OBJECTIVE:Cryoablation has proved to be an effective method to cure lung cancer based upon existing research, thus has been widely used in clinical practice. This pilot study aimed to evaluate the efficacy and safety of CT-guided cryoablation for the treatment of different lung tumors, including solid and sub-solid lung tumors. METHODS:This retrospective study enrolled a total of 77 patients with lung tumors, comprising 46 solid tumors and 31 sub-solid tumors. All patients underwent CT-guided cryoablation. The various aspects of the treatment, including procedural details, technical success rate, complications, and local tumor control were systematically evaluated. RESULTS:The technical success rate of CT-guided cryoablation was 100%. The procedure was well-tolerated, with a low rate of major complications (4%). The most common complication is pneumothorax, which presents in 34.8% of patients with solid tumors as well as 51.6% of patients with sub-solid tumors. The incidence rates of all the complications were not statistically different. The median follow-up period was 24 months, during which local tumor control rates were 74% for solid lung tumors and 100% for sub-solid tumors. The overall survival rates at 24 months were 100%. CONCLUSION:CT-guided cryoablation appears to be an effective and safe treatment modality for different lung tumors, including solid and sub-solid tumors. The high technical success rate, low rate of major complications, and favorable local tumor control suggest that cryoablation could serve as a valuable alternative treatment especially for the tumors manifesting as sub-solid tumors.

OBJECTIVES:Patients with anti-threonyl (PL7) positive anti-synthetase syndrome (ASS) exhibit a high prevalence of interstitial lung disease (ILD), which can progress to progressive pulmonary fibrosis (PPF) and increased mortality. This study aims to explore the clinical characteristics, imaging features and predictive factors for PPF. METHODS:A retrospective cohort of PL7-ASS patients at a single tertiary centre between January 2018 and December 2022 was analysed. Clinical, serological and radiological data were collected at baseline and during follow-up. RESULTS:The study included 69 PL7-ASS patients with ILD (mean age: 54.5 years; 73.9% female). Baseline CT imaging revealed the following patterns: cellular non-specific interstitial pneumonia (cNSIP, 29%), fibrotic NSIP (fNSIP, 18.8%), organizing pneumonia (OP, 14.5%), OP-cNSIP overlap (15.9%), OP-fNSIP overlap (14.5%) and usual interstitial pneumonia (UIP, 7.2%). PPF developed in 39.1% of patients. Elevated levels of lactate dehydrogenase (LDH; HR = 1.021, 95% CI: 1.002-1.04, P = 0.031) and carbohydrate antigen 125 (CA125; HR = 1.164, 95% CI: 1.023-1.326, P = 0.022) were identified as independent predictors of PPF. Patients with UIP or OP-NSIP overlap patterns exhibited worse survival (P = 0.0479) and higher PPF prevalence (P = 0.029). Patients who developed PPF had significantly lower survival rates compared with those without PPF (HR = 5.120, 95% CI: 1.566-16.740, P = 0.018). CONCLUSION:PL7-ASS patients with ILD are at significant risk of developing PPF, which is associated with poor survival outcomes. Elevated LDH and CA125 levels may serve as reliable predictors of PPF, highlighting the importance of early identification and aggressive management strategies.

Currently, there are only a few effective treatments for anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5) positive dermatomyositis (DM)-associated interstitial lung disease (ILD). The aim of this study was to evaluate the efficacy and safety of baricitinib in patients with MDA5 + DM-ILD. The study was a retrospective cohort design that evaluated patients with MDA5 + DM-ILD who had received or not received baricitinib. Clinical symptoms, laboratory data, and survival were compared in the two groups. Thirty-nine patients with MDA5 + DM-ILD who received baricitinib were included in the study. After baricitinib therapy, 31 patients (79.5

