Imaging Examination Research Articles

Pitfalls in Interpretive Applications of Artificial Intelligence in Radiology.

Interpretive artificial intelligence (AI) tools are poised to change the future of radiology. However, certain pitfalls may pose particular challenges for optimal AI interpretative performance. These include anatomic variants, age-related changes, postoperative changes, medical devices, image artifacts, lack of integration of prior and concurrent imaging examinations and clinical information, and the satisfaction-of-search effect. Model training and development should account for such pitfalls to minimize errors and optimize interpretation accuracy. More broadly, AI algorithms should be exposed to diverse and complex training datasets to yield a holistic interpretation that considers all relevant information beyond the individual examination. Successful clinical deployment of AI tools will require that radiologist end users recognize these pitfalls and other limitations of the available models. Furthermore, developers should incorporate explainable AI techniques (e.g., heat maps) into their tools, to improve radiologists' understanding of model outputs and to enable radiologists to provide feedback for guiding continuous learning and iterative refinement. In this article, we provide an overview of common pitfalls that radiologists may encounter when using interpretive AI products in daily practice. We present how such pitfalls lead to AI errors and offer potential strategies that AI developers may use for their mitigation.

Prenatal Diagnosis of Reno-Urinary Malformations in a Tertiary Center of Republic of Moldavia.

Malformative uropathy in children is one of the most common pathological conditions, with an incidence of 5-14% in newborns. Recent research shows that even in the current conditions, they are often diagnosed only in the advanced stages, when Chronic Kidney Disease is already affirming. This study's objective is to identify urinary tract anomalies, including malformative uropathies in the prenatal stage, using imaging techniques, namely ultrasound of the pregnant uterus. Using prenatal ultrasonography of the pregnant uterus and postnatal clinical and paraclinical examination, we prospectively evaluated a cohort of fifty children with pyelectasia. We describe the demographic and pathological characteristics of patients diagnosed with renal-urinary abnormalities, as well as their postnatal management. A prenatal diagnosis made during the first 15 to 22 weeks of pregnancy enables the evaluation of early malformative uropathies and the determination of the best time to operate in order to minimize complications. When prenatal ultrasonography, fetal karyotype, tissue sample, and embryonic appendages work together, problems may be partially or entirely revealed by these methods due to mistakes made in imaging examinations. In the case of a pregnancy with an antenatal malformation detected, it is necessary for the delivery to take place in a clinic that can provide favorable services for the survival and investigation of the child born with malformative abnormalities.

The retrospective clinical study of asymptomatic primary hyperparathyroidism

Objective: To summarize and analyze the diagnostic and therapeutic characteristics of asymptomatic primary hyperparathyroidism (aPHPT). Methods: A retrospective analysis was conducted on the clinical data of 103 patients with aPHPT admitted to the Chinese PLA General Hospital from January 2012 to September 2023. The clinical characteristics, treatment modes, and prognoses of the patients were analyzed. GraphPad Prism 8.0 software was used for statistical analysis. Results: Among the 103 cases, there were 37 males and 66 females, aged from 25 to 78 years, with an average age of (53.81±11.34) years. Ninety-eight cases (95.15%) visited due to abnormal findings during physical examination and 5 cases (4.85%) due to hypertension, diabetes or other diseases. All patients underwent minimally invasive parathyroidectomy with small incision, with 96 cases (93.20%) pathologically diagnosed as adenomas and 7 cases as hyperplasia (6.80%). Postoperative mean serum calcium, parathyroid hormone (PTH) and alkaline phosphatase (ALP) levels were respectively significantly lower than preoperative levels, while postoperative serum phosphorus level was significantly higher than preoperative level (P<0.05). The mean lesion volume was (3.32±6.72)cm3 (range 0.05-49.50 cm3). Patients with different lesion volumes had significant differences in preoperative serum calcium, PTH and ALP levels. Lesion volume was positively correlated to preoperative serum calcium(ρ=0.36, P<0.01), PTH(ρ=0.50, P<0.01) and ALP(ρ=0.39, P<0.01). Among 103 patients, 94 cases were followed up (91.26%), 9 cases were lost (8.74%), and the mean follow-up period was (60.15±29.23) months. The followed-up patients were alive and had no recurrence of lesions or complications, and their blood calcium levels were normal. Conclusion: aPHPT can be preliminarily diagnosed through blood biochemistry and imaging examination, and minimally invasive surgery can offer good prognosis without serious complications.

