Standard diffusion-weighted, diffusion kurtosis and intravoxel incoherent motion in differentiating invasive placentas.

PURPOSE: To investigate the diagnostic value of monoexponential, biexponential, and diffusion kurtosis MR imaging (MRI) in distinguishing invasive placentas. METHODS: A total of 53 patients with invasive placentas and 47 patients with noninvasive placentas undergoing conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) were retrospectively enrolled. The mean, minimum, and maximum parameters including the apparent diffusion coefficient (ADC) and exponential ADC (eADC) from standard DWI, diffusion kurtosis (MK), and diffusion coefficient (MD) from DKI and pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from IVIM were measured and compared from the volumetric analysis. Receiver operating characteristics (ROC) curve and logistic regression analyses were conducted to evaluate the diagnostic efficiency of different diffusion parameters for distinguishing invasive placentas. RESULTS: Comparisons between accreta lesions in patients with invasive placentas (AL) and lower 1/3 part of the placenta in patients with noninvasive placentas (LP) demonstrated that MD mean, D mean, and D* mean were significantly lower while ADC max and D max were significantly higher in invasive placentas (all p < 0.05). Multivariate analysis demonstrated that D mean, D max and D* mean differed significantly among all the studied parameters for invasive placentas. A combined use of these three parameters yielded an AUC of 0.86 with sensitivity, specificity, and accuracy of 84.91%, 76.60%, and 80%, respectively. CONCLUSION: The combined use of different IVIM parameters is helpful in distinguishing invasive placentas.

Association of MRI Features and Adverse Maternal Outcome in Patients With Placenta Accreta Spectrum Disorders After Abdominal Aortic Balloon Occlusion.

BACKGROUND: MRI features may be associated with adverse maternal outcome in patients with placenta accreta spectrum (PAS) disorders even with abdominal aortic balloon occlusion (AABO). PURPOSE: This study aimed to identify risk factors of MRI for association with adverse maternal outcome in patients with PAS disorders after AABO. STUDY TYPE: Retrospective. POPULATION: Clinical and MRI features of 80 patients were retrospectively reviewed from October 2016 to August 2021. A total of 40 patients had adverse maternal outcomes including intrapartum/peripartum bleeding >1000 mL and/or emergency hysterectomy after AABO. SEQUENCE: Half-Fourier acquisition single-shot turbo spin echo and gradient echo imaging True fast imaging with steady-state precession (True-FISP) at 1.5T MR scanner. ASSESSMENT: MRI features were evaluated by three radiologists and were tested for any association with adverse maternal outcome. STATISTICAL TESTS: Interobserver agreement was calculated with kappa (k) statistics. Association between MRI features and adverse maternal outcomes were evaluated by univariate and multivariate analyses. A nomogram was constructed based on the logistic regression. RESULTS: The interobserver agreement ranged from fair to substantial (k = 0.379-0.783). Multivariate analyses revealed that short cervical length (OR: 4.344), abnormal intraplacental vascularity (OR: 6.005), placental bulge (OR: 9.085), and myometrial interruption (OR: 9.550) were independent risk factors for adverse maternal outcomes. The combination of four risk factors together demonstrated the highest AUC of 0.851 (95% CI 0.769-0.933) with a sensitivity and specificity of 77.5% and 72.5%, respectively and then a nomogram composed of the above four risk factors was constructed to represent the probability of adverse maternal outcome. DATA CONCLUSION: The nomogram demonstrated the association between MRI features and patient's poor outcome after undergoing AABO and C-section delivery for PAS. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3.

In vitro antifungal activities, molecular docking, and DFT studies of 4-amine-3-hydrazino-5-mercapto-1,2,4-triazole derivatives.

Six disubstituted Schiff base compounds were synthesized (A1-A6) and characterized using infrared spectroscopy (IR), elemental analyses (EA), 1H NMR, 13C NMR and HRMS spectroscopic techniques. Crystal structure of A1 has been determined by single crystal X-ray diffraction. The antifungal activities against three fungi were assessed, and the results showed that compounds of A1 and A2 have good activity for Wheat gibberellic with EC50 value of 15.89 and 16.99 mg/L, respectively. Compounds of A3, A4 and A6 have good bioactivity against Maize rough bacteria (the value of EC50 is 8.23, 7.56 and 7.92 mg/L, respectively). According to the result of molecular docking, compounds of A1 and A2 have the smallest docking energy (-8.33, -9.00 kcal/mol). Besides, for A1 and A2, the analysis of highest occupied molecular orbital (HOMO), the lowest unoccupied molecular orbital (LUMO) analysis and molecular electrostatic potential map were to further elaborate the reason for the good activity with density functional theory (DFT)-B3LYP/6-31G.

