Intralesional Interstitial Injection of Bleomycin for Management of Extracranial Arteriovenous Malformations in Children

Background Despite many advances in the treatment for extracranial arteriovenous mal­formations(AVMs),they still result in tedious dissection and potential unacceptable com­plications,particularly in children.Therefore,this study aimed to investigate the efficacy and safety of intralesional interstitial injection of bleomycin for the treatment of children with AVMs.Methods A total of 10 children(6 boys and 4 girls)with AVMs were treated with serial interstitial bleomycin injections between May 2014 and January 2017.Maximum single doses of 15 U and 1 U/kg per session were administered for six sessions at a 1-month inter­val.Therapeutic effectiveness was evaluated and classified into four categories:complete response(CR),partial response(PR),no response,and worsening at 3 months after the last session.Further clinical follow-up outcomes were classified as improved,stable,or aggra­vated.Adverse events were recorded according to the Society of Interventional Radiology classification.Results All 10 children completed the sessions and follow-ups.CR occurred in 3(30%)patients,PR in 6(60%),and no response in 1(20%).Minor complications(class A)included maculopapular rash,bulla,vomiting,and hyperpigmentation,whereas no major complications occurred.Conclusion Intralesional interstitial injection of bleomycin is a feasible approach for the treatment of AVMs in children and provides safe and effective outcomes.This method may be an earlier treatment alternative in children to prevent potential destructive progression,considering the serious complications of currently available therapeutic methods.

Novel fast FFR derived from coronary CT angiography based on static first-pass algorithm:a comparison study

BACKGROUND Fractional flow reserve(FFR)is the invasive gold standard for evaluating coronary arterial stenosis.However,there have been a few non-invasive methods such as computational fluid dynamics FFR(CFD-FFR)with coronary CT angiography(CCTA)images that can perform FFR assessment.This study aims to develop a new method based on the principle of static first-pass of CT perfusion imaging technique(SF-FFR)and evaluate the efficacy in direct comparisons between CFD-FFR and the invasive FFR.METHODS A total of 91 patients(105 coronary artery vessels)who were admitted from January 2015 to March 2019 were enrolled in this study,retrospectively.All patients underwent CCTA and invasive FFR.64 patients(75 coronary artery vessels)were successfully analyzed.The correlation and diagnostic performance of SF-FFR method on per-vessel basis were analyzed,using invasive FFR as the gold standard.As a comparison,we also evaluated the correlation and diagnostic performance of CFD-FFR.RESULTS The SF-FFR showed a good Pearson correlation(r=0.70,P<0.001)and intra-class correlation(r=0.67,P<0.001)with the gold standard.The Bland-Altman analysis showed that the average difference between the SF-FFR and invasive FFR was 0.03(0.11–0.16);between CFD-FFR and invasive FFR was 0.04(-0.10–0.19).Diagnostic accuracy and area under the ROC curve on a per-vessel level were 0.89,0.94 for SF-FFR,and 0.87,0.89 for CFD-FFR,respectively.The SF-FFR calculation time was about 2.5 s per case while CFD calculation was about 2 min on an Nvidia Tesla V100 graphic card.CONCLUSIONS The SF-FFR method is feasible and shows high correlation compared to the gold standard.This method could simplify the calculation procedure and save time compared to the CFD method.

临床磁共振波谱数据处理方法及原理

临床磁共振波谱(MRS)技术可以无创性地测量在体及离体组织中的代谢产物组成、浓度水平及能量状态,从而反映机体的病理生理变化。正确的评估来源于准确的结果,而影响MRS结果的因素繁多,其中正确的数据处理是关键步骤之一。就MRS数据处理的各种方法及其原理进行综述。

