Background:Pericoronary adipose tissue (PCAT) attenuation serves as a marker of coronary inflammation. However, numerous confounders may affect PCAT attenuation. This study aimed to investigate the influence of coronary computed tomography angiography (CCTA) imaging parameters and clinical characteristics on the fat attenuation index (FAI) of PCAT. Methods:One hundred and ninety-six subjects [mean age ± standard deviation (SD), 55.4±9.5 years; 81 males] who underwent CCTA and had no coronary plaque were included in this retrospective study. Images were scanned at 100 or 120 kVp and reconstructed using two methods. PCAT attenuation was assessed using two measurement approaches: a proximal 40-mm segment of each coronary artery and a 10-mm segment in each coronary artery segment. The intraclass correlation coefficient (ICC) was used to assess interobserver agreement for FAI measurements. Linear regression analyses were performed to identify independent factors associated with FAI. Results:Interobserver agreement for FAI measurements was excellent, with an ICC of 0.985-0.998; 120 kVp was independently associated with higher FAI values across the majority of segments (β=4.9-8.1, all P<0.001), except for FAI_RCA_mid_10mm and FAI_LCX_dist_10mm. The reconstruction method Iterative Model Reconstruction (IMR; level 1) with Cardiac Routine yielded significantly lower FAI than iDose4 (level 5) with Xres Standard in FAI_RCA_40mm, FAI_LAD_40mm, FAI_LAD_mid_10mm, and FAI_LCX_prox_10mm (β=-3.0 to -2.2, all P<0.05). Sex (male vs. female) was independently associated with FAI_LCX_dist_10mm (β=-3.7, P=0.032). Body mass index (BMI) ≥24 kg/m2 was associated with lower FAI_LAD_40mm, FAI_LAD_prox_10mm, and FAI_LAD_dist_10mm (β=-3.4 to -2.4, all P<0.05). Diabetes was negatively associated with FAI_LAD_prox_10mm (β=-3.9, P=0.030). Smoking was a positive predictor for FAI_RCA_40mm, FAI_LAD_40mm, FAI_RCA_mid_10mm, FAI_LAD_prox_10mm, and FAI_LCX_dist_10mm (β=4.1-6.5, all P<0.05). Dyslipidemia showed a negative association with FAI_LAD_40mm, FAI_RCA_dist_10mm, and FAI_LCX_prox_10mm (β=-3.9 to -2.5, all P<0.05). Other factors, including vessel attenuation, age, hypertension, and family history of coronary artery disease (CAD), showed no significant associations. Conclusions:In patients without coronary plaque, PCAT attenuation depends on imaging parameters and clinical characteristics, underscoring the importance of considering both imaging and clinical factors when interpreting FAI measurements.

PURPOSE:To investigate the diagnostic performance of spectral detector CT (SDCT)-derived reconstructions, including iodine density overlay maps (IDOM) and virtual monoenergetic images at 40 keV (VMI40keV), in assessing extramural venous invasion (EMVI) in rectal cancer. METHODS:Patients with rectal cancer who underwent preoperative SDCT and MRI followed by surgery were retrospectively enrolled. Two radiologists independently evaluated EMVI status using conventional images (CI), IDOM, VMI40keV, and MRI, respectively. Sensitivity, specificity, and accuracy were calculated using histopathological findings as the reference standard. RESULTS:Among the 78 enrolled patients (mean age, 60 years ± 13 [standard deviation]; 42 males), 22 had pathologically confirmed EMVI. IDOM demonstrated the highest sensitivity (68.2 %), followed by VMI40keV and MRI (both 59.1 %), while CI showed a much lower sensitivity (27.3 %). Compared with CI, IDOM, VMI40keV, and MRI showed significantly higher sensitivity (P = 0.004, 0.016, and 0.016, respectively). However, no significant differences were observed among IDOM, VMI40keV, and MRI (all P > 0.05). Specificities ranged from 87.5 % to 94.6 % across all modalities, with no significant differences (all P > 0.05). IDOM showed the highest accuracy (85.9 %), followed by VMI40keV (83.3 %), MRI (79.5 %), and CI (75.6 %). Compared with CI, all three modalities demonstrated significantly improved accuracy (P = 0.002, 0.008, and < 0.001, respectively), although no significant differences were found among IDOM, VMI40keV, and MRI (all P > 0.05). CONCLUSIONS:IDOM and VMI40keV derived from SDCT, as well as MRI showed no statistically significant differences in diagnostic performance relative to one another. All three modalities were superior to CI in the detection of EMVI.

