OBJECTIVES:To identify preoperative Gd-EOB-DTPA-enhanced MRI features and clinical variables predictive of an exploratory subtype and proportion of vessels encapsulating tumor clusters (VETC) in hepatocellular carcinoma (HCC), and to evaluate their preliminary prognostic value. METHODS:This retrospective study included 211 patients with pathologically confirmed HCC who underwent preoperative Gd-EOB-DTPA-enhanced MRI (January 2015-December 2024). Patients were classified by exploratory VETC subtype and proportion. Predictive imaging features were identified using logistic regression, and the prognostic implications of VETC-based stratification were assessed by integrating relevant imaging and clinicopathological indices using Cox regression. RESULTS:Macrotrabecular-VETC (MaT-VETC) (≥6 layers) was independently associated with satellite nodules (aOR 4.54, 95% CI: 1.46-14.08; p = 0.009) and low arterial-phase enhancement ratio (aOR 3.33, 95% CI: 1.22-9.17; p = 0.019). A complete enhancing capsule (aOR 2.63, 95% CI: 1.46-4.79; p = 0.001), lower hepatobiliary phase lesion-to-liver signal ratio (aOR 0.17, 95% CI: 0.06-0.52; p = 0.002), and smaller lesion size (aOR 0.51, 95% CI: 0.28-0.94; p = 0.031) independently predicted higher VETC proportion. Elevated AFP (≥300 µg/L) predicted both MaT-VETC (aOR 3.55, 95% CI: 1.12-11.27; p = 0.031) and higher VETC proportion (aOR 2.32, 95% CI: 1.28-4.23; p = 0.006). MaT-VETC was independently associated with worse overall survival (aHR 2.84, 95% CI: 1.03-7.78; p = 0.043), whereas higher VETC proportion showed a nonsignificant trend toward shorter survival (aHR 2.07, 95% CI: 0.78-5.48; p = 0.143). CONCLUSIONS:Preoperative Gd-EOB-DTPA-enhanced MRI features and elevated AFP were associated with an exploratory, endothelial-caliber-based VETC subtype and with VETC proportion in HCC. MaT-VETC, but not VETC proportion, showed an association with worse overall survival in this preliminary study; these hypothesis-generating findings require validation in larger, external cohorts before clinical application.

High-grade gliomas are highly aggressive brain tumors, and precise target volume delineation is crucial for effective treatment. This study aimed to evaluate the concordance and discrepancy between biological tumor volume (BTV) delineated using union of [18F]FAPI-42 and [11C]methionine and conventional gross tumor volume (GTV) in gliomas. Nineteen glioma patients were retrospectively enrolled, who underwent [18F]FAPI-42 and [11C]methionine PET/MRI before radiation therapy. The optimal [18F]FAPI-42 threshold for delineation was determined from five predefined thresholds based on volumetric consistency. Target volumes, including BTV based on [18F]FAPI-42 PET (BTV-FAPI), [11C]methionine (BTV-MET), their union (BTV-UNION), GTV on contrast-enhanced T1-weighted MRI (GTV-ce-T1w), clinical target volume (CTV)-UNION, and CTV-ce-T1w were delineated, and geometric comparisons were made between BTV-FAPI and BTV-MET, BTV-UNION and GTV-ce-T1w, and CTV-UNION and CTV-ce-T1w. Dice Similarity Coefficient (DSC), Jaccard similarity coefficient (JSC), and overlap volumes (OV) parameters were calculated for comparison among the different target volumes. The 20

To investigate the clinical utility of 18F-NOTA-NFB PET/MRI relative to 11C-methionine (11C-MET) PET/MRI and contrast-enhanced MRI (CE-MRI) for glioma recurrence detection. Patients with suspected recurrence of glioma were prospectively enrolled. All patients underwent paired 18F-NOTA-NFB and 11C-MET PET/MRI. Diagnostic efficiency of glioma recurrence detection by different imaging methods were assessed and compared. The suspected lesions showed via 18F-NOTA-NFB and 11C-MET PET/MRI were compared by SUVmax and tumor-to-background ratio (TBR). The diagnostic performance of 18F-NOTA-NFB and 11C-MET SUVmax/TBR was tested by receiver operating characteristic curve. Thirty-eight patients with suspected recurrent glioma were included, with 28 positive for recurrent gliomas and 10 negative for recurrence which were confirmed by the pathology or clinical follow-up. For visual assessment, the accuracy and specificity of 18F-NOTA-NFB PET were equivalent to 11C-MET PET (accuracy: 92.11

