PurposeTo establish and validate radiomics models for predicting the early efficacy (less than 3 months) of microwave ablation (MWA) in malignant lung tumors.MethodsThe study enrolled 130 malignant lung tumor patients (72 in the training cohort, 32 in the testing cohort, and 26 in the validation cohort) treated with MWA. Post-operation CT images were analyzed. To evaluate the therapeutic effect of ablation, three models were constructed by least absolute shrinkage and selection operator and logistic regression: the tumoral radiomics (T-RO), peritumoral radiomics (P-RO), and tumoral-peritumoral radiomics (TP-RO) models. Univariate and multivariate analyses were performed to identify clinical variables and radiomics features associated with early efficacy, which were incorporated into the combined radiomics (C-RO) model. The performance of the C-RO model was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA). The C-RO model was used to derive the best cutoff value of ROC and to distinguish the high-risk group (Nomo-score of C-RO model below than cutoff value) from the low-risk group (Nomo-score of C-RO model higher than cutoff value) for survival analysis of patients.ResultsFour radiomics features were selected from the region of interest of tumoral and peritumoral CT images, which showed good performance for evaluating prognosis and early efficacy in three cohorts. The C-RO model had the highest AUC value in all models, and the C-RO model was better than the P-RO model (AUC in training, 0.896 vs. 0.740; p = 0.036). The DCA confirmed the clinical benefit of the C-RO model. Survival analysis revealed that in the C-RO model, the low-risk group defined by best cutoff value had significantly better progression-free survival than the high-risk group (p<0.05).ConclusionsCT-based radiomics models in malignant lung tumor patients after MWA could be useful for individualized risk classification and treatment.

BackgroundThe advent of next-generation computed tomography (CT)- and magnetic resonance imaging (MRI) opened many new perspectives in the evaluation of tumor characteristics. An increasing body of evidence suggests the incorporation of quantitative imaging biomarkers into clinical decision-making to provide mineable tissue information. The present study sought to evaluate the diagnostic and predictive value of a multiparametric approach involving radiomics texture analysis, dual-energy CT-derived iodine concentration (DECT-IC), and diffusion-weighted MRI (DWI) in participants with histologically proven pancreatic cancer.MethodsIn this study, a total of 143 participants (63 years ± 13, 48 females) who underwent third-generation dual-source DECT and DWI between November 2014 and October 2022 were included. Among these, 83 received a final diagnosis of pancreatic cancer, 20 had pancreatitis, and 40 had no evidence of pancreatic pathologies. Data comparisons were performed using chi-square statistic tests, one-way ANOVA, or two-tailed Student’s t-test. For the assessment of the association of texture features with overall survival, receiver operating characteristics analysis and Cox regression tests were used.ResultsMalignant pancreatic tissue differed significantly from normal or inflamed tissue regarding radiomics features (overall P < .001, respectively) and iodine uptake (overall P < .001, respectively). The performance for the distinction of malignant from normal or inflamed pancreatic tissue ranged between an AUC of ≥ 0.995 (95% CI, 0.955–1.0; P < .001) for radiomics features, ≥ 0.852 (95% CI, 0.767–0.914; P < .001) for DECT-IC, and ≥ 0.690 (95% CI, 0.587–0.780; P = .01) for DWI, respectively. During a follow-up of 14 ± 12 months (range, 10–44 months), the multiparametric approach showed a moderate prognostic power to predict all-cause mortality (c-index = 0.778 [95% CI, 0.697–0.864], P = .01).ConclusionsOur reported multiparametric approach allowed for accurate discrimination of pancreatic cancer and revealed great potential to provide independent prognostic information on all-cause mortality.

