Meta-analysis of Quantitative Diffusion-weighted MR Imaging in Differentiating Benign and Malignant Pancreatic Masses

There have been numerous studies done to explore the diagnostic performance of quanti- tative diffusion-weighted （DW） MR imaging to differentiate between benign and malignant pancre- atic masses. However, the results have been inconsistent. We performed a meta-analysis to investigate whether DW-MR imaging can differentiate between these two diseases. Databases including MEDLINE, EMBASE and Cochrane Library were utilized to find relevant articles published between January 2001 and January 2014. A Stata version 12.0 and a Meta-Disc version 1.4 were used to de- scribe primary results. Twelve studies with 594 patients, which fulfilled the inclusion criteria, were enrolled for the analysis. The pooled sensitivity and specificity of DW imaging was 0.91 （95% CI： 0.84, 0.95） and 0.86 （95% CI： 0.76, 0.93） respectively. The area under the curve of the summary re- ceiver operating characteristic was 0.95 （95% CI： 0.93, 0.96）. The results indicated that DW imaging might be a valuable tool for differentiating benign and malignant pancreatic masses.

Diagnosis value of diffusion-weighted MR imaging with dynamic enhanced scanning toward pancreatic endocrine tumors

Objective： The aim of our study was to analysis the pictures of conventional magnetic resonance imaging （MR）, diffusion-weighted imaging （DWl） and dynamic enhanced magnetic resonance imaging （DEMRI） of pancreatic endocrine tumors （PETs）, and evaluate diagnostic value of MR, DWl and DEMRI for diagnosing PETs. Methods： DWl and DEMRI scanning toward 13 patients with PETs being confirmed by surgical pathology before surgery on the basis of conventional MR scanning were carried out, and MR findings was analyzed retrospectively. Results： Of 13 patients with PETs there was 11 cases with single lesion, 2 with multiple, and had 15 lesions altogether, of which there were 3 lesions in pancreatic head, 1 in its neck, 2 in its body, 4 in its body and tail, 5 in its tail. MR findings： （1） T1WI signal was low or slightly lower （9/15）, and equal ones （5/15）; （2） T2WI showed high or slightly higher signal （10/15）, and equal ones （5/15）; （3） T1WI with fat suppression： the signal was low （11/15）, mixed signal （2/15）, and equal ones （2/15）; （4） DWI： normal pancreatic tissue exhibited homogeneous intermediate signal, all 15 lesions were high or slightly higher signal, the measured ADC values of tissue of PETs was （1.124 ± 0.252） × 104 mm2/s, and the ADC value of normal pancreatic tissue （1.873 ± 0.157） × 10^3 mm2/s; （5） Enhanced （M3D/LAVA） scanning： among 13 patients with PETs there were 12 pancreatic lesions with significantly enhanced signals in the arterial phase in all 15, and significantly higher than normal pancreatic tissue, and two slight enhancement was slightly higher signal; and 1 no enhancement. Enhanced pattern： homogeneous enhancement were 6 lesions, and the heterogeneous 4, and the edge ring 5. Conclusion： MR and DWl combining with DEMRI help qualitative diagnosis of pancreatic endocrine tumors.

Diffusion-Weighted MR Imaging of the Benign Hepatic Focal Lesions

Purpose: To determine the role of diffusion weighted MR imaging and apparent diffusion coefficient (ADC) in benign hepatic focal lesions. Method and Materials: This study included 47 patients (29 M, 18 F with mean age of 43 years) with benign hepatic focal lesions. They were cyst (n = 8), hemangioma (n = 23), abscess (n = 5), adenoma (n = 5), focal nodular hyperplasia (n = 4) and nodular regenerative hyperplasia (n = 2). They underwent routine MR imaging and diffusion MR weighted imaging using 1.5 tesla MR unit (Symphony-Siemens). Diffusion MR imaging was done using spin echo type of single shot echo planar imaging (EPI) with b value of 0, 500 & 1000 sec/mm2. The apparent diffusion coefficient (ADC) map was reconstructed and ADC value was measured. The mean ADC values correlated with histo-pathological results as well as follow-up imaging results. Results: Adequate ADC maps were obtained in 47 patients. The mean ADC values were 3.4 ± 0.12 × 10-3 mm2/sec in cystic lesion, 2.23 ± 0.08 × 10-3 mm2/sec in hemangioma, 1.94 ± 0.05 × 10-3 mm2/sec in abscess, 1.72 ± 0.07 × 10-3 in focal nodular hyperplasia, 1.65 ± 0.06 × 10-3 mm2/sec in adenoma, 1.62 ± 0.07 × 10-3 mm2/sec in nodular regenerative hyperplasia. The mean ADC values were significantly different within benign hepatic focal lesions (P < 0.001). The differences between the mean ADC values of FNH, adenoma and NRH were not statistically significant (P < 0.23). Conclusion: Diffusion weighted MR imaging is a new imaging modality for diagnosis and characterization of different benign hepatic focal lesions, particularly in patient with renal dysfunction.

