Thoracic aortic penetration by an esophageal foreign body (EFB) is a rare, fatal emergency (> 80

RATIONALE AND OBJECTIVES:To evaluate the clinical impact of low-dose ultra-high-resolution temporal bone imaging using photon-counting detector CT (PCD-CT) with 100 kVp tin filtration (Sn100 kVp), focusing on radiation dose reduction and image quality compared with conventional energy-integrating detector CT (EID-CT). MATERIALS AND METHODS:Patients with suspected or confirmed temporal bone lesions were prospectively enrolled and underwent PCD-CT scanning. Their prior EID-CT scans were retrospectively retrieved for comparison. PCD-CT was performed at Sn100 kVp, and images were reconstructed at 0.2 mm (PCD-0.2) and 0.6 mm (PCD-0.6) slice thicknesses. The EID-CT scans were acquired at 120 kVp with 0.6 mm reconstruction (EID-0.6). Quantitative parameters including CT attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured. In addition, qualitative assessment of six normal anatomical structures, preference ranking and radiation dose metrics were performed for comparison. RESULTS:A total of 46 patients (24 females; mean age, 40.37 ± 15.89 years) contributed 55 temporal bone CT image datasets. Compared with EID-CT, PCD-CT achieved a 53 % reduction in radiation dose (effective dose: 0.35 ± 0.05 vs. 0.75 ± 0.12 mSv; p < 0.001). PCD-0.6 demonstrated significantly lower image noise (55.51 ± 7.66 vs. 79.70 ± 13.04 HU; p < 0.001) and higher CNR of vestibule, muscle and bone than in EID-0.6 (all p < 0.001). PCD‑0.2 was preferred over PCD‑0.6, and both PCD reconstructions were preferred over EID‑0.6 for visualization of six anatomical structures and overall image quality (all p < 0.05). CONCLUSION:In this comparison of real-world clinical protocols with multiple varying parameters, the low-dose Sn100 kVp PCD-CT protocol reduced dose by 53 % and improved image quality versus EID-CT. Ultra-thin 0.2 mm reconstruction, despite higher noise, leveraged PCD-CT's high spatial resolution to better depict fine temporal bone details.

Background Vertebral artery compression syndrome (VACS) is characterized by recurrent and reversible dizziness, consistently triggered by head rotation or hyperextension. Currently, no simple yet effective screening and diagnostic methods are available. This study aimed to explore the application of transcranial Doppler ultrasound with dual transducers (TCD-D) and a head stent in the screening and diagnosis of VACS. Methods From April 2018 to September 2024, three patients with dizziness upon head rotation, diagnosed as VACS, were enrolled. TCD-D was used to simultaneously monitor the real-time blood flow of the bilateral posterior cerebral arteries (PCAs) during the patients' head rotation. Positional nystagmus was recorded by video goggles at the bedside. Additional examinations were performed to assess the otologic and cervical conditions. Seven control subjects were also included. Results Among the three patients, TCD-D results demonstrated a marked reduction in blood flow of bilateral PCAs upon head rotation, which provoked dizziness. A reactive hyperemic response was observed when the patients returned to the neutral position, supporting the diagnosis of VACS. In contrast, controls demonstrated only mild blood flow changes during non-specific head movements, without dizziness. Downbeat-dominant nystagmus, accompanied by complex horizontal components, was observed in all patients with VACS during head movements. Conclusions TCD-D is an effective, convenient, safe, and cost-effective tool for screening and diagnosing VACS. More importantly, it can be operated in the consultation room and simultaneous recording of positional nystagmus can improve diagnostic accuracy.

