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BACKGROUND: Accurate microsatellite instability (MSI) testing is essential for identifying gastric cancer (GC) patients eligible for immunotherapy. We aimed to develop and validate a CT-based radiomics signature to predict MSI and immunotherapy outcomes in GC. METHODS: This retrospective multicohort study included a total of 457 GC patients from two independent medical centers in China and The Cancer Imaging Archive (TCIA) databases. The primary cohort (n = 201, center 1, 2017-2022), was used for signature development via Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression analysis. Two independent immunotherapy cohorts, one from center 1 (n = 184, 2018-2021) and another from center 2 (n = 43, 2020-2021), were utilized to assess the signature's association with immunotherapy response and survival. Diagnostic efficiency was evaluated using the area under the receiver operating characteristic curve (AUC), and survival outcomes were analyzed via the Kaplan-Meier method. The TCIA cohort (n = 29) was included to evaluate the immune infiltration landscape of the radiomics signature subgroups using both CT images and mRNA sequencing data. RESULTS: Nine radiomics features were identified for signature development, exhibiting excellent discriminative performance in both the training (AUC: 0.851, 95%CI: 0.782, 0.919) and validation cohorts (AUC: 0.816, 95%CI: 0.706, 0.926). The radscore, calculated using the signature, demonstrated strong predictive abilities for objective response in immunotherapy cohorts (AUC: 0.734, 95%CI: 0.662, 0.806; AUC: 0.724, 95%CI: 0.572, 0.877). Additionally, the radscore showed a significant association with PFS and OS, with GC patients with a low radscore experiencing a significant survival benefit from immunotherapy. Immune infiltration analysis revealed significantly higher levels of CD8 + T cells, activated CD4 + B cells, and TNFRSF18 expression in the low radscore group, while the high radscore group exhibited higher levels of T cells regulatory and HHLA2 expression. CONCLUSION: This study developed a robust radiomics signature with the potential to serve as a non-invasive biomarker for GC's MSI status and immunotherapy response, demonstrating notable links to post-immunotherapy PFS and OS. Additionally, distinct immune profiles were observed between low and high radscore groups, highlighting their potential clinical implications.
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Radiómica , Neoplasias Gástricas , Humanos , Estudios de Cohortes , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/genética , Neoplasias Gástricas/terapia , Estudios Retrospectivos , Inestabilidad de Microsatélites , Inmunoterapia , Tomografía Computarizada por Rayos X , InmunoglobulinasRESUMEN
OBJECTIVES: To develop a CT-based radiomics model for preoperative prediction of lymph node (LN) metastasis in perihilar cholangiocarcinoma (pCCA). METHODS: The study enrolled consecutive pCCA patients from three independent Chinese medical centers. The Boruta algorithm was applied to build the radiomics signature for the primary tumor and LN. The k-means algorithm was employed to cluster the selected LNs based on the radiomics signature LN. Support vector machines were used to construct the prediction models. The diagnostic efficiency was measured by the area under the receiver operating characteristic curve (AUC). The optimal model was evaluated in terms of calibration, clinical usefulness, and prognostic value. RESULTS: A total of 214 patients were included in the study (mean age: 61.6 years ± 9.4; 130 male). The selected LNs were classified into two clusters, which were significantly correlated with LN metastasis in all cohorts (p < 0.001). The model incorporated the clinical risk factors, radiomics signature primary tumor, and the LN cluster obtained the best discrimination, with AUC values of 0.981 (95% CI: 0.962-1), 0.896 (95% CI: 0.810-0.982), and 0.865 (95% CI: 0.768-0.961) in the training, internal validation, and external validation cohorts, respectively. High-risk patients predicted by the optimal model had shorter overall survival than low-risk patients (median, 13.7 vs. 27.3 months, p < 0.001). CONCLUSIONS: The study proposed a radiomics model with good performance to predict LN metastasis in pCCA. As a noninvasive preoperative prediction tool, this model may help in patient risk stratification and personalized treatment. CLINICAL RELEVANCE STATEMENT: A CT-based radiomics model accurately predicts lymph node metastasis in perihilar cholangiocarcinoma patients. This noninvasive preoperative tool can aid in patient risk stratification and personalized treatment, potentially improving patient outcomes. KEY POINTS: ⢠The radiomics model based on contrast-enhanced CT is a useful tool for preoperative prediction of lymph node metastasis in perihilar cholangiocarcinoma. ⢠Radiomics features extracted from lymph nodes show great potential for predicting lymph node metastasis. ⢠The study is the first to identify a lymph node phenotype with a high probability of metastasis based on radiomics.
