Impact of autologous platelet concentrates on wound area reduction: A meta-analysis of randomized controlled trials.

This meta-analysis aimed to evaluate the impact of autologous platelet concentrates (APCs) on wound area reduction based on randomized controlled trials (RCTs). A comprehensive search was conducted in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Web of Science, and the Cochrane Library to identify relevant literature. The primary outcome measure was the percentage of wound area reduction. Secondary outcome measures included wound healing time and the incidence of infection. A total of 14 studies were included in the meta-analysis. The results showed that the percentage of wound area reduction was significantly greater in the APCs group compared to conventional treatments (standardized mean difference [SMD] 1.98, 95% confidence interval [CI]: 1.27-2.68, p < 0.001). Subgroup analysis revealed that the percentage of wound area reduction varied based on wound location, follow-up duration, and type of APCs used. The healing time and incidence of infection presented no significant difference between the two groups. The findings suggest that APCs can effectively reduce wound areas when compared to conventional treatments, without increasing the risk of infection. In addition, the effectiveness of APCs in wound area reduction may vary depending on factors such as wound location, type of APCs used, and follow-up duration.

Complications of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects the apocrine glands in the axillary, groin, and breast regions, with apparent physiological and psychosocial sequelae. As many studies have reported, surgical management is one of the treatment options. A comprehensive systematic review of surgical treatment for HS is provided in this study. Literature retrieval was conducted on MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI) and clinical registries from their inception to 1 May 2022. The principles of the PRISMA were adhered to in the process of literature search and the reference lists of the articles retrieved were also checked for further reference. Heterogeneity was assessed in meta-analysis by means of the Q-test and I2 index. A total of 13 studies were finally included which involved 535 participants in total. The average estimated complication rate was 11.1% (95% confidence interval [CI], 6.4%-16.9%). The meta-analysis was conducted on pooled complication sample studies and pooled recurrence sample studies. The recurrence was 16.2% (95% CI, 9.1%-24.9%). Subgroup analysis revealed significant differences in HS complications among different closure types. Among different locations, the highest rate of 16.0% (95% CI, 6.8%-28.2%) was multiple locations. Besides, differences were also observed in diverse excision methods and the highest was deroofing 13.9% (95% CI, 2.2%-33.2%). Extensive resection, using skin flaps or skin grafts as a closure method, was associated with a higher incidence of complications. Providers should consider carefully the use of extensive resection or using skin flaps or skin grafts as a closure method so as to minimise the risk of adverse events.

Comparison of Conventional Gadoxetate Disodium-Enhanced MRI Features and Radiomics Signatures With Machine Learning for Diagnosing Microvascular Invasion.

OBJECTIVE. This study aimed to determine the best model for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) using conventional gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (gadoxetate disodium)-enhanced MRI features and radiomics signatures with machine learning. MATERIALS AND METHODS. This retrospective study included 269 patients with a postoperative pathologic diagnosis of HCC. Gadoxetate disodium-enhanced MRI features were assessed, including T1 relaxation time, tumor margin, tumor size, peritumoral enhancement, peritumoral hypointensity, and ADC. Radiomics models were constructed and validated by machine learning. The least absolute shrinkage and selection operator (LASSO) was used for feature selection, and radiomics-based LASSO models were constructed with six classifiers. Predictive capability was assessed using the ROC AUC. RESULTS. Histologic examination confirmed MVI in 111 (41.3%) of the 269 patients. ADC value, nonsmooth tumor margin, and 20-minute T1 relaxation time showed diagnostic accuracy with AUC values of 0.850, 0.847, and 0.846, respectively (p < .05 for all). A total of 1395 quantitative imaging features were extracted. In the hepatobiliary phase (HBP) model, the support vector machine (SVM), extreme gradient boosting (XGBoost), and logistic regression (LR) classifiers showed greater diagnostic efficiency for predicting MVI, with AUCs of 0.942, 0.938, and 0.936, respectively (p < .05 for all). CONCLUSION. ADC value, nonsmooth tumor margin, and 20-minute T1 relaxation time show high diagnostic accuracy for predicting MVI. Radiomics signatures with machine learning can further improve the ability to predict MVI and are best modeled during HBP. The SVM, XGBoost, and LR classifiers may serve as potential biomarkers to evaluate MVI.

Diagnostic Value of Gd-EOB-DTPA-Enhanced MRI for the Expression of Ki67 and Microvascular Density in Hepatocellular Carcinoma.

