The study aimed to assess the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with transarterial chemoembolization (TACE) for treating hepatocellular carcinoma (HCC) patients who have portal vein tumor thrombus (PVTT) and variceal bleeding secondary to portal hypertension. This retrospective study analysed 39 patients with HCC and PVTT who experienced variceal bleeding and were treated with TIPS and TACE from June 2018 to April 2025. The evaluated outcomes included the technical success, clinical success and overall survival (OS). The technical success rate was 100

BACKGROUND:The mechanisms underlying immune microenvironment remodeling remain unclear for patients with unresectable hepatocellular carcinoma (uHCC) undergoing transarterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). This study aims to identify the key features that change following the combination therapy in patients with uHCC. METHODS:Single-cell transcriptomic profiling was conducted on uHCC samples from the control group, pre-treatment group, and post-treatment group. The Cancer Genome Atlas (TCGA) database was obtained for prognostic analysis. Enriched genes and pathways were identified, and the association and underlying mechanisms of the identified sub-cluster of cells were elucidated in relation to other cellular components. RESULTS:A total of 82,687 cells were obtained from seven patients with uHCC. In the pre-treatment group, the CancerCells_1 was associated with epithelial-mesenchymal transition, indicating a poor prognosis, as evidenced by data from 370 HCC patients in TCGA database. In the post-treatment group, a high proportion of macrophages_FOLR2 was observed corresponding to an elevated interferon response signature score and a diminished pro-angiogenic signature score. The exhaustion of CD8+ effector T cell (CD8Teff) was mitigated by downregulating the notable expression of BHLHE40 and CXCL13. Following treatment, there was an increase in liver sinusoidal endothelial cell (LSEC), while both angiogenesis and TGF-β pathway scores were reduced. Notable changes were observed in the interactions across different cells, particularly concerning the key signatures of LGALS9_HAVCR2, CSF1_CSF1R, and VEGFB_FLT1. CONCLUSION:After combined treatment, uHCC patients were characterized by macrophages_FOLR2, CD8Teff, and LSEC, indicating a remodeling of the immune microenvironment.

Introduction: The prognosis of patients with acute ischemic stroke (AIS) following endovascular therapy (EVT) is largely influenced by the extent of reperfusion. Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is a simple imaging sign which assessed based on fluid-attenuated inversion recovery (FLAIR) images. We aimed to evaluate whether FVH on posttreatment FLAIR can serve as a surrogate imaging marker of cortical hyperperfusion identified by arterial spin labeling (ASL) in patients with AIS after EVT. Methods: We retrospectively enrolled 150 patients with AIS who achieved successful recanalization after EVT. Clinical data and posttreatment magnetic resonance imaging sequences including diffusion-weighted imaging (DWI), FLAIR, and ASL were systematically collected. The 150 patients were categorized into four groups based on DWI and FVH status (A: DWI−, FVH−; B: DWI+, FVH−; C: DWI−, FVH+; D: DWI+, FVH+). Perfusion was evaluated within six predefined Alberta Stroke Program Early CT Score (ASPECTS) regions (M1–M6) per patient, yielding a total of 900 cortical regions analyzed. The perfusion status was evaluated based on visual assessment of absolute cerebral blood flow maps derived from ASL, followed by statistical analysis. Results: Among the 900 cortical territories, 250 (27.78%) were classified as group A, 361 (40.11%) as group B, 55 (6.11%) as group C, and 234 (26.00%) as group D. Inter-rater agreement for evaluating the status of posttreatment FVH was excellent (κ = 0.851). There were significant differences in perfusion characteristics across four groups (p < 0.001). In subgroup analysis, group C exhibited a higher proportion of hyperperfusion compared to group A (21.82% vs. 15.20%), although the difference did not reach significance (p = 0.442), while group D demonstrated a significantly higher percentage of hyperperfusion relative to group B (48.72% vs. 34.34%, p < 0.001). Conclusion: Positive FVH may be associated with post-EVT cortical hyperperfusion in AIS patients following successful revascularization.