Impact of Field Strength and Respiratory Motion Control on Diffusion-Weighted MR Imaging of the Liver

Purpose: To evaluate the impact of field strength and respiratory motion control on diffusion-weighted MR imaging (DWI) of the liver at 1.5 and 3 T. Material and Methods: Three DWI sequences using seven b-values from 20 - 400 s/mm2 were designed with identical parameters but with different handling of respiratory motion [respiratory triggered (RT), free breathing (FB), breath hold (BH)] on 3 T and 1.5 T. Thirteen volunteers were examined at a 3 T and six of them also at a 1.5 T magnet. DW images were analyzed quantitatively and qualitatively. Regions of interest were placed in cranial, middle and caudal parts of the right liver lobe (RLL) and ADC and SNR were calculated. Results: ADC in RLL tended to be lower at 3 T MRI. Least inter-subject ADC variability was found with RT in the middle RLL at 3 T. Highest ADCs were found caudally in the RLL. Significant differences in ADC between middle and caudal RLL were calculated in FB and RT at 3 T and FB and BH at 1.5 T, respectively. No significant difference in SNR was found between 3 T and 1.5 T. There were significantly more artifacts in the left liver lobe (LLL) compared to the RLL in all sequences and in the LLL at 3 T compared to 1.5 T. Conclusion: Our study suggests that longitudinal hepatic ADC measurements should be performed using equivalent field strength, b-values, and acquisition technique, given influence of these factors on ADC measurements.

Staging liver fibrosis with various diffusion-weighted magnetic resonance imaging models

BACKGROUND Diffusion-weighted imaging(DWI)has been developed to stage liver fibrosis.However,its diagnostic performance is inconsistent among studies.Therefore,it is worth studying the diagnostic value of various diffusion models for liver fibrosis in one cohort.AIM To evaluate the clinical potential of six diffusion-weighted models in liver fibrosis staging and compare their diagnostic performances.METHODS This prospective study enrolled 59 patients suspected of liver disease and scheduled for liver biopsy and 17 healthy participants.All participants underwent multi-b value DWI.The main DWI-derived parameters included Mono-apparent diffusion coefficient(ADC)from mono-exponential DWI,intravoxel incoherent motion model-derived true diffusion coefficient(IVIM-D),diffusion kurtosis imaging-derived apparent diffusivity(DKI-MD),stretched exponential model-derived distributed diffusion coefficient(SEM-DDC),fractional order calculus(FROC)model-derived diffusion coefficient(FROC-D)and FROC model-derived microstructural quantity(FROC-μ),and continuous-time random-walk(CTRW)model-derived anomalous diffusion coefficient(CTRW-D)and CTRW model-derived temporal diffusion heterogeneity index(CTRW-α).The correlations between DWI-derived parameters and fibrosis stages and the parameters’diagnostic efficacy in detecting significant fibrosis(SF)were assessed and compared.RESULTS CTRW-D(r=-0.356),CTRW-α(r=-0.297),DKI-MD(r=-0.297),FROC-D(r=-0.350),FROC-μ(r=-0.321),IVIM-D(r=-0.251),Mono-ADC(r=-0.362),and SEM-DDC(r=-0.263)were significantly correlated with fibrosis stages.The areas under the ROC curves(AUCs)of the combined index of the six models for distinguishing SF(0.697-0.747)were higher than each of the parameters alone(0.524-0.719).The DWI models’ability to detect SF was similar.The combined index of CTRW model parameters had the highest AUC(0.747).CONCLUSION The DWI models were similarly valuable in distinguishing SF in patients with liver disease.The combined index of CTRW parameters had the highest AUC.