BACKGROUND:Long non-coding RNAs (lncRNAs) regulate macrophage inflammation and atherosclerotic plaque stability, but mechanisms need comprehensive investigations. METHODS:Whole-transcriptome sequencing was used to identify a novel human-specific lncRNA, lncAPAT (atherosclerotic plaque instability-associated transcript), in the peripheral blood of patients with coronary artery disease (CAD; n = 5) with mixed plaques on coronary computed tomography angiography (CCTA). LncAPAT was quantified using quantitative real-time polymerase chain reaction in the discovery cohort and independently validated in patients with coronary mixed plaques by CCTA (n = 22) and in patients with acute ST-segment elevation myocardial infarction (STEMI; n = 22). Myeloid cell-specific lncAPAT knock-in mice were generated and injected with recombinant adeno-associated virus of murine proprotein convertase subtilisin/kexin type 9 to induce atherosclerosis and explore the effects of lncAPAT on inflammation and plaque instability. Macrophages were cultured to evaluate lncAPAT function in vitro. Chromatin isolation by RNA purification and sequencing and RNA immunoprecipitation assays were used to identify potential targets of lncAPAT. RESULTS:LncAPAT expression was highly expressed in the peripheral blood of CAD and STEMI patients compared with the control individuals. Mice with myeloid cell-specific lncAPAT knock-in showed an increased plaque burden (2.7-fold), elevated macrophage counts (2.4-fold), and higher matrix metalloproteinase (MMP) expression (3.3-fold for MMP9, 2.0-fold for MMP2) in thoracic aortic plaques. In vitro, lncAPAT significantly promoted the inflammatory responses, adhesive capacity and cholesterol accumulation of macrophages, and decreased the cholesterol efflux ratio. LncAPAT interacted with the promoter of the ribosomal protein L22 gene (RPL22) and inhibited RPL22 transcription. RPL22 inhibition significantly increased the expression of inflammatory cytokines. The RPL22 protein directly interacted with monocyte chemoattractant protein-1 (MCP-1) mRNA and decreased MCP-1 expression. Furthermore, RPL22 expression in the peripheral blood was lower in CAD and STEMI patients than in control individuals. CONCLUSIONS:LncAPAT promoted the macrophage inflammatory response by inhibiting RPL22 transcriptional activity, contributing to plaque instability. KEY POINTS:A novel human-specific long non-coding RNA (lncRNA), named as lncAPAT, is highly expressed in the peripheral blood of patients with coronary mixed plaques. LncAPAT increases thoracic aortic plaque instability and promotes macrophage inflammatory responses. LncAPAT directly interacted with the promoter region of RPL22 to inhibit RPL22 transcriptional activity and increase the expression of MCP-1, thereby contributing to plaque instability.

OBJECTIVE:To evaluate the clinical manifestation, surgical strategies, and long-term outcomes of lateral skull base tumors extending to the craniovertebral junction (CVJ), with a focus on the infratemporal fossa approach (IFA) and individualized treatment options for cervical-occipital stability. METHODS:This retrospective cohort study included 12 patients with lateral skull base tumors extending to the CVJ who underwent surgical treatment between 2018 and 2024. Surgical resection via IFA (Type A, Type B, or Type A + Type B), with OCF performed when indicated by the extent of occipital condyle and C1-C2 resection. RESULTS:Primary presenting symptoms included hearing loss (42%), headache (25%), and neck mass (17%). Imaging demonstrated that the original lateral skull base primary tumors often involved the temporal bone (92%), foramen magnum (92%), and jugular foramen (83%). Eight patients (67%) needed staged resections, while four (33%) patients underwent one-stage surgery. Occipitocervical fusion (OCF) was performed in five patients (42%), and the others received rigid collar or Halo-vest immobilization. Gross-total resection was accomplished in 11 patients (92%); one patient (8%) received palliative treatment. No recurrence was observed in these cases during a median follow-up of 45 months (range 6-78). Persistent posterior cranial nerve deficits occurred in 83% of the patients, and 33% developed transient aspiration pneumonia, both of which resolved with treatment. CONCLUSION:In a multidisciplinary context, the IFA, when combined with selective OCF, allows for complete resection and long-term tumor control of complex lateral skull base-CVJ tumors. This approach achieves both oncologic radicality and biomechanical stability.