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Neoplasias de los Conductos Biliares , Tumor de Klatskin , Humanos , Masculino , Persona de Mediana Edad , Metástasis Linfática/patología , Tumor de Klatskin/diagnóstico por imagen , Tumor de Klatskin/cirugía , Radiómica , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos , Ganglios Linfáticos/patología , Neoplasias de los Conductos Biliares/diagnóstico por imagen , Neoplasias de los Conductos Biliares/cirugía , Neoplasias de los Conductos Biliares/patologíaRESUMEN
BACKGROUND: The morphological information of the pulmonary vein (PV) and left atrium (LA) is of immense clinical importance for effective atrial fibrillation ablation. The aim of this study is to examine the consistency in different LA diameter measurement techniques. METHODS: Retrospective imaging data from 87 patients diagnosed with PV computed tomography angiography were included. The patients consisted of 50 males and 37 females, with an average age of (60.74 ± 8.70) years. Two physicians independently measured the anteroposterior diameter, long diameter, and transverse diameter of the LA using six different methods. Additionally, we recorded the post-processing time of the images. Physician 1 conducted measurements twice with a one-month interval between the measurements to assess intra-rater reliability. Using the intraclass correlation coefficient (ICC), the consistency of each LA diameter measurement by the two physicians was evaluated. We compared the differences in the LA diameter and the time consumed for measurements using different methods. This was done by employing the rank sum test of a randomized block design (Friedman M test) and the q test for pairwise comparisons among multiple relevant samples. RESULTS: (1) The consistency of the measured LA diameter by the two physicians was strong or very strong. (2) There were statistical differences in the anteroposterior diameter, long diameter, and transverse diameter of LA assessed using different methods (χ2 = 222.28, 32.74, 293.83, P < 0.001). (3) Different methods for measuring the diameters of LA required different amounts of time (χ2 = 333.10, P < 0.001). CONCLUSION: The results of left atrium (LA) diameter measurements conducted by different physicians were found to be reliable. However, the LA diameters obtained through various techniques exhibited variations. It was observed that measuring LA long diameters using only the VR (volume rendering) picture was the most clinically applicable method.
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Fibrilación Atrial , Atrios Cardíacos , Femenino , Masculino , Humanos , Persona de Mediana Edad , Anciano , Reproducibilidad de los Resultados , Estudios Retrospectivos , Atrios Cardíacos/diagnóstico por imagen , Fibrilación Atrial/diagnóstico por imagen , AngiografíaRESUMEN
BACKGROUND: Current radiomics for treatment response assessment in gastric cancer (GC) have focused solely on Computed tomography (CT). The importance of multi-parametric magnetic resonance imaging (mp-MRI) radiomics in GC is less clear. PURPOSE: To compare and combine CT and mp-MRI radiomics for pretreatment identification of pathological response to neoadjuvant chemotherapy in GC. STUDY TYPE: Retrospective. POPULATION: Two hundred twenty-five GC patients were recruited and split into training (157) and validation dataset (68) in the ratio of 7:3 randomly. FIELD/SEQUENCE: T2-weighted fast spin echo (fat suppressed T2-weighted imaging [fs-T2WI]), diffusion weighted echo planar imaging (DWI), and fast gradient echo (dynamic contrast enhanced [DCE]) sequences at 3.0T. ASSESSMENT: Apparent diffusion coefficient (ADC) maps were generated from DWI. CT, fs-T2WI, ADC, DCE, and mp-MRI Radiomics score (Radscores) were compared between responders and non-responders. A multimodal nomogram combining CT and mp-MRI Radscores was developed. Patients were followed up for 3-65 months (median 19) after surgery, the overall survival (OS) and progression free survival (PFS) were calculated. STATISTICAL TESTS: A logistic regression classifier was applied to construct the five models. Each model's performance was evaluated using a receiver operating characteristic curve. The association of the nomogram with OS/PFS was evaluated by Kaplan-Meier survival analysis and C-index. A P value <0.05 was considered statistically significant. RESULTS: CT Radscore, mp-MRI Radscore and nomogram were significantly associated with tumor regression grading. The nomogram achieved the highest area under the curves (AUCs) of 0.893 (0.834-0.937) and 0.871 (0.767-0.940) in training and validation datasets, respectively. The C-index was 0.589 for OS and 0.601 for PFS. The AUCs of the mp-MRI model were not significantly different to that of the CT model in training (0.831 vs. 0.770, P = 0.267) and validation dataset (0.797 vs. 0.746, P = 0.137). DATA CONCLUSIONS: mp-MRI radiomics provides similar results to CT radiomics for early identification of pathologic response to neoadjuvant chemotherapy. The multimodal radiomics nomogram further improved the capability. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: 2.
