BACKGROUND Accurate preoperative differentiation of benign and malignant thyroid nodules is critical for optimal patient management.However,conventional imaging modalities present inherent diagnostic limitations.AIM T...BACKGROUND Accurate preoperative differentiation of benign and malignant thyroid nodules is critical for optimal patient management.However,conventional imaging modalities present inherent diagnostic limitations.AIM To develop a non-contrast computed tomography-based machine learning model integrating radiomics and clinical features for preoperative thyroid nodule classification.METHODS This multicenter retrospective study enrolled 272 patients with thyroid nodules(376 thyroid lobes)from center A(May 2021-April 2024),using histopathological findings as the reference standard.The dataset was stratified into a training cohort(264 lobes)and an internal validation cohort(112 lobes).Additional prospective temporal(97 lobes,May-August 2024,center A)and external multicenter(81 lobes,center B)test cohorts were incorporated to enhance generalizability.Thyroid lobes were segmented along the isthmus midline,with segmentation reliability confirmed by an intraclass correlation coefficient(≥0.80).Radiomics feature extraction was performed using Pearson correlation analysis followed by least absolute shrinkage and selection operator regression with 10-fold cross-validation.Seven machine learning algorithms were systematically evaluated,with model performance quantified through the area under the receiver operating characteristic curve(AUC),Brier score,decision curve analysis,and DeLong test for comparison with radiologists interpretations.Model interpretability was elucidated using SHapley Additive exPlanations(SHAP).RESULTS The extreme gradient boosting model demonstrated robust diagnostic performance across all datasets,achieving AUCs of 0.899[95%confidence interval(CI):0.845-0.932]in the training cohort,0.803(95%CI:0.715-0.890)in internal validation,0.855(95%CI:0.775-0.935)in temporal testing,and 0.802(95%CI:0.664-0.939)in external testing.These results were significantly superior to radiologists assessments(AUCs:0.596,0.529,0.558,and 0.538,respectively;P<0.001 by DeLong test).SHAP analysis identified radiomic score,age,tumor size stratification,calcification status,and cystic components as key predictive features.The model exhibited excellent calibration(Brier scores:0.125-0.144)and provided significant clinical net benefit at decision thresholds exceeding 20%,as evidenced by decision curve analysis.CONCLUSION The non-contrast computed tomography-based radiomics-clinical fusion model enables robust preoperative thyroid nodule classification,with SHAP-driven interpretability enhancing its clinical applicability for personalized decision-making.展开更多
BACKGROUND Intracerebral hemorrhage(ICH)comprises 9%-27%of stroke patients.Hematoma expansion(HE)occurs in approximately 20%of patients following ICH,typically within the first 24 hours.HE increases mortality and long...BACKGROUND Intracerebral hemorrhage(ICH)comprises 9%-27%of stroke patients.Hematoma expansion(HE)occurs in approximately 20%of patients following ICH,typically within the first 24 hours.HE increases mortality and long-term disability in these patients and is being investigated as a therapeutic target to improve the outcome in these patients by limiting HE.Non-contrast computed tomography(NCCT)has potential in predicting HE,which can identify the individuals at risk.AIM To evaluate NCCT markers for predicting HE in patients with ICH and to develop a simple,practical grading system for risk stratification.METHODS This prospective observational study evaluated 192 patients with spontaneous ICH who underwent a baseline NCCT within four hours of admission,followed by a follow-up scan after six hours or earlier if there was clinical deterioration.Hematoma volumes and imaging characteristics that predicted HE were evaluated.A simple five-point grading system score was created to predict HE.In RESULTS Of the 192 patients studied,HE was seen in 106(55.2%).The mean