BACKGROUND:Percutaneous computed tomography (CT)-guided biopsy and cryoablation are commonly used techniques for diagnosing and treating pulmonary malignant tumors. Performing these procedures simultaneously allows for tissue diagnosis while potentially offering therapeutic benefits. This study aimed to evaluate whether the efficacy and safety of simultaneous percutaneous CT-guided biopsy and cryoablation in managing pulmonary tumors suspected of malignancy are comparable to those of sequential procedures. METHODS:This retrospective study involved 124 patients with 131 highly suspicious malignant pulmonary nodules. Patients either underwent synchronous percutaneous core-needle biopsy and cryoablation (Group A) or separately underwent these procedures (Group B) from December 2020 to May 2024. All procedures were performed under CT guidance using a percutaneous approach. We analyzed technical success rates, complications, diagnostic yield, and local tumor control. RESULTS:Technical success rates were 100% in both groups. The rate of pneumothorax was 42.1% (16/38) in Group A and 34.9% (30/86) in Group B. In Group A, hemoptysis and pleural effusion rates were 18.4% (7/38) and 23.7% (9/38), respectively, while in Group B, these rates were 16.3% (14/86) and 12.8% (11/86). These differences were not statistically significant. The diagnostic positive rate in Group A was 87.5%. The mean follow-up duration was 11.8 months (95% confidence interval [CI], 10.2-13.4), with local tumor control rates of 97% for Group A and 88% for Group B. The effectiveness rates of synchronous and separate procedures were similar. CONCLUSION:Synchronous biopsy-ablation is an effective method for obtaining tumor pathology and local treatment of lung tumors simultaneously. It is a viable option for select patients where expedited diagnosis-therapy is clinically justified, particularly when molecular profiling is not immediately indicated.

OBJECTIVES:To investigate cardiac involvement in patients with anti-melanoma differentiation-associated gene-5 antibody-positive dermatomyositis (MDA5-DM). METHODS:This prospective study included 37 patients with MDA5-DM and 31 age- and sex-matched healthy controls (HCs). Electrocardiography, echocardiography (ECHO), and cardiac magnetic resonance (CMR) was performed to assess cardiac involvement. Clinical features were compared between patients with and without CMR abnormalities. Logistic regression analysis was used to explore independent risk factors for CMR abnormalities. Six patients with abnormal CMR findings were followed up. RESULTS:Three patients complained of chest pain, and nine reported palpitations. The incidence of sinus tachycardia and ST-T changes were 13.5%. Premature atrial/ventricular contractions were detected in three patients. Four patients had decreased left ventricular systolic function on ECHO. 24 patients had abnormal CMR mapping results. Patients had significantly higher values in native T1 (p<0.001) and T2 (p=0.007) mapping, compared with HCs. Elevated extracellular volume was detected in 45.9% of the patients. Subgroup analysis showed significantly higher constitutional Visual Analog Scale (VAS) score, cutaneous VAS score, serum NT-proBNP level, and anti-MDA5 antibody titre in patients with abnormal CMR parameters than in those with normal CMR parameters (all p≤0.001). Logistic regression analysis revealed cutaneous VAS score as a risk factor for abnormal CMR (p=0.033). Follow-up of six patients with abnormal CMR findings showed significantly improved CMR mapping parameters post-treatment. CONCLUSIONS:Subclinical cardiac involvement was predominant in patients with MDA5-DM and can be sensitively detected by CMR. Cardiac involvement is closely correlated with cutaneous lesions and may improve after treatment with prednisone and immunosuppressants.

Background:Computed tomography (CT)-guided microcoil localization before video-assisted thoracoscopic surgery (VATS), while generally safe, carries non-negligible risks of intrapulmonary hemorrhage. This study identifies independent predictors of higher-grade hemorrhage (≥ Grade 2) caused by CT-guided microcoil localization to optimize patient selection and procedural planning. Methods:In this retrospective study, 432 consecutive patients [2016-2020] undergoing microcoil localization prior to VATS for solitary pulmonary nodules were analyzed. Hemorrhage severity was graded radiologically (Grade 0-4). Univariate and multivariate logistic regression identified the independent factors associated with higher-grade hemorrhage (≥ Grade 2), with P<0.05 considered significant. Results:Intrapulmonary hemorrhage occurred in 161 of the 432 CT-guided microcoil localizations (37.27%), and higher-grade hemorrhage occurred in 41 of all procedures (9.49%). The logistic regression revealed that repeat insertion [odds ratio (OR) =9.712, P<0.001] was the only risk factor for higher-grade intrapulmonary hemorrhage, while procedure-related pneumothorax (OR =0.159, P=0.005), nodule size (>5-10 mm, OR =0.216, P=0.002; >10 mm, OR =0.349, P=0.04), pleura-microcoil distance (>20-30 mm, OR =0.365, P=0.02), and lung radiodensity along the needle passage [>-900 to -850 Hounsfield unit (HU), OR =0.426, P=0.03; ≤-900 HU, OR =0.273, P=0.009] were protective factors for higher-grade intrapulmonary hemorrhage. Conclusions:Repeat insertion during microcoil localization significantly increases hemorrhage risk, while pneumothorax, larger nodule size (>5 mm), longer pleura-microcoil distance (>20-30 mm) and lower lung density (≤-850 HU) are protective. These findings enable risk-stratified patient management.