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Neoplasias Gástricas , Humanos , Imagen por Resonancia Magnética/métodos , Terapia Neoadyuvante/métodos , Estudios Retrospectivos , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Gastric glomus tumor (GGT) is a rare neoplasm that is difficult to distinguish from other gastric submucosal tumors due to a lack of diagnostic experience. The goal of this study was to better understand GGT by looking at its clinicopathological features, computed tomography (CT) features, and differential diagnosis. METHODS: The clinical data and CT findings of 21 pathologically confirmed GGT patients were examined. The clinical characteristics and CT findings of benign GGT were compared to gastric stromal tumors (GST) (n = 30) and heterotopic pancreas (n = 30). RESULTS: The 21 cases included six males and fifteen females ranging in age from 42 to 64 years. The lesions were found in the gastric body in four cases and the antrum in seventeen. GGT was diagnosed as benign in 20 cases and malignant in one. In benign cases, the glomus cells were small, uniform, showed perivascular hemangiopericytomalike or solid nestlike structures. Obvious mitotic figures were observed in the malignant case. SMA staining was positive in the tumor cells. A quasi-round or round solid mass protruded into the gastric cavity in 20 benign cases, with a clear and smooth edge. The long to short diameter ratio was 1.01 ± 0.15. All of the benign cases had obvious enhancement, with homogeneous enhancement in ten cases and heterogeneous enhancement in ten cases, as well as central filling enhancement in 12 cases. The ratio of CT value of lesion to abdominal aorta in arterial phase and venous phase were (0.41 ± 0.11) and (0.81 ± 0.20), which were significantly higher than GST and heterotopic pancreas. The irregular mass broke through the gastric wall and invaded liver with poorly defined boundary and internal necrosis, heterogeneous persistent moderate enhancement with thickening blood supply arteries was seen in one malignant case with a long diameter of 150 mm and a thick diameter of 30 mm. CONCLUSIONS: CT enhancement usually shows persistent obvious enhancement, especially in arterial phase, which provides important value for the diagnosis. CT findings can help in the differential diagnosis of GGT and other submucosal tumors.
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Tumor Glómico , Neoplasias Gástricas , Adulto , Diagnóstico Diferencial , Femenino , Tumor Glómico/diagnóstico por imagen , Tumor Glómico/patología , Humanos , Masculino , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Páncreas/patología , Estudios Retrospectivos , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Intravascular papillary endothelial hyperplasia (IPEH) is a vascular tumor characterized by the proliferation of endothelial cells with papillary formation. It is a rare benign condition affecting the head and neck. Currently, no cases of IPEH of the spleen have been reported. Here, we report a case of IPEH of the spleen in a child and discuss its clinical manifestations, imaging features, and surgical treatment. CASE PRESENTATION: A 5-year-old female presented with a 4-month-old tumor in the left upper abdomen, abdominal pain, and constipation. She underwent radiography, barium enema, US, and MRI. A solid space-occupying mass was found in the left abdominal cavity on preoperative imaging, and it was diagnosed as angiosarcoma. The lesion was surgically resected. Histopathological analysis was consistent with IPEH. CONCLUSION: Clinicians should consider the possibility of IPEH in patients presenting with tumors in the spleen, which is curable by surgical resection. Malignant vascular tumors must be excluded in the differential diagnosis of IPEH to prevent misdiagnosis and inappropriate overtreatment.
