BACKGROUND: Lung adenocarcinoma is an important pathohistologic subtype of non-small cell lung cancer (NSCLC). Invasive non-mucinous pulmonary adenocarcinomas (INMA) tend to have a poor prognosis due to their significant heterogeneity and diverse histologic components. Establishing a histologic grading system for INMA is crucial for evaluating its malignancy. In 2021, the International Association for the Study of Lung Cancer (IASLC) proposed that a new histological grading system could better stratify the prognosis of INMA patients. The aim of this study was to establish a visualized nomogram model to predict INMA IASLC grading preoperatively by means of dual-energy computed tomography (DECT), fractal dimension (FD), clinical features and conventional CT parameters. METHODS: A total of 112 patients with INMA who underwent preoperative DECT were retrospectively enrolled from March 2021 to January 2025. Patients were categorized into low-intermediate grade and high grade groups based on IASLC grading. The clinical characteristics and conventional CT parameters, including baseline features, biochemical markers, and serum tumor markers, were collected. DECT-derived parameters, including iodine concentration (IC), effective atomic number (eff-Z), and normalized IC (NIC), were collected and determined as NIC ratio (NICr) and fractal dimension (FD). Univariate analysis was employed to compare differences in conventional characteristics and DECT parameters between the two groups. Variables demonstrating statistical significance were subsequently incorporated into a multivariate Logistic regression analysis. A nomogram model integrating clinical data, conventional CT parameters, and DECT parameters was developed to identify independent predictors for IASLC grading of INMA. The discriminatory performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Multivariate analysis identified smoking history [odds ratio (OR)=2.848, P=0.041], lobulation sign (OR=2.163, P=0.004), air bronchogram (OR=7.833, P=0.005), eff-Z in arterial phase (OR=4.266, P<0.001), and IC in arterial phase (OR=1.290, P=0.012) as independent and significant predictors for IASLC grading of INMA. The nomogram model constructed based on these indicators demonstrated optimal predictive performance, achieving an area under the curve (AUC) of 0.804 (95%CI: 0.725-0.883), with specificity and sensitivity of 85.3% and 65.7%, respectively. CONCLUSIONS The nomogram model based on clinical features, imaging features and spectral CT parameters have a large potential for application in the preoperative noninvasive assessment of INMA IASLC grading.
Humans ; Nomograms ; Female ; Male ; Middle Aged ; Tomography, X-Ray Computed/methods* ; Lung Neoplasms/pathology* ; Aged ; Retrospective Studies ; Adenocarcinoma of Lung/pathology* ; Neoplasm Grading ; Adult

Objective:To analyze the CT and MRI manifestations of hepatic angiomyolipoma (HAML) to improve the diagnostic accuracy of HAML.Methods:A retrospective analysis was conducted on the clinical data of 46 cases of HAML confirmed by tumor surgery or biopsy in Yueqing People's Hospital of Zhejiang and Rui'an People's Hospital of Zhejiang from November 2015 to June 2024. Among them, there were 20 males and 26 females, with an average age of (40±18) years. The CT and MRI manifestations of the patients were recorded, and the tumor location, size, shape, boundary, CT density, T 1-weighted imaging, T 2-weighted imaging, diffusion-weighted imaging (DWI), fat suppression sequence, and inverse phase signal were observed. Results:29 cases underwent plain CT scan combined with enhanced scan. Among them, 4 cases (13.8%) had a round shape, 22 cases (47.8%) had a nearly round shape, and 3 cases (10.3%) had an irregular shape. 26 cases (89.7%) had clear boundaries, and 3 cases (10.3%) had unclear boundaries. 5 cases (17.2%) had uniform density, and 24 cases (82.8%) had non-uniform density. The CT value of the tumor was (32±6.8) Hu. 25 cases (86.2%) contained fat tissue within the tumor. Among them, 13 cases (44.8%) were mixed type. After enhancement, the fat tissue and necrotic cystic changes did not enhance, and the soft tissue components showed varying degrees of enhancement in the arterial phase. Among them, 6 cases continued to enhance in the portal venous phase and delayed phase, showing " fast in and slow out" , and 7 cases showed decreased enhancement in the portal venous phase and delayed phase, showing " fast in and fast out" . 17 cases underwent plain MRI scan combined with enhanced scan. Among them, 12 cases were mixed type. On T 2-weighted imaging with fat suppression, it was a mixed high signal, on T 1-weighted imaging, it was an isointense/low signal or mixed low signal, and on DWI, it was a high signal, with partial signal reduction on the inverse phase. 9 cases of tumor septation showed isointense signals on T 1-weighted imaging, 7 cases showed isointense signals on T 2-weighted imaging, and 2 cases showed high signals on T 2-weighted imaging. After enhancement, the mass showed heterogeneous enhancement, with 7 cases showing " fast in and fast out" and 5 cases showing " fast in and slow out" . Conclusion:Plain CT scan shows that HAML is round or nearly round, with non-uniform low density or uniform isodensity. Plain MRI scan shows isointense or slightly high signal on T 2-weighted imaging, low signal on T 1-weighted imaging, and high signal on T 2-weighted imaging with fat suppression. After enhancement, there is significant or mild to moderate enhancement in the arterial phase, with " fast in and fast out" or " fast in and slow out" as the characteristics.

