A dynamic online nomogram predicting prostate cancer short-term prognosis based on 18F-PSMA-1007 PET/CT of periprostatic adipose tissue: a multicenter study.

BACKGROUND: Rising prostate-specific antigen (PSA) levels following radical prostatectomy are indicative of a poor prognosis, which may associate with periprostatic adipose tissue (PPAT). Accordingly, we aimed to construct a dynamic online nomogram to predict tumor short-term prognosis based on 18F-PSMA-1007 PET/CT of PPAT. METHODS: Data from 268 prostate cancer (PCa) patients who underwent 18F-PSMA-1007 PET/CT before prostatectomy were analyzed retrospectively for model construction and validation (training cohort: n = 156; internal validation cohort: n = 65; external validation cohort: n = 47). Radiomics features (RFs) from PET and CT were extracted. Then, the Rad-score was constructed using logistic regression analysis based on the 25 optimal RFs selected through maximal relevance and minimal redundancy, as well as the least absolute shrinkage and selection operator. A nomogram was constructed to predict short-term prognosis which determined by persistent PSA. RESULTS: The Rad-score consisting of 25 RFs showed good discrimination for classifying persistent PSA in all cohorts (all P < 0.05). Based on the logistic analysis, the radiomics-clinical combined model, which contained the optimal RFs and the predictive clinical variables, demonstrated optimal performance at an AUC of 0.85 (95% CI: 0.78-0.91), 0.77 (95% CI: 0.62-0.91) and 0.84 (95% CI: 0.70-0.93) in the training, internal validation and external validation cohorts. In all cohorts, the calibration curve was well-calibrated. Analysis of decision curves revealed greater clinical utility for the radiomics-clinical combined nomogram. CONCLUSION: The radiomics-clinical combined nomogram serves as a novel tool for preoperative individualized prediction of short-term prognosis among PCa patients.

Multimodal radiomics based on 18F-Prostate-specific membrane antigen-1007 PET/CT and multiparametric MRI for prostate cancer extracapsular extension prediction.

OBJECTIVES: To compare the performance of the multiparametric magnetic resonance imaging (mpMRI) radiomics and 18F-Prostate-specific membrane antigen (PSMA)-1007 PET/CT radiomics model in diagnosing extracapsular extension (EPE) in prostate cancer (PCa), and to evaluate the performance of a multimodal radiomics model combining mpMRI and PET/CT in predicting EPE. METHODS: We included 197 patients with PCa who underwent preoperative mpMRI and PET/CT before surgery. mpMRI and PET/CT images were segmented to delineate the regions of interest and extract radiomics features. PET/CT, mpMRI, and multimodal radiomics models were constructed based on maximum correlation, minimum redundancy, and logistic regression analyses. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and indices derived from the confusion matrix. RESULTS: AUC values for the mpMRI, PET/CT, and multimodal radiomics models were 0.85 (95% CI, 0.78-0.90), 0.73 (0.64-0.80), and 0.83 (0.75-0.89), respectively, in the training cohort and 0.74 (0.61-0.85), 0.62 (0.48-0.74), and 0.77 (0.64-0.87), respectively, in the testing cohort. The net reclassification improvement demonstrated that the mpMRI radiomics model outperformed the PET/CT one in predicting EPE, with better clinical benefits. The multimodal radiomics model performed better than the single PET/CT radiomics model (P < .05). CONCLUSION: The mpMRI and 18F-PSMA-PET/CT combination enhanced the predictive power of EPE in patients with PCa. The multimodal radiomics model will become a reliable and robust tool to assist urologists and radiologists in making preoperative decisions. ADVANCES IN KNOWLEDGE: This study presents the first application of multimodal radiomics based on PET/CT and MRI for predicting EPE.

Deep Learning-Based Multiparametric MRI Model for Preoperative T-Stage in Rectal Cancer.