基于影像组学构建乳腺癌前哨淋巴结转移预测模型的研究

目的:探讨基于MRI动态增强扫描(DCE-MRI)的影像组学在预测乳腺癌前哨淋巴结(SLN)转移中的价值。方法:回顾性收集经病理证实并行DCE-MRI检查的浸润性乳腺癌164例(训练组124例,验证组40例)。在DCE-MRI图像上提取影像组学特征,并计算DCE参数,采用Lasso-Logistic回归模型对影像组学特征进行筛选。分别建立单纯影像组学模型、单纯DCE参数模型及联合模型。采用ROC的AUC评价不同模型的鉴别预测效能,并对模型的ROC曲线行DeLong检验;在验证队列中评估其预测效能。结果:共提取396个影像组学特征,经筛选得到28个特征,联合DCE参数分别建模。对于术前预测SLN转移的效能,在训练组中单纯影像组学模型AUC的95%CI为0.81(0.72,0.89),单纯DCE参数模型AUC的95%CI为0.77(0.68,0.86),联合预测模型AUC的95%CI为0.80(0.72,0.89);在验证组中单纯影像组学模型AUC的95%CI为0.74(0.59,0.89),单纯DCE参数模型AUC的95%CI为0.74(0.59,0.90),联合预测模型AUC的95%CI为0.76(0.61,0.91),Delong检验显示差异无统计学意义(P>0.05),联合模型的效能可能稍高。结论:基于DCE-MRI图像提取影像组学特征及DCE参数建立预测模型,作为一种无创性预测乳腺癌SLN转移的工具,有良好的应用前景。

基于T_(2)WI的影像组学模型对鉴别前列腺癌和前列腺增生的诊断价值

目的探讨基于T_(2)WI的影像组学模型对鉴别前列腺癌(PCa)和前列腺增生(BPH)的诊断价值。方法选取并分析2019年5月~2020年5月在我院经手术或活检病理确诊的88例患者(PCa 48例、BPH 40例)的T_(2)WI特征。应用ITK-SNAP软件勾画兴趣区(ROI),将T_(2)WI图像导入Analysis-Kinetics分析软件,进行影像特征提取。采用Lasso回归分析进行特征降维。建立随机森林模型(LF)对筛选出的特征参数进行分类训练并进行验证,绘制ROC曲线评价模型在训练组和验证组中对鉴别PCa和BPH的预测效能。结果共提取396个影像组学特征,通过特征筛选后最后筛选出3个影像组学特征。建模后影像组学特征对鉴别PCa和BPH具有较好的预测效能,预测模型鉴别效能的曲线下面积、敏感度、特异度和准确度分别为0.96、86.0%、58.0%和71.0%。结论基于磁共振T_(2)WI的影像组学模型对诊断PCa和BPH具有一定价值。

基于ADC图影像组学特征预测非特殊类型浸润性乳腺癌组织学分级的临床研究

目的:探讨基于ADC图影像组学特征预测非特殊类型浸润性乳腺癌组织学分级的价值。方法:将152例经病理确诊的非特殊类型浸润性乳腺癌患者随机分为训练集108例(Ⅰ~Ⅱ级54例,Ⅲ级54例)和测试集44例(Ⅰ~Ⅱ级22例,Ⅲ级22例)。每例患者的ADC图通过AK和ITK-SNAP软件进行预处理、肿瘤分割和特征提取,应用Mann-Whitney U检验和单因素Logistic回归分析筛选训练集组学特征和临床特征,构建支持向量机、决策树、逻辑回归和组合模型,并在测试集中验证。利用ROC曲线的AUC量化模型预测性能并用Delong检验比较。应用决策曲线分析评估模型的临床应用价值。结果:逻辑回归、支持向量机、决策树和组合模型在测试集的AUC分别为0.58[95%置信区间(95%CI)(0.40,0.75)]、0.61[95%CI(0.44,0.78)]、0.78[95%CI(0.65,0.90)]、0.81[95%CI(0.68,0.94)]。决策树模型训练集与测试集的AUC均显著高于逻辑回归和支持向量机模型(均P<0.05),组合模型训练集与测试集的AUC均高于决策树模型,但差异无统计学意义(均P>0.05)。在决策曲线分析中,决策树和组合模型的净收益高于逻辑回归和支持向量机模型。结论:基于ADC图的影像组学模型预测非特殊类型浸润性乳腺癌组织学分级的最佳分类模型为决策树,结合影像征象能改善其预测性能。