BackgroundSeveral previous studies demonstrated that the combination of self-expandable metallic stents (SEMS) and 125I seed implantation might prolong stent patency and obtain survival benefits for malignant obstructive jaundice (MOJ) patients. However, these studies rarely mentioned a comparison between CT-guided intratumoral 125I seed implantation and intraluminal 125I seed strand insertion combined with stenting for the management of MOJ. This study aimed to further evaluate the safety and efficacy of SEMS combined with 125I brachytherapy in the management of unresectable MOJ.MethodsFifty-nine patients with unresectable MOJ were retrospectively included from March 2018 to June 2021. The main therapeutic outcomes were evaluated in terms of stent patency, and overall survival. Cumulative stent patency and overall survival rates were calculated by Kaplan–Meier survival analysis. Both clinical and treatment factors associated with survival were analyzed.ResultsTechnical success was achieved in all patients. The clinical success rate was 94% (32/34) in the seeds group and 92% (23/25) in the control group, no significant difference was found (p =1.000). The median duration of stent patency was significantly longer in the 125I brachytherapy group compared with the control group (289 days vs. 88 days, respectively, p =0.001). The 125I brachytherapy group demonstrated a significantly better median overall survival rate than the control group (221 days vs. 78 days, respectively, p =0.001). In multivariate analysis, stents with 125I brachytherapy (p =0.004) was a significant favorable prognostic factor that affected patient survival. No significant difference was observed between CT-guided 125I seed implantation and 125I seed strand insertion in stent patency (p =0.268), and overall survival (p =0.483).ConclusionSEMS combined with 125I brachytherapy is safe and effective for treating MOJ. 125I brachytherapy may help to maintain stent patency and prolong overall survival. There was no significant difference between CT-guided 125I seed implantation with SEMS and 125I seed strand insertion with SEMS in stent patency and overall survival.

BackgroundHypoperfusion or resultant hypoxia in solid tumours is a main reason for therapeutic resistance. Augmenting the blood perfusion of hypovascular tumours might improve both hypoxia and drug delivery. Cavitation is known to result in microstreaming and sonoporation and to enhance drug diffusion into tumours. Here, we report the ability to enhance both tumour blood perfusion and doxorubicin (Dox) delivery using a new sononeoperfusion effect causing a cavitation effect on tumour perfusion in subcutaneous Walker-256 tumours of rats using ultrasound stimulated microbubble (USMB).MethodsTo induce the sononeoperfusion effect, USMB treatment was performed with a modified diagnostic ultrasound (DUS) system and SonoVue® microbubbles. The therapeutic pulse was operated with a peak negative pressure of 0.26 to 0.32 MPa and a pulse repetition frequency (PRF) of 50 Hz to 2 kHz. Contrast-enhanced ultrasound (CEUS) was used for tumour perfusion assessment.ResultsThe USMB treatment of 0.26 MPa and 1 kHz could significantly enhance tumour perfusion with a 20.29% increase in the CEUS peak intensity and a 21.42% increment in the perfusion area for more than 4 hours (P < 0.05). The treatment also increased Dox delivery to tumours by approximately 3.12-fold more than that of the control (P < 0.05). Furthermore, ELISAs showed that vasodilators and inflammatory factors increased 4 hours after treatment (P < 0.05), suggesting that the inflammatory response plays an important role in the sononeoperfusion effect.ConclusionThe USMB-induced sononeoperfusion effect could significantly enhance the blood perfusion of Walker-256 tumours and promote drug delivery. It might be a novel physical method for overcoming the therapeutic resistance of hypoperfused or hypoxic tumours.

BackgroundWe aimed to prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced Computed Tomography (CECT) for hepatocellular carcinoma (HCC) detection and liver transplant (LT) eligibility assessment in cirrhotic patients with explant histopathology correlation.MethodsIn this prospective, single-institution ethics-approved study, 101 cirrhotic patients were enrolled consecutively from the pre-LT clinic with written informed consent. Patients underwent CECT and EOB-MRI alternately every 3 months until LT or study exclusion. Two blinded radiologists independently scored hepatic lesions on CECT and EOB-MRI utilizing the liver imaging reporting and data system (LI-RADS) version 2018. Liver explant histopathology was the reference standard. Pre-LT eligibility accuracies with EOB-MRI and CECT as per Milan criteria (MC) were assessed in reference to post-LT explant histopathology. Lesion-level and patient-level statistical analyses were performed.ResultsSixty patients (49 men; age 33–72 years) underwent LT successfully. One hundred four non-treated HCC and 42 viable HCC in previously treated HCC were identified at explant histopathology. For LR-4/5 category lesions, EOB-MRI had a higher pooled sensitivity (86.7% versus 75.3%, p < 0.001) but lower specificity (84.6% versus 100%, p < 0.001) compared to CECT. EOB-MRI had a sensitivity twice that of CECT (65.9% versus 32.2%, p < 0.001) when all HCC identified at explant histopathology were included in the analysis instead of imaging visible lesions only. Disregarding the hepatobiliary phase resulted in a significant drop in EOB-MRI performance (86.7 to 72.8%, p < 0.001). EOB-MRI had significantly lower pooled sensitivity and specificity versus CECT in the LR5 category with lesion size < 2 cm (50% versus 79%, p = 0.002 and 88.9% versus 100%, p = 0.002). EOB-MRI had higher sensitivity (84.8% versus 75%, p < 0.037) compared to CECT for detecting < 2 cm viable HCC in treated lesions. Accuracies of LT eligibility assessment were comparable between EOB-MRI (90–91.7%, p = 0.156) and CECT (90–95%, p = 0.158).ConclusionEOB-MRI had superior sensitivity for HCC detection; however, with lower specificity compared to CECT in LR4/5 category lesions while it was inferior to CECT in the LR5 category under 2 cm. The accuracy for LT eligibility assessment based on MC was not significantly different between EOB-MRI and CECT.Trial registrationClinicalTrials.gov Identifier: NCT03342677, Registered: November 17, 2017.

