Volume 102 ·  Issue 03 ·  2022

Since the concept of radiomics was proposed, both domestic and foreign scholars have successively carried out many scientific researches on radiomics. Domestic and foreign research teams and their corresponding research have achieved certain results in radiomics, but we still face many challenges on the clinical application of radiomics-based models. Currently radiomics is still facing challenges. We should certainly pay attention to the research hotspots, existing problems, and future perspectives of radiomics.

As an emerging subspecialty of neurology and neurosurgery, neurocritical care medicine is facing many challenges in its development in China. The lack of innovative theme, rational design and standardized clinical research is the "bottleneck" problem that needs to be solved urgently. In order to solve these problems, multidisciplinary experts and scholars jointly discussed the limitations and challenges of the current development and clinical research of neurocritical care, and summarized six main priority development and research directions, including the mechanism of cerebral edema, outcome prediction and research and development of therapeutic drugs based on new targets; Individualized assessment and management under the guidance of multimodal neurological function monitoring; Prevention and treatment of reperfusion injury after vascular opening; Mechanism, assessment and management strategy of consciousness disorder after brain injury; Establishment of Quality Control and Sustainable Improvement System of Neurocritical Care; Construction of intelligent neurocritical diagnosis and treatment system. It is hoped that these guidelines can promote the development of neurocritical care medicine in China and comprehensively improve the quality of neurocritical care medical services.

Asymptomatic carotid stenosis (aCAS) is an important risk factor for stroke, but opinions on the benefits and risks of screening for aCAS differ. In order to further clarify related issues, Chinese Stroke Society organized domestic experts in related fields to discuss, and formulated the undergraduate statement based on domestic and foreign research progress, evidence-based evidence of aCAS and China's national conditions. This statement proposes that routine carotid artery screening is not recommended for the general population, in order to improve the theoretical and operability of clinicians and related personnel in carrying out aCAS population assessment and management. At the same time, it also proposes clinical issues and public health issues that need in-depth research.

Cancer-associated fatigue (CRF) is a prevalent symptom of cancer patients with high prevalence, which seriously affects the quality of life of patients, may lead to interruption of anti-cancer therapy and affect the therapeutic effect. There is an international consensus on CRF guidelines to guide clinical practice, but oncologists in China have problems such as insufficient understanding of CRF, low diagnosis rate and irregular management. Therefore, the Cancer Rehabilitation and Palliative Care Professional Committee of Chinese Anti-Cancer Association and the Cancer Support and Rehabilitation Treatment Expert Committee of Chinese Society of Clinical Oncology organized domestic experts to integrate the existing diagnosis and treatment guidelines and clinical research, discussed the definition and diagnosis of CRF, pathogenesis and influencing factors, screening and evaluation, intervention and treatment, and formulated this consensus, aiming at providing guiding suggestions for the treatment and management of cancer-related fatigue.

To evaluate the feasibility, robustness and reproducibility of radiomics features derived from lung diffusion-weighted imaging (DWI).

Thirty patients with pulmonary nodules/masses who underwent magnetic resonance imaging examination in the Department of Radiology, the First Affiliated Hospital of Guangzhou Medical University, from January 4 2019 to May 5 2019, including 16 males and 14 females, aged from 27 to 69 (57±11) years, were prospectively collected. Planar echo imaging (EPI) -DWI and fast spin-echo (TSE) -DWI scans were performed under free-breathing conditions. Each scan was repeated at an interval of 5 minutes, and the corresponding apparent diffusion coefficient (ADC) maps were reconstructed. Each DWI and ADC sequence (a total of eight groups of images) were manually segmented by two radiologists, and a total of 396 radiomics features in 6 categories were extracted from each group of images. Consistency correlation coefficient (CCC) and dynamic range (DR) were used to evaluate the robustness of features between two scans, and stable features were defined as both CCC values and DR values ≥0.85. Intra-observer and interobserver reproducibility were evaluated by intra-group correlation coefficient (ICC), and ICC values≥0.75 was considered to be good reproducibility.