baseline hematoma volume was significantly greater among patients in the HE group(44.1 mL)compared to those in the non-HE group(12.2 mL),with a P-value<0.05.Additionally,imaging biomarkers such as the island sign,swirl sign,and black hole sign were observed with significantly higher frequency in the HE group relative to the non-HE cohort(all P-values<0.05).The island sign was strongly associated with HE[odds ratio(OR)13.7;95%confidence interval(CI):10.15-16.37;P<0.001].Similarly,the black hole sign(OR 9.4;95%CI:7.4-11.62;P<0.001)and the swirl sign(OR 5.2;95%CI:3.72-6.53;P<0.001)emerged as significant predictors of HE.Initial hematoma volume≥30 mL also showed a sig-nificant association(OR 1.9;95%CI:1.41-2.74;P=0.039).A five-point predictive scoring model demonstrated a strong positive association between increasing scores and the probability of HE.Specifically,the likelihood of HE corresponding to scores of 0,1,2,3,4,and 5 was 7.4%,37.5%,75%,85%,93.3%,and 100%,respectively.CONCLUSION The five variables demonstrated statistically significant associations with HE.This simple and practical 5-point prediction score can enable identification of patients at elevated risk of HE based on baseline NCCT findings.This can facilitate timely recognition of high-risk individuals who may benefit from targeted anti-expansion therapy.展开更多
BACKGROUND Contrast-induced nephropathy(CIN)is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material.CIN is the third leading cause of hospital-acquired acu...BACKGROUND Contrast-induced nephropathy(CIN)is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material.CIN is the third leading cause of hospital-acquired acute kidney injury and accounts for 12%of such cases.Risk factors for CIN development can be divided into patientand procedure-related.The former includes pre-existing chronic renal insufficiency and diabetes mellitus.The latter includes high contrast volume and repeated exposure over 72 h.The incidence of CIN is relatively low(up to 5%)in patients with intact renal function.However,in patients with known chronic renal insufficiency,the incidence can reach up to 27%.AIM To examine the association between renal enhancement pattern on non-contrast enhanced computed tomographic(CT)images obtained immediately following hepatic artery embolization with development of CIN.METHODS Retrospective review of all patients who underwent hepatic artery embolization between 01/2010 and 01/2011(n=162)was performed.Patients without intraprocedural CT imaging(n=51),combined embolization/ablation(n=6)and those with chronic kidney disease(n=21)were excluded.The study group comprised of 84 patients with 106 procedures.CIN was defined as 25%increase above baseline serum creatinine or absolute increase≥0.5 mg/dL within 72 h post-embolization.Post-embolization CT was reviewed for renal enhancement patterns and presence of renal artery calcifications.The association between noncontrast CT findings and CIN development was examined by Fisher’s Exact Test.RESULTS CIN occurred in 11/106(10.3%)procedures(Group A,n=10).The renal enhancement pattern in patients who did not experience CIN(Group B,n=74 with 95/106 procedures)was late excretory in 93/95(98%)and early excretory(EE)in 2/95(2%).However,in Group A,there was a significantly higher rate of EE pattern(6/11,55%)compared to late excretory pattern(5/11)(P<0.001).A significantly higher percentage of patients that developed CIN had renal artery calcifications(6/11 vs 20/95,55%vs 21%,P=0.02).CONCLUSION A hyperdense renal parenchyma relative to surrounding skeletal muscle(EE pattern)and presence of renal artery calcifications on immediate post-HAE noncontrast CT images in patients with low risk for CIN are independently associated with CIN development.展开更多