To investigate the influence of the patient's position on the entry of embolized air into the systemic circulation after air embolism (AE). 116 patients with AE were selected as study subjects, including 81 patients undergoing CT-guided transthoracic biopsy and 35 patients undergoing CT-guided localization of pulmonary nodule before video-assisted thoracoscopic surgery. While maintaining the patient's original position, 94 out of 116 patients underwent at least one follow-up CT within 5-15 min after AE. The following two situations were considered as embolized air entering into systemic circulation: (1) CT showed air in the aorta and/or branches; (2) follow-up CT showed a decrease or disappearance of air in the left heart. The positions of the 116 patients with AE included 6 in supine position (SP), 70 in prone position (PP), 20 in left lateral decubitus position (LLDP), and 20 in right lateral decubitus position (RLDP). Embolized air entering the systemic circulation occurred in 33.3% (2/6) patients in SP, 47.1% (33/70) patients in PP, 70% (14/20) patients in LLDP, and 55% (11/20) patients in RLDP. The difference is not statistically significant (χ2 = 4.16, P = .24). The proportion of embolized air entering the systemic circulation is similar among patients in SP, PP, LLDP, and RLDP within 5-15 min after AE. The above 4 positions cannot effectively prevent the embolized air from entering the systemic circulation. Embolized air enters the systemic circulation within a few minutes in about half of patients with AE. Within 5-15 min after AE, the proportion of embolized air entering the systemic circulation is similar among patients in SP, PP, LLDP, and RLDP. Changing the patient's position after AE cannot prevent embolized air from entering the systemic circulation.

To investigate the diagnostic performance and complication rates of percutaneous transthoracic CT-guided coaxial core needle biopsy (PTCNB) in persistent consolidations and evaluate its safety in routine clinical practice. A total of 685 patients (404 males, 281 females) underwent PTCNB with coaxial core technique for persisted consolidation were reviewed in this study. According to histopathological and microbiological analysis, the results of biopsy specimens were categorized as follows: malignant, specific benign, non-specific benign and non-diagnostic. The final diagnosis was established through surgical resection or clinicoradiological follow-up for at least 12 months following biopsy. Diagnostic yield of PTCNB was defined as the percentage of the true diagnosis from biopsy as malignant and specific benign lesions. With respect to the final diagnosis, 54 (54/685; 7.88

Idiopathic inflammatory myopathy (IIM) with antimitochondrial M2 antibody (AMA-M2) has been associated with distinct clinical characteristics. In this study, we explore the magnetic resonance imaging (MRI) findings of the muscles of the lower extremities in AMA-M2-positive IIM to gain more insight. MRI of 22 lower extremity muscles was retrospectively evaluated in 14 patients with AMA-M2-positive IIM and 37 age- and sex-matched patients with AMA-M2-negative IIM. Muscles with inflammatory edema and fatty infiltration were assessed according to the Stramare and Mercuri criteria. Patients with AMA-M2-positive IIM had significantly higher incidence of MRI involvement with fatty infiltration in five lower extremity muscles, namely the adductor magnus (AM) (13/14 VS 14/37, p < 0.001), semimembranosus (SM) (13/14 VS 17/37, p = 0.002), biceps femoris (BF) (12/14 VS 15/37, p = 0.004), soleus (13/14 VS 23/37, p = 0.041), and the medial head of the gastrocnemius (Gastroc M) (13/14 VS 17/37, p = 0.002) than patients with AMA-M2-negative IIM. Furthermore, the severity scores of fatty infiltrations of the above five muscles in AMA-M2-positive IIM were significantly higher than those in patients with AMA-M2-negative IIM (p < 0.001). Severe fatty infiltrations of the AM, SM, BF, soleus, and Gastroc M in the posterior muscles of the lower extremities are dominant MRI features in our patients with AMA-M2-positive IIM. This unique muscle MRI character may be a helpful indicator in clinical practice for patients with AMA-M2-positive IIM.

