This study aimed to develop machine learning models for predicting tumor recurrence in breast cancer before neoadjuvant systemic therapy (NST) by integrating clinical and radiomic features derived from pretreatment computed tomography (CT). We retrospectively enrolled 235 patients with 237 breast tumors who underwent contrast-enhanced CT before NST. Datasets were randomly divided into five-fold training and testing sets using semi-random partitioning to ensure similar clinical characteristics between the two subsets. Subsequently, a nested five-fold cross-validation was performed to develop a recurrence prediction model using three machine learning algorithms across clinical, radiomics, and integrated models. The performance of prediction models was compared using the area under the receiver-operating characteristic curve (AUC), and the best clinical and radiomics models were further integrated to develop the final model. Kaplan-Meier analysis with a log-rank test was conducted to compare survival curves between high- and low-risk groups stratified by the prediction models. The comparisons demonstrated that the random survival forest (RSF) clinical model (mean AUC = 0.755) and the Cox-least absolute shrinkage and selection operator (Cox-LASSO) radiomics model (mean AUC = 0.636) outperformed other machine learning algorithms. The integration of the clinical (RSF) and radiomics (Cox-LASSO) models achieved a mean AUC of 0.777 in predicting tumor recurrence. The log-rank analysis revealed significant differences in the survival curves between the high- and low-risk groups stratified by the integration model on the testing sets. In conclusion, the integration of clinical and CT-based radiomics models was helpful for the pretreatment prediction of tumor recurrence in patients with breast cancer after NST.

Introduction: Cor Triatriatum Sinister (CTS) is a rare congenital anomaly, accounting for 0.1%- 0.4% of congenital heart diseases. While often diagnosed and treated in infancy, some cases remain asymptomatic until adulthood due to large fenestrations. This report presents a unique case of CTS in an adult coexisting with chronic adhesive pericarditis, which may have contributed to chronic atrial dilatation, a condition not previously documented. Case Presentation: A 60-year-old asymptomatic Taiwanese male underwent a routine medical examination. Coronary computed tomography angiography revealed a fenestrated septum dividing the left atrium, consistent with CTS. Virtual endoscopy confirmed two wide fenestrations. Notably, chronic adhesive pericarditis, evidenced by curvilinear calcifications, was diagnosed. This condition likely exacerbated the hemodynamic impact of CTS, contributing to left atrial dilation and atrial fibrillation. Atrial fibrillation was identified, and the patient was treated with an anticoagulant for stroke prevention. Conclusion: This is the first reported case of CTS coexisting with chronic adhesive pericarditis. Advanced imaging modalities, including cardiac computed tomography, angiography, and virtual endoscopy, are crucial for diagnosis and anatomical evaluation. Chronic adhesive pericarditis may amplify the effects of CTS, leading to complications, including atrial fibrillation. Anticoagulation is essential for stroke prevention in such cases.

It is challenging for radiologists to diagnose pulmonary metastases when they encounter only a few (n ≤ 5) small pulmonary nodules (< 10 mm) on staging CT in breast cancer patients. We conducted this study to assess clinical and imaging features related to metastasis for better risk stratification. Retrospective analysis of 249 pulmonary nodules present at the baseline CTs of 194 patients diagnosed with breast cancer between 2014 and 2021 was performed. The evaluated features included nodular characteristics, perifissural nodules, associated imaging findings, clinical stage, and breast cancer subtype. Nodules with interval change were determined to be metastases. A large proportion of the patients had single nodule (78.9%) presence, and most of the nodules were less than 6 mm (86.3%). Among the 249 nodules, 63 (25.3%) nodules were in metastases. The independent predictors were nodule ≥ 6 mm, mediastinal/hilar lymphadenopathy, clinical Stages III and IV, and triple-negative breast cancer subtype. Nodules (≥ 6 mm) were assessed as weak evidence to rule in metastasis, and the results were as follows: positive likelihood ratio (+LR), 3.74; sensitivity, 30.2%; and specificity, 91.9%. With weak evidence of small pulmonary nodules (≧ 6 mm) to rule in metastases, it may be appropriate to follow the recommendations of growing nodule management. By contrast, the nodular shape, margin, location, perifissural nodules, and pleural tag did not show an association with metastasis.