Value of multiple models of diffusion-weighted imaging to predict hepatic lymph node metastases in colorectal liver metastases patients

BACKGROUND About 10%-31% of colorectal liver metastases(CRLM)patients would concomitantly show hepatic lymph node metastases(LNM),which was considered as sign of poor biological behavior and a relative contraindication for liver resection.Up to now,there’s still lack of reliable preoperative methods to assess the status of hepatic lymph nodes in patients with CRLM,except for pathology examination of lymph node after resection.AIM To compare the ability of mono-exponential,bi-exponential,and stretchedexponential diffusion-weighted imaging(DWI)models in distinguishing between benign and malignant hepatic lymph nodes in patients with CRLM who received neoadjuvant chemotherapy prior to surgery.METHODS In this retrospective study,97 CRLM patients with pathologically confirmed hepatic lymph node status underwent magnetic resonance imaging,including DWI with ten b values before and after chemotherapy.Various parameters,such as the apparent diffusion coefficient from the mono-exponential model,and the true diffusion coefficient,the pseudo-diffusion coefficient,and the perfusion fraction derived from the intravoxel incoherent motion model,along with distributed diffusion coefficient(DDC)andαfrom the stretched-exponential model(SEM),were measured.The parameters before and after chemotherapy were compared between positive and negative hepatic lymph node groups.A nomogram was constructed to predict the hepatic lymph node status.The reliability and agreement of the measurements were assessed using the coefficient of variation and intraclass correlation coefficient.RESULTS Multivariate analysis revealed that the pre-treatment DDC value and the short diameter of the largest lymph node after treatment were independent predictors of metastatic hepatic lymph nodes.A nomogram combining these two factors demonstrated excellent performance in distinguishing between benign and malignant lymph nodes in CRLM patients,with an area under the curve of 0.873.Furthermore,parameters from SEM showed substantial repeatability.CONCLUSION The developed nomogram,incorporating the pre-treatment DDC and the short axis of the largest lymph node,can be used to predict the presence of hepatic LNM in CRLM patients undergoing chemotherapy before surgery.This nomogram was proven to be more valuable,exhibiting superior diagnostic performance compared to quantitative parameters derived from multiple b values of DWI.The nomogram can serve as a preoperative assessment tool for determining the status of hepatic lymph nodes and aiding in the decision-making process for surgical treatment in CRLM patients.

Transient elastography and diffusion-weighted magnetic resonance imaging for assessment of liver fibrosis in children with chronic hepatitis C

BACKGROUND Chronic hepatitis C(CHC)is a health burden with consequent morbidity and mortality.Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treatment.Noninvasive altern-atives for liver biopsy such as transient elastography(TE)and diffusion-weighted magnetic resonance imaging(DW-MRI)are critical needs.AIM To evaluate TE and DW-MRI as noninvasive tools for predicting liver fibrosis in children with CHC.METHODS This prospective cross-sectional study initially recruited 100 children with CHC virus infection.Sixty-four children completed the full set of investigations including liver stiffness measurement(LSM)using TE and measurement of apparent diffusion coefficient(ADC)of the liver and spleen using DW-MRI.Liver biopsies were evaluated for fibrosis using Ishak scoring system.LSM and liver and spleen ADC were compared in different fibrosis stages and correlation analysis was performed with histopathological findings and other laboratory parameters.RESULTS Most patients had moderate fibrosis(73.5%)while 26.5%had mild fibrosis.None had severe fibrosis or cirrhosis.The majority(68.8%)had mild activity,while only 7.8%had moderate activity.Ishak scores had a significant direct correlation with LSM(P=0.008)and were negatively correlated with both liver and spleen ADC but with no statistical significance(P=0.086 and P=0.145,respectively).Similarly,histopatho-logical activity correlated significantly with LSM(P=0.002)but not with liver or spleen ADC(P=0.84 and 0.98 respectively).LSM and liver ADC were able to significantly discriminate F3 from lower fibrosis stages(area under the curve=0.700 and 0.747,respectively)with a better performance of liver ADC.CONCLUSION TE and liver ADC were helpful in predicting significant fibrosis in children with chronic hepatitis C virus infection with a better performance of liver ADC.