BACKGROUND:This real-world study aimed to evaluate and compare the efficacy and safety of two treatment strategies for advanced hepatocellular carcinoma (HCC): transarterial chemoembolisation (TACE) combined with camrelizumab and apatinib versus camrelizumab and apatinib alone. METHODS:In this nationwide, multi-centre retrospective cohort study, data were collected on patients with advanced HCC who received either TACE combined with camrelizumab and apatinib (T-C-A) or camrelizumab and apatinib alone (C-A) between January 2018 and December 2022. To reduce potential bias, stabilised inverse probability of treatment weighting (sIPTW) was applied. The primary outcome was overall survival (OS), while secondary outcomes included progression-free survival (PFS), objective response rate (ORR) based on RECIST v1.1 criteria, and safety. RESULTS:A total of 252 HCC patients were included (T-C-A group, n = 183; C-A group, n = 69). Among them, 210 were males and 42 were females, with a median age of 54 years. After sIPTW, the median OS was significantly longer in the T-C-A group compared to the C-A group (24.2 months [95% CI: 21.4-33.4] vs. 15.2 months [95% CI: 9.8-21.0]; p < 0.001). The T-C-A group also demonstrated a significantly improved median PFS of 10.1 months [95% CI: 8.8-12.2], compared to 4.9 months [95% CI: 4.0-12.5] in the C-A group (p < 0.001). Further, the ORR was higher in the T-C-A group. Grade 3/4 adverse events were reported in 12.0% of patients in the T-C-A group and 14.5% in the C-A group. CONCLUSION:The combination of TACE with camrelizumab and apatinib suggests potential survival advantages for patients with advanced HCC while maintaining an acceptable safety profile.(Study series number CHANCE 2311).

Background: Intermediate-risk pulmonary embolism (PE), defined by right ventricular (RV) dysfunction without hemodynamic instability, carries a significant risk of adverse outcomes. While anticoagulation is standard therapy, the optimal treatment strategy remains controversial. Catheter-directed thrombolysis (CDT) has emerged as a potential alternative to systemic thrombolysis, but its short-term efficacy and safety remain incompletely defined. This study aimed to compare the short-term improvement in RV function and the safety of CDT plus anticoagulation with anticoagulation alone in patients with acute intermediate-risk PE. Methods: Between March 2020 and February 2023, a total of 89 patients diagnosed with acute intermediate-risk PE were retrospectively identified, including 33 patients who received CDT plus anticoagulation (CDT group) and 56 patients who received anticoagulation alone. The primary outcome was the difference in the RV/left ventricular (LV) ratio at 1 week vs. baseline. Safety outcomes included major bleeding and clinically relevant non-major bleeding (CRNMB). Results: The rate of improvement in the RV/LV ratio was significantly greater in the CDT group than in the anticoagulation group (34.0% vs. 19.4%, P<0.001). In addition, a higher rate of improvements in the Qanadli score (65.0% vs. 52.5%, P=0.03) was also obtained in the CDT group. Multivariate analyses revealed that CDT treatment was an independent favorable prognostic factor for the higher rate of improvement in the RV/LV ratio (P=0.02). One patient (3.0%) in the CDT group experienced a major bleeding event during hospitalization, while no major bleeding events occurred in the anticoagulation group during hospitalization (P=0.79). There was no difference in CRNMB events between the CDT group and the anticoagulation group during hospitalization (18.2% vs. 16.1%, P>0.99) or the 3-month follow-up period (6.1% vs. 3.6%, P=0.99). Conclusions: Compared to anticoagulation alone, CDT seemed to obtain a rapid short-term improvement in RV function with no statistically significant increase in bleeding observed in this cohort, although larger studies are required to verify safety.