This study examined whether CT metrics at the 12th thoracic vertebra (T12) can replace those at the 3rd lumbar vertebra (L3) for diagnosing sarcopenia, and analyzed their impact on outcomes in esophageal squamous cell carcinoma (ESCC). We retrospectively reviewed 405 CT scans (person-times) of 206 ESCC patients (stages II–IV) who had received chemoradiotherapy (CRT). Metrics including Skeletal Muscle Index (SMI), Skeletal Muscle Attenuation (SMA), Intramuscular Adipose Content (IMAC), and Visceral-to-Subcutaneous Adipose Tissue Ratio (VSR) were measured at both T12 and L3. These were compared with clinical outcomes. Significant correlations were found between body composition parameters measured at T12 and L3, with Spearman’s coefficients of 0.62 for SMI, 0.72 for SMA, 0.59 for IMAC, and 0.46 for VSR (all p < 0.01). After adjusting for age, gender, and tumor stage, a low post-CRT T12 SMI was significantly associated with reduced overall survival (adjusted hazard ratio = 1.56, p = 0.04), which corresponded to low post-CRT L3 SMI (adjusted hazard ratio = 1.65, p = 0.04). We concluded that measuring skeletal muscle at T12 can effectively diagnose sarcopenia using chest-only CT scans. Post-CRT T12 SMI may serve as a prognostic indicator for ESCC patients. Question Assessing sarcopenia in esophageal cancer patients is crucial for prognosis, yet traditional metrics rely on the 3rd lumbar vertebra, which may not be optimal. Findings Our study demonstrates that the muscle index at the 12th thoracic vertebra correlates well with that of the 3rd lumbar vertebra, effectively predicting patient survival. Clinical relevance Evaluating sarcopenia at the 12th thoracic vertebra via chest CT offers a reliable prognostic tool for esophageal squamous cell carcinoma patients, potentially improving survival predictions after chemoradiotherapy.

BackgroundMore than 50% of esophageal cancer patients are diagnosed with advanced diseases and commonly experience dysphagia, some of whom even have tracheoesophageal fistula. Self-expandable metal stent (SEMS) is one of the recommended palliative methods, although complications such as chest pain and stent migration are not uncommon. The goal of this study was to examine the predictors of stent migration.MethodsWe conducted a retrospective cohort study to include patients with esophageal cancer and dysphagia/tracheoesophageal fistula. Clinicopathological information, stent characteristics and patient outcomes were collected for analysis, while side-effects of SEMS were recorded, potential predictors were examined, and patients’ nutritional outcomes were compared in the migration and non-migration groups.ResultsA total of 54 patients with esophageal cancer who received fully covered SEMS between 2013 and 2022 were included. We found tumor across the esophagogastric junction (adjusted odds ratio (OR) = 32.64, P = 0.01) and the female sex (adjusted OR = 12.5, P = 0.02) were significant predictors for stent migration. There was a decreasing tendency in body mass index/body weight in migration and non-migration groups, but the former had a steeper downslope.ConclusionFully covered SEMS is a safe and effective strategy to palliate dysphagia or fistula. Tumor across esophagogastric junction and the female sex were higher risk predictors of stent migration. A careful patient selection would optimize the effects of SEMS placement, especially in those with short-expected lifespan.

Background:Domestic and foreign studies on lung cancer have been oriented to the medical efficacy of low-dose computed tomography (LDCT), but there is a lack of studies on the costs, value and cost-effectiveness of the treatment. There is a scarcity of conclusive evidence regarding the cost-effectiveness of LDCT within the specific context of Taiwan. This study is designed to address this gap by conducting a comprehensive analysis of the cost-effectiveness of LDCT and chest X-ray (CXR) as screening methods for lung cancer. Methods:Markov decision model simulation was used to estimate the cost-effectiveness of biennial screening with LDCT and CXR based on a health provider perspective. Inputs are based on probabilities, health status utility (quality-adjusted life years (QALYs)), costs of lung cancer screening, diagnosis, and treatment from the literatures, and expert opinion. A total of 1,000 simulations and five cycles of Markov bootstrapping simulations were performed to compare the incremental cost-utility ratio (ICUR) of these two screening strategies. Probability and one-way sensitivity analyses were also performed. Results:The ICUR of early lung cancer screening compared LDCT to CXR is $-24,757.65/QALYs, and 100% of the probability agree to adopt it under a willingness-to-pay (WTP) threshold of the Taiwan gross domestic product (GDP) per capita ($35,513). The one-way sensitivity analysis also showed that ICUR depends heavily on recall rate. Based on the prevalence rate of 39.7 lung cancer cases per 100,000 people in 2020, it could be estimated that LDCT screening for high-risk populations could save $17,154,115. Conclusion:LDCT can detect more early lung cancers, reduce mortality and is cost-saving than CXR in a long-term simulation of Taiwan's healthcare system. This study provides valuable insights for healthcare decision-makers and suggests analyzing cost-effectiveness for additional variables in future research.

