Abstract:Objective To investigate and improve the diagnostic performance of preoperative prediction of the Ki-67 expres-sion index using CT-based radiomics.Methods The imaging and clinicopathological data of 100 esophagogastric junction ad-enocarcinoma patients who had a Ki-67 measurement and contrast-enhanced CT scan of the abdomen were collected.According to the expression index of Ki-67,they were divided into high expression(60 cases)and low expression(40 cases).According to the ratio of 7∶3,the enrolled cases were randomly divided into the training set(70 cases)and the test set(30 cases).The univari-ate analysis was used to compare the clinical and pathological features of the high and low expression groups of Ki-67.Tumor ROIs were manually segmented on axial contrast-enhanced CT venous phase images(CE-CT).Radiomics features were extracted from axial contrast-enhanced CT venous phase images based on the training set.Then,we used 7 best radiomics features to devel-oped a radiomics signature and built a radiomics model to preoperatively predict Ki-67 expression level of the esophagogastric junction adenocarcinoma.The receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to com-pare the performance of the model in the training set and the test set.The fit of the model was assessed using a calibration curve.The net benefit of the radiomics model was assessed using decision curve analysis(DCA).Results The univariate analysis showed that age,gender,CT-reported lymph node status,CEA,CA125,CA199,CA724 and the major location of the esopha-gogastric junction adenocarcinoma had no statistically significant difference between the high and low expression groups(P>0.05).A total of 7 radiomic features significantly correlated with Ki-67 levels were finally identified,and a radiomic prediction model for Ki-67 expression levels was constructed.The ROC curve showed that the AUC for preoperative prediction of Ki-67 ex-pression level with the radiomics model was 0.812 and 0.795 in the training and test sets,respectively.The calibration curve demonstrated a good fitting performance of the model,and the decision curve analysis indicated that the application of this ra-diomic model for predicting Ki-67 expression levels could yield favorable clinical benefits.Conclusion The efficiency of ab-dominal enhanced CT-based radiomics in predicting Ki-67 expression index in esophagogastric junction adenocarcinoma is ideal.

Abstract:Objective To dynamically observe the temporal changes in cardiac structure,function,and hemodynamics of neonates using echocardiography and to elucidate their developmental patterns.Methods A retrospective study was conducted involving 278 full-term neonates who underwent echocardiographic examinations.Echocardiographic evaluations were performed during the 7th,28th,90th,and 180th day.Cardiac structure and hemodynamic characteristics were analyzed.Results Com-pared with the 7th day,LA,RA,LV,RV,AO,E/A,AV,LVEF were increased,and PA was decreased in the 28th day(all P<0.05);LA,RA,LV,AO,E/A,LVEF were increased,PA,TR Vmax,and PV were decreased in the 90th day(all P<0.05);LA,RA,LV,RV,AO E/A,AV,LVEF were increased,PA,TR Vmax,and PV were decreased in the 180th day(all P<0.05).At 7th day,the incidence of patent foramen ovale(PFO)was 56.1%,patent ductus arteriosus(PDA)was 27.0%,ventricular septal defect(VSD)was 9.0%,systemic-to-pulmonary collateral circulation(SPCC)was 23.7%,mild pulmonary hypertension(PH)was 7.6%,and increased pulmonary artery branch velocity(IPAV)was 70.5%.Over time,the incidence of PFO,PDA,VSD,SPCC,PH,and IPAV significantly decreased(all P<0.05),to 8.3%,5.4%,2.5%,1.4%,0,and 2.1%,respectively,at 180th.Conclusion Echocardiography is a non-invasive method for assessing dynamic changes in neonatal cardiac develop-ment.PFO,PDA,VSD,SPCC,PH,and IPAV are common during early neonate,and follow-up examination at 6 months is rec-ommended to monitor spontaneous closure.

