BackgroundParkinson’s disease (PD) is a progressive neurodegenerative disorder. Two positron emission tomography (PET) tracers, carbon-11-labeled 2β-carbomethoxy-3β-(4-fluorophenyl) tropane (11C-CFT) and fluorine-18-labeled fluoropropyl-(+)-dihydrotetrabenazine [18F-FP-(+)-DTBZ], have emerged as key tools for PD imaging studies. However, the clinical utility of both 11C-CFT and 18F-FP-(+)-DTBZ in the diagnosis of PD, as well as their relative ability to detect early-stage disease, has not been clarified. This study aimed to evaluate the similarities and differences between 18F-FP-(+)-DTBZ and 11C-CFT PET/magnetic resonance (MR) in assessing idiopathic PD.MethodsA total of 28 patients with PD (10 with mild PD, 11 with moderate PD, and 7 with advanced PD) and 12 healthy controls (HCs) underwent both 11C-CFT and 18F-FP-(+)-DTBZ hybrid PET/MR imaging scans within a week of one another. Visual and semiquantitative analyses were applied to interpret the results. The mean standardized uptake value ratio (SUVR) of both tracers was measured in six brain regions and then compared for analysis.ResultsAnalysis of variance indicated significant differences in the SUVR between HC status, mild PD, moderate PD, and advanced PD across various brain regions with both tracers (all P values <0.05), except for the ipsilateral substantia nigra (SN) under 11C-CFT. Strong positive correlations between 18F-FP-(+)-DTBZ and 11C-CFT were observed in certain brain regions, including the bilateral caudate body, caudate head, anterior putamen, posterior putamen, and contralateral SN (all P values <0.05). Both tracers exhibited good performance in diagnosing and distinguishing patients with PD at different stages (all areas under the curve >0.7). Notably, the DeLong test revealed that 11C-CFT was more effective than 18F-FP-(+)-DTBZ in distinguishing HC status, mild PD, and moderate PD (P<0.05).ConclusionsOur findings suggest that 18F-FP-(+)-DTBZ PET/MR provides comparable results to those of 11C-CFT PET/MR in most brain regions in the evaluation of early, moderate, and advanced PD. Future studies with larger sample sizes are warranted to explore discrepancies between the two tracers in the SN of mild PD patients.

BackgroundPrevious research has shown that cadmium-zinc-telluride (CZT) crystals, as semiconductor detectors, provide higher spatial and energy resolution than thallium-activated sodium iodide [NaI(Tl)] crystals. This study aimed to evaluate the extent to which a full-ring CZT single-photon emission computed tomography/computed tomography (SPECT/CT) system could improve the image quality of 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) parathyroid imaging, as well as its potential to enhance diagnostic accuracy and optimize imaging protocols.MethodsTwo phantoms were acquired: (I) a uniform phantom to obtain the calibration factor; and (II) a National Electrical Manufacturers Association (NEMA) International Electrotechnical Commission (IEC) phantom containing different-sized spheres to compare the contrast-to-noise ratio (CNR) and recovery coefficients (RCs). A total of 85 patients who were diagnosed with hyperparathyroidism (HPT) were enrolled in this study. Two hours after injecting 99mTc-MIBI, delay-phase parathyroid scanning was performed sequentially on NaI(Tl) SPECT/CT in 8 minutes and full-ring CZT SPECT/CT in 6 minutes. List-mode data were used to reconstruct 3-minute CZT SPECT/CT images. A 10-mm diameter volume of interest (VOI) was used to delineate the lesion and reference regions. The coefficient of variation (CV) and CNR were calculated to quantitatively compare image quality and lesion contrast. The standardized uptake values (SUVs) of the lesions were calculated from the images acquired using the full-ring CZT SPECT/CT. Clinical and pathology information were collected through standardized pre-procedural medical history inquiry and subsequent patient follow-up.ResultsThe NaI(Tl) system exhibited a lower CNR than the full-ring CZT system when using the same injected activity and their respective recommended NEMA IEC phantom parameters. For the images acquired with the full-ring CZT system, those reconstructed using block sequential regularized expectation maximization (BSREM) 20i10s exhibited a higher CNR than those reconstructed using OSEM 4i10s. Compared with OSEM 20i10s, although the difference in the CNR was not statistically significant, the