Abstract Background We investigated the value of three-dimensional amide proton transfer-weighted imaging (3D-APTWI) in the diagnosis of early-stage breast cancer (BC) and its correlation with the immunohistochemical characteristics of malignant lesions. Methods Seventy-eight women underwent APTWI and dynamic contrast-enhanced (DCE)-MRI. Pathological results were categorized as either benign (n = 43) or malignant (n = 37) lesions. The parameters of APTWI and DCE-MRI were compared between the benign and malignant groups. The diagnostic value of 3D-APTWI was evaluated using the area under the receiver operating characteristic curve (ROC-AUC) to establish a diagnostic threshold. Pearson’s correlation was used to analyze the correlation between the magnetization transfer asymmetry (MTRasym) and immunohistochemical characteristics. Results The MTRasym and time-to-peak of malignancies were significantly lower than those of benign lesions (all p < 0.010). The volume transfer constant, rate constant, and wash-in and wash-out rates of malignancies were all significantly greater than those of benign lesions (all p < 0.010). ROC-AUCs of 3D-APTWI, DCE-MRI, and 3D-APTWI+DCE to differential diagnosis between early-stage BC and benign lesions were 0.816, 0.745, and 0.858, respectively. Only the difference between AUCAPT+DCE and AUCDCE was significant (p < 0.010). When a threshold of MTRasym for malignancy for 2.42%, the sensitivity and specificity of 3D-APTWI for BC diagnosis were 86.5% and 67.6%, respectively; MTRasym was modestly positively correlated with pathological grade (r = 0.476, p = 0.003) and Ki-67 (r = 0.419, p = 0.020). Conclusions 3D-APTWI may be used as a supplementary method for patients with contraindications of DCE-MRI. MTRasym can imply the proliferation activities of early-stage BC. Relevance statement 3D-APTWI can be an alternative diagnostic method for patients with early-stage BC who are not suitable for contrast injection. Key points • 3D-APTWI reflects the changes in the microenvironment of early-stage breast cancer. • Combined 3D-APTWI is superior to DCE-MRI alone for early-stage breast cancer diagnosis. • 3D-APTWI improves the diagnostic accuracy of early-stage breast cancer. Graphical Abstract

Background: Myocardial microcirculation dysfunction is the most potent predictor of adverse cardiovascular events in hypertension. The current study aimed to apply intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) to assess hypertension-related microcirculation dysfunction. Methods: In this prospective study, 102 participants were recruited from our hospital and underwent cardiac magnetic resonance (CMR) examination on a 3T scanning system. Hypertensive patients were divided into 3 subgroups based on blood pressure (BP) types. Two experienced CMR radiologists independently analyzed all images, and Bland-Altman analysis was applied to assess intra- and inter-observer reproducibility. Cardiac function indexes and IVIM-DWI parameters were compared between the hypertension and healthy control groups, as well as among the three hypertension subgroups. Results: Totally 62 participants with hypertension and 27 healthy controls were included. 13 participants were excluded for poor quality of IVIM-DWI images. Significantly higher maximal left ventricular wall thickness (10.3 +/- 2.0 vs. 8.6 +/- 1.4 mm, P<0.001) and left ventricular mass index (49.0 +/- 9.1 vs. 42.1 +/- 7.5 g/m(2), P<0.05) were observed inhypertension group compared with healthy control group. There were significant statistical differences in pseudo diffusion (D*) between them (81.3 +/- 16.3 vs. 111.8 +/- 18.9 mm(2)/s, P<0.001), as well as among the three hypertension subgroups (99.4 +/- 13.9 vs. 79.7 +/- 10.6 vs. 67.1 +/- 6.6 mm(2)/s, P<0.001). Participants with poor quality of IVIM-DWI images had higher heart rates (72.2 +/- 10.0 vs. 62.0 +/- 8.1 bpm, P<0.001). Conclusions: IVIM-DWI is feasible for quantitatively evaluating myocardial microcirculation dysfunction in hypertension. The D* parameter has a potential value for assessing the severity of microcirculation dysfunction in different BP categories.

新辅助治疗(NAT)是乳腺癌综合治疗的重要组成部分.目前,NAT疗效评估的金标准是组织病理学,但其需要术后标本,存在明显滞后性.准确评估和预测NAT疗效对及时改进治疗方案、确定精准的手术计划具有重要价值.已有多种影像学检查方法被用于乳腺癌NAT疗效评估与预测,其中磁共振(MR)检查因其优越的软组织分辨力和多方位、多参数成像特点,成为准确性最高的影像学手段.传统MR成像可从肿瘤长径、体积和退缩模式等形态学改变来评估与预测NAT疗效.近年来随着MR功能成像技术不断更新迭代,动态对比增强磁共振成像、扩散加权成像及体素内不相干运动扩散加权成像、酰胺质子转移成像、磁共振波谱成像等MR功能成像从不同维度实现了对乳腺癌NAT疗效的早期预测,进一步提高了MR成像对NAT疗效的早期预测能力.

