This study aimed to investigate the application of T2-based MRI delta-radiomics as a novel predictive tool for neoadjuvant chemotherapy (NACT) response in patients with osteosarcoma. We retrospectively analyzed data from 152 patients with pathologically confirmed osteosarcoma who underwent NACT at our institution. Axial T2-weighted MRI sequences were acquired both at baseline (pre-NACT) and after NACT (post-NACT). After image segmentation and preprocessing, 1158 radiomic features were extracted from the T2-weighted images. We developed and compared four models: the conventional quantitative imaging features-based model (CQIF model), the pre-NACT radiomics model, the post-NACT radiomics model, and the Delta-Radiomics model. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and accuracy (ACC). Based on histopathological assessment, patients were divided into two groups: good responders (n = 57) and poor responders (n = 95). Significant differences in change rates for tumor diameter and volume were observed between the two groups (P < 0.001). The Delta-Radiomics model demonstrated superior predictive performance compared to other models, achieving an AUC of 0.796, ACC of 0.756, sensitivity of 0.529, specificity of 0.893, PPV of 0.750, and NPV of 0.758 in the test set. However, the Delong test revealed no significant differences among these models, except between the Post-NACT and Delta-Radiomics models (P < 0.05). T2-based MRI delta-radiomics showed strong predictive value for NACT response in patients with osteosarcoma. This model holds potential for guiding clinical decision-making and improving patient management by identifying responders early in the treatment course.

Segond fractures are avulsion fractures of the anterolateral tibial plateau, but the ligamentous structures involved remain debated. This study aimed to determine whether CT-measured fragment distance to the Gerdy tubercle predicts combined involvement of the anterolateral ligament (ALL) and the capsulo-osseous layer of the iliotibial band (ITB) as defined by MRI. We retrospectively analyzed 86 patients (58 male, 28 female; mean age 30.9 ± 11.4 years) with acute Segond fractures on CT and MRI. CT measured fragment dimensions and distance to the Gerdy tubercle. MRI assessed the ALL, ITB, and its capsulo-osseous layer, classifying patients into ALL-only (n = 48) vs combined ALL + ITB involvement (n = 38). ROC analysis evaluated CT parameters. Anterior cruciate ligament(ACL) injury occurred in all 86 patients (100

Rationale and Objectives Increasing evidence links large artery atherosclerosis to cerebral small vessel disease(CSVD), but the relationship between carotid vulnerable plaque features and lacunar infarction (LAC) remains unclear. This study investigates this association in patients with moderate-to-severe carotid stenosis. Materials and Methods Patients with symptomatic 50–99% or asymptomatic 70–99% carotid stenosis referred for carotid endarterectomy were recruited. All underwent carotid vessel wall and brain MRI. Plaque burden and compositional characteristics were assessed. LAC presence was determined and severity categorized as mild (1−5), moderate (6−10), or severe (>10 infarcts). Logistic regression analyzed associations of plaque features with LAC presence and severity. Results Among 194 patients (84% male, mean age 65.3±8.0 years), 110 (56.7%) had LAC. LAC patients had larger calcification volume (OR 1.004, 95%CI 1.000–1.007) and calcified area percentage (OR 1.052, 95%CI 1.017–1.089). Mild and moderate LAC also showed larger calcified area percentages (OR 1.060, 95%CI 1.019–1.102 and OR 1.061, 95%CI 1.012–1.113, respectively). Severe LAC patients had higher LRNC (OR 1.002, 95%CI 1.000–1.003) and IPH volumes (OR 1.003, 95%CI 1.001–1.006). Conclusion Our study demonstrates that LAC patients exhibit significantly greater carotid plaque calcification burden, particularly in mild-to-moderate cases, with these associations remaining statistically significant after multivariable adjustment. Severe LAC shows stronger correlations with IPH and LRNC volumes, suggesting that vulnerable plaque characteristics may mediate distinct pathophysiological mechanisms in patients with severe LAC.