Abstract:Objective To investigate the value of radiomics features extracted from chest CT imaging in the diagnosis of lung cancer and the prediction of treatment response.Methods A total of 120 patients with pulmonary nodules admitted to our hos-pital were enrolled.All patients underwent contrast-enhanced chest CT scans and were pathologically confirmed.Using the Pyradiomics platform,285 radiomics features were extracted,and the least absolute shrinkage and selection operator(LASSO)algorithm was applied for feature selection to construct a radiomics model.With pathological results as the gold stan-dard,the diagnostic efficacy of the model for lung cancer was evaluated.Additionally,clinical follow-up data were analyzed to assess the correlation between radiomics features and progression-free survival(PFS)and overall survival(OS)in these pa-tients.Results The radiomics model demonstrated robust performance in both the training and validation sets.In the validation set,the AUC reached 0.912,with a sensitivity of 88.33%,specificity of 85.90%,and accuracy of 87.00%.Survival analysis re-vealed that patients in the radiomics high-risk group had significantly shorter progression-free survival(PFS)(13.46 months vs.18.79 months,P<0.01)and overall survival(OS)(21.57 months vs.33.12 months,P<0.01)compared to the low-risk group(Figure 4).Multivariate analysis identified original_glcm_ClusterProminence(HR=1.321,95%CI:1.082-1.614,P=0.009)and SurfaceVolumeRatio(HR=0.703,95%CI:0.542-0.901,P=0.007)as independent predictors of PFS and OS,respectively.Conclusion Radiomics features can effectively assist in lung cancer diagnosis and provide quantitative evidence for treatment response and prognosis evaluation.

Abstract:Objective To investigate the predictive value of CT pulmonary angiography(CTPA)combined with digital sub-traction angiography(DSA)in the short-term prognosis of patients with acute pulmonary embolism(APE).Methods A total of 211 patients with APE were selected and divided into survival group(160 cases)and death group(51 cases)according to the short-term prognosis.The general data,CTPA parameters,in terms of pulmonary artery diameter(dPA),right ventricular short axis maximum diameter(RVSAMD),left ventricular short axis maximum diameter(LVSAMD),and CT pulmonary artery ob-struction index(CTPAO),and DSA imaging parameters were compared between the two groups.Spearman method was used to analyze the relationship between CTPA,DSA examination parameters and abnormal electrocardiograms,embolism area,risk classification,PAH.Logistic regression analysis was used to analyze the relationship between each imaging parameter and short-term prognosis of APE.The receiver operating characteristic(ROC)curve was used to analyze the value of each imaging param-eter in predicting the short-term prognosis of APE.Results The proportion of abnormal electrocardiograms,massive embo-lism,high risk and PAH,CTPAO,dPA,RVSAMD,main pulmonary artery diameter and main pulmonary artery/ascending aorta diameter ratio in the death group were higher than those in the survival group(all P<0.05).Correlation analysis showed that CTPAO,dPA,RVSAMD,main pulmonary artery diameter and main pulmonary artery/ascending aorta diameter ratio in patients with acute pulmonary embolism were related to abnormal electrocardiogram,embolism area,risk classification and PAH(all P<0.05).Logistic regression analysis showed that CTPAO,dPA,RVSAMD,main pulmonary artery diameter and main pulmonary artery/ascending aorta diameter were related to the short-term prognosis of patients with APE(P<0.05).ROC curve analysis showed that the AUC of CTPA and DSA combined to predict the short-term prognosis of APE patients was 0.898.Conclusion The examination parameters of CTPA and DSA are closely related to the short-term prognosis of APE patients,and the combined application has certain predictive value for short-term prognosis.

