningioma (AtM) from transitional meningioma (TrM) is critical to clinical treatment. PURPOSE: To investigate the role of apparent diffusion coefficient (ADC) histogram analysis in differentiating AtM from TrM and its correlation with the Ki-67 proliferation index (PI). METHODS: Clinical, imaging, and pathological data of 78 AtM and 80 TrM were retrospectively collected. Regions of interest (ROIs) were delineated on axial ADC images using MaZda software and histogram parameters (mean, variance, skewness, kurtosis, 1st percentile [ADCp1], 10th percentile [ADCp10], 50th percentile [ADCp50], 90th percentile [ADCp90], and 99th percentile [ADCp99]) were generated. The Mann-Whitney U test was used to compare the differences in histogram parameters between the two groups; receiver operating characteristic (ROC) curves were used to assess diagnostic efficacy in differentiating AtM from TrM preoperatively. The correlation between histogram parameters and Ki-67 PI was analyzed. RESULTS: All histogram parameters of AtM were lower than those of TrM, and the variance, skewness, kurtosis, ADCp90, and ADCp99 were significantly different (P < 0.05). Combined ADC histogram parameters (variance, skewness, kurtosis, ADCp90, and ADCp99) achieved the best diagnostic performance for distinguishing AtM from TrM. Area under the curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 0.800%, 76.25%, 67.95%, 70.15%, 70.93%, and 73.61%, respectively. All histogram parameters were negatively correlated with Ki-67 PI (r = -0.012 to -0.293). CONCLUSION: ADC histogram analysis is a potential tool for non-invasive differentiation of AtM from TrM preoperatively, and ADC histogram parameters were negatively correlated with the Ki-67 PI.

Whole-tumor histogram analysis of multi-parametric MRI for differentiating brain metastases histological subtypes in lung cancers: relationship with the Ki-67 proliferation index.

This study aims to investigate the predictive value of preoperative whole-tumor histogram analysis of multi-parametric MRI for histological subtypes in patients with lung cancer brain metastases (BMs) and explore the correlation between histogram parameters and Ki-67 proliferation index. The preoperative MRI data of 95 lung cancer BM lesions obtained from 73 patients (42 men and 31 women) were retrospectively analyzed. Multi-parametric MRI histogram was used to distinguish small-cell lung cancer (SCLC) from non-small cell lung cancer (NSCLC), and adenocarcinoma (AC) from squamous cell carcinoma (SCC), respectively. The T1-weighted contrast-enhanced (T1C) and apparent diffusion coefficient (ADC) histogram parameters of the volumes of interest (VOIs) in all BMs lesions were extracted using FireVoxel software. The following histogram parameters were obtained: maximum, minimum, mean, standard deviation (SD), variance, coefficient of variation (CV), skewness, kurtosis, entropy, and 1st-99th percentiles. Then investigated their relationship with the Ki-67 proliferation index. The skewness-T1C, kurtosis-T1C, minimum-ADC, mean-ADC, CV-ADC and 1st - 90th ADC percentiles were significantly different between the SCLC and NSCLC groups (all p < 0.05). When the 10th-ADC percentile was 668, the sensitivity, specificity, and accuracy (90.80%, 76.70% and 86.32%, respectively) for distinguishing SCLC from NSCLC reached their maximum values, with an AUC of 0.895 (0.824 - 0.966). Mean-T1C, CV-T1C, skewness-T1C, 1st - 50th T1C percentiles, maximum-ADC, SD-ADC, variance-ADC and 75th - 99th ADC percentiles were significantly different between the AC and SCC groups (all p < 0.05). When the CV-T1C percentiles was 3.13, the sensitivity, specificity and accuracy (75.00%, 75.60% and 75.38%, respectively) for distinguishing AC and SCC reached their maximum values, with an AUC of 0.829 (0.728-0.929). The 5th-ADC and 10th-ADC percentiles were strongly correlated with the Ki-67 proliferation index in BMs. Multi-parametric MRI histogram parameters can be used to identify the histological subtypes of lung cancer BMs and predict the Ki-67 proliferation index.

Traumatic divergent dislocation of the elbow in the adults.

PURPOSE: This retrospective study aimed to investigate the clinical outcomes of DDE in adults. METHODS: From September 2010 to March 2020, adult patients with traumatic DDEs admitted to Beijing Chaoyang Hospital and Beijing Jishuitan Hospital were included in this study. Each patient underwent operative or conservative treatment during hospitalization. The clinical and radiological examinations were followed up. The primary outcomes included the Mayo Modified Wrist Score (MMWS), the Mayo Elbow Performance Score (MEPS), the Broberg and Morrey functional index, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the Visual Analogue Scale (VAS) score that were performed. Post-operative complications and secondary surgery details were also collected. RESULTS: Of the fourteen patients, clinical and radiographic results were reviewed at a mean of 53.2 months (18 to 110 months) postoperatively. There were 11 men and three women with an average age of 31.5 years (17 to 51 years). At the final follow-up, the average MMWS, MEPS, Broberg and Morrey functional index, and DASH scores were 91.4 points, 93.4 points, 92.6 points, and 10.7 points. The mean VAS at rest and during activities was 0.4 and 1.7 points. Two patients required a secondary procedure due to radial malalignment and elbow contracture, respectively. In addition, two patients were found degeneration. CONCLUSIONS: Within the context of high-energy DDE combined with simultaneous upper limb injuries, our study recommended obtaining the mechanical benefit of the forearm ring with concentric elbow stability. Despite the various and complicated traumatic patterns of DDE, great clinical results could be acquired based on adequate surgical treatments and early rehabilitation training.