Background: Low-dose computed tomography (LDCT) has been widely adopted for lung cancer screening due to its proven ability to reduce lung cancer mortality, especially among high-risk populations. Methods: This retrospective study aims to evaluate the impact of LDCT screening on non-small cell lung cancer (NSCLC) staging at Kaohsiung Medical University Hospital (KMUH) from 2011 to 2020, following the introduction of LDCT in 2013. The study examines the correlation between LDCT screening volume and changes in the distribution of NSCLC stages, particularly early-stage (stages 0 and I) and late-stage (stage IV) diagnoses. Additionally, it explores the differences in histopathological subtypes, focusing on adenocarcinoma and squamous cell carcinoma, and assesses the impact of early detection on five-year survival rates. Results: The results show a significant increase in early-stage NSCLC diagnoses, particularly in adenocarcinoma cases, where early-stage diagnoses rose from 10.4% in 2010 to 38.7% in 2019. However, the number of stage IV cases remained stable, indicating that LDCT may not substantially reduce late-stage diagnoses. Pearson’s correlation analysis demonstrated a strong positive correlation between LDCT screening and early-stage NSCLC detection, particularly for adenocarcinoma (p < 0.001), though the early detection of squamous cell carcinoma and small cell carcinoma remained limited. Conclusions: The study concludes that LDCT screening plays a crucial role in improving early NSCLC detection and five-year survival rates. Future research should focus on optimizing screening strategies to capture more at-risk populations and enhance the detection of harder-to-diagnose subtypes like squamous cell carcinoma.

Interstitial pneumonia with autoimmune features (IPAF) is a new disease entity proposed in 2015. Numerous questions regarding IPAF require clarification, including diagnostic criteria, standard managements for stable disease and exacerbation, and prognosis. We report a case of a 67-year-old Asian woman who presented with progressive dyspnea. Chest computed tomography (CT) scans revealed nonspecific interstitial pneumonia. Serologic testing indicated positive anti-Jo-1 without presence of extrathoracic manifestations. An IPAF diagnosis was made after a multidisciplinary discussion. The patient experienced a severe exacerbation requiring mechanical ventilation, and she was successfully salvaged with methylprednisolone pulse therapy and single-dose cyclophosphamide. During the one-year follow-up, she reported bilateral leg muscle weakness with noticeably elevated serum creatine kinase, suggesting polymyositis. The development of malignancy was also noted 15 months after the initial presentation, and the patient eventually died. This report demonstrated successful salvage treatment with glucocorticoid pulse therapy for IPAF with acute exacerbation. However, the maintenance therapy failed to control disease progression. The treatment strategies for exacerbation and stable disease in IPAF remain unknown and need further studies. Given the high risk of evolution into a defined connective tissue disease (CTD), regular evaluation of the clinical features and biomarkers of CTDs is essential for patients with IPAF.

To develop a multitask deep learning (DL) algorithm to automatically classify mammography imaging findings and predict the existence of extensive intraductal component (EIC) in invasive breast cancer. Mammograms with invasive breast cancers from 2010 to 2019 were downloaded for two radiologists performing image segmentation and imaging findings annotation. Images were randomly split into training, validation, and test datasets. A multitask approach was performed on the EfficientNet-B0 neural network mainly to predict EIC and classify imaging findings. Three more models were trained for comparison, including a single-task model (predicting EIC), a two-task model (predicting EIC and cell receptor status), and a three-task model (combining the abovementioned tasks). Additionally, these models were trained in a subgroup of invasive ductal carcinoma. The DeLong test was used to examine the difference in model performance. This study enrolled 1459 breast cancers on 3076 images. The EIC-positive rate was 29.0