Objective To investigate the application value of 320-slice wide-detector multi-phase left at-rial appendage computed tomography angiography(LAA-CTA)with pulmonary artery(PA)monitoring in the preoperative evaluation of left atrial appendage closure.Methods A retrospective analysis was conducted on the clinical data of 110 patients who underwent LAA-CTA before left atrial appendage closure.Among them,47 patients underwent single-phase enhanced scanning with superior vena cava(SVC)monitoring(con-trol group),and 63 patients underwent multi-phase enhanced scanning with pulmonary artery monitoring(study group).The differences in imaging effects of the left atrial appendage under different monitoring points and phase imaging methods were compared,as well as the accuracy of comparing with the diagnostic results of transesophageal ultrasound(TEE),and the differences in the presentation of thrombus,perithrombus,and hypoperfusion areas in the left atrial appendage.Results The study group could comprehensively display the multi-phase CT value changes of different components(thrombus,peri-thrombotic viscosity,normal blood)within the left atrial appendage cavity,and its evaluation of lesion size and progression was superior to that of the control group.Using TEE as the gold standard,the study group demonstrated better diagnostic ac-curacy for different components and normal regions within the left atrial appendage cavity compared to the control group(P<0.001).Additionally,the study group improved the detection rate of peri-thrombotic vis-cosity,clearly delineated thrombus boundaries,and enhanced diagnostic accuracy(P<0.001).Conclusion Multi-phase LAA-CTA with pulmonary artery monitoring can effectively evaluate the morphological dimensions,thrombus,and peri-thrombotic CT manifestations of the left atrial appendage.It is simple to operate,with an accuracy rate close to the gold standard,providing reliable imaging evidence for preoperative evaluation of left atrial appendage closure.

Objective To investigate the effects of traditional laparoscopic surgery,natural orifice specimen extraction surgery(NOSES),and intersphincteric resection(ISR)on treatment outcomes and quality of life in patients with low rectal cancer.Methods A total of 152 patients with low rectal cancer who were admitted from January 2020 to June 2022,and they were divided into the traditional laparoscopic group(49 cases),the NOSES group(51 cases),and the ISR group(52 cases)according to the surgical method.The operation status,postoperative recovery status,pain,anal function recovery status,quality of life and complications were compared in the 3 groups.Results The operation time of the traditional laparoscopic group[(193.98±12.31)min]was lower than that of the NOSES group[(203.54±15.02)min]and the ISR group[(199.85±11.98)min](P＜0.05),operation time of NOSES group and ISR group was no difference(P＞0.05).The first exhaust time[(60.21±10.05)h],the first time of getting out of bed[(37.52±6.21)h],and the length of postoperative hospital stay[(12.51±1.47)d]in the traditional laparoscopic group were all higher than those in the NOSES group[(51.06±8.67)h,(30.13±4.92)h,and(11.27±)1.23)d]and ISR group[(53.19±9.24)h,(28.97±4.71)h,(11.73±1.35)d](P＜0.05),and there were no statistically significant differences in the first exhaust time,the first time to get out of bed,and the length of postoperative hospital stay between the NOSES and ISR groups(P＞0.05).There was no statistically significant difference in the Visual Analogue Scale(VAS)scores for pain at 4 hours,24 hours,and 48 hours after surgery among the three groups(P＞0.05).The VAS scores of the three groups at 24 hours after surgery were higher than those at 4 hours and 48 hours after surgery,and the difference was statistically significant(P＜0.05).The VAS scores of the three groups at 48 hours after surgery were higher than those at 4 hours after surgery,and the difference was statistically significant(P＜0.05).The NOSES group's Wexner score[(4.93±0.76)points]at 3 months after surgery and Wexner score[(3.21±0.42)points]at 6 months after surgery were lower than those of the ISR group[(6.32±0.93)points,(4.48±0.54)points]and the traditional laparoscopic group[(5.93±0.81)points,(4.01±0.53)points](P＜0.05),and the Wexner score of the 3 groups at 3 months after surgery was lower than that at 1 month after surgery(P＜0.05).The EORTC QLQ-C30 score of the NOSES group at 3 months after surgery was(74.82±4.01)points,and that at 6 months was(85.49±4.93)points,which were higher than those of the ISR group[(67.05±5.03)points and(71.64±4.21)points]and the traditional laparoscopic group[(70.42±3.92)points,(76.28±4.48)points](P＜0.05),and the EORTC QLQ-C30 scores of the traditional laparoscopic group at 3 and 6 months after surgery were higher than those of the ISR group,and the difference was statistically significant(P＜0.05).The EORTC QLQ-C30 score of the 3 groups at 6 months after surgery was higher than that before surgery and 3 months after surgery(P＜0.05),and the EORTC QLQ-C30 score of the 3 groups at 3 months after surgery was higher than that before surgery(P＜0.05).There was no significant difference in the incidence of total complications among the three groups(P＞0.05).Conclusion Compared with traditional laparoscopic surgery for low rectal cancer,the NOSES and ISR methods accelerate postoperative bowel function recovery,and the NOSES methods have advantages in anal function recovery and better and satisfactory quality of life.