spheres appeared visually clearer, which may be attributed to a more uniform background (CV: OSEM 20i10s, 19.9%; BSREM 20i10s, 17.9%). In the clinical patients, all the three imaging conditions, including 8-minute NaI(Tl), 3-minute CZT, and 6-minute CZT imaging, identified the same positive lesions upon visual assessment. In the image quality comparison, the full-ring CZT system with the standard 6-minute imaging sequence demonstrated better performance than the NaI(Tl) system to varying degrees. Specifically, the CV was lower for the CZT system based on the thyroid (P=0.022) and mediastinal blood pool (P<0.001), but not significantly different based on the cervical muscles (P=0.599). Similarly, the CNR was higher for the CZT system when using the thyroid as the reference region (P=0.033) and mediastinal blood pool as the reference region (P=0.001), but not significantly different when using the cervical muscles as the reference region (P=0.223). The CNR values from the 3-minute CZT imaging were comparable to those from the standard 6-minute CZT imaging (thyroid, P=0.956; cervical muscles, P=0.265; mediastinal blood pool, P=0.182).ConclusionsThe full-ring CZT SPECT/CT system exhibited a higher CNR than the NaI(Tl) crystal-based system in the delay-phase scan of 99mTc-MIBI parathyroid imaging when using the thyroid and mediastinal blood pool as references. Additionally, it enables acquisition within a reduced time frame while maintaining comparable diagnostic sensitivity.

BackgroundPulmonary nodules attached to the interlobar pleura (PNs-AIP) represent a distinct subset of pulmonary nodules (PNs), for which accurate differentiation between benign and malignant status is critical for guiding clinical decisions. Chest computed tomography (CT) has become an effective method for evaluating PNs. However, the correlation between specific CT characteristics of PNs-AIP—particularly their spatial relationship with the interlobar pleura (IP)—and their pathological nature remains inadequately understood. Therefore, this study aimed to investigate the clinical and CT features of PNs-AIP, with a particular focus on their spatial relationship with the IP, and to identify features that may help to distinguish benign from malignant PNs-AIP, thereby predicting malignant PNs-AIP.MethodsA retrospective review was conducted of the clinical and CT imaging data from 464 patients diagnosed with PNs-AIP. We assigned the patients to benign and malignant cohorts based on either surgical pathology or the complete resolution observed in follow-up CT scans. To identify discriminative features, we utilized univariate analysis to compare clinical and CT characteristics across the two groups. Based on these findings, we successively constructed two binary logistic regression models to identify predictors associated with malignant PNs-AIP. In addition to the clinical and morphological nodular features utilized in Model 1, Model 2 further incorporated CT features related to the IP. The performance of both models was subsequently compared to identify which one had superior efficacy. Additionally, 116 patients from a different medical center were enrolled and utilized for external validation.ResultsThe univariate analysis identified two clinical features and 10 CT features that exhibited significant differences between benign and malignant PNs-AIP (all P<0.05). Model 1 indicated that age ≥56 years, female sex, nodule size ≥11.80 mm, regular shape, lobulation, spiculation, and subsolid density were independent predictors of malignant PNs-AIP, obtaining an area under the curve (AUC) of 0.863. In contrast, Model 2 revealed that alongside predictors from Model 1, nodule-IP angle type I and nodule-IP positional relationship type IV were also independent predictors of malignant PNs-AIP, achieving an improved AUC of 0.886. In the external validation cohort, Model 1 and Model 2 achieved AUCs of 0.859 and 0.903 in the external validation cohort, respectively. Model 2 significantly outperformed Model 1 in both cohorts, as evidenced by the DeLong test, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) (P<0.05).ConclusionsBenign and malignant PNs-AIP exhibit distinct clinical and imaging characteristics. In addition to the morphological features of nodules, a careful assessment of the relationship between the nodules and the IP will enhance the diagnostic accuracy of PNs-AIP.