DCE-MRI定量参数评估肺癌BACE治疗早期疗效的初步研究

目的探讨动态增强磁共振成像(DCE-MRI)定量参数对肺癌支气管动脉灌注化疗栓塞术(BACE)早期疗效的评估价值。方法收集经病理证实的18例肺癌患者,分别于术前一天和术后1个月行DCE-MRI检查。利用后处理软件分析图像,记录术前术后K^(trans)、K_(ep)、V_e、V_p四个定量参数的变化情况,比较术前术后各参数的差异。结果 1个月后复查,11例患者治疗有效,K^(trans)、K_(ep)、V_e、V_p四个数值较术前均下降,其中K^(trans)、K_(ep)、V_e的变化有统计学意义(P<0.05),V_p的下降无统计学意义(P>0.05),有效组与无效组术后四个数值相比,K^(trans)和V_p的差异有统计学意义(P<0.05),相应的AUC(曲线下面积)为1和0.818、灵敏度100%和85.7%,特异度100%和72.7%。结论 DCE-MRI定量参数有助于判断肺癌BACE治疗效果,但需要大样本、长期随访进一步研究。

Preparation of magnetic resonance probes using one-pot method for detection of hepatocellular carcinoma

AIM: To prepare the specific magnetic resonance(MR) probes for detection of hepatocellular carcinoma(HCC) using one-pot method.METHODS: The carboxylated dextran-coated nanoparticles were conjugated with anti-α-fetoprotein(anti-AFP) or anti-glypican 3(anti-GPC3) antibodies through 1-(3-dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride/N-hydroxysuccinimide(EDC/NHS)-mediated reaction to synthesize the probes.The physical and chemical properties of the probes were determined by transmission electron microscopy(TEM) and dynamic light scattering, and the relaxivity was compared to uncombined ultrasmall superparamagnetic iron oxide nanoparticles(USPIONs) using a 1.5T clinical MR scanner.The binding efficiency of the antibodies to nanoparticles was measured with an ultravioletvisible spectrophotometer.In addition, the probes were incubated with targetable cells in vitro.RESULTS: The superparamagnetic MR probes(antiGPC3-USPION probe and anti-AFP-USPION probe) were synthesized using one-pot method.Their mean hydrodynamic diameter was 47 nm with a broader slight size distribution.The coupling efficiency of carboxylated dextran-coated ultrasmall superparamagnetic iron oxide(USPIO) with anti-GPC3 or anti-AFP antibody was 15.9% and 88.8%, respectively.Each of the USPIO nanoparticles may bind 3 GPC3 antibodies or 12 AFP antibodies.The statistical analysis showed no significance(P > 0.05) in shortening the T1 and T2 values when comparing the USPIO-AFP or USPIOGPC3 to USPIO.Analysis of TEM images revealed that anti-GPC3-USPION probes and anti-AFP-USPION probes could specifically enter into the Hep G2 cell by combining with the GPC3 receptors or AFP receptors, whereas the Hep G2 cell sample incubated with USPIONs showed no or few nanoparticles in the cytoplasm.CONCLUSION: The synthesized probes using one-pot method can be used for in vitro experimental study and have potential clinical application in MR imaging for detection of hepatocellular carcinomas.

Development and in vitro study of a bi-specific magnetic resonance imaging molecular probe for hepatocellular carcinoma