To investigate the prognostic value of baseline MRI characteristics based on the DISTANCED structured report in patients with MRI-defined T3 (mrT3) rectal cancer. We retrospectively analyzed 190 patients with mrT3 rectal cancer who received neoadjuvant therapy followed by surgical resection between December 2014 and June 2023, with a median follow-up of 43 months (range: 2–126 months). Baseline MRI features, clinical characteristics, and follow-up data were assessed. The patients were randomly assigned to a training cohort (n = 133) or a validation cohort (n = 57) in a 7:3 ratio. Cox regression analyses were performed to identify independent risk factors for disease-free survival (DFS), which were then used to construct a nomogram in the training cohort. The nomogram was independently validated using the validation cohort. Harrell’s concordance index (C-index) and time-independent receiver operating characteristic (ROC) analysis were used to evaluate the model’s discrimination. For patient stratification, the DFS rates of high- and low-risk patients were calculated using the Kaplan-Meier method. Baseline MRI-determined lateral lymph node (mrLLN) metastasis, circumference resection margin (mrCRM) involvement, and tumor deposits (mrTDs) were independent predictors of DFS. The nomogram exhibited good discrimination, with a C-index of 0.805 (95

Large granular lymphocytic leukemia (LGLL) is characterized by the clonal proliferation of cytotoxic T lymphocytes or NK cells. Standard first-line immunosuppressive treatments have limitations, achieving complete remission (CR) rates of up to 50%. Immune system dysregulation is implicated in LGLL. Promising results for thalidomide, an immunomodulatory drug, combined with prednisone and methotrexate (TPM), were observed in our pilot study. This multicenter study evaluated the efficacy and safety of a thalidomide, prednisone, and methotrexate (TPM) regimen in 52 symptomatic, methotrexate- and thalidomide-naive LGLL patients from June 2020 to August 2022. Thalidomide (100 mg daily for up to 24 months), prednisone (0.5–1.0 mg/kg every other day, tapered after 3 months), and methotrexate (10 mg/m2 weekly for up to 12 months) were administered. The primary objective was to determine the CR rate. The median follow-up duration was 29.0 months (range: 4.0–42.0). Forty-seven patients (90.4%) achieved hematological and symptomatic responses. Thirty-nine patients (75.0%) achieved CR. The median time to response was 3.0 months (range: 3.0–9.0). The median progression-free survival was 40.0 months (95% confidence interval (CI): 38.0–42.0), and the median duration of response was 39.0 months (95% CI: 36.1–41.9). The most common adverse event was peripheral neuropathy (24.1%), most of which (84.6%) were grades 1–2. Four patients experienced grade ≥3 adverse events. In conclusion, the TPM regimen was an effective and safe treatment for symptomatic LGLL patients, with a particularly high CR rate. This trial was registered at www.clinicaltrials.gov (#NCT04453345).

Objectives:To investigate the diagnostic value of dynamic contrast-enhanced MRI (DCE-MRI) quantitative parameters in acute radiation-induced rectal injury (RRI) among patients with rectal cancer. Methods:This retrospective study included patients confirmed to rectal cancer who underwent rectal MRI (including a DCE-MRI sequence) and endoscopy after neoadjuvant chemoradiotherapy from November 2014 to July 2022. The enrolled patients were divided into an acute RRI group and a non-acute RRI group based on Vienna rectoscopy score. Two radiologists independently measured DCE-MRI quantitative parameters (including the forward volume transfer constant [K trans], rate constant [k ep], and fractional extravascular extracellular space volume [v e]) and thickness of rectal wall. Receiver operating characteristic curve analysis was performed to analyze statistically significant parameters. Results:Forty-nine patients (median age, 58 years; interquartile range, 14 years; 34 men) were enrolled, 28 of whom were in the acute RRI group. K trans in patients with acute RRI was significantly lower compared to those without acute RRI (0.049 min-1 vs 0.107 min-1; P < 0.001). The area under the receiver operating characteristic curve of K trans was 0.80. With a K trans cutoff value of 0.079 min-1, the sensitivity and specificity were 93 % and 67 %, respectively. Conclusion:K trans demonstrated moderate performance in diagnosing acute RRI, providing a non-invasive and objective basis for managing and treating rectal cancer patients with acute RRI.

