Contrast-enhanced CT Research Articles

Deep learning to estimate response of concurrent chemoradiotherapy in non-small-cell lung carcinoma

BackgroundConcurrent chemoradiotherapy (CCRT) is a crucial treatment for non-small cell lung carcinoma (NSCLC). However, the use of deep learning (DL) models for predicting the response to CCRT in NSCLC remains unexplored. Therefore, we constructed a DL model for estimating the response to CCRT in NSCLC and explored the associated biological signaling pathways.MethodsOverall, 229 patients with NSCLC were recruited from six hospitals. Based on contrast-enhanced computed tomography (CT) images, a three-dimensional ResNet50 algorithm was used to develop a model and validate the performance in predicting response and prognosis. An associated analysis was conducted on CT image visualization, RNA sequencing, and single-cell sequencing.ResultsThe DL model exhibited favorable predictive performance, with an area under the curve of 0.86 (95% confidence interval [CI] 0.79–0·92) in the training cohort and 0.84 (95% CI 0.75–0.94) in the validation cohort. The DL model (low score vs. high score) was an independent predictive factor; it was significantly associated with progression-free survival and overall survival in both the training (hazard ratio [HR] = 0.54 [0.36−0.80], P = 0.002; 0.44 [0.28−0.68], P < 0.001) and validation cohorts (HR = 0.46 [0.24−0.88], P = 0.008; 0.30 [0.14−0.60], P < 0.001). The DL model was also positively related to the cell adhesion molecules, the P53 signaling pathway, and natural killer cell-mediated cytotoxicity. Single-cell analysis revealed that differentially expressed genes were enriched in different immune cells.ConclusionThe DL model demonstrated a strong predictive ability for determining the response in patients with NSCLC undergoing CCRT. Our findings contribute to understanding the potential biological mechanisms underlying treatment responses in these patients.

Variants of Mutual Arrangement of Parts of Human Pancreas According to Computed Tomography Data

INTRODUCTION: With development of methods of diagnosis and surgical treatment of diseases of hepatopancreato-biliary region, there is increasing interest in and necessity to search for various methods of studying organs of this zone. Compared to the earlier methods of studying topographic anatomy, the method of computed tomography (KT) permits to work with a wide scope of lifetime data of human anatomy. We did not find enough information in the literature about peculiarities of the shape, size and position of pancreas in the horizontal projection. AIM: To study the peculiarities of the shape, size and position of the pancreas using contrast-enhanced CT data. MATERIALS AND METHODS: The work was based on the available archive of examination of organs of the abdominal cavity by CT method with contrast in patients (n = 31) without pathology of the hepatopancreatobiliary zone, gastrointestinal tract, spleen, kidneys and spine. Measurements were performed based on the horizontal projection of scans. The length was determined by measuring the organ in parts. The degree of curvature of the pancreas shape was determined by constructing the central axis of the organ and measuring the angles formed by it. The obtained data were subjected to statistical processing. RESULTS: According to increase in the length of the organ, three groups were formed. Different degrees of the organ bending were identified. Upon that, no clear correlation was found with skeletopy data, age and gender and parametric data of the upper part of the abdominal cavity. CONCLUSION: Owing to the developed method of measuring angles between parts of the pancreas, a range of mutual arrangement of the head and body, body and tail of the gland in the horizontal projection was obtained. Our data complement the anatomy of the pancreas and can be considered as a promising resource for further study of the features of syntopy and blood supply of the organs of the upper part of the abdominal cavity.

Unusual gastrointestinal bleeding - Small intestinal venous ectasias.

A 34-year-old man presented to our emergency department with a 6-day history of bloody stools. He had no complaints of alteration in bowel habits in the stool. He did not consume alcohol and was a non-smoker. The patient had no any previous notable medical history or family history of similar complaints. Physical examination was unremarkable. In the local hospital, laboratory studies showed a hemoglobin level of 6.0g per deciliter (normal range, 11.5 to 15.5). After blood transfusion, an upper gastrointestinal endoscopy and complete colonoscopy did not reveal any bleeding lesion. In our hospital, the patient underwent abdominal contrast-enhanced CT, small intestinal venous ectasias were detected. The selective angiography was performed, but no aneurysm or arteriovenous fistula was found. The gastrointestinal tract bleeding still occurred for an unknown reason. Subsequently, single-balloon enteroscopy was carried out. By oral approach enteroscopy, obvious jejunum venous ectasias were detected.