Transformative insights: Image-based breast cancer detection and severity assessment through advanced AI techniques

Abstract In the realm of image-based breast cancer detection and severity assessment, this study delves into the revolutionary potential of sophisticated artificial intelligence (AI) techniques. By investigating image processing, machine learning (ML), and deep learning (DL), the research illuminates their combined impact on transforming breast cancer diagnosis. This integration offers insights into early identification and precise characterization of cancers. With a foundation in 125 research articles, this article presents a comprehensive overview of the current state of image-based breast cancer detection. Synthesizing the transformative role of AI, including image processing, ML, and DL, the review explores how these technologies collectively reshape the landscape of breast cancer diagnosis and severity assessment. An essential aspect highlighted is the synergy between advanced image processing methods and ML algorithms. This combination facilitates the automated examination of medical images, which is crucial for detecting minute anomalies indicative of breast cancer. The utilization of complex neural networks for feature extraction and pattern recognition in DL models further enhances diagnostic precision. Beyond diagnostic improvements, the abstract underscores the substantial influence of AI-driven methods on breast cancer treatment. The integration of AI not only increases diagnostic precision but also opens avenues for individualized treatment planning, marking a paradigm shift toward personalized medicine in breast cancer care. However, challenges persist, with issues related to data quality and interpretability requiring continued research efforts. Looking forward, the abstract envisions future directions for breast cancer identification and diagnosis, emphasizing the adoption of explainable AI techniques and global collaboration for data sharing. These initiatives promise to propel the field into a new era characterized by enhanced efficiency and precision in breast cancer care.

Noninvasive assessment of single kidney glomerular filtration rate using multiple diffusion weighted imaging models.

This study aimed to assess single kidney glomerular filtration rate (GFR) using various diffusion weighted imaging (DWI) models. We reviewed adult patients with kidney diseases who underwent magnetic resonance imaging (MRI) examination from February 2021 to December 2023. DWI with 13 b-values was performed using 3.0-T scanners. Diffusion parameters were calculated with multi-slice ROIs positioned in renal parenchyma using four DWI models, including monoexponential model (MEM), diffusion kurtosis imaging (DKI), stretched exponential model (SEM), and intravoxel incoherent motion (IVIM). The split GFRs were measured by 99mTc-DTPA scintigraphy using Gates' method. Four different regression algorithms including the linear regression, regression tree, Gaussian regression and support vector machine (SVM) regression were employed to predict the GFR value based on different diffusion parameters. The leave-one-out cross validation was used to evaluate prediction ability of different models, and the performance of each model was quantified using the root mean square error (RMSE) and correlation coefficient. Fifteen (male/female, 10/5; age, 41.60±10.83 years) patients were included in this study. Among the four DWI models, the IVIM parameters with SVM regression model achieved the best performance with 0.184 RMSE and 0.789 correlation coefficient ( ). The parameters combining the four DWI models with SVM regression algorithm achieved the best performance in this study, with 0.171 RMSE and 0.815 correlation coefficient ( ). The DWI characteristics are able to serve as imaging biomarkers for assessing the function of single kidney. The integration of DWI into clinical practice could contribute to the advancement of non-invasive diagnostic methodologies.

Second malignancy in advanced or recurrent non-small cell lung cancer after the advent of molecular targeted drugs and immunotherapy.