A 37-year-old woman with recurrent glioblastoma in the right temporo-occipital lobe after surgery exhibited contrast-enhanced foci on contrast-enhanced MRI, with mild tracer uptake on 11 C-methionine PET/MRI and significantly increased tracer uptake on 18 F-NOTA-NFB, an 18 F-labeled chemokine receptor-4–targeted PET tracer, PET/MRI. 18 F-NOTA-NFB PET showed a significantly higher tumor-to-background ratio for recurrence than 11 C-methionine PET, allowing a more precise visualization of recurrent lesions. This case indicates that 18 F-NOTA-NFB PET/MRI might give advantages in glioma delineation that might provide valuable information for making a treatment strategy and personalized radiotherapy planning.

Eosinophilic solid and cystic renal cell carcinoma (ESC-RCC) represents a novel subtype of renal cell carcinoma that is increasingly recognized for its unique morphological features, immunological profile, and genetic alterations. It also frequently exhibits indolent biological behavior. Initially, it was only reported in female patients with tuberous sclerosis. Here we report a rare case of ESC-RCC in a young man with typical pathological features of mixed solid and cystic growth structures with eosinophilic cytoplasm and characteristic immunohistochemical markers (KRT20 positive/KRT7 negative). The MRI imaging features are solid cystic mass with hemorrhage, the cystic lesions were mainly located around the periphery of the tumor and has uneven enhancement. The patient was in good condition with no signs of recurrence or metastasis thirteen months after the kidney tumor was resection.

This study aimed to longitudinally investigate the evolution and prognosis of radiologic progression patterns (RPPs) in glioblastoma (GBM) using multi-state model (MSM). A retrospective analysis of 119 GBM patients with confirmed progression identified four RPPs: complete (cT1, T2-circumscribed, T2-diffuse), classic-T1, non-responder, and non-local. About 11 genes were analyzed on 69 patients. Prognostic and molecular differences among RPPs were compared. A unidirectional MSM with 6 states (“surgery”, “complete”, “classic-T1”, “non-responder”, “non-local”, “death”) and 14 transitions was constructed to systematically analyze the trajectories and outcomes of various progression patterns in GBM. Significant differences in first progression-free survival and overall survival were observed among RPPs (P < 0.001), while key gene alterations showed no significant differences. In the 6 months post-surgery, cumulative risk for non-responder increased, with state probabilities peaking at 5 months (20

AIM:We design a feasibility study to obtain a set of metabolic-hemodynamic habitats for tackling tumor spatial metabolic patterns with hemodynamic information. MATERIALS AND METHODS:Preoperative data from 69 high-grade gliomas (HGG) patients with subsequent histologic confirmation of HGG were prospectively collected (January 2016 to March 2020) after concurrent chemoradiotherapy (CCRT). Four vascular habitats were automatically segmented by multiparametric magnetic resonance imaging (MRI). The metabolic information, either at enhancing or edema tumor regions, was obtained by two neuroradiologists. The relative habitat volumes were used for weight estimation procedures for computing the coefficients of a linear regression model using weighted least squares (WLS) for metabolite semiquantifications (i.e. the Cho/NAA ratio and the Cho/Cr ratio) at vascular habitats. Multivariate Cox proportional hazard regression analyses are used to obtain the odds ratio (OR) and develop a nomogram using weighted estimators corresponding to each covariate derived from Cox regression coefficients. RESULTS:There was a strongly correlation between perfusion indexes and the Cho/Cr ratio (rCBV, r=0.71) or Cho/NAA ratio (rCBV, r=0.66) at high-angiogenic enhancing tumor habitats (HAT) habitat. Compared isocitrate dehydrogenase (IDH) mutation to their wild type, the IDH wild type had significantly decreased Cho/Cr ratio (IDH mutation: Cho/Cr ratio = 2.44 ± 0.33, IDH wildtype: Cho/Cr ratio = 2.66 ± 0.36, p=0.02) and Cho/NAA ratio (IDH mutation: Cho/Cr ratio = 4.59 ± 0.61, IDH wildtype: Cho/Cr ratio = 4.99 ± 0.66, p=0.022) at the HAT. The C-index for the median progression-free survival (PFS) prediction was 0.769 for the Cho/NAA nomogram and 0.747 for the Cho/Cr nomogram through 1000 bootstrapping validation. CONCLUSIONS:Our findings suggest that spatial metabolism combined with hemodynamic heterogeneity is associated with individual PFS to HGG patients post-CCRT.

