A CT-based nomogram for differentiating invasive fungal disease of the lung from bacterial pneumonia.

BACKGROUND: There is an annual increase in the incidence of invasive fungal disease (IFD) of the lung worldwide, but it is always a challenge for physicians to make an early diagnosis of IFD of the lung. Computed tomography (CT) may play a certain role in the diagnosis of IFD of the lung, however, there are no specific imaging signs for differentiating IFD of lung from bacterial pneumonia (BP). METHODS: A total of 214 patients with IFD of the lung or clinically confirmed BP were retrospectively enrolled from two institutions (171 patients from one institution in the training set and 43 patients from another institution in the test set). The features of thoracic CT images of the 214 patients were analyzed on the picture archiving and communication system by two radiologists, and these CT images were imported into RadCloud to perform radiomics analysis. A clinical model from radiologic analysis, a radiomics model from radiomics analysis and a combined model from integrating radiologic and radiomics analysis were constructed in the training set, and a nomogram based on the combined model was further developed. The area under the ROC curve (AUC) of the receiver operating characteristic (ROC) curve was calculated to assess the diagnostic performance of the three models. Decision curve analysis (DCA) was conducted to evaluate the clinical utility of the three models by estimating the net benefit at a range of threshold probabilities. RESULTS: The AUCs of the clinical model for differentiating IFD of lung from BP in the training set and test sets were 0.820 and 0.827. The AUCs of the radiomics model in the training set and test sets were 0.895 and 0.857. The AUCs of the combined model in the training set and test setswere 0.944 and 0.911. The combined model for differentiating IFD of lung from BP obtained the greatest net benefit among the three models by DCA. CONCLUSION: Our proposed nomogram, based on a combined model integrating radiologic and radiomics analysis, has a powerful predictive capability for differentiating IFD from BP. A good clinical outcome could be obtained using our nomogram.

Assessment of Twin Fetal Exposure to Environmental Magnetic and Electromagnetic Fields.

Fetal development is vital in the human lifespan. Therefore, it is essential to characterize exposure by a series of typical environmental magnetic and electromagnetic fields. In particular, there has recently been a sharp increase in the twin birth rate. However, lack of appropriate models has prohibited dosimetric evaluation, restricting characterization of the impact of these environmental factors on twins. The present study developed two whole-body pregnant models of 31 and 32 weeks of gestation with twin fetuses and explored several typical exposure scenarios, including 50-Hz uniform magnetic field exposure, local 125-kHz magnetic field (MF), and 13.56-MHz electromagnetic field exposure, as well as wideband planewave radiofrequency (RF) exposure from 20 to 6000 MHz. Finally, dosimetric results were derived. Compared to the singleton pregnancy with similar weeks of gestation, twin fetuses were overexposed at 50-Hz uniform MF, but they were probably underexposed in the RF scenarios with frequencies for wireless communications. Furthermore, the twin fetuses manifested large dosimetric variability compared to the singleton, which was attributed to the incident direction and fetal position. Based on the analysis, the dosimetric results over the entire gestation period were estimated. The results can be helpful to estimate the risk of twin-fetal exposure to electromagnetic fields and examine the conservativeness of the international guidelines.© 2022 Bioelectromagnetics Society.

The evaluation of bone marrow edema in sacroiliac joint in patients with ankylosing spondylitis using magnetic resonance imaging Dixon sequence.

BACKGROUND: Bone marrow edema of the sacroiliac joint is the early imaging manifestation, an indicator of inflammatory activity of ankylosing spondylitis (AS) (Yang R, et. al. Medicine (Baltimore) 98:e14620, 2019). OBJECTIVE: The aim of the study was to investigate the value of magnetic resonance imaging (MRI) Dixon sequence in the diagnosis of marrow edema of the sacroiliac joint in patients with AS. METHODS: Forty-five patients with AS admitted in our hospital between November 2016 and February 2019 were selected retrospectively as the case group. Forty-five healthy subjects recruited between November 2016 and February 2019 served as the control group. Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were recorded after admission to the hospital. The Dixon sequence water-fat ratio of the iliac and sacral surfaces of the bilateral sacroiliac joints in the study group were compared with indicators above in order to find the correlation. RESULTS: The water-fat ratio under the bilateral sacroiliac joints on Dixon sequence images in the case group was significantly higher than that in the healthy control group (P<0.05). The Dixon sequence water-fat ratio of the iliac and sacral surfaces of the bilateral sacroiliac joints in the study group were positively correlated with spinal arthritis research (SPARCC), BASFI and BASDAI score (all P < 0.05), but did not correlate with ESR and CRP. CONCLUSION: The water-fat ratio of magnetic resonance Dixon sequence can be used as a reference index to evaluate the degree of bone marrow edema in active stage of sacroiliac arthritis.

