A broad spectrum of etiologies can lead to aortic wall thickening. This study aimed to evaluate the utility of quantitative parameters derived from dual-layer computed tomography (CT) in differentiating intramural hematoma (IMH), non-calcified plaques, and aortic thrombosis, and to explore their associations with laboratory inflammatory markers. 365 patients were retrospectively enrolled, including atherosclerosis (n = 98), aortic dissection (n = 126), and IMH (n = 141). Laboratory indicators were collected from the electronic medical record system. Regions of interest (ROI) of non-calcified plaques, thrombi, hematomas, and periaortic adipose tissue around lesions were outlined. The lesion enhancement values and degree of enhancement were calculated from the CT values in polyenergetic and virtual non-contrast image. The slope of the energy spectrum curve was determined using the formula: K = (CT40keV - CT100keV) / 60. Normalization was performed for the effective atomic number (Z), iodine density (ID), and iodine non-water density (IW) using the aortic lumen as the standard reference, resulting in normalized Z values, normalized iodine density (NID), and normalized iodine non-water density (NIW). The enhancement values and degrees of enhancement differed among the three lesions (all P < 0.05). Differences in Z value, ID, IW, and K were observed among non-calcified plaques, thrombi, and hematomas (all P < 0.05). The NID of hematoma was the largest, while the NIW of thrombus was the smallest. Normalized Z value of non-calcified plaque was significantly smaller than those of thrombus and hematoma (both P < 0.05), with no difference between thrombus and hematoma (P > 0.05). The Zperiaortic fat pre- and post-normalization were significantly smaller around the plaques than around the thrombi and hematomas (both P < 0.05). Significant correlations were found between aortic wall normalized Zlesion, Zperiaortic fat, and laboratory parameters, including neutrophil

OBJECTIVES:Waiting for postoperative pathologic confirmation of visceral pleural invasion (VPI) may delay treatment decisions. This study aimed to develop a contrast-enhanced CT-based radiomics model for preoperative prediction of VPI in early-stage non-small cell lung cancer (NSCLC). MATERIALS AND METHODS:We retrospectively enrolled 523 surgically resected NSCLC patients (195 with VPI, 328 without VPI) with clinically staged IA based on preoperative imaging between December 2019 and June 2022. Patients were randomly divided into training, validation, and testing sets at a ratio of 5:2:3. For each patient, 13 CT features were recorded, including the types I-V tumor relationships to the pleura. Regions of interest (ROIs) were segmented semi-automatically using deep learning. Least absolute shrinkage and selection operator (LASSO) regression was applied to select key radiomics features. Three models were developed: a CT-feature model, a radiomics model, and a combined model. The performance and clinical utility of these models were evaluated using the area under the curve (AUC) and decision curve analysis. RESULTS:The tumor relationship to the pleura, density, maximum diameter, and spiculation were selected to construct the CT-feature model. A total of 10 optimal features formed the radiomics model. The radiomics model achieved an AUC of 0.812 in the testing set, outperforming the CT-feature model (0.714). Furthermore, the combined model showed a slightly higher AUC (0.825) compared to the radiomics model. CONCLUSIONS:The radiomics model demonstrated satisfactory performance for predicting VPI in early-stage NSCLC, outperforming the CT-feature model. The integration of radiomics and CT features may provide enhanced predictive value. CRITICAL RELEVANCE STATEMENT:This study constructed a contrast-enhanced CT-based radiomics model with promising performance for the preoperative prediction of VPI, which aims to guide treatment planning for early-stage NSCLC. KEY POINTS:VPI affects the tumor-node-metastasis (TNM) staging of tumors and subsequent treatment strategies. The radiomics model outperformed the CT-feature model in predicting VPI. The contrast-enhanced CT-based radiomics model may be valuable for optimizing clinical decision-making.