Primary pulmonary meningioma (PPM) is a rare tumor and only sporadic cases have been reported. Here, we report a case with complete clinical procedure and imaging data including chest radiography, preoperative CT, CT-guided biopsy, and postoperative pathological results. A 66-year-old male was found to have an incidental left lung nodule on chest radiography following a traffic accident. Chest CT revealed a 3.0 × 1.9 × 2.3 cm solid nodule with a well-circumscribed margin and slightly homogeneous enhancement in the lower lobe of the left lung. (Figure 1A) CT-guided biopsy suggested a provisional diagnosis of low-grade epithelioid tumor positive for EMA and negative for SSTR2A in immunohistochemistry. For pathological confirmation, video-assisted thoracoscopic lobectomy of the lower lobe of the left lung was performed under the impression of stage IB(T2aN0M0) non-small cell lung cancer with visceral pleural invasion. Macroscopically, the tumor manifested as a yellowish-white and well-circumscribed firm nodule; while microscopically, it was composed of meningothelial-like cells and spindle-shaped cells arranged in whorl and fascicular patterns. Immunohistochemical stains were positive for EMA and SSTR2A. (Figure 1B–D) The results of tests for CK, CD34, STAT6, and TLE were negative. Negative staining was used to differentiate PPM from solitary fibrous tumor and synovial sarcoma. There was no malignant feature. As postoperative brain MRI revealed negative findings, this case was diagnosed as a benign PPM. No tumor recurrence was observed in the one-year follow-up CT study. PPMs are extremely rare. A total of 70 patients (including our case) have been diagnosed with PPM and reported in the English literature.1, 2 Most PPMs are benign (0.4–6.5 cm in diameter), but five malignant PPMs (1.5–15 cm) have been reported. Radiologically, a PPM typically presents as an isolated, well-defined solid nodule1; however, some PPMs may present as ground-glass density nodules or multiple solid nodules.1, 3 PPMs have various enhancement CT manifestations, and the pattern of lesion enhancement might not help to determine whether the PPM is benign or malignant. On 18F-FDG PET, most PPMs exhibit high or slightly high metabolic activity, but four PPMs showed low uptake of 18F-FDG.1 Additionally, one recent study reported increased glucose uptake in synchronous benign and malignant PPMs.4 This result suggested that the malignancy of PPM might not be correlated with 18F-FDG uptake. Some PPM patients have a known history of malignancy1 so a comprehensive and careful evaluation of pulmonary lesions must be carried out to differentiate between primary lung lesions and metastasis. Additionally, it is difficult to distinguish PPM from other lung tumors through radiological findings only, pathological examination for the suspicious lesion is important for the diagnosis of PPM. Histologically, the tumor cells are arranged in sheets, whorls, or onion peel-like formations. Immunohistochemistry manifested tumor cell positivity for SSTR2A, EMA, and PR, and negative for STAT6 and SOX as is the characteristic of a meningioma.5 Solitary fibrous tumor, synovial sarcomas, and schwannoma are the diseases that should be considered in the histopathlogical differential diagnosis of PPMs. Solitary fibrous tumor reveals positive for STAT6. Synovial sarcomas show positive for SSTR2A, EMA, and ILA. Schwannoma reveals positive for SOX10 and negative for SSTR2A. However, the immunohistochemical profile of meningioma might be overlapped with other entities such as solitary fibrous tumor.5 Our case was misdiagnosed as having a low-grade epithelioid tumor positive for EMA and negative for SSTR2A based on CT-guided biopsy. It was worth reviewing that this case was not sent a frozen section before lobectomy. This tumor was peripheral. A wedge resection might replace lobectomy if a benign PPM was diagnosed on frozen section before lobectomy. Diagnosis of a PPM relies on the presence of the tumor in the lungs and exclusion by a meningioma in the CNS. Surgical resection of PPM is the treatment of choice, and no relapse has been reported in benign cases after complete resection. The authors declare no conflict of interest.

Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is a chronic autoimmune disorder characterized by mass-forming sclerosing lesions, elevated IgG4 levels, and tissue infiltration by IgG4-positive plasma cells. While commonly affecting multiple organs, sole lung involvement in IgG4-RD, is relatively rare or underreported. We present an uncommon case of IgG4-RD with isolated lung involvement, manifesting as a pseudotumor in the patient's lung. We report a 76-year-old Asian male with a history of spontaneous secondary pneumothorax, related to bilateral bullous emphysema, and chronic obstructive pulmonary disease (COPD). He was seen in our emergency department with acute dyspnea, general weakness, and right chest pain. Chest x-ray confirmed recurrent right-side pneumothorax, requiring emergent surgical decompression. Preoperative images of contrast-enhanced chest computed tomography (CT) revealed a nodule with calcified flecks, adjacent to a cyst, raising the suspicion of lung cancer (Figure 1A). Bilateral pulmonary wedge resection was performed in order to treat recurrent pneumothorax and acquire a pathologic diagnosis of the nodule abutting the cyst (Figure 1B). Histopathological analysis revealed lung parenchyma with cystic change and a dense infiltration of lymphoplasmacytic cells, stromal fibrosis, and obliterative phlebitis (Figure 1C, D). Immunohistochemistry demonstrated 155 IgG4-positive cells per high power field (HPF) and an IgG4/IgG ratio of 55% (Figure 1E–G). Laboratory findings showed increased serum levels of IgG (1897 mg/dL; normal: 540–1822 mg/dL), IgG4 (616 mg/dL; normal: 3–201 mg/dL), and immunoglobulin E (IgE) (281 IU/mL; normal: <87 IU/mL). Complement components C3 and C4 were within normal range. The systematic survey of other organs has not shown other manifestations of IgG4-RD, solely lungs were involved. The patient was then initiated on first-line therapy with oral dexamethasone, and anti-rheumatic with oral hydroxychloroquine. Over a 3-month follow-up at rheumatology outpatient department, his IgG and IgG4 serum levels have declined, showing no signs of disease relapse. Isolated lung IgG4-RD is rarely reported, with only less than 20 published cases thus far. Similar to previously reported cases, correctly diagnosing IgG4-related lung disease (RLD) can be challenging especially when the disease manifests as a pseudotumor. It is crucial for physicians to correctly recognize this underestimated diagnosis, to minimize excessive resection and to avoid unnecessary surgeries. The 2019 ACS/EULAR classification provides a comprehensive scoring system based on clinical, biological, imaging, and histological findings, giving us characterization of IgG4-RLD.1 Umehera et al.'s diagnostic criteria established three definitive features of IgG4-RLD: (1) CT-objectified thoracic organ involvement, (2) IgG4 levels above 135 mg/dL, and (3) IgG4+ cell infiltration >10/HPF with an IgG4+/IgG+ ratio >40%.2 Our case fulfills all three Umehera's criteria, making the diagnosis of IgG4-RLD certain.3 First-line therapy with corticosteroids is usually effective for disease control and to prevent disease relapse, while early administration of anti-rheumatic drugs remains a subject of divided consensus.4, 5 IgG4-RLD, especially sole involvement of the lungs, is a relatively rare manifestation, and is effectively treated by steroid therapy. The IgG4-RLD should be taken into a possible entity in differential diagnosis of mass-forming lung lesion, even when no other organ manifestation is clinically apparent at the time of diagnosis. The authors declare no conflict of interest.

This study investigated the relationship between body composition parameters and changes in future liver remnant volume (FLRV) in hepatocellular carcinoma (HCC) patients undergoing portal vein embolization (PVE) in preparation for right hepatectomy. This retrospective study enrolled 21 patients between May 2013 and October 2020. Body composition parameters, including skeletal muscle attenuation (SMA), skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR), were measured by computed tomography (CT) prior to PVE. Liver volumetry was measured before and at least 5 weeks after PVE. The mean interval between two CT volumetries was 9.1 ± 4.9 weeks, the mean value of increase in FLRV (ΔFLRV) was 236.0 ± 118.3 cm3 , the ratio of increased FLRV (ΔFLRV%) was 55.7 ± 29.4%, and the rate of increased FLRV was 31.0 ± 18.8 (cm3 /week). Subjects with high IMAC showed significantly lower (p = 0.044) ΔFLRV% than those with normal IMAC. Furthermore, ΔFLRV% was linearly reduced (p for trend = 0.043) among those with low Ishak fibrosis stage (<3) + normal IMAC (76.1 ± 36.8%), those with low Ishak fibrosis stage (<3) + high IMAC or high Ishak fibrosis stage (>3) + normal IMAC (54.0 ± 24.1%), and those with high Ishak fibrosis stage (>3) + low IMAC (28.7 ± 1.6%) (p for trend = 0.043). Our data indicated that high IMAC with a high Ishak fibrosis stage (>3) had a significant negative effect on ΔFLRV%.