Background: Even though CT-guided microcoil localization before video-assisted thoracoscopic surgery (VATS) is considered as a safe and effective procedure, related complications are not rare and sometimes are severe. The purpose of this study was to investigate the associated factors of higher-grade intrapulmonary hemorrhage caused by CT-guided microcoil localization. Methods: Totally, 432 consecutive patients with solitary nodule who underwent CT-guided microcoil localization prior to VATS were enrolled in this study. According to CT images after procedure, all the nodules were divided into two groups: higher-grade and no or lower-grade intrapulmonary hemorrhage. The clinical characteristics and microcoil localization procedure-related variables of the nodules were analyzed by univariate analysis and multivariate logistic regression analysis to screen the independent factors associated with higher-grade intrapulmonary hemorrhage. P＜0.05 was considered to indicate a statistically significant difference. Results:Intrapulmonary hemorrhage occurred in 161 of the 432 CT-guided microcoil localizations (37.27%), and higher-grade hemorrhage occurred in 41 of all procedures (9.49%). The logistic regression revealed that repeat insertion (OR=9.712, P<0.001) was the only risk factor for higher-grade intrapulmonary hemorrhage, while procedure-related pneumothorax (OR=0.159, P=0.005), nodule size(>5∽10mm, OR=0.216, P=0.002; >10mm, OR=0.349, P=0.035), pleura-microcoil distance(>20∽30mm, OR=0.365, P=0.018), and lung radiodensity along the needle passage(-850HU∽-900HU, OR=0.426, P=0.032; -900HU or less, OR=0.273, P=0.009) were protective factors for higher-grade intrapulmonary hemorrhage. Conclusions: Repeat insertion was shown to be an independent risk factor for higher-grade hemorrhage in patients with CT-guided microcoil localization. Procedure-related pneumothorax, nodule size(>5mm), pleura-microcoil distance(>20∽30mm), and lung radiodensity along the needle passage(-850HU or less) were protective factors associated with higher-grade hemorrhage.

Background:Pulmonary artery sarcoma (PAS) is a very rare malignancy with a poor prognosis; however, its clinical manifestations and imaging findings are often indistinguishable from pulmonary thromboembolism (PTE). We thus aimed to accurately diagnose PAS by comparing the clinical and computed tomography pulmonary angiography (CTPA) and magnetic resonance imaging (MRI) imaging characteristics of PAS and PTE.Methods:This case-control study retrospectively enrolled 20 patients with PAS (from March 2017 to September 2022), 40 patients with central acute PTE, and 40 patients with central chronic PTE (from January 2021 to December 2022) in the China-Japan Friendship Hospital. The following clinical and imaging findings were compared between the three groups: initial symptoms; D-dimer, C-reactive protein, and N-terminal pro B-type natriuretic peptide levels; wall-eclipsing sign (WES); scope of lesion involvement; and morphological characteristics. Signal intensity was also observed on different MRI sequences.Results:The D-dimer level in PAS was significantly lower than that in central acute PTE (P<0.001). The WES was present in 17 cases of PAS (85.0%), which was a greater proportion than that of the central acute PTE and chronic PTE groups (all P values <0.001). The involvement of the pulmonary valve or right ventricular outflow tract was observed in five PAS cases but none of the central acute PTE or chronic PTE cases (all P values =0.001). In 19 PAS cases (95.0%), the lesions grew expansively in the central pulmonary artery. The proximal margin of 18 patients with PAS (90.0%) was bulging or lobulated. Nine cases of PAS (45.0%) showed aneurysm-like dilatation (grape-like sign) of the distal pulmonary artery, representing significantly greater proportion than that of the central acute PTE and chronic PTE groups (all P values <0.001). In 37 patients with central acute PTE (92.5%), the clots were observed to be floating in the pulmonary artery lumen with saddle, tubular or polypoid shape. Eccentric filling defects attached to the pulmonary artery wall were observed in 32 cases of central chronic PTE (80.0%). On MRI, PAS lesions were hyperintense on fat-suppressed T2-weighted imaging and diffusion-weighted imaging, demonstrating heterogeneous enhancement.Conclusions:Comprehensive analysis of the clinical data and imaging features on CTPA and MRI can aid in the accurate differential diagnosis of PAS and PTE.