A rare case of intestinal obstruction due to tuberculosis.

A 19-year-old previously healthy patient presented with severe abdominal pain. A contrast-enhanced CT scan identified ileal obstruction and lower left lung lobe changes suggestive of an inflammatory process. Diagnostic laparoscopy revealed ileal distension, hyperemia, and whitish nodules on the serosa. Acid-fast bacilli staining was positive, confirming Mycobacterium tuberculosis infection. The patient improved with a tuberculosis regimen. Intestinal TB often affects the ileocecal area and presents with symptoms like abdominal pain and obstruction. Diagnosis is confirmed by AFB staining, and treatment mirrors pulmonary TB, though surgery may be needed for complications.

Computed tomography-based radiomics nomogram for prediction of lympho-vascular and perineural invasion in esophageal squamous cell cancer patients: a retrospective cohort study

PurposeLympho-vascular invasion (LVI) and perineural invasion (PNI) have been established as prognostic factors in various types of cancers. The preoperative prediction of LVI and PNI has the potential to guide personalized medicine strategies for patients with esophageal squamous cell cancer (ESCC). This study investigates whether radiomics features derived from preoperative contrast-enhanced CT could predict LVI and PNI in ESCC patients.Methods and materialsA retrospective cohort of 544 ESCC patients who underwent esophagectomy were included in this study. Preoperative contrast-enhanced CT images, pathological results of PNI and LVI, and clinical characteristics were collected. For each patient, the gross tumor volume (GTV-T) and lymph nodes volume (GTV-N) were delineated and four categories of radiomics features (first-order, shape, textural and wavelet) were extracted from GTV-T and GTV-N. The Mann–Whitney U test was used to select significant features associated with LVI and PNI in turn. Subsequently, radiomics signatures for LVI and PNI were constructed using LASSO regression with ten-fold cross-validation. Significant clinical characteristics were combined with radiomics signature to develop two nomogram models for predicting LVI and PNI, respectively. The area under the curve (AUC) and calibration curve were used to evaluate the predictive performance of the models.ResultsThe radiomics signature for LVI prediction consisted of 28 features, while the PNI radiomics signature comprised 14 features. The AUCs of the LVI radiomics signature were 0.77 and 0.74 in the training and validation groups, respectively, while the AUCs of the PNI radiomics signature were 0.69 and 0.68 in the training and validation groups. The nomograms incorporating radiomics signatures and significant clinical characteristics such as age, gender, thrombin time and D-Dimer showed improved predictive performance for both LVI (AUC: 0.82 and 0.80 in the training and validation group) and PNI (AUC: 0.75 and 0.72 in the training and validation groups) compared to the radiomics signature alone.ConclusionThe radiomics features extracted from preoperative contrast-enhanced CT of gross tumor and lymph nodes have demonstrated their potential in predicting LVI and PNI in ESCC patients. Furthermore, the incorporation of clinical characteristics has shown additional value, resulting in improved predictive performance.

A flexible deep learning framework for liver tumor diagnosis using variable multi-phase contrast-enhanced CT scans

