Background:Preoperative assessment of human epidermal growth factor receptor 2 (HER2) status relies on invasive biopsy, which is subject to sampling limitations. Meanwhile, conventional contrast-enhanced magnetic resonance imaging (MRI) and radiomics face barriers to widespread adoption due to high costs, complexity, and poor reproducibility. In contrast, non-contrast MRI based on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI)/apparent diffusion coefficient (ADC) offers a non-invasive, cost-effective, and safe alternative. This study aimed to evaluate whether non-contrast T2WI combined with ADC can non-invasively stratify HER2-zero, HER2-low, and HER2-overexpressing invasive breast cancer. Methods:In this retrospective single-center study, 361 women with surgically confirmed invasive breast cancer (February 2015-December 2023) were stratified into HER2-zero expressing (n=63), HER2-low expressing (n=181), and HER2-overexpressing (n=117) cohorts. All underwent preoperative 3 Tesla (T) breast MRI including fat-suppressed (FS) T2WI and DWI. Two readers assessed breast edema score (BES 1-4) and lesion-to-muscle T2 signal ratio (L/M). ADC maps were generated based on the b values of 50 and 800 s/mm2 or 0 and 1,000 s/mm2 DWI MRI data, and clinicopathologic variables were integrated into a predictive model. Independent predictors were identified by multivariable logistic regression and receiver operating characteristic (ROC) analysis. Results:After pairwise comparison, tumor edema extent differed significantly between HER2-low and HER2-overexpressing (P=0.032). Intratumoral T2FS hyperintensity also differed between HER2-zero and HER2-low (P<0.001) and between HER2-low and HER2-overexpressing (P=0.004). Multivariate logistic regression analysis revealed that intratumoral T2FS hyperintensity (P=0.001) and L/M ratio (P=0.004) were independent predictors for differentiating the HER2-zero group from the HER2-low group, whereas ADC values (P<0.001), L/M ratio (P=0.028) and Ki-67 levels (P<0.001) were independent predictors for distinguishing the HER2-low group from the HER2-high group. The predictive model achieved areas under the curve (AUCs) of 0.737 for differentiating HER2-zero versus HER2-low and 0.761 for differentiating HER2-low versus HER2-overexpressing. Conclusions:T2WI-derived edema and signal intensity (SI), together with ADC, may serve as valuable noninvasive MRI biomarkers to complement existing approaches for HER2 level assessment, offering a simple and reproducible adjunctive screening method in clinical practice.

Purpose:Previous studies have revealed alterations of the functional connectivity of the brain networks in ankylosing spondylitis (AS). Fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) are both voxel-based functional metrics capable of estimating local spontaneous neural activities. This study aimed to investigate the local spontaneous neural activities in AS patients by utilizing the analytical approaches of fALFF and ReHo. Patients and Methods:A total of 78 AS patients and 59 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging. fALFF and ReHo maps were generated to identify brain regions with aberrations of spontaneous neural activities in AS patients. Different frequency bands, including the standard frequency band (0.01-0.1 Hz), slow-5 (0.01-0.027 Hz), and slow-4 (0.027-0.073 Hz), were adopted in the fALFF analysis. Results:Compared with HCs, AS patients exhibited extensive alterations of fALFF and ReHo values in brain regions belonging to the default mode network (DMN), salience network (SN), frontoparietal network (FPN), sensorimotor network, visual network and the cerebellum. Clusters found in the slow-5 band only showed significantly decreased fALFF values, whereas the slow-4 was the major contributor to the elevated fALFF values in the standard band. Conclusion:The fALFF and ReHo analyses consistently revealed significantly altered local spontaneous neural activities in AS patients, especially in the DMN, SN and FPN, comprising the triple network model. The slow-4 band might be more sensitive to the elevated fALFF values in AS patients than the slow-5 band. Our findings provide further evidence that the aberrations of the triple network model serve as an important feature of AS from the perspective of local neural activities.