This study aimed to investigate the characteristics of patients with recurrent or advanced non-small cell lung cancer (NSCLC) treated with tyrosine kinase inhibitors (TKIs) or immune-checkpoint inhibitors (ICIs) who developed secondary malignancies, as well as evaluate the impact of these secondary malignancies on the course of lung cancer. This study included 112 patients with postoperative recurrent or advanced NSCLC, who received TKIs, ICIs, or immune combination therapy as the primary treatment modality between April1, 2013, and March 31, 2020, and achieved long-term survival (≥2 years). Secondary malignancies were defined as newly diagnosed cancers in other organs occurring after NSCLC treatment initiation. Among the 112 patients, 10 (8.9%) developed 12 carcinomas, including third primary malignancies. Univariate analysis, considering secondary malignancies as the outcome, revealed a non-significant trend towards a higher incidence of secondary malignancies in smokers compared to non-smokers. This study found that 8.9% of patients with advanced NSCLC who received TKIs, ICIs, or immune combination therapy and survived ≥2 years developed secondary malignancies. This underscores the importance of early diagnosis and treatment, even during lung cancer treatment, to identify suspicious lesions in other organs either via imaging or physical examinations.

Desmoplastic Fibroma of the Gnathic Bones-A Systematic Review.

To summarize published information about the desmoplastic fibroma of the gnathic bones into a descriptive analysis of the main features of this condition. A systematic review according to the PRISMA guidelines was conducted. Electronic search was performed in four databases and in the gray literature. Case reports and case series were included. Frequencies were obtained for descriptive analysis. We identified 66 articles, for a total of 96 cases. Female patients (55.8%) in the first decade of life (40.6%) with a mean age of 18.2 years were more affected. The mandible was the most affected bone with 81.2% of the cases. The main clinical feature was painless swelling (54.2%). Most of the imaging examinations (radiological, computed tomography, and magnetic resonance) showed well-defined radiolucencies (65.4%) lesions. The treatment was surgical removal in all cases. The recurrence rate was 10.8% and all in the posterior mandible. Spindle cell fibroblasts in a collagenized stroma were often described in the histopathological features. Vimentin, smooth muscle actin, and β-catenin were common immunohistochemical markers. Desmoplastic fibroma is a locally aggressive lesion that commonly affects the jaws in children. Histopathology is essential for diagnosis, and the pathogenesis of this tumor should be further investigated.

Neuroimaging in Optic Neuropathies

Optic neuropathy is a frequent cause of vision loss encountered during routine ophthalmology practice. While some of the cases can be easily diagnosed due to symptoms and examination findings, a significant group of them require neuroimaging tests for differential diagnosis. Imaging examinations such as magnetic resonance imaging, computed tomography, doppler ultrasonography, magnetic resonance, and computed tomography angiography provide valuable clues in differential diagnosis when used in appropriate clinical scenarios.

7483 The Pharmacokinetic Profile of Lanreotide Autogel® Improved Long-Term Arrhythmia Fluctuations in Acromegalic Cardiomyopathy

