Recent advances in large models demonstrate significant prospects for transforming the field of medical imaging. These models, including large language models, large visual models, and multimodal large models, offer unprecedented capabilities in processing and interpreting complex medical data across various imaging modalities. By leveraging self-supervised pretraining on vast unlabeled datasets, cross-modal representation learning, and domain-specific medical knowledge adaptation through fine-tuning, large models can achieve higher diagnostic accuracy and more efficient workflows for key clinical tasks. This review summarizes the concepts, methods, and progress of large models in medical imaging, highlighting their potential in precision medicine. The article first outlines the integration of multimodal data under large model technologies, approaches for training large models with medical datasets, and the need for robust evaluation metrics. It then explores how large models can revolutionize applications in critical tasks such as image segmentation, disease diagnosis, personalized treatment strategies, and real-time interactive systems, thus pushing the boundaries of traditional imaging analysis. Despite their potential, the practical implementation of large models in medical imaging faces notable challenges, including the scarcity of high-quality medical data, the need for optimized perception of imaging phenotypes, safety considerations, and seamless integration with existing clinical workflows and equipment. As research progresses, the development of more efficient, interpretable, and generalizable models will be critical to ensuring their reliable deployment across diverse clinical environments. This review aims to provide insights into the current state of the field and provide directions for future research to facilitate the broader adoption of large models in clinical practice.
Humans ; Diagnostic Imaging/methods* ; Precision Medicine/methods* ; Image Processing, Computer-Assisted/methods*

Objective: To analyze the results of national external quality assessment (EQA) for transfusion compatibility test from 2018 to 2023, with the aim of providing references for improving laboratory testing quality and ensuring the safety of clinical blood transfusion. Methods: Three EQA programs were conducted annually, each distributing 22 quality assessment samples. Participating transfusion laboratories were required to complete testing within specified deadlines and to submit results along with documentation of testing methodologies, reagents, and equipment used. National Center for Clinical Laboratories (NCCL) conducted statistical analysis of laboratory results, evaluated testing outcomes and related circumstances, and provided feedback to participating laboratories. EQA data from transfusion laboratories across China from 2018 to 2023 were collected and systematically analyzed. Results: From 2018 to 2023, the qualification rates for all five items (ABO forward typing, ABO reverse typing, Rh blood group typing, antibody screening, and cross-matching) were 67.59%, 77.11%, 77.38%, 72.78%, 79.96%, and 85.16%, respectively. The mean qualification rates for ABO forward typing, ABO reverse typing, RhD blood group typing, antibody screening, and cross-matching over the past six years were 96.25%±0.59%, 90.45%±4.52%, 96.05%±0.71%, 90.88%±2.86%, and 88.34%±3.48%, respectively. The qualification rates in 2019, 2020, 2022, and 2023 all showed a stable trend of "blood stations>tertiary hospitals>secondary hospitals". The mean qualification rate of laboratories in secondary hospitals from 2018 to 2023 was significantly lower than those of laboratories in tertiary hospitals and blood stations (P<0.05), while no significant difference was observed between laboratories in tertiary hospitals and blood stations (P>0.05). The micro column agglutination method was the most widely used in all five tests. In the four test items, namely ABO forward typing, ABO reverse typing, antibody screening, and cross-matching, there was a statistically significant difference in the qualification rate of micro column agglutination method compared to other methods (P<0.05). There was a statistical difference in the qualification rate between manual and automated detection using micro column agglutination method in the cross-matching tests (P<0.05), whereas no significant difference was noted for the other test items (P>0.05). Conclusion: From 2018 to 2023, the number of laboratories participating in EQA activities has been increasing year by year, and the qualification rate has shown an overall upward trend. The type of laboratory is a key factor affecting the qualification rate, and the testing capabilities of some laboratories still need to be improved. The micro column agglutination method is widely used in transfusion compatibility tests. The established EQA program effectively monitors quality issues in laboratories, drives continuous improvement, and ensures sustained enhancement of testing standards to safeguard clinical blood safety.