STUDY DESIGN:Diagnostic accuracy study. OBJECTIVE:To evaluate the diagnostic performance of a combined screening method for adolescent idiopathic scoliosis (AIS), integrating scoliometer-based Angle of Trunk Rotation (ATR) measurement with physical examination findings, and to determine optimal screening thresholds. SUMMARY OF BACKGROUND DATA:The scoliometer and Adam Forward Bending Test (FBT) are widely used in AIS screening, but the optimal ATR cutoff and the additive value of clinical signs remain debated. Accurate and efficient school-based screening is essential for early detection and timely intervention. METHODS:This study included 595 participants (458 with AIS and 137 without scoliosis). Screening involved visual inspection, Adam Forward Bending Test (FBT), and Angle of Trunk Rotation (ATR) measurement. Diagnostic confirmation was performed using a standing whole spine x-ray or spine ultrasound. Receiver operating characteristic (ROC) analysis and logistic regression were used to identify the best predictive combination of ATR thresholds and clinical signs. RESULTS:Among the 595 participants, the mean Cobb angle was 21.0˚±8.1˚ for AIS patients and 4.0˚±4.0˚ for non-AIS individuals. An ATR cutoff of 5.5 degrees yielded an AUC of 0.72, with a sensitivity of 73.1% and specificity of 70.8%. Combining ATR ≥5.5 degrees with at least 3 clinical signs (head tilt, shoulder unlevel, waistline asymmetry, and pelvic prominence) improved sensitivity to 84.1% (AUC=0.694). For clinical implementation, a simplified threshold of 5 degrees combined with/or ≥ 3 clinical signs further increased sensitivity to 91.5%, with acceptable specificity (47.4%). Among patients with Cobb angles ≥20 degrees, 10.3% had an ATR <6 degrees, emphasizing the role of clinical signs in identifying severe cases. In sex-specific analyses, girls showed higher sensitivity (89.7%) at an ATR cutoff of 4.5 degrees, compared with boy who had a cutoff of 5.5 degrees, while boys exhibited sensitivity improved when clinical signs were added. A unified threshold of ATR ≥6 degrees combined with/or ≥ 4 clinical signs achieved a sensitivity above 90% for both sexes in detecting severe scoliosis, supporting its practical value for school-based screening. CONCLUSION:Combining ATR with clinical signs substantially enhances AIS screening performance. A practical strategy of ATR ≥5 degrees combine with/or ≥ 3 clinical signs offers balanced sensitivity and specificity for general screening. For detecting severe scoliosis, ATR ≥6 degrees combine with/or ≥ 4 clinical signs is recommended. This structured protocol supports more accurate, sex-adapted and severity-adapted school-based AIS screening.

This study aims to identify predictors of bowel resection due to bowel necrosis in patients with recent portal vein thrombosis (PVT) based on computed tomography (CT) presentations and clinical data. This retrospective study was conducted from January 2013 to June 2023 and included patients with noncirrhotic, nontumoral recent PVT. Patients were followed up from initial hospitalization until September 2023 or death. Presentations on CT images, laboratory tests, adverse events, and clinical outcomes were recorded. Independent predictors of bowel resection due to bowel necrosis were identified using univariate and multivariate logistic regression models. Seventy-six patients (mean age, 41.6 years ± 13.0; 57 males) were evaluated. All patients received low molecular weight heparin, fasting, and intravenous antibiotics during hospitalization, and long-term oral anticoagulation after discharge. CT imaging revealed completely occlusive main portal vein in 73.7

BACKGROUND:Tuberculosis (TB) is a global health burden, and extrapulmonary TB, particularly urogenital TB, is a significant concern in males. Given the nonspecific clinical manifestations of epididymal and/or testicular TB, this study characterizes the MRI features of this condition to facilitate earlier and more accurate diagnosis. METHODS:This retrospective study was approved by the ethics committee. We included 14 patients with epididymal and/or testicular TB (diagnosed between January 2015 and September 2024) who underwent contrast-enhanced MRI scans on a 1.5-T scanner. MRI features and clinical characteristics were analyzed by two experienced radiologists. RESULTS:Among these 14 patients (median age, 44.5 years), 78.6% of them had epididymal TB with or without testicular involvement, while 21.4% had isolated testicular TB. The most common local symptom was a painful scrotal mass (85.7%), and 64.3% reported fever. TB in other sites was identified in 71.4% patients. T lymphocyte spot test was positive in 57.1% patients, and pathological confirmation was obtained in 42.9%. Most lesions (71.4%) were unilateral. On T1-weighted images, 50% of lesions were isointense and 42.9% were mildly hyperintense. T2-weighted imaging showed hypointense signals in 64.3% of cases. All lesions appeared hyperintense on diffusion-weighted imaging, with 92.9% showing restricted diffusion. Heterogeneous or annular enhancement was observed in 85.7% of lesions. Hydrocele was present in all patients, and 21.4% had abscess formation or fistula. CONCLUSIONS:MRI provides valuable soft-tissue characterization for diagnosing epididymal and/or testicular TB. CLINICAL TRIAL NUMBER:Not applicable.