BackgroundLiver cancer is a significant cause of cancer-related mortality worldwide and requires tailored treatment strategies for different types. However, preoperative accurate diagnosis of the type presents a challenge. This study aims to develop an automatic diagnostic model based on multi-phase contrast-enhanced CT (CECT) images to distinguish between hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and normal individuals.MethodsWe designed a Hierarchical Long Short-Term Memory (H-LSTM) model, whose core components consist of a shared image feature extractor across phases, an internal LSTM for each phase, and an external LSTM across phases. The internal LSTM aggregates features from different layers of 2D CECT images, while the external LSTM aggregates features across different phases. H-LSTM can handle incomplete phases and varying numbers of CECT image layers, making it suitable for real-world decision support scenarios. Additionally, we applied phase augmentation techniques to process multi-phase CECT images, improving the model’s robustness.ResultsThe H-LSTM model achieved an overall average AUROC of 0.93 (0.90, 1.00) on the test dataset, with AUROC for HCC classification reaching 0.97 (0.93, 1.00) and for ICC classification reaching 0.90 (0.78, 1.00). Comprehensive validation in scenarios with incomplete phases was performed, with the H-LSTM model consistently achieving AUROC values over 0.9.ConclusionThe proposed H-LSTM model can be employed for classification tasks involving incomplete phases of CECT images in real-world scenarios, demonstrating high performance. This highlights the potential of AI-assisted systems in achieving accurate diagnosis and treatment of liver cancer. H-LSTM offers an effective solution for processing multi-phase data and provides practical value for clinical diagnostics.

Exploring the Intersection of Blood Transfusion and Same-Day Computed Tomography Imaging: An Overview of Clinical Risks and Practices.

The use of transfusions, whether involving whole blood or specific blood components, is essential for managing various clinical conditions. Many cases are acute, often requiring post-transfusion imaging evaluation. While there is no absolute contraindication for chest imaging following blood transfusion, it should be approached cautiously. We conducted a comprehensive search across multiple databases and registries. Research studies were limited to full-text original articles, reviews, and case reports published in English, involved human subjects, and focused on the interplay between blood transfusions and contrast-enhanced imaging. Scientific analyses were excluded if they did not focus on transfusion practices in the context of imaging or failed to address issues such as hemoglobin thresholds, transfusion reactions, or the clinical implications of contrast agents. Our research fills this gap by emphasizing the need for a cautious, multidisciplinary approach to post-transfusion computed tomography (CT) scans, especially in the presence of contrast agents. This study calls for increased awareness of the heightened risk of complications, such as autoimmune hemolysis, when both procedures are performed together. New insights from our research recommend individualized assessments and close patient monitoring when combining these interventions. Nevertheless, patients need to be hemodynamically and clinically stable before undergoing CT. Discussions. Symptoms that develop within the first 24 h post-transfusion are classified as secondary post-transfusion reactions unless proven otherwise. The prevalence of side effects from same-day CT scans and blood transfusions is challenging to quantify, as few studies focus on this combination. Transfusions and contrast-enhanced CT scans share overlapping adverse reactions and carry significant risks. Acute hemolytic red blood cell transfusion reactions are among the most frequent side effects, with a prevalence of 1:12,000-38,000. Conclusion. Our study contributes new insights to the literature by filling the gap concerning the interplay between transfusions and contrast media, paving the way for more informed clinical protocols to enhance patient safety.

Superior Identification of Metastatic Lesions by 68 Ga-FAPI-46 PET/CT Than 18 F-FDG PET/CT in Hepatic Solitary Fibrous Tumor.

Solitary fibrous tumors (SFTs) are fibroblast tumors that occur mainly in the pleura. Hepatic SFT with skeleton metastases was rarely documented. In this case, we report the contrast-enhanced CT, 18 F-FDG, and 68 Ga-FAPI-46 PET/CT findings of a rare hepatic SFT with bone metastases. 68 Ga-FAPI-46 PET/CT showed much higher tumor-to-background contrast of hepatic tumors and revealed more metastatic bone lesions than 18 F-FDG PET/CT. This case demonstrated the superiority of 68 Ga-FAPI-46 PET/CT over 18 F-FDG for identifying metastatic lesions in malignant SFTs. This observation may add information on the benefit of FAPI PET/CT in SFT staging.

