Development of a combined radiomics and CT feature-based model for differentiating malignant from benign subcentimeter solid pulmonary nodules.

BACKGROUND: We aimed to develop a combined model based on radiomics and computed tomography (CT) imaging features for use in differential diagnosis of benign and malignant subcentimeter (≤ 10 mm) solid pulmonary nodules (SSPNs). METHODS: A total of 324 patients with SSPNs were analyzed retrospectively between May 2016 and June 2022. Malignant nodules (n = 158) were confirmed by pathology, and benign nodules (n = 166) were confirmed by follow-up or pathology. SSPNs were divided into training (n = 226) and testing (n = 98) cohorts. A total of 2107 radiomics features were extracted from contrast-enhanced CT. The clinical and CT characteristics retained after univariate and multivariable logistic regression analyses were used to develop the clinical model. The combined model was established by associating radiomics features with CT imaging features using logistic regression. The performance of each model was evaluated using the area under the receiver-operating characteristic curve (AUC). RESULTS: Six CT imaging features were independent predictors of SSPNs, and four radiomics features were selected after a dimensionality reduction. The combined model constructed by the logistic regression method had the best performance in differentiating malignant from benign SSPNs, with an AUC of 0.942 (95% confidence interval 0.918-0.966) in the training group and an AUC of 0.930 (0.902-0.957) in the testing group. The decision curve analysis showed that the combined model had clinical application value. CONCLUSIONS: The combined model incorporating radiomics and CT imaging features had excellent discriminative ability and can potentially aid radiologists in diagnosing malignant from benign SSPNs. RELEVANCE STATEMENT: The model combined radiomics features and clinical features achieved good efficiency in predicting malignant from benign SSPNs, having the potential to assist in early diagnosis of lung cancer and improving follow-up strategies in clinical work. KEY POINTS: • We developed a pulmonary nodule diagnostic model including radiomics and CT features. • The model yielded the best performance in differentiating malignant from benign nodules. • The combined model had clinical application value and excellent discriminative ability. • The model can assist radiologists in diagnosing malignant from benign pulmonary nodules.

Diagnostic performance of a deep learning-based method in differentiating malignant from benign subcentimeter (≤10 mm) solid pulmonary nodules.

Background: This study assessed the diagnostic performance of a deep learning (DL)-based model for differentiating malignant subcentimeter (≤10 mm) solid pulmonary nodules (SSPNs) from benign ones in computed tomography (CT) images compared against radiologists with 10 and 15 years of experience in thoracic imaging (medium-senior seniority). Methods: Overall, 200 SSPNs (100 benign and 100 malignant) were retrospectively collected. Malignancy was confirmed by pathology, and benignity was confirmed by follow-up or pathology. CT images were fed into the DL model to obtain the probability of malignancy (range, 0-100%) for each nodule. According to the diagnostic results, enrolled nodules were classified into benign, malignant, or indeterminate. The accuracy and diagnostic composition of the model were compared with those of the radiologists using the McNemar-Bowker test. Enrolled nodules were divided into 3-6-, 6-8-, and 8-10-mm subgroups. For each subgroup, the diagnostic results of the model were compared with those of the radiologists. Results: The accuracy of the DL model, in differentiating malignant and benign SSPNs, was significantly higher than that of the radiologists (71.5% vs. 38.5%, P<0.001). The DL model reported more benign or malignant deterministic results and fewer indeterminate results. In subgroup analysis of nodule size, the DL model also yielded higher performance in comparison with that of the radiologists, providing fewer indeterminate results. The accuracy of the two methods in the 3-6-, 6-8-, and 8-10-mm subgroups was 75.5% vs. 28.3% (P<0.001), 62.0% vs. 28.2% (P<0.001), and 77.6% vs. 55.3% (P=0.001), respectively, and the indeterminate results were 3.8% vs. 66.0%, 8.5% vs. 66.2%, and 2.6% vs. 35.5% (all P<0.001), respectively. Conclusions: The DL-based method yielded higher performance in comparison with that of the radiologists in differentiating malignant and benign SSPNs. This DL model may reduce uncertainty in diagnosis and improve diagnostic accuracy, especially for SSPNs smaller than 8 mm.

Longitudinal assessment of cardiac parameters through MRI in breast cancer patients treated with anti-HER2 therapy.