Advancement in utilization of magnetic resonance imaging and biomarkers in the understanding of schizophrenia

Historically,psychiatric diagnoses have been made based on patient’s reported symptoms applying the criteria from diagnostic and statistical manual of mental disorders.The utilization of neuroimaging or biomarkers to make the diagnosis and manage psychiatric disorders remains a distant goal.There have been several studies that examine brain imaging in psychiatric disorders,but more work is needed to elucidate the complexities of the human brain.In this editorial,we examine two articles by Xu et al and Stoyanov et al,that show developments in the direction of using neuroimaging to examine the brains of people with schizo-phrenia and depression.Xu et al used magnetic resonance imaging to examine the brain structure of patients with schizophrenia,in addition to examining neurotransmitter levels as biomarkers.Stoyanov et al used functional magnetic resonance imaging to look at modulation of different neural circuits by diagnostic-specific scales in patients with schizophrenia and depression.These two studies provide crucial evidence in advancing our understanding of the brain in prevalent psychiatric disorders.

Retrospective analysis of pathological types and imaging features in pancreatic cancer: A comprehensive study

BACKGROUND Pancreatic cancer remains one of the most lethal malignancies worldwide,with a poor prognosis often attributed to late diagnosis.Understanding the correlation between pathological type and imaging features is crucial for early detection and appropriate treatment planning.AIM To retrospectively analyze the relationship between different pathological types of pancreatic cancer and their corresponding imaging features.METHODS We retrospectively analyzed the data of 500 patients diagnosed with pancreatic cancer between January 2010 and December 2020 at our institution.Pathological types were determined by histopathological examination of the surgical spe-cimens or biopsy samples.The imaging features were assessed using computed tomography,magnetic resonance imaging,and endoscopic ultrasound.Statistical analyses were performed to identify significant associations between pathological types and specific imaging characteristics.RESULTS There were 320(64%)cases of pancreatic ductal adenocarcinoma,75(15%)of intraductal papillary mucinous neoplasms,50(10%)of neuroendocrine tumors,and 55(11%)of other rare types.Distinct imaging features were identified in each pathological type.Pancreatic ductal adenocarcinoma typically presents as a hypodense mass with poorly defined borders on computed tomography,whereas intraductal papillary mucinous neoplasms present as characteristic cystic lesions with mural nodules.Neuroendocrine tumors often appear as hypervascular lesions in contrast-enhanced imaging.Statistical analysis revealed significant correlations between specific imaging features and pathological types(P<0.001).CONCLUSION This study demonstrated a strong association between the pathological types of pancreatic cancer and imaging features.These findings can enhance the accuracy of noninvasive diagnosis and guide personalized treatment approaches.

Imaging characteristics of hypervascular focal nodular hyperplasialike lesions in patients with chronic alcoholic liver disease

BACKGROUND Focal nodular hyperplasia(FNH)-like lesions are hyperplastic formations in patients with micronodular cirrhosis and a history of alcohol abuse.Although pathologically similar to hepatocellular carcinoma(HCC)lesions,they are benign.As such,it is important to develop methods to distinguish between FNH-like lesions and HCC.AIM To evaluate diagnostically differential radiological findings between FNH-like lesions and HCC.METHODS We studied pathologically confirmed FNH-like lesions in 13 patients with alco-holic cirrhosis[10 men and 3 women;mean age:54.5±12.5(33-72)years]who were negative for hepatitis-B surface antigen and hepatitis-C virus antibody and underwent dynamic computed tomography(CT)and magnetic resonance imaging(MRI),including superparamagnetic iron oxide(SPIO)and/or gadoxetic acid-enhanced MRI.Seven patients also underwent angiography-assisted CT.RESULTS The evaluated lesion features included arterial enhancement pattern,washout appearance(low density compared with that of surrounding liver parenchyma),signal intensity on T1-weighted image(T1WI)and T2-weighted image(T2WI),central scar presence,chemical shift on in-and out-of-phase images,and uptake pattern on gadoxetic acid-enhanced MRI hepatobiliary phase and SPIO-enhanced MRI.Eleven patients had multiple small lesions(<1.5 cm).Radiological features of FNH-like lesions included hypervascularity despite small lesions,lack of“corona-like”enhancement in the late phase on CT during hepatic angiography(CTHA),high-intensity on T1WI,slightly high-or iso-intensity on T2WI,no signal decrease in out-of-phase images,and complete SPIO uptake or incomplete/partial uptake of gadoxetic acid.Pathologically,similar to HCC,FNH-like lesions showed many unpaired arteries and sinusoidal capillarization.CONCLUSION Overall,the present study showed that FNH-like lesions have unique radiological findings useful for differential diagnosis.Specifically,SPIO-and/or gadoxetic acid-enhanced MRI and CTHA features might facilitate differential diagnosis of FNH-like lesions and HCC.