Background:The convalescent phase of myocarditis in patients with preserved left ventricular ejection fraction remains poorly characterized. Persistent myocardial inflammation may elevate the risk of major adverse cardiovascular events (MACE). Conventional assessment of left ventricular function is limited in sensitivity, whereas myocardial strain analysis provides detection of subclinical myocardial dysfunction. Methods:In this retrospective study, 317 patients with myocarditis underwent cardiac magnetic resonance (CMR). Feature-tracking CMR was used to quantify ventricular and atrial strain parameters. Late gadolinium enhancement (LGE) was assessed for myocardial tissue characterization. Patients were followed clinically, with MACE as the primary endpoint. Results:Among 146 patients included in the final analysis (71 male; mean age 26 ± 16 years), 36 experienced MACE. LGE was present in 54.8% of patients. In LGE positive patients, one, two, and three or more segments were involved in 6.25%, 16.25%, and 77.50% of cases, respectively. In univariable and multivariable Cox regression analyses, left ventricular global radial strain (p = 0.026) and left ventricular diastolic middle circumferential strain rate (p = 0.014) emerged as independent predictors of MACE. Conclusions:Left ventricular global radial strain may reflect persistent myocardial inflammation during convalescence from myocarditis. Myocardial strain parameters provide incremental prognostic value beyond conventional functional measures.

Central nervous system involvement has been implicated in the pathophysiology of Crohn’s disease (CD). This study aimed to develop a predictive model integrating choroid plexus (CP) morphology derived from brain MRI with clinical and psychological factors to forecast treatment outcomes following anti-tumor necrosis factor-alpha (anti-TNF-ɑ) therapy in CD. This prospective study enrolled adult patients with CD who underwent brain MRI prior to initiating anti-TNF-ɑ therapy between 2019 and 2022. All participants received brain MRI scans within two weeks of study inclusion and before treatment commencement. The CP was manually segmented from baseline MRI scans, and mesh volume (MV) and surface area (SA) were calculated. Patients were evaluated for short-term (12week) and long-term (≥ 48 week) clinical remission (STCR and LTCR, respectively). A total of 130 patients were included, of whom 73

BACKGROUND:Mesenchymal neoplasms characterized by ALK fusions mainly include inflammatory myofibroblastic tumors (IMTs) and epithelioid fibrous histiocytomas (EFHs). More recently, ALK-rearranged mesenchymal tumors that are not IMTs or EFHs, characterized by S100 and CD34 coexpression, have been reported in a few small series and isolated case reports. The neoplasms present a broad clinicopathological spectrum and variable biological behavior. CASE PRESENTATION:Here, we report the case of an 11-year-old girl with a giant mesenchymal neoplasm in her left thoracic cavity. Pathological biopsy revealed that the tumor was composed of monomorphic spindle cells arranged in a fascicular growth pattern with extensive necrosis and coexpression of S100 and CD34; subsequently, PLEKHH2::ALK fusion was identified via next-generation sequencing (NGS). The patient underwent tumor resection via thoracoscopy. The specimen from radical resection indicated that the tumor was heterogeneous. Some tumor cells showed moderate to severe atypia with increased mitosis and necrosis, suggesting that the neoplasm had overtly malignant features and may be associated with an aggressive clinical course. The patient developed brain metastasis 3 months after surgery and subsequently responded well to targeted therapy with the ALK inhibitor alectinib. CONCLUSIONS:Our findings indicate that ALK-rearranged mesenchymal neoplasms with fibrosarcoma-like features, particularly those associated with elevated mitotic activity or tumor necrosis, should be classified as high grade in pathology reports. In addition, this case also demonstrated that neoadjuvant therapy may be a better treatment strategy compared to upfront surgery for ALK-rearranged mesenchymal neoplasms with a relatively high tumor burden.

BACKGROUND:The short-term CT behavior of pulmonary ground-glass nodules (GGNs) during immune checkpoint inhibitor (ICI) therapy remains uncertain. We compared longitudinal CT changes in GGNs observed during ICI therapy with those in a matched surveillance cohort of untreated GGNs. METHODS:In this retrospective exploratory study, the ICI cohort was identified from 1,930 patients with malignant tumors and synchronous pulmonary nodules. After eligibility screening, 98 patients with one target GGN per patient were included, and 80 patients entered the patient-level matched analysis. The comparator cohort was derived from individuals with incidentally detected GGNs on health screening CT, and 80 matched controls were included. Baseline and follow-up CT scans were assessed for changes in diameter, volume, CT attenuation, and solid component proportion. Monthly change rates and multivariable analyses were used to evaluate volume change and progression. RESULTS:In the matched cohort, GGNs in the ICI group showed a decrease in diameter, whereas control GGNs showed increases in both diameter and volume. Compared with controls, the ICI group had lower monthly rates of change in diameter (-0.062 vs 0.048 mm/month; FDR < 0.001) and volume (-0.855 vs 2.425 mm3/month; FDR = 0.001). In multivariable analysis, ICI-group assignment remained associated with a lower Δvolume rate (β = -11.28, 95% CI -22.34 to -0.23; p = 0.046) and lower odds of volumetric progression (OR = 0.43, 95% CI 0.19-0.93; p = 0.037). CONCLUSIONS:ICI-treated GGNs showed different short-term quantitative CT trajectories compared with untreated ones, particularly lower monthly growth in diameter and volume. However, these observational findings should be interpreted as associations rather than causal treatment effects.

