The correlations between shear wave velocity(SWV)calculated from virtual touch tissue imaging quantification(VTIQ)technique and histological prognostic factors of invasive ductal carcinoma was investigated.A total of ...The correlations between shear wave velocity(SWV)calculated from virtual touch tissue imaging quantification(VTIQ)technique and histological prognostic factors of invasive ductal carcinoma was investigated.A total of 76 breast tumors histologically confirmed as invasive ductal carcinomas were included in this study.SWV values were measured by VTIQ for each lesion preoperatively or prior to breast biopsy.The maximum values were recorded for statistical analysis.Medical records were reviewed to determine tumor size,histological grade,lymph node status and immunohistochemical results.Tumor subtypes were categorized as luminal A,luminal B,human epidermal growth factor receptor 2(HER2)positive and triple negative.The correlations between SWV and histological prognostic factors were analyzed.It was found that tumor size showed positive association with SWV(r=0.465,P<0.001).Larger tumors had significantly higher SWV than smaller ones(P=0.001).Histological grade 1 tumors had significantly lower SWV values than those with higher histological grade(P=0.015).The Ki67 expression,tumor subtypes and lymph node status showed no statistically significant correlations with SWV,although triple negative tumors and lymph node-positive tumors showed higher SWV values.It was concluded that tumor size was significantly associated with SWV.Higher histological grade was associated with increased SWV.There was no statistically significant correlations between SWV and other histological prognostic factors.展开更多
Objective Appropriate medical imaging is important for value-based care.We aim to evaluate the performance of generative pretrained transformer 4(GPT-4),an innovative natural language processing model,providing approp...Objective Appropriate medical imaging is important for value-based care.We aim to evaluate the performance of generative pretrained transformer 4(GPT-4),an innovative natural language processing model,providing appropriate medical imaging automatically in different clinical scenarios.Methods Institutional Review Boards(IRB)approval was not required due to the use of nonidentifiable data.Instead,we used 112 questions from the American College of Radiology(ACR)Radiology-TEACHES Program as prompts,which is an open-sourced question and answer program to guide appropriate medical imaging.We included 69 free-text case vignettes and 43 simplified cases.For the performance evaluation of GPT-4 and GPT-3.5,we considered the recommendations of ACR guidelines as the gold standard,and then three radiologists analyzed the consistency of the responses from the GPT models with those of the ACR.We set a five-score criterion for the evaluation of the consistency.A paired t-test was applied to assess the statistical significance of the findings.Results For the performance of the GPT models in free-text case vignettes,the accuracy of GPT-4 was 92.9%,whereas the accuracy of GPT-3.5 was just 78.3%.GPT-4 can provide more appropriate suggestions to reduce the overutilization of medical imaging than GPT-3.5(t=3.429,P=0.001).For the performance of the GPT models in simplified scenarios,the accuracy of GPT-4 and GPT-3.5 was 66.5%and 60.0%,respectively.The differences were not statistically significant(t=1.858,P=0.070).GPT-4 was characterized by longer reaction times(27.1 s in average)and extensive responses(137.1 words on average)than GPT-3.5.Conclusion As an advanced tool for improving value-based healthcare in clinics,GPT-4 may guide appropriate medical imaging accurately and efficiently。展开更多
