Correlation of CT parameters and PD-L1 expression status in gastric cancer.

OBJECTIVE: We aimed to explore the correlation between routine computed tomography (CT) imaging features and programmed cell death ligand-1(PD-L1) expression status in gastric cancer and evaluate the predictive value of imaging parameters for this immunotherapy biomarker. MATERIALS AND METHODS: Patients with gastric adenocarcinoma who underwent abdominal CT three-stage enhanced scan and PD-L1 immunohistochemical testing before treatment were retrospectively examined. All diagnoses were confirmed through pathology. According to the expression status of PD-L1, they were divided into the positive (CPS ≥ 5) or negative group (CPS < 5). Baseline CT imaging features were collected. Diagnostic performances of the different variables were evaluated using receiver operating characteristic (ROC) curve. RESULTS: In total, 67 patients (17 women and 50 men; mean age: 59.55 ± 10.22 years) with gastric adenocarcinoma were included in the study. The overall stages, probability of maximum lymph node short diameter > 1 cm and peak of lesion enhancement occurring in the arterial phase were statistically significant between the two groups (p < 0.05). Moreover, the arterial enhancement fraction (AEF) was significantly higher in the positive group than that in the negative group (p < 0.05), and ROC curve analysis showed that the AEF exhibited a high evaluation efficacy (area under the curve [AUC] = 0.724 [95% confidence interval (CI): 0.602-0.826]). The combined parameters had the best diagnostic efficacy (AUC = 0.825 [95%CI: 0.716-0.933]), sensitivity (75.00%), and specificity (81.40%). CONCLUSIONS: These findings confirm a correlation between CT imaging features and PD-L1 expression status in gastric cancer, and AEF may help evaluate high PD-L1 expression and select patients suitable for immunotherapy.

Nomogram combining pre-operative clinical characteristics and spectral CT parameters for predicting the WHO/ISUP pathological grading in clear cell renal cell carcinoma.

PURPOSE: To develop a novel clinical-spectral-computed tomography (CT) nomogram incorporating clinical characteristics and spectral CT parameters for the preoperative prediction of the WHO/ISUP pathological grade in clear cell renal cell carcinoma (ccRCC). METHODS: Seventy-three ccRCC patients who underwent spectral CT were included in this retrospective analysis from December 2020 to June 2023. The subjects were pathologically divided into low- and high-grade groups (WHO/ISUP 1/2, n = 52 and WHO/ISUP 3/4, n = 21, respectively). Information on clinical characteristics, conventional CT imaging features, and spectral CT parameters was collected. Multivariate logistic regression analyses were conducted to create a nomogram combing clinical data and image data for preoperatively predicting the pathological grade of ccRCC, and the area under the curve (AUC) was utilized to assess the predictive performance of the model. RESULTS: Multivariate logistic regression analyses revealed that age, systemic immune-inflammation index (SII), and the slope of the spectrum curve in the cortex phase (CP-K) were independent predictors for predicting high-grade ccRCC. The clinical-spectral-CT model exhibited high evaluation efficacy, with an AUC of 0.933 (95% confidence interval [CI]: 0.878-0.998; sensitivity: 0.810; specificity: 0.923). The calibration curve revealed that the predicted probability of the clinical-spectral-CT nomogram could better fit the actual probability, with high calibration. The Hosmer-Lemeshow test showed that the model had a good fitness (χ2 = 5.574, p = 0.695). CONCLUSION: The clinical-spectral-CT nomogram has the potential to predict WHO/ISUP grading of ccRCC preoperatively.

Differentiation of acute coronary syndrome with radiomics of pericoronary adipose tissue.

OBJECTIVE: To assess the potential values of radiomics signatures of pericoronary adipose tissue (PCAT) in identifying patients with acute coronary syndrome (ACS). METHODS: In total, 149, 227, and 244 patients were clinically diagnosed with ACS, chronic coronary syndrome (CCS), and without coronary artery disease (CAD), respectively, and were retrospectively analysed and randomly divided into training and testing cohorts at a 2:1 ratio. From the PCATs of the proximal left anterior descending branch, left circumflex branch, and right coronary artery (RCA), the pericoronary fat attenuation index (FAI) value and radiomics signatures were calculated, among which features closely related to ACS were screened out. The ACS differentiation models AC1, AC2, AC3, AN1, AN2, and AN3 were constructed based on the FAI value of RCA and the final screened out first-order and texture features, respectively. RESULTS: The FAI values were all higher in patients with ACS than in those with CCS and no CAD (all P < .05). For the identification of ACS and CCS, the area-under-the-curve (AUC) values of AC1, AC2, and AC3 were 0.92, 0.94, and 0.91 and 0.91, 0.86, and 0.88 in the training and testing cohorts, respectively. For the identification of ACS and no CAD, the AUC values of AN1, AN2, and AN3 were 0.95, 0.94, and 0.94 and 0.93, 0.87, and 0.89 in the training and testing cohorts, respectively. CONCLUSIONS: Identification models constructed based on the radiomics signatures of PCAT are expected to be an effective tool for identifying patients with ACS. ADVANCES IN KNOWLEDGE: The radiomics signatures of PCAT and FAI values are expected to differentiate between patients with ACS, CCS and those without CAD on imaging.