Objectives Standing contrast esophagography (SCE) is the conventional method for screening anastomotic leakage (AL) after esophagectomy, however, its clinical utility is limited by low sensitivity and potential adverse events. This study introduces an innovative approach utilizing Cradle-bed X-ray esophagography (CBXE) for the detection of AL post-esophagectomy. Materials and methods Between June 2020 and January 2024, a total of 786 esophageal cancer patients underwent surgical resection at our facility. All patients received systematic postoperative imaging evaluation via SCE, CBXE, and CT. Patient demographics, preoperative treatments, surgical details, and outcomes were assessed. The imaging results of the three modalities were compared to diagnose AL. Results Among the 786 patients, 117 (14.9%) exhibited AL (leakage-positive group), while 669 (85.1%) did not (leakage-negative group), with no significant differences in baseline characteristics between the two groups. CBXE showed superior sensitivity at 83.8% compared to 45.2% for SCE and 16.2% for CT examination. Specificity was maintained at high levels for all methods, 96.5% for Cradle-bed X-ray, 97.9% for SCE, and 100.0% for CT. Conclusions CBXE offers a noninvasive diagnostic alternative for AL following esophagectomy in esophageal cancer patients. This method shows potential to replace conventional SCE and CT examination in the detection of AL.

BackgroundImmune checkpoint inhibitors (ICIs) have improved survival in patients with lung cancer, leading to more frequent detection of synchronous ground-glass nodules (GGNs) during follow-up. This study aimed to evaluate short-term longitudinal quantitative CT changes of synchronous GGNs in lung cancer patients receiving ICI therapy.MethodsIn this retrospective matched cohort study, we included 90 patients with lung cancers harboring 110 synchronous GGNs receiving 3–4 cycles of ICIs, and compared them with a matched cohort of incidentally detected pulmonary GGNs without any therapy. Baseline and follow-up chest CT scans were quantitatively analyzed to capture changes of diameter, volume, surface area, mass, mean CT attenuation, standard deviation of CT attenuation, solid component proportion, sphericity, energy and entropy. Volume change proportion (VCP) was assessed to define nodule response, using ± 25% as the threshold. Subgroup analyses were conducted according to nodule density and Lung-RADS category.ResultsVCP showed that nodules in ICI group were more likely to show regression than those in the control group (23.6% vs. 1.8%, p< 0.001). Improvement in Lung-RADS category was also more common in the ICI group than in controls (8.2% vs 1.8%; p = 0.018). Compared with matched controls, nodules in the ICI group showed significantly lower monthly increases in diameter, volume, surface area and mass. Within the ICI group, nodules showed a significant reduction in diameter, while increases in mean CT value, standard deviation, solid component proportion, and entropy. In subgroup analyses, part-solid nodules (PSNs) showed larger volume reduction than pure GGNs, and nodules with Lung-RADS ≥ 4A showed a significant decrease in entropy.ConclusionAmong lung cancer patients receiving ICIs, synchronous GGNs exhibited attenuated longitudinal CT growth patterns, with favorable shifts in VCP and Lung-RADS categories, particularly in PSNs and nodules with Lung-RADS ≥ 4A.