Objectives: Dementia is a clinical syndrome caused by multiple etiologies, usually manifests with progressive and diffuse brain dysfunction. The activity of the human glymphatic system was evaluated in cases of dementia by the diffusion tensor image analysis along the perivascular space (DTI-ALPS). Methods: We recruited 28 healthy subjects and 77 patients, including 38 with Alzheimer’s disease (AD),18 with mild cognitive impairment (MCI), 28 with normal controls (NC) and 21 with vascular cognitive impairment (VCI). All participants underwent DTI scanning. Diffusivities in the X, Y and Z axes were obtained in the lateral ventricle body plane of all subjects. We assessed the diffusivity along the perivascular spaces, as well as projection fibers and association fibers, respectively, in order to acquire an DTI-ALPS-index and correlated them with mini mental state examination (MMSE) and montreal cognitive assessment (MOCA) scores using partial correlation which the influence of age was controlled. Results: The AD, MCI, and VCI patients showed significantly lower DTI-ALPS-index (p < 0.001) compared to the NC. Besides, the VCI group had significantly higher DTI-ALPS-index than the AD group (p = 0.007). There was a significant positive correlation between DTI-ALPS-index and MMSE and MOCA scores (the effect of age was controlled), showing that lower water diffusivity along the perivascular spaces associated with dementia.The higher Dzassoc led to the reduced DTI-ALPS-index in VCI, while lower Dxassoc contributed to the decrease of DTI-ALPS-index in AD. Conclusion: The evaluation of DTI-ALPS demonstrates impairment of the glymphatic system in dementia patients by decreased DTI-ALPS-index. Different from AD, the VCI patients show glymphatic drainage disorder rather than glymphatic system impairment. Advances in knowledge: This article comprehensively covers several types of dementia and performs the comparison of VCI, AD and MCI in glymphatic system dysfunction.

To explore the role of peripheral lymphocyte count in phenotyping and prognosis prediction in dermatomyositis (DM) patients with anti-MDA5 antibodies. In total, 1669 patients with idiopathic inflammatory myopathy (IIM) were retrospectively enrolled. Clinical characteristics and prognosis of patients with anti-MDA5+ DM were analyzed in association with peripheral lymphocyte counts and clusters determined by unsupervised machine learning. The peripheral lymphocyte count was significantly lower in the anti-MDA5+ DM group ( N  = 421) than in the other IIM serotype groups. The anti-MDA5+ DM patients were divided into three groups; the severe lymphopenia group had skin ulcers and rapidly progressive interstitial lung disease (RP-ILD); patients with a normal lymphocyte count had a younger age of onset, more frequent arthritis, and normal serum ferritin levels, whereas mild lymphopenia group showed a moderate increase of serum ferritin and intermediate incidence of RP-ILD. Survival analysis revealed that the 3- and 6-month mortality rates were significantly higher in the severe lymphopenia group (29.0% and 42.1%, respectively) than in the mild lymphopenia group and normal lymphocyte count group ( p value <0.001). Consistently, unsupervised machine learning identified three similar groups; the arthritis cluster shows the highest lymphocyte counts and best prognosis; the RP-ILD cluster presents the lowest peripheral lymphocyte, high incidence of RP-ILD, and poor prognosis; the typical DM rash cluster had a moderate peripheral lymphocyte count and an intermediate prognosis. Lymphopenia is a unique manifestation of anti-MDA5+ DM. Peripheral lymphocyte count can define clinical phenotypes and predict prognosis in anti-MDA5+ DM.