Background:The cumulative effect of body mass index(BMI)on brain health remains ill-deffned.The effects of overweight on brain health across different age groups need clariffcation.We analyzed the effect of cumulative...Background:The cumulative effect of body mass index(BMI)on brain health remains ill-deffned.The effects of overweight on brain health across different age groups need clariffcation.We analyzed the effect of cumulative BMI on neuroimaging features of brain health in adults of different ages.Methods:This study was based on a multicenter,community-based cohort study.We modeled the trajectories of BMI over 16 years to evaluate cumulative exposure.Multimodality neuroimaging data were collected once for volumetric measurements of the brain macrostructure,white matter hyperintensity(WMH),and brain microstructure.We used a generalized linear model to evaluate the association between cumulative BMI and neuroimaging features.Two-sample Mendelian randomization analysis was performed using summary level of BMI genetic data from 681,275 individuals and neuroimaging genetic data from 33,224 individuals to analyze the causal relationships.Results:Clinical and neuroimaging data were obtained from 1,074 adults(25 to 83 years).For adults aged under 45 years,brain volume differences in participants with a cumulative BMI of>26.2 kg/m^(2) corresponded to 12.0 years[95%conffdence interval(CI),3.0 to 20.0]of brain aging.Differences in WMH were statistically substantial for participants aged over 60 years,with a 6.0-ml(95%CI,1.5 to 10.5)larger volume.Genetic analysis indicated causal relationships between high BMI and smaller gray matter and higher fractional anisotropy in projection ffbers.Conclusion:High cumulative BMI is associated with smaller brain volume,larger volume of white matter lesions,and abnormal microstructural integrity.Adults younger than 45 years are suggested to maintain their BMI below 26.2 kg/m^(2) for better brain health.Trial Registration:This study was registered on clinicaltrials.gov(Clinical Indicators and Brain Image Data:A Cohort Study Based on Kailuan Cohort;No.NCT05453877;https://clinicaltrials.gov/ct2/show/NCT05453877).展开更多
背景和目的关于缺血性卒中后脑肿胀患者的最佳管理方案，仍有许多尚未确定的问题。需要制定相关指南来指导如何处理这种严重并发症，如何提供最佳的综合性神经科和内科治疗，以及在患者病情恶化时如何与面临外科干预复杂决策的家属进行...背景和目的关于缺血性卒中后脑肿胀患者的最佳管理方案，仍有许多尚未确定的问题。需要制定相关指南来指导如何处理这种严重并发症，如何提供最佳的综合性神经科和内科治疗，以及在患者病情恶化时如何与面临外科干预复杂决策的家属进行良好的沟通。本科学声明为大脑或小脑半球缺血性卒中伴脑肿胀的患者提供了早期的管理方案。方法写作组利用系统文献综述，参考公开发表的临床和流行病学研究、发病率和死亡率报告、临床与公共卫生指南、权威声明、个人文件以及专家意见，对现有证据进行总结并指出与当前知识水平的差距。写作组通过对MEDLINE、EMBASE和Web of Science数据库进行医学文献计算机检索（最后检索时间为2013年3月，研究对象为成年人）回顾最相关的文献。在美国心脏协会（American Heart Association，ARIA）框架背景下对证据进行组织，根据AHA／美国心脏病学学会基金会以及AHA卒中委员会的证据强度分级方案进行分类。这份声明经过AHA内部的广泛同行评议。结果已有适用于由缺血性梗死引起的半球（累及整个大脑中动脉供血区或更大范围）和小脑（累及小脑后下动脉或小脑上动脉供血区）肿胀的临床标准。幕上半球缺血性卒中伴脑肿胀发生恶化的临床表现包括新发意识障碍或意识障碍加重、脑性上睑下垂以及瞳孔大小变化。在小脑梗死伴肿胀患者中，意识水平下降是脑干受压的结果，因此可能出现早期角膜反射丧失和瞳孔缩小。应制定标准化定义以促进多中心和基于人群的发病率、患病率、危险因素和转归研究。脑肿胀高危患者的识别应包括临床和神经影像学资料。如果大面积卒中患者有必要进入全面复苏状态，则需要收入具备神经监护功能的病房。这些患者最好被收入由技术熟练和经验丰富的医生（如神经重症监护医生或神经血管科医生）负责的重症监护室或卒中单元。综合性医疗管理包括气道管理和机械通气、血压控制、液体管理以及血糖和体温控制。在幕上半球缺血性卒中伴肿胀患者中，不需行常规颅内压监测或脑脊液引流，但神经功能继续恶化的患者应考虑行去骨瓣减压和硬脑膜切开术。去骨瓣减压术在≥60岁的患者中的疗效尚不确定。在神经功能恶化的小脑卒中伴肿胀患者中，应行枕骨下颅骨切除和硬脑膜切开术。当应用脑室造瘘术缓解小脑梗死后梗阻性脑积水时，应同时行枕骨下颅骨切除术以防小脑向上移位导致的病情恶化。幕上半球梗死伴肿胀患者可获得令人满意的转归，但即使行去骨瓣减压术，仍有1／3的患者会遗留严重残疾和完全生活依赖。多数小脑梗死患者在术后能获得可接受的功能转归。结论大脑和小脑梗死伴肿胀是需要立即给予专业神经重症监护、并常需要进行神经外科干预的危重情况。去骨瓣减压术是很多患者的必然治疗选择，经过选择的患者能从中受益匪浅，尽管他们可能会遗留残疾，但仍可生活自理。展开更多