Regardless of EPI or TSE technique, the number of robust features extracted fromDWI (TSE: n=197, EPI: n=169) were higher than that of the corresponding ADC (TSE: n=126, EPI: n=148). The proportion of robust features of TSE-DWI、EPI-DWI、TSE-ADC、EPI-ADC was 49.7% (197/396), 42.7% (169/396), 31.8% (126/396) and 37.4% (148/396), respectively. Of the 396 features, 54 (13.6%) of them demonstrated great robustness (CCC and DR≥0.85) and interobserver and interobserver reproducibility (ICC≥0.75) across all sequences.

Radiomics features derived from lung DWI showed robustness and reproducibility. Different sequences and different feature clusters have different proportions of stable features, and some features have good robustness and reproducibility between different scans, different observers, and even different sequences.

To explore the value of radiomics model based on dynamic contrast-enhanced magnetic resonance imaging (MRI) in differentiation fat-poor angiomyolipoma (fp-AML) from alpha-fetoprotein-negative hepatocellular carcinoma (n-HCC) in the background of non-cirrhotic liver.

The complete data of 121 patients from Guangdong Provincial People′s Hospital, Zhongshan Hospital Affiliated to Fudan University and Sun Yat-sen University Cancer Center with hepatic fp-AML and n-HCC confirmed by pathology from October 2010 to July 2020 were retrospectively analyzed. Among them, 75 were males and 46 were females, aged from 23 to 80 (55±12) years. A total of 93 patients from Zhongshan Hospital Affiliated to Fudan University were divided into the training cohort (n=75) and internal test cohort (n=18) according to entry time, and the patients of other 2 hospitals were divided into external test cohort (n=28). The radiomics features were extracted from the preoperative triple-phase contrast-enhanced images. The feature selection algorithm based on Joint Mutual Information Maximisation (JMIM) was used to extract the optimal feature subset, and support vector machine (SVM) was used to build the radiomics model. The diagnostic performance of radiomics model was evaluated using the receiver operating characteristic (ROC) curve, and was compared with that of two radiologists.

In the internal cohort, the area under the curve (AUC) for the differential diagnosis between fp-AML and n-HCC of the radiomics model was 0.819 (with an accuracy of 72.2%), outperforming than radiologist 1 with 10 years of diagnostic experience (AUC=0.542, P=0.029) and radiologist 2 with 2 years of diagnostic experience (AUC=0.375, P=0.004). In the external cohort, the AUC of the radiomics model was 0.772 (with and accuracy of 71.4%), which was comparable to that of radiologist 1 (AUC=0.661, P=0.442) and better than that of radiologist 2 (AUC=0.400, P=0.008).

The radiomics model based on dynamic contrast-enhanced MRI is of high accuracy for preoperatively differentiating hepatic fp-AML from n-HCC in the noncirrhotic liver.

To investigate a preoperative multi-sequence MRI-based radiomic nomogram for prediction of platinum-based chemotherapy sensitivity in patients with epithelial ovarian cancer (EOC).

The complete data of 114 patients with EOC confirmed by surgery and pathology in Nantong Tumor Hospital of Nantong University from January 2015 to May 2020 were retrospectively analyzed, with an average age of 32-76 (57±8) years. All patients underwent platinum-based chemotherapy after maximal cytoreductive surgery. According to whether relapse occurred within 6 months, those patients were divided into platinum-resistant disease (PR, n=39) group and platinum-sensitive disease group (PS, n=75).All patients underwent MRI examination before treatment, and the 3-dimensional solid component of the tumor area of interest (ROI) on T2-weighted image (T₂WI), diffusion weighted imaging (DWI) and T₁-weighted image-enhanced image (T₁CE) were manually delineated using Itk-snap software.Then AK software was imported for radiomics features extracting. They were randomly divided into training group (n=80) and validation group (n=34) in a ratio of 7∶3 (stratified sampling method). Firstly, the radiomics features were initially screened by the method of maximum correlation and minimum redundancy (mRMR), and features with the greatest predictive power were retained. Then, the LASSO regression analysis was performed to select the best features and construct the radiomics model. Univariate analysis was used to screen out clinical relevant factors, which combined with radiomic score (Radscore) was applied to develop a radiomics nomogram by multivariable logistic regression. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate the predictive ability and clinical application value of radiomics model, clinical related factor model and radiomics nomogram.