To develop a machine learning (ML)-based model using MRI and clinical risk factors to enhance diagnostic accuracy for axial spondyloarthritis (axSpA). We retrospectively analyzed datasets from four centers (A–D), focusing on patients with chronic low back pain. A subset from center A was used for prospective validation. A deep learning (DL) model based on ResNet50 was constructed using sacroiliac joint MRI. Clinical variables were integrated with DL scores in ML algorithms to distinguish axSpA from non-axSpA patients. Model performance was assessed by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. The study included 1294 patients (median age 31 years [interquartile range 24–42]; 35.5

Purpose:To explore the clinical and imaging features of rare site Kimura's disease (KD).Methods:Retrospective analysis was conducted on the clinical manifestations, laboratory examinations, and imaging features of five patients with rare site KD. All imaging data, including the location, quantity, size, uniformity, boundary, and enhanced appearance of the lesion were evaluated by two independent radiologists.Results:Of the five patients, four were asymptomatic, and one experienced localized skin itching. Four cases involved subcutaneous nodules in the upper arm, while one was in the inguinal region. The main manifestations were single (three cases) or multiple (two cases) subcutaneous nodules/masses, with three patients accompanied by local lymph node enlargement. Four patients exhibited elevated eosinophil counts in their peripheral blood. Four patients had lesions with vascular flow voids; in three of these, the lesions also showed prominent enhancement. Notably, the lesion in a 5-year-old did not show vascular flow voids but displayed significant enhancement. Additionally, two patients showed edema around the lesions.Conclusion:The presence of solitary or multiple subcutaneous nodules/masses in the upper arm or inguinal area, accompanied by lymph node enlargement, elevated eosinophils in the peripheral blood, and the observation of internal vascular within the lesion, can aid in the diagnosis of KD occurring in uncommon anatomical locations.

To evaluate the correlation between dual-energy CT (DECT) virtual calcium free (VNCA), CT attenuation, the ratio and difference of VNCA to CT attenuation, and Pfirrmann grading of lumbar disc degeneration. A retrospective analysis on 135 intervertebral discs from 30 patients who underwent DECT and MR. Discs was graded using the Pfirrmann system. ROIs on the sagittal plane assessed HU value, VNCA value, Rho value, Z value, R-VH value, and D-VH value. Correlation, grade differences, and multivariate regression models were assessed. Diagnostic performance and cut-off values were determined using AUC. VNCA (r = 0.589, P < 0.001), R-VH (r = 0.622, P < 0.001), and D-VH (r = 0.613, P < 0.001) moderately correlated with Pfirrmann grading. HU (r = 0.388, P < 0.001), Rho (r = 0.142, P = 0.102), and Z (r = −0.125, P = 0.153) showed a weak correlation. R-VH, D-VH, and VNCA had significantly higher correlation than HU. Statistically significant differences were observed in P values of VNCA, HU, R-VH, and D-VH in relative groups (P < 0.05), but not in Rho and Z values (P > 0.05). R-VH and D-VH had significant differences between Pfirrmann grades 1 and 2, and grades 2 and 3 (early stage) (P < 0.05). AUC readings of R-VH and D-VH (≥2, ≥3, ≥4) were higher. The multivariate model IVNCa + CT had the highest AUC. The new quantitative indices R-VH value and D-VH value of DECT have advantages over VNCA value and HU value in evaluating early-stage disc degeneration (≥2 grades, ≥3 grades). The multivariate model IVNCa + CT has the best AUC values for evaluating disc degeneration at all stages.