Objective:To summarise and analyse the experience in the diagnosis and management of abdominal aortic endograft infection in recent years.Methods:Retrospectively summarised and analysed the general data, clinical presentation, laboratory and imaging findings, causative organisms and treatment choices of 14 patients with abdominal aortic endograft infection treated in Beijing Friendship Hospital, Capital Medical University, from January 2018 to June 2024, and analysed the prognosis of the patients and the risk factors associated with prognosis.Results:Positive bacterial cultures were 10 out of 14 patients. One non-operatively treated patient died of infectious toxic shock. Thirteen surgically treated patients underwent axillary-bifemoral artery bypass, removal of the infected stent, and closure of the aortic stump. Four of the 13 cases had combined aortoenteric fistula, 3 cases underwent one-stage enterocutaneous fistula repair, 1 case only fistula drainage, 3 cases of gastrojejunal anastomosis, all of them underwent gastric or jejunal nutrient tube implantation. Two of the 13 patients had combined the infection foci spread to the renal artery openings. To save the kidney, intraoperative left kidney autologous renal transplantation was performed in 1 case, and autologous saphenous vein reconstruction from celiac trunk artery-left renal artery and superior mesenteric artery-right renal artery was performed in the other case. All 14 patients were retrospectively summarised and followed up in August 2024, with 5 deaths in the early postoperative period (< 3 months), 3 deaths in the mid- to long-term period (≥3 months), and 5 survivors, with a median follow-up time of 2 years (1-5 years) for surviving patients. Among the 13 operated patients, 4 cases were combined with aortoenteric fistula, and 3 cases died in the early postoperative period; 4 cases of abdominal aortic infection foci involving renal artery openings, 2 cases of early postoperative death; 4 cases with pleural effusion, 4 cases died in the early postoperative period; 2 cases of combined creatinine elevation, 2 cases of early postoperative death; 2 cases of postoperative infection of artificial blood vessels.Conclusions:Abdominal aortic endograft infection are aggressive. The risk of early death is increased in patients who are elderly, in poor general condition, with aortoenteric fistula or with pre-existing cardiac, pulmonary, hepatic and renal insufficiency, but surgery based on adequate anti-infective therapy remains an effective means of saving the patient′s life.

Objective To investigate the value of CT imaging texture analysis in predicting simplified pathological types of thymic epithelial tumors(TETs).Methods The CT data from 114 patients with TETs confirmed by surgical or pathology were analyzed retrospectivel,and the types of TETs were divided into three groups,including low-risk thymoma(LRT)group,high-risk thymoma(HRT)group,and thymic carcinoma(TC)group.First,the texture parameters of CT images were extracted,and then the weighted Rad-score values were obtained,and the predictive performance of the texture features was evaluated by using the receiver operating characteristic(ROC)curve.Results There were 114 TETs patients,including 45 patients with LRT,44 patients with HRT,and 25 patients with TC.Based on CT imaging texture analysis,the area under the curve(AUC)in differentiating LRT and HRT or TC via CT plain scan,arterial phase,and venous phase were 0.776,0.885,and 0.761,respectively.In differentiating HRT from TC,the AUC of CT plain scan,arterial phase,and venous phase were 0.828,0.808,and 0.804,respectively.In differentiating thymoma from TC,the AUC of CT plain scan,arterial phase,and venous phase were 0.808,0.769,and 0.774,respectively.Conclusion CT imaging texture analysis can serve as an effective auxiliary tool for predicting the simplified pathological types of TETs,helping to develop personal-ized treatment plans for TETs patients.CT enhanced scanning of arterial phase texture parameters has the highest differential diag-nostic efficiency.

Objectives:To evaluate the safety and efficacy of implantation of subcutaneous implantable cardioverter defibrillator(S-ICD)after transvenous lead extraction(TLE)in ICD patients without pacing indications. Methods:All patients who underwent TLE at Peking University People's Hospital from June 2018 to October 2023 were consecutively included.TLE indication,S-ICD implantation indication,defibrillation threshold(DFT)test,complications and postoperative follow-up were collected and analyzed. Results:A total of 11 patients with TV-ICD underwent S-ICD implantation after TLE,eight patients were males and median age were 56(44,65)years.The indications for TLE were infection and lead dysfunction.Nine patients were implanted with S-ICD for secondary prevention,and the most common cause of implantation was ion channelopathies(5 cases).The operative time for S-ICD was 51(48,58)minutes and no perioperative complications were noted.Eight patients underwent DFT testing,and 100%were successful.During a median follow up of 30(9,39)months,a total of six appropriate treatments occurred in two patients,and no complications occurred,including inappropriate treatment,ineffective treatment,infection,lead malfunction and death. Conclusions:Our study provides evidence for S-ICD implantation as a replacement after TV-ICD removal.The S-ICD implantation after TLE is safe and effective.