BackgroundThe optimal endovascular treatment strategy for basilar artery trunk aneurysms (BATAs) remains a subject of ongoing debate.PurposeTo report the experience of management strategies for different types of BATA, with a focus on safety, efficacy, and mid-term outcomes.Material and MethodsA total of 33 consecutive BATAs (19 dissecting, 9 lateral saccular, 5 fusiform) were retrospectively analyzed. The treatment protocol consisted of overlapping stent-assisted coiling (SAC) for dissecting and ruptured cases, single SAC for lateral saccular aneurysms, and flow diverters (FDs) for most fusiform aneurysms; giant fusiform BATAs were treated with dual Leo-plus stents. The primary outcome measure was the 3-month clinical outcome.ResultsSAC was performed in 30 patients (8 single SAC; 22 overlapping SAC), and FD was used in 3 patients. Immediate occlusion was Raymond class 1 in 14/30 (46.7%), class 2 in 11/30 (36.7%), and class 3 in 5/30 (16.7%) among SAC-treated aneurysms; all FD-treated aneurysms (3/33) were OKM-B immediately. One patient died due to intraprocedural re-rupture of a dissecting aneurysm. Periprocedural ischemic complications occurred in 1 (3.0%) patient. A periprocedural hemorrhagic event occurred in 1/4 ruptured cases (overlapping SAC). One delayed ischemic stroke followed FD (mRS at 3 months = 4). At the 3-month follow-up, 30 patients (90.9%, 95% CI=75.1-97.3) achieved favorable outcomes. DSA follow-up (n = 27) demonstrated complete occlusion in 21 aneurysms (77.8%, 95% CI=59.2-89.4).ConclusionEndovascular treatment of BATAs is technically feasible and encouraging, characterized by high occlusion rates and acceptable morbidity rates. The use of overlapping SAC and judicious FD application may optimize treatment outcomes, especially for complex subtypes.

BACKGROUND: Noninvasive detection of neurovascular in-stent restenosis (ISR) remains challenging because of blooming artifacts and limited spatial resolution on conventional computed tomography angiography (CTA). Ultra-high-resolution (UHR) photon-counting detector CTA (PCD-CTA) may offer an improved approach for accurate ISR detection, potentially overcoming these challenges. METHODS: In this prospective study, consecutive patients who had undergone neurovascular stent implantation were enrolled at The First Affiliated Hospital of Nanjing Medical University between July and November 2025. All participants underwent UHR PCD-CTA. Simulated energy-integrating detector CTA data sets were reconstructed from the same raw data to approximate conventional CTA for comparison. Two blinded radiologists independently assessed subjective image quality, diagnostic confidence for ISR, and visualization of in-stent intimal hyperplasia and low-attenuation plaque in stents without restenosis. Diagnostic performance for ISR detection was evaluated on a stent-based level, using digital subtraction angiography as the reference standard when available. RESULTS: Forty-three participants (mean age, 63.1 years ± 9.5; 8 women) with 51 stents were included. ISR was present in 14 stents and absent in 37; digital subtraction angiography was available for 26 stents, including all stents with ISR. Compared with simulated energy-integrating detector CTA, UHR PCD-CTA demonstrated significantly higher subjective image quality ( P =0.004) and diagnostic confidence for ISR ( P <0.001), and markedly reduced blooming artifacts ( P <0.001). UHR PCD-CTA achieved excellent diagnostic performance for ISR detection, with a sensitivity of 100.0%, specificity of 97.3%, and overall accuracy of 98.0%. In stents without restenosis, visualization of in-stent intimal hyperplasia and low-attenuation plaque was significantly improved with UHR PCD-CTA compared with simulated energy-integrating detector CTA ( P <0.001). CONCLUSIONS: UHR PCD-CTA demonstrates high diagnostic performance for noninvasive detection of neurovascular ISR and may serve as a promising tool for poststent surveillance.

Among symptomatic nonacute intracranial atherosclerotic occlusion (ICAO), endovascular recanalization has shown potential efficacy and acceptable periprocedural complications. However, the long-term benefits of stent implantation could be diminished by in-stent restenosis (ISR). This study aimed to investigate the association between radiological features on preoperative high-resolution MRI (HR-MRI) and ISR. We retrospectively reviewed 103 patients with symptomatic nonacute ICAO who underwent stenting between January 2018 to December 2024 at our institution. Patients’ clinical-hematological parameters, HR-MRI features and procedural results were collected. Potential factors related to ISR were analyzed by univariate and multivariate analyses. At a median 4.1-month imaging follow-up, this study observed a ISR rate of 29.1