Validation of clinical tumor depth of invasion measure in patients with oral cavity cancer

ObjectivesThe 8th edition of the American Joint Committee on Cancer (AJCC) for head and neck malignancies incorporated depth of invasion (DOI) for oral cavity squamous cell carcinoma (OCSCC). Currently, there is no standardized method to determine clinical DOI (cDOI). We aim to validate radiologic DOI (rDOI) utilizing contrast-enhanced computed tomography (CECT) imaging. Materials and MethodsRadiographic DOI was defined as the coronal measurement of the deepest margin parallel to the expected normal mucosal plane. To establish a valid, accurate and repeatable rDOI, a retrospective cohort at a single institution tertiary hospital underwent preoperative CECT. Radiographic DOI was independently assessed by 2 neuroradiologists. Correlation was determined between rDOI and pDOI. A prospective pilot study of 49 patients with newly diagnosed OCSCC underwent rDOI assessment compared to final pDOI to assess our rDOI method clinical applicability. ResultsNeuroradiologists demonstrated a high degree of predictability between rDOI and pDOI with as great as 90.91% accuracy for readable CECTs. Inter-observer correlations were strong in the retrospective (Session 1: ICC= 0.956; Session 2: ICC= 0.932) and prospective cohorts (Session 1: ICC= 0.859; Session 2: ICC=0.913) illustrating reliability. Intraobserver correlations were also strong (Retrospective Reader 1 ICC=0.968, Reader 2 ICC=0.941; prospective Reader 1 ICC=0.965, Reader 2 ICC=0.800, p<0.001). T1 lesions were immeasurable 25-62.5% of the time. ConclusionsUsing CECT, the coronal measurement of the deepest margin parallel to the expected normal mucosal plane can enhance determination of a reliable cDOI in OCSCC corresponding to pDOI without change in staging for T2 and greater lesions.

Optimization of surgical evaluation algorithms for living donor liver transplantation

BackgroundLiving donor liver transplantation (LDLT) is an established and endorsed alternative for deceased donor liver transplantation with better recipient outcomes. Nevertheless, while extensive evaluation of potential donors is crucial, evaluation algorithms differ between transplant centres and guidelines. MethodsWe included 317 individuals evaluated for LDLT between 07/2007–07/2022 in a retrospective analysis. The evaluation process was analysed to identify the key reasons for declining 77 potential donors. Additionally, 146 donors that underwent LDLT were analysed regarding risk factors for complications. ResultsThe main reasons for donor refusal were liver volumetry (40.3 %) and metabolic factors including obesity or steatotic liver disease (20.8 %). Contrast-enhanced computed tomography (CECT) identified 63.6 % of all declined donors; CECT combined with assessment of medical history, physical examination, blood testing and ultrasonography, identified 87.0 % of declined potential donors. Associated with this selection, complication rates in donors were low (≥II in 17.1 %; none with ≥IVb). Notably, higher age was a risk factor for developing a complication ≥II after hemi-hepatectomy (p = 0.0373). ConclusionsWe propose a progressive 4-step evaluation algorithm that begins with a very basic assessment combined with up-front CECT. This early phase of testing is expected to identify nearly 90 % of ineligible donors, thereby conserving critical resources, time and money, as well as minimising burden for potential donors. FundingJ.M.W. received funding by grant We-4675/6–1 from the Deutsche Forschungsgemeinschaft (DFG) in Bonn, Germany.

Leakage sign based on contrast-enhanced CT is a predictive marker for hematoma expansion and poor prognosis in primary brainstem hemorrhage

BackgroundAlthough hematoma expansion is a poor prognostic factor in patients with intracerebral hemorrhage (ICH), its effect on primary brainstem hemorrhage (PBSH) remains unclear. Since we previously observed the “leakage sign” (LS) on computed tomography (CT) to be a significant predictor for hematoma expansion, we herein investigated the effect of LS in PBSH. MethodsBetween January 2013 and August 2023, 515 patients with ICH were admitted to our institute. Thirty-six patients with PBSHs met the inclusion criteria, who were then divided into LS-positive (LS+) and LS-negative (LS-) groups based on the presence of LS. We evaluated hematoma expansion and prognosis at discharge. ResultsPatients in the LS+ group had larger baseline hematoma volume and lower Glasgow Coma Scale scores on admission and significantly poor prognosis at discharge. Subgroup analysis revealed that LS was frequently observed within 100 min after the onset of symptoms in patients with a hematoma size of >10 mm3 on CT; additionally, patients in the LS+ group more frequently experienced hematoma expansion and had poor prognosis at discharge. ConclusionLS is a significant predictive marker for disease severity at admission, hematoma expansion, and poor prognosis at discharge

A deep learning algorithm for the detection of aortic dissection on non-contrast-enhanced computed tomography via the identification and segmentation of the true and false lumens of the aorta.