Abstract Disclosure: M. Iwabuchi: None. Background: The prognosis of acromegaly is related to the status of cardiac complications. Ventricular premature contractions (VPC) are frequently observed in acromegaly, and it is very important to suppress fatal arrhythmias to improve long-term prognosis. Somatostatin analogs are widely used as pharmacotherapy for acromegaly, and they have been reported to improve cardiac prognosis. In comparison to LAR, lanreotide Autogel® has a unique property of self-aggregation under favorable conditions, leading to a stable structure of highly organized nanotubules and has a long half-life after subcutaneous injection determined by pseudo-first order kinetics. CASE: 55-year-old man visited a cardiologist for the treatment of PVCs and heart failure. Because of his acromegalic features, endocrinological and image examinations were performed, and diagnosis of acromegaly was confirmed. His GH was 7.17 ng/mL, IGF-1 566 ng/mL (Normal range: 59-215). Concerning excess of GH may cause nonischemic cardiomyopathy, administration of 20 mg of LAR once a month was started. GH and IGF-1 improved to1.52 ng/mL and 217 ng/mL respectively. The dose of LAR was increased to 30mg because of a remaining fluctuation of VPCs. Considering a possibility of the problem of bioavailability due to method of injection and the pharmacokinetics of LAR, administration of lanreotide Autogel® was started instead of LAR, with the result that an improvement of the fluctuation of the symptom was observed without remarkable change in GH and IGF-1. Arrhythmia status was assessed over time using Holter electrocardiography. Pretreatment Holter electrocardiogram showed 18% of total heart rates in PVCs. After LAR injection, the frequency of PVCs decreased to 3%, and 6 years after changing LAR to lanreotide, the frequency of PVCs decreased to 2%. Clinical Lessons: Simulated steady state pharmacokinetic profiles of LAR and lanreotide Autogel® differ significantly. During LAR treatment, serum concentrations of the drug are approximately stable, whereas the characteristic first-order kinetics of lanreotide Autogel® is superimposed on levels just before the next administration. The pharmacokinetic differences indicate that LAR can be better tailored to therapeutic levels, whereas serum levels of lanreotide must be high for part of the interval between injections to be effective in the period before the next administration. Lanreotide Autogel® has similar clinical effects compared to LAR for the treatment of cardiomyopathy of acromegaly and has the advantage of being available in a convenient pre-filled syringe and no necessity of injection by healthcare professionals. It is suggested that the pharmacokinetic profile of Lanreotide Autogel® resulted in decreased arrhythmia fluctuation in acromegalic hearts, which has been maintained for the past 6 years. Presentation: 6/3/2024

Kimura Disease of the Head and Neck Region.

Objective: We analyzed the clinical characteristics and treatment results in surgical patients with a final diagnosis of Kimura disease. Patients and Methods: A total of 8 patients with a final diagnosis of Kimura disease of the head and neck region after surgery from January 2007 to December 2022 were enrolled. Results: The most common symptom was a mass in the head and neck region (n = 7), followed by incidental detection (n = 1). Multiple head and neck lesions were observed except for 1 patient with Kimura disease in the buccal space. Kimura disease could not be diagnosed in 5 patients who underwent preoperative fine-needle aspiration cytology. All patients underwent surgical resection. No major complications after surgery occurred. Six patients received steroids after surgery, with 1 patient undergoing radiotherapy as a side effect of steroid treatment. During the follow-up period, 5 patients relapsed. Of the parameters assessed, only longer symptom duration was statistically significant with relapse of Kimura disease. Conclusion: Clinicians should suspect Kimura disease based on asymptomatic masses, peripheral blood eosinophilia, and imaging examinations and make a definitive diagnosis via surgery.

Age-Related Features of Clinical and Neurological Characteristics and Pathogenetic Therapy in Patients with Multiple Sclerosis

INTRODUCTION: Multiple sclerosis (MS) is a neurological demyelinating disease of the central nervous system manifested by pronounced heterogeneous symptoms. Peculiarities of the onset, progression rate, and severity of syndromes are different in different age groups. An increase in the frequency of exacerbations, high degree of disability of patients in different age groups evidence insufficient effectiveness of the conducted pathogenetic therapy. Due to a wide choice of multiple sclerosis disease modifying drugs (MSDMDs), it is important to study the clinical and neurological characteristics of patients with MS in different age groups with the aim of further developing an individual approach to treatment. AIM: To study clinical and neurological features and effectiveness of pathogenetic therapy of MS in patients of different age groups. MATERIALS AND METHODS: A prospective analysis of the data of neurological examination and results of magnetic resonance imaging of 100 patients of different age groups with relapsing-remitting MS, who received outpatient treatment in Kursk Regional Multidisciplinary Clinical Hospital, was conducted in the period of stable remission. RESULTS: The leading syndromes in patients with relapsing-remitting course of MS were cerebellar (78%) and pyramidal (70%) syndromes, besides, dysfunction of the cranial nerves (71%) was also observed. A quantitative parameter of explicitness of pelvic disorder syndrome predominated in middle-aged and elderly patients compared to young ones (p 0.001). Cognitive disorders were more often (14%) recorded in middle-aged and elderly patients (p 0.001). The use of glatiramer acetate permitted to reduce the degree of disability in young subjects (p 0.05); in patients of the middle age group, the most effective was a timely transition from interferon beta to ocrelizumab (p 0.05). The use of first-line MSDMDs (interferon-beta) in elderly patients demonstrated low effectiveness (p 0.05). CONCLUSION: In middle-aged and elderly patients with equal timing of MS onset, the neurological deficit is more expressed than in young ones. First-line pathogenetic therapy, in particular, glatiramer acetate, is more effective in young patients, while patients of middle age are recommended an early transition to second-line MSDMDs.