BACKGROUND Hepatocellular carcinoma(HCC)ranks second in terms of cancer mortality worldwide.Molecular magnetic resonance imaging(MRI)targeting HCC biomarkers such as alpha-fetoprotein(AFP)or glypican-3(GPC3)offers new strategies to enhance specificity and help early diagnosis of HCC.However,the existing iron oxide nanoparticle-based MR molecular probes singly target AFP or GPC3,which may hinder their efficiency to detect heterogeneous micro malignant HCC tumors<1 cm(MHCC).We hypothesized that the strategy of double antibody-conjugated iron oxide nanoparticles which simultaneously target AFP and GPC3 antigens may potentially be used to overcome the tumor heterogeneity and enhance the detection rate for MRI-based MHCC diagnosis.AIM To synthesize an AFP/GPC3 double antibody-labeled iron oxide MRI molecular probe and to assess its impact on MRI specificity and sensitivity at the cellular level.METHODS A double antigen-targeted MRI probe for MHCC anti-AFP-USPIO-anti-GPC3(UAG)was developed by simultaneously conjugating AFP andGPC3 antibodies to a 5 nm ultra-small superparamagnetic iron oxide nanoparticle(USPIO).At the same time,the singly labeled probes of anti-AFP-USPIO(UA)and anti-GPC3-USPIO(UG)and non-targeted USPIO(U)were also prepared for comparison.The physical characterization including morphology(transmission electron microscopy),hydrodynamic size,and zeta potential(dynamic light scattering)was conducted for each of the probes.The antigen targeting and MRI ability for these four kinds of USPIO probes were studied in the GPC3-expressing murine hepatoma cell line Hepa1-6/GPC3.First,AFP and GPC3 antigen expression in Hepa1-6/GPC3 cells was confirmed by flow cytometry and immunocytochemistry.Then,the cellular uptake of USPIO probes was investigated by Prussian blue staining assay and in vitro MRI(T2-weighted and T2-map)with a 3.0 Tesla clinical MR scanner.RESULTS Our data showed that the double antibody-conjugated probe UAG had the best specificity in targeting Hepa1-6/GPC3 cells expressing AFP and GPC3 antigens compared with single antibody-conjugated and unconjugated USPIO probes.The iron Prussian blue staining and quantitative T2-map MRI analysis showed that,compared with UA,UG,and U,the uptake of double antigen-targeted UAG probe demonstrated a 23.3%(vs UA),15.4%(vs UG),and 57.3%(vs U)increased Prussian stained cell percentage and a 14.93%(vs UA),9.38%(vs UG),and 15.3%(vs U)reduction of T2 relaxation time,respectively.Such bi-specific probe might have the potential to overcome tumor heterogeneity.Meanwhile,the coupling of two antibodies did not influence the magnetic performance of USPIO,and the relatively small hydrodynamic size(59.60±1.87 nm)of double antibodyconjugated USPIO probe makes it a viable candidate for use in MHCC MRI in vivo,as they are slowly phagocytosed by macrophages.CONCLUSION The bi-specific probe presents enhanced targeting efficiency and MRI sensitivity to HCC cells than singly-or non-targeted USPIO,paving the way for in vivo translation to further evaluate its clinical potential.

MRI纹理参数对乳腺癌分子分型鉴别的初步探讨

目的:探讨乳腺癌MRI增强扫描的纹理参数鉴别乳腺癌分子分型的可能性。方法:收集79例乳腺癌患者的MRI动态增强扫描图像,其中42例为人表皮生长因子受体-2(HER-2)阳性Luminal B型乳腺癌患者,37例为HER-2阳性非Luminal B型乳腺癌患者。共采集43个影像学纹理参数,通过Mann-Whitney检验评判MRI纹理参数在两类乳腺癌中的差异性,并通过ROC曲线评价差异有统计学意义的纹理参数对两类乳腺癌鉴别诊断的敏感度和特异度。结果:5个纹理参数在两类乳腺癌患者中差异均有统计学意义(均P<0.05),其中4个纹理参数的敏感度和特异度较高。回归模型对两类乳腺癌患者的整体判别准确率为88.6%,预测概率ROC曲线下面积为0.88。结论:乳腺癌MRI纹理参数可满足对乳腺癌HER-2阳性Luminal B型与HER-2阳性非Luminal B型的鉴别诊断,有望成为乳腺癌的临床辅助检查手段,基于乳腺癌MRI纹理参数建立的Logistic回归模型以较高的敏感度和特异度实现了对两类分子分型乳腺癌的鉴别诊断。

Bi-specific T1 positive-contrast-enhanced magnetic resonance imaging molecular probe for hepatocellular carcinoma in an orthotopic mouse model

