Diagnostic Study of Nodular Pulmonary Cryptococcosis Based on Radiomic Features Captured from CT Images.

BACKGROUND: Radiomics can quantify pulmonary nodule characteristics non-invasively by applying advanced imaging feature algorithms. Radiomic textural features derived from Computed Tomography (CT) imaging are broadly used to predict benign and malignant pulmonary nodules. However, few studies have reported on the radiomics-based identification of nodular Pulmonary Cryptococcosis (PC). OBJECTIVE: This study aimed to evaluate the diagnostic and differential diagnostic value of radiomic features extracted from CT images for nodular PC. METHODS: This retrospective analysis included 44 patients with PC (29 males, 15 females), 58 with Tuberculosis (TB) (39 males, 19 females), and 60 with Lung Cancer (LC) (20 males, 40 females) confirmed pathologically. Models 1 (PC vs. non-PC), 2 (PC vs. TB), and 3 (PC vs. LC) were established using radiomic features. Models 4 (PC vs. TB) and 5 (PC vs. LC) were established based on radiomic and CT features. RESULTS: Five radiomic features were predictive of PC vs. non-PC model, but accuracy and Area Under the Curve (AUC) were 0.49 and 0.472, respectively. In model 2 (PC vs. TB) involving six radiomic features, the accuracy and AUC were 0.80 and 0.815, respectively. Model 3 (PC vs. LC) with six radiomic features performed well, with AUC=0.806 and an accuracy of 0.76. Between the PC and TB groups, model 4 combining radiomics, distribution, and PI, showed AUC=0.870. In differentiating PC from LC, the combination of radiomics, distribution, PI, and RBNAV achieved AUC=0.926 and an accuracy of 0.90. CONCLUSION: The prediction models based on radiomic features from CT images performed well in discriminating PC from TB and LC. The individualized prediction models combining radiomic and CT features achieved the best diagnostic performance.

Left Atrial Dysfunction in Apical Hypertrophic Cardiomyopathy: Assessed by Cardiovascular Magnetic Resonance Feature-tracking.

PURPOSE: To evaluate the left atrial (LA) function in participants with apical hypertrophic cardiomyopathy (AHCM) by cardiovascular magnetic resonance feature tracking (CMR-FT). MATERIALS AND METHODS: Thirty typical AHCM (TAHCM) patients, 23 subclinical AHCM (SAHCM) patients and 32 normal healthy volunteers who underwent CMR exam were retrospectively analyzed. LA reservoir, conduit, and contractile function were quantified by volumetric and CMR-FT derived strain and strain rate (SR) parameters from 2-chamber and 4-chamber cine imaging. RESULTS: Compared with healthy participants, both TAHCM and SAHCM patients had impaired LA reservoir function (total strain [%]: TAHCM 31.3±12.2, SAHCM 31.8±12.3, controls 40.4±10.7, P <0.01; total SR [/s]: TAHCM 1.1±0.4, SAHCM 1.1±0.5, controls 1.4 ± 0.4, P <0.01) and conduit function (passive strain [%]: TAHCM 14.4±7.6, SAHCM 16.4±8.8, controls 23.3±8.1, P <0.01; passive SR [/s]: TAHCM -0.5±0.3, SAHCM -0.6±0.3, controls -1.0±0.4, P <0.01). Regarding contraction function, although TAHCM and SAHCM patients had preserved active emptying fraction and strain (all P >0.05), patients with TAHCM had the lowest active SR value among the 3 groups ( P= 0.03). LA reservoir and conduit strain were both significantly associated with left ventricular mass index and maximal wall thickness (all P <0.05). A moderate correlation between LA passive SR and left ventricular cardiac index ( P <0.01). CONCLUSIONS: The LA reservoir and conduit function are predominately impaired and appeared in both SAHCM and TAHCM patients.

Radiomics in Addition to Computed Tomography-Based Body Composition Nomogram May Improve the Prediction of Postoperative Complications in Gastric Cancer Patients.

OBJECTIVES: The study aimed to determine the impact of computed tomography (CT)-based body composition and radiomics nomogram on the prediction of postoperative complications in gastric cancer. METHODS: The clinical data of 457 individuals with surgically confirmed gastric cancer, 320 patients in the training cohort (TC) and 137 patients in the validation cohort (VC), were retrospectively analyzed. Body composition data were measured using CT. Postoperative complications were graded using the Clavien-Dindo system. Dedicated radiomics prototype software was used to segment lesions and extract characteristics from preoperative portal venous-phase CT images. Clinical, radiomics, and combined models were developed using logistic regression analysis. Model performance was evaluated using the area under the curve (AUC) of receiver operating characteristic curve, and the prediction ability of the optimal model was evaluated using calibration curves and decision curve analysis (DCA). RESULTS: Nutritional Risk Screening 2002 (NRS2002) score, sarcopenia, and blood loss were independent predictors of postoperative complications in gastric cancer. A radiomics signature was created using 19 conserved radiomics features. The nomogram based on both the clinical model and radiomics signature showed the greatest predictive performance, with AUCs of 0.763 (95% confidence interval [CI], 0.708-0.817) and 0.748 (95% CI: 0.667-0.818) in the TC and VC, respectively. The calibration curve and DCA revealed that the nomogram was beneficial in clinical practice for the preoperative prediction of postoperative complications. CONCLUSIONS: The combined model consisting of NRS2002 score, sarcopenia, blood loss, and a radiomics signature holds potential application value for the individualized prediction of postoperative complications in gastric cancer patients.

The value of multi-parameter diffusion and perfusion magnetic resonance imaging for evaluating epithelial-mesenchymal transition in rectal cancer.