BackgroundAbdominal computed tomography angiography (CTA) often requires a high tube voltage and relatively large contrast volume to ensure adequate vascular enhancement, which increases radiation exposure and contrast-related risks. Deep learning reconstruction techniques have demonstrated potential to improve image quality under low-dose acquisition conditions. This study evaluated a 70-kVp abdominal CTA protocol using low tube voltage and low contrast medium volume (“dual-low”), reconstructed with ClearInfinity (Neusoft Medical) at different weighting levels.MethodsA prospective study was conducted on 100 patients undergoing abdominal CTA who were divided into two groups: group A (70 kVp, 40–45 mL of contrast medium, and a flow rate of 2.0–2.5 mL/s) and group B (conventional 100-kVp protocol, 60–70 mL of contrast medium, and a flow rate of 3.0–3.5 mL/s). Group B served as standard-dose reference, and its images were reconstructed using the vendor-recommended ClearView iterative reconstruction. Images in Group A were reconstructed with ClearInfinity at four weighting levels—30%, 50%, 70%, and 90%—which corresponded to groups A1 to A4, respectively. Radiation dose parameters, including computed tomography dose index volume (CTDIvol), dose-length product (DLP), and effective dose (ED) were recorded and analyzed for both groups. Objective evaluation included CT attenuation, image noise (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Subjective image quality was independently evaluated by two radiologists.ResultsThe CTDIvol, DLP, and ED in group A were significantly lower than those in group B (P<0.001). Mean vascular attenuation did not differ significantly between the groups (P>0.05). As the ClearInfinity weighting increased from 30% to 90%, image noise progressively decreased, whereas both the SNR and CNR progressively increased. Compared with the iterative reconstruction group (group B), group A4 exhibited a lower SD and higher SNR and CNR across major abdominal vessels (all P values <0.05). Subjective image quality increased from A1 to A2 and then remained stable at higher ClearInfinity weights, with no significant differences across groups A2–A4. Interobserver agreement for subjective scoring was excellent (κ>0.81).ConclusionsA 70-kVp abdominal CTA protocol reconstructed with 90% ClearInfinity weighting provides substantial radiation dose reduction while preserving diagnostic vascular image quality despite reduced contrast volume.

Transcatheter arterial chemoembolization (TACE) is a standard minimally invasive treatment for hepatocellular carcinoma (HCC); however, technical reports on TACE in nude rat orthotopic patient-derived tumor xenograft (PDX) HCC models are lacking. This study aimed to establish the technical feasibility and procedural parameters of transfemoral TACE in this clinically relevant model. Six male Foxn1rnu nude rats (average body weight: 307±28.3 g, range, 273–350 g) with established orthotopic PDX HCC [average tumor diameter: 6.2±0.8 mm, confirmed by magnetic resonance imaging (MRI)] underwent transfemoral TACE performed by two experienced interventional radiologists. A 1.2 Fr microcatheter and 0.008-inch micro-guidewire were used for femoral artery cannulation, celiac trunk angiography, and selective hepatic arterial catheterization. An iodized oil and idarubicin emulsion (dose ≤2 mg/kg) was administered as the chemoembolic agent. Technical success, defined as the successful completion of all procedural steps without procedure-related mortality or major complications, was achieved in all cases (6/6). Procedural efficiency was quantified using four time metrics: duration from skin incision to femoral artery exposure (T1: 4.1±1.2 min; range, 2.5–6.0 min), femoral artery cannulation time (T2: 4.5±1.5 min; range, 3.0–7.5 min), hepatic artery catheterization time (T3: 4.5±1.5 min; range, 2.5–6.4 min), and total procedural time from incision to wound closure (T4: 39.3±7.1 min; range, 29.0–48.0 min). Anatomical variations in celiac trunk origin exhibiting “U”, “C”, or “L” configurations were observed between the L1 and L2 vertebral levels. No anesthesia-related complications or major bleeding occurred. These findings demonstrate the technical feasibility and reproducibility of transfemoral TACE in small-sized, low-body-weight nude rat orthotopic PDX HCC models, providing technical support and a reference for transcatheter arterial approaches in such models.