High-grade mucinous tubular and spindle cell carcinoma of the kidney in a patient on hemodialysis: a case report and literature review

BackgroundEnd-stage renal disease is a risk factor for renal cell carcinoma. However, mucinous tubular and spindle cell carcinoma of the kidney is rare. We report a patient on hemodialysis who had high-grade mucinous tubular and spindle cell carcinoma of the kidney.Case presentationA 62-year-old Japanese woman had end-stage renal disease and had been on hemodialysis for the previous 4 years. However, periodic imaging examinations to detect kidney cancer had not been conducted. The patient visited our department of urology complaining of general fatigue and dyspnea. Computed tomography with enhancement revealed a solid renal mass with a diameter of 66 mm. It had invaded the right psoas muscle and had multiple lymph node metastases. In addition, the patient had massive ascites and right-sided predominant pleural effusion. We drained the pleural effusion, but she died 11 days after admission. An autopsy was performed. Pathological examination revealed high-grade mucinous tubular and spindle cell carcinoma of the right kidney; multiple organ metastases to the bilateral lungs, liver, gall bladder, uterus, ovary, and inferior vena cava; cancerous pleuritis; and cancerous peritonitis. Our case indicates that high-grade mucinous tubular and spindle cell carcinoma emerging in end-stage kidney causes a detrimental clinical course.ConclusionHigh-grade mucinous tubular and spindle cell carcinoma of the kidney had a severe clinical course. We recommend periodic screening of patients with end-stage renal disease, using computed tomography or ultrasound.

Supraclavicular-median sternotomy approach for a large neurilemmoma invading the thoracic outlet: a case report and review of the literature

BackgroundLarge mediastinum tumors invading the thoracic outlet have consistently been a challenge in thoracic surgery. Due to the large size of the tumor and its proximity to many important tissues, appropriate surgical approaches are crucial for a successful surgery.Case presentationsHere, we present a case of a large neurilemmoma that invaded the thoracic outlet that was resected by a supraclavicular-median sternotomy approach. The case was a 58-year-old woman with a large mass in the right chest cavity that had invaded the thoracic outlet. The preoperative biopsy showed a blood clot with a few fibrous connective tissues covered by a single layer of flat epithelium. There was insufficient evidence to diagnose the mass as a tumor, and imaging examinations suggested a diagnosis of solitary pleural fibroma. For good exposure of the cranial and caudal aspects of the large mass, we devised a median sternotomy combined with a supraclavicular approach and safely achieved complete resection. The patient recovered well and experienced no severe complications or functional restrictions of the upper extremity. The postoperative pathology diagnosis was a neurilemmoma.ConclusionsThe supraclavicular-median sternotomy approach could be an optional approach for the complete resection of large mediastinal tumors invading the thoracic outlet.

A fine-grained image classification algorithm based on self-supervised learning and multi-feature fusion of blood cells