CONTRACT GRANT SPONSOR: National Natural Science Foundation of China; Contract grant number: 81260214. BACKGROUND: Recent studies have highlighted the diagnostic value of Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI in small hepatocellular carcinoma (HCC). Ki67 and CD34 are histologic markers that reflect the proliferation of tumor cells and the microvascular density (MVD). PURPOSE: To explore the diagnostic value of Gd-EOB-DTPA-enhanced MRI for Ki67 expression and MVD in HCC. STUDY TYPE: Retrospective. SUBJECTS: In all, 180 patients with HCC. FIELD STRENGTH/SEQUENCE: 3.0T, Gd-EOB-DTPA-enhanced T1 WI volumetric interpolated breath-hold examination (VIBE) axial fat suppression plain, and enhanced scanning. ASSESSMENT: The T1 relaxation time (T1 rt) and signal intensity (SI) of the lesion were measured. The Ki67 expressions and MVD were evaluated by immunohistochemistry. STATISTICAL TEST: Receiver operating characteristic (ROC) curves were used to analyze the diagnostic efficacy of T1 rt for high Ki67 expression (≥50%) and high MVD (≥100). RESULTS: The T1 rt-20min, rrT1 rt-20min, and SI-hepatobiliary phase (SI-HBP) were strongly correlated with Ki67, the r values were 0.846, -0.765, and -0.760 (P < 0.05), respectively. There were moderate correlations with CD34, with r values -0.444, 0.336, and -0.463 (P < 0.05), respectively. The T1 rt-Pre, T1 rt-20min, SI-Pre, and SI-HBP were significantly different both between the high and low ki67 expression groups (P < 0.05) and between the high MVD and low MVD groups (P < 0.05). In the two groups the T1 rt-20min and SI-HBP was 800.06 ± 128.91 vs. 530.06 ± 139.29 (P < 0.05) and 122.29 ± 39.39 vs. 173.49 ± 46.15 (P < 0.05); T1 rt-20min was found to have high diagnostic efficiency for high ki67 expression (area under the curve [AUC], 0.937; P < 0.05) T1 rt-20min had moderate diagnostic value for high MVD (AUC, 0.716; P < 0.05). DATA CONCLUSION: The T1 rt and SI of Gd-EOB-DTPA-enhanced MRI were correlated with Ki67 expression and MVD. T1 rt-20min has a high diagnostic value for high ki67 expression and high MVD in HCC tissues. LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1755-1763.

Hepatocellular carcinoma grading and recurrence prediction using T1 mapping on gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging.

The aim of the present study was to explore the value of T1 mapping on gadolinium-ethoxybenzyl diethylenetriamine pentaacetic (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for grading hepatocellular carcinoma (HCC) and predicting its recurrence rate. A retrospective study was performed that included 75 patients (66 men and 9 women; mean age, 52.89 years; age range, 23-79 years) with HCC who had undergone Gd-EOB-DTPA-enhanced MRI with T1 mapping before surgery. The T1 relaxation time of the 81 lesions and non-tumorous liver parenchyma in 75 patients with HCC were measured before Gd-EOB-DTPA was injected and then at 5, 10 and 20 min after administration, respectively. T1[lesion (L)-hepatic parenchyma (H)]/H (%) was calculated as the increment rate of the T1 value in the lesions relative to the non-tumorous liver parenchyma. One-way analysis of variance and Spearman's correlation analysis was used to compare the differences and relationship of T1 mapping values among the three grades of HCC. A total of 81 lesions were divided into well-differentiated HCC (grades I; n=21), moderately differentiated HCC (grades II; n=40) and poorly differentiated HCC (grades III; n=20) according to the histopathology. The T1(L-H)/H (%) value among grades I, II and III HCC on pre-contrast results and on post-contrast results at the 5-, 10- and 20-min hepatobiliary phase (HBP) were significantly different (P<0.05), and T1(L-H)/H (%) was correlated with the histological grade of HCC at each time point (r=0.637, r=0.554, r=0.499 and r=0.560, respectively, P<0.001). A total of 41 recurrence cases [grade I (n=5), grade II (n=23) and grade III (n=13)] were verified by imaging (CT, MRI or ultrasound) or reoperation. Patients with grade III and grade II HCC had higher recurrence rates compared with that in patients with grade I HCC (P<0.05; median recurrence times were 258 days, 605 days and undefined, respectively). According to the optimal cut-off point for the T1(L-H)/H (%) of the three grades of HCC, patients with HCC in the low T1(L-H)/H (%) value group (≤155.15%) had lower cumulative recurrence rates compared with that in the medium (T1(L-H)/H (%) >155.15% and T1(L-H)/H (%) ≤241.20%) and high (T1(L-H)/H (%) >241.20%) value groups at the 20-min HBP (P<0.05; median recurrence times were undefined, 530 days and 447 days, respectively). These results indicate that the parameters of T1 mapping would be beneficial for predicting the grading and recurrence of HCC.