High-spatial-resolution T2-weighted imaging (HR-T2WI) has been demonstrated to overestimate the staging of early rectal cancer, which could lead to missed opportunities for organ-preserving treatments. This study aimed to investigate the value of diffusion kurtosis imaging (DKI) in distinguishing between T0-T1 and T2 rectal tumors. A total of 138 patients with pathologically confirmed T0-T2 rectal tumors who underwent surgery between 2018 and 2023 were included. The pathological findings on tumor staging obtained from surgical specimens were used as the reference standard. The depth of tumor invasion was assessed using HR-T2WI. Kurtosis and diffusivity from DKI and apparent diffusion coefficient (ADC) from diffusion-weighted imaging were measured for the entire tumor. Diffusion parameters were compared between pT0-T1 and pT2 tumors. Multivariable logistic regression and receiver operating characteristic curve analyses were conducted to evaluate the diagnostic performance of significant individual parameters and their combinations in determining pT0-T1 tumors. Kurtosis was lower in pT0-T1 than in pT2 rectal tumors (0.799 vs. 0.950, P < 0.001), while diffusivity and ADC were higher than those of pT2 rectal cancer (1.732 × 10−3 mm2/s vs. 1.368 × 10−3 mm2/s, P < 0.001; 1.316 × 10−3 mm2/s vs. 1.043 × 10−3 mm2/s, P < 0.001). Diffusivity demonstrated the highest diagnostic efficacy in differentiating pT0-T1 from pT2 rectal tumors, with an AUC of 0.810, which was higher that of HR-T2WI (AUC = 0.752, P < 0.001) and kurtosis (AUC = 0.729, P = 0.007), but showed no difference compared to ADC (AUC = 0.785, P = 0.087). A multivariable logistic regression model incorporating HR-T2WI and diffusivity improved diagnostic performance compared with all other individual parameters, achieving an AUC of 0.885 (all P < 0.05). The combination of HR-T2WI and diffusivity can effectively detect pT0-T1 rectal tumors. HR-T2WI combined with diffusivity derived from DKI may serve as a potential biomarker for early assessment of rectal tumors, offering valuable insights for selecting suitable candidates for organ-preserving surgery.

OBJECTIVE:To evaluate the feasibility of dynamic contrast-enhanced MRI (DCE-MRI) in differentiating tumor deposits (TDs) from metastatic lymph nodes (MLNs) in rectal cancer. MATERIALS AND METHODS:A retrospective analysis was conducted on 70 patients with rectal cancer, including 168 lesions (70 TDs and 98 MLNs confirmed by histopathology), who underwent pretreatment MRI and subsequent surgery between March 2019 and December 2022. The morphological characteristics of TDs and MLNs, along with quantitative parameters derived from DCE-MRI (Ktrans, kep, and ve) and DWI (ADCmin, ADCmax, and ADCmean), were analyzed and compared between the two groups. Multivariable binary logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of significant individual quantitative parameters and combined parameters in distinguishing TDs from MLNs. RESULTS:All morphological features, including size, shape, border, and signal intensity, as well as all DCE-MRI parameters showed significant differences between TDs and MLNs (all P < 0.05). However, ADC values did not demonstrate significant differences (all P > 0.05). Among the single quantitative parameters, ve had the highest diagnostic accuracy, with an area under the ROC curve (AUC) of 0.772 for distinguishing TDs from MLNs. A multivariable logistic regression model incorporating short axis, border, ve, and ADCmean improved diagnostic performance, achieving an AUC of 0.833 (P = 0.027). CONCLUSION:The combination of morphological features, DCE-MRI parameters, and ADC values can effectively aid in the preoperative differentiation of TDs from MLNs in rectal cancer.