Multiparameter magnetic resonance imaging-based radiomics model for the prediction of rectal cancer metachronous liver metastasis

BACKGROUND The liver,as the main target organ for hematogenous metastasis of colorectal cancer,early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients.Herein,this study aims to investigate the application value of a combined machine learning(ML)based model based on the multiparameter magnetic resonance imaging for prediction of rectal metachronous liver metastasis(MLM).AIM To investigate the efficacy of radiomics based on multiparametric magnetic resonance imaging images of preoperative first diagnosed rectal cancer in predicting MLM from rectal cancer.METHODS We retrospectively analyzed 301 patients with rectal cancer confirmed by surgical pathology at Jingzhou Central Hospital from January 2017 to December 2023.All participants were randomly assigned to the training or validation queue in a 7:3 ratio.We first apply generalized linear regression model(GLRM)and random forest model(RFM)algorithm to construct an MLM prediction model in the training queue,and evaluate the discriminative power of the MLM prediction model using area under curve(AUC)and decision curve analysis(DCA).Then,the robustness and generalizability of the MLM prediction model were evaluated based on the internal validation set between the validation queue groups.RESULTS Among the 301 patients included in the study,16.28%were ultimately diagnosed with MLM through pathological examination.Multivariate analysis showed that carcinoembryonic antigen,and magnetic resonance imaging radiomics were independent predictors of MLM.Then,the GLRM prediction model was developed with a comprehensive nomogram to achieve satisfactory differentiation.The prediction performance of GLRM in the training and validation queue was 0.765[95%confidence interval(CI):0.710-0.820]and 0.767(95%CI:0.712-0.822),respectively.Compared with GLRM,RFM achieved superior performance with AUC of 0.919(95%CI:0.868-0.970)and 0.901(95%CI:0.850-0.952)in the training and validation queue,respectively.The DCA indicated that the predictive ability and net profit of clinical RFM were improved.CONCLUSION By combining multiparameter magnetic resonance imaging with the effectiveness and robustness of ML-based predictive models,the proposed clinical RFM can serve as an insight tool for preoperative assessment of MLM risk stratification and provide important information for individual diagnosis and treatment of rectal cancer patients.

Temporal dynamics of neonatal hypoxic-ischemic encephalopathy injuries on magnetic resonance imaging

Moderate to severe perinatal hypoxic-ischemic encephalopathy occurs in~1 to 3/1000 live births in high-income countries and is associated with a significant risk of death or neurodevelopmental disability.Detailed assessment is important to help identify highrisk infants,to help families,and to support appropriate interventions.A wide range of monitoring tools is available to assess changes over time,including urine and blood biomarkers,neurological examination,and electroencephalography.At present,magnetic resonance imaging is unique as although it is expensive and not suited to monitoring the early evolution of hypoxic-ischemic encephalopathy by a week of life it can provide direct insight into the anatomical changes in the brain after hypoxic-ischemic encephalopathy and so offers strong prognostic information on the long-term outcome after hypoxic-ischemic encephalopathy.This review investigated the temporal dynamics of neonatal hypoxic-ischemic encephalopathy injuries,with a particular emphasis on exploring the correlation between the prognostic implications of magnetic resonance imaging scans in the first week of life and their relationship to long-term outcome prediction,particularly for infants treated with therapeutic hypothermia.A comprehensive literature search,from 2016 to 2024,identified 20 pertinent articles.This review highlights that while the optimal timing of magnetic resonance imaging scans is not clear,overall,it suggests that magnetic resonance imaging within the first week of life provides strong prognostic accuracy.Many challenges limit the timing consistency,particularly the need for intensive care and clinical monitoring.Conversely,although most reports examined the prognostic value of scans taken between 4 and 10 days after birth,there is evidence from small numbers of cases that,at times,brain injury may continue to evolve for weeks after birth.This suggests that in the future it will be important to explore a wider range of times after hypoxic-ischemic encephalopathy to fully understand the optimal timing for predicting long-term outcomes.