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Neoplasias Vasculares , Femenino , Niño , Humanos , Preescolar , Lactante , Neoplasias Vasculares/patología , Neoplasias Vasculares/cirugía , Bazo/diagnóstico por imagen , Bazo/cirugía , Hiperplasia/diagnóstico por imagen , Hiperplasia/cirugía , Hiperplasia/patología , Células Endoteliales/patología , AbdomenRESUMEN
OBJECTIVE: This study aimed to investigate the predictive and prognostic values of repeated spectral computed tomographic (CT) parameter changes for the prediction of treatment responses to the angiogenesis inhibitor AL3818 in hepatic tumors. METHODS: A total of 30 rabbits with VX2 hepatic tumors that underwent spectral contrast-enhanced abdominal CT before and during treatment were included in the study. The percent change (Δ, %) of the normalized iodine concentration (nIC) during the arterial phase (AP) and venous phase (VP) was used to predict the tumor response and to calculate the overall survival (OS). The threshold of the nIC for tumor response prediction and prognostic significance was determined by a receiver operating characteristic curve and Kaplan-Meier analysis. RESULTS: After treatment, there were 43% (13/30) responders and 57% (17/30) nonresponders. When ΔnICAP ≥ -13.10% was used as the threshold, the sensitivity and specificity for the prediction of tumor response were 82.41% and 92.31%, respectively. ΔnICVP resulted in 88.20% sensitivity and 76.92% specificity for cutoff values ≥10.78%. Kaplan-Meier analyses showed that high ΔnICAP and ΔnICVP were associated with improved OS. CONCLUSIONS: The current study shows the capability of the changes (Δ) in repeated spectral CT parameters to predict the tumor response during antiangiogenesis therapy in small hepatic tumors. ΔnICAP and ΔnICVP were predictors for treatment response and were associated with OS.
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Inhibidores de la Angiogénesis/farmacología , Indoles/farmacología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/tratamiento farmacológico , Quinolinas/farmacología , Tomografía Computarizada por Rayos X , Animales , Medios de Contraste , Modelos Animales de Enfermedad , Yohexol/análogos & derivados , Valor Predictivo de las Pruebas , Pronóstico , Conejos , Interpretación de Imagen Radiográfica Asistida por ComputadorRESUMEN
OBJECTIVE: The purpose of this study was to use virtual monochromatic spectral CT to investigate the usefulness of iodine concentration (IC) and its correlation with clinicopathologically determined prognostic factors in gastric adenocarcinoma. SUBJECTS AND METHODS: From June 2012 to March 2015, 34 patients with gastric adenocarcinoma underwent arterial and portal venous phase spectral CT. The ICs in the arterial and portal venous phases were calculated and then normalized with the aorta as normalized IC (NIC). The surgical specimen was evaluated with CD34 staining to determine microvessel density (MVD). The correlation between imaging results and clinicopathologic findings was investigated for histologic grading, lymph node metastasis, serosal involvement, distant metastasis, pathologic TNM stage, and MVD. RESULTS: The mean arterial phase NIC value of tumors was 0.12 ± 0.03, portal venous phase NIC value was 0.39 ± 0.06, and MVD was 26.94 ± 7.87 vessels per high-power field (×400). Both arterial phase and portal venous phase NIC values were significantly higher in poorly differentiated gastric adenocarcinomas (p = 0.005) than in moderately differentiated tumors (p = 0.013). There was no significant correlation between NIC and serosal involvement or distant metastasis. There was significant correlation between the NIC and MVD in gastric adenocarcinoma (arterial phase NIC, p = 0.013; portal venous phase NIC, p = 0.001). However, neither the arterial nor the portal venous phase NIC of gastric adenocarcinoma had a significant relation to lymphatic metastasis or pathologic TNM stage. There was a significant difference between the high and low MVD groups with respect to portal venous phase NIC (p = 0.045). CONCLUSION: NIC can serve as a useful predictor of angiogenesis and degree of differentiation of moderately and poorly differentiated gastric adenocarcinomas.
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Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Yodo/metabolismo , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , Tomografía Computarizada por Rayos X , Adenocarcinoma/metabolismo , Anciano , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Neoplasias Gástricas/metabolismo , Ácidos TriyodobenzoicosRESUMEN
The contrast medium (CM) induced nephropathy required new CT imaging protocol. This study evaluated the feasibility of low contrast medium (CM) volume and injection flow using aortic dual-energy CT (DECT) angiography with non-linear blending technique. Sixty patients were randomly assigned to two groups: control group (n=30), single-energy CT 70 ml CM at injection rate of 5 ml/s; study group (n=30), DECT mode, 0.5 ml per kg of patient weight CM at injection rate=(weight × 0.5 ml/kg)/(4+scan time). Non-linear blending technique was used for dual-energy images. Mean attention, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of aorta were compared. The level of visible renal artery branches was scored. There was no significant difference between the two groups in the mean aortic attention, SNR and CNR (all P > 0.05). Significant difference was showed in CM injection rate (p < 0.001) and volume (P < 0.001). The renal artery score had no statistically significant difference (P=0.771). Compared conventional scan and CM injection protocol, DECT with non-linear blending technique maintained the image quality of aortic CT angiography with reduced CM volume and flow rate, which could reduce the risks associated with CM injection.