Objectives: This study aimed to determine whether errors in vascular measurements would affect device selection in endovascular aortic repair (EVAR) by comparing measurements obtained using non-contrast computed tomog...Objectives: This study aimed to determine whether errors in vascular measurements would affect device selection in endovascular aortic repair (EVAR) by comparing measurements obtained using non-contrast computed tomography (NCT) with those obtained using contrast-enhanced CT (CECT). Materials and Methods: This single-center, retrospective study included 25 patients who underwent EVAR for abdominal aortic aneurysm at our institution. A 1-mm horizontal cross-sectional slice of NCT and CECT from each patient was retrospectively reviewed. The area from the abdominal aorta to the common iliac artery was divided into four zones. A centerline was created using the NCT by manually plotting the center points. Subsequently, the centerlines were automatically extracted and manually corrected during the arterial phase of CECT. The diameter and length of each zone were measured for each modality. The mean diameters and lengths of the target vessels were compared between NCT and CECT. Results: The measurements obtained using both methods were reproducible and demonstrated good agreement. The mean differences in vessel length and diameter measurements for each segment between NCT and CECT were not statistically significant, indicating good consistency. Conclusion: NCT may be useful for preoperative EVAR evaluation in patients with renal dysfunction or allergies to contrast agents.展开更多
Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate ( GFR) for chronic obstructed kidneys,and to compare the co...Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate ( GFR) for chronic obstructed kidneys,and to compare the correlations between two morphologic indices of renal parenchyma and GFR for chronic obstructed kidneys.展开更多
Spontaneous intracerebral hemorrhage carries high early mortality and long-term disability,with hematoma expansion(HE)being the most important modifiable determinant of poor outcome.Although the computed tomography(CT...Spontaneous intracerebral hemorrhage carries high early mortality and long-term disability,with hematoma expansion(HE)being the most important modifiable determinant of poor outcome.Although the computed tomography(CT)angiography(CTA)“spot sign”is a validated predictor of HE,it is not universally available,highlighting the need for accessible imaging tools.In this invited editorial,we discuss the study by Parry et al,who developed a simplified fivepoint prediction score based solely on non-contrast CT findings-baseline hematoma volume≥30 mL,intraventricular hemorrhage,and the island,black hole,and swirl signs.Tested prospectively in 192 patients scanned within 4 hours of onset,the score showed a stepwise rise in HE risk from 7%at a score of 0%to 100%at a score of 5.We place these findings in the context of existing CTA and non-contrast CT literature and highlight their potential to accelerate triage and treatment,particularly where CTA is unavailable.Broader multicenter validation and integration with clinical and machine-learning approaches will further define the clinical impact of this streamlined,imaging-only tool.展开更多
目的比较双能CT血管造影(CTA)衍生的虚拟平扫(VNC)与常规CT平扫(NCCT)在图像质量、病变对比度以及Alberta卒中项目早期CT评分(ASPECTS)差异,评价基于VNC图像进行ASPECTS评分的准确性,以探究VNC对于急性缺血性脑卒中(AIS)的应用价值。方...目的比较双能CT血管造影(CTA)衍生的虚拟平扫(VNC)与常规CT平扫(NCCT)在图像质量、病变对比度以及Alberta卒中项目早期CT评分(ASPECTS)差异,评价基于VNC图像进行ASPECTS评分的准确性,以探究VNC对于急性缺血性脑卒中(AIS)的应用价值。方法选取2023年11月至2024年1月接受常规头颅CT平扫和双能CTA扫描的AIS患者,获得颅脑NCCT和VNC图像。对两组图像进行客观及主观图像质量评价:客观图像质量评价选取半卵圆中心、放射冠、内囊、尾状核头、丘脑和静脉窦区域为感兴趣区(ROI),测量CT值、噪声,计算信噪比(SNR)、灰白质间对比噪声比(CNR);主观图像质量评价由两名放射诊断医师采用李克特(Likert)5分量表法独立进行。选取梗死病变和相应健侧区域测量平均组织密度,计算梗死灶CNR和对比度临床差异(CID),并由两名放射科医师独立对NCCT图像和VNC图像进行ASPECTS评分。结果共87例患者纳入影像分析,平均年龄65.8岁,其中女性27例,男性60例。VNC图像的半卵圆中心、放射冠、内囊、尾状核头、丘脑和静脉窦区域的SNR和CNR均显著低于NCCT图像(P<0.05)。VNC图像的主观图像质量评分显著低于NCCT图像(3.29±0.73 vs 4.95±0.21;P<0.01)。VNC图像的病变临床对比度较NCCT降低54.87%。VNC组、NCCT组图像ASPECTS分别为9.03±1.08、8.86±1.47,差异无统计学意义(P=0.29)。结论AIS患者VNC图像ASPECTS评分与NCCT图像一致,虽图像质量相对较差,但必要时可作为临床评价参考。展开更多
基金Supported by the Science and Technology Development Fund of Nanjing Medical University,No.NMUB20230037the Youth Scientific Research Nurturing Fund of Jiangbei Campus of Zhongda Hospital Affiliated with Southeast University,No.JB2024Q01.