Aortic dissection is a life-threatening clinical emergency, but it is often missed and misdiagnosed due to the limitations of diagnostic technology. In this study, we developed a deep learning-based algorithm for identifying the true and false lumens in the aorta on non-contrast-enhanced computed tomography (NCE-CT) scans and to ascertain the presence of aortic dissection. Additionally, we compared the diagnostic performance of this algorithm with that of radiologists in detecting aortic dissection. We included 320 patients with suspected acute aortic syndrome from three centers (Beijing Anzhen Hospital Affiliated to Capital Medical University, Fujian Provincial Hospital, and Xiangya Hospital of Central South University) between May 2020 and May 2022 in this retrospective study. All patients underwent simultaneous NCE-CT and contrast-enhanced CT (CE-CT). The cohort comprised 160 patients with aortic dissection and 160 without aortic dissection. A deep learning algorithm, three-dimensional (3D) full-resolution U-Net, was continuously trained and refined to segment the true and false lumens of the aorta to determine the presence of aortic dissection. The algorithm's efficacy in detecting dissections was evaluated using the receiver operating characteristic (ROC) curve, including the area under the curve (AUC), sensitivity, and specificity. Furthermore, a comparative analysis of the diagnostic capabilities between our algorithm and three radiologists was conducted. In diagnosing aortic dissection using NCE-CT images, the developed algorithm demonstrated an accuracy of 93.8% [95% confidence interval (CI): 89.8-98.3%], a sensitivity of 91.6% (95% CI: 86.7-95.8%), and a specificity of 95.6% (95% CI: 91.2-99.3%). In contrast, the radiologists achieved an accuracy of 88.8% (95% CI: 83.5-94.1%), a sensitivity of 90.6% (95% CI: 83.5-94.1%), and a specificity of 94.1% (95% CI: 72.9-97.6%). There was no significant difference between the algorithm's performance and radiologists' mean performance in accuracy, sensitivity, or specificity (P>0.05). The algorithm proficiently segments the true and false lumens in aortic NCE-CT images, exhibiting diagnostic capabilities comparable to those of radiologists in detecting aortic dissection. This suggests that the algorithm could reduce misdiagnoses in clinical practice, thereby enhancing patient care.

Giant intra-abdominal desmoid-type fibromatosis infiltrating into the pancreas

Abstract: Intra-abdominal desmoid-type fibromatosis is a proliferative fibroblastic lesion that constitutes 8% of all desmoid tumors and 0.03% of all neoplasm. It is histologically benign with a local aggressive nature and recurs even after excision. It can occur sporadically and or associated with familial adenomatous polyposis mutation. The present case is a 25-year-old female admitted with a chief complaint of abdominal mass gradually increasing in size in the last 6 months. Ultrasound of the whole abdomen initially suggested it to be a uterine/ovarian mass, which is further detailed by the contrast-enhanced computerized tomography (CT) scan. The CT scan showed a large heterodense intraperitoneal mass lesion measuring 34 cm × 25 cm × 16 cm with foci of calcification and necrosis. The mass extended superomedially. It displaced and compressed the stomach wall. It was abutting the peritoneum and was associated with diffuse peritoneal thickening anterolaterally. Posteriorly it was abutting small bowel loops and inferiorly extending into the pelvis and compressing the urinary bladder wall. Posterosuperiorly seems to abut the left kidney and spleen. Desmoid tumor and gastrointestinal stromal tumor (GIST) remained as differentials radiologically and then the patient underwent laparotomy. Histology and immunohistochemistry confirmed it to be fibromatosis. It is, therefore, justified to describe the tumor by considering its rarity, difficulties in diagnosis, and therapeutic ambit.