Prediction of clinically relevant pancreatic fistula after pancreatic surgery using preoperative CT scan: A systematic review and meta-analysis.

BACKGROUND: Body composition analysis has emerged as a practical tool for predicting outcomes following pancreatic surgery. However, the impact of body composition disorders on clinically relevant postoperative pancreatic fistula (CR-POPF) remains inconclusive. The aim of this study was to review and analyse whether radiographically assessed body composition is predictive of CR-POPF. METHODS: PubMed, MEDLINE, Web of Science, and the Cochrane Library databases were searched up to January 2020 to identify relevant studies. CR-POPF was defined according to the definition and grading system proposed by the International Study Group on Pancreatic Surgery (ISGPS). Pooled odds ratios (OR) for CR-POPF were calculated to evaluate the predictive values of radiographically assessed body composition. RESULTS: Fifteen studies published between 2008 and 2019 with a total of 3136 patients were included. There was a significant increase in the incidence of CR-POPF in patients with visceral obesity (OR 2.97, 95% CI 2.05-4.29, P < 0.00001) and sarcopenic obesity (OR 2.88, 95% CI 1.31-6.34, P = 0.009). Conversely, the impact of sarcopenia (OR 0.91, 95% CI 0.65-1.28, P = 0.59) and low muscle attenuation (MA) on CR-POPF did not reach statistical significance. CONCLUSION: Preoperative visceral obesity and sarcopenic obesity are more effective at predicting CR-POPF than decreased muscle quantity and quality. This finding may lead to appropriate management and early intervention of patients at risk of CR-POPF.

The accuracy of aneurysm size in predicting rebleeding after subarachnoid hemorrhage: a meta-analysis.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) is a severe cerebrovascular disease. Rebleeding is an independent predictor of unfavorable outcome after aneurysmal SAH. However, the accuracy of aneurysm size for predicting rebleeding after aneurysmal SAH is still unclear. Hence, we conducted this meta-analysis to evaluate the predictive accuracy of large aneurysm for rebleeding after SAH. METHODS: We performed a literature search in PubMed and Embase. Original studies about aneurysm size and rebleeding after SAH were included. Two reviewers completed data extraction and quality assessment. Pooled sensitivity, specificity, and their 95% confidence intervals (CIs) of large aneurysm for predicting rebleeding were calculated and shown in a forest plot. The overall accuracy of large aneurysm for predicting rebleeding after SAH was shown using a summary receiver operating characteristic (SROC) curve. Publication bias were assessed using Deeks' funnel plot. RESULTS: A total of ten studies with 3889 patients met eligibility criteria and were included in this meta-analysis. The pooled sensitivity and specificity of large aneurysm for predicting rebleeding were 0.39 (95% CI 0.25-0.56) and 0.75 (95% CI 0.67-0.82), respectively. The area under SROC curve was 0.67 (95% CI 0.62-0.71). Deeks' funnel plot did not show obvious publication bias among included studies in this meta-analysis. CONCLUSION: The specificity of large aneurysm for predicting rebleeding after SAH is relatively high. However, its overall accuracy for predicting aneurysm rebleeding is not very satisfying. A comprehensive model should be developed to improve the accuracy of rebleeding prediction after SAH.

Diagnostic accuracy of hepatic proton density fat fraction measured by magnetic resonance imaging for the evaluation of liver steatosis with histology as reference standard: a meta-analysis.