BACKGROUND: Conventional MRI staging can be challenging in the preoperative assessment of rectal cancer. Deep learning methods based on MRI have shown promise in cancer diagnosis and prognostication. However, the value of deep learning in rectal cancer T-staging is unclear. PURPOSE: To develop a deep learning model based on preoperative multiparametric MRI for evaluation of rectal cancer and to investigate its potential to improve T-staging accuracy. STUDY TYPE: Retrospective. POPULATION: After cross-validation, 260 patients (123 with T-stage T1-2 and 134 with T-stage T3-4) with histopathologically confirmed rectal cancer were randomly divided to the training (N = 208) and test sets (N = 52). FIELD STRENGTH/SEQUENCE: 3.0 T/Dynamic contrast enhanced (DCE), T2-weighted imaging (T2W), and diffusion-weighted imaging (DWI). ASSESSMENT: The deep learning (DL) model of multiparametric (DCE, T2W, and DWI) convolutional neural network were constructed for evaluating preoperative diagnosis. The pathological findings served as the reference standard for T-stage. For comparison, the single parameter DL-model, a logistic regression model composed of clinical features and subjective assessment of radiologists were used. STATISTICAL TESTS: The receiver operating characteristic curve (ROC) was used to evaluate the models, the Fleiss' kappa for the intercorrelation coefficients, and DeLong test for compare the diagnostic performance of ROCs. P-values less than 0.05 were considered statistically significant. RESULTS: The Area Under Curve (AUC) of the multiparametric DL-model was 0.854, which was significantly higher than the radiologist's assessment (AUC = 0.678), clinical model (AUC = 0.747), and the single parameter DL-models including T2W-model (AUC = 0.735), DWI-model (AUC = 0.759), and DCE-model (AUC = 0.789). DATA CONCLUSION: In the evaluation of rectal cancer patients, the proposed multiparametric DL-model outperformed the radiologist's assessment, the clinical model as well as the single parameter models. The multiparametric DL-model has the potential to assist clinicians by providing more reliable and precise preoperative T staging diagnosis. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.

Machine learning-based radiomics for multiple primary prostate cancer biological characteristics prediction with 18F-PSMA-1007 PET: comparison among different volume segmentation thresholds.

BACKGROUND: PET-based radiomics features could predict the biological characteristics of primary prostate cancer (PCa). However, the optimal thresholds to predict the biological characteristics of PCa are unknown. This study aimed to compare the predictive power of 18F-PSMA-1007 PET radiomics features at different thresholds for predicting multiple biological characteristics. METHODS: One hundred and seventy-three PCa patients with complete preoperative 18F-PSMA-1007 PET examination and clinical data before surgery were collected. The prostate lesions' volumes of interest were semi-automatically sketched with thresholds of 30%, 40%, 50%, and 60% maximum standardized uptake value (SUVmax). The radiomics features were respectively extracted. The prediction models of Gleason score (GS), extracapsular extension (ECE), and vascular invasion (VI) were established using the support vector machine. The performance of models from different thresholding regions was assessed using receiver operating characteristic curve and confusion matrix-derived indexes. RESULTS: For predicting GS, the 50% SUVmax model showed the best predictive performance in training (AUC, 0.82 [95%CI 0.74-0.88]) and testing cohorts (AUC, 0.80 [95%CI 0.66-0.90]). For predicting ECE, the 40% SUVmax model exhibit the best predictive performance (AUC, 0.77 [95%CI 0.68-0.84] and 0.77 [95%CI 0.63-0.88]). As for VI, the 50% SUVmax model had the best predictive performance (AUC, 0.74 [95%CI 0.65-0.82] and 0.74 [95%CI 0.56-0.82]). CONCLUSION: The 18F-1007-PSMA PET-based radiomics features at 40-50% SUVmax showed the best predictive performance for multiple PCa biological characteristics evaluation. Compared to the single PSA model, radiomics features may provide additional benefits in predicting the biological characteristics of PCa.

Comparative analysis of two mathematical algorithms for the calculation of computed tomography perfusion parameters in the healthy and diseased pancreas.