Current screening practices for esophageal squamous cell carcinoma (ESCC) subject to both over- and under-surveillance of precancerous lesions. This study aims to evaluate potential immunohistochemical (IHC) markers associated with the incidence of ESCC and to establish an IHC-based panel for surveillance. Tissue microarrays were constructed using 946 formalin-fixed, paraffin-embedded (FFPE) samples from 883 participants with baseline Lugol-unstained lesions (LULs) enrolled in a population-based screening trial. Candidate IHC markers were identified from literature and our previous findings. IHC results (H-scores) were quantified via HALO software, and optimal cut-offs were set by X-tile. Incident esophageal malignancy identified during a median follow-up of 11.76 years served as the outcome. Cox regression models were applied to identify predictive markers. Eight candidate markers were evaluated. After multivariable adjustment and backward elimination, γH2AX and p53 were identified as significant predictors [HR (95

The biological mechanism underlying the association between low body mass index (BMI) and increased risk of esophageal malignancy remains uncertain. We aimed to explore the role of metabolic alterations in the effect of low BMI on esophageal malignancy. We conducted a nested case-control study using a large-scale community-based screening cohort in a high-risk region for esophageal cancer (263 cases and 263 matched controls). Metabolomic profiling was performed based on untargeted ultra-high-performance liquid chromatography-tandem mass spectrometry, using the serum samples collected at enrollment prior to cancer diagnosis. Linear regression and conditional logistic regression were used to identify BMI-related metabolites and metabolites associated with esophageal malignancy, respectively, and the shared metabolites were included in mediation analysis. Low BMI was positively associated with esophageal malignancy (odds ratio (OR) = 1.8 (95

Cervical cancer patients are at high risk of psychological distress. Stigma is a critical psychological stressor for this population that significantly contributes to anxiety and depression; however, the underlying mechanisms linking stigma to these outcomes remain unclear. This study aimed to explore the mediating role of self-concealment and the moderating effect of perceived social support between stigma and psychological distress among cervical cancer patients based on the Stress and Coping Theory. A cross-sectional survey was conducted among 291 cervical cancer patients recruited from several Grade IIIA hospitals (the highest tier in China’s hospital grading system) in Liaoning and Shanxi provinces. Participants completed four validated questionnaires measuring stigma, self-concealment, perceived social support, anxiety and depression. SPSS 27.0 and Hayes’ PROCESS macro (Model 7) with 5,000 bootstrap resamples were used to test the moderated mediation model. The results showed that stigma positively predicted self-concealment (β = 0.386, p < 0.001) and anxiety and depression (β = 0.155, p = 0.010). Self-concealment exerted a partial mediating effect, with an indirect effect of 0.125 (95

The postnatal white matter connectome undergoes profound reorganization, yet the topological principles governing its spatiotemporal maturation remain largely unknown. Using connectome mapping, machine learning, and neurobiological annotation, we show hierarchical network development from birth to childhood and its association with neurobiological signatures. We identify two cardinal topological transformations that change rapidly during infancy and continue to refine into childhood, as characterized by nonlinear global increases in network efficiency and robustness to nodal attack, and regional reorganization with accelerated hub consolidation and prolonged modular reconfiguration, predominantly involving the prefrontal and insular cortices. Early developmental trajectories of these association cortices predict late childhood network architecture through local microstructural maturation of connected white matter tracts. These patterns align with well-established multiscale cortical hierarchies, including anatomical, evolutionary, and energy metabolism axes. Our findings reveal critical neurotopological milestones after postnatal development and establish a unified multiscale framework linking macroscale network dynamics to biologically constrained rules. This study reveals a hierarchical development of the brain’s structural connectome from infancy to childhood, characterized by distinct sensorimotor-association trajectories and alignment with multiple neurobiological hierarchies.

OBJECTIVE:The objective of this study is to evaluate the effectiveness of a novel training model that integrates problem-based learning (PBL) and simulation-based learning (SBL) in improving the emergency response of radiology staff to iodinated contrast media (ICM) allergic reactions. METHODS:A sequential exploratory mixed-methods design was employed. First, qualitative data from semi-structured interviews with nine radiology staff members (June-August 2024) were analysed using Colaizzi's method to inform the development of a contextually relevant PBL-SBL training model. Subsequently, a randomised controlled trial (September-December 2024) was conducted with 60 radiology staff (physicians, technologists and nurses), who were assigned to either an observation group (PBL-SBL training) or a control group (traditional lectures and skill demonstration). The primary outcome was emergency skills performance, assessed via a structured practical simulation. Secondary outcomes included critical thinking disposition, measured by the Critical Thinking Disposition Inventory (CTDI-CV), and training satisfaction. RESULTS:Compared to the control group, the observation group performed significantly better in emergency procedures, medication use and teamwork (Z = -6.544 to -6.667, p < 0.05) and scored higher across all critical thinking dimensions (Z = -5.660 to -6.654, p < 0.01). They also reported higher satisfaction with teaching methods, stronger teamwork and self-directed learning, improved learning quality and greater learning interest (Z = -2.149 to -5.161, p < 0.05). CONCLUSION:The integrated PBL-SBL model is more effective than traditional methods in enhancing emergency skills, critical thinking and learner satisfaction, supporting its adoption for training healthcare providers in managing ICM allergies.