Phase-Field Simulation of the Effect of Coagulation Bath Temperature on the Structure and Properties of Polyvinylidene Fluoride Microporous Membranes Prepared by a Nonsolvent-Induced Phase Separation.

We used the phase-field model of the existing Nonsolvent Induced Phase Separation (NIPS) method to add the variable of temperature in simulating the changes in the process of membrane formation. The polyvinylidene fluoride (PVDF) membrane system was applied to examine the influence of coagulation bath temperature change on the skin-sublayer of the membrane structure, thereby elucidating the development process of membrane structure under different conditions and shedding light on the most suitable coagulation bath temperature ranges. It was found that as coagulation bath temperature increased, the number of interface pores in the outer skin layer decreased, but the size increased. As a result, it changed from the crack shape to round-hole shape, thus making the pore structure looser. In the sublayer, the mesh support structure was increased, which enhanced the mechanical strength of the membrane. Relevant experiments also verify the effectiveness of the model.

Risk assessment of severe postpartum hemorrhage after invasive placenta accreta based on three-dimensional reconstruction of magnetic resonance imaging.

Background: The aim of this study was to investigate the significance and feasibility of risk assessments based on the three-dimensional (3D) reconstruction of magnetic resonance imaging (MRI) of invasive placenta accreta (IPA) to create individualized surgical protocols and perioperative management plans in late pregnancy. Methods: MRI and clinical data of 36 pregnant women with IPA admitted to Southwest Hospital from January 2017 to June 2021 were retrospectively analyzed. The patients were divided into the following 4 groups: peripartum hysterectomy (PH), abdominal aortic balloon block (AABB), PH with AABB, and nonsurgical treatment. Each group was then divided into severe and nonsevere postpartum hemorrhage subgroups based on postpartum hemorrhage volumes of not more than 2,000 mL and more than 2,000 mL, respectively. The uteri, placentas, IPA, and urinary bladders in each group were segmented and 3-dimensionally reconstructed using Amira 5.2.2 (Visage Imaging, Richmond, Australia) software, and their surface areas and volumes were calculated. A multifactorial unconditional logistic regression analysis was performed to evaluate the 3D morphological parameters of postpartum hemorrhage and calculate the optimal threshold. Results: The bleeding volume, IPA area, placental area:uterine area ratio, IPA area:placental area ratio, maximum depth of IPA, placental position score, IPA position score, and implantation volume were greater in the severe postpartum hemorrhage subgroup than in the nonsevere postpartum hemorrhage subgroup of all groups. In the multifactorial regression analysis, the areas under the receiver operating characteristic curve of the implantation area, implantation volume, maximum depth of implantation, and implantation area:placental area ratio exceeded 0.9 and correlated strongly with severe postpartum hemorrhage, while those of the uterine area, uterine volume, placental area, placental volume, and placental area:uterine area ratio were between 0.5 and 0.7 and correlated with severe postpartum hemorrhage. The threshold (cutoff values) determining severe postpartum hemorrhage were 20,286.25 mm2 of the implantation area, 0.01271 of the implantation area:placental area ratio, 15.03 mm of the maximum depth of implantation, and 46,846 mm3 of the implantation volume. Conclusions: The MRI 3D reconstruction of IPA and its adjacent structures can accurately display the location, anatomical morphology, and spatial relationship of IPA, which can be used to improve the accuracy of IPA diagnosis, predict postpartum hemorrhage, and provide optimized treatment decisions for obstetricians.

Primary pulmonary hyalinizing clear cell carcinoma with fusions of both EWSR1::CREM and IRF2::NTRK3: report of a case with an aggressive behavior.

Primary pulmonary hyalinizing clear cell carcinoma (HCCC) is a rare salivary gland-type tumor newly recognized in recent years, with approximately 21 cases reported to date in the English literature, which constitutes a challenge in pathology diagnosis, particularly in small biopsy specimens. Here, we present a case of pulmonary HCCC diagnosed by computed tomography-guided percutaneous lung biopsy in a 70-year-old man's right lower lung. Although the morphology and immunophenotype of the tumor suggested the diagnosis of mucoepidermoid carcinoma, fluorescence in situ hybridization failed to reveal the rearrangement of MAML2 gene, which is characteristic of mucoepidermoid carcinoma. Instead, further molecular genetic testing showed that the tumor harbored a rare EWSR1::CREM fusion combined with a previously unreported IRF2::NTRK3 fusion. Pulmonary HCCC is commonly regarded as a low-grade malignant tumor with an indolent course, but this case has a different biological behavior, presenting extensive dissemination and metastases at the time of diagnosis, which expands our understanding of the prognosis of this tumor. The patient has had five cycles of combination chemotherapy and has been alive with the tumor for eight months.