To assess the value of orthogonal axial images (OAI) of MRI in gastric cancer T staging. This retrospective study enrolled 133 patients (median age, 63 [range, 24–85] years) with gastric adenocarcinoma who underwent both CT and MRI followed by surgery. MRI lacking or incorporating OAI and CT images were evaluated, respectively. Diagnostic performance (accuracy, sensitivity, and specificity) for each T stage, overall diagnostic accuracy and rates of over- and understaging were quantified employing pathological T stage as a reference standard. The McNemar’s test was performed to compare the overall accuracy. Among patients with pT1–pT4 disease, MRI with OAI (accuracy: 88.7–94.7

Abstract Background After neoadjuvant therapy, most of the lymph nodes (LNs) will shrink and disappear in patients with rectal cancer. However, LNs that are still detectable on MRI carry a risk of metastasis. This study aimed to evaluate the performance of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) criterion (short-axis diameter ≥ 5 mm) in diagnosing malignant LNs in patients with rectal cancer after neoadjuvant therapy, and whether nodal morphological characteristics (including shape, border, signal homogeneity, and enhancement homogeneity) could improve the diagnostic efficiency for LNs ≥ 5 mm. Methods This retrospective study included 90 patients with locally advanced rectal cancer who underwent surgery after neoadjuvant therapy and performed preoperative MRI. Two radiologists independently measured the short-axis diameter of LNs and evaluated the morphological characteristics of LNs ≥ 5 mm in consensus. With a per node comparison with histopathology as the reference standard, a ROC curve was performed to evaluate the diagnostic performance of the size criterion. For categorical variables, either a χ 2 test or Fisher’s exact test was used. Results A total of 298 LNs were evaluated. The AUC for nodal size in determining nodal status was 0.81. With a size cutoff value of 5 mm, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 65.9%, 87.0%, 46.8%, 93.6% and 83.9%, respectively. No significant differences were observed in any of the morphological characteristics between benign and malignant LNs ≥ 5 mm (all P > 0.05). Conclusions The ESGAR criterion demonstrated moderate diagnostic performance in identifying malignant LNs in patients with rectal cancer after neoadjuvant therapy. It was effective in determining the status of LNs < 5 mm but not for LNs ≥ 5 mm, and the diagnostic efficiency could not be improved by considering nodal morphological characteristics.

To explore the potential of dynamic contrast-enhanced MRI (DCE-MRI) quantitative parameters in predicting severe acute radiation-induced rectal injury (RRI) in rectal cancer. This retrospective study enrolled 49 patients with rectal cancer who underwent neoadjuvant chemoradiotherapy and rectal MRI including a DCE-MRI sequence from November 2014 to March 2021. Two radiologists independently measured DCE-MRI quantitative parameters, including the forward volume transfer constant (Ktrans), rate constant (kep), fractional extravascular extracellular space volume (ve), and the thickness of the rectal wall farthest away from the tumor. These parameters were compared between mild and severe acute RRI groups based on histopathological assessment. Receiver operating characteristic curve analysis was performed to analyze statistically significant parameters. Forty-nine patients (mean age, 54 years ± 12 [standard deviation]; 37 men) were enrolled, including 25 patients with severe acute RRI. Ktrans was lower in severe acute RRI group than mild acute RRI group (0.032 min−1 vs 0.054 min−1; p = 0.008), but difference of other parameters (kep, ve and rectal wall thickness) was not significant between these two groups (all p > 0.05). The area under the receiver operating characteristic curve of Ktrans was 0.72 (95

To evaluate the identification of tumor deposits (TDs) and the prognostic significance of an MRI tumor regression grade for TDs in patients with rectal cancer treated with neoadjuvant chemoradiotherapy (nCRT). Ninety-one patients with cT3 or cT4 rectal cancer who underwent surgery following nCRT between August 2014 and June 2020 were retrospectively analyzed. Changes in pre-nCRT MRI-detected TDs (mrTDs) were described as mrTD regression grade. The diagnostic performance of post-nCRT MRI-detected TDs (ymrTDs) was compared with histopathological reference standard. The correlation between ymrTDs, mrTD regression grade, and disease-free survival (DFS) was assessed. The sensitivity and specificity of ymrTDs were 88.00 • MRI provides a preoperative and noninvasive way to visualize tumor deposits (TDs) after neoadjuvant chemoradiotherapy (nCRT). • Post-nCRT MRI-detected TDs are a poor prognostic marker in cT3 and cT4 rectal cancer patients. • The regression of MRI-detected TDs after nCRT is associated with an improved disease-free survival.