Background:Despite the rising global incidence of young-onset ischemic stroke-especially in East Asia, where large-vessel atherosclerosis predominates-intracranial atherosclerotic plaque distribution and imaging features in these patients remain poorly characterized. This study aimed to investigate these features in young patients with stroke or transient ischemic attack (TIA) and compare them with those in middle-aged and older patients (MOP). Methods:Patients aged 18-45 years (young group) and >45 years (MOP group) with recent large-vessel atherosclerotic stroke or TIA who underwent high-resolution vessel wall imaging (HRVWI) were retrospectively enrolled. Atherosclerotic risk factors, plaque-affected vessel segments, and plaque distribution were assessed. Culprit plaques were analyzed for degree of stenosis, plaque area, plaque burden, remodeling ratio, eccentricity index, plaque volume, length, intraplaque hemorrhage, enhancement ratio, and circular involvement. Quantitative measurements were obtained using semi-automated software or manual assessment when appropriate. Group comparisons were performed using χ2 tests for categorical variables and independent two-sample t‑tests or nonparametric tests for continuous variables, according to data distribution. Multivariable logistic regression analysis was performed to identify features independently associated with age. Results:A total of 244 patients were included (145 young and 99 MOP). Younger patients had significantly fewer plaque-involved vessel segments, reflected by a lower affected segment ratio (0.39±0.20 vs. 0.63±0.19, P<0.001). Age-related differences in plaque distribution were most prominent in the bilateral intracranial carotid arteries (IICA), bilateral terminal ICA (ICA-T), and the basilar artery (BA). Plaque incidence at these sites was significantly higher in the MOP group than in the young group (right IICA: 91.9% vs. 57.2%; left IICA: 93.9% vs. 57.2%; right ICA-T: 89.9% vs. 55.7%; left ICA-T: 89.0% vs. 57.8%; BA: 83.8% vs. 39.3%; all P<0.001). Within the young cohort, patients aged 36-45 years also showed significantly higher plaque incidence than those aged 18-35 years across the same five vascular sites (right IICA: 69.0% vs. 31.1%, P<0.001; left IICA: 63.0% vs. 44.4%, P=0.037; right ICA-T: 63.5% vs. 38.6%, P=0.006; left ICA-T: 63.3% vs. 45.5%, P=0.047; and BA (47.0% vs. 22.2%, P=0.005). Regarding culprit plaque morphology, the younger group exhibited lower stenosis (72.77% vs. 88.73%, P=0.031), smaller plaque area (6.66 vs. 7.37 mm2, P<0.001), lower plaque burden (0.85 vs. 0.95, P<0.001), a higher eccentricity index (0.53 vs. 0.42, P<0.001), and a significantly lower prevalence of intraplaque hemorrhage (20.00% vs. 32.32%, P=0.045). Multivariate regression analysis further identified plaque burden as an independent morphological feature associated with age (odds ratio 0.092, 95% confidence interval: 0.009-0.950, P=0.045). Conclusions:Intracranial atherosclerosis demonstrates heterogeneous development across vascular territories. Compared with MOP, young patients with stroke exhibit a distinct plaque phenotype. Plaque burden may serve as an independent imaging marker associated with age.

Objective To develop and externally validate a time-dependent model for predicting overt hepatic encephalopathy (OHE) after transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with cirrhosis. Methods This retrospective two-centre study included patients with cirrhosis who underwent TIPS between November 2018 and October 2024. Patients were assigned to training and external validation cohorts according to treatment centre. The primary outcome was post-TIPS OHE. Associations of demographic, laboratory, imaging and procedural variables with OHE were evaluated using Cox regression. The model was developed and validated internally and externally. Performance was assessed using the concordance index (C-index), time-dependent receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). Results A total of 561 patients were included, comprising 437 (77.9%) in the training and 124 (22.1%) in the external validation cohort. During a median follow-up of 25.0 months (interquartile range, 11.0-43.5), 108 patients (19.3%) developed OHE. Age, history of OHE, Child-Pugh class, albumin and cholinesterase levels were retained in the final model. The model showed good discrimination, with a C-index of 0.762 (95% CI 0.710-0.814) in the training cohort and 0.801 (95% CI 0.722-0.880) in the external validation cohort. Time-dependent area under the ROC curve (AUC) values were favourable across follow-up intervals. Calibration performance was acceptable, and DCA suggested potential clinical benefit. Conclusions This time-dependent model may assist in post-TIPS OHE risk stratification and follow-up planning after haemodynamically successful shunt creation. However, prospective validation and comparison with established prediction tools are warranted before routine clinical adoption.