Biological sex fundamentally shapes human brain organization, but sex-specific normative neuroanatomical trajectories across the lifespan remain largely uncharted. Here, we constructed independent, sex-specific lifespan brain charts using structural neuroimaging data from 59,915 healthy individuals (29,760 males and 30,155 females) ranging in age from 266 postconception days to 100 years. By examining 296 structural phenotypes across global, cortical, and subcortical measures, these models revealed widespread sex differences in maturational timing, with males reaching peak milestones later than females. These trajectories demonstrate that sex differences evolve dynamically, with phenotype-specific windows of emergence and maximal separation. Compared with conventional sex-pooled references, sex-specific models achieved superior predictive accuracy and reduced misestimation of individual deviations in healthy populations. Across five neuropsychiatric conditions, sex-specific models improved the detection of extreme deviations and revealed both shared and sex-dependent patterns of disorder-related neuroanatomical abnormalities. These sex-specific charts establish tailored normative references for assessing brain development, ageing, and disease.

The human cortical functional hierarchy, spanning from primary sensorimotor to transmodal association regions, represents a fundamental principle of brain organisation. Here, we show lifespan changes in the sensorimotor-association (S-A) gradient in the cortical functional hierarchy using multimodal neuroimaging data from 33,247 participants aged 32 postmenstrual weeks to 80 years. We identify three critical neurodevelopmental milestones: initiation (third trimester to perinatal period), establishment (infancy to early childhood), and expansion-stabilisation (late childhood to adulthood). Pronounced gradient changes are predominantly observed during the first decade, with continued refinement extending into mid-adulthood. Spatiotemporally heterogeneous growth patterns in functional gradients align with evolutionary hierarchies, segregation-integration dynamics, structural maturation, and cognitive spectrum development, proceeding along a dominant S-A growth axis. These findings establish a unified neurodevelopmental framework that links connectome gradient dynamics to multifaceted functional and structural properties, advancing our understanding of cortical hierarchy maturation across the lifespan.

OBJECTIVE:To systematically evaluate the association between perioperative hyperglycemia and postoperative prognosis in esophageal squamous cell carcinoma (ESCC) patients using large-scale, multicenter real-world data. METHODS:A total of 5 952 patients with ESCC who underwent radical esophagectomy were consecutively included in this retrospective cohort study from the Anyang Cancer Hospital in Anyang, Henan Province (January 2012 to December 2017) and the Cancer Hospital of Shantou University Medical College in Shantou, Guangdong Province (August 2009 to December 2018). Perioperative fasting glucose data were obtained from the hospital information system. The perioperative period was divided into preoperative and postoperative phases: Preoperative hyperglycemia was defined as a mean fasting glucose level ≥7.0 mmol/L from day 14 to day 2 before surgery, and postoperative hyperglycemia was defined as a mean fasting glucose level ≥7.0 mmol/L from day 2 to day 14 after surgery. The primary outcome was overall survival (OS), and secondary outcomes included 30 d/90 d postoperative mortality and in-hospital complications. Multivariable Cox proportional hazards models were used to assess the association between perioperative hyperglycemia and OS, with adjusted hazard ratios (HR) and 95% confidence intervals (CI) calculated. RESULTS:The maximum follow-up period was 12 years. The prevalence of preoperative and postoperative hyperglycemia was 6.7% and 18.3%, respectively. Patients with preoperative hyperglycemia had a lower 5-year OS rate than those without (57.3% vs. 65.0%), with an adjusted HR of 1.41 (95%CI: 1.19-1.68). The patients with postoperative hyperglycemia also had reduced 5-year survival (61.8% vs. 66.4%), with an adjusted HR of 1.39 (95%CI: 1.22-1.58). Joint analysis showed that compared with patients without hyperglycemia, those with hyperglycemia in either the preoperative or postoperative phase alone had an elevated mortality risk (HR=1.24, 95%CI: 1.07-1.43), while the patients with hyperglycemia in both phases had the highest mortality risk (HR=1.86, 95%CI: 1.49-2.32). Stratified analysis revealed that BMI significantly modified the association between hyperglycemia and adverse prognosis (Pinteraction=0.010), with the association being particularly pronounced in patients with BMI ≥24.0 kg/m2. Additionally, perioperative hyperglycemia was associated with poorer short-term postoperative outcomes. CONCLUSION:Perioperative hyperglycemia is an independent risk factor for long-term survival in ESCC patients undergoing curative esophagectomy. These findings suggest that enhanced routine glucose monitoring and control during perioperative management of ESCC may help improve long-term patient outcomes.