Objective To explore the value of MRI functional imaging in the differential diagnosis between inflammatory pseudo-tumors and malignant tumors in the parotid gland.Methods A total of 20 cases with malignant tumors of the parotid gland and 15 cases with inflammatory pseudotumors of the parotid gland were retrospectively analyzed,and all patients were underwent enhanced MRI examinations of the maxillofacial region.All patients had complete MRI examination data and were confirmed by surgical pathology or clinical follow-up results.The morphological manifestations and the characteristics of MRI functional imaging of the parotid gland tumors that was time-signal intensity curve(TIC)type,apparent diffusion coefficient(ADC)were observed,and all imaging mani-festations data of the two groups were statistically analyzed via the x2 test,respectively.Results There were no statistical differ-ences in the morphological manifestations and functional imaging characteristics(TIC type and average ADC value)between the two groups(P＞0.05),while there was statistical difference in maximum ADC value between the two groups(P=0.017).Conclusion There is an overlap in the imaging characteristics of inflammatory pseudotumors and malignant tumors in the parotid gland.The wide distribution range and higher maximum value of ADC in multiple measurements of parotid gland inflammatory pseudotumors have certain significance for the differential diagnosis,thus guiding the clinical formulation of treatment plans.

Objective To investigate the preoperative prediction of the expression level of programmed cell death ligand 1(PD-L1)in non-small cell lung cancer(NSCLC)by a nomogram model constructed with clinical data,conventional CT signs and spectral CT parameters.Methods A retrospective analysis was conducted on 52 patients with pathologically confirmed NSCLC and undergoing preoperative spectral CT examination.The patients were categorized into positive and negative groups according to PD-L1 expression level,and their clinical data,conventional CT signs and spectral CT parameters were collected.Specifically,clinical data included gender,age,Ki-67 and tumor markers;conventional CT signs included tumor density,margins,calcification,spiculation,lobulation,pleural indentation and cavitation;and spectral CT parameters measured in the arterial and venous phases included effective atomic number(Eff-Z),iodine concentration(IC),water concentration(WC)and normalized iodine concentration(NIC).Intergroup differences were analyzed,and multivariate Logistic regression was used to identify independent predictors and establish the prediction model which was evaluated for prediction performance and accuracy using receiver operating characteristic(ROC)curves,calibration curve and decision curve analyses.Results For clinical data,only the difference in gender between two groups had statistical significance(P<0.05).The spectral CT parameters(IC,NIC and Eff-Z)in the arterial and venous phases of PD-L1 positive group were all greater than those of PD-L1 negative group,with statistically significant differences(P<0.05).Multivariate Logistic regression analysis identified gender(P=0.024),venous-phase Eff-Z(P=0.002),and venous-phase IC(P=0.003)as independent predictive factors for PD-L1 expression.The nomogram prediction model constructed with these independent predictors had an area under curve of 0.80,a sensitivity of 88.00%,and a specificity of 59.00%.The calibration curve showed that the predicted values had a high consistency with the actual values.The decision curve revealed that when the high-risk threshold was between 0.10 and 0.83,the model could achieve the maximum net benefit.Conclusion The nomogram model constructed with spectral CT parameters and clinical data has certain value in predicting the expression level of PD-L1 in NSCLC.