Compared with the radiomics model (12 optimal radiomics features) and the clinical relevant factors model (residual disease, neutrophil count, carbohydrate antigen 199), the radiomics nomogram model demonstrated the best prediction performance: in the training groups, the AUC (Area Under the ROC Curve), accuracy, sensitivity, and specificity were 0.90 (95%CI:0.82-0.99), 90.0%, 89.0%, and 92.0%, respectively. In the validation groups, the AUC, accuracy, sensitivity, and specificity were 0.89 (95%CI:0.78-1.00), 85.0%, 87.0%, and 80.0%, respectively. DCA shows that the use of nomograms with a threshold in the range of 0.01 to 0.90 has a greater clinical application value in predicting the sensitivity of platinum chemotherapy in patients with EOC.

The multi-sequence MRI-based radiomics nomogram has a high diagnostic value in predicting the sensitivity of platinum-based chemotherapy in patients with EOC.

To evaluate the best radiomic features based prediction model for identifying the histopathological subtypes of invasive adenocarcinoma or noninvasive pulmonary nodules appearing as subsolid nodules.

A total of 352 patients (108 males and 244 females, median age was [M(Q₁,Q₃)]57 (50,65), underwent high-resolution chest CT and appearing as subsolid nodules and further treated by surgical resection whose subsequently pathological results were classified as atypical adenomatous hyperplasia (AAH), carcinoma in situ (AIS), microinvasive carcinoma (MIA), invasive adenocarcinoma (IA), from January 2015 to September 2019, in Radiology Department of Zhongda Hospital Affiliated to Southeast University and Jinling Hospital, Medical School of Nanjing University were retrospectively collected. They were divided into non-invasive group (n=233) and invasive group (n=119) according to pathological findings. According to the ratio of training set: internal test set: external test set, which is about 3∶1∶1,the patients in Zhongda Hospital Affiliated to Southeast University were randomly divided into training set (n=215, non-IA∶IA 155∶60) and internal test set(n=69, non-IA∶IA 52∶17), meanwhile a certain number of patients in Jinling Hospital, Medical School of Nanjing University(n=68, non-IA∶IA 26∶42)were randomly selected as an independent external test set. Particular quantitative parameters of the nodules, radiomic features, morphological characteristics, clinical data, and serum tumor markers were recorded. Radiomic label was constructed using LASSO regression method. The morphological model, CT model and comprehensive model were constructed by binary logistic regression and were verified in test sets, respectively.

Shape_MinorAxis(Gradient),Glszm_ZoneEntropy(LBP) were selected as the two most significant features based on training set. Radiomic tag=1.065 75×Shape_MinorAxis(Gradient)+0.030 58×Glszm_ZoneEntropy(LBP). Comparing the prediction performance of all models in each data cohort, the CT model (Ln(P/1-P)=-2.417 11+1.031 60×Radimic tag+1.203 06×Diameter+1.614 21×(Pleural indentation sign = Y) constructed by radiomic label, pleural depression, and quantitative parameters (diameter, average density) was much better than other models and was chosen as the optimal model, with an AUC of CT models in training cohort and test cohort was 0.954 (95%CI: 0.927-0.981), 0.865 (95%CI:0.764-0.966), better than morphological model 0.857 (95%CI:0.796-0.918), 0.818(95%CI: 0.686-0.949) and comprehensive model 0.951(95%CI: 0.921-0.981), 0.856(95%CI: 0.730-0.982), respectively.

The integrative CT model has a better prediction efficiency for identifying invasive or noninvasive nodules appearing as subsolid nodules.

To clarify the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant on the performance of existing molecular diagnostic assays, and investigate the detection ability of clinical laboratories across China.