背景和目的2015年10月5日至6日在美国华盛顿特区召开的第4届卒中治疗专业学术圆桌会议(Stroke Treatment Academy Industry Roundtable,STAIR)期间,卒中影像学研究(Stroke Imaging Research Group,STIR)组、卒中网络影像学工作组、美国...背景和目的2015年10月5日至6日在美国华盛顿特区召开的第4届卒中治疗专业学术圆桌会议(Stroke Treatment Academy Industry Roundtable,STAIR)期间,卒中影像学研究(Stroke Imaging Research Group,STIR)组、卒中网络影像学工作组、美国神经放射学学会和美国神经放射学学会基金会共同举办了一次影像学会议和研讨会。本路径图的目的是关注影像学在将来的研究和临床试验中的作用。方法此次会议将卒中神经病学专家、神经放射学专家、神经影像学研究人员、美国国立神经疾病与卒中研究所(National Institute of Neuro Wlgical Dworders and Stroke,NINDS)成员、企业代表以及美国食品药品管理局(Food and Drug Administramion,)成员汇聚一堂,根据前所未有的一系列急性卒中血管内治疗临床试验的阳性结果来探讨将来STIR的重点。结果此次影像学会议对影像学在近期阳性血管内治疗试验中的作用进行了总结和比较,并且提出了汇总分析的可能。此次影像学研讨会对多重影像学模式中采集和分析缺血核心、半暗带不匹配以及侧支循环的最佳成像方法制定出共识推荐,并且提出了在前瞻性临床试验中测量最终梗死灶体积的标准化方法。结论近期的阳性急性卒中血管内治疗临床试验证明了神经血管成像的额外价值。血管内治疗的最佳影像学特征包括大血管闭塞、梗死核心较小、侧支循环良好和半暗带较大。然而,可能需要利用来自近期阳性血管内治疗试验的汇总数据对这些影像学特征参数在不同成像模式之间进行等效定义以及做出标准化尝试。展开更多
卒中影像学研究组（StrokeImagingResearchGroup，STIR）、美国神经放射学学会和美国神经放射学学会基金会在过去1年多的时间时举办了一系列的工作会议，最后一次会议于2013年3月9日至10日在华盛顿召开的卒中治疗专业学术圆桌会议（Stro...卒中影像学研究组（StrokeImagingResearchGroup，STIR）、美国神经放射学学会和美国神经放射学学会基金会在过去1年多的时间时举办了一系列的工作会议，最后一次会议于2013年3月9日至10日在华盛顿召开的卒中治疗专业学术圆桌会议（Stroke Treatment Academy Industry Roundtable，STAIR）期间举行。展开更多
基金grants from the Fundamental Research Funds for the Central Universities(No.2172015YGYL019)the Fundamental Research Funds for the Central Universities(No.2015LC021)+1 种基金National Natural Science Foundation of China(No.81000616)Hubei Key Laboratory of Molecular Imaging Research Funds(No.02.03.2015-149).
文摘The correlations between shear wave velocity(SWV)calculated from virtual touch tissue imaging quantification(VTIQ)technique and histological prognostic factors of invasive ductal carcinoma was investigated.A total of 76 breast tumors histologically confirmed as invasive ductal carcinomas were included in this study.SWV values were measured by VTIQ for each lesion preoperatively or prior to breast biopsy.The maximum values were recorded for statistical analysis.Medical records were reviewed to determine tumor size,histological grade,lymph node status and immunohistochemical results.Tumor subtypes were categorized as luminal A,luminal B,human epidermal growth factor receptor 2(HER2)positive and triple negative.The correlations between SWV and histological prognostic factors were analyzed.It was found that tumor size showed positive association with SWV(r=0.465,P<0.001).Larger tumors had significantly higher SWV than smaller ones(P=0.001).Histological grade 1 tumors had significantly lower SWV values than those with higher histological grade(P=0.015).The Ki67 expression,tumor subtypes and lymph node status showed no statistically significant correlations with SWV,although triple negative tumors and lymph node-positive tumors showed higher SWV values.It was concluded that tumor size was significantly associated with SWV.Higher histological grade was associated with increased SWV.There was no statistically significant correlations between SWV and other histological prognostic factors.
基金National Natural Science Foundation of China(Grant Nos.62171297 and 61931013).