OBJECTIVES: The aim of this meta-analysis was to evaluate the diagnostic accuracy of hepatic magnetic resonance imaging-proton density fat fraction (MRI-PDFF) for the assessment of liver steatosis (LS) with histology as reference standard. METHODS: A systematic literature search was performed to identify pertinent studies. Quality analyses were conducted by Quality Assessment of Diagnostic Accuracy Studies-2. Diagnostic data were extracted and inconsistency index was calculated for LS≥G1, LS≥G2, and LS=G3, respectively. The area under summary receiver operating characteristic curve (AUC) served as the indicator of diagnostic accuracy. The pooled sensitivity and specificity were calculated if threshold effect was absent. RESULTS: Thirteen studies containing 1100 subjects were included. There was significant threshold effect for LS≥G1. The AUCs for LS≥G1, LS≥G2, and LS=G3 were 0.98 (95% confidence interval (CI) 0.76, 1.00), 0.91 (95% CI 0.89, 0.94), and 0.92 (95% CI 0.89, 0.94), respectively. The pooled sensitivities for LS≥G2 and LS=G3 were 0.83 (95% CI 0.75, 0.88) and 0.79 (95% CI 0.63, 0.90), respectively; the pooled specificities for LS≥G2 and LS=G3 were 0.89 (95% CI 0.84, 0.92) and 0.89 (95% CI 0.84, 0.92), respectively. CONCLUSIONS: MRI-PDFF has high diagnostic accuracy at detecting and grading LS with histology as reference standard, suggesting that MRI-PDFF is able to provide an accurate quantification of LS in clinical trials and patient care. KEY POINT: • MRI-PDFF is able to provide an accurate quantification of LS in clinical trials and patient care.

[Predicting Histological Grade of HCC in Rats using Intravoxel Incoherent Motion Imaging].

OBJECTIVE: To predict histological grade of hepatocellular carcinoma (HCC) in Wistar rats using intravoxel incoherent motion imaging (IVIM) with magnetic resonance imaging (MRI). METHODS: Liver lesions of HCC rat models induced by oral diethylnitrosamine (DEN) were scanned by IVIM to obtain apparent diffusion coefficient (ADC) and IVIM parameters,including true diffusion coefficient (D),pseudodiffusion coefficient (D*) and perfusion fraction (f). These HCC lesions were confirmed by Hematoxylin-Eosin (HE) stain and pathologically graded into low (grade Ⅰ+Ⅱ) and high (grade Ⅲ+Ⅳ) using the Edmondson-Steiner method. The ADC and IVIM parameters of the two grade groups were compared: their diagnostic performance were assessed using ROC curves. RESULTS: HCC models were successfully established in 48 rats,containing 50 HCC lesions (28 low-grade and 22 high-grade). The high-grade lesions had lower ADC (P=0.009) and D (P=0.005) values and higher D* (P=0.032) and f (P=0.044) values compared with the low-grade lesions. The largest jonden index appeared in the ROC curves at 0.907 8×10-3 mm2/s of ADC,0.817 6×10-3 mm2/s of D,24.31×10-3 mm2/s of D*,and 14.4% of f,respectively. The area under curves (AUCs) of these parameters ranged from 0.5 to 0.9,showing no significant differences (P>0.05). CONCLUSION: ADC and IVIM parameters have equal and moderate diagnostic values in predicting histologic grade of HCCs, which can be used for estimating pathological grading of HCCs before surgery.

The predictive accuracy of the black hole sign and the spot sign for hematoma expansion in patients with spontaneous intracerebral hemorrhage.

In patients with spontaneous intracerebral hemorrhage (sICH), hematoma expansion (HE) is associated with poor outcome. Spot sign and black hole sign are neuroimaging predictors for HE. This study was aimed to compare the predictive value of two signs for HE. Within 6 h after onset of sICH, patients were screened for the computed tomography angiography spot sign and the non-contrast computed tomography black hole sign. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of two signs for HE prediction were calculated. The accuracy of two signs in predicting HE was analyzed by receiver-operator analysis. A total of 129 patients were included in this study. Spot sign was identified in 30 (23.3%) patients and black hole sign in 29 (22.5%) patients, respectively. Of 32 patients with HE, spot sign was observed in 19 (59.4%) and black hole sign was found in 14 (43.8%). The occurrence of black hole sign was significantly associated with spot sign (P < 0.001). The sensitivity, specificity, PPV, and NPV of spot sign for predicting HE were 59.38, 88.66, 63.33, and 86.87% respectively. In contrast, the sensitivity, specificity, PPV, and NPV of black hole sign for predicting HE were 43.75, 84.54, 48.28, and 82.00%, respectively. The area under the curve was 0.740 for spot sign and 0.641 for black hole sign. (P = 0.228) Both spot sign and black hole sign appeared to have good predictive value for HE, and spot sign seemed to be a better predictor.

The Accuracy of the Spot Sign and the Blend Sign for Predicting Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage.