Symptomology of celiac artery compression: Classifying patients by the degree of celiac artery stenosis and secondary changes in collateral branches on computed tomography angiogram

PurposeThis study aimed to analyze the correlation between the degree of celiac artery (CA) stenosis and the secondary changes in collateral branches in patients with CA compression (CAC) by CT and to classify patients by the combination of the two imaging features. MethodsPatients with CAC identified by contrast-enhanced CT from January 2012 to December 2013 were retrospectively enrolled and divided into the symptomatic group and asymptomatic group. CA stenosis was categorized as mild, moderate, or severe, and collateral circulation as invisible, visible, or prominent. The correlation between the imaging features was analyzed with Kendall’s Tau-b. Multivariate regression identified risk factors for symptomatic CAC. And patients were further classified into three subtypes (Type A to C) based on CA stenosis and collateral circulation. ResultsThis study included 150 patients (79 men, 71 women), with 49 (32.7 %) symptomatic. The collateral circulation classification correlated with the CA stenosis (Tau-b = 0.295, p < 0.001). And both imaging features were proven to be independent risk factors for the symptomatic CAC (all p < 0.05). Of the three subtypes of patients, only one patient with Type A (1/26 [3.8 %]) was symptomatic; a small proportion of patients with Type B (23/99 [23.2 %]) were symptomatic; and all patients with Type C (25/25 [100 %]) were symptomatic. ConclusionsThe development of collateral circulation is positively correlated with the degree of CA stenosis. Our proposed classification system based on the combination of the degree of CA stenosis and collateral circulation helps to identify patients with symptomatic CAC.

Renal Cell Carcinoma With Tumor Thrombus Extending Into the Inferior Vena Cava and the Right Atrium Demonstrated by 68 Ga-DOTATATE PET/CT.

Approximately 10% of all renal cell carcinoma (RCC) patients develop a venous tumor thrombus, a major negative prognostic factor. Surgical excision is commonly required for RCC patients with tumor thrombus. Accurate preoperative diagnosis and assessment of tumor thrombus level is vital because the level of thrombus may influence treatment decisions. MRI, contrast-enhanced CT, 18 F-FDG PET/CT, and 68 Ga-PSMA PET/CT have been used to diagnose and evaluate the extent of tumor thrombus in RCC. However, no case of RCC with inferior vena cava tumor thrombus showing 68 Ga-DOTATATE uptake has been reported yet. Herein, we report a case of metastatic RCC with tumor thrombus in the inferior vena cava on 68 Ga-DOTATATE PET/CT.

Thoracic MRI in pleural infection – a feasibility study from patients’ and radiographers’ perspectives

BackgroundPleural infections present significant clinical challenges, particularly in elderly or immunosuppressed patients, leading to prolonged hospital stay, high morbidity and high mortality. While CT and X-ray are standard imaging modalities, MRI's potential remain unexplored due to historical limitations in scan duration and patient discomfort. Advances in MRI technology, however, may enable its broader use in thoracic imaging. The study aimed to explore the feasibility of thoracic MRI from the radiographers’ and patients’ perspectives. MethodsA prospective feasibility study was conducted involving thirteen patients with pleural infections who underwent thoracic MRI as an add-on within 48 hours of the conventional contrast-enhanced chest CT. Feasibility was assessed on technical success, and scan duration. Patients and radiographers experiences were evaluated through questionnaires and qualitative comments. ResultsTechnical success was high as all thirteen patients completed the scans. The mean in-room time was 30.7±5.5 minutes and the mean scan time was 23±5.4 minutes. Radiographers reported the MRI scans as feasible with few patients requiring breaks or assistance. Most patients found the MRI experience manageable though two reported difficulties with breath-hold instructions. No patients were challenged by lying in supine position and no patients felt very anxious. No significant movement- or breathing artefacts were identified on MRI. ConclusionThoracic MRI is feasible with high technical success, acceptable scan time, and good patient experience in patients with pleural infections offering potential as a radiation-free imaging modality. Furthermore, compared to CT, the use of MRI showed potential advantages in identifying pleural effusion septations.