Treatment Response and Prognosis Evaluation in High-Grade Glioma: An Imaging Review Based on MRI.

In recent years, the development of advanced magnetic resonance imaging (MRI) technology and machine learning (ML) have created new tools for evaluating treatment response and prognosis of patients with high-grade gliomas (HGG); however, patient prognosis has not improved significantly. This is mainly due to the heterogeneity between and within HGG tumors, resulting in standard treatment methods not benefitting all patients. Moreover, the survival of patients with HGG is not only related to tumor cells, but also to noncancer cells in the tumor microenvironment (TME). Therefore, during preoperative diagnosis and follow-up treatment of patients with HGG, noninvasive imaging markers are needed to characterize intratumoral heterogeneity, and then to evaluate treatment response and predict prognosis, timeously adjust treatment strategies, and achieve individualized diagnosis and treatment. In this review, we summarize the research progress of conventional MRI, advanced MRI technology, and ML in evaluation of treatment response and prognosis of patients with HGG. We further discuss the significance of the TME in the prognosis of HGG patients, associate imaging features with the TME, indirectly reflecting the heterogeneity within the tumor, and shifting treatment strategies from tumor cells alone to systemic therapy of the TME, which may be a major development direction in the future. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 4.

Advances in computed tomography-based prognostic methods for intracerebral hemorrhage.

Spontaneous intracerebral hemorrhage (ICH) has high morbidity and mortality. Computed tomography (CT) plays an important role in the diagnosis, treatment, and research of cerebrovascular diseases. Non-contrast CT is widely used in the clinical diagnosis of ICH because of its high imaging speed and high sensitivity and specificity in the detection of stroke. Many markers-based CT imaging, quantitative parameters, and artificial intelligence (AI) methods based on CT are increasingly used for the prediction of hematoma expansion (HE), prognosis of ICH, and the evaluation of perihematomal edema (PHE). Therefore, we performed a comprehensive review of studies, focusing on current research evidence related to CT use for the prediction of HE and prognostic. This review discusses recent insights into, outlines current limitations, and puts forward suggestions for the challenges and directions of future research. Although at present the prognosis for ICH is not optimistic, the treatment methods remain controversial. However, identifying imaging markers that can evaluate and predict existing possible existing therapeutic targets could help to provide individualized advice for patients and achieve patient risk stratification, which is a key step in improving treatment outcomes.

Value of energy spectrum CT parameters in the differential diagnosis of high-grade clear cell renal cell carcinoma and type II papillary renal cell carcinoma.

BACKGROUND: Energy spectrum computed tomography (CT) has become a promising approach for the differential diagnosis of tumor subtypes. PURPOSE: To explore the value of energy spectrum CT parameters in the differential diagnosis of high-grade clear cell renal cell carcinoma (ccRCC) and type II papillary renal cell carcinoma (pRCC). MATERIAL AND METHODS: Forty-two cases of high-grade ccRCC and 28 cases of type II pRCC were retrospectively reviewed. All region of interest (ROI) measurements were maintained consistently between the two-phase contrast-enhanced examinations. The ROIs encompassed as much of the enhancing areas of the lesions as possible. Energy spectrum CT parameters of all cases, including the 70 keV (HU) value, normalized iodine concentration (NIC), and energy spectrum curve slope were recorded by two radiologists with over 10 years of experience in abdominal CT diagnosis. RESULTS: In the cortical phase (CP) and parenchymal phase (PP), the 70 keV (HU) value, NIC, and slope value of the energy spectrum curve of high-grade ccRCC were significantly higher than those of type II pRCC. In the CP, NIC showed the highest differential diagnosis efficiency for the two group tumors, with a sensitivity of 78.9% and a specificity of 77.0%. There was no statistical difference in tumor hemorrhage, tumor envelope, tumor morphology, tumor border, lymph node metastasis, embolism, renal pelvis invasion, or tumor calcification between the two tumor types. However, there was significant difference in the number of tumors (P = 0.019). CONCLUSION: Energy spectrum CT parameters are valuable for the differential diagnosis of high-grade ccRCC and type II pRCC.

Preoperative surgical risk assessment of meningiomas: a narrative review based on MRI radiomics.

Meningiomas are one of the most common intracranial primary central nervous system tumors. Regardless of the pathological grading and histological subtypes, maximum safe resection is the recommended treatment option for meningiomas. However, considering tumor heterogeneity, surgical treatment options and prognosis often vary greatly among meningiomas. Therefore, an accurate preoperative surgical risk assessment of meningiomas is of great clinical importance as it helps develop surgical treatment strategies and improve patient prognosis. In recent years, an increasing number of studies have proved that magnetic resonance imaging (MRI) radiomics has wide application values in the diagnostic, identification, and prognostic evaluations of brain tumors. The vital importance of MRI radiomics in the surgical risk assessment of meningiomas must be apprehended and emphasized in clinical practice. This narrative review summarizes the current research status of MRI radiomics in the preoperative surgical risk assessment of meningiomas, focusing on the applications of MRI radiomics in preoperative pathological grading, assessment of surrounding tissue invasion, and evaluation of tumor consistency. We further analyze the prospects of MRI radiomics in the preoperative assessment of meningiomas angiogenesis and adhesion with surrounding tissues, while pointing out the current challenges of MRI radiomics research.