BACKGROUND Hematoma expansion is associated with poor outcome in intracerebral hemorrhage (ICH) patients. The spot sign and the blend sign are reliable tools for predicting hematoma expansion in ICH patients. The aim of this study was to compare the accuracy of the two signs in the prediction of hematoma expansion. MATERIAL AND METHODS Patients with spontaneous ICH were screened for the presence of the computed tomography angiography (CTA) spot sign and the non-contrast CT (NCCT) blend sign within 6 hours after onset of symptoms. The sensitivity, specificity, and positive and negative predictive values of the spot sign and the blend sign in predicting hematoma expansion were calculated. The accuracy of the spot sign and the blend sign in predicting hematoma expansion was analyzed by receiver-operator analysis. RESULTS A total of 115 patients were enrolled in this study. The spot sign was observed in 25 (21.74%) patients, whereas the blend sign was observed in 22 (19.13%) patients. Of the 28 patients with hematoma expansion, the CTA spot sign was found on admission CT scans in 16 (57.14%) and the NCCT blend sign in 12 (42.86%), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the spot sign for predicting hematoma expansion were 57.14%, 89.66%, 64.00%, and 86.67%, respectively. In contrast, the sensitivity, specificity, positive predictive value, and negative predictive value of the blend sign were 42.86%, 88.51%, 54.55%, and 82.80%, respectively. The area under the curve (AUC) of the spot sign was 0.734, which was higher than that of the blend sign (0.657). CONCLUSIONS Both the spot sign and the blend sign seemed to be good predictors for hematoma expansion, and the spot sign appeared to have better predictive accuracy.

Diffusion-derived vessel density (DDVD) computed from a simple diffusion MRI protocol as a biomarker of placental blood circulation in patients with placenta accreta spectrum disorders: A proof-of-concept study.

OBJECTIVES: Increasing trend of PAS (placenta accreta spectrum disorders) incidence is a major health concern as PAS is associated with high maternal morbidity and mortality during cesarean section. Prenatal identification of PAS is crucial for delivery planning and patients management. This study aims to explore whether diffusion-derived vessel density (DDVD) computed from a simple diffusion MRI protocol differs in PAS from normal placenta. METHODS: We enrolled 86 patients with PAS disorders and 40 pregnant women without PAS disorders. Each patient underwent intravoxel incoherent motion (IVIM) MRI sequence with 11 b-values. Placenta diffusion-derived vessel density (DDVD-b0b50) was the signal difference between b = 0 and b = 50 s/mm2 images. DDVD(b0b50) A/N was calculated as [accreta lesion DDVD(b0b50)]/ [normal placenta DDVD(b0b50)]. The correlation between DDVD and gestational age was explored using Spearman rank correlation. Differences of DDVD(b0b50) A/N in patients with normal placentas and with PAS, and in patients with different subtypes of PAS were explored. RESULTS: DDVD was negatively correlated with gestational age (p = 0.023, r = -0.359) in patients with normal placentas. DDVD(b0b50) A/N was significantly higher in patients with PAS (median:1.16, mean: 1.261) than normal placenta (median:1.02, mean: 1.032, p < 0.001) and especially higher in patients with placenta increta (median:1.14, mean: 1.278) and percreta (median: 1.20, mean: 1.396, p < 0.001). CONCLUSION: As a higher DDVD indicates higher physiological volume of micro-vessels in PAS, this study suggests DDVD can be a potential biomarker to evaluate the placenta perfusion.

T2WI-based MRI radiomics for the prediction of preoperative extranodal extension and prognosis in resectable rectal cancer.