Leukemia is a prevalent and widespread blood disease, and its early diagnosis is crucial for effective patient treatment. Diagnosing leukemia types heavily relies on pathologists’ morphological examination of blood cell images. However, this process is tedious and time-consuming, and the diagnostic results are subjective, leading to potential misdiagnosis and underdiagnosis. This paper proposes a blood cell image classification method that combines MAE with an enhanced Vision Transformer to tackle these challenges. Initially, pre-training occurs on two datasets, TMAMD and Red4, using the MAE self-supervised learning algorithm. Subsequently, the pre-training weights are transferred to our improved model.This paper introduces feature fusion of the outputs from each layer of the Transformer encoder to maximize the utilization of features extracted from lower layers, such as color, contour, and texture of blood cells, along with deeper semantic features. Furthermore, the dynamic margins for the subcenter Arcface Loss function are employed to enhance the model’s fine-grained feature representation by achieving inter-class dispersion and intra-class aggregation. Models trained using our method achieved state-of-the-art results on both the TMAMD dataset and Red4 dataset, with classification accuracies of 93.51% and 81.41%, respectively. This achievement is expected to be a valuable reference for physicians in their clinical diagnoses.

Public perception of esports: an examination of esports image and genre differences

ABSTRACT As esports continues to gain popularity, a clear understanding of the public image associated with esports would help corporations and organizations working within or collaborating with the esports industry to establish effective communication strategies for their target audiences. In this study, we identify the image people associate with esports and examine whether it varies across different esports genres. Two surveys were conducted for exploratory factor analysis and confirmatory factor analysis, followed by a series of ANOVA. Results reveal mixed image of esports, comprising three negative associations (i.e. provocative, addictive, and impulsive) and four positive associations (i.e. entertaining, competitive, aesthetic, and social). Moreover, distinct patterns exist for the image of esports across five different genres (i.e. Fighting, FPS, MOBA, Sport Simulation, and DCC games). It appears that positive associations vary more distinctly across esports genres than negative associations. Findings imply that there is no “one-size-fits-all” regarding how esports are perceived, highlighting the image of esports as multidimensional, highly contextual and advising against uniform treatment.

Qianggan Ruanjian Pill ameliorates liver fibrosis through regulation of the TGF-β1/Smad and PI3K/AKT signalling pathways

Ethnopharmacological relevanceLiver fibrosis is a critical pathological process in the progression of chronic liver injury, ultimately resulting in cirrhosis, for which currently available therapeutic interventions remain inadequate. Among these, the Qianggan Ruanjian Pill (QGRJP) has emerged as a clinically experienced formula with notable therapeutic efficacy against liver fibrosis. However, the precise underlying mechanisms require further investigation. Aim of the studyIn this study, we investigated the key pathways and target genes of QGRJP that attenuate liver fibrosis and elucidated the underlying mechanisms. Materials and methodsHigh-performance liquid chromatography-mass spectrometry (HPLC-MS) was used to identify the major components of the QGRJP. Mouse models of liver fibrosis were established by injecting olive oil containing 25% carbon tetrachloride (CCl4), which was administered at different doses of QGRJP by gavage. Liver damage and function were assessed using serum biochemical detection, ultrasound imaging, and histopathological examination. The anti-fibrosis effect was assessed using immunohistochemistry, western blotting, and quantitative real-time PCR (qRT-PCR). The in vivo safety of the QGRJP was evaluated using weight monitoring and biopsy. Potential anti-liver fibrosis signalling pathways and key targets of QGRJP were identified using RNA-seq analysis and network pharmacology. The predicted targets and pathways were validated using in vitro and in vivo experiments. ResultsQGRJP significantly ameliorated CCl4-induced liver fibrosis, and its mechanism was correlated with the inhibition of hepatic stellate cell (HSC) activation and the inflammatory response via inhibition of the TGF-β1/Smad and PI3K/AKT pathways, leading to a significant reduction in the expression of collagen and other fibrosis-related proteins. Additionally, no obvious toxic side effects were observed in the major organs of the mice or in activated HSCs (aHSCs). ConclusionThis study demonstrated that QGRJP mitigated liver injury, inflammation, and fibrosis by inhibiting the TGF-β1/Smad and PI3K/AKT signalling pathways.