Cadmium (Cd) pollution poses a significant threat to agricultural safety and ecological health. Understanding plant tolerance mechanisms is crucial for developing solutions. In this study, we investigated the physiological and molecular mechanisms underlying Cd tolerance in two Amaranthus varieties, CZ074 (tolerant) and CZ081 (sensitive). Physiological analysis revealed CZ074 exhibited less severe growth inhibition under Cd stress. Notably, CZ074 exhibited a lower Cd transport coefficient from roots to shoots, which contributes to protecting its aboveground tissues from toxicity. Comparative transcriptome analysis of roots, stems, and leaves identified a significantly larger number of differentially expressed genes (DEGs) in CZ074, suggesting an “active investment” strategy involving comprehensive transcriptional reprogramming. In CZ074 roots, DEGs were markedly enriched in pathways related to phenylpropanoid biosynthesis, cell wall formation (cutin, suberine, and wax), ribosome biogenesis, and plant hormone signal transduction. Key transcription factors (bZIP, NAC, WRKY) and transporter genes (HMA3, NRAMPs, CAXs) were more strongly up-regulated in CZ074 roots, indicating enhanced defense, sequestration, and transport capabilities. In shoots, CZ081 showed more dysregulated gene expression, interpreted as a symptom of severe stress damage rather than an effective defense. We propose that CZ074’s tolerance stems from a coordinated network involving robust root defenses, efficient Cd translocation in stems, all supported by extensive and precise transcriptional regulation. These findings provide valuable candidate genes and insights for phytoremediation and breeding Cd-tolerant crops.

BACKGROUND Screening can play a role in primary prevention by mitigating modifiable risk factors. However, whether upper gastrointestinal (UGI) endoscopic screening can reduce the burden of modifiable risk factors is unknown. AIM To evaluate the effect of UGI endoscopic screening on modifiable risk factors for cancer and its potential role in primary prevention. METHODS We collected data from 11842 participants in the screening arm (received standard UGI endoscopy) and 12793 participants in the control arm (received abdominal B-ultrasound examination) of a randomized controlled trial. The participants completed questionnaires before and after screening (median interval: 6.55 years). Data on three modifiable risk factors including cigarette smoking, alcohol drinking, and unhealthy dietary habits, at both time-points were collected. Logistic regression was applied to assess the effect of UGI endoscopic screening on the cessation and incidence of these three modifiable risk factors. RESULTS UGI endoscopic screening significantly increased the cessation rate of cigarette smoking, alcohol drinking and unhealthy dietary habits [odds ratio (OR)(smoking) = 1.20 (1.06-1.36), ORdrinking = 1.33 (1.19-1.50) and ORunhealthy dietary habits = 1.07 (1.02-1.13)]. Subgroup analysis showed that the cessation effects were dominant among subjects who completed UGI endoscopy, while no significant effects were observed among those who declined endoscopy. Females and individuals aged > 60 years were more prone to changes in behavior. Analysis of the incidence of the three modifiable risk factors showed that only the incidence of unhealthy dietary habits was significantly decreased by UGI endoscopic screening [OR = 0.85 (0.80-0.91)]. CONCLUSION UGI endoscopic screening increased the cessation of modifiable risk factors; thus, contributing to primary prevention of cancers. Females and individuals aged > 60 years in rural China were more prone to changes in behavior.

The benefit of endoscopy for non-cardia gastric cancer (GC) prevention lacks evidence from randomized controlled trials (RCTs). This study aimed to evaluate the effect of endoscopic screening for non-cardia GC through an RCT. We conducted a cluster RCT in rural Hua County, northern China (ClinicalTrials.gov, NCT01688908). A total of 668 villages were randomly selected and assigned to either undergo upper gastrointestinal endoscopic screening (screening group) or no screening (control group). Permanent residents aged 45-69 years were enrolled from January 2012 to September 2016. Non-cardia GC mortality between the two groups was compared in intention-to-treat, per-protocol, and subgroup analyses. Poisson regression fitted with generalized estimating equations was used, adjusting for baseline characteristics and accounting for village clustering. The study enrolled 17,104 participants in the screening group, of whom 15,165 (88.7