OBJECTIVE: To investigate whether T2-weighted imaging (T2WI)-based intratumoral and peritumoral radiomics can predict extranodal extension (ENE) and prognosis in patients with resectable rectal cancer. METHODS: One hundred sixty-seven patients with resectable rectal cancer including T3T4N + cases were prospectively included. Radiomics features were extracted from intratumoral, peritumoral 3 mm, and peritumoral-mesorectal fat on T2WI images. Least absolute shrinkage and selection operator regression were used for feature selection. A radiomics signature score (Radscore) was built with logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of each Radscore. A clinical-radiomics nomogram was constructed by the most predictive radiomics signature and clinical risk factors. A prognostic model was constructed by Cox regression analysis to identify 3-year recurrence-free survival (RFS). RESULTS: Age, cT stage, and lymph node-irregular border and/or adjacent fat invasion were identified as independent clinical risk factors to construct a clinical model. The nomogram incorporating intratumoral and peritumoral 3 mm Radscore and independent clinical risk factors achieved a better AUC than the clinical model in the training (0.799 vs. 0.736) and validation cohorts (0.723 vs. 0.667). Nomogram-based ENE (hazard ratio [HR] = 2.625, 95% CI = 1.233-5.586, p = 0.012) and extramural vascular invasion (EMVI) (HR = 2.523, 95% CI = 1.247-5.106, p = 0.010) were independent risk factors for predicting 3-year RFS. The prognostic model constructed by these two indicators showed good performance for predicting 3-year RFS in the training (AUC = 0.761) and validation cohorts (AUC = 0.710). CONCLUSION: The nomogram incorporating intratumoral and peritumoral 3 mm Radscore and clinical risk factors could predict preoperative ENE. Combining nomogram-based ENE and MRI-reported EMVI may be useful in predicting 3-year RFS. CRITICAL RELEVANCE STATEMENT: A clinical-radiomics nomogram could help preoperative predict ENE, and a prognostic model constructed by the nomogram-based ENE and MRI-reported EMVI could predict 3-year RFS in patients with resectable rectal cancer. KEY POINTS: • Intratumoral and peritumoral 3 mm Radscore showed the most capability for predicting ENE. • Clinical-radiomics nomogram achieved the best predictive performance for predicting ENE. • Combining clinical-radiomics based-ENE and EMVI showed good performance for 3-year RFS.

[Screening for EGFR mutations in lung cancer by a novel real-time PCR with double-loop probe and Sanger DNA sequencing].

OBJECTIVE: To map the frequency and types of EGFR gene mutations present in lung cancer tissues. To evaluate the clinical applicability of a novel real-time double-loop probe PCR of which the ADx-EGFR kit is based, and to compare its performance with traditional Sanger DNA sequencing in the detection of somatic mutations of tumor genes. METHODS: A total of 208 formalin-fixed paraffin-embedded (FFPE) tumor samples were tested. Genomic DNA of the tissue samples was extracted and purified, and subjected to both traditional PCR amplification, Sanger sequencing of EGFR gene in exon 18, 19, 20, 21, and ADx's EGFR mutation detection kit. The mutation rates for EGFR gene in exon 18, 19, 20, 21, as well as the frequency of each mutation detected by the two methods, were analyzed. RESULTS: The traditional Sanger DNA sequencing technique was successfully performed in 196 out of 208 (94.2%) lung cancer samples, and 22 samples (11.2%) showed EGFR gene mutations. ADx-EGFR kit was successfully used in the lung cancers of all of the 208 cases (100.0%), and 40 samples (19.2%) showed mutations. In the lung cancer samples analyzed, mutations were mainly detected in the exon 19 and exon 21 L858R point mutation, i.e. 4.8% (10/208) and 11.6% (23/208) of total mutations, respectively, and the remaining mutations were rare. CONCLUSIONS: The success rate of ADx-EGFR real-time PCR for formalin-fixed and paraffin-embedded tissues samples is significantly higher than that of Sanger sequencing (P < 0.01). There are significant differences between the two methods. ADx-EGFR real-time PCR shows a much higher successful detection rate and mutation rate of lung cancer tissues compared with that of Sanger sequencing. As a result, the real-time PCR with ADx-EGFR kit is proved to have a good clinical applicability and a strong advantage over the traditional Sanger DNA sequencing. It is an effective and reliable tool for clinical screening of somatic gene mutations in tumors.

Longitudinal course of hyperintensity on diffusion weighted imaging in adult-onset neuronal intranuclear inclusion disease patients.

Background: High signals on diffusion weighted imaging along the corticomedullary junction (CMJ) have demonstrated excellent diagnostic values for adult-onset neuronal intranuclear inclusion disease (NIID). However, the longitudinal course of diffusion weighted imaging high intensities in adult-onset NIID patients has rarely been investigated. Methods: We described four NIID cases that had been discovered using skin biopsy and NOTCH2NLC gene testing, after diffusion weighted imaging exhibiting the distinctive corticomedullary junction high signals. Then using complete MRI data from NIID patients, we analyzed the chronological diffusion weighted imaging alterations of those individuals that had been published in Pub Med. Results: We discussed 135 NIID cases with comprehensive MRI data, including our four cases, of whom 39 had follow-up outcomes. The following are the four primary diffusion weighted imaging dynamic change patterns: (1) high signal intensities in the corticomedullary junction were negative on diffusion weighted imaging even after an 11-year follow-up (7/39); (2) diffusion weighted imagings were initially negative but subsequently revealed typical findings (9/39); (3) high signal intensities vanished during follow-up (3/39); (4) diffusion weighted imagings were positive at first and developed in a step-by-step manner (20/39). We discovered that NIID lesions eventually damaged the deep white matter, which comprises the cerebral peduncles, brain stem, middle cerebellar peduncles, paravermal regions, and cerebellar white matter. Conclusion: The longitudinal dynamic changes in NIID of diffusion weighted imaging are highly complex. We find that there are four main patterns of dynamic changes on diffusion weighted imaging. Furthermore, as the disease progressed, NIID lesions eventually involved the deep white matter.