Magnetic resonance imaging (MRI) has been extensively studied over the past few decades, so developing strategies to enhance the T-2 contrast is of significant importance. Herein, we synthesized a series of cubic zinc-doped iron oxide nanoparticles (CZINs) with different dopant ratios by the thermal decomposition method. CZINs with a dopant ratio of 1:5 show the best magnetic performance and T-2 relaxivity among all CZINs. More importantly, we demonstrate that differentiated surface modifications lead to diverse in vivo behavior of CZINs, resulting in the distinct contrast efficiency for different types of tumor. Compared to sodium citrate (SC)-modified CZINs, polyethylene glycol (PEG)-modified CZINs show lower protein absorption, longer blood circulation time, and lower uptake amount in liver. These behavior differences lead PEG-modified CZINs to be potential candidates for assisting precise subcutaneous tumor diagnosis, while SC-modified CZINs are more suitable for achieving accurate liver metastases imaging. This research holds significant promise to develop potential T-2 contrast agents, which can be translated into clinical practice.

AIM: To determine whether tumour vascular and cellular heterogeneity of high-grade glioma (HGG) is predictive of isocitrate dehydrogenase (IDH) mutation status and overall survival (OS) by using tumour habitat-based analysis constructed by perfusion and/or diffusion magnetic resonance imaging (MRI).MATERIALS AND METHODS: Seventy-eight HGG patients that met the 2021 World Health Organization WHO Classification of Tumors of the Central Nervous System, 5th edition (WHO CNS5), were enrolled to predict IDH mutation status, of which 32 grade 4 patients with unmethylated O-6-methylguanine-DNA methyltransferase (MGMT) promoter were enrolled for prognostic analysis. The deep-learning-based model nnU-Net and K-means clustering algorithm were applied to construct the Traditional Habitat, Vascular Habitat (VH), Cellular Density Habitat (DH), and their Combined Habitat (CH). Quantitative parameters were extracted and compared between IDH-mutant and IDH-wild-type patients, respectively, and the prediction potential was evaluated by receiver operating characteristic (ROC) curve analysis. OS was analysed using Kaplan-Meier survival analysis and the log-rank test.RESULTS: Compared with IDH-mutants, median relative cerebral blood volume (rCBVmedian) values in the whole enhancing tumour (WET), VH1, VH3, CH1-4 habitats were significantly increased in IDH-wild-type HGGs (all p<0.05). Additionally, the accuracy of rCBVmedian values in CH1 outperformed other habitats in identifying IDH mutation status (p<0.001) at a cut-off value of 4.83 with AUC of 0.815. Kaplan-Meier survival analysis highlighted significant differences in OS between the populations dichotomised by the median of rCBVmedian in WET, VH1, CH1-3 habitats (all p<0.05).CONCLUSIONS: The habitat imaging technique may improve the accuracy of predicting IDH mutation status and prognosis, and even provide a new direction for subsequent personalised precision treatment.(c) 2023 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Objective: This study aimed to establish a model based on Multi-detector Computed Tomography (MDCT), F-18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (F-18-FDG PET/CT), and clinical features for predicting different growth patterns of preoperative Invasive Adenocarcinoma (IAC). Methods: This retrospective study included 357 patients diagnosed with IAC who underwent surgical treatment. According to pathological subtypes, IAC was classified into low-risk growth patterns (lepidic, acinar) and high-risk growth patterns (papillary, micropapillary, and solid). The clinical features of patients, preoperative MDCT, and F-18-FDG PET imaging characteristics were collected. Logistic regression analysis was used to determine the independent risk factors for the high-risk growth pattern of IAC and construct models for predicting the high-/low-risk growth patterns of IAC. Receiver operating characteristics and calibration curves were plotted and Decision Curve Analysis (DCA) was performed to evaluate the performance and clinical benefits of the models, respectively. Results: Gender, tumor location, size, spiculation, and SUVavg were independent risk factors for high-risk growth patterns of IAC. The PET/CT imaging- clinical characteristics combined model could well identify high-/low-risk growth patterns of IAC (AUC=0.789), which outperformed the CT model (AUC=0.689, p=0.0012), PET model (AUC=0.742, p=0.0022), and clinical model (AUC=0.607, p<0.0001). The calibration curve indicated good coherence between all model predictions and actual observations in both training and test sets (p>0.05). DCA revealed the highest clinical benefit of PET/CT imaging-clinical characteristics combined model in identifying the high-risk growth pattern of IAC. Conclusion: The PET/CT imaging-clinical model based on multiphase MDCT features, F-18-FDG PET features, and clinical characteristics could predict the high-risk growth pattern of IAC preoperatively, aiding clinicians in deciding personalized treatment strategies.