The relationship between different exercise conditions and pericoronary inflammation as quantified by coronary CTA in coronary artery disease.

Objectives: The correlation between exercise type and intensity and coronary artery inflammation in patients with stable coronary artery disease (CAD) is unknown. Therefore, this study assessed the relationship between coronary inflammation quantified by coronary computed tomography angiography (CCTA) and exercise intensity and pattern in patients with CAD. Materials and methods: Patients who underwent CCTA between 2019 and 2023 in the second hospital of Lanzhou University were retrospectively examined. We calculated the pericoronary fat attenuation index (FAI) on the right coronary artery (RCA) as a marker of coronary inflammation. We compared basic information, exercise status, and RCA-FAI values between the two groups, and described the relationship between different exercise durations and RCA-FAI using analysis of variance and restricted cubic splines. Results: In total, 1222 patients were included: 774 had no CAD and 448 patients had CAD. Sex (P = 0.016; odds ratio [OR]: 0.673), high-density lipoprotein (P = 0.006; OR: 0.601), low-density lipoprotein (P = 0.001; OR. 0.762), hypertension (P = 0.000; OR: 0.762), smoking (P = 0.005; OR: 0.670), and postprandial glucose (P = 0.030; OR: 0.812), household income (P = 0.038; OR:1.117), and body mass index (P = 0.000; OR:1.084) were the risk factors for elevated RCA-FAI values in the patients with coronary artery disease group. And when the exercise modality was running and aerobics, the correlation between RCA-FAI values and exercise time showed a "U"-shaped relationship. Follow-up revealed that short periods of high-intensity exercise resulted in lower RCA-FAI values. Conclusion: RCA-FAI was significantly associated with coronary artery inflammation. Although appropriate physical activity reduced the risk of pericoronary inflammation and coronary atherosclerosis, overly prolonged exercise could exacerbate the coronary inflammatory response and increase the likelihood of CAD.

Association of mean pericoronary adipose tissue attenuation with different demographic factors in a subgroup of patients without coronary artery disease stratified by sex, body mass index, and age.

Background: In patients without coronary artery disease (CAD), few studies have evaluated the association between mean pericoronary adipose tissue attenuation (PCATMA) and patient-based demographic factors, for example, age or sex. Therefore, the purpose of this study is to investigate the association between PCATMA and various demographic factors in patients without CAD. Methods: In this case-control study, the 806 patients who underwent coronary computed tomography angiography and were not diagnosed with CAD between July 2020 and July 2022 were retrospectively enrolled. Their PCATMA values of the proximal right coronary artery were measured automatically. Patients without CAD were stratified according to sex, body mass index (BMI), and age, and the relationship between PCATMA and different clinical characteristics was explored using Fisher's exact test or Chi-squared test and independent t-tests or Wilcoxon Mann-Whitney U tests. Results: Compared to non-smoking women [-88.00 (-95.00, -81.00) HU], women who smoked [-84.00 (-94.00, -78.00) HU, P=0.037] had higher PCATMA values and a positive correlation with PCATMA (rs=0.101, P=0.036). Compared to non-hypertensive patients with BMI ≥24.91 kg/m2 [-87.00 (-95.00, -81.00) HU], hypertensive patients with BMI ≥24.91 kg/m2 [-84.00 (-92.00, -78.00) HU, P=0.004] had higher PCATMA values, and a positive correlation with PCATMA (rs=0.144, P=0.004). In a subgroup of patients without CAD stratified by sex, BMI, and age, PCATMA values were all higher in patients with dyslipidemia (women, men, BMI ≥24.91 kg/m2, BMI <24.91 kg/m2, age ≥55 years, and age <55 years: -82.00, -82.00, -81.50, -82.00, -81.00 and -83.50 HU, respectively) than in those without dyslipidemia (-89.00, -89.00, -89.00, -90.00, -90.00 and -88.00 HU, respectively; all P<0.001) and showed a positive relationship (rs=0.328, 0.339, 0.342, 0.326, 0.367, and 0.298, respectively; all P<0.001). Conclusions: Higher PCATMA attenuation values were observed in patients with dyslipidemia, smoking women, and hypertensive patients with BMI ≥24.91 kg/m2, suggesting that PCATMA values can be used to detect patients at high risk for future events with CAD even if they do not currently have atherosclerosis.