BACKGROUND Hepatocellular carcinoma(HCC)is the second leading cause of cancer-related mortality.HCC-targeted magnetic resonance imaging(MRI)is an effective noninvasive diagnostic method that involves targeting clinically-related HCC biomarkers,such as alpha-fetoprotein(AFP)or glypican-3(GPC3),with iron oxide nanoparticles.However,in vivo studies of HCC-targeted MRI utilize single-target iron oxide nanoprobes as negative(T2)contrast agents,which might weaken their future clinical applications due to tumor heterogeneity and negative MRI contrast.Ultra-small superparamagnetic iron oxide(USPIO)nanoparticles(approximately 5 nm)are potential optimal positive(T1)contrast agents.We previously verified the efficiency of AFP/GPC3-double-antibody-labeled iron oxide MR molecular probe in vitro.AIM To validate the effectiveness of a bi-specific probe in vivo for enhancing T1-weighted positive contrast to diagnose the early-stage HCC.METHODS The single-and double-antibody-conjugated 5-nm USPIO probes,including antiAFP-USPIO(UA),anti-GPC3-USPIO(UG),and anti-AFP-USPIO-anti-GPC3(UAG),were synthesized.T1-and T2-weighted MRI were performed on day 10 after establishment of the orthotopic HCC mouse model.Following intravenous injection of U,UA,UG,and UAG probes,T1-and T2-weighted images were obtained at 12,12,and 32 h post-injection.At the end of scanning,mice were euthanized,and a histologic analysis was performed on tumor samples.RESULTS T1-and T2-weighted MRI showed that absolute tumor-to-background ratios in UAG-treated HCC mice peaked at 24 h post-injection,with the T1-and T2-weighted signals increasing by 46.7%and decreasing by 11.1%,respectively,relative to pre-injection levels.Additionally,T1-weighted contrast in the UAG-treated group at 24 h post-injection was enhanced 1.52-,2.64-,and 4.38-fold compared to those observed for single-targeted anti-GPC3-USPIO,anti-AFP-USPIO,and nontargeted USPIO probes,respectively.Comparison of U-,UA-,UG-,and UAG-treated tumor sections revealed that UAG-treated mice exhibited increased stained regions compared to those observed in UG-or UA-treated mice.CONCLUSION The bi-specific T1-positive contrast-enhanced MRI probe(UAG)for HCC demonstrated increased specificity and sensitivity to diagnose early-stage HCC irrespective of tumor size and/or heterogeneity.

EVALUATION OF SPECTRAL SELECTED PRESS SEQUENCE IN BREAST LESION CHARACTERIZATION

客观：为了评估 1H spetral 的角色，选择了 point-resolvedspectroscopy (SS 压) 在区分的顺序从由胆碱山峰并且到的恶意标记的恶意的胸损害良性调查影响诊断的因素。方法: 131 个病人的一个总数(年老的 24-83 年，一般水准 44.8 年) 在这研究被注册。Theexaminations 在 1 上被执行。有四隧道的分阶段执行的数组胸 coil.Single-voxel 质子的 5T 扫描仪磁性的回声光谱学(1H 太太) 被 SS 压顺序在外科的指的这些病人或活体检视咨询获得。结果：在这些病人之中， 74 被证明有胸癌， 57 由组织病理学说的考试有良性的损害。31 座提高的胆碱山峰在这 74 证实的恶意的损害，和 5detectable 胆碱被观察山峰在 57 良性的损害被表明。1H SS 压太太的敏感和特性分别地是 41.9% 和 91.2% 。影响诊断的主要因素是 signal-to-noise 比率和病理学的类型。结论：1H SS 压太太能提供新陈代谢的以后侵略的、生物化学的测量并且改进胸的特性磁性的回声成像。在 vivo 的胆碱山峰是恶意的一个特定然而并非敏感的标记。技术因素和损害的组织病理学说的描述影响察觉率。