Abstract:Objective To evaluate the acoustic characteristics of carotid atherosclerotic culprit plaques based on superb mi-crovascular imaging(SMI),and to explore their relationship with symptomatic ischemic cerebrovascular disease(SICVD).Methods A total of 100 patients with ischemic cerebrovascular disease treated were selected as the research objects.According to whether there were symptoms of ischemic cerebrovascular disease,they were divided into asymptomatic group(n=32)and symptomatic group(n=68).The clinical data and the characteristics of carotid plaque were compared between the two groups.Multivariate Logistic regression analysis were used to analyze the influencing factors of SICVD.Generalized additive model(GAM)was used to analyze the relationship between the degree of carotid stenosis and the characteristics of each carotid plaque.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was used to evaluate the di-agnostic efficacy of each carotid plaque characteristics for different degrees of carotid artery stenosis in SICVD patients.The sen-sitivity,specificity,accuracy and AUC were compared to analyze the efficacy of each carotid plaque characteristics in the diagno-sis of SICVD under different degrees of carotid artery stenosis.Results Compared with the asymptomatic group,the symptom-atic group had significant increases in plaque thickness,plaque length,and neovascularization grade(all P<0.05).Multivariate Logistic regression analysis showed that plaque thickness and plaque length were risk factors for SICVD(P<0.05).GAM analysis showed that the degree of carotid stenosis and the characteristics of carotid plaque showed a curve relationship,and the differ-ence was statistically significant(all P<0.05).The degree of carotid stenosis was positively correlated with plaque thickness(F=4.474,P=0.011),plaque length(F=3.251,P=0.018)and neovascularization grade(F=3.936,P=0.013).ROC curve analysis showed that with the increase of the degree of carotid stenosis,the diagnostic efficacy of each carotid plaque characteristics for carotid stenosis increased significantly(all P<0.05).With the increase of the degree of carotid stenosis,the sensitivity,specific-ity,accuracy and AUC of single indicator and combined indicator of carotid plaque characteristics in the diagnosis of SICVD showed an increasing trend.Compared with single index,the AUC of combined index in the diagnosis of SICVD in the population with different degrees of carotid artery stenosis was significantly increased(all P<0.05).Conclusion The thickness,length and neovascularization grade of carotid atherosclerotic plaques diagnosed by SMI are risk factors for SICVD.With the aggravation of carotid stenosis,the combination of plaque characteristics can accurately identify patients with high risk of SICVD.

Abstract:Objective To evaluate the efficacy and safety of ultrasound-guided fine-needle injection of methotrexate(MTX)in the treatment of tubal ectopic pregnancy.Methods A total of 80 patients with tubal ectopic pregnancy were randomly as-signed to either the observation group or the control group,with 40 cases in each group.The observation group received ultrasound-guided fine-needle injection of MTX,while,the control group was treated with intramuscular injection of MTX.Se-rum β-HCG levels,gestational sac size,overall symptom improvement,overall adverse reaction rate,and treatment failure rate were compared between the two groups before and after treatment.Results Both groups showed a reduction in serum β-HCG levels and a decrease in gestational sac size after treatment compared to before treatment(P<0.05).Compared with the control group,the observation group showed a greater reduction in serum β-HCG levels and gestational sac size after treat-ment,along with a higher symptom relief rate and lower rates of adverse reactions and treatment failure,all with statistically significant differences(P<0.05).Conclusion Ultrasound-guided fine-needle injection of MTX can effectively improve the therapeutic efficacy for tubal ectopic pregnancy and reduce the incidence of adverse reactions and treatment failure,thereby providing patients with a safer and more effective treatment option.

Abstract:Objective To explore the diagnostic value of multi-parameter imaging with dual-layer detector spectral CT for pulmonary embolism.Methods A total of 270 patients with clinically suspected pulmonary embolism were selected.All pa-tients underwent dual-layer detector spectral CT examination.A single scan simultaneously acquired both conventional CT pulmo-nary angiography(CTPA)and spectral multi-parameter images.Multi-parameter analysis of the spectral CT images was per-formed,including iodine density measurements,spectral curve analysis,and effective atomic number determination.These re-sults were then compared with those from conventional CTPA and the comprehensive clinical diagnosis.Results The dual-layer detector spectral CT multi-parameter imaging had a high consistency with conventional CTPA in showing pulmonary artery emboli(Kappa=0.923,P<0.001),but it had unique advantages in aspects such as analysis of iodine distribution uniformity in emboli and evaluation of the perfusion status of the surrounding lung tissue.The iodine density,the shape of the energy spectrum curve and the effective atomic number of the emboli in patients with pulmonary embolism had extremely significant differences com-pared with those of normal lung tissues(P<0.001).Conclusion Multi-parameter imaging of spectral CT can provide more com-prehensive and accurate imaging information for patients with pulmonary embolism,which holds significant importance for im-proving diagnostic efficiency.