文摘BACKGROUND Accurate preoperative differentiation of benign and malignant thyroid nodules is critical for optimal patient management.However,conventional imaging modalities present inherent diagnostic limitations.AIM To develop a non-contrast computed tomography-based machine learning model integrating radiomics and clinical features for preoperative thyroid nodule classification.METHODS This multicenter retrospective study enrolled 272 patients with thyroid nodules(376 thyroid lobes)from center A(May 2021-April 2024),using histopathological findings as the reference standard.The dataset was stratified into a training cohort(264 lobes)and an internal validation cohort(112 lobes).Additional prospective temporal(97 lobes,May-August 2024,center A)and external multicenter(81 lobes,center B)test cohorts were incorporated to enhance generalizability.Thyroid lobes were segmented along the isthmus midline,with segmentation reliability confirmed by an intraclass correlation coefficient(≥0.80).Radiomics feature extraction was performed using Pearson correlation analysis followed by least absolute shrinkage and selection operator regression with 10-fold cross-validation.Seven machine learning algorithms were systematically evaluated,with model performance quantified through the area under the receiver operating characteristic curve(AUC),Brier score,decision curve analysis,and DeLong test for comparison with radiologists interpretations.Model interpretability was elucidated using SHapley Additive exPlanations(SHAP).RESULTS The extreme gradient boosting model demonstrated robust diagnostic performance across all datasets,achieving AUCs of 0.899[95%confidence interval(CI):0.845-0.932]in the training cohort,0.803(95%CI:0.715-0.890)in internal validation,0.855(95%CI:0.775-0.935)in temporal testing,and 0.802(95%CI:0.664-0.939)in external testing.These results were significantly superior to radiologists assessments(AUCs:0.596,0.529,0.558,and 0.538,respectively;P<0.001 by DeLong test).SHAP analysis identified radiomic score,age,tumor size stratification,calcification status,and cystic components as key predictive features.The model exhibited excellent calibration(Brier scores:0.125-0.144)and provided significant clinical net benefit at decision thresholds exceeding 20%,as evidenced by decision curve analysis.CONCLUSION The non-contrast computed tomography-based radiomics-clinical fusion model enables robust preoperative thyroid nodule classification,with SHAP-driven interpretability enhancing its clinical applicability for personalized decision-making.
文摘BACKGROUND Intracerebral hemorrhage(ICH)comprises 9%-27%of stroke patients.Hematoma expansion(HE)occurs in approximately 20%of patients following ICH,typically within the first 24 hours.HE increases mortality and long-term disability in these patients and is being investigated as a therapeutic target to improve the outcome in these patients by limiting HE.Non-contrast computed tomography(NCCT)has potential in predicting HE,which can identify the individuals at risk.AIM To evaluate NCCT markers for predicting HE in patients with ICH and to develop a simple,practical grading system for risk stratification.METHODS This prospective observational study evaluated 192 patients with spontaneous ICH who underwent a baseline NCCT within four hours of admission,followed by a follow-up scan after six hours or earlier if there was clinical deterioration.Hematoma volumes and imaging characteristics that predicted HE were evaluated.A simple five-point grading system score was created to predict HE.In RESULTS Of the 192 patients studied,HE was seen in 106(55.2%).The mean baseline hematoma volume was significantly greater among patients in the HE group(44.1 mL)compared to those in the non-HE group(12.2 mL),with a P-value<0.05.Additionally,imaging biomarkers such as the island sign,swirl sign,and black hole sign were observed with significantly higher frequency in the HE group relative to the non-HE cohort(all P-values<0.05).The island sign was strongly associated with HE[odds ratio(OR)13.7;95%confidence interval(CI):10.15-16.37;P<0.001].Similarly,the black hole sign(OR 9.4;95%CI:7.4-11.62;P<0.001)and the swirl sign(OR 5.2;95%CI:3.72-6.53;P<0.001)emerged as significant predictors of HE.Initial hematoma volume≥30 mL also showed a sig-nificant association(OR 1.9;95%CI:1.41-2.74;P=0.039).A five-point predictive scoring model demonstrated a strong positive association between increasing scores and the probability of HE.Specifically,the likelihood of HE corresponding to scores of 0,1,2,3,4,and 5 was 7.4%,37.5%,75%,85%,93.3%,and 100%,respectively.CONCLUSION The five variables demonstrated statistically significant associations with HE.This simple and practical 5-point prediction score can enable identification of patients at elevated risk of HE based on baseline NCCT findings.This can facilitate timely recognition of high-risk individuals who may benefit from targeted anti-expansion therapy.