BACKGROUND:In Taiwan, lung cancers occur predominantly in never-smokers, of whom nearly 60% have stage IV disease at diagnosis. We aimed to assess the efficacy of low-dose CT (LDCT) screening among never-smokers, who had other risk factors for lung cancer. METHODS:The Taiwan Lung Cancer Screening in Never-Smoker Trial (TALENT) was a nationwide, multicentre, prospective cohort study done at 17 tertiary medical centres in Taiwan. Eligible individuals had negative chest radiography, were aged 55-75 years, had never smoked or had smoked fewer than 10 pack-years and stopped smoking for more than 15 years (self-report), and had one of the following risk factors: a family history of lung cancer; passive smoke exposure; a history of pulmonary tuberculosis or chronic obstructive pulmonary disorders; a cooking index of 110 or higher; or cooking without using ventilation. Eligible participants underwent LDCT at baseline, then annually for 2 years, and then every 2 years up to 6 years thereafter, with follow-up assessments at each LDCT scan (ie, total follow-up of 8 years). A positive scan was defined as a solid or part-solid nodule larger than 6 mm in mean diameter or a pure ground-glass nodule larger than 5 mm in mean diameter. Lung cancer was diagnosed through invasive procedures, such as image-guided aspiration or biopsy or surgery. Here, we report the results of 1-year follow-up after LDCT screening at baseline. The primary outcome was lung cancer detection rate. The p value for detection rates was estimated by the χ2 test. Univariate and multivariable logistic regression analyses were used to assess the association between lung cancer incidence and each risk factor. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LDCT screening were also assessed. This study is registered with ClinicalTrials.gov, NCT02611570, and is ongoing. FINDINGS:Between Dec 1, 2015, and July 31, 2019, 12 011 participants (8868 females) were enrolled, of whom 6009 had a family history of lung cancer. Among 12 011 LDCT scans done at baseline, 2094 (17·4%) were positive. Lung cancer was diagnosed in 318 (2·6%) of 12 011 participants (257 [2·1%] participants had invasive lung cancer and 61 [0·5%] had adenocarcinomas in situ). 317 of 318 participants had adenocarcinoma and 246 (77·4%) of 318 had stage I disease. The prevalence of invasive lung cancer was higher among participants with a family history of lung cancer (161 [2·7%] of 6009 participants) than in those without (96 [1·6%] of 6002 participants). In participants with a family history of lung cancer, the detection rate of invasive lung cancer increased significantly with age, whereas the detection rate of adenocarcinoma in situ remained stable. In multivariable analysis, female sex, a family history of lung cancer, and age older than 60 years were associated with an increased risk of lung cancer and invasive lung cancer; passive smoke exposure, cumulative exposure to cooking, cooking without ventilation, and a previous history of chronic lung diseases were not associated with lung cancer, even after stratification by family history of lung cancer. In participants with a family history of lung cancer, the higher the number of first-degree relatives affected, the higher the risk of lung cancer; participants whose mother or sibling had lung cancer were also at an increased risk. A positive LDCT scan had 92·1% sensitivity, 84·6% specificity, a PPV of 14·0%, and a NPV of 99·7% for lung cancer diagnosis. INTERPRETATION:TALENT had a high invasive lung cancer detection rate at 1 year after baseline LDCT scan. Overdiagnosis could have occurred, especially in participants diagnosed with adenocarcinoma in situ. In individuals who do not smoke, our findings suggest that a family history of lung cancer among first-degree relatives significantly increases the risk of lung cancer as well as the rate of invasive lung cancer with increasing age. Further research on risk factors for lung cancer in this population is needed, particularly for those without a family history of lung cancer. FUNDING:Ministry of Health and Welfare of Taiwan.

The purpose of the present study was to examine the potential of a machine learning model with integrated clinical and CT-based radiomics features in predicting pathologic complete response (pCR) to neoadjuvant systemic therapy (NST) in breast cancer. Contrast-enhanced CT was performed in 329 patients with breast tumors (n = 331) before NST. Pyradiomics was used for feature extraction, and 107 features of seven classes were extracted. Feature selection was performed on the basis of the intraclass correlation coefficient (ICC), and six ICC thresholds (0.7–0.95) were examined to identify the feature set resulting in optimal model performance. Clinical factors, such as age, clinical stage, cancer cell type, and cell surface receptors, were used for prediction. We tried six machine learning algorithms, and clinical, radiomics, and clinical–radiomics models were trained for each algorithm. Radiomics and clinical–radiomics models with gray level co-occurrence matrix (GLCM) features only were also built for comparison. The linear support vector machine (SVM) regression model trained with radiomics features of ICC ≥0.85 in combination with clinical factors performed the best (AUC = 0.87). The performance of the clinical and radiomics linear SVM models showed statistically significant difference after correction for multiple comparisons (AUC = 0.69 vs. 0.78; p < 0.001). The AUC of the radiomics model trained with GLCM features was significantly lower than that of the radiomics model trained with all seven classes of radiomics features (AUC = 0.85 vs. 0.87; p = 0.011). Integration of clinical and CT-based radiomics features was helpful in the pretreatment prediction of pCR to NST in breast cancer.