BackgroundEsophageal squamous intraepithelial neoplasia could be detected in normally stained mucosa under Lugol's chromoendoscopy. We aim to determine whether an active biopsy should be performed on such mucosa.MethodsThis study was based on a population-based screening cohort where participants underwent Lugol's chromoendoscopy with biopsies taken from abnormal-unstaining areas and normally stained standard site. A total of 641 participants with esophageal squamous intraepithelial neoplasia or more severe lesions were included in the analysis. The cumulative incidence of high-grade intraepithelial neoplasia/esophageal squamous cell carcinoma (HGIN/ESCC) and ESCC-specific mortality were compared between participants biopsied from iodine unstained and stained areas. Additionally, paired eligible tissues were utilized for comparative genomic analysis.ResultsFor participants diagnosed with low-grade intraepithelial neoplasia (LGIN), HGIN, and ESCC, 292 (54.8%), 11 (14.9%), and 1 (2.9%) cases, respectively, were biopsied from normal-staining mucosa. Over a median 9.5-year follow-up, no incident HGIN/ESCC cases were identified among individuals with LGIN diagnosed from normal-staining esophageal mucosa. In contrast, LGIN cases detected in unstained lesions exhibited a cumulative incidence of HGIN/ESCC of 15.8 (95% CI, 11.4-21.0) per 100 persons. No ESCC-related deaths occurred in patients having normal-staining lesions, irrespective of pathological grade. Contrastingly, cumulative ESCC-specific mortality per 100 persons for LGIN, HGIN, and ESCC patients of unstained lesions were 2.1 (95% CI, 0.7-4.8), 14.3 (95% CI, 6.7-25.4), and 36.4 (95% CI, 20.4-54.9), respectively. Genomic analysis revealed minimal copy number variants in normally stained lesions compared to substantial alterations in unstained lesions.ConclusionsRandom biopsies of normally stained esophageal mucosa under Lugol's chromoendoscopy should be unnecessary for population-level ESCC screening.

The current surveillance guideline of esophageal squamous cell carcinoma (ESCC) runs the risk of underestimation of early Lugol-unstained lesions (LULs), and extremely early genomic events in the carcinogenesis and their temporal order of occurrence remain unclear. Here, we performed whole-exome sequencing analyses of 148 biopsy samples obtained at different time points (with a median 4.6-year interval) from the same esophageal lesions of 74 asymptomatic subjects with LULs detected at community-based screening, of whom 33 individuals showed progression at the follow-up chromoendoscopy, while the other 41 did not. We found that progressors showed higher tumor mutational burden, chromosomal instability level, whole-genome doubling (WGD) events, and apolipoprotein B mRNA-editing catalytic polypeptide-like (APOBEC) activity at both index and follow-up compared to non-progressors. Sustained TP53 two-hit events, absence of NOTCH1 mutation, presence of CDKN2A mutation/deletion, and WGD were detected both before and after LUL progression in 64% (9/14) of progressors and none (0/19) of non-progressors with non-dysplastic LULs (ND-LULs). CCND1, FGFs, and MIR548K amplification in chromosome 11q13.3 only occurred in progressors with high-grade intraepithelial neoplasia or above lesions. TP53 two-hit events, absence of NOTCH1 mutation, and presence of CDKN2A mutation/deletion were positively correlated with WGD and successfully distinguished all 5 progressed individuals from the 24 subjects at so-called "low risk" of progression (ND-LULs with a size of ≤5 mm) under current surveillance criteria. Collectively, TP53 two-hit events, absence of NOTCH1 mutation, and presence of CDKN2A mutation/deletion are extremely early events in the carcinogenesis of ESCC, providing early warning markers for the surveillance of high-risk precursor lesions of ESCC.