Magnetic resonance imaging evaluation and nuclear receptor binding SET domain protein 1 mutation in the Sotos syndrome with attention-deficit/hyperactivity disorder

Sotos syndrome is characterized by overgrowth features and is caused by alterations in the nuclear receptor binding SET domain protein 1 gene.Attentiondeficit/hyperactivity disorder(ADHD)is considered a neurodevelopment and psychiatric disorder in childhood.Genetic characteristics and clinical presentation could play an important role in the diagnosis of Sotos syndrome and ADHD.Magnetic resonance imaging(MRI)has been used to assess medical images in Sotos syndrome and ADHD.The images process is considered to display in MRI while wavelet fusion has been used to integrate distinct images for achieving more complete information in single image in this editorial.In the future,genetic mechanisms and artificial intelligence related to medical images could be used in the clinical diagnosis of Sotos syndrome and ADHD.

Diagnostic value of upper gastrointestinal imaging for duodenal webbing in adults:A case report

BACKGROUND Duodenal web is a rare congenital malformation,exceedingly uncommon in adults,and often misdiagnosed due to the subtle imaging features.CASE SUMMARY By analyzing the clinical diagnosis process and various imaging findings of a patient from our institution,this case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs,outlines its typical radiographic features,and provides a literature review on the etiology,clinical presentation,and management of this condition.CONCLUSION This case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs.

Diabetes mellitus and glymphatic dysfunction:Roles for oxidative stress,mitochondria,circadian rhythm,artificial intelligence,and imaging

Diabetes mellitus(DM)is a debilitating disorder that impacts all systems of the body and has been increasing in prevalence throughout the globe.DM represents a significant clinical challenge to care for individuals and prevent the onset of chronic disability and ultimately death.Underlying cellular mechanisms for the onset and development of DM are multi-factorial in origin and involve pathways associated with the production of reactive oxygen species and the generation of oxidative stress as well as the dysfunction of mitochondrial cellular organelles,programmed cell death,and circadian rhythm impairments.These pathways can ultimately involve failure in the glymphatic pathway of the brain that is linked to circadian rhythms disorders during the loss of metabolic homeostasis.New studies incorporate a number of promising techniques to examine patients with metabolic disorders that can include machine learning and artificial intelligence pathways to potentially predict the onset of metabolic dysfunction.

Recent progress in the applications of presynaptic dopaminergic positron emission tomography imaging in parkinsonism

Nowadays,presynaptic dopaminergic positron emission tomography,which assesses deficiencies in dopamine synthesis,storage,and transport,is widely utilized for early diagnosis and differential diagnosis of parkinsonism.This review provides a comprehensive summary of the latest developments in the application of presynaptic dopaminergic positron emission tomography imaging in disorders that manifest parkinsonism.We conducted a thorough literature search using reputable databases such as PubMed and Web of Science.Selection criteria involved identifying peer-reviewed articles published within the last 5 years,with emphasis on their relevance to clinical applications.The findings from these studies highlight that presynaptic dopaminergic positron emission tomography has demonstrated potential not only in diagnosing and differentiating various Parkinsonian conditions but also in assessing disease severity and predicting prognosis.Moreover,when employed in conjunction with other imaging modalities and advanced analytical methods,presynaptic dopaminergic positron emission tomography has been validated as a reliable in vivo biomarker.This validation extends to screening and exploring potential neuropathological mechanisms associated with dopaminergic depletion.In summary,the insights gained from interpreting these studies are crucial for enhancing the effectiveness of preclinical investigations and clinical trials,ultimately advancing toward the goals of neuroregeneration in parkinsonian disorders.