文摘BACKGROUND Contrast-induced nephropathy(CIN)is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material.CIN is the third leading cause of hospital-acquired acute kidney injury and accounts for 12%of such cases.Risk factors for CIN development can be divided into patientand procedure-related.The former includes pre-existing chronic renal insufficiency and diabetes mellitus.The latter includes high contrast volume and repeated exposure over 72 h.The incidence of CIN is relatively low(up to 5%)in patients with intact renal function.However,in patients with known chronic renal insufficiency,the incidence can reach up to 27%.AIM To examine the association between renal enhancement pattern on non-contrast enhanced computed tomographic(CT)images obtained immediately following hepatic artery embolization with development of CIN.METHODS Retrospective review of all patients who underwent hepatic artery embolization between 01/2010 and 01/2011(n=162)was performed.Patients without intraprocedural CT imaging(n=51),combined embolization/ablation(n=6)and those with chronic kidney disease(n=21)were excluded.The study group comprised of 84 patients with 106 procedures.CIN was defined as 25%increase above baseline serum creatinine or absolute increase≥0.5 mg/dL within 72 h post-embolization.Post-embolization CT was reviewed for renal enhancement patterns and presence of renal artery calcifications.The association between noncontrast CT findings and CIN development was examined by Fisher’s Exact Test.RESULTS CIN occurred in 11/106(10.3%)procedures(Group A,n=10).The renal enhancement pattern in patients who did not experience CIN(Group B,n=74 with 95/106 procedures)was late excretory in 93/95(98%)and early excretory(EE)in 2/95(2%).However,in Group A,there was a significantly higher rate of EE pattern(6/11,55%)compared to late excretory pattern(5/11)(P<0.001).A significantly higher percentage of patients that developed CIN had renal artery calcifications(6/11 vs 20/95,55%vs 21%,P=0.02).CONCLUSION A hyperdense renal parenchyma relative to surrounding skeletal muscle(EE pattern)and presence of renal artery calcifications on immediate post-HAE noncontrast CT images in patients with low risk for CIN are independently associated with CIN development.
文摘Objectives: This study aimed to determine whether errors in vascular measurements would affect device selection in endovascular aortic repair (EVAR) by comparing measurements obtained using non-contrast computed tomography (NCT) with those obtained using contrast-enhanced CT (CECT). Materials and Methods: This single-center, retrospective study included 25 patients who underwent EVAR for abdominal aortic aneurysm at our institution. A 1-mm horizontal cross-sectional slice of NCT and CECT from each patient was retrospectively reviewed. The area from the abdominal aorta to the common iliac artery was divided into four zones. A centerline was created using the NCT by manually plotting the center points. Subsequently, the centerlines were automatically extracted and manually corrected during the arterial phase of CECT. The diameter and length of each zone were measured for each modality. The mean diameters and lengths of the target vessels were compared between NCT and CECT. Results: The measurements obtained using both methods were reproducible and demonstrated good agreement. The mean differences in vessel length and diameter measurements for each segment between NCT and CECT were not statistically significant, indicating good consistency. Conclusion: NCT may be useful for preoperative EVAR evaluation in patients with renal dysfunction or allergies to contrast agents.
文摘Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate ( GFR) for chronic obstructed kidneys,and to compare the correlations between two morphologic indices of renal parenchyma and GFR for chronic obstructed kidneys.