The long-term effects of coronavirus disease 2019 (COVID-19) were increasingly drawing public attention and posed a significant challenge to global healthcare systems. This study developed a deep learning system that integrated CT scans and optional clinical information from the acute phase to predict residual lung lesion (RLL) status in COVID-19 survivors at short-(1 month), medium-(3 months), and long-term (6 months) of follow-ups. A retrospective CT database of 3524 scans from 881 confirmed COVID-19 patients, followed at 1-, 3-, and 6month intervals across five medical centers, was analyzed. Patients were categorized based on the presence (RLL) or absence (NRLL) of residual lung lesions on follow-up CT scans. A cascaded multi-head framework with cross-period fusion pathway was introduced, enabling deeper supervision and ensuring consistency across time-period predictions. The proposed model outperformed other comparative methods across all follow-up periods, achieving average AUC of 0.832. Additionally, integrating embedded image features with clinical characteristics using SVM classifiers enhanced predictive performance even more. These findings provided valuable insights for optimizing follow-up and management strategies for COVID-19 survivors.

Journal Article Accepted manuscript Congenital Partial Pericardial Defect and Concomitant Right Ventricular Herniation Get access Yukun Cao, Yukun Cao Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, ChinaHubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Mengting Huang, Mengting Huang Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, ChinaHubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Xiaoqing Liu, Xiaoqing Liu Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, ChinaHubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China https://orcid.org/0009-0005-6445-0312 Search for other works by this author on: Oxford Academic PubMed Google Scholar Xiaowen Mao, Xiaowen Mao Department of Radiology, Central Hospital of Shaoyang, Shaoyang 422000, China Corresponding Author: Xiaowen Mao (Tel: +86-13973929495 , E-mail: [email protected]); Heshui Shi (Tel: +86-138 7108 9008 , E-mail: [email protected]) Search for other works by this author on: Oxford Academic PubMed Google Scholar Heshui Shi Heshui Shi Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, ChinaHubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China Corresponding Author: Xiaowen Mao (Tel: +86-13973929495 , E-mail: [email protected]); Heshui Shi (Tel: +86-138 7108 9008 , E-mail: [email protected]) https://orcid.org/0000-0001-7644-3711 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal - Cardiovascular Imaging, jeaf003, https://doi.org/10.1093/ehjci/jeaf003 Published: 07 January 2025 Article history Received: 01 January 2025 Accepted: 05 January 2025 Published: 07 January 2025

BackgroundEarly detection of subclinical myocardial dysfunction in asymptomatic patients with type 2 diabetes mellitus (T2DM) is essential before overt changes in left ventricular ejection fraction (LVEF) and myocardial strain occur. The objective of this study is to quantitatively assess hemodynamic forces (HDFs) using a rigorous mathematical model based on conventional cine cardiac magnetic resonance (CMR) images in patients with T2DM, and investigate their correlation with late gadolinium enhancement (LGE) and duration of diabetes.MethodsWe recruited 63 T2DM patients and 50 healthy volunteers to undergo contrast-enhanced CMR examinations. T2DM patients were divided into three groups according to the course of disease: early, middle and later stage (time <5 years, 5 ≤ time <10 years, time ≥10 years, respectively). LV deformation parameters, global circumferential strain (LVGCS), radial strain (LVGRS), longitudinal strain (LVGLS) and HDFs parameters such as longitudinal (apical-basal/A-B), transversal (lateral-septal/L-S) HDF strength (RMS) were measured and compared among the three groups.ResultsCompared with healthy volunteers, no significant differences in LV function and strains were observed (P > 0.05), while HDF Strength (RMS) L-S (%) were significantly higher in T2DM patients (p < 0.001). LVGLS was significantly decreased in late T2DM patients (p < 0.05), but HDF Strength (RMS) L-S (%) was significantly increased compared with early T2DM patients. Both HDF Strength (RMS) L-S (%) and HDF Strength (RMS) A-B (%) value were independently related to the extent of LGE (β = 0.435, p = 0.001; β = −0.329, p = 0.006, respectively). In addition, HDF Strength (RMS) L-S (%) was also independently correlated with insulin treatment(β = 0.291, p = 0.013).ConclusionsHDF analysis can provide valuable insights into subclinical myocardial dysfunction prior to changes in ejection fraction and myocardial strain, suggesting that HDF analysis may be a potential early marker of subclinical myocardial dysfunction. LVGLS damage is gradually obvious with the prolongation of diabetes duration in T2DM patients. HDFs parameters are associated with the extent of LGE, and the transversal component of HDF increased with the duration of diabetes.