Quantitative MRI evaluation of articular cartilage in patients with meniscus tear.

Purpose: The aim of this study was to assess quantitatively articular cartilage volume, thickness, and T2 value alterations in meniscus tear patients. Materials and methods: The study included 32 patients with meniscus tears (17 females, 15 males; mean age: 40.16 ± 11.85 years) and 24 healthy controls (12 females; 12 males; mean age: 36 ± 9.14 years). All subjects were examined by 3 T magnetic resonance imaging (MRI) with 3D dual-echo steady-state (DESS) and T2 mapping images. All patients underwent diagnostic arthroscopy and treatment. Cartilage thickness, cartilage volume and T2 values of 21 subregions of knee cartilage were measured using the prototype KneeCaP software (version 2.1; Siemens Healthcare, Erlangen, Germany). Mann-Whitney-U tests were utilized to determine if there were any significant differences among subregional articular cartilage volume, thickness and T2 value between patients with meniscus tear and the control group. Results: The articular cartilage T2 values in all subregions of the femur and tibia in the meniscus tear group were significantly higher (p< 0.05) than in the healthy control group. The cartilage thickness of the femoral condyle medial, femur trochlea, femur condyle lateral central, tibia plateau medial anterior and patella facet medial inferior in the meniscus tear group were slightly higher than in the control group (p< 0.05). In the femur trochlea medial, patella facet medial inferior, tibia plateau lateral posterior and tibia plateau lateral central, there were significant differences in relative cartilage volume percentage between the meniscus tear group and the healthy control group (p< 0.05). Nineteen patients had no cartilage abnormalities (Grade 0) in the meniscus tear group, as confirmed by arthroscopic surgery, and their T2 values in most subregions were significantly higher (p< 0.05) than those of the healthy control group. Conclusion: The difference in articular cartilage indexes between patients with meniscus tears and healthy people without such tears can be detected by using quantitative MRI. Quantitative T2 values enable early and sensitive detection of early cartilage lesions.

Short-Term Clinical Efficacy of Neoadjuvant Chemotherapy Combined With Laparoscopic Gastrectomy for Locally Advanced Siewert Type II and III Adenocarcinoma of the Esophagogastric Junction: A Retrospective, Propensity Score-Matched Study.

BACKGROUND: Laparoscopic gastrectomy (LG) has been increasingly used for the treatment of locally advanced Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). However, whether LG can achieve the same short-term efficacy in the treatment of patients who receive neoadjuvant chemotherapy (NACT) remains controversial. Thus, the aim of this study was to investigate the clinical outcomes of NACT combined with LG for Siewert type II and III AEG. METHODS: This retrospective study identified patients with locally advanced Siewert type II and III AEG diagnosed between May 2011 and October 2020 using the clinical tumor-node-metastasis (cTNM) staging system. The short-term outcomes were compared between the matched groups using a 1:3 propensity score matching (PSM) method, which was performed to reduce bias in patient selection. RESULTS: After PSM, 164 patients were selected, including 41 in the NACT group and 123 in the LG group. The baseline characteristics were similar between the two groups. Compared with the LG group, the NACT group exhibit a smaller tumor size and significantly less advanced pathological tumor classification and nodal classification stages. The time to first flatus of the NACT group was significantly shorter, but the hospital stay was significantly longer than that of the LG group. The NACT group showed similar overall (29.3% vs 25.2%, P=0.683), systemic (24.4% vs 21.1%, P=0.663), local (12.2% vs 9.8%, P=0.767), minor (19.5% vs 19.5%, P=1.000) and major (9.8% vs 5.7%, P=0.470) complications as the LG group. Subgroup analyses showed no significant differences in most stratified parameters. Operation time≥ 300 minutes was identified as an independent risk factor for overall complications. Age≥ 60 years was identified as an independent risk factor for major complications. CONCLUSION: NACT combined with LG for AEG does not increase the risk of postoperative morbidity and mortality compared with LG.

Quantitative measurement of cartilage volume with automatic cartilage segmentation in knee osteoarthritis.