文摘目的探讨成人非偏头痛症状与卵圆孔未闭(patent foramen ovale,PFO)的相关性。方法回顾分析我院心血管内科超声心动图室2024年2~12月经胸超声心动图右心声学造影(contrast transthoracic echocardiography,cTTE)检查患者的临床资料,根据症状分为偏头痛症状组(n=527)、非偏头痛症状组(包括不明原因的头晕、耳鸣、一过性听力减退、晕厥、肢体麻木、一过性视野缺损症状,n=144)和无症状对照组(n=87)。比较3组PFO阳性率、PFO阳性患者右向左分流(right to left shunt,RLS)的差异;多因素logistic回归分析PFO阳性的独立相关因素。结果偏头痛症状组、非偏头痛症状组和无症状对照组PFO阳性率分别为85.0%(448/527)、84.0%(121/144)和26.4%(23/87),3组差异有显著性(χ^(2)=153.434,P=0.000),偏头痛症状组和非偏头痛症状组PFO阳性率显著高于无症状对照组(均P=0.000)。592例诊断PFO,3组RLS分级差异有显著性(H=18.762,P=0.000),偏头痛症状组和非偏头痛症状组RLS分级显著高于无症状对照组(均P=0.000)。多因素logistic回归分析显示,年龄≤40岁(OR=2.221,95%CI:1.515~3.256,P=0.000)、偏头痛(OR=3.373,95%CI:2.322~4.899,P=0.000)、头晕(OR=2.499,95%CI:1.694~3.685,P=0.000)和肢体麻木(OR=1.981,95%CI:1.052~3.729,P=0.034)与PFO阳性独立相关。结论头晕、肢体麻木等非偏头痛症状与成人PFO相关,对这些症状的患者进行cTTE检查是必要的。
文摘Spontaneous intracerebral hemorrhage carries high early mortality and long-term disability,with hematoma expansion(HE)being the most important modifiable determinant of poor outcome.Although the computed tomography(CT)angiography(CTA)“spot sign”is a validated predictor of HE,it is not universally available,highlighting the need for accessible imaging tools.In this invited editorial,we discuss the study by Parry et al,who developed a simplified fivepoint prediction score based solely on non-contrast CT findings-baseline hematoma volume≥30 mL,intraventricular hemorrhage,and the island,black hole,and swirl signs.Tested prospectively in 192 patients scanned within 4 hours of onset,the score showed a stepwise rise in HE risk from 7%at a score of 0%to 100%at a score of 5.We place these findings in the context of existing CTA and non-contrast CT literature and highlight their potential to accelerate triage and treatment,particularly where CTA is unavailable.Broader multicenter validation and integration with clinical and machine-learning approaches will further define the clinical impact of this streamlined,imaging-only tool.
文摘目的比较双能CT血管造影(CTA)衍生的虚拟平扫(VNC)与常规CT平扫(NCCT)在图像质量、病变对比度以及Alberta卒中项目早期CT评分(ASPECTS)差异,评价基于VNC图像进行ASPECTS评分的准确性,以探究VNC对于急性缺血性脑卒中(AIS)的应用价值。方法选取2023年11月至2024年1月接受常规头颅CT平扫和双能CTA扫描的AIS患者,获得颅脑NCCT和VNC图像。对两组图像进行客观及主观图像质量评价:客观图像质量评价选取半卵圆中心、放射冠、内囊、尾状核头、丘脑和静脉窦区域为感兴趣区(ROI),测量CT值、噪声,计算信噪比(SNR)、灰白质间对比噪声比(CNR);主观图像质量评价由两名放射诊断医师采用李克特(Likert)5分量表法独立进行。选取梗死病变和相应健侧区域测量平均组织密度,计算梗死灶CNR和对比度临床差异(CID),并由两名放射科医师独立对NCCT图像和VNC图像进行ASPECTS评分。结果共87例患者纳入影像分析,平均年龄65.8岁,其中女性27例,男性60例。VNC图像的半卵圆中心、放射冠、内囊、尾状核头、丘脑和静脉窦区域的SNR和CNR均显著低于NCCT图像(P<0.05)。VNC图像的主观图像质量评分显著低于NCCT图像(3.29±0.73 vs 4.95±0.21;P<0.01)。VNC图像的病变临床对比度较NCCT降低54.87%。VNC组、NCCT组图像ASPECTS分别为9.03±1.08、8.86±1.47,差异无统计学意义(P=0.29)。结论AIS患者VNC图像ASPECTS评分与NCCT图像一致,虽图像质量相对较差,但必要时可作为临床评价参考。