文摘Objective Appropriate medical imaging is important for value-based care.We aim to evaluate the performance of generative pretrained transformer 4(GPT-4),an innovative natural language processing model,providing appropriate medical imaging automatically in different clinical scenarios.Methods Institutional Review Boards(IRB)approval was not required due to the use of nonidentifiable data.Instead,we used 112 questions from the American College of Radiology(ACR)Radiology-TEACHES Program as prompts,which is an open-sourced question and answer program to guide appropriate medical imaging.We included 69 free-text case vignettes and 43 simplified cases.For the performance evaluation of GPT-4 and GPT-3.5,we considered the recommendations of ACR guidelines as the gold standard,and then three radiologists analyzed the consistency of the responses from the GPT models with those of the ACR.We set a five-score criterion for the evaluation of the consistency.A paired t-test was applied to assess the statistical significance of the findings.Results For the performance of the GPT models in free-text case vignettes,the accuracy of GPT-4 was 92.9%,whereas the accuracy of GPT-3.5 was just 78.3%.GPT-4 can provide more appropriate suggestions to reduce the overutilization of medical imaging than GPT-3.5(t=3.429,P=0.001).For the performance of the GPT models in simplified scenarios,the accuracy of GPT-4 and GPT-3.5 was 66.5%and 60.0%,respectively.The differences were not statistically significant(t=1.858,P=0.070).GPT-4 was characterized by longer reaction times(27.1 s in average)and extensive responses(137.1 words on average)than GPT-3.5.Conclusion As an advanced tool for improving value-based healthcare in clinics,GPT-4 may guide appropriate medical imaging accurately and efficiently。
基金supported by the National Natural Science Foundation of China(62171297 and 61931013)Natural Science Foundation of Beijing Municipality(7242267)Beijing Scholars Program([2015]160).
文摘Background:The cumulative effect of body mass index(BMI)on brain health remains ill-deffned.The effects of overweight on brain health across different age groups need clariffcation.We analyzed the effect of cumulative BMI on neuroimaging features of brain health in adults of different ages.Methods:This study was based on a multicenter,community-based cohort study.We modeled the trajectories of BMI over 16 years to evaluate cumulative exposure.Multimodality neuroimaging data were collected once for volumetric measurements of the brain macrostructure,white matter hyperintensity(WMH),and brain microstructure.We used a generalized linear model to evaluate the association between cumulative BMI and neuroimaging features.Two-sample Mendelian randomization analysis was performed using summary level of BMI genetic data from 681,275 individuals and neuroimaging genetic data from 33,224 individuals to analyze the causal relationships.Results:Clinical and neuroimaging data were obtained from 1,074 adults(25 to 83 years).For adults aged under 45 years,brain volume differences in participants with a cumulative BMI of>26.2 kg/m^(2) corresponded to 12.0 years[95%conffdence interval(CI),3.0 to 20.0]of brain aging.Differences in WMH were statistically substantial for participants aged over 60 years,with a 6.0-ml(95%CI,1.5 to 10.5)larger volume.Genetic analysis indicated causal relationships between high BMI and smaller gray matter and higher fractional anisotropy in projection ffbers.Conclusion:High cumulative BMI is associated with smaller brain volume,larger volume of white matter lesions,and abnormal microstructural integrity.Adults younger than 45 years are suggested to maintain their BMI below 26.2 kg/m^(2) for better brain health.Trial Registration:This study was registered on clinicaltrials.gov(Clinical Indicators and Brain Image Data:A Cohort Study Based on Kailuan Cohort;No.NCT05453877;https://clinicaltrials.gov/ct2/show/NCT05453877).