Surgical results in patients with CNS lymphoma. Comparison of predictive value of intraoperative MRI and intraoperative histological examination for diagnostic biopsy yield

IntroductionCentral nervous system lymphoma poses significant diagnostic challenges, with stereotactic biopsy being the gold standard for diagnosis. Intraoperative magnetic resonance imaging and intraoperative histological examination are utilized to enhance biopsy yield, yet their comparative efficacy remains unclear. Research questionThis study aims to compare the diagnostic yield of intraoperative magnetic resonance imaging and intraoperative histological examination in stereotactic brain biopsies for central nervous system lymphoma. Materials and methodsA retrospective analysis was conducted on 115 patients who underwent stereotactic brain biopsies for central nervous system lymphoma. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative magnetic resonance imaging and intraoperative histological examination were assessed and compared. ResultsOut of 125 surgeries, frameless biopsies were the most common, accounting for 74.4 percent. Intraoperative magnetic resonance imaging demonstrated a sensitivity of 80.00 percent and a specificity of 98.51 percent (AUC = 0.893, p = 0.004), whereas intraoperative histological examination showed a sensitivity of 66.67 percent and a specificity of 59.09 percent (AUC = 0.629, p = 0.459). Discussion and conclusionsThe study emphasizes the critical role of intraoperative examinations, thus improving precision and diagnostic yield in the surgical management of central nervous system lymphoma. Intraoperative magnetic resonance imaging outperforms intraoperative histological examination in terms of sensitivity and specificity for confirming positive biopsy yields in central nervous system lymphoma, thereby reducing the need for additional surgeries. These findings support the routine use of intraoperative magnetic resonance imaging in the surgical strategy for central nervous system lymphoma to improve diagnostic accuracy and patient outcomes.

Clinical Analysis of Reversible Posterior Encephalopathy Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation in Children

To summarize the clinical features of reversible posterior encephalopathy syndrome (PRES) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children. The clinical data of six children who developed PRES after undergoing allo-HSCT in the Department of Hematology of Wuhan Children's Hospital from June 2016 to December 2022 were retrospectively analyzed, and their clinical characteristics, imaging examination, laboratory examination, and treatment regression were summarized. Among 281 children underwent allo-HSCT, 6 cases (2.14%) developed PRES, with a median age of 5.1(1.5-9.7) years old. 4 cases underwent related haploidentical donor transplantation, and 2 cases underwent sibling allografting and unrelated donor allografting donor transplantation, respectively. All six children had an acute onset of illness, with clinical manifestations of nausea and vomiting, seizures, psychiatric disorders, visual disturbances. The five cases elevated blood pressure. All children with PRES were treated with oral immunosuppressive drugs during seizures, and 3 cases were combined with different degrees of graft-versus-host disease. Most of the children showed effective improvement in clinical symptoms and imaging after adjusting/discontinuing suspected medications (cyclosporine, etc.) and symptomatic supportive treatments (oral antihypertensive, diazepam for antispasmodic, mannitol to lower cranial blood pressure), and one of them relapsed more than 8 months after the first seizure. PRES is rare after hematopoietic stem cell transplantation in children, and its onset may be related to hypertension, cytotoxic drugs, graft-versus-host disease, etc. Most of them can be recovered after active treatment, but not completely reversible, and the prognosis of those who combined with TMA is poor.

Comparison of computer-aided quantitative measurement and physician visual assessment in the evaluation of intracranial atherosclerotic stenosis: a vessel wall magnetic resonance imaging study.

