The recombinant human thyroid-stimulating hormone (rhTSH) can be used for differentiated thyroid cancer (DTC) preparation before ¹³¹I therapy, and follow-up. Since its approval by the American Food and Drug Administration (FDA) in 1998, rhTSH has been clinically used in European countries, the United States, and other countries for nearly 30 years. In April 2024, China’s first independently developed rhTSH agent was approved. Based on clinical experience and evidence from domestic and international studies, an expert consensus on the application of rhTSH has been developed following thorough consultations among experts. The consensus offers evidence-based recommendations to guide the appropriate use of rhTSH in clinical practice.

Objective:To investigate the value of habitat radiomic features based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI in establishing a predictive model for cytokeratin 19 (CK19) expression in hepatocellular carcinoma (HCC) and to evaluate its role in prognostic risk stratification.Methods:This multicenter case-control study retrospectively enrolled 489 patients with pathologically confirmed HCC who underwent Gd-EOB-DTPA-enhanced MRI between June 2016 and June 2024. Among them, 346 patients from the First Affiliated Hospital of Soochow University were divided into a training cohort ( n=245) and an internal test cohort ( n=101) via stratified sampling at a 7∶3 ratio. And 143 patients from Nantong Third Hospital Affiliated to Nantong University served as an external validation cohort. The training cohort included 53 CK19-positive and 192 CK19-negative patients. The internal test cohort included 21 CK19-positive and 80 CK19-negative patients. The external validation cohort included 30 CK19-positive and 113 CK19-negative patients. Univariate logistic regression analysis was performed to identify potential factors associated with CK19 expression, and a clinical-radiologic model was constructed. The k-means clustering algorithm was applied to segment target HCC lesions into 3 subregions. Radiomic features were extracted and selected from these habitat subregions. Habitat radiomics models were constructed for the arterial phase (AP), portal venous phase, hepatobiliary phase (HBP), and combined phases (CP). Multivariate logistic regression analysis identified independent clinical and radiologic predictors of CK19 expression, and the optimal habitat model score was integrated to build a clinical-radiologic-habitat combined model. The area under the receiver operating characteristic curve (AUC) was used to evaluate model predictive performance. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method and the differences in survival curves were compared with the log-rank test. Results:Univariate logistic regression analysis revealed that alpha-fetoprotein (AFP) ( OR=2.629, 95% CI 1.412-4.896, P=0.002), AP enhancement ( OR=3.636, 95% CI 1.642-8.052, P=0.001), AP peritumoral enhancement ( OR=2.219, 95% CI 1.084-4.542, P=0.029), and HBP peritumoral hypointensity ( OR=2.010, 95% CI 1.004-4.021, P=0.049) were potential factors associated with CK19 expression, which were incorporated into the clinical-radiologic model. In the internal and external validation cohorts, the AUC of the clinical-radiologic model was 0.690 (95% CI 0.590-0.778) and 0.650 (95% CI 0.565-0.727), respectively. The habitat radiomics model based on CP images demonstrated the highest performance. It achieved AUC of 0.729 (95% CI 0.622-0.836) and 0.725 (95% CI 0.607-0.842) in the internal and external validation cohorts, respectively. Multivariate analysis identified AFP ( OR=2.494, 95% CI 1.163-5.348, P=0.019), AP enhancement ( OR=5.230, 95% CI 1.868-14.643, P=0.002) and habitat radiomics model score ( OR=4.105, 95% CI 2.643-6.368, P<0.001) as independent predictors of CK19 positivity. Based on these factors, a combined clinical-radiologic-habitat combined model was established. The clinical-radiologic-habitat combined model achieved AUCs of 0.767 (95% CI 0.671-0.846) and 0.730 (95% CI 0.649-0.801) in the internal and external validation cohorts, respectively. Significant differences in RFS were observed between the CK19-positive group (25.1 month) and CK19-negative group (51.0 month) as predicted by the clinical-radiologic-habitat model ( χ2=4.17, P=0.041). Conclusion:The clinical-radiologic-habitat combined model based on Gd-EOB-DTPA-enhanced MRI habitat radiomics demonstrates good predictive performance for CK19 expression in HCC and offers valuable prognostic stratification for clinical practice.