Rationale and Objectives This study aimed to develop predictive models based on conventional magnetic resonance imaging (cMRI) and radiomics features for predicting human epidermal growth factor receptor 2 (HER2) status of breast cancer (BC) and compare their performance. Materials and Methods A total of 287 patients with invasive BC in our hospital were retrospectively analyzed. All patients underwent preoperative breast MRI consisting of fat-suppressed T2-weighted imaging, axial dynamic contrast-enhanced MRI, and diffusion-weighted imaging sequences. From these sequences, radiomics features were derived. Three distinct models were established utilizing cMRI features, radiomics features, and a comprehensive model that amalgamated both. The predictive capabilities of these models were assessed using the receiver operating characteristic curve analysis. The comparative performance was then determined through the DeLong test and net reclassification improvement (NRI). Results In a randomized split, the 287 patients with BC were allotted to either training (234; 46 HER2-zero, 107 HER2-low, 81 HER2-positive) or test (53; 8 HER2-zero, 27 HER2-low, 18 HER2-positive) at an 8:2 ratio. The mean area under the curve (AUCs) for cMRI, radiomics, and comprehensive models predicting HER2 status were 0.705, 0.819, and 0.859 in training set and 0.639, 0.797, and 0.842 in test set, respectively. DeLong's test indicated that the combined model's AUC surpassed the radiomics model significantly (p < 0.05). NRI analysis verified superiority of the combined model over the radiomics for BC HER2 prediction (NRI 25.0) in the test set. Conclusion The comprehensive model based on the combination of cMRI and radiomics features outperformed the single radiomics model in noninvasively predicting the three-tiered HER2 status in patients with BC.

Background Parapharyngeal involvement (PI) is common in local invasion but with different degrees in nasopharyngeal carcinoma (NPC). This study firstly assessed the prognostic value of PI subclassifications divided by parapharyngeal muscles in NPC. Methods 1,752 newly diagnosed NPC patients from two centers were enrolled. The involvement of parapharyngeal muscles including levator veli palatine muscle (LVPMI), tensor veli palatine muscle (TVPMI), medial pterygoid muscle (MPMI) and lateral pterygoid muscle (LPMI) was diagnosed by magnetic resonance imaging (MRI). Univariate and multivariate models were constructed to assess the association between PI and survival. Results The progression-free survival (PFS), overall survival (OS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) between No-PI and LVPMI were similar, p values were 0.446, 0.337, 0.372 and 0.446, respectively, similar to PFS, OS, DMFS and LRRFS between MPMI and LPMI. So PI subclassifications were divided into four degrees: No-PI/LVPMI, TVPMI, MPMI/LPMI, and (infratemporal fossa involvement, IFI). The survival curves among four degrees were statistically different (p < 0.05), except for PFS, OS, and LRRFS between grade 3 and grade 4. Multivariate analyses indicated PI degree (grade 1/2 vs. grade 3/4) was an independent prognostic factor of PFS, OS, DMFS and LRRFS (p < 0.05). If MPMI/LPMI was classified into the T3 stage, there were only 0.6% (10/1,752) incidence rates changing in T2 or T3 stages, and the predictive value was without statistical difference (p > 0.05). Conclusions In NPC patients, it was feasible to divide PI by parapharyngeal muscles. The advanced PI predicted poorer survival outcomes than those with mild PI.

To investigate the application advantages of dual-low technology (low radiation dose and low contrast agent dose) in deep learning image reconstruction (DLIR) compared to the adaptive statistical iterative reconstruction-Veo (ASIR-V) standard protocol when combing coronary computed tomography angiography (CCTA) and abdominal computed tomography angiography (ACTA). Sixty patients who underwent CCTA and ACTA were recruited. Thirty patients with low body mass index (BMI) (< 24 kg/m(2), Group A, standard protocol) were reconstructed using 60% ASIR-V, and 30 patients with high BMI (> 24 kg/m(2), Group B, dual-low protocol) were reconstructed using DLIR at high strength (DLIR-H). The effective dose and contrast agent dose were recorded. The CT values, standard deviations, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured. The subjective evaluation criteria were scored by two radiologists using a blind Likert 5-point scale. The general data, objective evaluation, and subjective scores between both groups were compared using corresponding test methods. The consistency of objective and subjective evaluations between the two radiologists were analyzed using Kappa tests. Group B showed a remarkable 44.6% reduction in mean effective dose (p < 0.01) and a 20.3% decrease in contrast agent dose compared to Group A (p < 0.01). The DLIR-H demonstrated the smallest standard deviations and highest SNR and CNR values (p < 0.01). The subjective score of DLIR-H was the highest (p < 0.01), and there was good consistency between the two radiologists in the subjective scoring of CCTA and ACTA image quality (kappa = 0.751 similar to 0.919, p < 0.01). In combined CCTA and ACTA protocols, DLIR can significantly reduce the effective dose and contrast agent dose compared to ASIR-V while maintaining good image quality.