BackgroundPatients with colorectal liver metastases (CRLM) combined with hepatic lymph node (HLN) metastases have a poor prognosis. In this study, we developed and validated a model using clinical and magnetic resonance imaging (MRI) parameters to predict HLN status before surgery.MethodsA total of 104 CRLM patients undergoing hepatic lymphonodectomy with pathologically confirmed HLN status after preoperative chemotherapy were enrolled in this study. The patients were further divided into a training group (n = 52) and a validation group (n = 52). The apparent diffusion coefficient (ADC) values, including ADCmean and ADCmin of the largest HLN before and after treatment, were measured. rADC was calculated referring to the target liver metastases, spleen, and psoas major muscle (rADC-LM, rADC-SP, rADC-m). In addition, ADC change rate (Δ% ADC) was quantitatively calculated. A multivariate logistic regression model for predicting HLN status in CRLM patients was constructed using the training group and further tested in the validation group.ResultsIn the training cohort, post-ADCmean (P = 0.018) and the short diameter of the largest lymph node after treatment (P = 0.001) were independent predictors for metastatic HLN in CRLM patients. The model’s AUC was 0.859 (95% CI, 0.757-0.961) and 0.767 (95% CI 0.634-0.900) in the training and validation cohorts, respectively. Patients with metastatic HLN showed significantly worse overall survival (p = 0.035) and recurrence-free survival (p = 0.015) than patients with negative HLN.ConclusionsThe developed model using MRI parameters could accurately predict HLN metastases in CRLM patients and could be used to preoperatively assess the HLN status and facilitate surgical treatment decisions in patients with CRLM.

Contrast-enhanced mammography (CEM) is becoming a widely adopted modality in breast imaging over the past few decades and exponentially so over the last few years, with strong evidence of high diagnostic performance in cancer detection. Evidence is also growing indicating comparative performance of CEM to MRI in sensitivity with fewer false positive rates. As application of CEM ranges from potential use in screening dense breast populations to staging of known breast malignancy, increased familiarity with the modality and its implementation, and disease processes encountered becomes of great clinical significance. This review emphasizes expected normal findings on CEM followed by a focus on examples of the commonly encountered benign and malignant pathologies on CEM.

ObjectiveParathyroid carcinoma (PC) and atypical parathyroid tumor (APT) are rare parathyroid disorders carrying the risk of recurrence of varying degrees. This study aims to explore the value of 2D-shear wave elastography (SWE) in the discrimination of PC/APT among suspicious parathyroid lesions.Methods and materialsIn this prospective study, patients with primary hyperparathyroidism and suspicious parathyroid lesions on ultrasonography (US) were recruited. All the lesions were assessed by SWE before surgery. The velocity (m/s), Young’s modulus (Kpa), and elastogram of SWE were compared between pathologically proven parathyroid carcinoma or atypical parathyroid tumor (Group1) and parathyroid adenoma (Group2). All the SWE parameters were displayed at the setting of 50 or 70 kPa. Correlations between SWE and the lesion size as well as biochemical parameters were analyzed.Results36 target lesions were enrolled for analysis. The mean shear wave velocity (SWV) between the two groups was 2.4 m/s vs 1.9 m/s, respectively, while the mean Young’s modulus was 11.1 kPa vs 18.2 kPa, respectively. The cut-off values are 2.35 m/s and 17.05 kPa correspondingly. The sensitivity and specificity of the selecting cut-off values were 0.56 vs 0.63 and 0.95 vs 1.0 (area under the curve [AUC]: 0.813 vs 0.852 [95% confidence interval (CI): 0.669–0.956 vs 0.720–0.983]; p < 0.001, p < 0.001; respectively). In contrast, the max SWV and Young’s modulus showed a better sensitivity of 0.75 and 0.81, respectively. The “colored lesion” and “stiff rim” patterns on the elastogram are more indicated in parathyroid carcinoma and atypical parathyroid tumor, whereas the negative elastogram prevails in parathyroid adenoma. The SWV and Young’s modulus of the parathyroid lesions were independent of the tumor size, but the max SWV and Young’s modulus slightly correlated with serum parathyroid hormone concentration (PTH) (r = 0.398, p = 0.016; r = 0.396, p = 0.017).Conclusions2D-shear wave elastography plays a useful role in the preoperative assessment of parathyroid lesions with suspicious malignancy. The mean SWV and Young’s modulus are advised as the favored diagnostic parameter with the best AUC and excellent specificities, while the max SWV and Young’s modulus are more sensitive to distinguish the PC and APT compared with other parameters.