BACKGROUND: The maximum slope (MS) and deconvolution (DC) algorithms are commonly used to post-process computed tomography perfusion (CTP) data. This study aims to analyze the differences between MS and DC algorithms for the calculation of pancreatic CTP parameters. METHODS: The pancreatic CTP data of 57 patients were analyzed using MS and DC algorithms. Two blinded radiologists calculated pancreatic blood volume (BV) and blood flow (BF). Interobserver correlation coefficients were used to evaluate the consistency between two radiologists. Paired t-tests, Pearson linear correlation analysis, and Bland-Altman analysis were performed to evaluate the correlation and consistency of the CTP parameters between the two algorithms. RESULTS: Among the 30 subjects with normal pancreas, the BV values in the three pancreatic regions were higher in the case of the MS algorithm than in the case of the DC algorithm (t = 39.35, p < 0.001), and the BF values in the three pancreatic regions were slightly higher for the MS algorithm than for the DC algorithm (t = 2.19, p = 0.031). Similarly, among the 27 patients with acute pancreatitis, the BV values obtained using the MS methods were higher than those obtained using the DC methods (t = 54.14, p < 0.001). Furthermore, the BF values were higher with the MS methods than the DC methods (t = 8.45, p < 0.001). Besides, Pearson linear correlation and Bland-Altman analysis showed that the BF and BV values showed a good correlation and a bad consistency between the two algorithms. CONCLUSIONS: The BF and BV values measured using MS and DC algorithms had a good correlation but were not consistent.

SPARC promotes pancreatic cancer cell proliferation and migration through autocrine secretion into the extracellular milieu.

SPARC is a secreted glycoprotein that plays a complex and multifaceted role in tumour formation and progression. However, whether SPARC is an oncogene or a tumour suppressor is still unclear. Moreover, SPARC demonstrates potential in clinical pancreatic adenocarcinoma (PAAD) treatment, although it has been identified as an oncogene in some studies and a tumor suppressor in others. In the present study, a pan-cancer analysis of SPARC was carried out using The Cancer genome Atlas data, which demonstrated that SPARC was an oncogene in most cancer types and a cancer suppressor in others. In addition, SPARC expression was significantly upregulated in PAAD and associated with poor prognosis. SPARC also promoted the proliferation and migration of PANC-1 and SW1990 cell lines in vitro. SPARC was detected in the culture supernatant of PAAD cells and pancreatic acinar AR42J cells. SPARC regulated PAAD cell proliferation only when secreted into the extracellular milieu, thus explaining why the prognosis of patients with PAAD is correlated with the SPARC expression of both tumour cells and stromal cells. Collectively, the present findings demonstrated that the function of SPARC was associated with tumour type and that SPARC may represent an important oncogene in PAAD that merits further study.

Association and Interaction Between Serum Interleukin-6 Levels and Metabolic Dysfunction-Associated Fatty Liver Disease in Patients With Severe Coronavirus Disease 2019.

Background and Aim: Circulating levels of interleukin (IL)-6, a well-known inflammatory cytokine, are often elevated in coronavirus disease-2019 (COVID-19). Elevated IL-6 levels are also observed in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Our study aimed to describe the association between circulating IL-6 levels and MAFLD at hospital admission with risk of severe COVID-19. Methods: A total of 167 patients with laboratory-confirmed COVID-19 from three Chinese hospitals were enrolled. Circulating levels of IL-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ were measured at admission. All patients were screened for fatty liver by computed tomography. Forty-six patients were diagnosed as MAFLD. Results: Patients with MAFLD (n = 46) had higher serum IL-6 levels (median 7.1 [interquartile range, 4.3-20.0] vs. 4.8 [2.6-11.6] pg/mL, p = 0.030) compared to their counterparts without MAFLD (n = 121). After adjustment for age and sex, patients with MAFLD had a ~2.6-fold higher risk of having severe COVID-19 than those without MAFLD. After adjustment for age, sex and metabolic co-morbidities, increased serum IL-6 levels remained associated with higher risk of severe COVID-19, especially among infected patients with MAFLD (adjusted-odds ratio 1.14, 95% CI 1.05-1.23; p = 0.002). There was a significant interaction effect between serum IL-6 levels and MAFLD for risk of severe COVID-19 (p for interaction = 0.008). Conclusions: Patients with MAFLD and elevated serum IL-6 levels at admission are at higher risk for severe illness from COVID-19.

The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis.