Background:Type 2 diabetes mellitus (T2DM) increases the risk of poor long-term outcomes in patients with non-ischemic dilated cardiomyopathy (DCM). However, the prognostic significance of T2DM on late gadolinium enhancement (LGE) patterns and bi-ventricular myocardial strain in non-ischemic DCM remains unclear. Therefore, we aimed to investigate and compare the clinical characteristics, cardiovascular magnetic resonance (CMR) features and outcomes in non-ischemic DCM patients with and without T2DM. Methods:A total of 423 non-ischemic DCM patients (121 with T2DM and 302 without) who underwent CMR were retrospectively analyzed. Comprehensive clinical evaluations and CMR parameters, including global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) of left ventricular (LV) and right ventricular (RV), as well as LGE mass ratios and patterns, were obtained. Major adverse cardiac events (MACE) during follow-up included cardiovascular death, heart transplantation, heart-failure readmission, and LV assist device implantation for advanced heart failure. Cox regression analysis and Kaplan-Meier analysis assessed the associations between variables and outcomes. Results:DCM patients with T2DM had significantly lower LVGLS {-6.2% [interquartile range (IQR), -7.8% to -4.8%] vs. -7.6% (IQR, -12.1% to -5.4%), P<0.001}, LVGRS [13.8% (IQR, 10.7-19.2%) vs. 16.0% (IQR, 11.3-21.5%), P=0.027], and RVGLS [-10.8% (IQR, -13.2% to -9.0%) vs.-14.7% (IQR, -18.3% to -10.2%), P<0.001]. They also exhibited a higher LGE mass ratio [10.4% (IQR, 2.6-19.0%) vs. 4.0% (IQR, 1.0-9.1%), P<0.001] despite similar LV ejection fraction compared to those without T2DM. Patients with T2DM also showed a greater incidence of mimicking ischemic LGE patterns (33.1% vs. 14.6%, P<0.001), particularly subendocardial LGE (27.3% vs. 10.6%, P<0.001), despite similar overall prevalence of LGE. After a median follow-up of 42 months (IQR, 30-54 months), MACE occurred in 117 patients (28%) for the overall population. Kaplan-Meier analysis indicated that T2DM patients had a significantly elevated risk of MACE compared to non-T2DM individuals. In the multivariate Cox analysis of patients with T2DM, N-terminal pro-B-type natriuretic peptide (NT-proBNP) [hazard ratio (HR): 1.812, 95% confidence interval (CI): 1.276-2.543, P=0.001], hemoglobin A1c (HbA1c) (HR: 1.259, 95% CI: 1.031-1.53, P=0.025), LVGLS (HR: 1.339, 95% CI: 1.128-1.591, P=0.001), and ischemic LGE prevalence (HR: 2.46, 95% CI: 1.361-4.458, P=0.003) were identified as independent predictors of the MACE endpoint. Conclusions:T2DM adversely affects biventricular myocardial strain, LGE mass ratio, and ischemic LGE prevalence in non-ischemic DCM patients. Combining NT-proBNP, HbA1c, LVGLS, and ischemic LGE prevalence may serve as effective markers for predicting outcomes in T2DM patients.

Background:The predictive value of body composition and inflammatory parameters in patients with resectable non-small cell lung cancer (NSCLC) undergoing neoadjuvant chemoimmunotherapy remains poorly defined. The study sought to evaluate the association between computed tomography (CT)-based body composition, inflammatory markers, and survival outcomes in NSCLC patients following neoadjuvant chemoimmunotherapy. Methods:This retrospective study included resectable NSCLC patients undergoing neoadjuvant chemoimmunotherapy from June 2019 to March 2023. CT images were collected at three levels (T4, T10, and L1) for quantifying skeletal muscle and adipose tissue. Blood routine results were collected to calculate inflammatory parameters. All measurements were obtained at baseline and preoperatively. Kaplan-Meier survival curves were plotted and compared using the log-rank tests. Cox regression analysis was performed to investigate the predictive value of clinical, inflammatory, and body composition parameters for disease-free survival (DFS). Results:A total of 154 patients were included, with 21 (13.6%) deaths and 27 (17.5%) experienced recurrence or metastasis. Major pathological response (MPR) was observed in 71 (46.1%) patients. Multivariate analysis identified MPR and treatment time as independent clinical predictors of DFS. In body composition analysis, baseline subcutaneous adipose tissue area at L1, subcutaneous adipose tissue density at T10, pectoral muscle density (PMD) at T4, and delta-PMD at T4 demonstrated predictive value for DFS. Baseline inflammatory markers, including neutrophil-to-lymphocyte ratio and systemic immune inflammation index, were also associated with DFS. A comprehensive model integrating clinical, body composition, and inflammatory parameters demonstrated superior prognostic performance with the receiver operating characteristic areas under the curve for DFS at 1-, 2-, and 3-year of 0.832, 0.806 and 0.797, respectively. Conclusions:Baseline body composition and inflammation parameters were valuable in predicting DFS, while preoperative parameters had limited prognostic value. A combined model integrating clinical, body composition, and inflammatory parameters demonstrated enhanced predictive performance for DFS, and may serve as a valuable tool for assessing prognosis in resectable NSCLC patients undergoing neoadjuvant chemoimmunotherapy.