ObjectiveTo evaluate the combined efficacy of multiparametric ultrasonography (mpUS) and multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI-TRUS) fusion for detecting clinically significant prostate cancer (csPCa).MethodsFrom November 2019 to September 2021, biopsy-naïve patients underwent mpMRI-TRUS fusion imaging combined with mpUS-guided targeted biopsies (TB) and systematic biopsies (SB). To further evaluate the additional diagnostic value of mpUS, the imaging features of 202 focus obtained from fusion imaging were assessed. The diagnostic accuracies of mpMRI-TRUS fusion imaging and the combination of mpMRI-TRUS fusion imaging with mpUS for csPCa were comparatively evaluated.ResultsA total of 202 prostate lesions (160 patients) were included in the final analysis, of which 105 were csPCa, 16 were ciPCa, and 81 were noncancerous. The median patient age was 69 (65–73) years and the median tPSA was 22.07 (11.22–62.80) ng/mL. For csPCa, the detection rate of TB was higher than that of SB (50.0% vs. 45.5%, p < 0.05). The imaging characteristics of mpUS in the PCa and non-PCa groups were significantly different (p < 0.001). When compared with mpMRI-TRUS fusion imaging, the positive predictive value, false positive rate, and area under the curve (AUC) of csPCa diagnosis by mpMRI-TRUS fusion imaging combined with mpUS increased by 11.30%, decreased by 19.58%, and increased from 0.719 to 0.770 (p < 0.05), respectively.ConclusionTB can improve the detection rate of csPCa and hence can be effectively used in the diagnosis and risk assessment of csPCa. The mpUS-enriched valuable diagnostic information for mpMRI-TRUS fusion imaging and their combination showed a higher diagnostic value for csPCa, which can guide subsequent clinical treatment.

BackgroundRadiation-induced hypothyroidism (RIHT) is a common, but underestimated, late adverse effect in head and neck cancer. We investigated the value of early post-treatment 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for predicting RIHT.MethodsWe searched our institutional database for patients aged ≥ 20 years who had undergone definitive radiotherapy for nasopharyngeal or oropharyngeal cancer between 2005 and 2017, followed by 18F-FDG PET/CT within 180 days of radiotherapy completion. We visually assessed and compared PET/CT and baseline characteristics in patients with and without RIHT using the chi-square test for categorical variables and the t-test for continuous variables. Variable predictive ability was evaluated by measuring the area under receiver operating characteristic curves.ResultsFifty-two patients were included; 22 (42%) developed RIHT and 30 (58%) did not. Two patients presented with diffuse thyroid uptake on PET/CT via visual assessment, and both developed RIHT later. Among the PET/CT variables, thyroid functioning volume was significantly higher in patients without RIHT than in patients with RIHT (16.30 ± 6.03 cm3 vs. 10.61 ± 3.81 cm3, p < 0.001). The maximum standard uptake values of the thyroid and pituitary glands did not differ significantly between the groups. Two patient characteristics, pretreatment thyroid volume and mean radiotherapy dose to the thyroid, also showed significant differences between the groups. An algorithmic approach combining visual grading of thyroid 18F-FDG uptake and thyroid functioning volume cutoff of 14.01 yielded an area under curve of 0.89 (95% confidence interval, 0.80–0.98); the sensitivity, specificity, positive predictive value, and negative predictive value were 87.0%, 82.3%, 80.0%, and 88.9%, respectively.ConclusionEarly post-treatment PET/CT-derived thyroid functioning volume was a good predictor of RIHT development. Diffusely increased thyroid 18F-FDG uptake on PET/CT may indicate impending RIHT. Routine surveillance of thyroid function is warranted in patients at high risk of developing RIHT.