BACKGROUND: Hypertriglyceridemia has arisen as the third leading cause of acute pancreatitis. This study aimed at exploring the association between the severity of hypertriglyceridemia-induced pancreatitis (HTGP) and computed tomography (CT)-based body composition parameters and laboratory markers. METHODS: Laboratory and clinical parameters were collected from 242 patients with HTGP between 2017 and 2020. Severity of HTGP was evaluated by original or modified CT severity index. Body composition parameters such as area and radiodensity of muscle, subcutaneous adipose tissue and visceral adipose tissue were calculated by CT at the level of third lumbar vertebra. Parameters were compared between mild and moderately severe to severe HTGP. Uni-variate and multi-variate Logistic regression analyses were employed to assess the risk factors of the severity of HTGP. RESULTS: Seventy patients (28.9%) presented with mild HTGP. Body mass index, waist circumference and all CT-based body composition parameters differed between male and female patients. None was associated with the severity of HTGP, neither in males nor in females. Receiver operating characteristic curves showed that areas under the curves of apolipoprotein A-I and albumin to predict the severity of HTGP were 0.786 and 0.759, respectively (all P < 0.001). Uni-variate and further multi-variate Logistic regression analysis confirmed that low serum albumin (< 35 g/L, P = 0.004, OR = 3.362, 95%CI = 1.492-8.823) and apolipoprotein A-I (< 1.1 g/L, P < 0.001, OR = 5.126, 95%CI = 2.348-11.195), as well as high C-reactive protein (> 90 mg/L, P = 0.005, OR = 3.061, 95%CI = 1.407-6.659) and lipase (P = 0.033, OR = 2.283, 95%CI = 1.070-4.873) were risk factors of moderately severe to severe HTGP. Levels of albumin, apolipoprotein A-I, C-reactive protein and lipase were also associated with the length of hospital stay (all P < 0.05). Besides, low serum albumin, low-density lipoprotein cholesterol and high radiodensity of subcutaneous adipose tissue were significant risk factors of pancreatic necrosis in patients with HTGP (all P < 0.05). CONCLUSIONS: Low serum albumin and apolipoprotein A-I, and high C-reactive protein and lipase upon admission were associated with a more severe type of HTGP and longer hospital stay for these patients. Albumin and apolipoprotein A-I may serve as novel biomarkers for the severity of HTGP. However, none of the body composition parameters was associated with the severity of HTGP.

Metabolic associated fatty liver disease increases coronavirus disease 2019 disease severity in nondiabetic patients.

BACKGROUND AND AIM: Coronavirus disease 2019 (COVID-19) has attracted increasing worldwide attention. While diabetes is known to aggravate COVID-19 severity, it is not known whether nondiabetic patients with metabolic dysfunction are also more prone to more severe disease. The association of metabolic associated fatty liver disease (MAFLD) with COVID-19 severity in nondiabetic patients was investigated here. METHODS: The study cohort comprised 65 patients with (i.e. cases) and 65 patients without MAFLD (i.e. controls). Each case was randomly matched with one control by sex (1:1) and age (±5 years). The association between the presence of MAFLD (as exposure) and COVID-19 severity (as the outcome) was assessed by binary logistic regression analysis. RESULTS: In nondiabetic patients with COVID-19, the presence of MAFLD was associated with a four-fold increased risk of severe COVID-19; the risk increased with increasing numbers of metabolic risk factors. The association with COVID-19 severity persisted after adjusting for age, sex, and coexisting morbid conditions. CONCLUSION: Health-care professionals caring for nondiabetic patients with COVID-19 should be cognizant of the increased likelihood of severe COVID-19 in patients with MAFLD.

Radiomics-based model for accurately distinguishing between severe acute respiratory syndrome associated coronavirus 2 (SARS-CoV-2) and influenza A infected pneumonia.

Clinicians have been faced with the challenge of differentiating between severe acute respiratory syndrome associated coronavirus 2 (SARS-CoV-2) infected pneumonia (NCP) and influenza A infected pneumonia (IAP), a seasonal disease that coincided with the outbreak. We aim to develop a machine-learning algorithm based on radiomics to distinguish NCP from IAP by texture analysis based on computed tomography (CT) imaging. Forty-one NCP and 37 IAP patients admitted from January to February 6, 2019 admitted to two hospitals in Wenzhou, China. All patients had undergone chest CT examination and blood routine tests prior to receiving medical treatment. NCP was diagnosed by real-time RT-PCR assays. Eight of 56 radiomic features extracted by LIFEx were selected by least absolute shrinkage and selection operator regression to develop a radiomics score and subsequently constructed into a nomogram to predict NCP with area under the operating characteristics curve of 0.87 (95% confidence interval: 0.77-0.93). The nomogram also showed excellent calibration with Hosmer-Lemeshow test yielding a nonsignificant statistic (P = .904). The novel nomogram may efficiently distinguish between NCP and IAP patients. The nomogram may be incorporated to existing diagnostic algorithm to effectively stratify suspected patients for SARS-CoV-2 pneumonia.