Objective:To explore the value of the deep learning model based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI in preoperatively predicting vessels completely encapsulating tumor clusters (VETC) in hepatocellular carcinoma (HCC).Methods:This study adopted a case-control design to retrospectively analyze 420 patients with HCC confirmed by postoperative pathology who underwent Gd-EOB-DTPA enhanced MRI between June 2016 and March 2023. A total of 420 patients were divided into a training set ( n=305) from the First Affiliated Hospital of Soochow University and an external validation set ( n=115) from Affiliated Nantong Hospital 3 of Nantong University. Based on postoperative pathological findings, patients were stratified into VETC-positive and VETC-negative groups. The training set comprised 161 VETC-positive cases and 144 VETC-negative cases, while the external validation set included 55 VETC-positive cases and 60 VETC-negative cases. Tumor regions of interest in arterial, portal venous, and hepatobiliary phases were manually delineated using ITK-SNAP software. Pre-trained Vgg19, Densenet121, and Vision Transformer (ViT) models were employed for transfer learning, extracting deep learning features from each image. Feature data were processed using FAE software, and 12 logistic regression models (arterial phase, portal venous phase, hepatobiliary phase, and combined three-phase models) were constructed to select the optimal deep learning model. Independent predictors in clinical characteristics were identified through univariate and multivariate logistic analyses to establish a clinical model for predicting VETC pattern. Subsequently, a clinical-deep learning fusion model was developed by integrating these clinical predictors with the optimal deep learning features. Model performance in predicting VETC-positive HCC was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). Results:In the external validation set, the area under the curve (AUC) of the Vgg19 model in the arterial phase, portal venous phase, hepatobiliary phase, and combined three-phase, respectively were 0.799,0.756,0.789,0.821, which were higher than those of Densenet121 (AUC: 0.544,0.581,0.544,0.583) and ViT (AUC: 0.740,0.752,0.785,0.767) model. The three-phase combined Vgg19 model achieved the highest AUC of 0.821 (95% CI 0.746-0.897). Multivariate logistic regression identified alpha-fetoprotein level ( OR=1.826,95% CI 1.069-3.120, P=0.028) and tumor diameter ( OR=1.329,95% CI 1.206-1.466, P<0.001) as independent predictors of VETC-positive HCC, forming the clinical model with an AUC of 0.789 (95% CI 0.703-0.859). The clinical-deep learning fusion model further achieved the AUC of 0.825 (95% CI 0.749-0.900). Calibration curves confirmed high concordance between predicted and actual probabilities for the three-phase Vgg19 model, while DCA revealed greater net clinical benefit for the combined Vgg19 and fusion models compared with the clinical model alone. Conclusions:The deep learning model based on Gd-EOB-DTPA enhanced MRI can be used to predict VETC of HCC preoperatively, among which the three-phase combined Vgg19 model and the clinical-deep learning model provide high predictive value.

Objective:To construct a combined prediction model based on dual-layer detector spectral CT radiomics features and quantitative parameters, and to evaluate its value in preoperative prediction of serosal invasion in gastric cancer.Methods:This case-control study retrospectively analyzed data from 253 gastric cancer patients confirmed by postoperative pathology at the First Affiliated Hospital of Soochow University (Center 1) and Changshu No.2 People′s Hospital (Center 2) from January 2022 to December 2023. Patients from Center 1 ( n=157) were randomly divided into training set ( n=110) and test set ( n=47) in a 7∶3 ratio, while patients from Center 2 ( n=96) served as an external validation set. Based on postoperative pathological serosal invasion status, patients were classified into serosal invasion group ( n=164) and non-serosal invasion group ( n=89), with distributions of 70/40, 30/17, and 64/32 in the training, test, and external validation sets, respectively. Spectral CT quantitative parameters, including arterial and venous phase iodine concentration (IC), normalized iodine concentration (NIC), arterial-venous IC differences, arterial-venous NIC differences (NIC pa), arterial enhancement fraction (AEF), and effective atomic number (Z eff), were measured. Radiomics features were extracted from venous-phase 40 keV monochromatic images. The least absolute shrinkage and selection operator (LASSO) algorithm was used for feature selection. The logistic regression classifier (LR-LASSO) was applied to construct the radiomics model. Univariate and multivariate logistic regression analyses identified independent risk factors for serosal invasion, including the radiomics signature (RadScore) and quantitative parameters. A clinical model was built using significant quantitative parameters, and a combined model integrated RadScore. An artificial model was based on cT4 staging assessed by two radiologists using venous-phase CT. The diagnostic performance of each model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Results:A total of six radiomics features were selected to establish the radiomics model. RadScore ( OR=7.598, 95% CI 2.259-25.562, P=0.001) and NIC pa ( OR=4.598, 95% CI 1.404-15.050, P=0.012) served as independent risk factors. The NIC pa served as the clinical model. The AUCs (95% CI) of the combined model in the training, test, and external validation sets were 0.984 (0.969-1.000), 0.855 (0.728-0.982), and 0.773 (0.665-0.882), respectively. The AUCs of the artificial model were 0.741, 0.670, 0.644; of the clinical model were 0.709, 0.633, 0.626. The AUCs of the radiomics model were 0.963, 0.824, 0.741, respectively. Calibration curves showed good agreement between predicted probability and observed probability. The DCA confirmed higher clinical net benefits for the combined model. Conclusion:The combined model integrating dual-layer detector spectral CT radiomics features and quantitative parameters exhibits high efficacy for preoperative prediction of gastric cancer serosal invasion.