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Aortografía/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Medios de Contraste/química , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
This study was designed to explore the protective effect and mechanism of naringin (NG) on radiation-induced heart disease (RIHD) in rats. Rats were divided into four x-ray (XR) irradiation groups with different absorbed doses (0/10/15/20 Gy), or into three groups (control, XR, and XR + NG groups). Subsequently, the ultrasonic diagnostic apparatus was adopted to assess and compare the left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), left ventricular internal diameter at end diastole (LVIDd), and left ventricular internal diameter at end systole (LVIDs) in rats. Hematoxylin-eosin (H&E) staining and Masson staining were applied to detect the pathological damage and fibrosis of heart tissue. Western blot was used to measure the expression levels of myocardial fibrosis-related proteins, endoplasmic reticulum stress-related proteins, and Sirt1 (silent information regulator 1)/NF-κB (nuclear factor kappa-B) signaling pathway-related proteins in cardiac tissues. Additionally, enzyme-linked immunosorbent assay was utilized to detect the activities of pro-inflammatory cytokines, malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) in cardiac tissue. The results showed that NG treatment significantly attenuated the 20 Gy XR-induced decline of LVEF and LVFS and the elevation of LVIDs. Cardiac tissue damage and fibrosis caused by 20 Gy XR were significant improved after NG treatment. Meanwhile, in rats irradiated by XR, marked downregulation was identified in the expressions of fibrosis-related proteins (Col I, collagen type I; α-SMA, α-smooth muscle actin; and TGF-ß1, transforming growth factor-beta 1) and endoplasmic reticulum stress-related proteins (GRP78, glucose regulatory protein 78; CHOP, C/EBP homologous protein; ATF6, activating transcription factor 6; and caspase 12) after NG treatment. Moreover, NG treatment also inhibited the production of pro-inflammatory cytokines [interleukin-6, interleukin-1ß, and monocyte chemoattractant protein-1 (MCP-1)], reduced the expression of MDA, and promoted the activities of SOD and CAT. Also, NG treatment promoted Sirt1 expression and inhibited p65 phosphorylation. Collectively, XR irradiation induced cardiac injury in rats in a dose-dependent manner. NG could improve the cardiac injury induced by XR irradiation by inhibiting endoplasmic reticulum stress and activating Sirt1/NF-κB signaling pathway.
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Flavanonas , Cardiopatías , FN-kappa B , Ratas , Animales , FN-kappa B/metabolismo , Sirtuina 1/metabolismo , Volumen Sistólico , Ratas Sprague-Dawley , Función Ventricular Izquierda , Transducción de Señal , Citocinas/metabolismo , Fibrosis , Superóxido Dismutasa/metabolismo , Estrés del Retículo EndoplásmicoRESUMEN
OBJECTIVE: To develop and validate a deep learning model based on multi-lesion and time series CT images in predicting overall survival (OS) in patients with stage IV gastric cancer (GC) receiving anti-HER2 targeted therapy. METHODS: A total of 207 patients were enrolled in this multicenter study, with 137 patients for retrospective training and internal validation, 33 patients for prospective validation, and 37 patients for external validation. All patients received anti-HER2 targeted therapy and underwent pre- and post-treatment CT scans (baseline and at least one follow-up). The proposed deep learning model evaluated the multiple lesions in time series CT images to predict risk probabilities. We further evaluated and validated the risk score of the nomogram combining a two-follow-up lesion-based deep learning model (LDLM-2F), tumor markers, and clinical information for predicting the benefits from treatment (Nomo-LDLM-2F). RESULTS: In the internal validation and prospective cohorts, the one-year AUCs for Nomo-LDLM-2F using the time series medical images and tumor markers were 0.894 (0.728-1.000) and 0.809 (0.561-1.000), respectively. In the external validation cohort, the one-year AUC of Nomo-LDLM-2F without tumor markers was 0.771 (0.510-1.000). Patients with a low Nomo-LDLM-2F score derived survival benefits from anti-HER2 targeted therapy significantly compared to those with a high Nomo-LDLM-2F score (all p < 0.05). CONCLUSION: The Nomo-LDLM-2F score derived from multi-lesion and time series CT images holds promise for the effective readout of OS probability in patients with HER2-positive stage IV GC receiving anti-HER2 therapy. CRITICAL RELEVANCE STATEMENT: The deep learning model using baseline and early follow-up CT images aims to predict OS in patients with stage IV gastric cancer receiving anti-HER2 targeted therapy. This model highlights the spatiotemporal heterogeneity of stage IV GC, assisting clinicians in the early evaluation of the efficacy of anti-HER2 therapy. KEY POINTS: ⢠Multi-lesion and time series model revealed the spatiotemporal heterogeneity in anti-HER2 therapy. ⢠The Nomo-LDLM-2F score was a valuable prognostic marker for anti-HER2 therapy. ⢠CT-based deep learning model incorporating time-series tumor markers improved performance.