BACKGROUND: We evaluated the early changes in left ventricular (LV) volumetric, functional, and tissue characteristics in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients treated with trastuzumab and/or pertuzumab at cardiac magnetic resonance imaging (MRI). METHODS: HER2-positive breast cancer patients undergoing planned anti-HER2 therapy and nonanthracycline-based chemotherapy were enrolled and subdivided into dual anti-HER2 (trastuzumab plus pertuzumab) group and trastuzumab group. Cardiac MRI was performed before treatment and three months after starting, covering ventricular volumes, cardiac function, systolic myocardial strain, myocardial oedema, and T1 and T2 relaxation times. Cardiac dysfunction was primarily defined as a > 10% reduction in LV ejection fraction (LVEF) to < 55% and/or a > 15% global longitudinal strain (GLS) change at the follow-up MRI examination. RESULTS: Twenty-four HER2-positive patients were evaluated (16 in the dual anti-HER2 group, 8 in the trastuzumab group). Six patients developed cardiac dysfunction at follow-up, five of them in the dual anti-HER2 group. One patient developed symptomatic heart failure, and five patients developed asymptomatic cardiac dysfunction. Patients displayed significantly decreased systolic function and increased T1 and T2 relaxation time at follow-up (p ≤ 0.031). Systolic dysfunction remained significant in the dual anti-HER2 group. The decrease in GLS in the trastuzumab group was not significant (p = 0.169). T1 and T2 relaxation times tended to increase, but this was not significant at subgroup analysis. CONCLUSIONS: Cardiac MRI scans showed frequent signs of subclinical cardiotoxicity after short-term anti-HER2 therapy and nonanthracycline-based chemotherapy; the effect was slightly stronger in patients treated with dual therapy. KEY POINTS: • A frequent subclinical cardiotoxicity was detected by cardiac magnetic resonance imaging after short-term anti-human epidermal growth factor receptor 2 (HER2) therapy. • The change in myocardial strain was more marked in patients treated with dual (trastuzumab plus pertuzumab) than with trastuzumab only anti-HER2 therapy. • Cardiotoxicity surveillance through MRI is an interesting option particularly in patients treated with dual anti-HER2 therapy.

Research on the Effect of Digital Economy on Carbon Emissions under the Background of "Double Carbon".

(1) Background: In light of the global economy's digitalization and the "double carbon" target constraint, the digital economy is essential to fostering scientific and technological innovation, green growth, and lowering energy emissions. (2) Methods: This paper measures the digital economic index and carbon emission intensity and analyzes their characteristics in spatial and temporal dimensions using 282 Chinese urban panel data by improving various statistical methods of panel data, such as the entropy method, fixed effect model, multi-period DID model, moderating effect model and intermediary effect model. This paper examines the extent and mechanism of the digital economy's impact on urban carbon emissions. (3) Results: During the sample period, the overall trend of the digital economy in China was one of constant growth, showing an unbalanced distribution pattern of "high in the eastern regions, lower in the central regions and lowest in the western regions" in the spatial dimension. Carbon emissions can be significantly decreased by the digital economy, which has a dynamic effect and an inverted U-shaped trend in its influence. The digital economy plays a significant role in reducing carbon emissions through the rational layout of industrial structures. The transmission mechanisms for the digital economy's goal of reducing carbon emissions include environmental regulation and green technology innovation. (4) Conclusion: The research findings provide a reference for multiple decision makers to better formulate carbon emission policies and realize carbon emission decrease in the digital economy.

Research on Theoretical Mechanism and Promotion Path of Digital Economy Driving China's Green Development under "Double Carbon" Background.

(1) Background: Under the background of building a new pattern of "double cycle" development, the green meaning of the digital economy is highly valued. The innovative feature of the digital economy is forming a new economic growth pole, and gradually becomes the driving force for China's economic restructuring and green development; (2) methods: this paper empirically tests whether the digital economy can promote green development by using various econometric models based on panel dataset with 30 provinces from 2011 to 2019 in mainland China and measuring the development level of the digital economy and the greening index; (3) results: it is found that the digital economy can directly boost green development in greening degree of economic growth, resources and environment-carrying potential, and government policy support. The digital economy's influence on green development has an inverted U-shaped trend; environmental control is an effective regulatory variable with a substitution effect on green development. With an obvious regional heterogeneity, the digital economy promotes green development; the digital economy can greatly affect green growth through technical innovation through mechanism analysis. The robustness test supports the above conclusion; (4) conclusions: the findings provide a foundation for multi-party policymakers to effectively formulate and implement policies for the digital economy that encourage green growth.