To compare the clinical, radiological, and audiological features of otosclerosis across two tertiary centers in Switzerland and China. We included 478 adult patients (540 operated ears) who underwent primary stapes surgery for otosclerosis between 2015 and 2023 at a Swiss hospital (LH) and a Chinese hospital (PH). All patients underwent preoperative high-resolution CT and pure-tone audiometry. A semiquantitative CT scoring system was used to assess involvement at four anatomical subsites. Pre- and postoperative audiometric data were compared, and associations between CT findings and hearing outcomes were evaluated using correlation and regression analyses. Patients from PH were significantly younger, with a less balanced age distribution. Antefenestral and footplate CT scores were significantly higher in the LH group. PH patients showed worse preoperative air conduction (AC) thresholds. Preoperative bone conduction (BC) thresholds correlated modestly with regional and total CT scores. Postoperative BC and AC thresholds were also weakly associated with total and cochlear CT scores. Postoperative AC thresholds and ABG were significantly better in the LH group. Logistic regression identified hospital site and preoperative ABG as significant predictors of achieving ABG ≤ 10 dB HL. This dual-center study reveals distinct clinical profiles of otosclerosis between Chinese and Swiss patients. Although operated at a younger age, Chinese patients had worse hearing but milder CT changes. Both groups improved after surgery, yet complete ABG closure was more frequent in the Swiss group. This study emphasizes the need for population-sensitive treatment strategies and expectations in otosclerosis.

Accurate preoperative assessment of internal carotid artery (ICA) invasion is crucial in managing glomus jugulare tumors. This study evaluated the efficacy of contrast-enhanced 3D BRAin VOlume (BRAVO) imaging compared to enhanced fast spin-echo (FSE) T1-weighted imaging and enhanced computed tomography (CT). Retrospective analysis was performed on imaging data from surgically confirmed glomus jugulare tumors, including temporal bone enhanced BRAVO, enhanced T1-weighted FSE, and temporal bone enhanced CT sequences. ICA encasement and stenosis by tumor were graded and compared based on intraoperative assessment. According to Fisch criteria, the preoperative image C-type based on BRAVO, FSE and CT were separately and compared with surgical C-type (gold standard). Among 21 patients, For image Fisch C-type, BRAVO showed excellent agreement with surgical C-type (κ = 1.000, P < 0.001), outperforming enhanced FSE (κ = 0.561) and CT (κ = 0.702). For ICA encasement, BRAVO had moderate agreement (κ = 0.513), slightly better than enhanced FSE (κ = 0.431) but inferior to enhanced CT (κ = 0.648). For ICA stenosis, BRAVO (κ = 0.588) surpassed enhanced FSE (κ = 0.339) but was less accurate than enhanced CT (κ = 0.716). Enhanced BRAVO and temporal bone enhanced CT are complementary for assessing ICA involvement in glomus jugulare tumors, offering superior accuracy over conventional FSE imaging.

INTRODUCTION:Long noncoding RNAs (lncRNAs) are key regulators of vascular endothelial function. The lncRNA differentiation antagonizing non-protein coding RNA (DANCR) is implicated in cell proliferation and inflammatory responses; however, its specific role in atherosclerosis remains undefined. OBJECTIVE:To investigate the role of DANCR in modulating endothelial adhesive capacity and atherosclerotic plaque instability. METHODS:DANCR expression was profiled in vascular tissues and cell lines using RNA fluorescence in situ hybridization and real-time qPCR. Endothelial-specific DANCR-knockout mice were generated and injected with recombinant adeno-associated virus carrying murine PCSK9 to induce atherosclerosis. Chromatin isolation by RNA purification followed by sequencing was performed to identify potential targets of DANCR. Plasma DANCR level was measured in healthy subjects (n = 42) and in patients with mixed plaques detected by coronary computed tomography angiography (n = 30). RESULTS:DANCR expression was predominantly expressed in endothelial cells and was significantly lower by 43% in the endothelium of human carotid plaques than normal vessels. Endothelial-specific knockout of DANCR in mice led to a 78% increase in aortic plaque area and a 1.1-fold elevation in the plaque instability index, characterized by enlarged necrotic cores, elevated type III/I collagen ratio, and increased macrophage infiltration. The ribosomal protein L22 (RPL22) was identified to be a target of DANCR which repressed its transcriptional expression. Endothelial-specific knockdown of RPL22 reversed the plaque progression and instability induced by DANCR deficiency in vivo. In vitro, DANCR reduced endothelial adhesion capacity and the expression of ICAM1 and VCAM1 via inhibition of the RPL22/p53 pathway. Clinically, plasma DANCR level was lower in patients with mixed plaques compared with control subjects. CONCLUSIONS:Endothelial DANCR deficiency promotes atherosclerotic plaque instability through activation of the RPL22/p53 pathway, suggesting DANCR as a potential protective factor and therapeutic target in atherosclerosis.