Objective To evaluate the environmental radioactive safety level in China, monitor the radioactivity of strontium-90 (⁹⁰Sr) in seafood from selected marine regions of China, and optimize the di-(2-ethylhexyl)phosphoric acid (HDEHP) extraction chromatography method for determining Sr-90 in seafood. Methods In 2023, seafoods of fish, shrimp, shellfish, and seaweed were collected from the Shandong Province (Bohai Sea and Yellow Sea) and Hainan Province (South China Sea). The levels of Sr in the samples were determined by inductively coupled plasma atomic emission spectrometer (ICP-AES). The ⁹⁰Sr separation were performed using HDEHP extraction chromatography, while the recovery of ⁹⁰Sr were determined by the gravitmetry with the assistant of ICP-AES. Results The content of strontium in seafoods varies greatly, and excessive strontium and calcium in seafood may lead to overestimated recovery due to insufficient leaching during chromatographic separation by HDEHP extraction. Therefore, the yttrium content in the eluent should be analyzed by ICP . The radioactivity of ⁹⁰Sr in seafood from the sea areas in Shandong Province was 0.22-1.85 Bq/kg (dry weight), and that of seafood from Hainan Province was 0.19-1.82 Bq/kg (dry weight). Conclusion For the analysis of shirmp and seaweed samples, the recovery rate of ⁹⁰Sr should be analyzed using both gravimetry and ICP-AES. There is no significant linear correlation between total Sr and ⁹⁰Sr in seafood. There is no significant difference in ⁹⁰Sr radioactivity between the seafood samples collected from Shandong and Hainan. The ⁹⁰Sr radioactivity levels of all 28 samples are below the limit specified in the Limited concentrations of radioactive materials in foods (GB 14882—1994) and are within the range of environmental background fluctuations.

Objective To organize a nationwide interlaboratory comparison for measurement of gross α and gross β radioactivity in water, and improve the laboratory analysis of gross α and gross β radioactivity in water. Methods A unified comparison protocol was developed by the organizers. The groundwater with high natural radioactivity was used as water sample and distributed randomly to the participating laboratories. The participating laboratories used routine analytical methods to measure the samples and provided information such as analytical results, original records, and test reports. The results were evaluated using z-score. Results A total of 76 laboratories participated in the comparison, all employing the evaporation concentration-α/β counting method. Among them, 69 laboratories achieved |z| ≤ 2 for both gross α and gross β radioactivity measurements, and 32 laboratories achieved |z| ≤ 0.50 for both gross α and gross β radioactivity measurements. There were 69 laboratories with qualified results and 30 laboratories with excellent results, yielding a qualified rate of 90.8% and an excellent rate of 39.5%. Seven laboratories showed unqualified results and the unqualified rate was 9.2%. Conclusion Most laboratories have the ability to analyze gross α and gross β radioactivity in water. The main reasons for the deviation in comparison results are calibration efficiency, errors in the total residue mass caused by improper water sample processing operations. By analyzing the main technical problems existed in unqualified laboratories, their ability for measurement of gross α and gross β radioactivity in water has been improved.

Objective:To develop a method for determining 14C in seafood using a tube combustion furnace (or oxygen bomb combustion devices) coupled with liquid scintillation counting (LSC), in order to accurately determine 14C in seafood. Methods:Four categories of seafood samples (i.e., fish, crustaceans, mollusks, and algae) were collected. They were then subjected to high-temperature oxidation using a tube combustion furnace or oxygen bomb combustion devices to isolate CO 2, followed by an analysis of the radioactivity concentration of 14C using LSC. The combustion conditions were optimized by investigating the heating nodes and rates in the oxidation combustion furnace, and the CO 2 collection conditions were optimized by placing a NaOH absorption solution in the oxygen bomb combustion devices. Additionally, the optimal measurement conditions were determined by comparing the effects of varying scintillation cocktails and the dark adaptation time of two preparation methods, i. e., the adsorption and suspension method. Results:When a tubular combustion furnace was used for oxidation and combustion, the optimal heating rate of the sample pyrolysis temperature zone was determined at 1.5℃/min. In this case, the combustion efficiency of various seafood could reach over 95%. When the oxygen bomb combustion devices were employed, placing NaOH solutions both inside and at the exhaust end increased absorption efficiency by 10% compared to the traditional practice of placing a NaOH solution only at the exhaust end. Samples prepared using the absorption method should be kept in the dark for at least 10 h before measurement using LSC, while samples prepared with the suspension methods should be kept for at least 20 h. The results obtained using two preprocessing devices and two sample preparation method were consistent, with a detection limit of 9.10 Bq/kg (dry samples). Compared to the suspension method (The relative standard deviation of the results obtained by two preprocessing devices were 9.00% and 8.27%), the absorption method (the corresponding relative standard deviation were 3.61% and 3.29%) exhibited higher precision in repeated measurements.Conclusions:The aforementioned pretreatment devices and sample preparation method are suitable for determining 14C in seafood.