In Situ Observation of Ferroelastic Domain and Phase Transition in a Three-Dimensional Molecular Crystal.

Massive efforts have been devoted to designing molecular ferroic materials by molecular modification. For molecular ferroelastic, previous work is focused on the temperature-dependent ferroelastic domains, however, few are related to controlling the ferroelastic domain by the stress. Inspired by the "quasi-spherical theory" and fluorination effect, we designed a more flexible (MedabcoF)2+ (MedabcoF=1-fluoro-4-methyl-1,4-diazoniabicyclo[2.2.2]octane) cation by introducing a methyl group and a fluorine atom at the two symmetrical ends of the Dabco (1,4-diazoniabicyclo[2.2.2]octane) and synthesized a hybrid 3D perovskite (MedabcoF)Rb(BF4 )3 (1) which displays three reversible phase transitions accompanying dual ferroelastic behavior. Besides, it not only exhibits ferroelastic domains switching by the thermal stimulation, and the sensitive reaction of in situ domains under the stress of it is also realized. This work not only achieves a force-controlled ferroelastic domain but develops a more profound comprehension of the relationship between the thermal motion behavior of guest cations and the intriguing properties of materials.

In-Hospital Postoperative Atrial Fibrillation Indicates a Poorer Clinical Outcome after Myectomy for Obstructive Hypertrophic Cardiomyopathy.

OBJECTIVES: This study aims to investigate the risk factors of in-hospital postoperative atrial fibrillation (POAF) and the impact of POAF on the clinical outcome in hypertrophic cardiomyopathy (HCM) patients who underwent myectomy. METHODS: Data from a total of 494 obstructive HCM patients, who had undergone preoperative cardiac magnetic resonance (CMR) testing and who underwent myectomy at Fuwai Hospital from June 2011 to June 2016, were collected. RESULTS: Multivariate logistic regression analysis showed that old age (odds ratio [OR], 4.326; 95% confidence interval [CI], 2.248-8.325; p <0.001), maximal left atrium volume (LAV) (OR, 1.137; 95% CI, 1.075-1.202; p <0.001), and hypertension (OR, 2.754; 95% CI, 1.262-6.007; p = 0.011) were associated with the incidence of POAF. In the patients without preoperative AF, Cox regression analysis demonstrated that POAF (p = 0.002), decreased left atrium (LA) ejection fraction (LAEF) (p = 0.036), concomitant procedure (p = 0.039), and postoperative residual moderate or severe mitral valve regurgitation (p = 0.030) were independent predictors of composite cardiovascular events. CONCLUSIONS: POAF indicated a poorer clinical outcome after myectomy for obstructive HCM patients, which was similar to those with preoperative AF. Elevated LAV was independently related to POAF onset in HCM patients who underwent myectomy.

Retrospective Electrocardiography-Gated Real-Time Cardiac Cine MRI at 3T: Comparison with Conventional Segmented Cine MRI.

Objective: Segmented cardiac cine magnetic resonance imaging (MRI) is the gold standard for cardiac ventricular volumetric assessment. In patients with difficulty in breath-holding or arrhythmia, this technique may generate images with inadequate quality for diagnosis. Real-time cardiac cine MRI has been developed to address this limitation. We aimed to assess the performance of retrospective electrocardiography-gated real-time cine MRI at 3T for left ventricular (LV) volume and mass measurement. Materials and Methods: Fifty-one patients were consecutively enrolled. A series of short-axis cine images covering the entire left ventricle using both segmented and real-time balanced steady-state free precession cardiac cine MRI were obtained. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and LV mass were measured. The agreement and correlation of the parameters were assessed. Additionally, image quality was evaluated using European CMR Registry (Euro-CMR) score and structure visibility rating. Results: In patients without difficulty in breath-holding or arrhythmia, no significant difference was found in Euro-CMR score between the two techniques (0.3 ± 0.7 vs. 0.3 ± 0.5, p > 0.05). Good agreements and correlations were found between the techniques for measuring EDV, ESV, EF, SV, and LV mass. In patients with difficulty in breath-holding or arrhythmia, segmented cine MRI had a significant higher Euro-CMR score (2.3 ± 1.2 vs. 0.4 ± 0.5, p < 0.001). Conclusion: Real-time cine MRI at 3T allowed the assessment of LV volume with high accuracy and showed a significantly better image quality compared to that of segmented cine MRI in patients with difficulty in breath-holding and arrhythmia.