Abstract Background Diagnosing persistent pulmonary consolidation still faces challenges. The purpose of this study is to compare the diagnostic yield and the complication rate between percutaneous transthoracic CT-guided coaxial needle biopsy (PTCNB) and transbronchial lung biopsy (TBLB) of persistent pulmonary consolidation. Materials From January 1, 2016, to December 31, 2020, we have retrospectively enrolled a total of 155 consecutive patients (95 males, 60 females) with persistent pulmonary consolidation who underwent both TBLB and PTCNB. According to the standard reference, the diagnostic yield, accuracy, sensitivity and specificity of PTCNB and TBLB were assessed and compared. Results According to the standard reference, the final biopsy diagnoses of 11 cases were confirmed true malignant based on the surgical resections, the remaining were confirmed by clinical and imaging follow-up for at least 12 months. The overall diagnostic accuracy, sensitivity and specificity of PTCNB for malignant diagnosis were 91.61%, 72.34% and 100%, whereas of TBLB were 87.74%, 59.57% and 100%. The diagnostic yield of PTCNB and TBLB were 50.32% and 25.16%, respectively. For the TBLB-based negative cases, PTCNB provided a definite diagnostic yield of 37.93%. There were 45 (29.03%), 22 (14.19%) and 13 (8.39%) patients who experienced pneumothorax, intrapulmonary hemorrhage and hemoptysis, respectively, in PTCNB, while there were only 5 (3.22%) cases of mild intraprocedural bleeding occurring in TBLB. Conclusions CT-guided co-axial needle biopsy is an effective and safe modality, associated with higher diagnostic yield and better diagnostic accuracy compared to transbronchial lung biopsy for malignancy presenting as persistent consolidation, especially as the complementary method for TBLB-based negative lung lesions. Key Points Both PTCNB and TBLB showed high diagnostic accuracy for malignancy. PTCNB had a higher diagnostic yield than TBLB for persistent pulmonary consolidation. PTCNB could provide a complementary diagnosis for TBLB-based negative lung consolidation.

目的 探讨男性强直性脊柱炎(Ankylosingspondylitis,AS)患者中医证型与脊柱骨化的关系及AS脊柱骨化的危险因素.方法 采用双向队列研究方法,回顾性采集2013 年 12 月—2017 年8 月期间中日友好医院中医风湿病科门诊及住院收治初诊为AS的患者临床资料,纳入 2017 年 8 月—2021 年 4 月期间中日友好医院中医风湿病科门诊及住院收治初诊为AS的患者,依据事先设计的病例报告表进行临床资料收集,并对全部纳入的连续性病例进行定期随访、观察,从中选取性别为男且影像学资料齐全者的初次就诊临床资料进行研究,分析不同证型的男性AS患者的临床资料,采用Logistic回归分析男性AS患者脊柱骨化的危险因素.结果 325 例男性AS患者中肾虚督寒证组203 例,肾虚湿热证组 122 例.肾虚督寒证组脊柱骨化评分mSASSS 明显高于肾虚湿热证组,差异有统计学意义(P＜0.01),肾虚督寒证组病程、红细胞沉降率(Erythrocyte sedimentation rate,ESR)、AS疾病活动评分(AS disease activity score-CRP,ASDAS-CRP)高于肾虚湿热证组,差异有统计学意义(P＜0.05),且Schober评分明显低于肾虚湿热证组,差异有统计学意义(P＜0.05).多因素Logistic回归分析显示病程、体质量指数(Bodymassindex,BMI)≥24、肾虚督寒证、吸烟史、BASDAI≥4、髋关节受累与较高的脊柱骨化评分发生相关,差异有统计学意义(P＜0.05),病程、吸烟史、BASDAI≥4、髋关节受累是肾虚督寒证患者较高脊柱骨化评分的危险因素,差异有统计学意义(P＜0.05);病程、吸烟史、髋关节受累是肾虚湿热证患者较高脊柱骨化评分的危险因素,差异有统计学意义(P＜0.05).结论 男性肾虚督寒证患者脊柱骨化评分明显高于男性肾虚湿热证患者;病程、肾虚督寒证、吸烟史、BASDAI≥4、髋关节受累是男性AS患者脊柱骨化的危险因素.