Comparison of 10- and 20-min hepatobiliary phase images on Gd-EOB-DTPA-enhanced MRI T1 mapping for liver function assessment in clinic.

PURPOSE: To compare hepatobiliary phase (HBP) images obtained 10 and 20 min after Gd-EOB-DTPA-enhanced MRI for liver function assessment in clinic on 3.0 T MR imaging. METHODS: 103 patients were separated into four groups: 38 patients for the normal liver function (NLF) group, 33 patients for the liver cirrhosis with Child-Pugh A (LCA) group, 21 patients for the liver cirrhosis with Child-Pugh B group, and 11 patients for a liver cirrhosis with Child-Pugh C group. T1 relaxation times (T1rt) were measured on T1 mapping and reduction rates of T1rt (rrT1rt) were calculated. HBP images were obtained at the 10- and 20-min mark after Gd-EOB-DTPA enhancement. RESULTS: T1rt on pre-enhancement imaging showed no significant difference (p > 0.05) among all four groups. T1rt for both the 10-min HBP and the 20-min HBP showed a significant difference (p < 0.05) among all groups, but showed no significant difference (p > 0.05) between the NLF group and the LCA group. T1rt and rrT1rt showed no significant difference (p > 0.05) between 10-min HBP and 20-min HBP among all groups. The ROC analysis on 10-min HBP and 20-min HBP showed a lower diagnostic performance between NLF group and LCA group (AUC from 0.532 to 0.582), but high diagnostic performance (AUC from 0.788 to 1.000) among others group. CONCLUSIONS: In comparing 10-min HBP and 20-min HBP T1 mapping after Gd-EOB-DTPA enhancement, our results suggest that 10-min HBP T1 mapping is a feasible option for quantitatively assessing liver function.

Evaluating segmental liver function using T1 mapping on Gd-EOB-DTPA-enhanced MRI with a 3.0 Tesla.

BACKGROUND: Assessing the liver function provides valuable information to evaluate surgical risk and plan accordingly. Current studies focus on whole liver function evaluation. However, assessment of segmental liver function is equally important in the clinical practice. The purpose of this study was to investigate whether Gd-EOB-DTPA-enhanced MRI can evaluate the liver function of each segment by using T1 mapping at 3 Tesla MRI. METHODS: One hundred three patients were classified into one of 4 groups: a normal liver function (NLF) group (n = 38), a liver cirrhosis with Child-Pugh A (LCA) group (n = 33), a liver cirrhosis with Child-Pugh B (LCB) group (n = 21), and a liver cirrhosis with Child-Pugh C (LCC) group (n = 11). All patients underwent Gd-EOB-DTPA-enhanced MRI scans. T1 relaxation times were measured on the liver superimposing T1 mapping images. Reduction rate (△%) of T1 relaxation time of the liver parenchyma were calculated. RESULTS: After 20 min of Gd-EOB-DTPA enhancement, the T1 relaxation time of all liver segments in the LCC group were different from those in all the other groups, and more liver segments from the LCB and LCA groups different from the NLF group (p < 0.05). For the LCB group, the areas under the receiver operating characteristic curves (AUCs) of different liver segments for hepatobiliary phase (HBP) were 0.654-0.904 on T1 relaxation time, and 0.709-0.905 on △%. For the LCC group, the AUCs of different liver segments for HBP were 0.842-0.997 on T1 relaxation time, and 0.887-0.990 on △%. CONCLUSIONS: For LCB patients, segmental liver function evaluation is possible using Gd-EOB-DTPA-enhanced MRI T1 mapping. For LCC patients, all liver segments can be used to evaluate liver function and both T1 relaxation time and the △% of T1 relaxation time have good diagnostic performance.

Gd-EOB-DTPA-enhanced MRI T1 mapping for assessment of liver function in rabbit fibrosis model: comparison of hepatobiliary phase images obtained at 10 and 20 min.