Objective To investigate the values of enhancing tumor volume (V), total volume (Vn) and relative non-enhancing tumor ratio (rNTR) before second-line treatment on overall survival (OS) and post-recurrence survival (PRS) in recurrent glioblastoma (rGBM). Methods Clinical data of 85 patients with confirmed rGBM admitted in our medical center from July 2012 to December 2022 were collected and retrospectively analyzed. Quantitative measurements of V, Vn (including tumor enhancement, necrotic and cystic volume) and rNTR (FLAIR high signal volume/enhancing tumor volume) were performed with T1-weighted imaging (T1WI) subtraction mode. Kaplan-Meier survival curve and log-rank test were used to analyze the differences of prognosis between high and low level groups of above indicators. Cox proportional risk regression model was employed for univariate and multivariate prognostic analyses. Results The median PRS was 238 d (95%CI: 197.472~278.528) and the median OS was 449 d (95%CI: 348.755~549.245) in these patients. Kaplan-Meier curve and log-rank test showed significant differences in PRS and OS between high and low levels groups of V, Vn and rNTR (P < 0.05). Univariate analysis showed that V, Vn and rNTR were all influencing factors for PRS and OS (P < 0.05). Multivariate analysis indicated that V and Vn were independent risk factors for PRS (HR=1.019, P < 0.001), and Vn was an independent risk factor for OS (HR=1.008, P=0.042). The Vn-PRS model had the lowest -2 log likelihood (-2LL) among all the models. Conclusion Voxel subtraction technique can accurately assess the size of recurrent tumors in rGBM patients. V, Vn and rNTR can be used for prognosis, and Vn is the most valuable predictor for PRS, which can provide a reliable reference for clinical evaluation of the extent of lesions and survival time of patients.

BACKGROUND:The intratumoral heterogeneity of high-grade gliomas (HGGs) is associated with isocitrate dehydrogenase (IDH) status and prognosis, which can be established by quantitative radioanalysis of spatial tumor habitats. Therefore, we designed a framework for tackling tumors based on spatial metabolism using the hemodynamic tissue signature (HTS), focusing on metabolic changes in tumor habitat to predict IDH status and assess prognosis in patients with HGG. METHODS:Preoperative data for 121 patients with HGG with subsequent histologic confirmation of HGG were prospectively collected (January 2016 to December 2020). The HTS was mapped from the image data, chemical shift imaging voxels were selected from the HTS habitat as the region of interest, and the metabolic ratio of the HTS was calculated using weighted least square method fitting. The metabolic rate of the tumor enhancement area was used as a control to analyze the efficacy of each HTS metabolic rate in predicting the IDH status and prognosis of HGG. RESULTS:Total choline (Cho)/total creatine and Cho/N-acetyl-aspartate showed significant differences between IDH-wildtype and IDH-mutant in high- and low-angiogenic enhanced tumor sites (P < 0.05); Cho/total creatine was an independent risk factor for prognosis of HGG patients in high-angiogenic enhanced tumor habitats, with significant differences in survival time between groups (P < 0.05). The metabolic ratio in the tumor enhanced area could not predict IDH status or evaluate prognosis. CONCLUSIONS:Spectral analysis based on hemodynamic habitat imaging can clearly distinguish IDH mutations and the prognosis assessment is more accurate, rendering it superior to traditional spectral analysis in tumor enhancement areas.

[This corrects the article DOI: 10.7150/thno.44427.].