Systemic adverse effects and poor accumulation at tumor sites constitute important limitations of current chemotherapy in the battle against the majority of cancers. Even though utilization of nanoparticle technology is the preferred treatment modality for improving drug delivery efficiency, achieving controlled drug release and image-guided therapy still pose challenges. In this paper, we developed a tumor microenvironment-responsive gold nanodandelions encapsulating doxorubicin (GNDs@gelatin/DOX) for tumor-targeted imaging and drug delivery. High surface-area GNDs were prepared through a gelatin-mediated process which showed great DOX-loading efficiency. Specifically, GNDs@gelatin/DOX is cleavable by gelatinase (e.g., matrix metalloproteinases −2 and −9) to release the cancer therapeutic agent and aggregate in tissues where these enzymes are upregulated. We demonstrate that GNDs@gelatin/DOX accumulated preferentially in matrix metalloproteinases-2/-9 (MMP-2/-9) overexpressed tumor after intravenous injection, which is useful for computed tomography (CT) imaging-guided chemotherapeutics. Intriguingly, GNDs@gelatin/DOX exhibited the capacity to control and prolong Dox release induced suppression of tumor growth and less cardiotoxicity compared with conventional doxorubicin. In addition, our results show that the alternation of tissue inhibitors of metalloproteinases (TIMP) can attenuate MMP activity, and thus reduce the sensitivity of cancer cells to chemotherapeutics. It is noteworthy that in vivo CT imaging and subsequent inductively coupled plasma-mass spectroscopy (ICP-MS) of harvested tissues revealed that GNDs was found to transport into the gastrointestinal tract and substantial elimination from the mice with prolonged time. In aggregate, GNDs@gelatin/DOX is a highly promising chemotheranostic agent for clinical translation.

A 12-year-old boy with dyspnea secondary to pneumonia and left pleural effusion was referred to our hospital. Although his fever, cough, and dyspnea gradually subsided after antibiotic treatment [amoxicillin-clavulanic acid (90 mg/kg/day) and azithromycin (10 mg/kg/day)] and pleural effusion drainage, he complained of an acute and newly onset chest pain at rest 3 days after. Electrocardiography revealed sinus tachycardia despite normal serum cardiac enzyme levels. Additionally, repeat chest radiography revealed a Palla's sign on the right side (Fig. 1A).

Eisenmenger syndrome (ES) refers to congenital heart diseases (CHD) with reversal flow associated with increased pulmonary pressure and irreversible pulmonary vascular remodeling. Previous reports showed limited therapeutic strategies in ES. In this study, 5 ES patients (2 males and 3 females), who had been followed regularly at our institution from 2010 to 2019, were retrospectively reviewed. We adopted an add-on combination of sildenafil, bosentan, and iloprost and collected the clinical characteristics and outcomes as well as findings of echocardiography, computed tomography, pulmonary perfusion-ventilation scans, positron emission tomography, and biomarkers. The age of diagnosis in these ES patients ranged from 23 to 54 years (38.2 ± 11.1 years; mean ± standard deviation), and they were followed for 7 to 17 years. Their mean pulmonary arterial pressure and pulmonary vascular resistance index were 56.4 ± 11.3 mmHg and 24.7 ± 8.5 WU.m2, respectively. Intrapulmonary arterial thrombosis was found in 4 patients, ischemic stroke was noted in 2 patients, and increased glucose uptake of the right ventricle was observed in 4 patients. No patient mortality was seen within 5 years of follow-up. Subsequently, 2 patients died of right ventricular failure, 1 died of sepsis related to brain abscess, and another died of sudden death. The life span of these patients was 44–62 years. Although these patients showed longer survival, the beneficial data on specific-target pharmacologic interventions in ES is still preliminary. Thus, larger trials are warranted, and the study of cardiac remodeling in ES from various CHD should be explored.

Pediatric pulmonary hypertension (PH) has a similar clinical presentation to the adult disease but is associated with several additional disorders and challenges that require a specific approach for their fulminant course. With improved care for premature infants, various forms of pulmonary vascular disease have been found in children that did not previously exist. Pediatric PH can begin in utero, resulting in pulmonary vascularity growth abnormalities that may persist into adulthood. Here, we retrospectively reviewed several unique pediatric PH cases from 2000 to 2020 at Kaohsiung Medical University Hospital, Taiwan, a tertiary teaching hospital. Their comorbidities varied and included surfactant dysfunction, bronchopulmonary dysplasia, premature closure of the ductus arteriosus, high levels of renin and aldosterone, and Swyer–James–Macleod syndrome. Their clinical profiles, radiological characteristics, echocardiography, pulmonary angiogram, and therapeutic regimens were recorded. Further, because the underlying causes of pediatric PH were complex and markedly different according to age, adult PH classification may not be applicable to pediatric PH in all settings. We also classified these cases using different systems, including the Panama classification and the Sixth World Symposium on PH, and compared their advantages and disadvantages.