Background:This study aimed to assess the clinical outcomes of transarterial chemoembolization (TACE) with immune checkpoint inhibitors (ICIs) plus vascular endothelial growth factor (VEGF) inhibitors or tyrosine kinase inhibitors (TKIs) (combination therapy) versus TACE monotherapy as a first-line treatment for intermediate-stage hepatocellular carcinoma (HCC). Methods:This nationwide, retrospective cohort study employed a target trial emulation framework with a cloning-censoring-weighting approach. Patients with intermediate-stage HCC receiving either combination therapy or TACE monotherapy between January 2018 and December 2022 in China were included. Co-primary outcomes were overall survival (OS) and progression-free survival (PFS) per modified Response Evaluation Criteria in Solid Tumors (mRECIST), assessed using restricted mean survival time (RMST). Hazard ratio (HR) was additionally estimated using Cox proportional hazards models for reference. For both RMST and HR, 95% CIs were obtained by bootstrapping. Secondary outcomes included PFS per RECIST 1.1, objective response rate (ORR) per both mRECIST and RECIST 1.1, and safety. This study is registered at ClinicalTrials.gov (NCT05332496). Findings:A total of 941 patients were included in the study, with 308 (32.7%) receiving combination therapy, and 633 (67.3%) receiving TACE monotherapy. Median OS was 32.9 with combination therapy versus 23.0 months with TACE monotherapy, with an RMST difference of 9.2 months (95% CI 4.5-14.3, bootstrapped p < 0.001; HR 0.57 [95% CI 0.43-0.70]). Median PFS was 18.0 and 12.9 months in the respective groups, with an RMST difference of 6.7 months (95% CI 3.3-10.7, bootstrapped p = 0.001; HR 0.70 [95% CI 0.58-0.82]). Combination therapy also yielded a higher ORR per mRECIST (60.5% versus 44.3%; p < 0.001). Similar results for PFS and ORR were observed when assessed using RECIST 1.1. Grade ≥3 adverse events occurred in 64 (20.8%) and 43 (6.8%) patients, respectively. Interpretation:Combining TACE with ICIs and VEGF inhibitors or TKIs was associated with improved OS and PFS than TACE monotherapy, with an acceptable safety profile, supporting its potential as a first-line treatment strategy for intermediate-stage HCC. Funding:National Natural Science Foundation of China (82130060, 82502493), China Postdoctoral Science Foundation (2025M772071), Jiangsu Provincial Basic Research ProgramNatural Science Foundation-Frontier Leading Technology Basic Research Project (BK20232008), Jiangsu Provincial Medical Innovation Center (CXZX202219), Postdoctoral Fellowship Program of CPSF (GZC20251385), and Natural Science Foundation of Jiangsu Province (BK20251687).

BACKGROUND AND PURPOSE:For symptomatic nonacute long-segment internal carotid artery occlusion (LICAO) lesions, the endovascular treatment strategies are always complex and challenging. This study aims to analyze the effect of 2 recanalization techniques (angioplasty without distal embolic protection [AWDEP] or direct Aspiration Recanalization Combined with AngioplaSty under Intracranial Stent retriever protection [ARSIS]) on the technical success rate and clinical prognosis. MATERIALS AND METHODS:Fifty-three patients with LICAO who underwent endovascular treatment at our center were retrospectively analyzed, including 41 (77.4%) patients in the AWDEP group and 12 (22.6%) in the ARSIS group. Patients' clinical information, radiologic characteristics, recanalization rates, perioperative complications, and follow-up outcomes were compared between the 2 groups. RESULTS:Among these patients, the median interval from radiologic occlusion to recanalization was 35 days. Successful recanalization was achieved in a smaller proportion of the AWDEP group than in the ARSIS group (82.9% versus 100%, P = .29). The total number and length of implanted stents in the AWDEP group were significantly more in the ARSIS group (P = .009 and P = .007, respectively). The incidence of periprocedural complications and in-stent restenosis among patients undergoing the AWDEP technique was higher with the ARSIS technique (19.5% versus 0%, P = .23 and 26.5% versus 8.3%, P = .37, respectively). At 90-day follow-up, there was a greater trend toward better functional outcomes in the ARSIS group than in the AWDEP group (median mRS score: 0 [range, 0-1] versus 1 [range, 0-2], P = .07). CONCLUSIONS:Compared with the AWDEP technique, the ARSIS technique may be more beneficial for endovascular treatment of symptomatic nonacute LICAO, particularly in reducing the implanted stent burden. Prospective and multicenter studies are needed to further confirm the safety, efficacy, and durability of the ARSIS technique.