Objective To explore the value of MRI functional imaging in the differential diagnosis between inflammatory pseudo-tumors and malignant tumors in the parotid gland.Methods A total of 20 cases with malignant tumors of the parotid gland and 15 cases with inflammatory pseudotumors of the parotid gland were retrospectively analyzed,and all patients were underwent enhanced MRI examinations of the maxillofacial region.All patients had complete MRI examination data and were confirmed by surgical pathology or clinical follow-up results.The morphological manifestations and the characteristics of MRI functional imaging of the parotid gland tumors that was time-signal intensity curve(TIC)type,apparent diffusion coefficient(ADC)were observed,and all imaging mani-festations data of the two groups were statistically analyzed via the x2 test,respectively.Results There were no statistical differ-ences in the morphological manifestations and functional imaging characteristics(TIC type and average ADC value)between the two groups(P＞0.05),while there was statistical difference in maximum ADC value between the two groups(P=0.017).Conclusion There is an overlap in the imaging characteristics of inflammatory pseudotumors and malignant tumors in the parotid gland.The wide distribution range and higher maximum value of ADC in multiple measurements of parotid gland inflammatory pseudotumors have certain significance for the differential diagnosis,thus guiding the clinical formulation of treatment plans.

Objective To investigate the effects of traditional laparoscopic surgery,natural orifice specimen extraction surgery(NOSES),and intersphincteric resection(ISR)on treatment outcomes and quality of life in patients with low rectal cancer.Methods A total of 152 patients with low rectal cancer who were admitted from January 2020 to June 2022,and they were divided into the traditional laparoscopic group(49 cases),the NOSES group(51 cases),and the ISR group(52 cases)according to the surgical method.The operation status,postoperative recovery status,pain,anal function recovery status,quality of life and complications were compared in the 3 groups.Results The operation time of the traditional laparoscopic group[(193.98±12.31)min]was lower than that of the NOSES group[(203.54±15.02)min]and the ISR group[(199.85±11.98)min](P＜0.05),operation time of NOSES group and ISR group was no difference(P＞0.05).The first exhaust time[(60.21±10.05)h],the first time of getting out of bed[(37.52±6.21)h],and the length of postoperative hospital stay[(12.51±1.47)d]in the traditional laparoscopic group were all higher than those in the NOSES group[(51.06±8.67)h,(30.13±4.92)h,and(11.27±)1.23)d]and ISR group[(53.19±9.24)h,(28.97±4.71)h,(11.73±1.35)d](P＜0.05),and there were no statistically significant differences in the first exhaust time,the first time to get out of bed,and the length of postoperative hospital stay between the NOSES and ISR groups(P＞0.05).There was no statistically significant difference in the Visual Analogue Scale(VAS)scores for pain at 4 hours,24 hours,and 48 hours after surgery among the three groups(P＞0.05).The VAS scores of the three groups at 24 hours after surgery were higher than those at 4 hours and 48 hours after surgery,and the difference was statistically significant(P＜0.05).The VAS scores of the three groups at 48 hours after surgery were higher than those at 4 hours after surgery,and the difference was statistically significant(P＜0.05).The NOSES group's Wexner score[(4.93±0.76)points]at 3 months after surgery and Wexner score[(3.21±0.42)points]at 6 months after surgery were lower than those of the ISR group[(6.32±0.93)points,(4.48±0.54)points]and the traditional laparoscopic group[(5.93±0.81)points,(4.01±0.53)points](P＜0.05),and the Wexner score of the 3 groups at 3 months after surgery was lower than that at 1 month after surgery(P＜0.05).The EORTC QLQ-C30 score of the NOSES group at 3 months after surgery was(74.82±4.01)points,and that at 6 months was(85.49±4.93)points,which were higher than those of the ISR group[(67.05±5.03)points and(71.64±4.21)points]and the traditional laparoscopic group[(70.42±3.92)points,(76.28±4.48)points](P＜0.05),and the EORTC QLQ-C30 scores of the traditional laparoscopic group at 3 and 6 months after surgery were higher than those of the ISR group,and the difference was statistically significant(P＜0.05).The EORTC QLQ-C30 score of the 3 groups at 6 months after surgery was higher than that before surgery and 3 months after surgery(P＜0.05),and the EORTC QLQ-C30 score of the 3 groups at 3 months after surgery was higher than that before surgery(P＜0.05).There was no significant difference in the incidence of total complications among the three groups(P＞0.05).Conclusion Compared with traditional laparoscopic surgery for low rectal cancer,the NOSES and ISR methods accelerate postoperative bowel function recovery,and the NOSES methods have advantages in anal function recovery and better and satisfactory quality of life.