OBJECTIVES: To compare hepatobiliary phase (HBP) images obtained at 10 and 20 min after Gd-EOB-DTPA-enhanced MRI for assessment of liver function in rabbit fibrosis model on 3.0 T MR imaging. METHODS: 34 animals were separated into three groups: 5 for a control group, 14 for a mild fibrosis group, and 15 for a severe fibrosis group based on pathological proof. T1 relaxation times (T1rt) were measured on T1 mapping and reduction rates of T1rt (rrT1rt) were calculated. HBP images were obtained at 10 and 20 min after Gd-EOB-DTPA enhancement. Indocyanine green retention rates at 15 min (ICG R15) were performed for all animals. RESULTS: T1rt on pre-enhancement imaging showed no significant difference (p > 0.05) among all groups. T1rt on 10 min HBP and 20 min HBP showed significant difference (p < 0.05) among all groups. T1rt and rrT1rt in three groups showed no-significant difference (p > 0.05) between 10 min HBP and 20 min HBP. T1rt on both 10 and 20 min HBP showed significant correlation with ICG R15 (p < 0.05); rrT1rt on both 10 min HBP and 20 min HBP showed significant inverse correlation with ICG R15 (p < 0.05). CONCLUSIONS: Comparing 10 min HBP and 20 min HBP T1 mapping after Gd-EOB-DTPA enhancement, our results suggest that 10 min HBP T1 mapping is feasible for quantitatively assessing liver function.

Liver iron quantification by 3 tesla MRI: calibration on a rabbit model.

PURPOSE: To determine the feasibility of liver iron quantification by 3 Tesla (T) MRI using a novel iron overload rabbit model. MATERIALS AND METHODS: Forty-two rabbits underwent iron dextran loading from 1 to 15 weeks. MRI signal intensity ratio (SIR) was measured using a gradient-echo sequence, and R2(1/T2) measured using an eight-echo spin-echo sequence at 3T. Ex vivo hepatic pathology was obtained for all rabbits studied. Postmortem assessments of liver iron concentration (LIC) were conducted in an atomic absorption spectrophotometer. MRI measures were fitted against LIC using linear regression for 30 of the iron-loaded rabbits. The remaining 12 iron-loaded rabbits were used to test the prediction accuracy of the derived models. RESULTS: LIC was linearly correlated to both liver-to-muscle SIR (r = -0.845) and R2 (r = 0.965) in a range achieved in this study (LIC < 10 mg/g dry tissue) at 3T. By regression, the linear equations were determined as: Y1 = 10.581-5.924X1 (Y1 : LIC, X1 :SIR); Y2 = -1.273+0.103X2 (Y2 :LIC, X2 :R2). In the 12 test rabbits, the predicted LICs using the derived equations agreed well with the results obtained using the spectrophotometer. CONCLUSION: Both SIR and R2 are highly correlated with LIC in a novel rabbit model. MRI quantification of liver iron overload is feasible at 3T.

Relationship between changes in brain MRI and (1)H-MRS, severity of chronic liver damage, and recovery after liver transplantation.

Magnetic resonance imaging (MRI) and (1)H magnetic resonance spectroscopy ((1)H-MRS) have been used in clinics for diagnosis of chronic liver diseases. This study was designed to investigate the relationship between MRI/MRS outcomes and the severity of liver damage. Of 50 patients examined, the MRI signal intensity in the globus pallidus as determined by pallidus index (PI) increased as the disease severity (scored by Child Pugh ranking) worsened (r = 0.353, P < 0.05). The changes in PI values were also linearly associated with Mn concentrations in whole blood (MnB) (r = 0.814, P < 0.01). MRS analysis of four major brain metabolites (i.e., Cho, mI, Glx, and NAA) revealed that the ratios of Cho/Cr and mI/Cr in cirrhosis and CHE patients were significantly decreased in comparison to controls (P < 0.05), whereas the ratio of Glx/Cr was significantly increased (P < 0.05). The Child Pugh scores significantly correlated with mI/Cr (-0.484, P < 0.01) and Glx (0.369, P < 0.05), as well as MnB (0.368, P < 0.05), but not with other brain metabolites. Three patients who received a liver transplant experienced normalization of brain metabolites within 3 months of post-transplantation; the MR imaging of Mn in the globus pallidus completely disappeared 5 months after the surgery. Taken together, this clinical study, which combined MRI/MRS analysis, autopsy exam and liver transplant, clearly demonstrates that liver injury-induced brain Mn accumulation can reversibly alter the homeostasis of brain metabolites Cho, mI and Glx. Our data further suggest that liver transplantation can restore normal brain Mn levels.