PURPOSE:To compare the effectiveness of pre-emptive oxycodone versus sufentanil for acute and delayed pain control after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS:In this prospective, double-blind trial, 40 patients scheduled for TACE were randomized to receive intravenous oxycodone (0.1 mg/kg) or sufentanil (0.1 μg/kg) 15 minutes before TACE. Pain intensity was assessed using a visual analog scale (VAS) during acute (0-24 hours) and delayed (Days 2-7) phases. Inflammatory biomarkers (white blood cell count, neutrophil percentage, C-reactive protein, and interleukin [IL]-6) were measured at baseline and 24 hours after TACE. The primary outcome was the highest acute-phase VAS scores; secondary outcomes included delayed-phase pain, changes in inflammatory biomarkers, and adverse events. RESULTS:Oxycodone demonstrated superior analgesia, with lower intraprocedural VAS scores (median, 0 [interquartile range {IQR}, 0-1.0] vs 3.5 [IQR, 1.3-4.8]; P < .001) and reduced incidence of moderate-to-severe pain (5% vs 50%; P = .003). This benefit persisted at 1-6 hours after TACE (median, 0 [IQR, 0-1.0] vs 2 [IQR, 0-3.0]; P = .042). During the delayed phase, oxycodone maintained lower pain scores (median, 0 [IQR, 0-0] vs 0 [IQR, 0-3.8]; P = .042) and fewer episodes of moderate pain (0% vs 25%; P = .047). IL-6 elevation was greater in patients developing delayed pain (671.16% vs 135.97% increase; P = .030). Adverse event rates were comparable. CONCLUSIONS:Pre-emptive oxycodone provided more effective acute and delayed pain control after TACE compared with sufentanil, with comparable safety. The association between IL-6 elevation and delayed pain suggests an inflammatory pain component, supporting further investigation of combined opioid and anti-inflammatory strategies.

OBJECTIVES:Pre-endovascular identification of intracranial atherosclerotic stenosis - related large vessel occlusion (ICAS-LVO) is essential for optimizing recanalization strategy. This study aimed to develop a preoperative scale to predict ICAS-LVO in patients with acute vertebrobasilar artery occlusion (VBAO). METHODS:We retrospectively reviewed patients with acute VBAO who underwent endovascular thrombectomy at a single center between January 2015 and December 2024. The included patients were chronologically divided into a derivation cohort and a temporal internal validation cohort. ICAS-LVO was defined according to intra- or postprocedural angiographic findings. Candidate predictors were selected using a random forest approach, followed by regression-based model development. A prediction scale derived from the model was evaluated in both cohorts. RESULTS:A total of 196 patients were included for analysis, including 158 in the derivation cohort and 38 in the temporal internal validation cohort. Following random forest analysis, atrial fibrillation (AF), thrombus enhancement sign (TES), and occlusion site emerged as key predictors of ICAS-LVO. These variables were integrated into a multivariate logistic regression model. Subsequently, the ATO score - a weighted composite of these predictors - demonstrated robust discriminative performance, with an AUC of 0.939 (95% CI: 0.896-0.982, p < 0.001) in the derivation cohort and 0.929 (95% CI: 0.843-1.000, p < 0.001) in the temporal internal validation cohort. DISCUSSION:The ATO scale, which incorporates AF, TES, and the location of the occlusion site, may serve as a readily applicable instrument for predicting ICAS-LVO in VBAO patients before endovascular treatment.

Traditional imaging methods, like CT angiography (CTA), are unable to visualize the occluded vessels in acute ischemic stroke (AIS). We aimed to develop a deep learning based segmentation model for reconstructing the complete cerebral vasculature from non-contrast CT (NCCT) in LVO-AIS patients for endovascular thrombectomy planning. A nnU-Net model was trained and validated on retrospectively collected paired NCCT-CTA head images without large vessel occlusions (LVOs) from December 2018 to July 2025 (dataset 1: n = 280, for model training, internal validation and internal test; dataset 2: n = 40, for external validation). Model performance was evaluated using quantitative segmentation metrics, including the Dice Similarity Coefficient (DSC). Additionally, the model was evaluated on NCCT images of LVO-AIS patients from two hospitals, and the segmentation results were verified against post-recanalization DSA by two radiologists (dataset 3: n = 290). The nnU-Net model demonstrated robust segmentation performance, achieving DSC of 0.80 ± 0.04, 0.79 ± 0.04, and 0.79 ± 0.04 on the internal validation, internal test, and external validation sets, respectively. In the clinical evaluation involving LVO-AIS patients, high-quality segmentations were assigned by Rater 1 in 98.9