Autoimmune pancreatitis (AIP) is a specific type of chronic pancreatitis associated with elevated serum immunoglobulin G4 (IgG4).1, 2 Radiologically, AIP has been recognized as diffuse and focal pattern. The focal AIP is less common but often mistaken for malignancy.2, 3 Here, we reported a focal AIP which was mistaken for pancreatic cancer at initial diagnosis. A 45-year-old male came into the Emergency Department due to right upper quadrant pain and jaundice. The computed tomography (CT) scans showed dilatation of intrahepatic and extrahepatic bile ducts, with abrupt cut-off of common bile duct (CBD) at swelling pancreatic head (Figure 1A). Magnetic resonance imaging showed a well-circumscribed hypointense lesion in pancreatic head with dilatation of upstream bile duct on pre-contrast T1-weighted images (Figure 1B). The lesion enhanced gradually during dynamic enhanced series and showed homogeneous enhancement in delayed phase (Figure 1C). The lesion showed hyperintense on diffusion-weighted images (DWI) (Figure 1D) and hypointense on apparent diffusion coefficient (ADC) map (Figure 1E). Magnetic resonance cholangiopancreatography showed segment stenosis of the main pancreatic duct and bile duct dilatation (Figure 1F). The tumor marker CA 19-9 was slightly elevated (53.57 U/ml). Under the impression of pancreatic malignancy related obstructive jaundice, Whipple operation was carried out for this patient. The gross examination found a tumor-like mass in pancreatic head with size: 3.5 × 3.0 × 3.0 cm (Figure 1G). The pancreatic duct measured 3.0 cm in length and 0.2 cm in greatest diameter. The CBD was also involved. Microscopic examination showed intense lymphoplasmacytic infiltration associated with fibrosis within the lobules and periductal areas of pancreas (Figure 1H). Kappa and lambda light chain stain showed no evidence of light chain restriction. IgG and IgG4 stain showed significant IgG4-positive plasma cells (80%) and the cell count was up to 110 per high power field (Figure 1I). The features were consistent with IgG4 related pancreatitis. The inflammatory fibrosclerosis disease also involved CBD and ampulla of Vater. Serum IgG4 was checked afterward and revealed marked elevation (1300 mg/dl). Distinguishing AIP from pancreatic cancer is challenging because these patients share similar clinical and radiological features. Sometimes marker CA 19-9 and serum IgG4 alone are useless in diagnosis.4 Although difficult, we found the following clues in the retrospective review of this case. Both AIP and pancreatic cancer may present a mass-like lesion with bile duct dilatation, but long segment stenosis without dilatation of upstream pancreatic duct (Figure 1F) is seldom seen in pancreatic cancer. This case showed homogeneous delayed enhancement instead of heterogeneous enhanced featured which is often seen in the pancreatic cancer.5 AIP is a rare inflammatory disease but responds well to steroid therapy.2 Be familial with imaging features and combined with serum study may avoid unnecessary surgery.

Sarcopenia is prevalent in postmenopausal women but is inconclusive in total thyroidectomy and under levothyroxine replacement. We aim to analyze the determinants of sarcopenia and investigate the early detection of sarcopenia in this group. Fifty postmenopausal women with total thyroidectomy were measured for body composition via Dual-energy X-ray Absorptiometry (DXA) and Appendicular Skeletal Muscle mass divided by the height square (ASM/ht2). Handgrip strength and gait speed and Geriatric Nutritional Risk Index (GNRI) were calculated. Eight determinants associated with sarcopenia include GNRI (β, 0.042; 95% confidence interval (CI), 0.021 to 0.064), femoral neck BMD (β, 0.989; 95% CI, 0.049 to 1.929), TSH (β, 0.192; 95% CI, 0.027 to 0.357), and thyroglobulin Ab (0.657; 95% CI, 0.210 to 1.103) for ASM/height2; menopausal years (β, −3.112; 95% CI, −5.661 to −0.563) and ASM/height2 (β, 2.669; 95% CI, 1.073 to 4.265) for handgrip strength; and GNRI (β, 0.062; 95% CI, 0.019 to 0.105), T3 (β, −3.541; 95% CI, −7.019 to −0.063), and age (β, 0.043; 95% CI, 0.003 to 0.084) for gait speed. Our study confirmed a high prevalence of low skeletal muscle mass index in postmenopausal women with total thyroidectomy and revealed a number of determinants that could help early diagnosis and management this disease in daily clinical practice.