BackgroundDifferentiating benign multilocular hepatic cysts (MHCs) from premalignant mucinous cystic neoplasms (MCNs) is crucial for management but remains challenging due to overlapping imaging features. This study aimed to enhance diagnostic accuracy in distinguishing MHCs from MCNs by evaluating morphological imaging characteristics and constructing a predictive diagnostic model.MethodsThis retrospective study included a cohort of 86 patients with pathologically confirmed hepatic cystic lesions, 60 with MHCs and 26 with MCNs, diagnosed between July 2014 and April 2023. More than 20 imaging features were independently assessed by two radiologists blinded to clinical history. Feature selection was performed using Boruta regression, least absolute shrinkage and selection operator (LASSO) regression, as well as univariate and multivariate logistic regression analyses. Diagnostic performance was assessed across four machine learning models: logistic regression, random forest (RF), decision tree, and extreme gradient boosting (XGBoost). Firth logistic regression was used to examine the relationship between the ribbon sign and intracystic hemorrhage.ResultsMultiple lesions, smooth septal appearance, peripheral septal location, and the ribbon sign were more suggestive of MHCs, whereas solitary lesions, irregular septa, cyst wall thickening (≥2 mm), and the septum-intersection triangular sign were more indicative of MCNs. Among the models, the XGBoost classifier presented the highest diagnostic performance [area under the curve (AUC) =0.905]. The ribbon sign was significantly associated with intracystic hemorrhage (odds ratio =608.46, P<0.001), with no significant interaction observed between this association and lesion type (P=0.272).ConclusionsA high-performance diagnostic model was developed using XGBoost by integrating advanced feature selection techniques and machine learning algorithms. The ribbon sign was identified as a significant imaging marker independently associated with intracystic hemorrhage, regardless of lesion type.

BackgroundGiven the limitations of ultrasound-guided totally implantable venous access ports (TIVAPs) placement in detecting venous abnormalities and predicting pinch-off syndrome, this study evaluates whether preoperative venography can improve surgical planning and reduce complications by identifying these anatomical risks prior to implantation.MethodsThe retrospective study analyzed 479 cancer patients undergoing TIVAP implantation from January 2019 to December 2021. Patients received either preoperative venography (n=252) or conventional ultrasound guidance (n=227) to guide surgical planning. The venography group underwent venous assessment using digital subtraction angiography (DSA), with surgical decisions based on identified venous abnormalities and pinch-off syndrome simulation tests. Primary outcomes were the concordance rate between planned and executed surgical procedures and intraoperative complications. Statistical comparisons used Chi-squared or Fisher’s exact tests, with significance set at P<0.05.ResultsVenous anomalies were detected in 18% (46/252) of venography patients, which were strongly associated with ipsilateral surgery or peripherally inserted central catheters (PICCs) placement (39.1% vs. 0.5%, P<0.001). The venography-guided group demonstrated significantly higher procedural concordance than the ultrasound-guided group (100% vs. 97%, P=0.005). Intraoperative complication rates were similar (2.8% vs. 2.6%, P>0.05). Pinch-off syndrome simulation tests in the venography group identified high-risk anatomy in five patients, allowing preventive surgical modifications; no postoperative pinch-off syndrome occurred in this group, compared to three cases (1.3%) in the ultrasound-guided group.ConclusionsPreoperative venography has emerged as an indispensable tool in formulating judicious surgical strategies for the implantation of TIVAP, thereby preemptively mitigating unforeseen procedural alterations. Additionally, it affords a mechanism to assess the risk of pinch-off syndrome throughout the course of the procedure.