Is there an association between coronary artery inflammation and coronary atherosclerotic burden?

Background: As for the coronary artery inflammation and coronary atherosclerotic burden, which are used to assess the risk of adverse cardiac events in patients, it is unclear whether there is any certain correlation between them. Therefore, the purpose of this study was to explore the potential relationship between coronary artery inflammation and coronary atherosclerotic burden. Methods: A total of 346 eligible patients underwent assessment of computed tomography (CT) attenuation values of pericoronary adipose tissue (PCAT) in the right coronary artery and Agatston coronary artery calcium (CAC) based on coronary CT angiography. These measurements were utilized to evaluate coronary inflammation and atherosclerotic burden, respectively. Patients with a CAC score of 0 were categorized into groups based on the presence or absence of coronary artery disease (CAD). CAC scores of 10, 100, and 400 were chosen as cutoff values to compare differences in PCAT attenuation values across different CAC scores. Results: When comparing all CAD patients to non-CAD patients, a significantly higher PCAT attenuation was observed in CAD patients (-87.54±9.39 vs. -93.45±7.42 HU, P=0.000). The PCAT attenuation in CAD patients with a CAC score of 0 was significantly higher than that in patients with a CAC score greater than 0 and in non-CAD patients with a CAC score of 0 (-82.63±8.70 vs. -90.38±8.59 vs. -93.45±7.42 HU, P=0.000). The PCAT attenuation values did not exhibit significant differences among different CAC scores (all P>0.05); however, it was highest in CAD patients with a CAC score of 0 (P<0.05). Body mass index, hyperlipidemia, hypertension, and PCAT attenuation were identified as independent risk factors in both CAD patients with a CAC score of 0 and patients with a CAC score greater than 0 (all P<0.05). Conclusions: The results of this study suggest that a direct relationship between coronary inflammation and coronary atherosclerotic burden is not evident. Nonetheless, it is noteworthy that coronary inflammation was most pronounced in CAD patients with a CAC score of 0, while CAC score did not demonstrate an association with inflammation.

Development of a nomogram based on pericoronary adipose tissue histogram parameters to differentially diagnose acute coronary syndrome.

PURPOSE: To develop a nomogram based on pericoronary adipose tissue (PCAT) histogram parameters to identify patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: This study retrospectively enrolled 114 and 383 eligible patients with ACS and stable coronary artery disease (CAD), respectively, and divided them into training and testing cohorts in a 7:3 ratio. A blinded radiologist obtained PCAT histogram parameters from the right coronary artery's proximal segment using fully automated software and compared clinical characteristics and PCAT histogram parameters between the two patient groups. The binary logistic regression included significant parameters (P < 0.05), and a nomogram was constructed. RESULTS: In both the training and testing cohorts, the mean, 10th percentile, 90th percentile, median, and minimum values of PCAT were higher, and the interquartile range, skewness, and variance values of PCAT were lower in patients with ACS than in those with stable CAD (P ≤ 0.001). The mean (OR = 4.007), median (OR = 0.576), minimum (OR = 0.893), skewness (OR = 85,158.806) and variance (OR = 1.013) values of PCAT were independent risk factors for ACS and stable CAD in the training cohort. The nomogram was constructed using the five variables mentioned above with area under the curve values of 0.903 and 0.897, respectively, while the calibration and decision curves showed the nomogram's good clinical efficacy for the training and testing cohorts. CONCLUSIONS: The constructed nomogram had good discrimination and accuracy and can be a noninvasive tool to intuitively and individually distinguish between ACS and stable CAD.

Abdominal virtual non-contrast images derived from energy spectrum CT to evaluate chemotherapy-related fatty liver disease.