Intracranial atherosclerotic stenosis is a leading cause of ischemic stroke in China. Accurate assessment of intracranial atherosclerotic stenosis through imaging techniques is crucial for guiding therapeutic interventions and prognostic stratification. Vessel wall magnetic resonance imaging (VWMRI) has emerged as a reliable method for evaluating intracranial arterial vessels. With the advancement of technology, computer-aided quantitative measurement (CAQM) is increasingly used in imaging assessment. This study aimed to compare physician visual assessment (PVA) with CAQM in the VWMRI evaluation of intracranial atherosclerotic stenosis. This retrospective cross-sectional study consecutively enrolled patients diagnosed with intracranial atherosclerotic stenosis through imaging examinations at the Fourth Affiliated Hospital of China Medical University from December 2018 to December 2023. Clinical data were collected for analysis. Two radiologists independently and separately conducted CAQM and PVA on the VWMRI images of intracranial atherosclerotic stenosis patients. The imaging features evaluated encompassed stenosis severity, vessel wall remodeling, vessel wall thickening patterns, fibrous cap characteristics, lipid core ratio, and plaque enhancement degree. The study further assessed the discrepancies and concordance between the assessment results obtained from the two methods using paired sample t-tests, Wilcoxon signed-rank tests, and Cohen's kappa coefficient analysis. This study enrolled a total of 589 patients. The PVA time was shorter than CAQM (12.02±3.63 vs. 20.48±6.50 min). However, compared with digital subtraction angiography, the CAQM had a better area under the curve (0.88) than the PVA (0.80) in assessing luminal stenosis degree. The proportions of vessel wall remodeling (227/38.5%) and plaque surface irregularity (127/21.6%) evaluated by PVA were both lower than those by CAQM (438/74.4%, 171/29.0%). Meanwhile, no statistically significant differences were found in the patterns of wall thickening (P=0.12/0.39) and the proportion of plaque lipid core (P=0.65 and P=0.27), with good agreement between the two methods (K=0.67/0.85, K=0.97/0.94). While there were no statistical differences in the assessment of plaque enhancement degree in specific arteries (middle cerebral artery and basilar artery) (n=77/36, P=0.08/0.21), an overall statistical difference was observed (n=113, P=0.03). Additionally, there was poor agreement in assessing plaque enhancement degree, with Cohen's kappa values of 0.13 (-0.05 to 0.32) and 0.16 (-0.06 to 0.39). This study revealed disparities between PVA and CAQM in the evaluation of intracranial atherosclerotic stenosis of VWMRI. CAQM is recommended for assessing stenosis degree, vessel wall remodeling, and fibrous cap characteristics. However, PVA is suggested to assess wall thickening patterns and lipid core ratio to expedite diagnosis. Further research is needed to validate CAQM's superiority in evaluating plaque enhancement degrees.

Effectiveness of Preoperative Intrahepatic Portal Venous Classification System in Guiding Preoperative Surgical Decisions and Predicting Hypotensive Effects After Meso-rex Bypass for Children With EHPVO

BackgroundThe categorization of intrahepatic portal venous system (IHPS) patterns using wedged hepatic venous portography (WHVP) has proven to be an effective tool in the preoperative evaluation of Rex recessus and in identifying pediatric patients with extrahepatic portal vein obstruction (EHPVO) who are suitable for meso-Rex bypass (MRB). Despite this classification system being proposed a decade ago, its clinical application remains underutilized. MethodsA single-center retrospective study of 182 children with EHPVO was conducted between October 2014 and July 2023 when MRB was attempted. Data on demographics, etiology, imaging examinations, procedures, and follow-up were collected for 161 patients included. Two interventional radiologists used deVille’s method to classify patients into types A to E based on WHVP imaging, with interobserver agreement analyzed. Associations between IHPS patterns and surgical outcomes following MRB were investigated. ResultsTwo radiologists had a high level of agreement on identifying IHPS patterns and suitable patients for MRB. Of the 161 cases, 130 were type A, 10 were type B, 5 were type C, 7 were type D, and 9 were type E. One hundred and forty-five patients with types A, B and C underwent successful MRB, showing feasibility for 90% of patients. Children categorized as types A and B experienced more significant benefits than type C, including intraoperatively decreased portal vein pressure, esophageal/gastric varices relief, decreased portal venous collaterals and a lower rate of bypass occlusion after one year. The surgical outcomes of patients with types A and B were not influenced by the diameter of the Rex recessus as suggested by WHVP. ConclusionsThe majority of pediatric patients with EHPVO in mainland China have opportunities to receive successful MRB. There are potential differences in the etiology of Chinese and Western patients. The IHPS classification system aids in guiding preoperative surgical decisions and predicting hypotensive effects after MRB. Type C patients should be carefully chosen for MRB.