Objectives:To assess the clinical characteristics and lead extraction in patients with venous occlusion related to infection of cardiovascular implantable electronic devices. Methods:Clinical data of 405 patients(147 men,mean age[62.4±13.2]years)who underwent lead extraction from January 2020 to January 2024 in Peking University People's Hospital were reviewed.Contrast venography of the access vein was retrospectively analyzed.The patients were divided into venous occlusion group(n=119)and non-venous occlusion group(n=286)according to the presence or absence of venous occlusion.The clinical characteristics and lead extraction of patients in two groups were analyzed. Results:Occlusion of the access vein occurred in 119 patients(29.4%).The subclavian vein was occluded in 48 cases(40.3%),brachiocephalic vein was occluded in 37 cases(31.1%),axillary vein was occluded in 30 cases(25.2%),superior vena cava was occluded in 4 cases(3.4%).There were no significant differences between venous occlusion group and non-venous occlusion group in terms of age,sex,device type,number of leads,or anticoagulation therapy(all P>0.05).Time from implant of the initial leads was significantly longer in the venous occlusion group than in the non-venous occlusion group([10.4±3.8]years vs.[5.9±4.1]years,P=0.042).Clinical extraction success rate and complications were similar between the venous occlusion group and the non-venous occlusion group(both P>0.05).Procedural duration and fluoroscopy exposure time were significantly lower in non-venous occlusion group than in the venous occlusion group(both P<0.05).Patients in the venous occlusion group required more advanced tools(such as laser sheaths,evolution sheaths,and needle's eye snares)for lead extraction compared to patients in the non-venous occlusion group(84.0%vs.67.1%,P=0.001). Conclusions:The incidence of venous occlusion related to infection of cardiovascular implantable electronic devices is 29.4%.Time from implant of the initial leads is significantly longer and lead extraction is more difficult in patients with venous occlusion,and requires more advanced tools and more time to achieve the successful lead extraction.

Objectives:To evaluate the strategy and clinical outcomes of reimplanting biventricular cardiac resynchronization therapy (Biv-CRT) devices after transvenous removal of coronary sinus left ventricular leads due to device-related infections. Methods:A retrospective analysis was conducted on the clinical data and surgical outcomes of all patients who underwent transvenous removal of infectious coronary sinus left ventricular leads and subsequent reimplantation of Biv-CRT devices at Peking University People's Hospital from January 2013 to December 2022.Follow-up was performed to assess the incidence of complications and all-cause mortality. Results:A total of 167 patients underwent coronary sinus left ventricular lead removal due to infection,removal was successful in 161 cases (96.4％) and failed in 6 cases (3.6％).Among the patients with successful removal,109 cases (67.7％) were scheduled for Biv-CRT device reimplantation.After a median time of 7 (5,7) days,6 cases (5.5％) of reimplantation failed,while 103 reimplantations (94.5％) were successful.Among these successful reimplantation cases,102 patients (99.0％) were through the right-side approach,and 1 case (1.0％) through the left-side approach due to bilateral pocket infections.Of the 161 patients with successful removal,58 cases (36.0％) did not undergo left ventricular lead reimplantation,including 39 cases (24.2％) where the initial indications for Biv-CRT were questionable or had resolved.During the one-year postoperative follow-up,among the 103 patients who had undergone Biv-CRT device reimplantation,7 patients (6.8％) died,1 patient (1.0％) experienced pocket infection,and 1 patient (1.0％) had right atrial lead dislodgment. Conclusions:Reimplantation of Biv-CRT devices after removal of coronary sinus left ventricular leads due to infections is feasible,with a high success rate,low complication rate,and low mortality rate for right-side approach implantation.Therefore,for patients re-evaluated to have indications for repeated Biv-CRT after lead removal,right-side reimplantation of the coronary sinus left ventricular lead should be recommended.

Objective:To evaluate the safety of leadless pacemaker implantation in super-elderly patients.Methods:Eleven patients with average age of 90 (86, 92) years who underwent leadless pacemaker implantation in the Department of Cardiology, Peking University People′s Hospital from March 2021 to May 2022 were included. The clinical data and implantation information were collected. The complications (cardiac tamponade, myocardial infarction, cerebral infarction, pulmonary embolism, pacemaker reinfection, femoral vein hematoma) and death of patients were documented at 24 h, 3 d, and 1, 3, 6 months after pacemaker implantation.Results:There were 9 males and 2 females with the body mass index of 21(19, 23)kg/m 2. The underlying diseases were hypertension, diabetes, coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, previous cerebral infarction and moderate to severe tricuspid regurgitation in 9, 9, 9, 6, 4, 4, 4 patients, respectively. The left ventricular ejection fraction was 49% (45%, 52%), the hemoglobin concentration was 118 (114, 122)g/L, 4 patients were taking anticoagulant drugs, and 6 patients were taking antiplatelet drugs. Eight patients were newly implanted with a leadless pacemaker, 2 patients were implanted after removal the old ones, and 1 case was implanted at the same time as removal. The implantation time was 45(40, 47) minutes, the X-ray exposure time was 14 (13, 15) minutes, the release time was 1 (1, 2), the threshold value was 0.50(0.38, 0.75)V/0.24 ms, the impedance was 730 (700, 770) Ω, and the perceived R-wave amplitude 8.2(6.7, 12.8) mV. During the follow-up period of 8 (6, 10) months, no patient had pacemaker dysfunction; and the threshold, R wave sensing, and impedance were stable and maintained within the normal range. No cardiac tamponade, myocardial infarction, cerebral infarction, pulmonary embolism, pacemaker reinfection or death occurred perioperatively and during the follow-up period; 1 patient had hematoma after femoral vein puncture, which improved after compression treatment. Conclusion:This single-center and small-sample study shows that leadless pacemaker implantation is safe for super-elderly patients.