RATIONALE AND OBJECTIVES:Pericoronary adipose tissue (PCAT) is a key cardiovascular risk biomarker, yet its temporal changes after heart transplantation (HT) and comparison with controls remain unclear. This study investigates the temporal changes of PCAT in stable HT recipients and compares it to controls. MATERIALS AND METHODS:In this study, we analyzed 159 stable HT recipients alongside two control groups. Both control groups were matched to a subgroup of HT recipients who did not have coronary artery stenosis. Group 1 consisted of 60 individuals matched for age, sex, and body mass index (BMI), with no history of hypertension, diabetes, hyperlipidemia, or smoking. Group 2 included 56 individuals additionally matched for hypertension, diabetes, hyperlipidemia, and smoking history. PCAT volume and fat attenuation index (FAI) were measured using AI-based software. Temporal changes in PCAT were assessed at multiple time points in HT recipients, and PCAT in the subgroup of HT recipients without coronary stenosis was compared to controls. RESULTS:Stable HT recipients exhibited a progressive decrease in FAI and an increase in PCAT volume over time, particularly in the first five years post-HT. Similar trends were observed in the subgroup of HT recipients without coronary stenosis. Compared to controls, PCAT FAI was significantly higher in the HT subgroup during the first five years post-HT (P < 0.001). After five years, differences persisted but diminished, with no statistically significant differences observed in the PCAT of left anterior descending artery (LAD) (P > 0.05). A negative correlation was observed between FAI and PCAT volume post-HT (r = - 0.75 ∼ - 0.53). CONCLUSIONS:PCAT volume and FAI undergo temporal changes in stable HT recipients, especially during the first five years post-HT. Even in HT recipients without coronary stenosis, PCAT FAI differs from controls, indicating distinct changes in this cohort.

Background:Reliable predictors of surgical risk in Crohn's disease (CD) with small bowel stenosis are lacking. Longitudinal CT enterography (CTE) derived body composition parameters may improve risk stratification. Aims:To evaluate whether longitudinal CTE-derived body composition changes predict surgical risk in CD patients with small bowel stenosis. Methods:This retrospective cohort study analyzed 385 CD patients between January 2018 and June 2022 with paired CTE scans. High-risk patients (n = 96) required surgery for complications; low-risk patients (n = 289) achieved medical remission. Skeletal muscle (SM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intermuscular adipose tissue (IMAT) metrics at L3-L5 levels were measured and normalized by vertebral height. Gender-stratified analyzes and Cox regression identified predictors. Results:There were 289 cases in the low-risk group and 96 cases in the high-risk group. Interaction terms (time and gender) were tested, males showed significant reductions in L3-L4 skeletal muscle index (SMI) (p < 0.001), L3-L4 IMAT index (p < 0.001, p = 0.04), and L4-L5 VAT density (p = 0.008, p = 0.005). Independent predictors of surgical risk included SAT density at L5 level in baseline (p = 0.005), SMI at L3 level in follow up (p < 0.001), VAT/total adipose tissue index (VTR) (p = 0.004), delta SMI at L4 level (p < 0.001), age (p < 0.001), platelet count (p = 0.010), erythrocyte sedimentation rate (p < 0.001), and stenosis length (p = 0.001). Conclusion:Dynamic body composition parameters, particularly delta SMI and adipose tissue parameters, serve as valuable imaging biomarkers for predicting surgical necessity in CD patients with small bowel stenosis.