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Radiofrequency ablation (RFA) is the treatment of choice for atrial fibrillation (AF). Additionally, the utilization of 3D printing for cardiac models offers an in-depth insight into cardiac anatomy and cardiovascular diseases. The study aims to evaluate the clinical utility and outcomes of RFA following in vitro visualization of the left atrium (LA) and pulmonary vein (PV) structures via 3D printing (3DP). Between November 2017 and April 2021, patients who underwent RFA at the First Affiliated Hospital of Xinxiang Medical University were consecutively enrolled and randomly allocated into two groups: the 3DP group and the control group, in a 1:1 ratio. Computed tomography angiography (CTA) was employed to capture the morphology and diameter of the LA and PV, which facilitated the construction of a 3D entity model. Additionally, surgical procedures were simulated using the 3D model. Parameters such as the duration of the procedure, complications, and rates of RFA recurrence were meticulously documented. Statistical analysis was performed using the t-test or Mann-Whitney U test to evaluate the differences between the groups, with a P-value of less than 0.05 considered statistically significant. In this study, a total of 122 patients were included, with 53 allocated to the 3DP group and 69 to the control group. The analysis of the morphological measurements of the LA and PV taken from the workstation or direct entity measurement showed no significant difference between the two groups (P > 0.05). However, patients in the 3DP group experienced significantly shorter RFA times (97.03 ± 28.39 compared to 120.51 ± 44.76 min, t = 3.05, P = 0.003), reduced duration of radiation exposure (2.55 [interquartile range 2.01, 3.24] versus 3.20 [2.28, 3.91] min, Z = 3.23, P < 0.001), and shorter modeling times (7.68 ± 1.03 compared to 8.89 ± 1.45 min, t = 5.38, P < 0.001). 3DP technology has the potential to enhance standard RFA practices by reducing the time required for intraoperative interventions and exposure to radiation.
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A new tetracyclic triterpenoid compound named as mastichinoic acid A (1) was isolated from Mastich. The structure was established as 3,7-dioxo-11ß-hydroxy-5α-tirucalla-8,24(Z)-dien-26-oic acid by various spectroscopic techniques including MS, 1D, and 2D NMR and HRTOFMS.
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Pistacia/química , Resinas de Plantas/química , Triterpenos/aislamiento & purificación , Resina Mástique , Estructura Molecular , Resonancia Magnética Nuclear Biomolecular , Triterpenos/químicaRESUMEN
Inflammatory myofibroblastic tumor (IMT) is a rare tumor with intermediate biologic potential, in which lack of understanding often poses difficulties in preoperative diagnosis and treatment. The aim of the present study was to characterize the computed tomography (CT) features of the bladder IMT. The CT images of nine pathologically confirmed bladder IMT were retrospectively reviewed. All patients underwent both unenhanced CT and contrast-enhanced CT. The diameter, location, contour, growth pattern, margin, boundary, density and enhancement pattern of the lesions were assessed. The mean Ki67 value of an irregular blood clot was 18% and that of no blood clot was 12%. A total of eight (89%) patients had one tumor and 1 (11%) patient had multiple tumors. An endophytic growth pattern was observed in 4 (44%) patients, an exophytic growth pattern in 2 (22%) patients, and a mixed growth pattern in 3 (33%) patients. The tumor manifests morphologically as either polypoid (n=5), or cauliflower-like (n=1) soft-tissue mass with a wide base in the cavity, or a limited thick-walled (n=3). The tumor margins were smooth (n=8) or lobulated (n=1), and the tumor boundaries were either clear (n=7) or ill-defined (n=2). The lesions showed either ring-shaped (n=3) or heterogeneous (n=6). The polypoid and cauliflower-like soft-tissue mass showed a symmetrical change in the center of the lesion after enhancement. The bladder IMT is mostly a single polypoid nodule in the superior wall, mostly endophytic growth, with ring-haped enhancement and symmetrical change after enhancement as its characteristic manifestations.