To assess the effect of the combination of deep learning reconstruction (DLR) and time-resolved maximum intensity projection (tMIP) or time-resolved average (tAve) post-processing method on image quality of CTA derived from low-dose cerebral CTP. Thirty patients underwent regular dose CTP (Group A) and other thirty with low-dose (Group B) were retrospectively enrolled. Group A were reconstructed with hybrid iterative reconstruction (R-HIR). In Group B, four image datasets of CTA were gained: L-HIR, L-DLR, L-DLRtMIP and L-DLRtAve. The CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and subjective images quality were calculated and compared. The Intraclass Correlation (ICC) between CTA and MRA of two subgroups were calculated. The low-dose group achieved reduction of radiation dose by 33

BACKGROUND AND PURPOSE:Cochlear implant surgery is a standard treatment for severe-to-profound hearing loss. Accurate postoperative assessment of cochlear electrode is crucial for patient outcomes. Photon-counting CT (PCCT) has emerged as a novel imaging modality that may surpass multi-slice CT (MSCT) in image quality and metal artifact reduction. This study aimed to compare PCCT and MSCT in the radiographic evaluation of postoperative cochlear implantation. MATERIALS AND METHODS:A retrospective control study was conducted from March 2021 to September 2024, including 35 patients who underwent cochlear implant surgery and received either PCCT or MSCT scans postoperatively. We employ the multiplanar reconstruction (MPR) method to measure the depth of the electrode and conduct both qualitative and quantitative analysis of image quality. The electrode characteristics, anatomic structures and metal artifacts were compared between the two groups by using a four grades system. Finally, we quantitatively assessed the signal-to-noise ratio (SNR) and radiation dose between the two groups. RESULTS:The PCCT group (n = 16) demonstrated superior image quality with higher mean values of rating scores for the lateral cochlear wall, medial cochlear wall and modiolus compared to the MSCT group (n = 19). The PCCT group also showed significantly better visualization of electrode position (P < 0.001), overall image quality (P = 0.01), and fewer metal artifacts (P = 0.007). The PCCT group had significantly better signal-to-noise ratio and lower radiation dose compared to the MSCT group (P < 0.001). CONCLUSIONS:PCCT suggests potential advantages in terms of image quality, reduced metal artifacts, and lower radiation doses compared to MSCT for postoperative cochlear implant assessment. These advantages suggest that PCCT could potentially serve as a new standard in imaging protocols for patients with cochlear implants.

This study aimed to evaluate the long-term systematic effectiveness and reliability of the Objective Structured Clinical Examination (OSCE) in radiology resident training, from the perspectives of both examiners and examinees. This retrospective observational study analyzed subjective evaluations and objective examination data collected over 6 years (2018–2021, 2023, and 2024). Subjective evaluations were gathered via questionnaires from 198 examiners and 818 examinees to assess the difficulty and satisfaction with the OSCE. Objective data, including examination scores, difficulty indices, and discrimination indices, for each OSCE station were analyzed using correlation analysis and t-tests. The OSCE demonstrated stable performance over 6 years, with consistent difficulty levels and discrimination ability across all stations. The average scores for individual stations varied; however, the overall final scores remained stable. Strong correlations between the station and final scores indicate good discrimination. Examinees rated the overall difficulty higher than examiners, but the objective indices aligned with examiner assessments. Over 6 years (198 examiners, 818 examinees), OSCE scores stabilized (85.48–88.48), with improved consistency (station range narrowed to 85.51–93.9 by 2024). Difficulty (0.12–0.15) and discrimination indices remained stable (most p < 0.05). Examinees rated it harder than examiners (p < 0.001). The OSCE is a reliable, valid, and effective assessment tool in radiology. Evaluating the OSCE from both subjective and objective perspectives ensured the robustness and validity of the examination. This 6-year study evaluates the Objective Structured Clinical Examination (OSCE) in radiology training through multidimensional analysis of examination metrics (difficulty indices and discrimination coefficients) and stakeholder feedback (n = 198 examiners, 818 examinees), demonstrating its consistency for clinical competency assessment.