Differentiation of placenta percreta through MRI features and diffusion-weighted magnetic resonance imaging.

OBJECTIVES: To identify whether parameters measured from diffusion kurtosis and intravoxel incoherent motion help diagnose placenta percreta. METHODS: We retrospectively enrolled 75 patients with PAS disorders including 13 patients with placenta percreta and 40 patients without PAS disorders. Each patients underwent diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI). The apparent diffusion coefficient (ADC), perfusion fraction (f), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), mean diffusion kurtosis (MK) and mean diffusion coefficient (MD) were measured by the volumetric analysis and compared. MRI features were also analyzed and compared. The receiver operating characteristic (ROC) curve and logistic regression analysis were used to evaluate the diagnostic efficiency of different diffusion parameters and MRI features for distinguishing placental percreta. RESULTS: D* was an independent risk factor from DWI for predicting placenta percreta with sensitivity of 73% and specificity of 76%. Focal exophytic mass remained as independent risk factor from MRI features for predicting placenta percreta with sensitivity of 72.7% and specificity of 88.1%. When the two risk factors were combined together, the AUC was the highest, 0.880 (95% CI 0.8-0.96). CONCLUSION: D* and focal exophytic mass were associated with placenta percreta. A combination of the 2 risk factors can be used to predict placenta percreta. CRITICAL RELEVANCE STATEMENT: A combination of D* and focal exophytic mass can be used to differentiate placenta percreta.

Diffusion kurtosis and intravoxel incoherent motion in predicting postpartum hemorrhage in patients at high risk for placenta accreta spectrum disorders.

Background: Placenta accreta spectrum (PAS) disorder encompasses a spectrum of pathologies, from placenta accreta to placenta percreta, which is usually associated with postpartum hemorrhage (PPH). Methods: This cross-sectional study enrolled 109 patients suspected of having PAS disorders based on previous ultrasound results or clinical risk factors from November 2018 to March 2022 in Sichuan Provincial People's Hospital. Of the 109 patients, 34 had PPH and 75 did not have PPH. Magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) was performed for each patient and the apparent diffusion coefficient (ADC) from DWI, perfusion fraction (f), pure diffusion coefficient (D), and pseudo-diffusion coefficient (D*) from IVIM, and mean diffusion kurtosis (MK) and mean diffusion coefficient (MD) from DKI were measured and compared. The correlation between the DWI parameters and estimated blood loss (EBL) during surgery was identified using correlation analysis. The diagnostic performance for predicting PPH was compared between the two methods. Results: The amount of bleeding during delivery was positively correlated with D [r=0.331, P<0.001, 95% confidence interval (CI): 0.170 to 0.477], D* (r=0.389, P<0.001, 95% CI: 0.207 to 0.527), f (r=0.222, P=0.02, 95% CI: 0.036 to 0.398), and MD (r=0.277, P=0.003, 95% CI: 0.108 to 0.439), but negatively correlated with MK (r=-0.280, P=0.003, 95% CI: -0.431 to -0.098). In predicting PPH, multivariate analyses showed the independent risk factors were placenta previa and D; the area under the curve (AUC) was 0.795 (95% CI: 0.711 to 0.878) when the two risk factors were combined together. Conclusions: IVIM and DKI parameters are correlated with EBL. The combined use of placenta previa and D are helpful for predicting PPH in patients at high risk of PAS disorders.

Computed tomography enterography-based multiregional radiomics model for differential diagnosis of Crohn's disease from intestinal tuberculosis.