Abstract:Microvascular flow imaging(MVFI)is a novel Doppler flow imaging technique that employs a multi-dimensional filter designed to effectively preserve true low-velocity blood flow signals,while intelligently eliminating interference such as tis-sue motion.Based on its unique algorithm,MVFI enables clear visualization of microvessels without the need for contrast agents,effectively overcoming the limitation of conventional flow imaging techniques in detecting low-velocity microvascular signals,thereby significantly improving the ability of ultrasound to differentiate between benign and malignant thyroid nodules.There are notable differences in the vascular characteristics of benign and malignant thyroid nodules.MVFI evaluates the blood flow fea-tures of thyroid nodules from three dimensions:blood flow abundance,distribution,and morphology.Benign thyroid nodules of-ten exhibit evenly distributed and regularly shaped blood flow signals,whereas,malignant thyroid nodules typically display dis-ordered abnormal blood flow,among which penetrating vessels are a classic malignant feature.The Vascularity Index,as a quan-titative indicator of MVFI,directly reflects the blood supply within thyroid tissue or nodules and quantitatively analyzes the rich-ness of blood flow signals inside thyroid nodules.Furthermore,the combined application of MVFI with contrast-enhanced ultra-sound,ultrasound elastography,and other techniques can significantly enhance the diagnostic accuracy in distinguishing be-tween benign and malignant thyroid nodules.

Abstract:Objective To explore the key points and clinical value of prenatal echocardiography in the diagnosis of fetal heart tumors.Methods Twenty-six fetuses with cardiac tumors who underwent prenatal examinations at the prenatal diagnosis center were selected.Echocardiography was performed on them to observe the number,size and location of the tumors.Compared with the pathological results,the related complications were statistically analyzed.Results Of the 26 cases of fetal heart tu-mors,16 cases were solitary and 10 cases were multiple,and no other cardiac malformations or structural malformations were found.Among them,5 cases had obstruction due to the tumor located in the left ventricular outflow tract,1 case had tricuspid valve insufficiency due to the huge tumor occupying most of the right ventricular cavity,2 cases had arrhythmia,and 2 cases had pericardial effusion.Autopsy was performed on 12 of the 15-induced fetuses with the consent of their families.Pathological exami-nation results showed that 9 cases were diagnosed as rhabdomyoma,2 as teratoma,and 1 as fibroma.The coincidence rate of qualitative diagnosis by prenatal echocardiography of 12 autopsy fetuses was 91.6%,and there was no statistically significant dif-ference compared with the pathological results(P>0.05).5 cases were examined by ultrasound after birth,2 of which indicated nodular sclerosis.Conclusion Prenatal echocardiography of fetal heart tumors has relatively typical characteristics.Rhabdo-myoma is the most common,presenting as single or multiple circular uniform hyperechoic masses in the atrial lumen.Prenatal echocardiography can accurately diagnose fetal heart tumors,which is of great value for clinical decision-making and guiding treatment.