Effects of iodine contrast media on thyroid function - a prospective study.

When exposed to iodine contrast medium (ICM), thyroid dysfunction may develop, due to excess amounts of iodide. The incidence of contrast-induced thyroid dysfunction has been difficult to interpret, because of the observational and retrospective designs of most previous studies. With the Swedish CArdioPulmonary bioImage Study (SCAPIS), where randomly selected individuals aged 50-65 years, underwent contrast-enhanced coronary CT angiography (CCTA), we were able to prospectively assess the incidence, magnitude and clinical impact of contrast-induced thyroid dysfunction. In 422 individuals, thyroid hormone levels were analysed before and 4-12 weeks after CCTA. Thyroid-related patient-reported outcome questionnaires (ThyPRO) at the time of pre and post CCTA blood samplings were provided by 368 of those individuals. Thyroid peroxidase antibodies (TPOab) were analysed and ultrasound of the thyroid gland was performed to detect any thyroid nodules. There was a small statistically significant effect on thyroid hormone levels but no cases of overt hypo- or hyperthyroidism after ICM. Subclinical hypo- or hyperthyroidism or isolated low/high levels of free thyroxine (fT4) developed in 3.5% of the population with normal hormone levels pre-CCTA, but without any increased thyroid-related symptoms compared to the remaining cohort. Elevated TPOab and being born outside Sweden were risk factors of developing subclinical hypothyroidism. Presence of thyroid nodules was not associated with ICM-induced thyroid dysfunction. The results of this prospective study support the notion that in iodine-sufficient countries, ICM associated thyroid dysfunction is rare, usually mild, self-limiting and oligo/asymptomatic in subjects aged 50-65 years.

Radiomics Signatures Based on Computed Tomography for Noninvasive Prediction of CXCL10 Expression and Prognosis in Ovarian Cancer.

Ovarian cancer (OC) is an aggressive gynecological tumor usually diagnosed with malignant ascites and even observed widespread metastasis or distant spread. We aimed to develop and identify radiomics models according to computed tomography (CT) for preoperative prediction of CXCL10 expression and prognosis in patients with OC. Genomic data with CT images and corresponding clinicopathological parameters were extracted from The Cancer Imaging Archive (TCIA) and The Cancer Genome Atlas (TCGA). To analyze the prognosis, we carried out the univariate Cox regression analysis (UCRA), multivariate Cox regression analysis (MCRA), and Kaplan-Meier (KM) analysis. For the data reduction, logistic regression, operator regression, least absolute shrinkage selection, radiomic feature construction, and feature selection were utilized. The predictive performance of the radiomic signatures was assessed using the analyses of the receiver operating characteristic (ROC) curve, decision curve (DCA), and precision-recall (PR) curve. To evaluate the correlation between the radiomic score (Rad-score) and CXCL10 expression, the Wilcoxon rank-sum test was applied. Three radiomics models effectively predicted CXCL10 expression levels (AUC = 0.791, 0.748, and 0.718 for the set of training; AUC = 0.761, 0.746, and 0.701 for the set of validation). A higher Rad-score significantly correlated with upregulated CXCL10 expression. CXCL10 expression can be predicted noninvasively and preoperatively via radiomic signatures based on contrast-enhanced CT images.

CT assessed morphological features can predict higher mitotic index in gastric gastrointestinal stromal tumors.