BackgroundProstate cancer (PCa) is a malignant tumor that significantly threatens the quality of life of elderly men. This study evaluated the efficacy of multiparametric magnetic resonance imaging (MRI) combining synthetic magnetic resonance imaging (SyMRI), amide proton transfer-weighted (APTw) imaging, and multiplexed sensitivity encoding diffusion-weighted imaging (MUSE DWI) in the diagnosis and grading of PCa.MethodsA total of 195 patients with pathologically confirmed prostate lesions who underwent the SyMRI, APTw, and MUSE DWI were retrospectively analyzed. Quantitative parameters derived from SyMRI [T1, T2, proton density (PD)], APTw (APTmin, APTmax, APTmean), and apparent diffusion coefficient (ADC) from MUSE DWI were extracted by manually delineating regions of interest (ROIs). Group comparisons were performed using the independent t-test or Wilcoxon rank-sum test, as appropriate. Parametric variables were correlated with the International Society of Urological Pathology (ISUP) grades using the Spearman rank correlation coefficient. A one-way analysis of variance (ANOVA) test with Bonferroni correction or Kruskal-Wallis test was performed to determine the differences of each parameter among different ISUP grades. Receiver operating characteristic (ROC) curve analysis, DeLong test, and logistic regression modeling were conducted to assess the diagnostic performance of individual and combined parameters.ResultsTotals of 96 malignant and 99 benign patients were included in this study. In the transitional zone (TZ) and peripheral zone (PZ) of the prostate, all quantitative parameters except PD value showed statistical differences for distinguishing benign and malignant prostate lesions (P<0.05). T1, T2, and ADC values were significantly lower, whereas APTmin, APTmax, and APTmean were significantly higher in PCa compared to benign lesions. For the diagnosis of PZ PCa, the area under the curve (AUC) of the multiparametric model [AUC =0.948; 95% confidence interval (CI): 0.878–0.979] showed no significant difference from ADC value (AUC =0.896; 95% CI: 0.784–0.957) (DeLong test: P=0.118). Compared with Prostate Imaging Reporting and Data System (PI-RADS), the multiparametric model can significantly enhance the diagnostic efficacy (DeLong test: P=0.002). For the diagnosis of TZ PCa, the AUC of the multiparametric model (AUC =0.846; 95% CI: 0.754–0.910) was significantly higher than that of the single parameters (DeLong test: P<0.05). Compared with PI-RADS, the multiparametric model can significantly enhance the diagnostic efficacy (DeLong test: P=0.049). APTmax and APTmean were significantly positively correlated with ISUP grade (r=0.419, P<0.001; r=0.311, P=0.002). T2 and ADC values were significantly negatively correlated with ISUP grade (r=−0.285, P=0.005; r=−0.495, P<0.001). Compared to PCa lesions with grade 1, ISUP grade 4 exhibited significantly higher APTmax and APTmean (P<0.05) but lower T2 value (P=0.048), whereas ADC value was significantly higher in ISUP grade 1 than in ISUP grade 2–5 (P<0.05).ConclusionsMultiparametric MRI incorporating SyMRI, APTw imaging, and MUSE DWI may offer enhanced diagnostic performance in distinguishing benign from malignant prostate lesions and grading of PCa.

BackgroundExtrathyroidal extension (ETE) critically impacts the treatment and prognosis of thyroid cancer, necessitating accurate preoperative prediction models. This study aimed to develop and validate such a model combining clinicopathological and ultrasonographic features.MethodsThis retrospective study enrolled 435 thyroid cancer patients from The First Affiliated Hospital of Nanchang University, categorized as non-ETE and ETE groups based on postoperative pathology. Patients were randomly divided into training (70%) and validation (30%) cohorts, with an external test cohort (n=70) from Huashan Hospital, Fudan University. Clinicopathological and ultrasonographic features were analyzed. Significant variables (P<0.05) identified via univariate logistic regression were incorporated into multivariate models: a clinicopathological model, an ultrasonographic model, and a combined clinicopathological-ultrasonographic model. Performance was evaluated using the area under the curve (AUC), calibration curves, and decision curve analysis (DCA).ResultsThe combined model demonstrated robust calibration and discrimination across cohorts, with AUCs of 0.872 (training cohort), 0.835 (validation cohort), and 0.858 (external test cohort). Subgroup analyses revealed slightly lower AUC for microcarcinomas vs. non-microcarcinomas (0.772 vs. 0.893, P<0.05) and superior discrimination of gross ETE vs. minimal ETE (AUC: 0.963 vs. 0.824, P<0.05). No significant differences were observed between Hashimoto’s/non-Hashimoto’s (AUC: 0.875 vs. 0.843) or euthyroid/dysfunction subgroups (AUC: 0.852 vs. 0.845) (P>0.05).ConclusionsThe clinicopathological-ultrasonographic model provides reliable preoperative ETE prediction, facilitating personalized surgical planning and improved patient outcomes.