Abstract:Objective To investigate whether non-contrast CT(NCCT)radiomic signatures of hematoma and perihematomal edema,integrated with multidimensional clinical variables,can stratify 90-day poor outcome risk in spontaneous intracerebral hemorrhages(sICH).Methods Clinical and imaging data of 429 consecutive sICH patients were retrospectively collected.Pa-tients were dichotomized by 90-day modified Rankin Scale(mRS):good outcome 0-3(n=167)and poor outcome 4-6(n=262).After splitting into training(n=326)and validation(n=103)sets,radiomic features were extracted from manually segmented he-matoma and edema regions on NCCT.Gradient-boosting machines were trained separately for each region following mRMR and LASSO feature selection.Multivariable Logistic regression identified independent clinical predictors of poor outcome.Radiomic scores(RS)for hematoma and edema were computed and fused with clinical factors to build a combined model.Discrimination was assessed with ROC-AUC and clinical utility with decision-curve analysis(DCA).Results Eight hematoma and nine edema radiomic features remained after selection.Seven independent predictors of poor 90-day outcome were identified:age,ad-mission glucose,hematoma volume,edema volume,GCS,hematoma-RS,and edema-RS.The hematoma-only model achieved AUCs of 0.824(training)and 0.769(validation)and the edema-only model reached 0.844 and 0.756,respectively,with no sig-nificant differences.The combined radiomic-clinical model significantly outperformed either single-region model,with AUC of 0.933(training)and 0.851(validation),and provided the highest net benefit on DCA.Conclusion Quantitative NCCT ra-diomic features of both hematoma and perihematomal edema,when combined with readily available clinical variables,enable ac-curate early stratification of poor-outcome risk in sICH.

Abstract:Objective In order to explore the diagnostic value of color Doppler ultrasound in the prediction of newborn ar-rhythmias by intravenous catheter parameters combined with trivascular section.Methods 98 pregnant women who underwent prenatal examination were analyzed,and then were divided into 11 cases in the arrhythmia group and 87 cases in the normal rhythm group according to whether the newborns had arrhythmia after birth.Color Doppler ultrasonography was performed to mea-sure and compare the venous catheter blood flow parameters[peak ventricular systolic velocity(S),peak ventricular diastolic ve-locity(D),atrial systolic maximum flow velocity(A),mean time peak flow velocity(TAmax)]and resistance parameters[S/D,pulsatility index(PI),preload index(PLI),peak venous flow velocity index(PVIV)]and three-vessel section measurement in-ternal diameters of superior vena cava,ascending aorta and pulmonary artery between the two groups.The ROC curve was used to evaluate the predictive efficiency of intravenous catheter parameters,three-vessel sections measurement parameters and their com-bination in newborn arrhythmia.Results The fetal pulsatile index(PI),preload index(PLI)and peak velocity index vein(PVIV)in the arrhythmia group were significantly higher than those in the normal rhythm group,while the internal diameters of superior vena cava,ascending aorta and pulmonary artery in the arrhythmia group were significantly lower than those in the normal rhythm group(all P<0.05).The venous catheter parameters,the three-vessel section measurement parameters and the area under the ROC curve of the combination of the two were 0.759,0.801 and 0.852,respectively.The diagnostic efficiency of joint testing was higher than that of individual indicators(P<0.01).Conclusion The venous catheter parameters combined with three-vessel section measurement parameters can improve the specificity and coincidence rate of newborn arrhythmia predictive efficiency,which has high diagnostic value.

Abstract:This case report described a female patient with a double-pedunculated myxoma in the left atrium.Transthoracic echocardiography revealed a solid mass with limited mobility.However,it was insufficient to differentiate it from a thrombus or determine its benign or malignant nature.Further evaluation using contrast echocardiography and semi-quantitative myocardial analysis demonstrated low perfusion and delayed enhancement,suggesting a high likelihood of a benign tumor.After multidisci-plinary consultation,surgical resection was performed,and pathological examination confirmed myxoma.Double-pedunculated myxomas of the left atrium are rare.Contrast echocardiography can assess the blood supply of intracardiac lesions,aiding in the differentiation between thrombus and benign or malignant tumors.In this case,imaging findings supported the selection of the in-teratrial groove approach,avoiding right atrial incision and enabling successful tumor resection with minimal cardiac trauma.