OBJECTIVES:To compare integrated slice-specific dynamic shimming (iShim) and simultaneous multi-slice (SMS) readout-segmented echo-planar imaging (RESOLVE) for diffusion-weighted imaging (DWI) of malignant head and neck tumours. METHODS:In this prospective study, 45 patients with malignant head and neck lesions underwent iShim- and SMS-RESOLVE imaging with two b-values (0, 800 s/mm2) at 3 T. Subjective image quality scores (lesion distortion, signal loss, fat saturation, and artefacts), quantitative lesion distortion, quantitative image quality [signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and SNR efficiency], ADC values, and total acquisition times of iShim- and SMS-RESOLVE imaging were evaluated and compared. RESULTS:iShim-RESOLVE (3 mins 7 s) had longer acquisition times than SMS-RESOLVE (2 min 1 s). iShim-RESOLVE images had much better overall image quality, geometric distortion, fat saturation, and signal loss than SMS-RESOLVE (P < .05). The quantitative tumour distortion in iShim-RESOLVE images was significantly smaller than those of SMS-RESOLVE, measured either with b = 0 s/mm2 or b = 800 s/mm2 (P < .05). Using the iShim technique, the SNR, CNR of high b-value images, and SNR efficiency were significantly higher than those of SMS-RESOLVE (P < .001). The ADC measurements with excellent agreement of iShim-RESOLVE images were higher than those of SMS-RESOLVE. CONCLUSIONS:iShim-RESOLVE can decrease lesion distortion and improve overall image quality compared with SMS-RESOLVE in head and neck region. ADVANCES IN KNOWLEDGE:iShim-RESOLVE DWI may serve as a promising technique for reducing distortion and assessing head and neck lesions in clinical practice.

To evaluate diagnostic performance of positron emission tomography/magnetic resonance imaging (PET/MR) using a multiparametric model for the detection of cervical lymph node metastasis in head and neck squamous cell carcinoma (HNSCC). Preoperative PET/MR of 95 cervical lymph nodes from patients diagnosed with HNSCC were retrospectively evaluated. Parameters of diffusion weighted imaging (DWI), dynamic enhanced imaging (DCE) and stand-ardized uptake value (SUV) of the nodes were extracted, including ADCmean, Ktrans, Ve, Kep, SUVmean and SUVmax. Multivariable logistic regression analysis was used to develop the diagnostic model of lymph node metastasis. The diagnostic performance of the independent parameters and the combined diagnostic model were evaluated according to receiver operating characteristic (ROC) curve analysis. P values less than 0.05 were considered statistically significant. (1)30 metastatic and 65 benign lymph nodes with pathological diagnosis were involved. (2) There were significant differences of SUVmax, SUVmean, Ktrans and Ve between the groups with metastatic nodes and benign nodes. (3) Compared with independent parameters, PET/MR combined parameters had the highest diagnostic efficacy, with area under the ROC curve of 0.91 (P < 0.001). Combined diagnostic model base on multiparametric PET/MR could im-prove the diagnostic efficacy of cervical lymph node metastasis in HNSCC.

Transient perivascular inflammation of the carotid artery (TIPIC) syndrome is a relatively rare disease, and ultrasound is the first screening method for initial diagnosis of the disease. Contrast-enhanced ultrasound (CEUS) has unique advantages in the follow-up of patients with TIPIC syndrome. This paper reports a patient with TIPIC syndrome who was treated with acute left neck pain. The inflammation was significantly relieved and subsided after treatment with non-steroidal anti-inflammatory drugs. The ultrasound changes of carotid artery lesions in this patient during follow-up were analyzed, and the application value of CEUS in the follow-up diagnosis of this disease was summarized, in the hope of providing clinical reference.