Metabolic-associated fatty liver disease is associated with severity of COVID-19.

The Corona Virus Disease 2019 (COVID-19) pandemic has attracted increasing worldwide attention. While metabolic-associated fatty liver disease (MAFLD) affects a quarter of world population, its impact on COVID-19 severity has not been characterized. We identified 55 MAFLD patients with COVID-19, who were 1:1 matched by age, sex and obesity status to non-aged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients without MAFLD. Our results demonstrate that in patients aged less than 60 years with COVID-19, MAFLD is associated with an approximately fourfold increase (adjusted odds ratio 4.07, 95% confidence interval 1.20-13.79, P = .02) in the probability for severe disease, after adjusting for confounders. Healthcare professionals caring for patients with COVID-19 need to be aware that there is a positive association between MAFLD and severe illness with COVID-19.

Molecular Mechanism Exploration of Pancreatitis Based on miRNA Expression Profile.

BACKGROUND: Pancreatitis is a popular disease around the world, and can also lead to pancreatic cancer. Pancreatitis can be distinguished into two types, acute pancreatitis (AP) and chronic pancreatitis (CP). Every year, AP leads to approximately 275,000 new cases and is the most frequent gastrointestinal disease in American. METHODS: The miRNA expression profile of pancreatic cancer and pancreatitis was downloaded from GEO with accession id GSE24279. First, the differentially expressed miRNAs with |fold change| ≥ 2 and p-value ≤ 0.05 and then the target genes of significantly differentially expressed miRNAs in pancreatitis were identified and the interaction network was constructed. Also the biological functions of the target genes were explored based on GO and KEGG enrichment. Finally, the expression values of hsa-miR-373-5p and hsa-miR-374a-5p were validated using RT-PCR. RESULTS: A total of 40 and 13 differentially expressed miRNAs were screened out for pancreatic and pancreatitis, respectively. Two miRNAs, hsa-miR-373-5p and hsa-miR-374a-5p, had significantly down-regulated expression in pancreatitis. Target gene analysis showed that hsa-miR-373-5p probably participates in the development of pancreatitis by regulating MBL2, MAT2B, and BCL10. In addition, has-miR-374a-5p can regulate the expression of NCK1, MMP14. Those genes are involved in nuclear factor kappa B and p38 signaling in the early stage of pancreatitis. Also, NCK1 can regulate pancreatic ß-cell proinsulin content and participate in the progression of pancreatic cancer development. CONCLUSIONS: In summary, the findings in this study deciphered the potential miRNA regulation mechanism in pancreatitis, and identified valuable biomarkers for the diagnosis of pancreatitis.

Reduced artifacts and improved diagnostic value of 640-slice computed tomography in patients with cardiac pacemakers.

OBJECTIVE: The aim of this study was to compare the feasibility of 640-slice with 64-slice computed tomography (CT) coronary angiography for diagnosing coronary lesions in patients with pacemakers. METHODS: Forty-five and 50 patients with pacemakers and with suspected or known coronary artery disease underwent 64-slice (64 group) and 640-slice (640 group) CT scans, respectively. All segments of the vessels were evaluated according to the 15-segment model recommended by the American Heart Association. RESULTS: The incidence of moderate or severe artifacts was significantly lower (7.27% vs. 32.17%) and the diagnosable rate for coronary lesions was higher (98.91% vs. 94.19%) in the 640 compared with the 64 group. In the 64 group, the incidence of artifacts in patients with a heart rate >65 bpm (20.98%) was higher than in those with a heart rate <65 bpm (15.67%), although the difference was not significant, while the incidence of artifacts was significantly higher in patients with heart arrhythmia (21.40%) compared with in those with normal heart rhythm (15.09%). CONCLUSIONS: Among patients with pacemakers and a higher heart rate or heart arrhythmia, 640-slice CT may be more effective than 64-slice CT for diagnosing coronary lesions, by reducing moderate and severe artifacts.