Diagnostic accuracy of single-source dual-energy computed tomography and ultrasonography for detection of lateral cervical lymph node metastases of papillary thyroid carcinoma.

BACKGROUND: Dual-energy computed tomography (DECT) imaging can generate iodine-based material decomposition (MD) images and spectral HU curve. This study aimed to investigate the diagnostic accuracy of single-source dual-energy CT (DECT) and ultrasonography (US) for detecting lateral cervical lymph node metastases of papillary thyroid carcinoma (PTC). METHODS: Thirty patients with PTC were enrolled in the study and underwent DECT and US examination before thyroidectomy and cervical lymph node dissection. The spectral parameters included iodine concentration (IC), normalized iodine concentration (NIC) and slope (λHU) of lymph nodes. The CT morphological parameters included maximal short diameter, shape, margin, calcification and cystic degeneration of lymph nodes. The US morphological parameters included maximal short diameter, calcification and cystic degeneration of lymph nodes. The diagnostic value of every single spectral parameter, combined gemstone spectral image (GSI) parameters, CT morphological parameters and US morphological parameters between metastatic and non-metastatic lymph nodes were statistically compared. Receiver operating characteristic (ROC) curves, sensitivity, and specificity were used to determine the diagnostic value. RESULTS: Ninety-nine lymph nodes from thirty patients were pathologically confirmed. Among them, 70 (70.7%) were metastatic. For single GSI parameters, ROC analysis showed that the area under the curve (AUC) for IC was the highest (AUC =0.937) but the difference was not statistically significant when compared with NIC or slope (λHU) (P>0.05). The optimal diagnostic threshold for IC was 2.56 mg/mL, with a sensitivity, specificity and accuracy of 87.1%, 93.1%, and 88.9%, respectively. The AUC for combined GSI parameter (AUC =0.942) was higher compared with the US morphological parameters (AUC =0.771, P<0.001), with a sensitivity, specificity, and accuracy of 92.9%, 86.2%, and 90.9%, respectively. However AUC did not differ significantly among combined GSI parameters, combined CT morphological parameters and a single application for spectral CT parameters IC (P>0.05). CONCLUSIONS: Combined GSI parameters showed better diagnostic accuracy in lateral cervical lymph node metastasis of PTC compared with that of combined US morphological parameters. IC alone showed excellent diagnostic stability and could be performed easily.

LGE-CMR-derived texture features reflect poor prognosis in hypertrophic cardiomyopathy patients with systolic dysfunction: preliminary results.

OBJECTIVES: To evaluate the prognostic value of texture features based on late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) images in hypertrophic cardiomyopathy (HCM) patients with systolic dysfunction. METHODS: 67 HCM patients with systolic dysfunction (41 male and 26 female, mean age ± standard deviation, 46.20 years ± 13.38) were enrolled. All patients underwent 1.5 T CMR cine and LGE imaging. Texture features were extracted from LGE images. Cox proportional hazard analysis and Kaplan-Meier analysis were used to determine the association of texture features and traditional parameters with event free survival. RESULTS: Family history (hazard ratio [HR]=2.558, 95 % confidence interval [CI]=1.060-6.180), NYHA III-IV (HR=5.627, CI=1.652-19.173), left ventricular ejection fraction (HR=0.945, CI=0.902-0.991), left ventricular end-diastolic volume index (HR=1.006, CI=1.000-1.012), LGE extent (HR=1.911, CI=1.348-2.709) and three texture parameters [X0_H_skewness (HR=0.783, CI=0.691-0.889), X0_GLCM_cluster_tendency (HR=0.735, CI=0.616-0.877) and X0_GLRLM_energy (HR=1.344, CI=1.173-1.540)] were significantly associated with event free survival in univariate analysis (p<0.05). The HR of LGE extent (HR=1.548 [CI=1.046-2.293], 1.650 [CI=1.122-2.428] and 1.586 [CI=1.044-2.409] per 10 % increase, p<0.05) remained significant when adjusted by one of the three texture features. CONCLUSION: Increased LGE heterogeneity (higher X0_GLRLM_energy, lower X0_H_skewness and lower X0_GLCM_cluster_tendency) was associated with adverse events in HCM patients with systolic dysfunction. KEY POINTS: • Textural analysis from CMR can be applied in HCM. • Texture features derived from LGE images can capture fibrosis heterogeneity. • CMR texture analysis provides prognostic information in HCM patients.