PURPOSE: To determine the reproducibility of the automatic cartilage segmentation method using a prototype KneeCaP software (version 1.3; Siemens Healthcare, Erlangen, Germany) and to compare the difference in cartilage volume (CV) between the normal knee joint and knee osteoarthritis (KOA) of different degrees by using the above software. MATERIALS AND METHODS: The study included 62 subjects with knee OA and 29 healthy control subjects. The cartilage lesion patients were divided into a mild-to-moderate OA group (n = 29) and severe OA group (n = 33). Automatic cartilage segmentation was performed on all the subjects, and among them, 19 knee cases were randomly selected to also do the manual cartilage segmentation. Statistical significance was determined with one-way analysis of variance (ANOVA), intraclass correlation coefficient (ICC), and Pearson correlation coefficient. Automatic segmentation was compared with the manual one. The relative cartilage volume percentages of the femur, tibia, and patella in the normal control/mild-to-moderate/severe OA groups were assessed. RESULTS: Comparing the cartilage volumes derived by manual and automatic segmentation, the ICC value for the knee joint, patella, femur, or tibia was 0.784, 0.815, 0.740, and 0.797. The relative cartilage volume percentages of the femur, tibia, and patella in the normal control/mild-to-moderate/severe OA groups were 57.28%/59.30%/62.45% (femur), 25.35%/23.46%/21.84% (tibia), and 17.37%/17.24%/15.71% (patella), respectively. Compared with the normal control group, the relative tibia cartilage volume percentage was lower in the mild-to-moderate OA group and the severe OA group. Corresponding index showed a similar difference between the mild-to-moderate OA group and the severe OA group (p < 0.001). CONCLUSION: This study demonstrated that the relative cartilage volume percentage is correlated with the semi-quantitative systems and may be a preferred outcome measure in clinical studies of OA. Automatic cartilage segmentation using KneeCaP delivered reliable results on high-spatial-resolution 3 T MR images for the healthy, mild-moderate OA patients. Key Points • The cartilage automatic segmentation has excellent reproducibility and was not affected by inter-observer variation. • The relative cartilage volume percentage is correlated with the semi-quantitative systems and may be a preferred outcome measure in clinical studies of OA.

Contrast-enhanced CT radiomics for predicting lymph node metastasis in pancreatic ductal adenocarcinoma: a pilot study.

BACKGROUND: We developed a computational model integrating clinical data and imaging features extracted from contrast-enhanced computed tomography (CECT) images, to predict lymph node (LN) metastasis in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: This retrospective study included 159 patients with PDAC (118 in the primary cohort and 41 in the validation cohort) who underwent preoperative contrast-enhanced computed tomography examination between 2012 and 2015. All patients underwent surgery and lymph node status was determined. A total of 2041 radiomics features were extracted from venous phase images in the primary cohort, and optimal features were extracted to construct a radiomics signature. A combined prediction model was built by incorporating the radiomics signature and clinical characteristics selected by using multivariable logistic regression. Clinical prediction models were generated and used to evaluate both cohorts. RESULTS: Fifteen features were selected for constructing the radiomics signature based on the primary cohort. The combined prediction model for identifying preoperative lymph node metastasis reached a better discrimination power than the clinical prediction model, with an area under the curve of 0.944 vs. 0.666 in the primary cohort, and 0.912 vs. 0.713 in the validation cohort. CONCLUSIONS: This pilot study demonstrated that a noninvasive radiomics signature extracted from contrast-enhanced computed tomography imaging can be conveniently used for preoperative prediction of lymph node metastasis in patients with PDAC.

Pulmonary invasive fungal disease and bacterial pneumonia: a comparative study with high-resolution CT.

BACKGROUND: Early diagnosis of invasive fungal disease (IFD) is challenging. High-resolution computed tomography (CT) may improve IFD diagnosis; however, there are no definitive imaging signs for differentiating between bacterial pneumonia and IFD. METHODS: We retrospectively evaluated CT images of 208 patients with IFD (n = 102) or bacterial pneumonia (n = 106). We classified pulmonary opacities as consolidations, ground-glass opacities (GGOs), or nodules and recorded the presence of perinodular ground-glass halos, reversed halo sign (RSH), and cavitation (crescent-shaped or not). RESULTS: Consolidation appeared in 83.3% and 92.5% of patients with IFD and bacterial pneumonia, respectively. Multifocal non-segmental consolidation was more common in IFD (48%) than bacterial pneumonia (22.6%; P < 0.05). Segmental or subsegmental consolidation was more common in bacterial pneumonia (43.4%) than IFD (7.8%; P < 0.01). GGOs and nodules were more common in IFD than bacterial pneumonia (60.8% vs. 24.5% and 54.9% vs. 15.1%, respectively; each P < 0.05). Consolidation combined with GGO, nodules, or both GGO and nodules was more frequent in IFD than in bacterial pneumonia (each P < 0.05). Nodules with halo sign (n = 23) appeared in 22.5% and 3.8% of patients with IFD and bacterial pneumonia, respectively. Nodules with RSH appeared only in IFD, and those with cavitation appeared in 11.8% and 1.9% of patients with IFD and bacterial pneumonia, respectively. CONCLUSIONS: Consolidation plus GGO and nodules or consolidation plus nodules is suggestive for IFD. Segmental or subsegmental consolidations are more frequent in bacterial pneumonia than in IFD. Large nodules, as well as nodules with halo sign or both small and large nodules, are related to IFD.