Abstract:Objective To investigate the diagnostic value of high-frequency ultrasound(HFUS)combined with shear wave elastography(SWE)and hemodynamic parameters in carpal tunnel syndrome(CTS).Methods The clinical data of 114 pa-tients suspected of having CTS were selected.Using nerve electrophysiology and clinical diagnosis as the gold standard,73 pa-tients were confirmed to have CTS(CTS group),and 41 patients did not have CTS(non-CTS group).HFUS parameters,SWE parameters,and hemodynamic parameters were compared between the two groups.The diagnostic value of individual and com-bined tests was analyzed using receiver operating characteristic(ROC)curves.Results The HFUS parameters,D1,D2,CSA1,and CSA2 in the CTS group,were all greater than those in the non-CTS group(P<0.05).The SWE parameters,W,F,and FRatio in the CTS group,were all higher than those in the non-CTS group(P<0.05).The superb microvascular imaging(SMI)parameters peak systolic velocity(PSV)and end-diastolic velocity(EDV)in the CTS group were lower than those in the non-CTS group,while,the resistive index(RI)was higher than that in the non-CTS group(P<0.05).A combined diagnostic model was constructed based on HFUS,SWE,and hemodynamic parameters.ROC curve analysis showed that the area under the curve(AUC)for the combined model in diagnosing CTS was 0.995,which was higher than that of individual tests(Z was-4.407,-4.881,-4.221,all P<0.01).Conclusion HFUS combined with SWE and hemodynamic parameters has significant advantages in the diagnosis of CTS.

Abstract:Objective To explore the diagnostic value of shoulder contrast-enhanced ultrasound(CEUS),high-frequency ul-trasonography,and MRI in classifying rotator cuff injuries.Methods Twenty-three patients with rotator cuff injuries were se-lected and underwent shoulder arthroscopy,CEUS of the shoulder joint,high-frequency ultrasound examination of the shoulder joint,and MRI examination of the shoulder joint to assess the extent and type of supraspinatus muscle injury.Using shoulder ar-throscopy as the gold standard,the sensitivity,specificity,and accuracy of CEUS,high-frequency ultrasound examination,and MRI in diagnosing rotator cuff injury types were calculated.The Kappa consistency test was conducted between the results of three types of examinations and those of shoulder arthroscopy.ROC curves were plotted to comprehensively evaluate the diagnostic efficacy of the three examination methods in classifying rotator cuff injuries.Results Shoulder arthroscopy revealed 12 cases of full-thickness tears,8 cases of partial tears,and 3 cases of no tears.The diagnostic accuracy of CEUS,high-frequency ultrasound,and MRI was 91.30%,65.22%,and 86.96%,respectively,with AUC of 0.913,0.655,and 0.818,respectively.The diagnostic ac-curacy rates of the three methods for partial tears were 86.96%,69.57%,and 86.96%,respectively,with AUC of 0.871,0.650,and 0.842,respectively.The diagnostic accuracy rates of the three methods for no tears were 95.65%,69.57%,and 91.30%,re-spectively,with AUC of 0.833,0.542,and 0.808,respectively.Kappa value for the agreement of the three methods with the diag-nostic gold standard were 0.775,0.701,0.245,respectively,with CEUS>MRI>high-frequency ultrasound.Conclusion CEUS of the shoulder joint can visually display the location and extent of rotator cuff injuries,effectively evaluate the type of rotator cuff injury,and its diagnostic efficacy is higher than that of high-frequency ultrasound examination and comparable to MRI.CEUS sig-nificantly improves the diagnostic accuracy of ultrasound for rotator cuff tears,demonstrating comparable efficacy to MRI.

Abstract:Quantitative susceptibility mapping(QSM),as an emerging magnetic resonance imaging(MRI)technique,has the function of quantifying magnetic susceptibility.Currently,it is mainly applied in the diagnosis of central nervous system de-generative diseases,classification of intracranial tumors,and differentiation of calcification and hemorrhage,and etc.With the advancement of technologies,such as water-fat separation and compensation for cardiac and motion artifacts,the deficiencies of QSM in imaging outside the head have been gradually overcome,and its application scope in cardiovascular diseases,digestive system diseases,and urogenital system diseases has been continuously expanded.QSM offers the distinct advantage of providing susceptibility information directly linked to tissue pathophysiology,enabling true quantitative measurement of magnetic suscepti-bility.By integrating with radiomics,QSM has played a pivotal role in disease subtyping and predicting clinical outcomes.This synergy holds significant promise to become a powerful instrument for guiding personalized clinical therapy.