Clinical and imaging features of desmoid tumors of the extremities

BACKGROUND Desmoid fibroma is a rare soft tissue tumor originating from the aponeurosis,fascia,and muscle,and it is also known as aponeurotic fibroma,invasive fibroma,or ligamentous fibroma.AIM To investigate the clinical and imaging features of desmoid tumors of the extremities.METHODS Thirteen patients with desmoid fibroma of the extremities admitted to our hospital from October 2016 to March 2021 were included.All patients underwent computed tomography(CT),magnetic resonance imaging(MRI),and pathological examination of the lesion.Data on the diameter and distribution of the lesion,the relationship between the lesion morphology and surrounding structures,MRI and CT findings,and pathological features were statistically analyzed.RESULTS The lesion diameter ranged from 1.7 to 8.9 cm,with an average of 5.35±2.39 cm.All lesions were located in the deep muscular space,with the left and right forearm each accounting for 23.08%of cases.Among the 13 patients with desmoid fibroma of the extremities,the lesions were"patchy"in 1 case,irregular in 10,and quasi-round in 2.The boundary between the lesion and surrounding soft tissue was blurred in 10 cases,and the focus infiltrated along the tissue space and invaded the adjacent structures.Furthermore,the edge of the lesion showed"beard-like"infiltration in 2 cases;bone resorption and damage were found in 8,and bending of the bone was present in 2;the boundary of the focus was clear in 1.According to the MRI examination,the lesions were larger than 5 cm(61.54%),round or fusiform in shape(84.62%),had an unclear boundary(76.92%),showed uniform signal(69.23%),inhomogeneous enhancement(84.62%),and"root"or"claw"infiltration(69.23%).Neurovascular tract invasion was present in 30.77%of cases.CT examination showed that the desmoid tumors had slightly a lower density(69.23%),higher enhancement(61.54%),and unclear boundary(84.62%);a CT value<50 Hu was present in 53.85%of lesions,and the enhancement was uneven in 53.85%of cases.Microscopically,fibroblasts and myofibroblasts were arranged in strands and bundles,without obvious atypia but with occasional karyotyping;cells were surrounded by collagen tissue.There were disparities in the proportion of collagen tissue in different regions,with abundant collagen tissue and few tumor cells in some areas,similar to the structure of aponeuroses or ligaments,and tumor cells invading the surrounding tissues.CONCLUSION Desmoid tumors of the extremities have certain imaging features on CT and MRI.The two imaging techniques can be combined to improve the diagnostic accuracy,achieve a comprehensive diagnosis of the disease in the clinical practice,and reduce the risk of missed diagnosis or misdiagnosis.In addition,their use can ensure timely diagnosis and treatment.

First-in-human pilot study of an integrinα6-targeted radiotracer for SPECT imaging of breast cancer

Dear Editor,The molecular classification has been playing a crucial role in the precise theranostics of cancer.Compared with the invasive biopsy,the in vivo noninvasive detection of biomarkers by nuclear imaging possesses advantages due to tumor heterogeneity.As one member of the integrin family,integrinα6 subunit combines the integrinβ1 orβ4 subunit to form integrinα6β1 orα6β4 heterodimers,which function to promote the migration,invasion,and survival of tumor cells,leading to increased metastasis,poor prognosis,and reduced survival.Therefore,the in vivo imaging of integrinα6 expression could play an important role in the treatment planning and prognosis prediction.

MRI影像组学特征预测乳腺癌分子分型的价值

目的探讨基于脂肪抑制T2WI、DCE-T1WI和二者联合序列的影像组学特征预测乳腺癌分子分型的价值。方法回顾性分析经术后病理证实的122例乳腺癌患者,术前均行常规MRI和动态增强扫描。用ITK-SNAP软件勾画感兴趣区,利用AK软件分别提取脂肪抑制T2WI、DCE-T1WI和二者联合序列三维病灶的影像组学特征。采用卡方检验及方差分析比较不同分子分型乳腺癌患者间年龄、绝经状态、淋巴结转移情况特征的差异;使用单因素方法、相关性分析、多因素逻辑回归及套索算法(LASSO)进行特征筛选并降维,采用Logistic回归算法建立模型。利用受试者工作特征曲线评估模型的预测效能。结果 Luminal A型33例,Luminal B型54例,HER-2过表达型17例,三阴(TN)型18例,不同分子分型乳腺癌患者间年龄、绝经状态、淋巴结转移情况的差异均不具有统计学意义(P>0.05)。预测Luminal A型、Luminal B型、HER-2过表达型、TN型乳腺癌最佳效能模型是基于脂肪抑制T2WI和DCE-T1WI联合序列的影像组学特征建立的模型,曲线下面积分别为0.820(0.742,0.888)、0.808(0.745,0.869)、0.900(0.833,0.954)、0.837(0.758,0.905)。结论基于MRI影像组学特征构建的模型可有效无创预测乳腺癌分子分型。