Objective To evaluate the application value of four-dimensional CT(4D-CT)in the preoperative localization of primary hyperparathyroidism(PHPT). Methods A retrospective analysis was conducted on the clinical data and parathyroid 4D-CT images of 63 patients who underwent PHPT surgery at Peking Union Medical College Hospital between April 2020 and April 2023.Based on the clinical experience of the hospital's surgeons,parathyroid lesions were categorized into six anatomical regions:around the upper pole of the thyroid,posterior to the mid-thyroid,posterior to the lower pole of the thyroid and the tracheoesophageal groove,below the lower pole of the thyroid and the suprasternal fossa,retrosternal anterior mediastinum,and other rare locations.All images were independently analyzed by two experienced radiologists,with discrepancies resolved through discussion led by a senior radiologist.Using pathological results as the gold standard,the accuracy,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),Youden index,positive likelihood ratio(PLR),and negative likelihood ratio(NLR)of preoperative 4D-CT in diagnosing PHPT were calculated. Results There were no statistically significant differences between preoperative 4D-CT and surgical localization in the following regions:around the upper pole of the thyroid(χ2=0.500,P=0.480),posterior to the mid-thyroid(χ2<0.001,P>0.999),posterior to the lower pole of the thyroid and the tracheoesophageal groove(χ2=0.571,P=0.450),below the lower pole of the thyroid and the suprasternal fossa(χ2<0.001,P>0.999),retrosternal anterior mediastinum(χ2<0.001,P>0.999),and other rare locations(χ2<0.001,P>0.999).The preoperative 4D-CT diagnosis of PHPT lesions demonstrated a sensitivity of 82.09%,specificity of 97.43%,PPV of 87.30%,NPV of 96.19%,accuracy of 94.71%,Youden index of 79.52%,PLR of 31.94,and NLR of 0.18. Conclusion Parathyroid 4D-CT demonstrates good diagnostic efficacy in the preoperative localization of PHPT.

OBJECTIVES:Study the efficacy and safety of mycophenolate mofetil (MMF) combined with methotrexate (MTX) compared to cyclophosphamide (CYC) followed by azathioprine (AZA) to treat active Takayasu arteritis (TAK). METHODS:Adults with active TAK were randomised in a 2:1 ratio to receive oral MMF plus MTX or intravenous CYC followed by oral AZA. All subjects also received high-dose oral glucocorticoids with a predefined taper. The primary endpoint was overall response rate at week 52, defined as achieving a complete response (CR) or partial response (PR). Secondary endpoints included rates of CR and PR at weeks 28 and 52. RESULTS:A total of 111 patients with TAK were enrolled: 74 in the MMF+MTX group and 37 in the CYC/AZA group, with comparable baseline demographic and clinical features. The overall response rates at 28 and 52 weeks were 58.1% and 55.4% in the MMF+MTX group, respectively, higher than 32.4% at both time points in the CYC/AZA group (P = .011 and .022). CR and PR rates at 28 and 52 weeks were also higher in the MMF+MTX group. Relapse occurred in 4 patients in the MMF+MTX group and 2 in the CYC/AZA group. One serious adverse event, neutropenia with fever, occurred in 1 patient in the CYC/AZA group. CONCLUSIONS:Treatment of active TAK with MMF+MTX has more favourable efficacy compared to CYC/AZA. These findings provide evidence to use the combination of MTX and MMF, 2 generally well-tolerated and inexpensive therapies, to treat TAK.

Background/Objectives: The detection of unknown primary tumours in the palatine tonsils (PTs) on imaging relies heavily on asymmetry in size between the right and left sides, but the expected normal range in asymmetry is not well documented. This study aimed to document the expected range of asymmetry in the size of the PTs in adults without cancer. Methods: This retrospective study evaluated 250 pairs of normal PTs on MRIs of adults without head and neck cancer. The size (volume, V) of the PTs on the left and right sides were measured, and the percentage difference in volume (ΔV%) between the two sides was calculated. An additional analysis of PT volumes in 29 patients with ipsilateral early-stage palatine tonsillar cancer (PTCs) was performed. Results: In patients without PTC, the normal PTs had a mean volume of 3.0 ± 1.7 cm3, and there was a difference in size between the left and right PTs, showing a median ΔV% of 11.6% (range: 0.1–79.0%); most patients had a ΔV% of ≤40% (95%) for PTs. In patients with ipsilateral PTC, the normal PT had a smaller size compared with PTC (p < 0.01), showing a median ΔV% of 132.9% (range: 8.5–863.2%). Compared with patients without PTC, those with PTC showed a greater ΔV% (p < 0.01). An optimal ΔV% threshold of >39.6% achieved the best accuracy of 95% for identifying PTC. Conclusions: PTs are asymmetrical in size in adults without PTC. An additional analysis involving patients with PTC confirmed a threshold of ΔV% of 40% for PTs, which may be clinically valuable to help detect pathology using MRI.