PURPOSE: Epithelial-mesenchymal transition (EMT) is characterized by a decreased expression of E-cadherin and an increased expression of vimentin, which is associated with poor prognosis in rectal cancer. This study aimed to explore the feasibility of using multi-parameter diffusion and perfusion magnetic resonance imaging (MRI) to evaluate the expression of E-cadherin and vimentin. METHODS: One hundred and ten patients with rectal cancer, who underwent preoperative multi-parameter diffusion and perfusion MRI and subsequent radical resection of rectal carcinoma, were included in this prospective study. The expression of E-cadherin, vimentin, vascular endothelial growth factor (VEGF), and Ki67 was identified by immunohistochemical test and MRI morphology features; quantitative parameters were analyzed and combined diagnostic models were created by binary logistic regression. The receiver operating characteristics curve with area under the curve (AUC) was used to evaluated diagnostic performance. Interobserver agreement for MRI parameters was evaluated by intraclass correlation coefficient. RESULTS: In the low expression E-cadherin group, the VEGF expression was significantly higher than the high expression group (60.5% vs 37.3%, P < 0.05), and the Ki67 expression had no significant difference (P > 0.05). In the high expression vimentin group, the Ki67 expression was significantly higher than the low expression group (77.3% vs 56.1%, P < 0.05), and the VEGF expression was not significantly significant (P > 0.05). MRI morphological features had no significant diagnostic efficacy for E-cadherin and vimentin expression in rectal cancer (P > 0.05). There were positive and negative correlations between apparent diffusion coefficient (ADC) values with E-cadherin and vimentin expression (P < 0.05), the Ktrans and Kep values were negatively and positively correlated with the expression of E-cadherin and vimentin (P < 0.05). The ADC value (b = 3000 s/mm2) had mild significant diagnostic efficiencies for low E-cadherin expression and high vimentin expression (AUC = 0.63 and 0.644, P < 0.05), the Ktrans and Kep values had significant diagnostic efficiencies (AUC = 0.801 and 0.724, P < 0.05; AUC = 0.722 and 0.628, P < 0.05, respectively). The combined model of ADC, Ktrans, and Kep values had good diagnostic efficiencies for low E-cadherin expression and high vimentin expression (AUC = 0.814 and 0.728, P < 0.05). CONCLUSION: The quantitative parameters of diffusion (with ultra-high b-values) and perfusion MRI can assess the major biomarkers of EMT in rectal cancer, and the combined diagnostic model could further improve the evaluating efficiency for EMT, which possibly can provide valuable information for non-invasive and preoperative assessment of the tumor microenvironment.

Comparative Study of Diagnostic Efficacy of Single Phase-Computed Tomography Pulmonary Angiography and Dual Phase-Computed Tomography Pulmonary Angiography in the Diagnosis of Pulmonary Embolism.

Objective: We compared the efficacy of single phase-computed tomography pulmonary angiography (SP-CTPA) and dual phase-computed tomography pulmonary angiography (DP-CTPA) for the diagnosis of pulmonary embolism (PE). Methods: We recruited 1,019 consecutive patients (359 with PE) who underwent DP-CTPA (phase I: pulmonary artery phase; phase II: aortic phase) for suspected PE between January and October 2021. Phase I of DP-CTPA was used as SP-CTPA, and the final clinical diagnosis (FCD) was used as the gold standard. Results: Three hundred fifty-two cases of PE were detected by both methods, with the same sensitivity of 98.1% (99.6-99.5%). Using SP-CTPA, 142 cases [13 pulmonary insufficiency artifacts (PIA) and 129 systemic-pulmonary shunt artifacts (S-PSA)] were false-positive with specificity of 78.5% (75.3-81.6%). No false-positive was found with DP-CTPA, with specificity of 100%, positive predictive value of 1, and negative predictive value of 0.990 (Net Reclassification Improvement = 0.215; P < 0.05). According to FCD, the positive results of SP-CTPA were divided into PIA, S-PSA, and true-positive (TPSP-CTPA) groups, and pairwise comparisons were performed. The bronchiectasis and hemoptysis rate in S-PSA group was higher than that in PIA and TP groups (P < 0.001), and the pulmonary hypertension (PH) rate in PIA group was higher than that in S-PSA and TP groups (P < 0.001). Conclusion: The diagnostic efficiency of DP-CTPA for the diagnosis of PE was high. SP-CTPA may misdiagnose PIA (common in patients with PH) and S-PSA (common in patients with bronchiectasis and hemoptysis) as PE.

Correlations between CT perfusion parameters and vascular endothelial growth factor expression and microvessel density in implanted VX2 lung tumors.

To evaluate the correlation between CT perfusion parameters and tumor angiogenesis, expression of VEGF is implanted in VX2 lung tumor. VX2 tumor cells were injected in 15 healthy New Zealand rabbits. After 20 days, tumors with diameter over 7 mm were scanned with 16 row spiral CT. Using Software Perfusion 3, blood flow (BF), blood volume (BV), permeability surface area product (PS), and the maximum attenuation value (MAV) were obtained. After CT examination, rabbit was sacrificed, and slices from tumor tissue were prepared and checked with immunohistochemical staining with anti-CD34 and anti-VEGF monoclonal antibodies. Correlation of CT perfusion parameters with MVD and VEGF expression was determined by using Pearson correlation analysis. Blood supply of tumor and regions around tumor was higher than that of normal lung tissue. PS value increased sharply in tumor tissue. PS value in regions around tumor was also higher than that of normal lung tissue but lower than that of tumor tissue. Significant positive correlation was observed between CT perfusion parameters (BF, BV, PS, and MAV) and expression of VEGF and MVD in tumor tissue. CT perfusion parameters provide reliable information of the microcirculation in tumor tissue; therefore, it can be used as indexes to characterize angiogenesis of tumor.