PURPOSE: To build computed tomography enterography (CTE)-based multiregional radiomics model for distinguishing Crohn's disease (CD) from intestinal tuberculosis (ITB). MATERIALS AND METHODS: A total of 105 patients with CD and ITB who underwent CTE were retrospectively enrolled. Volume of interest segmentation were performed on CTE and radiomic features were obtained separately from the intestinal wall of lesion, the largest lymph node (LN), and region surrounding the lesion in the ileocecal region. The most valuable radiomic features was selected by the selection operator and least absolute shrinkage. We established nomogram combining clinical factors, endoscopy results, CTE features, and radiomic score through multivariate logistic regression analysis. Receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were used to evaluate the prediction performance. DeLong test was applied to compare the performance of the models. RESULTS: The clinical-radiomic combined model comprised of four variables including one radiomic signature from intestinal wall, one radiomic signature from LN, involved bowel segments on CTE, and longitudinal ulcer on endoscopy. The combined model showed good diagnostic performance with an area under the ROC curve (AUC) of 0.975 (95% CI 0.953-0.998) in the training cohort and 0.958 (95% CI 0.925-0.991) in the validation cohort. The combined model showed higher AUC than that of the clinical model in cross-validation set (0.958 vs. 0.878, P = 0.004). The DCA showed the highest benefit for the combined model. CONCLUSION: Clinical-radiomic combined model constructed by combining CTE-based radiomics from the intestinal wall of lesion and LN, endoscopy results, and CTE features can accurately distinguish CD from ITB.

Association of prostate zonal volume with location and aggressiveness of clinically significant prostate cancer: A multiparametric MRI study according to PI-RADS version 2.1.

BACKGROUND: The relationship between prostate cancer (PCa) and benign prostatic hyperplasia (BPH) remains unclear. This study aimed to determine whether prostate zonal volume was associated with the location and aggressiveness of PCa. METHODS: 412 PCa patients were retrospectively enrolled. The volumes of the whole prostate (V) and transition zone (Vtz) were calculated by the prolate ellipsoid formula, and volume of the peripheral zone (Vpz) was calculated by their subtraction. Locations of PCa were divided into three categories, including peripheral zone (PZ), transition zone (Vtz) and mixed zone group. The mixed zone group was further divided into PZ-dominated, TZ-dominated and equally distributed subgroups. RESULTS: The Vtz of Gleason score (GS) 3 + 4 group was the largest, while the Vpz of GS 9 group was the largest. Tumor diameters of the PZ and TZ groups were weakly correlated with their corresponding zonal volume (r = 0.261, p < 0.001; r = 0.311, p = 0.009, respectively). There was no significant difference in the zonal volumes and GS distribution among the location groups. The proportion of tumors with high-grade GS of 8 and 9 was higher in the PZ than that in the TZ group (38.5 vs 24.3%, p = 0.041). For tumors located in the TZ, the V and Vpz of tumors with high-grade GS were larger than those in the low-grade GS of 7 group (p = 0.033 and 0.039, respectively). Among the subgroups of mixed zone group, the Vtz of the TZ-dominated group was larger than those of PZ-dominated and equally distributed groups (p = 0.016 and 0.001, respectively). CONCLUSION: PCa with high-grade GS is more likely to have a relatively larger Vpz and involve PZ, while PCa with a larger Vtz is more likely to be with low-grade GS, which support the theoretical model that pressure exerted by increasing prostate size/mechanical deformation may inhibit PCa growth from the clinical point. However, the increase in zonal volume might not be the direct cause of tumorigenesis and aggressiveness.

Enhanced computed tomography features predict pancreatic neuroendocrine neoplasm with Ki-67 index less than 5.