Background The mesorectum surrounding the rectum provides an ideal substrate for tumour spread. However, preoperative risk assessment is still an issue. This study aimed to investigate the microstructural features of mesorectum with different prognostic statuses by intravoxel incoherent motion diffusion-weighted imaging (IVIM DWI). Methods Patients with pathologically proven rectal adenocarcinoma underwent routine high-resolution rectal magnetic resonance imaging (MRI) and IVIM DWI sequences were acquired. The MRI-detected circumferential resection margin (mrCRM) and extramural vascular invasion (mrEMVI) were evaluated. IVIM parameters of the mesorectum adjacent to (MAT) and distant from (MDT) the tumour were measured and compared between and within the prognostic factor groups. Results The positive mrCRM ( p MAT < 0.001; p MDT = 0.013) and mrEMVI ( p MAT = 0.001; p MDT < 0.001) groups demonstrated higher D values in the MAT and MDT than the corresponding negative groups. Conversely, the positive mrCRM ( p = 0.001) and mrEMVI ( p < 0.001) groups both demonstrated lower f values in the MAT. Similarly, in the self-comparison between the MAT and MDT in the above subgroups, D showed a significant difference in all subgroups ( p < 0.001 for all), and f showed a significant difference in the positive mrCRM ( p = 0.001) and mrEMVI ( p = 0.002) groups. Moreover, the MAT displayed a higher D* in the positive mrCRM ( p = 0.014), negative mrCRM ( p = 0.009) and negative mrEMVI groups ( p < 0.001). Conclusion The microstructure of the mesorectum in patients with rectal cancer with poor prognostic status shows changes based on IVIM parameters. IVIM parameters might be promising imaging biomarkers for risk assessment of tumour spread in mesorectum preoperatively.

目的 比较高分辨二维快速自旋回波T2加权成像(简称平扫)及平扫结合各向同性高分辨三维梯度回波T1加权成像脂肪抑制增强扫描(简称增强扫描)诊断直肠癌不同短径范围的区域转移淋巴结的价值.方法 纳入直接行全直肠系膜切除术且术前接受直肠高分辨MRI检查的直肠癌患者80例.两名放射科医师分别根据平扫及平扫结合增强扫描独立评价区域淋巴结性质.以短径5 mm和10 mm为界,将区域淋巴结分为三个亚组.以术后病理结果为金标准,计算平扫及平扫结合增强扫描诊断不同亚组区域转移淋巴结的敏感性、特异性及受试者工作特征曲线的曲线下面积(AUC).结果 影像与病理匹配的淋巴结共592枚.对于短径≤5 mm及短径＞5 mm且≤10 mm的区域淋巴结,平扫结合增强扫描诊断区域转移淋巴结的敏感性均高于平扫(52.94％vs.82.35％,P=0.002;65.28％vs.97.22％,P＜0.01),但特异性不如平扫(99.28％vs.96.15％,P＜0.01;98.36％vs.67.21％,P＜0.01).两者诊断这两个亚组的价值均中等(AUC为0.761～0.893).9枚短径＞10 mm的区域淋巴结均为恶性,平扫结合增强扫描均判定为转移,而平扫将其中1枚误判为良性.结论 平扫结合增强扫描诊断直肠癌区域转移淋巴结的价值优于平扫,具有更高的敏感性.