Objective The aim of this study was to investigate the value of ultrasound in diagnosis of benign and malignant thyroid nodules with rim calcification. Methods Sixty thyroid nodules with rim calcifications from Sun Yat-sen University Cancer center which were detected on ultrasound from January 2008 to December 2015 were included in this study, and all the thyroid nodules had pathological results. Ultrasonic features of thyroid nodules, including the size, border, internal echo, growth pattern, rear echo, interruption or inner sink of the rim calcification and hypoechoic soft tissue extrusion around rim calcification were analyzed. Results Thirty-seven nodules (61.7%) were confirmed to be benign, and twenty-three nodules (38.3%) were malignant. The ultrasonic features of interruption or inner sink of rim calcifications and hypoechoic soft tissue extrusion around rim calcification, were more often in malignant nodules than benign nodules. The sensitivity, specificity, the positive predictive values and the negative predictive values for interruption or inner sink of rim calcifications were 85.7%, 89.4%, 85.7% and 89.4%, respectively. The sensitivity, specificity, the positive predictive values and the negative predictive values for hypoechoic soft tissue extrusion around rim calcification were 81.3%, 94.4%, 92.9% and 85.0%, respectively. Internal hypoechogenicity was more frequently observed in the malignant nodules (82.6%) than in benign nodules (40.5%). The longitudinal growth pattern of thyroid was more frequently observed in malignant nodules (30.4%) than in benign nodules (2.7%). The differences of this two ultrasound features were statistically significant(χ2=9.958 and 9.440,both P<0.01).There were no significant differences in size,border and the rear echo between malignant and benign nodules (all P>0.05). Conclusion The interruption or inner sink of the rim calcification could be useful in differential diagnosis of thyroid nodules with rim calcification.

BACKGROUND:Zinc-modified calcium silicate (CaSiO3) bioceramics coating on the titanium surface prepared in preliminary experiments has good chemical stability and antibacterial property. OBJECTIVE:To observe the effects of zinc-modified CaSiO3 bioceramics coating on osteointegration. METHODS:MC3T3-E1 cels were respectively cultured on the titanium with zinc-modified CaSiO3 bioceramics coating (experiment group), titanium with CaSiO3 bioceramics coating (control group) and pure titanium (blank control group). Then, cel adhesion, proliferation, calcification rate and the expression of type I colagen and osteocalcin were detected. The implant materials mentioned above were respectively inserted into the femurs of New Zealand white rabbits, and after 1.5 months, the osteoproliferation and osteointegration between the implants and the host were tested. RESULTS AND CONCLUSION:In vitro experiment: The number of adhesive cels at 12 hours after co-culture was significantly increased in the experimental group compared with the control group and blank control group (P < 0.05). At 14 days after co-culture, cel proliferation ability and ability of calcium nodule formation in the experiment group were significantly better than those in the other groups (P < 0.05). At 21 days after co-culture, there was no significant difference in the expression of type I colagen, but the expression of osteocalcin in the experiment group was higher than that in the control group and blank control group (P < 0.05).In vivo experiment: In the experiment group, a large amount of bone substances were detected, the coating materials directly contacted with the bone interface, new bone tissues and little fibrous tissues were observed at the interface. In contrast, there was a small amount of bone hyperplasia in the control group and almost no bone hyperplase in the blank control group. Moreover, a small part of the implant directly contacted with the bone interface and the most part was separated from bone trabeculae by fibrous tissues. These findings indicate that zinc-modified CaSiO3 bioceramics coating can enhance the ability of osteointegration between titanium implants and the host.