ObjectiveTo explore the role of peripheral lymphocyte count in phenotyping and prognosis prediction in dermatomyositis (DM) patients with anti-MDA5 antibodies. MethodsIn total, 1669 patients with idiopathic inflammatory myopathy (IIM) were retrospectively enrolled. Clinical characteristics and prognosis of patients with anti-MDA5+ DM were analyzed in association with peripheral lymphocyte counts and clusters determined by unsupervised machine learning. ResultsThe peripheral lymphocyte count was significantly lower in the anti-MDA5+ DM group (N = 421) than in the other IIM serotype groups. The anti-MDA5+ DM patients were divided into three groups; the severe lymphopenia group had skin ulcers and rapidly progressive interstitial lung disease (RP-ILD); patients with a normal lymphocyte count had a younger age of onset, more frequent arthritis, and normal serum ferritin levels, whereas mild lymphopenia group showed a moderate increase of serum ferritin and intermediate incidence of RP-ILD. Survival analysis revealed that the 3- and 6-month mortality rates were significantly higher in the severe lymphopenia group (29.0% and 42.1%, respectively) than in the mild lymphopenia group and normal lymphocyte count group (p value <0.001). Consistently, unsupervised machine learning identified three similar groups; the arthritis cluster shows the highest lymphocyte counts and best prognosis; the RP-ILD cluster presents the lowest peripheral lymphocyte, high incidence of RP-ILD, and poor prognosis; the typical DM rash cluster had a moderate peripheral lymphocyte count and an intermediate prognosis. ConclusionsLymphopenia is a unique manifestation of anti-MDA5+ DM. Peripheral lymphocyte count can define clinical phenotypes and predict prognosis in anti-MDA5+ DM.

目的 分析基于从头训练模式深度学习-卷积神经网络模型[the deep learning convolutional neural network model trained from scratch,DL-CNN(fs)]的人工智能算法评估急性肺动脉血栓栓塞(acute pulmonary thromboembolism,APE)的价值.方法 回顾性纳入214例可疑APE行CT肺动脉造影(CTPA)的住院患者,包括急性肺动脉血栓栓塞137例,阴性77例.放射科医师根据CTPA图像判断有无APE,并计算Qanadli评分、Mastora评分和其他CTPA参数.采用DL-CNN(fs)训练网络模型自动检测栓子的分布及容积.评估DL-CNN(fs)模型测量血栓分布的价值,计算血栓负荷与Qanadli评分、Mastora评分和其他CTPA参数的相关性.结果 DL-CNN(fs)测算的中心肺动脉栓子敏感度、特异度、感兴趣区曲线下面积(AUC)分别为100%、16.8%、0.584(95%CI,0.508～0.661);DL-CNN(fs)测算的外周肺动脉栓子敏感度、特异度、AUC均较高(R1-R9,60.8%～95.2%,67.9%～87.1%,0.740～0.844;L1-L10,64.6%～93.4%,62.7%～83.1%,0.732～0.791).DL-CNN(fs)测算的栓子体积与Qanadli score肺栓塞指数显著正相关(r = 0.867,P<0.001),与Mastora score肺栓塞指数显著正相关(r = 0.854,P<0.001),与右心室及左心室最大横径比、右心室及左心室最大面积比呈正相关(r = 0.549,0.559,P<0.01).结论 DL-CNN(fs)模型检测外周肺动脉栓子具有较高的价值,对中心肺动脉栓子诊断特异度有待进一步提高.DL-CNN(fs)模型自动提供APE患者的栓子体积,可以一定程度反映栓塞程度及右心功能,能够辅助医生对于APE患者血栓负荷及危险分层的快速评估.

Objective: To investigate the incidence of air embolism (AE) related to CT-guided localization of pulmonary ground-glass nodules (GGNs) prior to video-assisted thoracoscopic surgery (VATS).Methods: The data of all patients who received CT-guided localization of GGNs before VATS from May 2020 to October 2021 were retrospectively analyzed.Results: A total of 1395 consecutive patients with 1553 GGNs were enrolled. AEs occurred in seven patients (0.5%). In four of the seven patients with AE, the embolism was detected before the patients left the CT table and emergency treatments were carried out. Among them, one patient had chest tightness and unilateral limb dyskinesia, one patient had convulsions and transient loss of consciousness, and two patients had no definite clinical symptoms. After a short-term high-flow oxygen inhalation, the clinical symptoms of two patients with symptomatic AE disappeared and two patients with asymptomatic AE did not show any symptoms. In the remaining three patients with AE, the embolism were detected retrospectively when evaluating the images in the PACS for this study. Fortunately, these three patients never developed clinical symptoms related to AE. All seven patients with AE underwent VATS on the day of localization and all GGNs were successfully removed under the guidance of markers.Conclusion: The incidence of AE related to CT-guided localization of GGNs was 0.5%, which was significantly higher than expected. Post-localization whole thoracic CT should be performed and observed carefully so as to avoid missed AE and delayed treatment.Advances in knowledge: The incidence of AE related to CT-guided localization of GGNs was 0.5%. In order to timely detect AE, whole thoracic CT scan rather than local CT in the lesion area should be performed after localization. A small amount of AE may be missed if the post- localization CT images are not carefully observed.