High-resolution direct magnetic resonance imaging fistulography with hydrogen peroxide for diagnosing anorectal fistula: A preliminary retrospective study

BACKGROUND Fistula-in-ano is an abnormal tunnel formation linking the anal canal with the perineum and perianal skin.Multiple imagining methods are available to evaluate it,among which magnetic resonance imaging(MRI)is the most advanced nonin-vasive preoperative method.However,it is limited in its visualization function.AIM To investigate the use of intraluminal MRI for perianal fistulas via a novel direct MRI fistulography method.METHODS We mixed 3%hydrogen peroxide(HP)with gadolinium for HPMRI fistulogra-phy,retrospectively analyzing 60 cases of complex/recurrent fistula-in-ano using physical examination,trans-perineal ultrasonography(TPUS),low-spatial-reso-lution MRI,and high-resolution direct HPMRI fistulography.We assessed detec-tion rates of fistula tracks,internal openings,their relationship with anal sphinc-ters,and perianal abscesses using statistical analyses,including interobserver agreement(Kappa statistic),and compared results with intraoperative findings.RESULTS Surgical confirmation in 60 cases showed that high-resolution direct HPMRI fis-tulography provided superior detection rates for internal openings(153)and fistula tracks(162)compared to physical exams,TPUS,and low-spatial-resolution MRI(Z>5.7,P<0.05).The effectiveness of physical examination and TPUS was also inferior to that of our method for detecting perianal abscesses(54)(Z=6.773,3.694,P<0.05),whereas that of low-spatial-resolution MRI was not significantly different(Z=1.851,P=0.06).High-resolution direct HPMRI fistulography also achieved the highest interobserver agreement(Kappa:0.89,0.85,and 0.80),while low-spatial-resolution MRI showed moderate agreement(Kappa:0.78,0.74,and 0.69).TPUS and physical examination had lower agreement(Kappa range:0.33-0.63).CONCLUSION High-resolution direct HPMRI fistulography enhances the visualization of recurrent and complex fistula-in-ano,including branched fistulas,allowing for precise planning and improved surgical outcomes.

Predictive value of magnetic resonance imaging parameters combined with tumor markers for rectal cancer recurrence risk after surgery

BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.

Guidelines for standard operation of imaging modalities in orbital diseases (2024)

Orbital disorders include conditions originating from the orbital bones,surrounding tissues,and post-orbital septum.They also include systemic ailments affecting the orbit.Different clinical symptoms make up the complex range of orbital disorders.Because these disorders mostly impact the orbital area instead of the intraocular compartment,there is little diagnostic usefulness for typical ophthalmic visual tests.As such,the vital instruments for diagnosing and evaluating orbital illnesses have become ophthalmic imaging modalities,including ocular ultrasonography(B-scan),computed tomography(CT),and magnetic resonance imaging(MRI).One way to improve the precision and promptness of diagnosing orbital diseases is to standardize the functioning of widely used imaging equipment and define the radiological features of orbital abnormalities.Such programs are crucial for the care of patients with orbital disorders since they considerably reduce the number of misdiagnoses and missed diagnoses in these individuals.The underlying concepts,operational techniques,and normal and pathological imaging findings associated with common diagnostic tools for orbital illnesses are all thoroughly reviewed in this guideline.The objective is to improve primary healthcare settings’diagnostic competence in the field of orbital pathology and to standardize procedures for diagnosing orbital disorders.

Lamb wave TDTE super-resolution imaging assisted by deep learning

Ultrasonic Lamb waves undergo complex mode conversion and diffraction at non-penetrating defects, such as plate corrosion and cracks. Lamb wave imaging has a resolution limit due to the guided wave dispersion characteristics and Rayleigh criterion limitations. In this paper, a full convolutional network is designed to segment and reconstruct the received signals, enabling the automatic identification of target modalities. This approach eliminates clutter and mode conversion interference when calculating direct and accompanying acoustic fields in time-domain topological energy(TDTE) imaging.Subsequently, the measured accompanying acoustic field is reversed for adaptive focusing on defects and enhance the imaging quality. To circumvent the limitations of the Rayleigh criterion, the direct acoustic field and the accompanying acoustic field were fused to characterize the pixel distribution in the imaging region, achieving Lamb wave super-resolution imaging. Experimental results indicate that compared to the sign coherence factor-total focusing method(SCF-TFM),the proposed method achieves a 31.41% improvement in lateral resolution and a 29.53% increase in signal-to-noise ratio for single-blind-hole defects. In the case of multiple-blind-hole defects with spacings greater than the Rayleigh criterion resolution limit, it exhibits a 27.23% enhancement in signal-to-noise ratio. On the contrary, when the defect spacings are relatively smaller than the limit, this method has a higher resolution limit than SCF-TFM in super-resolution imaging.