Background: Chemotherapy-related fatty liver disease (CRFLD) is an important evaluation in patients undergoing computed tomography (CT) for cancer follow-up. This study set out to explore the feasibility of using abdominal virtual non-contrast (VNC) images derived from energy spectrum CT to evaluate CRFLD and reduce the radiation dose. Methods: A total of 160 eligible consecutive patients who underwent energy spectrum CT at Lanzhou University Second Hospital between June 2020 and July 2021 were retrospectively enrolled. The average CT attenuation values of the liver and spleen and the liver-to-spleen ratio (LSR) were measured by two independent blinded radiologists on true non-contrast (TNC) images and three types of VNC image. The diagnostic performance of the LSR for CRFLD, image quality, and diagnostic confidence were compared between the two types of imaging. Results: The average CT attenuation values of the liver and spleen were significantly lower on VNC images than on TNC images (P<0.05), whereas the LSR showed good agreement between the two (P>0.05). The average CT attenuation values of the liver and the LSR measured on the TNC and three types of VNC image were significantly lower in patients with CRFLD than in those without CRFLD (P<0.001). The area under the curve (AUC) values of the LSR for the diagnosis of CRFLD calculated on TNC and three types of VNC image were 0.870 (95% CI: 0.808-0.918), 0.852 (95% CI: 0.787-0.903), 0.819 (95% CI: 0.750-0.875), and 0.851 (95% CI: 0.786-0.902), respectively. The DeLong test confirmed the consistency of TNC and VNC images of diagnostic efficacy (P>0.05). There were no significant differences in image quality or diagnostic confidence between the TNC and three types of VNC image (P>0.05). When VNC imaging was applied, the radiation dose was reduced by approximately 25.0%. Conclusions: VNC imaging could become a reliable alternative to TNC imaging for the clinical evaluation of patients with CRFLD and could reduce the radiation dose by up to 25%.

Pericoronary adipose tissue differences among plaque types: a retrospective assessment.

PURPOSE: To assess differences in pericoronary adipose tissue (PCAT) in patients with different plaque types by using several quantitative parameters of PCAT and investigate the relationship between PCAT and different plaque types. MATERIALS AND METHODS: We retrospectively recruited 488 patients diagnosed with stable coronary artery disease (CAD) via coronary computed tomographic angiography, including 279 with calcified plaques (CP), 153 with non-calcified plaques (NCP), and 56 with mixed plaques (MP). Volume, fat attenuation index (FAI), and 10th percentile, 90th percentile, median, and minimum Hounsfield unit (HU) values of PCAT surrounding plaques were quantified. Clinical features and quantitative PCAT parameters were compared between different plaque types. RESULTS: No intergroup differences were observed for age, sex, body mass index, risk factors, and plaque location. Length and PCAT volume in the NCP group were lower than those of the CP and MP groups (P < 0.001), whereas there were no significant differences between the CP and MP groups (P > 0.05). Patients with NCP and MP had a higher FAI and 10th percentile, 90th percentile, median, and minimum HU values of PCAT than CP (P < 0.001); however these values were not significantly different between the NCP and MP groups (P > 0.05). CONCLUSION: The quantitative parameters of PCAT, as a biosensor for CAD, vary among the different plaque types.

Radiomics: A review of current applications and possibilities in the assessment of tumor microenvironment.

With the recent success in the application of immunotherapy for treating various advanced cancers, the tumor microenvironment has rapidly become an important field of research. The tumor microenvironment is complex and its characteristics strongly influence disease biology and potentially responses to systemic therapy. Accurate preoperative assessment of tumor microenvironment is of great significance for the formulation of an immunotherapy strategy and evaluation of patient prognosis. As a research hotspot in medical image analysis technology, radiomics has been applied in the auxiliary diagnosis of the tumor microenvironment. This article reviews the current status of radiomics in the elective application on tumor microenvironment and discusses potential prospects.

Development and Validation of a Clinical-Based Signature to Predict the 90-Day Functional Outcome for Spontaneous Intracerebral Hemorrhage.

We aimed to develop and validate an objective and easy-to-use model for identifying patients with spontaneous intracerebral hemorrhage (ICH) who have a poor 90-day prognosis. This three-center retrospective study included a large cohort of 1,122 patients with ICH who presented within 6 h of symptom onset [training cohort, n = 835; internal validation cohort, n = 201; external validation cohort (center 2 and 3), n = 86]. We collected the patients' baseline clinical, radiological, and laboratory data as well as the 90-day functional outcomes. Independent risk factors for prognosis were identified through univariate analysis and multivariate logistic regression analysis. A nomogram was developed to visualize the model results while a calibration curve was used to verify whether the predictive performance was satisfactorily consistent with the ideal curve. Finally, we used decision curves to assess the clinical utility of the model. At 90 days, 714 (63.6%) patients had a poor prognosis. Factors associated with prognosis included age, midline shift, intraventricular hemorrhage (IVH), subarachnoid hemorrhage (SAH), hypodensities, ICH volume, perihematomal edema (PHE) volume, temperature, systolic blood pressure, Glasgow Coma Scale (GCS) score, white blood cell (WBC), neutrophil, and neutrophil-lymphocyte ratio (NLR) (p < 0.05). Moreover, age, ICH volume, and GCS were identified as independent risk factors for prognosis. For identifying patients with poor prognosis, the model showed an area under the receiver operating characteristic curve of 0.874, 0.822, and 0.868 in the training cohort, internal validation, and external validation cohorts, respectively. The calibration curve revealed that the nomogram showed satisfactory calibration in the training and validation cohorts. Decision curve analysis showed the clinical utility of the nomogram. Taken together, the nomogram developed in this study could facilitate the individualized outcome prediction in patients with ICH.