Purpose: To assess the clinical efficacy of integrating deep learning reconstruction (DLR) with contrast-enhancement-boost (CE-boost) in 80 kVp head and neck CT angiography (CTA) using substantially lowered radiation and contrast medium (CM) doses, compared to the standard 100 kVp protocol using hybrid iterative reconstruction (HIR). Methods: Sixty-six patients were prospectively enrolled and randomly assigned to one of two groups: the low-dose group (n=33), receiving 80 kVp and 28 mL contrast medium (CM) with a noise index (NI) of 15; and the regular-dose group (n=33), receiving 100 kVp and 40 mL CM with an NI of 10. For the low-dose group, images underwent reconstruction using both hybrid iterative reconstruction (HIR) and deep learning reconstruction (DLR) at mild-, standard-, and strong-strength levels, both before and after combination with contrast enhancement-boost (CE-boost). This generated eight distinct datasets: L-HIR, L-DLRmild, L-DLRstandard, L-DLRstrong, L-HIR-CE, L-DLRmild-CE, L-DLRstandard-CE, and L-DLRstrong-CE. Images for the regular-dose group were reconstructed solely with HIR (R-HIR). Quantitative analysis involved calculating and comparing CT attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) within six key vessels: the aortic arch (AA), internal carotid artery (ICA), external carotid artery (ECA), vertebral arteries (VA), basilar artery (BA), and middle cerebral artery (MCA). Two radiologists independently assessed subjective image quality using a 5-point scale, with statistical significance defined as P < 0.05. Results: Compared to the regular-dose group, the low-dose protocol achieved a substantial reduction in contrast media volume (28 mL versus 40 mL, a 30% decrease) and radiation exposure ((0.41±0.08) mSv versus (1.18±0.12) mSv, a 65% reduction). Both L-DLRstandard and L-DLRstrong delivered comparable or superior SNR and CNR across all vascular segments relative to R-HIR. However, subjective image quality scores for L-DLR at all strength levels fell below those for R-HIR (all P < 0.05 for both readers). Combining CE-boost with the low-dose protocol significantly enhanced the objective image performance of L-DLRstrong-CE (all P < 0.05) and produced subjective image scores comparable to R-HIR (reader 1: P=0.15; reader 2: P=0.06). Conclusion: When compared to the standard 100 kVp head and neck CTA, the combination of the DLR and CE-boost techniques at 80 kVp can achieve a 30% reduction in contrast dose and a 65% reduction in radiation dose, while maintaining both objective and subjective image quality.

BACKGROUND:Preoperative evaluation of the metastasis status of lateral lymph nodes (LNs) in papillary thyroid cancer is challenging. Strategies for using deep learning to diagnosis of lateral LN metastasis require additional development and testing. This study aimed to build a deep learning-based model to distinguish benign lateral LNs from metastatic lateral LNs in papillary thyroid cancer and test the model's diagnostic performance in a real-world clinical setting. METHODS:This was a prospective diagnostic study. An ensemble model integrating a three-dimensional residual network algorithm with clinical risk factors available before surgery was developed based on computed tomography images of lateral LNs in an internal dataset and validated in two external datasets. The diagnostic performance of the ensemble model was tested and compared with the results of fine-needle aspiration (FNA) (used as the standard reference method) and the diagnoses made by two senior radiologists in 113 suspicious lateral LNs in patients enrolled prospectively. RESULTS:The area under the receiver operating characteristic curve of the ensemble model for diagnosing suspicious lateral LNs was 0.829 (95% CI: 0.732-0.927). The sensitivity and specificity of the ensemble model were 0.839 (95% CI: 0.762-0.916) and 0.769 (95% CI: 0.607-0.931), respectively. The diagnostic accuracy of the ensemble model was 82.3%. With FNA results as the criterion standard, the ensemble model had excellent diagnostic performance ( P =0.115), similar to that of the two senior radiologists ( P =1.000 and P =0.392, respectively). CONCLUSION:A three-dimensional residual network-based ensemble model was successfully developed for the diagnostic assessment of suspicious lateral LNs and achieved diagnostic performance similar to that of FNA and senior radiologists. The model appears promising for clinical application.