患者女,50岁,1周前睡眠时突发肢体抽搐,呼之不应,2 min后自行缓解,之后不能回忆该过程;既往无特殊病史.查体及实验室检查均未见明显异常.颅脑MRI:右侧侧脑室三角区2.3 cmX2.2 cm病灶,形态规则,边界清晰,T1WI以低信号为主(图1A)、内见结节状更低信号及少许高信号,T2WI以高信号为主、内见结节状低信号(图1B),边缘见环形低信号;增强后呈明显不均匀强化(图1C),T1WI及T2WI所示明显低信号处无明显强化;脑室系统未见明显扩张、积水;诊断:右侧侧脑室三角区占位性病变,考虑脉络丛乳头状瘤.行全麻下右侧侧脑室肿瘤切除术,术中见右侧侧脑室三角区实性肿瘤,质硬,与周围组织分界清晰.术后病理:切除肿瘤呈灰白、灰红色,切面呈灰红色,局部似存在骨组织;光镜下见肿瘤细胞存在上皮样细胞分化,呈结节状排列,胞浆丰富,嗜酸性,异型性不明显(图1D);免疫组织化学:CK(+),CK8-18(+),Des(+).病理诊断:(右侧侧脑室三角区)软组织肌上皮瘤.

病例 女,38岁,因"头晕伴恶心呕吐1月余"入院.神经系统专科查体:正常.四肢肌力正常.生理反射正常,未引出病理反射.体征:正常.MRI平扫:左侧侧脑室后角一囊实性肿块,其内可见小囊变,形态为类圆形,可见浅分叶,大小约12.4 mm×16.3 mm×16.9 mm,左侧侧脑室后角扩张,与左侧枕叶分界不清,周围脑实质轻度水肿.

ObjectiveTo determine the predictive value of median relative cerebral blood volume（rCBVmedian）of each habitat of glioblastoma（GBM）for overall survival（OS）by using multi-parametric MR habitat imaging analysis constructed by dynamic susceptibility contrast-enhanced perfusion weighted imaging（DSC-PWI）and diffusion weighted imaging（DWI）.MethodsA retrospective cohort trial was conducted on 58 patients with pathology-diagnosed GBM in Army Medical Center of PLA from January 2016 to December 2021. All patients underwent routine MRI, DSC-PWI and DWI examination within 1 week before surgery. Deep learning-based nnU-Net model and K-means clustering algorithm were applied to construct traditional habitat（TH）, vascular habitat 1~4（VH1~4）, and their combined habitat 1~6（CH1~6）. Spearman correlation analysis was used to determine the correlation between rCBVmedian value and OS of the GBM patients in different habitats. Kaplan-Merier survival curve was plotted for rCBVmedian-high group and rCBVmedian-low group according to their rCBVmedian value, and the difference was showed by Log-rank test. Cox analysis was performed to predict independent risk factors for OS.ResultsThe correlation between rCBVmedian value and OS in GBM patients was stronger in CH1 and VHI than in other habitats（r=-0.404、-0.398, P=0.002）. In the Whole ET, VH1 and CH1 habitats, the conversion of rCBVmedian into binary variables showed significant differences in OS between the 2 groups（P<0.05）. The rCBVmedian values of VH1 and CH1 habitats were independent risk factors for the prognosis of GBM patients（P<0.05）.ConclusionThe rCBVmedian values, obtained from VH1 representing the high angiogenic-enhancing tumor habitat, and from CH1 representing the area with active tumor cell proliferation, may be significant indicators for predicting the overall postoperative survival of GBM patients.

1Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China; 2Department of Rehabilitation, Beibei Traditional Chinese Medical Hospital, Chongqing, China. Correspondence: Weiguo Zhang, PhD. E-mail: [email protected].

获得性囊性肾病相关肾细胞癌(acquired cystic disease-associated renal cell carcinoma,ACD-RCC)是终末期肾病及获得性囊性肾病患者最常见的肾脏肿瘤类型,2016年作为一种新的肾癌亚型纳入世界卫生组织肾脏肿瘤分类中.虽然该病是一种低度恶性肿瘤,但也可能出现局部复发或远处转移.对于长期透析尤其是并发症少的年轻患者,应定期行影像学监测,早期发现病变,早期干预,改善患者预后,提高其生存质量.目前,国内外文献主要聚焦在其临床病理方面,对该病影像特征、预后及监测方面的研究有限.该文归纳总结了ACD-RCC的流行病学特征、病因、病理特征、影像表现、治疗方法、预后及监测方法,旨在帮助临床医师更全面地认识ACD-RCC,为ACD-RCC的诊疗及监测提供参考.