Objective:To develop a method for determining 14C in seafood using a tube combustion furnace (or oxygen bomb combustion devices) coupled with liquid scintillation counting (LSC), in order to accurately determine 14C in seafood. Methods:Four categories of seafood samples (i.e., fish, crustaceans, mollusks, and algae) were collected. They were then subjected to high-temperature oxidation using a tube combustion furnace or oxygen bomb combustion devices to isolate CO 2, followed by an analysis of the radioactivity concentration of 14C using LSC. The combustion conditions were optimized by investigating the heating nodes and rates in the oxidation combustion furnace, and the CO 2 collection conditions were optimized by placing a NaOH absorption solution in the oxygen bomb combustion devices. Additionally, the optimal measurement conditions were determined by comparing the effects of varying scintillation cocktails and the dark adaptation time of two preparation methods, i. e., the adsorption and suspension method. Results:When a tubular combustion furnace was used for oxidation and combustion, the optimal heating rate of the sample pyrolysis temperature zone was determined at 1.5℃/min. In this case, the combustion efficiency of various seafood could reach over 95%. When the oxygen bomb combustion devices were employed, placing NaOH solutions both inside and at the exhaust end increased absorption efficiency by 10% compared to the traditional practice of placing a NaOH solution only at the exhaust end. Samples prepared using the absorption method should be kept in the dark for at least 10 h before measurement using LSC, while samples prepared with the suspension methods should be kept for at least 20 h. The results obtained using two preprocessing devices and two sample preparation method were consistent, with a detection limit of 9.10 Bq/kg (dry samples). Compared to the suspension method (The relative standard deviation of the results obtained by two preprocessing devices were 9.00% and 8.27%), the absorption method (the corresponding relative standard deviation were 3.61% and 3.29%) exhibited higher precision in repeated measurements.Conclusions:The aforementioned pretreatment devices and sample preparation method are suitable for determining 14C in seafood.

Objective:To investigate the value of habitat radiomic features based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI in establishing a predictive model for cytokeratin 19 (CK19) expression in hepatocellular carcinoma (HCC) and to evaluate its role in prognostic risk stratification.Methods:This multicenter case-control study retrospectively enrolled 489 patients with pathologically confirmed HCC who underwent Gd-EOB-DTPA-enhanced MRI between June 2016 and June 2024. Among them, 346 patients from the First Affiliated Hospital of Soochow University were divided into a training cohort ( n=245) and an internal test cohort ( n=101) via stratified sampling at a 7∶3 ratio. And 143 patients from Nantong Third Hospital Affiliated to Nantong University served as an external validation cohort. The training cohort included 53 CK19-positive and 192 CK19-negative patients. The internal test cohort included 21 CK19-positive and 80 CK19-negative patients. The external validation cohort included 30 CK19-positive and 113 CK19-negative patients. Univariate logistic regression analysis was performed to identify potential factors associated with CK19 expression, and a clinical-radiologic model was constructed. The k-means clustering algorithm was applied to segment target HCC lesions into 3 subregions. Radiomic features were extracted and selected from these habitat subregions. Habitat radiomics models were constructed for the arterial phase (AP), portal venous phase, hepatobiliary phase (HBP), and combined phases (CP). Multivariate logistic regression analysis identified independent clinical and radiologic predictors of CK19 expression, and the optimal habitat model score was integrated to build a clinical-radiologic-habitat combined model. The area under the receiver operating characteristic curve (AUC) was used to evaluate model predictive performance. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method and the differences in survival curves were compared with the log-rank test. Results:Univariate logistic regression analysis revealed that alpha-fetoprotein (AFP) ( OR=2.629, 95% CI 1.412-4.896, P=0.002), AP enhancement ( OR=3.636, 95% CI 1.642-8.052, P=0.001), AP peritumoral enhancement ( OR=2.219, 95% CI 1.084-4.542, P=0.029), and HBP peritumoral hypointensity ( OR=2.010, 95% CI 1.004-4.021, P=0.049) were potential factors associated with CK19 expression, which were incorporated into the clinical-radiologic model. In the internal and external validation cohorts, the AUC of the clinical-radiologic model was 0.690 (95% CI 0.590-0.778) and 0.650 (95% CI 0.565-0.727), respectively. The habitat radiomics model based on CP images demonstrated the highest performance. It achieved AUC of 0.729 (95% CI 0.622-0.836) and 0.725 (95% CI 0.607-0.842) in the internal and external validation cohorts, respectively. Multivariate analysis identified AFP ( OR=2.494, 95% CI 1.163-5.348, P=0.019), AP enhancement ( OR=5.230, 95% CI 1.868-14.643, P=0.002) and habitat radiomics model score ( OR=4.105, 95% CI 2.643-6.368, P<0.001) as independent predictors of CK19 positivity. Based on these factors, a combined clinical-radiologic-habitat combined model was established. The clinical-radiologic-habitat combined model achieved AUCs of 0.767 (95% CI 0.671-0.846) and 0.730 (95% CI 0.649-0.801) in the internal and external validation cohorts, respectively. Significant differences in RFS were observed between the CK19-positive group (25.1 month) and CK19-negative group (51.0 month) as predicted by the clinical-radiologic-habitat model ( χ2=4.17, P=0.041). Conclusion:The clinical-radiologic-habitat combined model based on Gd-EOB-DTPA-enhanced MRI habitat radiomics demonstrates good predictive performance for CK19 expression in HCC and offers valuable prognostic stratification for clinical practice.