BACKGROUND: Several studies have suggested that patients with pancreatic neuroendocrine neoplasm (pNEN) with the Ki-67 index of < 5% are more likely to show better prognosis after clinical intervention. Moreover, the Ki-67 index at 5% has also been suggested as a potential threshold by the 2016 European Neuroendocrine Tumor Society guidelines. OBJECTIVE: Based on preoperative enhanced computed tomography (CT), this study aimed to investigate imaging characteristics eligible to discriminate the ≤ 5% Ki-67 group from the > 5% Ki-67 group of patients with nonmetastatic pNEN. METHODS: Patients with pathologically diagnosed pNEN and preoperative multiphase CT were enrolled. Their Ki-67 index was calculated and grouped according to the 5% cutoff value. The following CT imaging characteristics and some serum biomarkers were assessed between the two groups: the diameter, location, tumor margin, calcification, pancreatic atrophy, distal pancreatic duct dilation, vessel involvement, and enhancement pattern characteristics of both arterial phase (AP) and portal vein phase (PVP). RESULTS: A total of 142 patients with pNEN were enrolled in this study, comprising 104 in the low (Ki-67, 1%-5%) and 38 in the high index group (Ki-67, >5%). Alpha fetoprotein and cancer antigen 125 were significantly different between the two groups (P-values, 0.030 and 0.049, respectively). The diameter (P < 0.0001), margin (P = 0.003), distal main ductal dilation (P = 0.021), vessel involvement (P = 0.002), AP hypoenhancement (P < 0.0001), PVP hypoenhancement (P = 0.003), AP ratio (P = 0.0001), and PVP ratio (P = 0.0003) were significantly different between the low and high index groups. The area under the curve of the multivariate logistic regression model was 0.853. CONCLUSION: Nonmetastatic pNENs with larger diameter, ill-defined margin, distal main ductal dilation, and tumor hypoenhancement in AP in preoperative enhanced CT tend to have a Ki-67 index of > 5%.The results of this study provide an alternative method to clinicians to decide whether surgery is appropriate.

Computed tomography-based radiomics for predicting lymphovascular invasion in rectal cancer.

PURPOSE: To develop and externally validate a computed tomography (CT)-based radiomics model for predicting lymphovascular invasion (LVI) before treatment in patients with rectal cancer (RC). METHOD: This retrospective study enrolled 351 patients with RC from three hospitals between March 2018 and March 2021. These patients were assigned to one of the following three groups: training set (n = 239, from hospital 1), internal validation set (n = 60, from hospital 1), and external validation set (n = 52, from hospitals 2 and 3). Large amounts of radiomics features were extracted from the intratumoral and peritumoral regions in the portal venous phase contrast-enhanced CT images. The score of radiomics features (Rad-score) was calculated by performing logistic regression analysis following the L1-based method. A combined model (Rad-score + clinical factors) was developed in the training cohort and validated internally and externally. The models were compared using the area under the receiver operating characteristic curve (AUC). RESULTS: Of the 351 patients, 106 (30.2%) had an LVI + tumor. Rad-score (comprised of 22 features) was significantly higher in the LVI + group than in the LVI- group (0.60 ± 0.17 vs. 0.42 ± 0.19, P = 0.001). The combined model obtained good predictive performance in the training cohort (AUC = 0.813 [95% CI: 0.758-0.861]), with robust results in internal and external validations (AUC = 0.843 [95% CI: 0.726-0.924] and 0.807 [95% CI: 0.674-0.903]). CONCLUSIONS: The proposed combined model demonstrated the potential to predict LVI preoperatively in patients with RC.

Diagnostic performance of mono-exponential DWI versus diffusion kurtosis imaging in breast lesions: A meta-analysis.

BACKGROUND: This meta-analysis aimed to explore the diagnostic value of diffusion kurtosis imaging (DKI) compared to mono-exponential diffusion weighted imaging (DWI) in the diagnosis of breast cancer. METHODS: A systematic electronic literature search (up to September 2020) was conducted for published English-language studies comparing the diagnostic values of DKI and DWI for the detection of breast cancer. The data of mean kurtosis (MK), mean diffusivity (MD), and apparent diffusion coefficient (ADC) were extracted to construct 2 × 2 contingency tables. The pooled sensitivities, specificities, and areas under the receiver operating characteristic curve (AUCs) were compared between DKI and DWI in the diagnosis of breast cancer. RESULTS: Eight studies were finally included, with a total of 771 patients in the same population. Pooled sensitivities were 82.0% [95% confidence interval (95% CI), 78.2-85.3%] for ADC, 87.3% (95% CI, 83.9-90.1%) for MK, and 83.9% (95% CI, 80.2-87.1%) for MD. Pooled specificities were 81.1% (95% CI, 76.7-84.9%) for ADC, 85.1% (95% CI, 81.1-88.5%) for MK, and 83.2% (95% CI, 79.0-86.8%) for MD. According to the summary receiver operator characteristic curve analyses, the AUCwas 0.901 for ADC, 0.930 for MK, and 0.918 for MD (ADC vs MK, P = .353; ADC vs MD, P = .611). No notable publication bias was found, while significant heterogeneity was observed. CONCLUSIONS: Although DKI is feasible for identifying breast cancer, MD and MK offer similar diagnostic performance to ADC values. Thus, we recommend that DKI should not be included in the routine evaluation of breast lesions now.