文摘背景和目的关于缺血性卒中后脑肿胀患者的最佳管理方案，仍有许多尚未确定的问题。需要制定相关指南来指导如何处理这种严重并发症，如何提供最佳的综合性神经科和内科治疗，以及在患者病情恶化时如何与面临外科干预复杂决策的家属进行良好的沟通。本科学声明为大脑或小脑半球缺血性卒中伴脑肿胀的患者提供了早期的管理方案。方法写作组利用系统文献综述，参考公开发表的临床和流行病学研究、发病率和死亡率报告、临床与公共卫生指南、权威声明、个人文件以及专家意见，对现有证据进行总结并指出与当前知识水平的差距。写作组通过对MEDLINE、EMBASE和Web of Science数据库进行医学文献计算机检索（最后检索时间为2013年3月，研究对象为成年人）回顾最相关的文献。在美国心脏协会（American Heart Association，ARIA）框架背景下对证据进行组织，根据AHA／美国心脏病学学会基金会以及AHA卒中委员会的证据强度分级方案进行分类。这份声明经过AHA内部的广泛同行评议。结果已有适用于由缺血性梗死引起的半球（累及整个大脑中动脉供血区或更大范围）和小脑（累及小脑后下动脉或小脑上动脉供血区）肿胀的临床标准。幕上半球缺血性卒中伴脑肿胀发生恶化的临床表现包括新发意识障碍或意识障碍加重、脑性上睑下垂以及瞳孔大小变化。在小脑梗死伴肿胀患者中，意识水平下降是脑干受压的结果，因此可能出现早期角膜反射丧失和瞳孔缩小。应制定标准化定义以促进多中心和基于人群的发病率、患病率、危险因素和转归研究。脑肿胀高危患者的识别应包括临床和神经影像学资料。如果大面积卒中患者有必要进入全面复苏状态，则需要收入具备神经监护功能的病房。这些患者最好被收入由技术熟练和经验丰富的医生（如神经重症监护医生或神经血管科医生）负责的重症监护室或卒中单元。综合性医疗管理包括气道管理和机械通气、血压控制、液体管理以及血糖和体温控制。在幕上半球缺血性卒中伴肿胀患者中，不需行常规颅内压监测或脑脊液引流，但神经功能继续恶化的患者应考虑行去骨瓣减压和硬脑膜切开术。去骨瓣减压术在≥60岁的患者中的疗效尚不确定。在神经功能恶化的小脑卒中伴肿胀患者中，应行枕骨下颅骨切除和硬脑膜切开术。当应用脑室造瘘术缓解小脑梗死后梗阻性脑积水时，应同时行枕骨下颅骨切除术以防小脑向上移位导致的病情恶化。幕上半球梗死伴肿胀患者可获得令人满意的转归，但即使行去骨瓣减压术，仍有1／3的患者会遗留严重残疾和完全生活依赖。多数小脑梗死患者在术后能获得可接受的功能转归。结论大脑和小脑梗死伴肿胀是需要立即给予专业神经重症监护、并常需要进行神经外科干预的危重情况。去骨瓣减压术是很多患者的必然治疗选择，经过选择的患者能从中受益匪浅，尽管他们可能会遗留残疾，但仍可生活自理。
文摘背景和目的2015年10月5日至6日在美国华盛顿特区召开的第4届卒中治疗专业学术圆桌会议(Stroke Treatment Academy Industry Roundtable,STAIR)期间,卒中影像学研究(Stroke Imaging Research Group,STIR)组、卒中网络影像学工作组、美国神经放射学学会和美国神经放射学学会基金会共同举办了一次影像学会议和研讨会。本路径图的目的是关注影像学在将来的研究和临床试验中的作用。方法此次会议将卒中神经病学专家、神经放射学专家、神经影像学研究人员、美国国立神经疾病与卒中研究所(National Institute of Neuro Wlgical Dworders and Stroke,NINDS)成员、企业代表以及美国食品药品管理局(Food and Drug Administramion,)成员汇聚一堂,根据前所未有的一系列急性卒中血管内治疗临床试验的阳性结果来探讨将来STIR的重点。结果此次影像学会议对影像学在近期阳性血管内治疗试验中的作用进行了总结和比较,并且提出了汇总分析的可能。此次影像学研讨会对多重影像学模式中采集和分析缺血核心、半暗带不匹配以及侧支循环的最佳成像方法制定出共识推荐,并且提出了在前瞻性临床试验中测量最终梗死灶体积的标准化方法。结论近期的阳性急性卒中血管内治疗临床试验证明了神经血管成像的额外价值。血管内治疗的最佳影像学特征包括大血管闭塞、梗死核心较小、侧支循环良好和半暗带较大。然而,可能需要利用来自近期阳性血管内治疗试验的汇总数据对这些影像学特征参数在不同成像模式之间进行等效定义以及做出标准化尝试。
文摘卒中影像学研究组（StrokeImagingResearchGroup，STIR）、美国神经放射学学会和美国神经放射学学会基金会在过去1年多的时间时举办了一系列的工作会议，最后一次会议于2013年3月9日至10日在华盛顿召开的卒中治疗专业学术圆桌会议（Stroke Treatment Academy Industry Roundtable，STAIR）期间举行。