Abstract:Spontaneous intracerebral hemorrhage(sICH)is divided into deep cerebral hemorrhage,lobar cerebral hemor-rhage,and infratentorial cerebral hemorrhage based on the location of occurrence.Different locations of sICH have different pathological and physiological foundations,and their prognosis also varies.Non-contrast computed tomography(NCCT)is a ba-sic imaging method for the diagnosis and evaluation of sICH.It has the advantages of noninvasive,fast imaging speed and low in-spection cost,and provides an important imaging basis for the prognosis evaluation.In recent years,with the widespread applica-tion of artificial intelligence combined with radiomics,powerful tools have been provided for accurately predicting adverse prog-nosis in sICH patients at different locations based on NCCT images.

Abstract:Objective To explore the correlation between cerebral white matter hyperintensities(WMHs)volume and changes in arterial arrival time(ATT)assessed by dual post-labeling delay(PLD)arterial spin labeling(ASL).Methods 92 patients with cerebral small vessel disease were selected.All patients underwent routine MRI and ASL scans with dual PLD.PLD was 1.6 s and 2.5 s,respectively.The volumes of WMHs,WMHs region,non-WMHs cerebral white matter(NAWM)region,cerebral cortex(GM)cerebral blood flow(CBF),ΔCBF were calculated.The relationship between different PLD CBF and ΔCBF with WMHs volume was analyzed.Results When PLD=1.6 s,WMHs and GM CBF were negatively correlated with WMHs volume(r was-0.570,-0.229,respectively,P<0.05).When PLD=2.5 s,WMHs,NAWM,and GM CBF were not cor-related with WMHs volume(P>0.05).WMHs ΔCBF,NAWMΔCBF,and GMΔCBF were all correlated with WMHs volume(r was 0.624,0.275,0.348,respectively,P<0.05).Conclusion ATT prolongation reflected by ΔCBF derived from dual-PLD ASL is associated with WMHs volume,whereas,CBF assessment based on a single PLD has limitations in characterizing WMHs-related perfusion abnormalities.

Abstract:Objective To explore the MRI imaging features of mass breast cancer with different molecular subtypes.Methods A total of 110 patients with mass-type breast cancer were selected and classified into molecular subtypes based on his-topathological examination,including 22 cases of HER-2 overexpressing type,35 cases of Luminal A type,38 cases of Luminal B type,and 15 cases of triple-negative type.Imaging data and clinicopathological data of the patients were collected.Age,histo-logical grade,maximum tumor diameter,morphological features,ADC values,and enhancement curve patterns were compared among patients with different molecular subtypes of mass-type breast cancer.Multivariate logistic regression analysis was em-ployed to screen for imaging characteristics associated with molecular subtypes.Results There was a statistically significant dif-ference between different molecular subtypes of breast cancers in terms of histological grade,maximum tumor diameter,spicula-tion sign,internal enhancement pattern,and ADC values(all P<0.05),among these,triple-negative breast cancer had the high-est proportion of Grade Ⅲ tumors,maximum tumor diameter>2 cm,and rim enhancement pattern.The spiculation sign was most common in the Luminal subtype,while HER-2 overexpressing subtype exhibited the highest ADC values.The differences in age of onset,lymph node metastasis,and tumor margins,morphology,lobulation sign,and curve type of different molecular subtypes of breast cancer were not statistically different(all P>0.05).Multi classification logistic regression analysis showed that the internal enhancement pattern was an independent risk factor in Luminal B(OR=6.711,95%CI:1.700-26.497,P<0.01),Luminal A(OR=5.072,95%CI:1.229-20.936,P<0.05),HER-2 positive(OR=9.132,95%CI:2.105-39.609,P<0.01).The spiculated sign was an independent risk factor for Luminal A(OR=9.604,95%CI:1.822-50.630,P<0.01).Conclusion The MRI imaging of mass breast cancer show certain differences among different molecular subtypes.Particular attention should be paid to tumor size,spiculated sign,internal enhancement pattern,and ADC value.