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RATIONALE: Only 20 cases of pediatric primary renal non-Hodgkin's lymphoma have been reported since 1995, rare cases and a variety of imaging manifestations have led to difficulties in its diagnosis and treatment. PATIENT CONCERNS: Herein, we share in detail a case of primary renal lymphoma (PRL) in a child and summarize the common clinical manifestations, imaging features, and prognostic factors of pediatric PRL by retrospectively analyzing cases reported in the literature. A 2-year-old boy presented to the clinic with a large mass on the right side of his abdomen along with loss of appetite. DIAGNOSES: Imaging revealed a large right renal mass, nearly replacing the entire renal tissue, along with numerous small nodules in the left kidney. Given no local adenopathy and metastases, the diagnosis was unclear. A percutaneous renal puncture was performed, which proved the diagnosis of Burkitt's lymphoma. Since no bone marrow involvement, this child was diagnosed with pediatric PRL. INTERVENTIONS: This PRL boy was treated with the NHL-BFM95 protocol and supportive care. OUTCOMES: Unfortunately, this boy died of multiple organ failure in the fifth month of treatment. LESSONS: As per literature review, the presentation of pediatric PRL is fatigue, loss of appetite, weight loss, abdominal swelling, or other nonspecific symptoms. Although in 81% of cases it often infiltrates the bilateral kidneys, urine abnormalities caused by pediatric PRL are uncommon. 76.2% of pediatric PRL were boys and 2/3 of all cases presented as diffuse renal enlargement. Those PRL presented as masses could easily be misdiagnosed as WT or other malignancies. Absent of local enlarged lymph node, no necrosis or calcification suggest atypical presentation of renal masses and a percutaneous biopsy is needed in timely establishing the accurate diagnosis for appropriate treatment. Based on our experience, percutaneous renal puncture core biopsy is a safe procedure.
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Linfoma de Burkitt , Enfermedades Renales , Masculino , Humanos , Niño , Preescolar , Femenino , Estudios Retrospectivos , Riñón/diagnóstico por imagen , Riñón/patología , Linfoma de Burkitt/patología , Enfermedades Renales/patología , NefrectomíaRESUMEN
Clinical and pathological features are important factors that affect the prognosis and treatment strategies of patients with gastric cancer (GC). An upper gastrointestinal barium X-ray examination is commonly used to show gastric mucosa and morphological changes. The aim of the present study was to evaluate the association between gastric morphological type and the clinicopathological features of patients with GC, based on double-contrast barium X-ray imaging. A total of 329 patients with GC who underwent upper gastrointestinal barium X-ray examination were analyzed. The gastric morphological type was divided into four types on barium X-ray images: Horn-type, hook-type, weak-type and waterfall-type stomach. The χ2 test or Fisher's exact test was used to assess the association between gastric morphological type and the clinicopathological features. There was a statistically significant difference in the location of GC between different types of gastric morphology. Hook-type and horn-type GC were commonly present in the lower region of the stomach, while waterfall-type GC was mainly located in the upper region of the stomach. The incidence of waterfall-type non-poorly differentiated GC was higher than that of other gastric types. The incidence of waterfall-type intestinal-type GC was higher than that of other gastric types, and horn-type GC was more common in mixed-type GC. There was a statistically significant difference in the T-staging of GC between different types of gastric morphology. In conclusion, gastric morphological type correlates with the location and T-stage distribution of GC.