The Nonrecurrent Laryngeal Nerve Without Abnormal Subclavian Artery: Report of Two Cases and Review of the Literature.

As a variant of recurrent inferior laryngeal nerve (RILN), the nonrecurrent inferior laryngeal nerve (NRILN) is closely related to the occurrence of abnormal subclavian artery (ASA). The nonrecurrent inferior laryngeal nerve has been found in patients without arterial abnormalities, which is seen in the coexistence of NRILN and RILN, but it is easily confused with sympathetic-inferior laryngeal anastomosis branch (SILAB). We encountered 2 right NRILN patients without ASA during thyroid surgery. This article summarizes the characteristics of these cases and proposes methods to distinguish the coexistence of NRILN and RILN from SILAB. So far, 11 articles have reported 16 cases of NRILN without arterial abnormalities. In patients without artery abnormality, the vagus nerve could send out a descending branch NRILN at the bifurcation of the carotid artery and enter the larynx after anastomosis with RILN. Adequate dissection of the carotid sheath may avoid confusion with SILAB, and neural monitoring is also expected to provide a reference for the identification.

FTO - A Common Genetic Basis for Obesity and Cancer.

In recent years, the prevalence of obesity and cancer have been rising. Since this poses a serious threat to human health, the relationship between the two has attracted much attention. This study examined whether fat mass and obesity-associated (FTO) genes are linked, taking into account a Genome-wide Association Study (GWAS) that revealed multiple single nucleotide polymorphism sites (SNPs) of the FTO gene, indicating an association between obesity and cancer in different populations. FTO proteins have been proved to participate in adipogenesis and tumorigenesis with post-transcriptional regulation of downstream molecular expression or through the target of the mammalian target protein rapamycin (mTOR). FTO inhibitors have also been found to share anti-obesity and anti-cancer effects in vivo. In this review, we comprehensively discuss the correlation between obesity and cancer by measuring FTO gene polymorphism, as well as the molecular mechanism involved in these diseases, emphasizing FTO as the common genetic basis of obesity and cancer.

Assessment of miR-212 and Other Biomarkers in the Diagnosis and Treatment of HBV-infection-related Liver Diseases.

OBJECTIVES: Our study aims to detect the sensitivity of the new biomarker miR-212 existing in serum exosomes along with other hepatocellular carcinoma biomarkers such as AFP (alpha-fetoprotein), CA125 (carbohydrate antigen-ca125), and Hbx protein in the diagnosis of HBV-related liver diseases. We also aim to study the roles of these biomarkers in the progression of chronic hepatitis B and provide scientific data to show the clinical value of these biomarkers. METHODS: We selected 200 patients with HBV-infection (58 cases of chronic hepatitis B, 47 cases of hepatocellular carcinoma, 30 cases of compensatory phase cirrhosis, and 65 cases of decompensatory phase cirrhosis), 31 patients with primary liver cancer without HBV infection, and 70 healthy individuals as the control group. The expression level of serum AFP and CA125 was detected with electrochemiluminescence immunoassay. The expression level of the Hbx protein was detected with ELISA. Meanwhile, the expression level of miR-212 in serum was analyzed with RT-qPCR. We collected patients' clinical information following the Child-Pugh classification and MELD score criterion, and statistical analysis was made between the expression level of miR-212 and the collected clinical indexes. Lastly, we predicted the target genes of the miR-212 and its functions using bioinformatics methods such as cluster analysis and survival prediction. RESULTS: Compared to the control group, the expression level of miR-212 in HBV infected patients was remarkably increased (P<0.05), especially between the HBV-infection Hepatocellular carcinoma group and the non-HBVinfection liver cancer group (P<0.05). The expression of miR-212 was increased in patients' Child-Pugh classification, MELD score, and TNM staging. Moreover, the sensitivity and specificity of miR-212 were superior to AFP, CA125, and HBx protein. CONCLUSION: There is a linear relationship between disease progression and expression level of miR-212 in the serum of HBV infected patients. This demonstrates that miR-212 plays a significant role in liver diseases. miR-212 is expected to be a new biomarker used for the diagnosis and assessment of patients with HBV-infection-related liver diseases.