Background:The aging population presents significant challenges to healthcare worldwide. Evidence concerning the safety and efficacy of neoadjuvant immunochemotherapy in patients with non-small-cell lung cancer (NSCLC) aged 70 years or older remains limited. Objectives:To investigate the safety and efficacy of neoadjuvant immunochemotherapy in NSCLC patients stratified by age into three groups, and to identify factors associated with overall survival (OS) and disease-free survival (DFS). Design:We performed a retrospective cohort study including 171 NSCLC patients with NSCLC who underwent neoadjuvant immunochemotherapy followed by surgical resection. The patients were categorized by age into three groups: ⩾70 years, 60-69 years, and <60 years. Methods:The safety and efficacy of neoadjuvant immunochemotherapy were comprehensively evaluated. Safety was assessed based on the incidence of treatment-related adverse events (AEs) and complications. Efficacy was determined through analyses of tumor response and survival outcomes. OS and DFS were analyzed using the Kaplan-Meier method, and independent prognostic factors were identified through the Cox proportional hazards model. Results:The study cohort comprised 24 patients aged ⩾70 years, 73 patients aged 60-69 years, and 74 patients under 60 years. OS and DFS did not differ significantly among the three age groups following neoadjuvant immunochemotherapy. Multivariate analysis identified major pathological response (MPR) as a significant independent predictor of OS (hazard ratio (HR): 0.232, 95% confidence interval (CI): 0.079-0.678, p = 0.008). For DFS, both MPR (HR: 0.342, 95% CI: 0.184-0.638, p = 0.001) and the occurrence of postoperative complications (HR: 2.115, 95% CI: 1.208-3.705, p = 0.009) were independent predictors. Overall, patients across all age groups exhibited acceptable tolerance to neoadjuvant immunochemotherapy. Conclusion:Neoadjuvant immunochemotherapy demonstrated consistent safety and efficacy across all age groups in this cohort of NSCLC patients. Achieving MPR was associated with improved OS and DFS, whereas the occurrence of postoperative complications was associated with diminished DFS.

RATIONALE AND OBJECTIVES:Little is known about the long-term impact of diabetes on lung impairment in COVID-19 survivors over a three-year period. This study evaluated the long-term impact of diabetes on persistent radiological pulmonary abnormalities and lung function impairment in COVID-19 survivors over three years. MATERIALS AND METHODS:In this prospective, multicenter, cohort study, pulmonary sequelae were compared between COVID-19 survivors with and without diabetes. Serial chest CT scans, symptom questionnaires and pulmonary function tests were obtained 6 months, 12 months, 2 years and 3 years post-discharge. The independent predictors for lung dysfunction at the 3-year follow-up were analyzed. RESULTS:A total of 278 COVID-19 survivors (63 [IQR 57-69] year-old, female: 103 [37.0%]) were included. At the 3-year follow-up, individuals in the diabetes group had higher incidences of respiratory symptoms, radiological pulmonary abnormalities and pulmonary diffusion dysfunction than those in the control group. Diabetes (OR: 2.18, 95% CI: 1.04-4.59, p = 0.034), allergy (OR: 2.26, 95% CI: 1.09-4.74, p = 0.029), female (OR: 2.70, 95% CI: 1.37-5.29, p = 0.004), severe COVID-19 (OR: 4.10, 95% CI: 1.54-10.93, p = 0.005), and fibrotic-like CT changes (OR: 5.64, 95% CI: 2.28-13.98, p < 0.001) were independent predictors of pulmonary diffusion dysfunction in COVID-19 survivors. CONCLUSION:These results highlight the long-term deleterious effect of diabetes status on radiological pulmonary abnormalities and pulmonary dysfunction in COVID-19 survivors. This study provides important evidence support for long-term monitoring of lung abnormalities in COVID-19 recovery survivors with diabetes.