Objective:To investigate the value of quantitative parameters derived from dual-layer spectral detector CT (SDCT) in characterizing regional lymph node (LN) status of colorectal cancer.Methods:From August 2019 to May 2020, 101 patients with colorectal cancer confirmed by pathology in the First Affiliated Hospital of Sun Yat-sen University were retrospectively collected. The largest regional LNs were matched with surgical pathology one by one and divided into metastatic LNs group (42 cases) and nonmetastatic LNs group (59 cases) according to pathological results. Based on preoperative venous phase contrast enhanced SDCT images he short-axis diameter (S) and the of the largest regional LN was measured, then its border and enhancement homogeneity were evaluated. Outlining the ROI along the edge of the LN on its widest cross section, the iodine density (ID) and effective atomic number (Z eff) were measured, then the normalized ID (nID) and normalized Z eff (nZ eff) were calculated. The χ 2 test, Fisher′s exact test, independent samples t-test or Mann-Whitney U test were used to compare the differences of each parameter between pathologically metastatic and nonmetastatic LNs and a logistic regression model was constructed. The ROC curves and area under the curve (AUC) were performed to evaluate the diagnostic performance of each parameter. DeLong test was used to compare the differences of each AUC. Results:The S, border, enhancement homogeneity, ID, Z eff, nID and nZ eff of LNs all showed significant differences between metastatic and nonmetastatic LNs (all P<0.001). The regression model constructed by S and Z eff of LNs had the highest value in differentiating metastatic and nonmetastatic LNs, with an AUC of 0.935, sensitivity and specificity of 85.7% and 89.8%, respectively. Its diagnostic value was higher than that of S, border, enhancement homogeneity (AUC 0.674-0.832, all P<0.05) and SDCT quantitative parameters (AUC 0.863-0.906, all P<0.05) of LNs. Conclusion:SDCT quantitative parameters facilitate the accurate diagnosis of regional metastatic LNs in patients with colorectal cancer, among which the multi-parameter regression model has the highest diagnostic value.

Calcification causes mixed signal intensity in the lymph node (LN) on high-resolution magnetic resonance imaging (MRI), which is a strong indicator of regional LN metastasis in rectal cancer. Calcified metastatic LNs in rectal cancer commonly display scattered fine punctate calcifications to varying degrees on computed tomography (CT). On high-resolution MRI, the calcifications manifest a patchy area of signal loss in corresponding calcified area that is larger than on CT. It is necessary to recognize the appearance of metastatic LN calcifications on high-resolution MRI in rectal cancer because it is the primary imaging method for local staging in rectal cancer. This pictorial essay aims to introduce an important imaging finding that can contribute to the diagnosis of LN metastasis by illustrating features and differences between CT and high-resolution MRI of metastatic LN calcifications in rectal cancer.

OBJECTIVE. The purpose of this study was to use quantitative dynamic contrast-enhanced MRI (DCE-MRI) to evaluate mesorectal microcirculation in patients with rectal cancer. MATERIALS AND METHODS. A total of 53 patients with semicircular rectal tumors underwent DCE-MRI with a 3-T MRI system before surgery. ROIs were manually delineated in the mesorectum that surrounded the tumor and the mesorectum that surrounded the normal rectal wall. DCE-MRI parameters including forward volume transfer constant (Ktrans), reverse volume transfer constant (kep), and fractional extravascular extracellular space volume (Ve) were estimated using computer software. Histopathologic analysis served as the standard reference. RESULTS. Mesorectum that surrounded the tumor showed significantly higher Ktrans val ues than mesorectum that surrounded normal rectal wall (mean, 0.069 ± 0.035 [SD] vs 0.039 ± 0.020 min-1; p < 0.001). The tumor-surrounding mesorectum also showed higher Ve values than normal mesorectum (p < 0.001). An opposite trend was observed for kep, but this was not significant (p = 0.077). A lower Ktrans of the tumor-surrounding mesorectum was observed in patients with malignant lymph nodes compared with those with benign lymph nodes (mean, 0.054 ± 0.027 vs 0.076 ± 0.036 min-1; p = 0.034). Although kep values for the tumor-surrounding mesorectum were higher in patients with tumors categorized as pathologic Tis (pTis) to pT2 than in those with pT3 tumors, the p value was close to 0.05 (p = 0.047). The tumor-surrounding mesorectum showed no significant differences in the aforementioned parameters between patients with positive MRI-detected extramural vascular invasion (mrEMVI) and those with negative mrEMVI. CONCLUSION. Mesorectum that surrounded rectal tumor had a higher blood flow than that close to the normal rectal wall. The blood flow decreased in the tumor-surrounding mesorectum when there was nodal involvement.