CMR assessment and clinical outcomes of hypertrophic cardiomyopathy with or without ventricular remodeling in the end-stage phase.

End-stage phase of hypertrophic cardiomyopathy (ES-HCM) is a recognized part of HCM disease spectrum. Information on cardiac magnetic resonance (CMR) studies for ES-HCM especially for those without ventricular remodeling has been limited. We aimed to evaluate the morpho-functional and tissue features of ES-HCM with or without ventricular remodeling and to explore CMR prognostic value in these patients. We analysed CMR scans of sixty-three ES-HCM patients and divided them into those with ventricular dilatation (D-ES, n = 41) and those with normal ventricular size (N-ES, n = 22). Cox proportional hazards models were used to assess the association between CMR parameters and outcomes. Patients in D-ES showed hypokinetic-dilated HCM phenotype, while patients in N-ES showed hypokinetic-restrictive HCM phenotype. LGE extent was significantly larger in D-ES (34.7% ± 15.4% vs. 22.8% ± 7.7%; P < 0.01). Atrial fibrillation and edema of lower extremity were more common in N-ES (72.7 vs. 29.3% and 54.5 vs. 24.4%, respectively; P < 0.05). Log-rank test found no significant difference between 2 groups in combined end point of cardiovascular events (χ2 = 0.66, P = 0.418). In multivariate analysis, LGE (HR 1.57-1.83 per 10% LGE increase, P < 0.01) and indexed left atrial volume (LAVI) (HR 1.14-1.21 per 20 mL/m2 increase, P < 0.05) remained independently associated with combined end point when adjusted by other risk factors. The CMR features of HCM in end-stage span between two extremes. LGE is more extensive in those with ventricular remodeling and LAVI is larger in those with normal ventricular size. Both LGE and LAVI are significant predictors of poor outcomes.

Cystoid angiocentric glioma: A case report and literature review.

Angiocentric glioma is a rare subtype of neuroepithelial tumor that is associated with a history of epilepsy. We report a case of cystoid angiocentric glioma associated with an area of calcification. This 25 year old male patient presented with tonic clonic spasm. He underwent craniotomy with complete resection of the lesion. Pathologic specimen showed monomorphous bipolar cells with angiocentric growth pattern.

Correlation of fractional anisotropy and metabolite concentrations measured using 1H-MRS of cerebral white matter in healthy adults.

Fractional anisotropy (FA) is currently an ideal index capable of reflecting the white matter structure. 1H magnetic resonance spectroscopy (1H-MRS) is often used as a noninvasive concentration measurement of important neurochemicals in vivo. This study was conducted to investigate the relationship between FA and metabolite concentrations by comparing 1H-MRS of bilateral medium corona radiata in healthy adults. The data of diffusion tensor imaging (DTI) and 1H-MRS were acquired from 31 healthy adults using a 3.0 T MR system. All subjects were divided into three groups: the total group (mean age=42 years), the junior group (mean age=29 years) and the senior group (mean age=56 years). There was a negative correlation between FA and age in three groups (r=-0.146, r=-0.204, r=-0.162, p<0.05). The positive correlation of FA with corresponding concentrations of N-acetylaspartate (NAA) was significant in three groups (r=0.339, r=0.213, r=0.430, respectively, p<0.05). The positive correlation of FA with the corresponding NAA/Cr was only significant difference between the total 353 samples and the junior group (r=0.166, r=0.305, respectively, p<0.05). Combining 1H-MRS with DTI reveals the relationship between structure and metabolic characteristics of white matter.