Abstract:Objective To explore the diagnostic value of transcranial Doppler ultrasound foam test(cTCD),right heart acoustic contrast(cTTE)combined with serum growth differentiation factor 15(GDF15)and cyclooxygenase-2(COX-2)levels for right-to-left shunt(RLS)in patients with migraine.Methods 104 of migraine patients suspected of having RLS(the obser-vation group)were selected,along with 95 healthy volunteers(the control group)from the same period.The observation group all underwent cTCD,cTTE and transesophageal echocardiography(cTEE)examinations.Serum GDF15 and COX-2 were de-tected by ELISA;the consistency of cTCD,cTTE with the gold standard for diagnosing RLS was analyzed by Kappa test;the cor-relation between serum GDF15,COX-2 levels and the grade of shunt volume in patients with migraine combined with RLS was analyzed by Spearman analysis;and the diagnostic efficacy of serum GDF15,COX-2 levels for migraine combined with RLS was analyzed by ROC curve.Results The cTEE examination revealed that,among 104 patients with migraine,59 had RLS.Based on the diagnostic results,the migraine patients were divided into the RLS positive(n=59).The cTCD test identified 54 cases of RLS as positive,with a sensitivity of 83.05%and a specificity of 88.89%,and an accuracy of 85.58%.The cTTE test identified 57 cases of RLS as positive,with a sensitivity of 86.44%,a specificity of 86.67%,and an accuracy of 86.54%.Com-pared with the control group,the levels of serum GDF15 and COX-2 in the observation group were higher(t=21.678,17.009,all P<0.05).Compared with the RLS negative group,the levels of serum GDF15 and COX-2 in the RLS positive group were also higher(t=11.587,10.270,all P<0.05).The Spearman analysis showed that the levels of serum GDF15 and COX-2 were significantly positively correlated with the microembolic signal(MES)flow grade in patients with migraine combined with RLS the correlation coefficients were 0.516 and 0.539 respectively(all P<0.05).The ROC curve analysis showed that the individual sensitivity of serum GDF15 and COX-2 levels in diagnosing migraine combined with RLS was 74.58%and 77.97%,respec-tively.The combined use of cTCD,cTTE and serum GDF15,COX-2 levels in diagnosing migraine combined with RLS had a sensitivity of 94.92%,a specificity of 84.44%,an accuracy rate of 90.38%,and the Kappa test indicated a high consistency be-tween the combined diagnosis and the gold standard(Kappa=0.802,P<0.05).Conclusion The combination of cTCD and cTTE with serum GDF15 and COX-2 has a relatively high diagnostic efficacy for migraine combined with RLS,which is helpful for clinical diagnosis.

Abstract:Ewing sarcoma is a common malignant tumor in orthopedics,but its occurrence in the kidney is rare.This article re-ported a case of pediatric renal Ewing's sarcoma that underwent 18F-FDG PET/CT examination.The imaging showed a large,soli-tary,irregular soft tissue mass in the kidney,with ill-defined borders from the renal parenchyma and a diffuse,infiltrative growth pattern.Necrotic and cystic changes,as well as calcification,were observed within the mass,which exhibited heterogeneous in-creased radiotracer uptake.Renal Ewing's sarcoma is prone to developing tumor thrombi in the renal vein and/or inferior vena cava,which also presents with high 18F-FDG uptake.Postoperative pathological examination confirms the diagnosis of left renal Ewing's sarcoma.18F-FDG PET/CT can accurately demonstrate the size,morphology,distribution and density of lesions,as well as the ex-tent of invasion and metastasis,which is conducive to guiding tumor staging and the formulation of clinical treatment plans.