BackgroundCardiovascular magnetic resonance (cardiac MR) reference ranges in Chinese children are lacking.PurposeTo establish age‐ and sex‐specific reference ranges for cardiac MR parameters in a cohort of healthy Chinese children.Study TypeRetrospective.SubjectsOne hundred ninety‐six healthy children (mean age 9.5 ± 3.6 years, 111 boys).Field Strength/Sequence1.5 T; balanced steady‐state free precession.AssessmentBiventricular volume and ejection fractions (EF), left atrial (LA) volume, right atrial (RA) area, left ventricular (LV) mass and thickness, aortic root (AR), and main pulmonary artery (MPA) dimensions were measured. Parameters were compared between age groups and sex. The relationships between parameters and age, body mass index (BMI) and body surface area (BSA) were investigated.Statistical TestsIndependent‐samples t tests; Pearson's correlation. A P value <0.05 was considered statistically significant.ResultsGenerally, boys exhibited greater absolute measurements of LV volume (end‐diastolic: 94.4 ± 29.5 vs. 81.3 ± 31.0 mL), LA volume (end‐diastolic: 42.6 ± 13.4 vs. 38.0 ± 13.3 mL), RA area (end‐diastolic: 11.6 ± 2.5 vs. 10.8 ± 2.6 cm2), LV thickness (base: 4.4 ± 1.1 vs. 3.8 ± 0.9 mm), AR dimensions (annuls: 16.3 ± 2.7 vs. 15.0 ± 2.8 mm), and MPA dimensions (14.3 ± 2.3 vs. 13.1 ± 2.4 mm) than girls did. However, these differences were not observed when the measurements were normalized to BSA (LV volume: 75.3 ± 11.7 vs. 71.9 ± 12.3 mL/m2, P = 0.052; LA volume: 34.8 ± 8.9 vs. 34.5 ± 7.6 mL/m2, P = 0.783; RA area: 9.7 ± 2.3 vs. 10.2 ± 2.3 cm2/m2, P = 0.107; LV thickness: 3.6 ± 0.7 vs. 3.6 ± 0.9 mm/m2, P = 0.990; AR: 13.6 ± 2.7 vs. 14.3 ± 3.4 mm/m2, P = 0.108; MPA: 11.9 ± 2.3 vs. 12.4 ± 2.4 mm/m2, P = 0.118). Boys had greater RV volume (end‐diastolic: 98.7 ± 33.5 vs. 82.7 ± 33.1 mL) and LV mass (52.6 ± 20.2 vs. 41.4 ± 16.0 g) compared to girls, irrespective of whether the values were indexed or not for BSA. Additionally, there were significant associations between age, BMI, and BSA with biventricular volume, LA volume, RA area, LV mass and thickness, AR and MPA dimensions in both boys and girls.Data ConclusionThis study suggests reference ranges at 1.5 T for Chinese children.Evidence Level3Technical EfficacyStage 2

Background: Anomalous systemic arterial supply to the normal basal segments of the lower lobe (ASALL) is a rare anomaly with a common complication of hemoptysis. To estimate the risk of hemoptysis, this study aims to investigate the value of contrast-enhanced computed tomography (CT) and construct a risk-scoring model based on radiological features and clinical materials of patients with ASALL. Methods: Forty-three eligible individuals (17 women and 26 males), who underwent multiphase contrast-enhanced CT, were included in this study. Hemoptysis was predicted by combined systemic arterial features (CD-A) and combined demographic and radiological features (CD-R). Potential hemoptysis predictors were identified using multivariate regression analysis. A receiver operating characteristic (ROC) curve analysis was used to assess the prediction efficiency. The coefficient of regression model was used to build a combined risk scoring (C-RS) model for hemoptysis. The decision curve analysis (DCA) was performed to evaluate the clinical usefulness of the risk-scoring model. Results: Hemoptysis was present in 17 (39.5%) ASALL patients. The areas under the curve (AUCs) for the predicted performance of CD-A and CD-R were 0.869 and 0.890, respectively. Independent predictors generated a scoring model using the formula C-RS = 3 x age + 3 x sex + 4 x [ground glass opacity (GGO)] + 3 x (CD-A >0.522). The prediction performance of this model was displayed with an AUC of 0.939. This scoring model was demonstrated to be significantly preferable to CD-A (P=0.046) and CD-R (P=0.02) by the Hanley and McNeil test. The DCA showed that the C-RS model was more beneficial when the threshold probability was between 5% and 92%. Conclusions: The scoring model offers a viable method for evaluating the risk of hemoptysis in patients with ASALL by combining radiological and clinical data.