PurposeTo confirm the ability of native T1 and T2 values in detecting and monitoring early myocardial injuries of chest radiotherapy in neoplasm patients.Materials and methodsFifteen participants received non-anthracycline chemotherapy and chest radiotherapy, and 30 age/gender-matched controls were enrolled in this prospective study. Cardiac magnetic resonance scans were performed within 2 days, 3 months, and 6 months after chest radiotherapy. Myocardial native T1 and T2 values were measured in irradiated and nonirradiated areas. Meanwhile, the parameters of left ventricular function and left ventricular myocardial strain were obtained.ResultsThere were no significant differences in left ventricular function, native T1, T2, and strain between patients and controls before chest radiotherapy. In 15 participants who were followed up for 6 months, there was a significant change only in left ventricular ejection fraction (LVEF) among baseline and the first follow-up (P = 0.021), while the adjusted P-value was higher than 0.05 after Bonferroni correction, as well as other parameters. Native T1 values were elevated at 3 and 6 months in irradiated areas compared with baseline (1,288.72 ± 66.59 ms vs. 1,212.51 ± 45.41 ms; 1,348.01 ± 54.16 ms vs. 1,212.51 ± 45.41 ms; P < 0.001 for both). However, T2 values only changed at 3 months in irradiated areas compared with baseline (44.21 ± 3.35 ms vs. 39.14 ± 1.44 ms; P = 0.006). Neither the native T1 nor T2 values changed in nonirradiated areas during the follow-up period (all P > 0.05). There were no significant differences in strain changes during the follow-up period (all P > 0.05).ConclusionNative T1 and T2 values elevated at 3 months after chest radiotherapy, whereas LVEF showed no significant change during the 6-month follow-up.

Objective The aim of the study was to evaluate the effect of empagliflozin on diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T1 mapping. Research methods and procedures Databases including PubMed, Cochrane library, Embase, and Sinomed for clinical studies of empagliflozin on myocardial fibrosis were searched. Two authors extracted the data and evaluated study quality independently. Weighted mean difference (WMD) and 95% confidence intervals (CI) were used for continuous variables. Review Manager 5.3 was used to performed the analysis. Results Six studies were included in this meta-analysis. One of the six studies was assessed as poor quality by the assessment of methodological quality; however, the remaining five studies were considered good. The WMD value of △extracellular volume (ECV) was merged by the fixed-effect model, and the pooled effect size was -1.48 (95% CI -1.76 to -1.21, P < 0.00001), which means in favor of empagliflozin. Heterogeneity analysis did not find any heterogeneity (chi 2 = 0.39, P = 0.82, I 2 = 0%). In addition, empagliflozin had a tendency to reduce ECV compared to treatment before with no statistical significance (WMD = -0.29, 95% CI -1.26 to 0.67, P = 0.55; heterozygosity test, chi 2 = 2.66, P = 0.45, I 2 = 0%). The WMD value of △native T1 was also merged by the fixed-effect model, but the pooled effect size showed neither statistical difference between empagliflozin and placebo treatment (WMD = -5.40, 95% CI -21.63 to 10.83, P = 0.51) nor heterogeneity (chi 2 = 0.05, P = 0.83, I 2 = 0%). Conclusions Empagliflozin has cardiovascular benefits by reducing diffuse myocardial fibrosis. ECV could act as a non-invasive imaging tool to assess diffuse myocardial fibrosis and monitor disease progression. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=324804 , identifier: CRD42022324804

目的 探讨基于可解释性心脏磁共振(CMR)参数的机器学习模型对儿童心肌炎患者预后的预测价值.方法 回顾性收集2012年9月至2017年11月临床诊断为儿童心肌炎患者45例,其中男28例,女17例,4～16岁,平均(9.8±3.4)岁.根据随访过程中是否出现心血管不良事件(ACE),将患者分为预后不良组(n=18例)和预后良好组(n=27例).所有患者于住院治疗后进行CMR扫描,获取心功能、心肌应变、首过灌注及延迟强化(LGE)相关方面共206个可解释性的CMR参数.利用MATLAB分类学习应用程序对参数进行训练,挑选精度最高的模型作为预测模型.采用受试者工作特征曲线(ROC)对模型的预测效能进行评估.结果 提取出14个可解释性的CMR参数,挑选其中无显著相关性的参数构建组合参数.单一参数中,美国心脏协会(AHA)分段法中的第7节段最大信号强度百分比(SI％)预测性能最佳,曲线下面积(AUC)、预测敏感性和特异性分别为0.790、0.667和0.833;组合参数达到了最高的预测性能,AUC、预测敏感性和特异性分别为0.940、0.750和0.889.结论 根据可解释性的CMR参数建立的机器学习模型对儿童心肌炎患者预后的预测具有良好价值,且在预后评估中组合参数比单一参数预测性能更高.