ObjectiveTo investigate the efficacy and safety of clinical, magnetic resonance imaging (MRI) changes in active ankylosing spondylitis (AS) patients with etanercept and celecoxib alone/combined treatment.MethodsA randomized controlled trial was conducted in three medical centers in China. Adult AS patients with BASDAI ≥4 or ASDAS ≥2.1, CRP >6 mg/L, or ESR 28 mm/1st hour were randomly assigned (1:1:1 ratio) to celecoxib 200 mg bid or etanercept 50 mg qw or combined therapy for 52 weeks. The primary outcomes were SPARCC change of the sacroiliac joint (SIJ) and spine and the proportion of patients achieving ASAS20 response at 52 weeks.ResultsBetween September 2014 and January 2016, we randomly assigned 150 patients (mean age, 32.4 years; mean disease duration, 109 months), and 133 (88.6%) completed the study. SPARCC inflammation scores of the SIJ and spine decreased in the three groups, and significant differences were found between the combined group and the celecoxib group [between-group difference: −6.33, 95% CI (−10.56, −2.10) for SIJ; −9.53, 95% CI (−13.73, −5.33) for spine] and between the etanercept group and the celecoxib group [between-group difference: −5.02, 95% CI (−9.29, −0.76) for SIJ; −5.80, 95% CI (−10.04, −1.57) for spine]. The ASAS20 response rates were 44%, 58%, and 84% in the celecoxib, etanercept, and combined groups, respectively, and a significant difference was only found between the combined and the celecoxib groups.ConclusionEtanercept with or without celecoxib decreases inflammation detected by MRI at 1 year compared to celecoxib alone in active AS patients. The combination of etanercept and celecoxib was superior to celecoxib alone for the primary clinical response.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT01934933.

Objective Evaluate the MRI evidence of active inflammatory and chronic structural damages in radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axial spondyloarthritis (nr-axSpA). Methods A retrospective review of 253 patients who underwent sacroiliac joint (SIJ) MRI between June 2014 and December 2019 was performed. MRI images including short tau inversion recovery scan and T1-weighted spin echo scans were assessed using the Spondyloarthritis Research Consortium of Canada (SPARCC) score and SPARCC MRI SIJ structural score by two independent readers. Results Higher mean score of inflammatory (SPARCC) was seen in r-axSpA patients when compared with nr-axSpA patients (8.08 vs 4.37, P <0.05). Frequencies of MRI structural lesions in r-axSpA patients and nr-axSpA patients were as follows: erosion (65.84 vs 88.23%, P =0.002), backfill (33.17 vs 13.73%, P <0.001), fat metaplasia (79.21 vs 60.78%, P =0.01), and ankylosis (37.13 vs 1.96%, P <0.001). Patients with r-axSpA had a higher mean score for fat metaplasia (8.93 vs 4.06, P =0.0003) and ankylosis (4.49 vs 0.04, P <0.001). Conclusion More active inflammatory and chronic structural damages except for erosion were seen in r-axSpA patients than nr-axSpA patients, while higher percentage of nr-axSpA patients presented with erosion in MRI.