INTRODUCTION:Image-based diagnostic tools that aid endoscopists to biopsy putative esophageal malignant lesions are essential for ensuring the standardization and quality of Lugol chromoendoscopy. But there is no such model available yet. METHODS:We developed a diagnostic model using endoscopic Lugol-unstained lesions (LULs) features and baseline data from 1,099 individuals enrolled from a large-scale population-based ESCC screening cohort. Six hundred three participants from a clinical outpatient cohort were included as the external validation set. High-grade intraepithelial neoplasia and above lesions identified at baseline or within 1 year after screening were defined as outcome. The final model was determined using logistic regression analysis by the Akaike information criterion. RESULTS:The optimal diagnostic model contained the size, irregularity, sharp border of LUL, age, and body mass index of the participant, with the area under the curve of 0.83 (95% confidence interval [CI]: 0.78-0.87) in the development set, 0.81 (95% CI: 0.77-0.86) in the internal validation set, and 0.87 (95% CI: 0.84-0.90) in the external set. This model stratified individuals with LULs into low-risk, moderate-risk, and high-risk groups based on tertiles of predicted probabilities. The high-risk group accounted for <40% participants but enriched 80.8% and 82.7% of high-grade intraepithelial neoplasia and above cases in the development and external validation sets, respectively, achieving detection ratios 16.2 and 11.0 times higher than the low-risk group. DISCUSSION:Our model can help maintain consistency and accuracy in detecting esophageal malignancy through Lugol chromoendoscopy, particularly in primary healthcare units in high-risk rural areas.

OBJECTIVES:Chronic internal carotid artery occlusion (CICAO) poses a considerable risk for stroke. While endovascular revascularization holds promise as a potential therapy, its real-world efficacy, safety, and long-term outcomes remain underexplored. This study aims to assess the effectiveness, safety, and long-term outcomes of endovascular revascularization in symptomatic CICAO patients refractory to medical therapy. MATERIALS AND METHODS:A retrospective cohort study was conducted to collect clinical and surgical data from CICAO patients meeting the inclusion criteria for endovascular revascularization therapy. Patients were categorized into groups based on the success or failure of revascularization procedures. Follow-up assessments were undertaken to ascertain patients' prognoses and survival outcomes. Logistic multivariate analysis was employed to identify risk factors associated with primary and secondary outcome events. COX proportional hazard regression was used to compare the risk ratios of these events between the two groups. RESULTS:The study included 59 patients undergoing 62 procedures with a 75.81 % success rate for revascularization. Perioperative complications were 6.45 %, and the average follow-up duration was 36.53 ± 3.92 months. In the successful revascularization group, the primary endpoint event rate was 6.52 %, contrasting with 23.08 % in the non-revascularization group. Carotid artery occlusion and diabetes emerged as independent risk factors for primary endpoint events. A significant difference was observed between the two groups in both primary endpoint (RR 0.16, [95 %CI, 0.03-0.84]) and total endpoint event rates (RR 0.27, [95 %CI, 0.08-0.96]) CONCLUSIONS: Failure of revascularization may be associated with an increased risk of recurrent cerebrovascular events in patients with CICAO, while successful endovascular revascularization appears to be linked to a lower incidence of such events. However, these results should be interpreted with caution due the relatively small sample size.

BACKGROUND: This study aimed to explore the association between the amount of carotid artery perivascular adipose tissue (PVAT) quantified by magnetic resonance imaging and prior cerebral infarction. METHODS: A total of 139 patients (mean age, 64.4±8.2 years; 112 men) with moderate-to-severe atherosclerotic stenosis referred to carotid endarterectomy were included and underwent multicontrast magnetic resonance vessel wall and brain imaging. The amount of carotid artery PVAT with vulnerable plaque components on magnetic resonance images of each patient was quantitatively analyzed, and the measurements included the average PVAT area, PVAT area index, and PVAT volume index. The amount measurements of PVAT at slices with vulnerable plaque between patients with and without prior cerebral infarction were compared. Logistic regression analyses were conducted to determine the association between the amount measurements of PVAT and prior cerebral infarction. RESULTS: Patients with prior cerebral infarction showed significantly higher PVAT area, PVAT area index, and PVAT volume index compared with those without (all P <0.01). The carotid PVAT area (odds ratio [OR], 1.015 [95% CI, 1.003–1.028]; P =0.018), PVAT area index (OR, 2.051 [95% CI, 1.084–3.880]; P =0.027), and PVAT volume index (OR, 2.864 [95% CI, 1.343–6.108]; P =0.006) on the index side were significantly associated with prior cerebral infarction in univariate logistic regression. After adjusting for clinical confounding factors and plaque features, the associations between the carotid PVAT area (OR, 1.028 [95% CI, 1.008–1.048]; P =0.006), PVAT area index (OR, 3.587 [95% CI, 1.451–8.870]; P =0.006), and PVAT volume index (OR, 6.053 [95% CI, 2.048–17.889]; P =0.001) and prior cerebral infarction remained statistically significant. CONCLUSIONS: The amount of PVAT in carotid artery with vulnerable plaques is independently associated with prior cerebral infarction and may, therefore, be related to the occurrence of ischemic stroke.