Abstract Purpose To re-assess cardiovascular metrics on computed tomography pulmonary angiography (CTPA) in predicting pulmonary hypertension (PH) under the 2022 ESC/ERS guidelines. Materials and methods This observational study retrospectively included 272 patients (female 143, mean age = 54.9 ± 12.5 years old) with suspected PH. 218 patients were grouped to evaluate cardiovascular metrics on CTPA and develop a binary logistic regression model. The other 54 patients were grouped into the validation group to assess the performance of the prediction model under the updated criteria. Based on mean pulmonary artery pressure (mPAP), patients were divided into three groups: group A consisted of patients with mPAP ≤ 20 mmHg, group B included patients with 20 mmHg < mPAP < 25 mmHg, and group C comprised patients with mPAP ≥ 25 mmHg. Cardiovascular metrics among the three groups were compared, and receiver operating characteristic curves (ROCs) were used to evaluate the performance of cardiovascular metrics in predicting mPAP > 20 mmHg. Results The main pulmonary arterial diameter (MPAd), MPAd/ascending aorta diameter ratio (MPAd/AAd ratio), and right ventricular free wall thickness (RVFWT) showed significant differences among the three groups (p < 0.05). The area under curve (AUC) of MPAd was larger than MPAd/AAd ratio and RVFWT. A MPAd cutoff value of 30.0 mm has a sensitivity of 83.1% and a specificity of 90.4%. The AUC of the binary logistic regression model (Z = − 12.98187 + 0.31053 MPAd + 1.04863 RVFWT) was 0.938 ± 0.018. In the validation group, the AUC, sensitivity, specificity, and accuracy of the prediction model were 0.878, 92.7%, 76.9%, and 88.9%, respectively. Conclusion Under the updated criteria, MPAd with a threshold value of 30.0 mm has better sensitivity and specificity in predicting PH. The binary logistic regression model may improve the diagnostic accuracy. Critical relevance statement Under the updated criteria, the main pulmonary arterial diameter with a threshold value of 30.0 mm has better sensitivity and specificity in predicting pulmonary hypertension. The binary logistic regression model may improve diagnostic accuracy. Key points • According to 2022 ESC/ERS guidelines, a MPAd cutoff value of 30.0 mm has better sensitivity and specificity in predicting mPAP > 20 mmHg • A binary logistic regression model (Z = − 12.98187 + 0.31053 MPAd + 1.04863 RVFWT) was developed and had a sensitivity, specificity, and accuracy of 92.7%, 76.9%, and 88.9% in predicting mPAP > 20 mmHg. • A binary logistic regression prediction model outperforms MPAd in predicting mPAP > 20 mmHg. Graphical Abstract

Objective The purpose of this study was to evaluate the usefulness of intraprocedural CT and prior PET/CT fusion imaging in improving the diagnostic yield of CT-guided transthoracic core-needle biopsy (CNB) in lung masses. Methods In total, 145 subjects with lung masses suspicious for malignancy underwent image-guided transthoracic CNB. According to imaging modality the subjects were divided into two groups. PET/CT images obtained no more than 14 days before the biopsy were integrated with intraprocedural CT images. The integrated or fused images were then used to plan the puncture sites. The clinical characteristics, diagnostic yield of CNB, diagnostic accuracy rate, procedure-related complications and procedure duration were recorded and compared between the two groups. Final clinical diagnosis was determined by surgical pathology or at least 6-months follow-up. The diagnostic accuracy of CNB was obtained by comparing with final clinical diagnosis. Results 145 subjects underwent CNB with adequate samples, including 76 in fusion imaging group and 69 in routine group. The overall diagnostic yield and diagnostic accuracy rate were 80.3% (53/66), 82.9% (63/76) for fusion imaging group, 70.7% (41/58), 75.4% (52/69) for routine group, respectively. In addition, the diagnostic yield for malignancy in fusion imaging group (98.1%, 52/53) was higher than that in routine group (81.3%, 39/48). No serious procedure-related complications occurred in both two groups. Conclusion CNB with prior PET/CT fusion imaging is particularly helpful in improving diagnostic yield and accurate rate of biopsy in lung masses, especially in heterogeneous ones, thus providing greater potential benefit for patients.