Background Acute vertebrobasilar artery occlusion is associated with mortality rates up to 80%. While endovascular thrombectomy has proven effective, patient selection remains challenging due to limited validated prediction models. This study aimed to develop and externally validate a nomogram for predicting 90-day excellent functional outcome (modified Rankin Scale score, 0-1) in patients with acute vertebrobasilar artery occlusion undergoing endovascular thrombectomy. Methods A total of 819 patients with vertebrobasilar artery occlusion undergoing endovascular thrombectomy were enrolled in this study. Of these, 242 patients from 4 stroke centers were allocated to the training cohort, while 577 patients from the PERSIST (Posterior Circulation Ischemic Stroke) registry comprised the validation cohort. Multivariate logistic regression identified independent predictors for nomogram development. Model performance was assessed using the concordance index, calibration curves, and decision curve analysis. Results The overall excellent outcome rate was 21.2%, with 85.1% achieving successful recanalization. Five independent predictors were identified: age <65 years (odds ratio [OR], 0.96; P=0.006), baseline National Institutes of Health Stroke Scale score <18 (OR, 0.97; P=0.012), thrombectomy passes <3 (OR, 0.59; P=0.033), Basilar Artery on Computed Tomography Angiography score >6 (OR, 1.34; P=0.028), and successful recanalization (OR, 4.49; P=0.019). The nomogram demonstrated excellent discriminative performance, with a concordance index of 0.82 in the training cohort and 0.92 in external validation. Good calibration was confirmed (Hosmer-Lemeshow test, P=0.514). Conclusions We developed and externally validated a practical nomogram incorporating 5 clinical variables for predicting excellent outcomes in patients with acute vertebrobasilar artery occlusion undergoing endovascular thrombectomy. The model demonstrates robust performance and clinical utility, providing valuable support for evidence-based decision making in posterior circulation stroke management.

Objective: To evaluate the benefit of nomogram-based model for predicting response and survival in patients with early recurrent hepatocellular carcinoma after hepatic resection by CK19 positive expression treated with transarterial chemoembolization (TACE). Materials and Methods: We retrospectively analyzed 82 patients with early recurrent HCC expressing CK19 positivity after hepatectomy who underwent TACE between January 2014 and December 2023. OS and PFS were compared using the Kaplan-Meier method and Log rank test. Based on the COX regression results, independent predictors were identified from them. These factors were used to construct a nomogram model. The discriminatory, predictive efficacy of this model was assessed using receiver operating characteristic curves (ROC), calibration curves, and internal validation. Results: CK19 expression grade and distant metastasis were independent prognostic risk factors, and the number of TACE sessions and whether it was combined with systemic therapy were prognostic protective factors, and survival after resection was strongly correlated with the CK19 grade. Compared with TACE alone, TACE combined with targeted and immunotherapy provided more survival benefit for patients with CK19-positive postoperative recurrence. The nomogram model has promising predictive efficacy. Conclusion: We constructed a validated tool for the prognosis of patients with postoperative recurrence of hepatocellular carcinoma, which helps to identify the risk level of hepatocellular carcinoma recurrence and optimize the treatment as early as possible in the clinic, and brings survival benefit to patients.