Background: To identify neoplastic and reactive neoformation bone by quantitative CT radiomics analysis, and to further validate the performance of the model by the diagnosis of osteosarcoma (OS) and chondrosarcoma (CS).Methods: A total of 478 bone tumor patients were retrospectively enrolled from 5 hospitals. Crucial radiomics features were selected and employed to construct radiomics signature by Least absolute shrinkage and selection operator (LASSO) regression. Then radiomics signature and clinical characteristics were combined to construct the model identifying neoplastic and reactive neoformation bone (ModelRN) in the training set (n = 300), and then validated in the validation set (n = 178). Furthermore, a new model (ModelOC) incorporating the clinical characteristics and the comprehensive scores produced by ModelRN was constructed to differentiate OS and CS (training set: n = 103; validation set: n = 41). The performance of the model was evaluated with respect to discrimination, calibration, and clinical usefulness. Findings: ModelRN incorporating radiomics signature, tumor position and course of disease achieved promising results with high identification accuracy (AUC: 0.9319 in the training set and 0.9350 in the validation set). ModelOC was built incorporating alkaline phosphatase with the comprehensive score produced by ModelRN. ModelOC also showed satisfying performance in the training (AUC: 0.8752) and validation (AUC: 0.9032) sets. Decision curve analysis showed the clinical usefulness of the model.Interpretation: This study suggested that CT-based radiomics can help radiologists to identify neoplastic and reactive neoformation bone, thereby more effectively distinguishing osteosarcoma from chondrosarcoma than current clinical images diagnosis.Funding Statement: This paper is supported by the National Natural Science Foundation of China (Grant Nos. 81871510, 81871511), Ministry of Science and Technology of China under Grant (No.2017YFA0205200, 2017YFA0700401, 2016YFA0100902, 2016YFC0103803, 2016YFA0201401, 2016YFC0103702).Declaration of Interests: The authors declare no potential conflicts of interest.Ethics Approval Statement: Ethical approval was obtained from the institutional review board (IRB) of the Third Affiliated Hospital of Southern Medical University, and the need for informed consent from the patients was waived.

PURPOSE:To develop and externally validate an MR-based radiomics nomogram from retrospective multicenter datasets for pretreatment prediction of early relapse (≤ 1 year) in osteosarcoma after surgical resection. METHODS:This multicenter study retrospectively enrolled 93 patients (training cohort: 62 patients from four hospitals; validation cohort: 31 patients from two hospitals) with clinicopathologically confirmed osteosarcoma who received neoadjuvant chemotherapy and surgical resection at six hospitals between January 2009 and October 2017. Radiomics features were extracted from contrast-enhanced fat-suppressed T1-weighted (CE FS T1-w) images. Least absolute shrinkage and selection operator (LASSO) regression was applied for feature selection and radiomics signature construction. The radiomics nomogram that incorporated the radiomics signature and subjective MRI-assessed candidate predictors was developed to predict early relapse with a multivariate logistic regression model in the training cohort and validated in the external validation cohort. The performance of the nomogram was assessed by its discrimination, calibration, and clinical usefulness. RESULTS:The radiomics signature comprised six selected features and achieved favorable prediction efficacy. The radiomics nomogram incorporating the radiomics signature and subjective MRI-assessed candidate predictors (joint invasion and perivascular involvement) from the multicenter datasets achieved better discrimination in the training cohort (C-index：0.907, 95 % CI: 0.838-0.977) and external validation cohort (C-index: 0.811, 95 % CI: 0.653-0.970), and good calibration. Decision curve analysis suggested that the combined nomogram was clinically useful. CONCLUSION:The proposed MRI-based radiomics nomogram could provide a non-invasive tool to predict early relapse of osteosarcoma, which has the potential to improve personalized pretreatment management of osteosarcoma.

A 65-year-old woman developed hyperpyrexia, mouth ulcers, coughing, expectoration with blood-stained sputum, right upper quadrant tenderness, and suppurative tonsillitis after receiving 6 weeks of combination treatment with leflunomide, celecoxib, and low-dose methotrexate for active rheumatoid arthritis. On admission, routine blood tests showed agranulocytopenia, severe thrombocytopenia, and a further decrease in hemoglobin concentration compared with relatively normal values for platelet and white cell counts and a slightly reduced hemoglobin concentration 45 days previously. Chest radiography revealed inflammation in both lungs and Murphy sign was positive. Severe bone marrow suppression accompanied by pulmonary infection and acute cholecystitis associated with leflunomide and low-dose methotrexate combination therapy was highly suspected. The patient's complications gradually resolved over 6 weeks of symptomatic treatment. This case highlights that, especially at the beginning of treatment, bone marrow suppression associated with methotrexate and leflunomide combination therapy for anti-rheumatic purpose can be very serious, even when administered in standard doses. Monitoring of blood counts during low-dose methotrexate and leflunomide combination therapy should be mandatory every 2 weeks, especially during the first 3 months of treatment. When blood counts decline rapidly, therapy with methotrexate and leflunomide should be stopped immediately.