To investigate the correlation of the mitotic index (MI) of 1-5 cm gastric gastrointestinal stromal tumors (gGISTs) with CT-identified morphological and first-order radiomics features, incorporating subgroup analysis based on tumor size. We enrolled 344 patients across four institutions, each pathologically diagnosed with 1-5 cm gGISTs and undergoing preoperative contrast-enhanced CT scans. Univariate and multivariate analyses were performed to investigate the independent CT morphological high-risk features of MI. Lesions were categorized into four subgroups based on their pathological LD: 1-2 cm (n = 69), 2-3 cm (n = 96), 3-4 cm (n = 107), and 4-5 cm (n = 72). CT morphological high-risk features of MI were evaluated in each subgroup. In addition, first-order radiomics features were extracted on CT images of the venous phase, and the association between these features and MI was investigated. Tumor size (p = 0.04, odds ratio, 1.41; 95% confidence interval: 1.01-1.96) and invasive margin (p < 0.01, odds ratio, 4.55; 95% confidence interval: 1.77-11.73) emerged as independent high-risk features for MI > 5 of 1-5 cm gGISTs from multivariate analysis. In the subgroup analysis, the invasive margin was correlated with MI > 5 in 3-4 cm and 4-5 cm gGISTs (p = 0.02, p = 0.03), and potentially correlated with MI > 5 in 2-3 cm gGISTs (p = 0.07). The energy was the sole first-order radiomics feature significantly correlated with gGISTs of MI > 5, displaying a strong correlation with CT-detected tumor size (Pearson's ρ = 0.85, p < 0.01). The invasive margin stands out as the sole independent CT morphological high-risk feature for 1-5 cm gGISTs after tumor size-based subgroup analysis, overshadowing intratumoral morphological characteristics and first-order radiomics features. Question How can accurate preoperative risk stratification of gGISTs be achieved to supporttreatment decision-making? Findings Invasive margins may serve as a reliable marker for risk prediction in gGISTs up to 5 cm, rather than surface ulceration, irregular shape, necrosis, or heterogeneous enhancement. Clinical relevance For gGISTs measuring up to 5 cm, preoperative prediction of the metastatic risk could help select patients who could be treated by endoscopic resection, thereby avoiding overtreatment.

N-(2,3-dihydroxypropyl) carbamoyl side chain: a potentially significant factor for recurrent iodinated contrast medium-related adverse drug reactions.

To determine whether switching to contrast media based on the sharing of N-(2,3-dihydroxypropyl) carbamoyl side chain reduces the recurrence of iodinated contrast media (ICM)-associated adverse drug reactions (ADRs). This single-center retrospective study included 2133 consecutive patients (mean age ± SD, 56.1 ± 11.4 years; male, 1052 [49.3%]) who had a history of ICM-associated ADRs and underwent contrast-enhanced CT examinations. The per-patient and per-exam-based recurrence ADR rates were compared between cases of switching and non-switching the ICM from ICMs that caused the previous ADRs, and between cases that used ICMs with common and different carbamoyl side chains from ICMs that caused the previous ADRs. Downgrade rates (no recurrence or the occurrence of ADR less severe than index ADRs) were also compared. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analysis were additionally performed. In per-patient analysis, switching of ICM showed a lower recurrence rate (switching, 10.4% [100/965] vs. non-switching, 28.4% [332/1168]), with the adjusted odds ratio (OR) of 0.27 (95% CI: 0.21, 0.34; p < 0.001). The result was consistent in PSM (OR, 0.29 [95% CI: 0.22, 0.39]; p < 0.001), IPTW (OR, 0.28 [95% CI: 0.22, 0.36]; p < 0.001), and in per-exam analysis (5.5% vs. 13.8%; OR, 0.32 [95% CI: 0.27, 0.37]; p < 0.001). There was lower per-exam recurrence (5.0% [195/3938] vs. 7.8% [79/1017]; OR, 0.63 [95% CI: 0.47, 0.83]; p = 0.001) and higher downgrade rates (95.6% [3764/3938] vs. 93.3% [949/1017]; OR, 1.51 [95% CI: 1.12, 2.03]; p = 0.006) when using different side chain groups. Switching to an ICM with a different carbamoyl side chain reduced the recurrent ADRs and their severity during subsequent examinations. Switching to an iodinated contrast media with a different carbamoyl side chain reduced the recurrent adverse drug reactions and their severity during subsequent examinations.