Objective:To explore the value of the deep learning model based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI in preoperatively predicting vessels completely encapsulating tumor clusters (VETC) in hepatocellular carcinoma (HCC).Methods:This study adopted a case-control design to retrospectively analyze 420 patients with HCC confirmed by postoperative pathology who underwent Gd-EOB-DTPA enhanced MRI between June 2016 and March 2023. A total of 420 patients were divided into a training set ( n=305) from the First Affiliated Hospital of Soochow University and an external validation set ( n=115) from Affiliated Nantong Hospital 3 of Nantong University. Based on postoperative pathological findings, patients were stratified into VETC-positive and VETC-negative groups. The training set comprised 161 VETC-positive cases and 144 VETC-negative cases, while the external validation set included 55 VETC-positive cases and 60 VETC-negative cases. Tumor regions of interest in arterial, portal venous, and hepatobiliary phases were manually delineated using ITK-SNAP software. Pre-trained Vgg19, Densenet121, and Vision Transformer (ViT) models were employed for transfer learning, extracting deep learning features from each image. Feature data were processed using FAE software, and 12 logistic regression models (arterial phase, portal venous phase, hepatobiliary phase, and combined three-phase models) were constructed to select the optimal deep learning model. Independent predictors in clinical characteristics were identified through univariate and multivariate logistic analyses to establish a clinical model for predicting VETC pattern. Subsequently, a clinical-deep learning fusion model was developed by integrating these clinical predictors with the optimal deep learning features. Model performance in predicting VETC-positive HCC was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). Results:In the external validation set, the area under the curve (AUC) of the Vgg19 model in the arterial phase, portal venous phase, hepatobiliary phase, and combined three-phase, respectively were 0.799,0.756,0.789,0.821, which were higher than those of Densenet121 (AUC: 0.544,0.581,0.544,0.583) and ViT (AUC: 0.740,0.752,0.785,0.767) model. The three-phase combined Vgg19 model achieved the highest AUC of 0.821 (95% CI 0.746-0.897). Multivariate logistic regression identified alpha-fetoprotein level ( OR=1.826,95% CI 1.069-3.120, P=0.028) and tumor diameter ( OR=1.329,95% CI 1.206-1.466, P<0.001) as independent predictors of VETC-positive HCC, forming the clinical model with an AUC of 0.789 (95% CI 0.703-0.859). The clinical-deep learning fusion model further achieved the AUC of 0.825 (95% CI 0.749-0.900). Calibration curves confirmed high concordance between predicted and actual probabilities for the three-phase Vgg19 model, while DCA revealed greater net clinical benefit for the combined Vgg19 and fusion models compared with the clinical model alone. Conclusions:The deep learning model based on Gd-EOB-DTPA enhanced MRI can be used to predict VETC of HCC preoperatively, among which the three-phase combined Vgg19 model and the clinical-deep learning model provide high predictive value.