The first nationwide external quality assessment (EQA) for molecular detection of Delta variant was carried out based on the non-infectious phage virus-like particles samples, which were prepared by genetic engineering methods and distributed to 8 488 laboratories nationwide. The EQA panel was composed of three Delta variant samples (7.5×10², 1.5×10³ and 6.0×10³ copies/ml), one non-variant weak positive sample and one negative sample. The percentage of agreement (PA) of Delta variant samples with different concentration, the PA of Delta variant and non-variant samples with 7.5×10² copies/ml, the PA of assays used by more than 100 laboratories for Delta variant samples with different concentration and the PA of Delta variant and non-variant samples with 7.5×10² copies/ml were calculated and analyzed.

The data from 8 127 laboratories were available for evaluation. The testing capability of 98.77% (8 027/8 127) of the participating laboratories was found to be competent in reporting correct results for all samples. The overall percentage of agreement (OPA), negative percentage of agreement (NPA) and positive percentage of agreement (PPA) of the samples were 99.64% (40 490/40 635), 99.73% (8 105/8 127), 99.62% (32 385/32 508), respectively. With the decrease of the concentration of the samples, the PPA of Delta variant samples decreased. The PPAs were 99.41% and 99.51% for Delta variant and non-variant samples with 7.5×10² copies/ml, respectively, with no statistical difference (P=0.392). The OPA, NPA and PPA of the assays used by more than 100 laboratories were all greater than 98%, and no statistical difference of the PPAs was identified between Delta variant and non-variant samples with 7.5×10² copies/ml (P>0.05).

Delta variant fails to impair the performance of current molecular diagnostic assays in China. The clinical laboratories have the same detection capabilities for Delta variant and non-variant samples. However, in certain laboratories, further improvement is required to ensure the accurate detection of weak positive samples.

To find out the relationship of the progression rate of amyotrophic lateral sclerosis (ALS) patients with relevant clinical indicators at initial visit so as to enrich the knowledge of ALS at its early stage.

The clinical data of 282 patients diagnosed with ALS at Neurology Department of the First Medical Center, Chinese PLA General Hospital from June 2016 to March 2021 were collected in order to make a retrospective analysis of the dynamic change of the progression rate (ΔFS) and influencing factors, and thus a classification of the progression rate will be summarized.

Among 282 patients, 164 were males and 118 were females. The age of onset was (53±11) years old. The ΔFS had a negative exponential relationship with delay time of diagnosis no matter what kinds of onset the patients experienced (upper limb onset, lower limb onset or bulbar onset). The ΔFS for the limb function sub-group had a similar functional relationship with diagnostic delay in patients with either upper limb onset or lower limb onset. The statistical model indicated that the disease progression rate of ALS at initial visit can be classified into three types (high speed type: ΔFS≥1.0 score/month; moderate speed type: 0.5≤ΔFS<1.0 score/month; low speed type: ΔFS<0.5 score/month). The critical values of the three types in patients with upper limb onset were 8 and 20 months, while 9 and 24 months for lower limb onset patients, and 9 and 36 months for bulbar onset patients. At initial visit, there were significant statistical differences among these three types in age at onset (P=0.008), diagnostic delay (P<0.001), ALS functional rating scale-revised (ALSFRS-R) score (P<0.001) and onset site (P=0.006). The age at onset in moderate speed type was significantly greater than that of the slow speed type [(54.9±10.4) years vs (50.2±9.6) years, P=0.002]. The diagnostic delay in high speed type [6 (4, 10) months] was significantly shorter than that in moderate speed type [12 (8, 19) months, P<0.001] and low speed type [22 (14, 36) months, P<0.001], and the moderate speed type was shorter in comparison with low speed type (P<0.001). As for the ALSFRS-R score, the high speed type [36(32, 39)] was significantly lower than the moderate speed type [39 (36, 42), P<0.001] and low speed type [42 (39, 44), P<0.001], and the moderate speed type was lower in comparison with low speed type (P=0.002). The proportion of cases with upper limb onset in high speed type (20.3%) was significantly lower than that in low speed type (42.2%, P<0.001) and moderate speed type (37.5%, P=0.014). By contrast, the proportion of cases with lower limb onset in high speed type (39.2%) was significantly higher than that in low speed type (28.9%, P=0.023), however no difference was shown between the fast speed type and moderate speed type (32.0%, P=0.061). There was no difference among these three progression types in patients with bulbar onset.