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Purpose: The present study aimed to investigate the clinical prognostic significance of radiomics signature (R-signature) in patients with gastric neuroendocrine neoplasm (GNEN). Methods and Materials: A retrospective study of 182 patients with GNEN who underwent dual-phase enhanced computed tomography (CT) scanning was conducted. LASSO-Cox regression analysis was used to screen the features and establish the arterial, venous and the arteriovenous phase combined R-signature, respectively. The association between the optimal R-signature with the best prognostic performance and overall survival (OS) was assessed in the training cohort and verified in the validation cohort. Univariate and multivariate Cox regression analysis were used to identify the significant factors of clinicopathological characteristics for OS. Furthermore, the performance of a combined radiomics-clinical nomogram integrating the R-signature and independent clinicopathological risk factors was evaluated. Results: The arteriovenous phase combined R-signature had the best performance in predicting OS, and its C-index value was better than the independent arterial and venous phase R-signature (0.803 vs 0.784 and 0.803 vs 0.756, P<0.001, respectively). The optimal R-signature was significantly associated with OS in the training cohort and validation cohort. GNEN patients could be successfully divided into high and low prognostic risk groups with radiomics score median. The combined radiomics-clinical nomogram combining this R-signature and independent clinicopathological risk factors (sex, age, treatment methods, T stage, N stage, M stage, tumor boundary, Ki67, CD56) exhibited significant prognostic superiority over clinical nomogram, R-signature alone, and traditional TNM staging system (C-index, 0.882 vs 0.861, 882 vs 0.803, and 0.882 vs 0.870 respectively, P<0.001). All calibration curves showed remarkable consistency between predicted and actual survival, and decision curve analysis verified the usefulness of the combined radiomics-clinical nomogram for clinical practice. Conclusions: The R-signature could be used to stratify patients with GNEN into high and low risk groups. Furthermore, the combined radiomics-clinical nomogram provided better predictive accuracy than other predictive models and might aid clinicians with therapeutic decision-making and patient counseling.
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BACKGROUND: The preoperative prediction of peritoneal metastasis (PM) in gastric cancer would prevent unnecessary surgery and promptly indicate an appropriate treatment plan. AIM: To explore the predictive value of visceral fat (VF) parameters obtained from preoperative computed tomography (CT) images for occult PM and to develop an individualized model for predicting occult PM in patients with gastric carcinoma (GC). METHODS: A total of 128 confirmed GC cases (84 male and 44 female patients) that underwent CT scans were analyzed and categorized into PM-positive (n = 43) and PM-negative (n = 85) groups. The clinical characteristics and VF parameters of two regions of interest (ROIs) were collected. Univariate and stratified analyses based on VF volume were performed to screen for predictive characteristics for occult PM. Prediction models with and without VF parameters were established by multivariable logistic regression analysis. RESULTS: The mean attenuations of VFROI 1 and VFROI 2 varied significantly between the PM-positive and PM-negative groups (P = 0.044 and 0.001, respectively). The areas under the receiver operating characteristic curves (AUCs) of VFROI 1 and VFROI 2 were 0.599 and 0.657, respectively. The mean attenuation of VFROI 2 was included in the final prediction combined model, but not an independent risk factor of PM (P = 0.068). No significant difference was observed between the models with and without mean attenuation of VF (AUC: 0.749 vs 0.730, P = 0.339). CONCLUSION: The mean attenuation of VF is a potential auxiliary parameter for predicting occult PM in patients with GC.
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Neoplasias Peritoneales , Neoplasias Gástricas , Humanos , Masculino , Femenino , Neoplasias Gástricas/patología , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/secundario , Grasa Intraabdominal/diagnóstico por imagen , Grasa Intraabdominal/patología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Effective identification of T1a stage cancer is crucial for planning endoscopic resection for early gastric cancers. The present study aimed to determine the diagnostic value of the double-track sign in patients with T1a gastric cancer using computed tomography (CT) imaging. A total of 152 patients diagnosed with pathologically proven T1a gastric cancer at The First Affiliated Hospital of Zhengzhou University (Zhengzhou, China) between July 2011 and August 2021 were retrospectively reviewed. The control group consisted of 2,926 patients with gastritis. Clinical data, including patient characteristics and preoperative CT imaging findings with gastric morphological features, were reviewed and analyzed. Out of 51 patients with T1a gastric cancer finally included, 31 (60.8%) exhibited local double-track enhancement changes of the stomach, referred to as the 'double-track sign', on CT images. In addition, four patients (7.8%) had well-enhanced mucosal thickening of the gastric wall. Of the 2,926 control subjects, none had any double-track sign and six patients (0.2%) had local gastric wall thickening with abnormally strengthened enhancement. In conclusion, a double-track sign on CT images is beneficial in the diagnostic differentiation of T1a gastric cancer.