Objectives The purpose of this study was to identify the molecular mechanism and prognosis-related genes of Jianpi Jiedu decoction in the treatment of hepatocellular carcinoma. Methods The gene expression data of hepatocellular carcinoma samples and normal tissue samples were downloaded from TCGA database, and the potential targets of drug composition of Jianpi Jiedu decoction were obtained from TCMSP database. The genes were screened out in order to obtain the expression of these target genes in patients with hepatocellular carcinoma. The differential expression of target genes was analyzed by R software, and the genes related to prognosis were screened by univariate Cox regression analysis. Then, the LASSO model was constructed for risk assessment and survival analysis between different risk groups. At the same time, independent prognostic analysis, GSEA analysis, and prognostic analysis of single gene in patients with hepatocellular carcinoma were performed. Results 174 compounds of traditional Chinese medicine were screened by TCMSP database, corresponding to 122 potential targets. 39 upregulated genes and 9 downregulated genes were screened out. A total of 20 candidate prognostic related genes were screened out by univariate Cox analysis, of which 12 prognostic genes were involved in the construction of the LASSO regression model. There was a significant difference in survival time between the high-risk group and low-risk group (p < 0.05). Among the genes related to prognosis, the expression levels of CCNB1, NQO1, NUF2, and CHEK1 were high in tumor tissues (p < 0.05). Survival analysis showed that the high expression levels of these four genes were significantly correlated with poor prognosis of HCC (p < 0.05). GSEA analysis showed that the main KEGG enrichment pathways were lysine degradation, folate carbon pool, citrate cycle, and transcription factors. Conclusions In the study, we found that therapy target genes of Jianpi Jiedu decoction were mainly involved in metabolism and apoptosis in hepatocellular carcinoma, and there was a close relationship between the prognosis of hepatocellular carcinoma and the genes of CCNB1, NQO1, NUF2, and CHEK1.

Background The aim of this study is to evaluate the microstructure and microcirculation of regional lymph nodes (LNs) in rectal cancer by using non-invasive intravoxel incoherent motion MRI (IVIM-MRI), and to distinguish metastatic from non-metastatic LNs by quantitative parameters. Methods All recruited patients underwent IVIM-MRI ( b = 0, 5, 10, 20, 30, 40, 60, 80, 100, 150, 200, 400, 600, 1000, 1500 and 2000 s/mm 2 ) on a 3.0 T MRI system. One hundred sixty-eight regional LNs with a short-axis diameter equal to or greater than 5 mm from 116 patients were evaluated by two radiologists independently, including 78 malignant LNs and 90 benign LNs. The following parameters were assessed: the short-axis diameter (S), long-axis diameter (L), short- to long-axis diameter ratio (S/L), pure diffusion coefficient ( D ), pseudo-diffusion coefficient ( D * ), and perfusion factor ( f ). Intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement between two readers. Receiver operating characteristic curves were applied for analyzing statistically significant parameters. Results Interobserver agreement of IVIM-MRI parameters between two readers was excellent (ICCs> 0.75). The metastatic group exhibited higher S, L and D ( P < 0.001), but lower f ( P < 0.001) than the non-metastatic group. The area under the curve (95% CI, sensitivity, specificity) of the multi-parameter combined equation for D , f and S was 0.811 (0.744~0.868, 62.82%, 87.78%). The diagnostic performance of the multi-parameter model was better than that of an individual parameter ( P < 0.05). Conclusion IVIM-MRI parameters provided information about the microstructure and microcirculation of regional LNs in rectal cancer, also improved diagnostic performance in identifying metastatic LNs.

OBJECTIVE. The aim of this study was to discriminate metastatic from nonmetastatic regional lymph nodes (LNs) with short-axis diameters of less than 5 mm in rectal cancer using quantitative parameters derived from dynamic contrast-enhanced (DCE) MRI. SUBJECTS AND METHODS. Sixty-five LNs from 122 patients were evaluated, including malignant LNs (n = 27) and benign LNs (n = 38). The following parameters were assessed: the forward volume transfer constant (K-trans), reverse volume transfer constant (k(ep)), fractional extravascular extracellular space volume (Ve), short-axis diameter, long-axis diameter, and short- to long-axis diameter ratio. ROC curves were used to analyze statistically significant parameters. RESULTS. Metastatic LNs exhibited a lower K-trans than did nonmetastatic LNs (p < 0.001), but the other parameters were not significantly different between the two groups. The AIX of the K-trans was 0.732, with a 95% CI of 0.610-0.854, and the diagnostic cutoff value was 0.088 min(-1) (sensitivity, 60.5%; specificity, 81.5%). CONCLUSION. K-trans had moderate diagnostic performance in assessing small regional LNs in rectal cancer and appears to be a useful predictor when distinguishing malignant LNs from benign LNs only by morphology is difficult.