BACKGROUND:Systemic therapy with or without radiotherapy is useful for hepatocellular carcinoma (HCC) with hepatic vein and/or inferior vena cava tumor thrombus (HVTT/IVCTT). However, the efficacy of transarterial chemoembolization (TACE) in such population is still unconfirmed. This study aims to evaluate whether TACE should be applied with systemic therapy for HCC with HVTT/IVCTT, in a first-line therapy setting. METHODS:This multi-center retrospective cohort study included HCC patients with HVTT/IVCTT treated between June 2018 and March 2024. Patients received either systemic therapy plus TACE (Group A) or systemic therapy alone (Group B). Propensity score matching (PSM) was utilized to balance the baseline characteristics. Multiple sensitivity analysis including inverse probability of treatment weighting (IPTW) were performed. The primary outcomes were overall survival (OS) and progression-free survival (PFS). Secondary outcomes included objective response rate (ORR) and safety. RESULTS:A total of 972 HCC patients with HVTT/IVCTT (696 in Group A and 276 in Group B) were included. The median follow-up time was 32.1 (95% CI: 30.4-33.8) months. After PSM, Group A demonstrated a significantly longer median OS compared to Group B (20.9 vs. 14.3 months; HR = 0.65, 95% CI: 0.54-0.77, P<0.001). Group A achieved a significantly longer median PFS compared to Group B (10.7 vs. 7.3 months; HR = 0.67, 95% CI: 0.57-0.79, P<0.001, per RECIST v1.1 criteria). Additionally, Group A exhibited a significantly higher objective response rate per RECIST v1.1 (45.3% vs. 28.8%, P<0.001) and mRECIST criteria (53.6% vs. 36.3%, P<0.001). Grade ≥3 treatment-related adverse events occurred in 238 patients in Group A (34.2%) and 87 patients in Group B (31.5%). CONCLUSIONS:TACE in combination with systemic therapy shows improved survival benefit and manageable safety profiles compared to systemic therapy alone for HCC patients with HVTT/IVCTT. These findings provide preliminary evidence supporting the integration of TACE into first-line systemic therapy for this patient population. However, given the retrospective nature of this study, validation through prospective randomized controlled trials is warranted.

BackgroundLacunar infarction accounts for almost 25% of ischemic strokes.PurposeTo evaluate the effectiveness of computed tomography perfusion (CTP) in identifying acute lacunar infarction (ALI) by comparing its performance with non-contrast CT (NCCT) and CT angiography (CTA), and to study the potential influence of various imaging characteristics on detection accuracy.Material and MethodsA total of 309 patients who underwent baseline CT and follow-up diffusion-weighted imaging due to lacunar symptoms were enrolled. The detection performance of NCCT, CTA, CTP, and various CTP-derived parametric maps for identifying ALI was calculated and compared. In addition, the study examined and compared the performance of CTP across different subgroups, categorized based on infarction location, infarction size, and degree of white matter hyperintensity.ResultsALI was identified in 184 patients. CTP demonstrated significantly higher sensitivity (44.6%) in detecting ALI compared to NCCT (8.2%) and CTA (12.0%) (both P < 0.001). Among the four CTP-derived parametric maps, sensitivity ranged from 2.2% (cerebral blood volume [CBV]) to 41.8% (mean transit time [MTT]). In subgroup analyses, CTP showed higher sensitivity for detecting cortical lesions (60.0%) compared to posterior lesions (41.0%) (P = 0.061) and subcortical lesions (39.8%) (P = 0.035). CTP showed slightly higher sensitivity in detecting ALI with a larger infarct size (>10.6 mm) and in cases with mild-to-moderate WMH. However, these differences were not statistically significant (>10.6 mm vs. ≤10.6 mm, 45.2% vs. 44.0%, P = 0.870; mild-to-moderate vs. severe WMH: 45.3% vs. 41.2%, P = 0.660).ConclusionIn this retrospective study, we found that CTP outperformed NCCT and CTA in detecting ALI. CTP demonstrated higher sensitivity for detecting ALI compared to posterior and subcortical lesions.

Hepatocellular carcinoma (HCC) is a highly malignant tumor with elevated incidence and mortality rates globally. Its complex etiology and pronounced heterogeneity present significant challenges in diagnosis and treatment. Recent advancements in artificial intelligence (AI) have demonstrated transformative potential to usher a new wave of precision oncology. Pathomics, an AI-based digital pathology technique, facilitates the extraction of extensive datasets from whole-slide histopathological images, enabling quantitative analyses to improve diagnosis, treatment, and prognostic prediction for HCC. Furthermore, emerging pathological foundation models are revolutionizing traditional paradigms and providing a robust framework for the development of specialized pathomics models tailored to specific clinical tasks in HCC. Despite its promise, pathomics research in HCC remains in its infancy, with clinical implementation hindered by challenges such as data heterogeneity, model interpretability, ethical concerns, regulatory issues, and the absence of standardized industry protocols. Future initiatives should prioritize the conduction of prospective multi-center studies, the integration of multi-modal data, the enhancement of regulatory frameworks, and the establishment of industry-wide standardized guidelines and compliant platform infrastructures to accelerate the clinical adoption of pathomics for personalized HCC treatment.