The disease progression rate of ALS at initial visit can be classified into three types including high speed, moderate speed and low speed. At early stage of ALS, ΔFS is affected by onset age, onset site, diagnostic delay and ALSFRS-R score.

To assess the relationship between health-related quality of life (HRQOL) and spinal sagittal parameters in patients with degenerative and isthmic spondylolisthesis before and after surgery, and to provide a biomechanical basis for improving the clinical prognosis of such patients.

A retrospective analysis of 63 patients with lumbar spondylolisthesis who received lumbar fusion surgery in the Department of Spine Surgery, Tianjin Union Medical Center from December 2017 to June 2020 was carried out. There were 16 males and 47 females with a mean age of (59±8) years. Subgroup analyses were conducted based on disease type (degenerative lumbar spondylolisthesis (DS) and the isthmic spondylolisthesis (IS)) and HRQOL scores. Patients were evaluated post-operatively to observe the improvement of symptoms and quality of life. The relationship between operative related factors, HRQOL scores before and after surgery, and spino-pelvic sagittal parameters (including sagittal axis of the spine, lumbar lordosis angle, pelvic incidence angle, pelvic tilt angle (PT), sacral tilt angle, matching degree of pelvic incidence angle (PI) and lumbar lordosis angle (LL), lumbar 1 vertebra plumb line, upper lumbar curve, lower lumbar curve) in the two groups were analyzed. The correlation between the improvement of HRQOL scores and spino-pelvic sagittal parameters in the DS group and the IS group was analyzed and compared.

There were significant differences between postoperative HRQOL scores compared with those before the operation in both the DS and IS groups at three times of follow-up after the operation (all P<0.05). There was no difference in the last HRQOL score, the number of surgical segments, operation time and intraoperative blood loss between the two groups (all P>0.05). The parameters of PT and PI-LL in DS patients with VAS back pain score>3 and ≤3 were statistically different (13.7°±6.4° vs 26.6°±7.4°, 5.1°±8.2° vs 18.2°±13.1°, respectively, both P<0.05), similar results were obtained in IS patients (14.1°±6.9° vs 16.4°±8.7°, 2.9°±9.7° vs 6.8°±9.8°, respectively, both P<0.05). In addition, the parameters of PT and PI-LL between patients with ODI>20 and ≤20 were all statistically different in the two groups at the last follow-up after surgery (all P<0.05). The improvement of VAS back pain score in DS and IS groups was significantly related to the improvement of PT value, respectively (r=0.76, 0.78, both P<0.05). The PT, LL and PI-LL were significantly correlated with the ODI in the DS group (r=0.60, 0.62, 0.50, all P<0.05). There was also a correlation between the improvement of ODI and PT, LL and PI-LL in the IS group, respectively (r=0.22, 0.41, 0.76, all P<0.05).

Certain correlation exists between the HRQOL and spinal sagittal parameters in patients with degenerative and isthmic spondylolisthesis before and after surgery. For the treatment of lumbar spondylolisthesis and improvement of quality of life, the primary goal is to reconstruct the matching degree of the lumbar lordosis angle and PI, and to reduce the PT value to the normal range by tilting the pelvis forward.

Post-stroke immunosuppressive syndrome (SIDS) is one of the serious complications that occur in patients with ischemic stroke, resulting in a decrease in the patient's immune function, which increases the patient's risk of infection, death and disability. Combined with relevant literature and clinical experience, this paper expounds the early identification methods of high-risk patients with SIDS and the potential management and treatment methods. Vascular risk factors, stroke severity, immune cell count, inflammatory immune related factors, nutritional indicators, etc. are the relevant risk factors of SIDS. Managing the risk factors, symptomatic anti-infection therapy, immunomodulatory therapy and intestinal flora intervention, and giving necessary nutritional intervention are potential therapeutic means.