Background: There are few studies about the Liver Imaging Reporting and Data System (LI-RADS), which was developed with the purpose of standardizing the interpretation and reporting of liver imaging examinations in patients at risk for hepatocellular carcinoma (HCC). Purpose: To evaluate the diagnostic accuracy of HCC diagnosis using LI-RADS. Material and Methods: The computed tomography (CT), magnetic resonance imaging (MRI), and clinical data of 297 lesions in 249 patients between June 2012 and August 2013 were retrospectively analyzed. Using LI-RADS 2014, two radiologists evaluated the lesions and a LI-RADS category was retrospectively assigned to each nodule. Results: The final diagnoses of 297 nodules in 249 patients consisted of 191 malignant and 106 benign lesions. Out of 44 LI-RADS category 1 lesions, none were HCCs. However, 2/25 category 2 lesions, 3/35 category 3 lesions, 16/25 category 4 lesions, 151/156 category 5 lesions, and 3/12 category LRM/OM (probable malignancy, not specific for HCC/other malignancy) lesions were HCCs. The Kappa value was 0.44 (95% confidence interval [CI]=0.39-0.49) between two observers during LI-RADS grading. Conclusion: The negative predictive value of LI-RADS category 1 was 100%. In addition, a relevant proportion of lesions categorized as category 2 or 3, or even as other malignancies, were HCCs. LI-RADS category 5 had a high specificity for HCC. LI-RADS was not able to give a differential diagnosis for the false-positive lesions of LI-RADS category 5.

Objectifs Résumer les caractéristiques du tissu de comblement (« backfill ») chez des patients souffrant de spondyloarthrite (SpA) axiale et de dorsalgie non spécifique et chez des témoins sains et évaluer la valeur diagnostique du tissu de comblement (« backfill ») pour la SpA axiale.

Objectives: To summarize the characteristics of backfill in patients with axial spondyloarthritis (SpA) and patients with non-specific back pain (NSBP) and healthy controls, and to assess the value of backfill in diagnosing axial SpA.Methods: Three readers blinded recorded backfill seen on T1SE MRI scans from 647 subjects: 297 patients with ankylosing spondylitis (AS), 126 patients with non-radiographic axial SpA (nr-axSpA), 147 patients with NSBP, and 77 healthy controls. The SPARCC SIJ Structural Score (SSS) method was used to assess backfill. The changes of backfill were evaluated by the follow-up MRI scans from 157 patients. We summarized the characteristics of backfill and calculated its sensitivity and specificity for diagnosing axial SpA.Results: Backfill was recorded in 78.8% AS patients, 11.1% nr-axSpA patients, 1.8% patients with NSBP, and no healthy control. Backfill affected more frequently at ilium bone, lower half of sacroiliac joints in axial SpA (both P<0.05). The SSS score of backfill was much higher in axial SpA than in patients with NSBP (both P< 0.01) and it did not correlate with demographics and BASDAI, BASFI, and CRP (all 13> 0.05). The score of backfill only positively correlated with symptom duration in AS (r=0.251, P<0.01) and in nr-axSpA (r=0.743, P< 0.01) patients. Only 8.9% patients had the change of backfill in an average followup time of 1.09 years. Backfill had high specificity (0.98) and moderate sensitivity (0.59) for diagnosing axial SpA.Conclusions: We summarized the characteristics of backfill and found that backfill is a specific sign of axial SpA seen on T1SE MRI. (C) 2015 Published by Elsevier Masson SAS on behalf of Societe francaise de rhumatologie.

恶性肿瘤是现今世界最常见、最棘手的疾患之一,肿瘤的发生是多因素的,包含许多不同的机制.细胞色素P4501B1(CYP1B1)在多种恶性肿瘤中过量表达,尤其是在性激素依赖性肿瘤中表达水平更高.随着研究的深入,对CYP1B1的基因结构和基因多态性及其在肿瘤发生、发展过程中的作用机制也有了较为全面的了解.该文对CYP1B1基因多态性与乳腺癌、肺癌、卵巢癌、子宫内膜癌、前列腺癌及子宫内膜异位症等病变间的关系及CYP1B1可能的致癌机制予以综述.