Objective:To analyze the CT and MRI manifestations of hepatic angiomyolipoma (HAML) to improve the diagnostic accuracy of HAML.Methods:A retrospective analysis was conducted on the clinical data of 46 cases of HAML confirmed by tumor surgery or biopsy in Yueqing People's Hospital of Zhejiang and Rui'an People's Hospital of Zhejiang from November 2015 to June 2024. Among them, there were 20 males and 26 females, with an average age of (40±18) years. The CT and MRI manifestations of the patients were recorded, and the tumor location, size, shape, boundary, CT density, T 1-weighted imaging, T 2-weighted imaging, diffusion-weighted imaging (DWI), fat suppression sequence, and inverse phase signal were observed. Results:29 cases underwent plain CT scan combined with enhanced scan. Among them, 4 cases (13.8%) had a round shape, 22 cases (47.8%) had a nearly round shape, and 3 cases (10.3%) had an irregular shape. 26 cases (89.7%) had clear boundaries, and 3 cases (10.3%) had unclear boundaries. 5 cases (17.2%) had uniform density, and 24 cases (82.8%) had non-uniform density. The CT value of the tumor was (32±6.8) Hu. 25 cases (86.2%) contained fat tissue within the tumor. Among them, 13 cases (44.8%) were mixed type. After enhancement, the fat tissue and necrotic cystic changes did not enhance, and the soft tissue components showed varying degrees of enhancement in the arterial phase. Among them, 6 cases continued to enhance in the portal venous phase and delayed phase, showing " fast in and slow out" , and 7 cases showed decreased enhancement in the portal venous phase and delayed phase, showing " fast in and fast out" . 17 cases underwent plain MRI scan combined with enhanced scan. Among them, 12 cases were mixed type. On T 2-weighted imaging with fat suppression, it was a mixed high signal, on T 1-weighted imaging, it was an isointense/low signal or mixed low signal, and on DWI, it was a high signal, with partial signal reduction on the inverse phase. 9 cases of tumor septation showed isointense signals on T 1-weighted imaging, 7 cases showed isointense signals on T 2-weighted imaging, and 2 cases showed high signals on T 2-weighted imaging. After enhancement, the mass showed heterogeneous enhancement, with 7 cases showing " fast in and fast out" and 5 cases showing " fast in and slow out" . Conclusion:Plain CT scan shows that HAML is round or nearly round, with non-uniform low density or uniform isodensity. Plain MRI scan shows isointense or slightly high signal on T 2-weighted imaging, low signal on T 1-weighted imaging, and high signal on T 2-weighted imaging with fat suppression. After enhancement, there is significant or mild to moderate enhancement in the arterial phase, with " fast in and fast out" or " fast in and slow out" as the characteristics.

Objective To investigate the preoperative prediction of the expression level of programmed cell death ligand 1(PD-L1)in non-small cell lung cancer(NSCLC)by a nomogram model constructed with clinical data,conventional CT signs and spectral CT parameters.Methods A retrospective analysis was conducted on 52 patients with pathologically confirmed NSCLC and undergoing preoperative spectral CT examination.The patients were categorized into positive and negative groups according to PD-L1 expression level,and their clinical data,conventional CT signs and spectral CT parameters were collected.Specifically,clinical data included gender,age,Ki-67 and tumor markers;conventional CT signs included tumor density,margins,calcification,spiculation,lobulation,pleural indentation and cavitation;and spectral CT parameters measured in the arterial and venous phases included effective atomic number(Eff-Z),iodine concentration(IC),water concentration(WC)and normalized iodine concentration(NIC).Intergroup differences were analyzed,and multivariate Logistic regression was used to identify independent predictors and establish the prediction model which was evaluated for prediction performance and accuracy using receiver operating characteristic(ROC)curves,calibration curve and decision curve analyses.Results For clinical data,only the difference in gender between two groups had statistical significance(P<0.05).The spectral CT parameters(IC,NIC and Eff-Z)in the arterial and venous phases of PD-L1 positive group were all greater than those of PD-L1 negative group,with statistically significant differences(P<0.05).Multivariate Logistic regression analysis identified gender(P=0.024),venous-phase Eff-Z(P=0.002),and venous-phase IC(P=0.003)as independent predictive factors for PD-L1 expression.The nomogram prediction model constructed with these independent predictors had an area under curve of 0.80,a sensitivity of 88.00%,and a specificity of 59.00%.The calibration curve showed that the predicted values had a high consistency with the actual values.The decision curve revealed that when the high-risk threshold was between 0.10 and 0.83,the model could achieve the maximum net benefit.Conclusion The nomogram model constructed with spectral CT parameters and clinical data has certain value in predicting the expression level of PD-L1 in NSCLC.