Objective:To investigate the value of diffusion kurtosis imaging (DKI) and 18F-prostate specific membrane antigen (PSMA)-1007 in the differential diagnosis of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) by using PET/MR imaging. Methods:From June 2019 to December 2022, a retrospective analysis was conducted on 134 patients ((65.5±10.0) years) with prostate diseases who underwent 18F-PSMA-1007 PET/MR whole-body examination at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, with the prostate specific antigen (PSA) level continuously rising to >4μg/L within 1 month and not yet receiving treatment. Patients were divided into 2 groups (PSA<10μg/L and PSA≥10μg/L). The PET/MR examination included high b-value diffusion imaging, and the ROI was delineated based on the prostate diffusion weighted imaging (DWI) high-signal area and apparent diffusion coefficient (ADC) low-signal area by the professional radiology physician. The SUV max, mean kurtosis (MK), and mean diffusivity (MD) were obtained. Spearman rank correlation analysis was performed, and ROC curve was used to analyze the diagnostic efficacy. Results:Of 134 patients, 72 were with PSA<10μg/L and 62 were with PSA≥10μg/L. There were 68 patients who obtained biopsy results, including 37 cases of BPH and 31 cases of PCa. In PSA<10μg/L group, there were no significant correlations between MK and SUV max, MK and PSA ( rs values: 0.22, 0.06, P values: 0.065, 0.603). In the PSA≥10μg/L group, there were positive correlations between MK and SUV max, MK and PSA ( rs values: 0.52, 0.40, P values: 0.008, 0.005). In the PSA<10μg/L group, SUV max, MK, and MD showed no diagnostic value (AUCs: 0.44-0.67, all P>0.05), while the AUC for combined diagnosis using these three parameters was 0.78( P=0.008). In the PSA≥10μg/L group, the AUCs of SUV max, MK, and MD were 0.81( P=0.001), 0.84( P<0.001) and 0.72( P=0.023) respectively, and the AUC for combined diagnosis using these three parameters was 0.91( P<0.001). Conclusion:The combination of MK, MD and SUV max improves the diagnostic efficacy of PCa in PET/MR examination.

Objective:To investigate the value of diffusion kurtosis imaging (DKI) and 18F-prostate specific membrane antigen (PSMA)-1007 in the differential diagnosis of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) by using PET/MR imaging. Methods:From June 2019 to December 2022, a retrospective analysis was conducted on 134 patients ((65.5±10.0) years) with prostate diseases who underwent 18F-PSMA-1007 PET/MR whole-body examination at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, with the prostate specific antigen (PSA) level continuously rising to >4μg/L within 1 month and not yet receiving treatment. Patients were divided into 2 groups (PSA<10μg/L and PSA≥10μg/L). The PET/MR examination included high b-value diffusion imaging, and the ROI was delineated based on the prostate diffusion weighted imaging (DWI) high-signal area and apparent diffusion coefficient (ADC) low-signal area by the professional radiology physician. The SUV max, mean kurtosis (MK), and mean diffusivity (MD) were obtained. Spearman rank correlation analysis was performed, and ROC curve was used to analyze the diagnostic efficacy. Results:Of 134 patients, 72 were with PSA<10μg/L and 62 were with PSA≥10μg/L. There were 68 patients who obtained biopsy results, including 37 cases of BPH and 31 cases of PCa. In PSA<10μg/L group, there were no significant correlations between MK and SUV max, MK and PSA ( rs values: 0.22, 0.06, P values: 0.065, 0.603). In the PSA≥10μg/L group, there were positive correlations between MK and SUV max, MK and PSA ( rs values: 0.52, 0.40, P values: 0.008, 0.005). In the PSA<10μg/L group, SUV max, MK, and MD showed no diagnostic value (AUCs: 0.44-0.67, all P>0.05), while the AUC for combined diagnosis using these three parameters was 0.78( P=0.008). In the PSA≥10μg/L group, the AUCs of SUV max, MK, and MD were 0.81( P=0.001), 0.84( P<0.001) and 0.72( P=0.023) respectively, and the AUC for combined diagnosis using these three parameters was 0.91( P<0.001). Conclusion:The combination of MK, MD and SUV max improves the diagnostic efficacy of PCa in PET/MR examination.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To explore the impact of the two-way referral model on compliance and prognosis in patients with heart failure.Methods:This bidirectional cohort study enrolled chronic heart failure (CHF) patients treated at Qilu Hospital of Shandong University or designated primary hospitals between March 2018 and March 2022. Patients were categorized into two groups based on referral status: two-way referral group (participating in the referral model with≥1 follow-up visit at primary hospitals) and the core hospital group (receiving treatment and follow-up exclusively at Qilu Hospital). Baseline clinical characteristics were collected and compared between groups. Patients underwent followed-up, with primary endpoints including follow-up rate, drug (β-blockers, angiotension converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blockers (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) utilization rate and target dose achievement rate. Secondary endpoints encompassed changes from baseline in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and N-terminal pro-brain natriuretic peptide (NT-proBNP), plus cardiovascular mortality and heart failure rehospitalization. Generalized linear mixed models analyzed longitudinal trends in LVEF, LVEDd, and NT-proBNP levels. Kaplan-Meier curves and Cox regression evaluated LVEF recovery rates, supplemented by subgroup analyses. Multivariate logistic regression was used to identify factors influencing target dose achievement rate for β-blockers and ACEI/ARB/ARNI therapies in CHF patients.Results:A total of 357 patients were enrolled, aged 53 (41, 63) years, including 256 males (71.7%). 157 patients were in the two-way referral group and 200 patients in the core hospital-treated group. Compared with the core hospital-treated group, the two-way referral group had lower baseline LVEF (28 (22, 34)% vs. 31 (23, 36)%, P=0.021) and systolic blood pressure (116 (104, 125) mmHg vs. 121 (109, 134) mmHg (1 mmHg=0.133 kPa), P=0.010). The 12-month follow-up rate of the two-way referral group was higher than the core hospital-treated group (73.8% vs. 56.0%, P=0.004). No significant between-group differences were observed in drug utilization rate of β-blockers, ACEI/ARB/ARNI, or sodium-glucose cotransporter 2 inhibitors during follow-up (all P>0.05), while mineralocorticoid receptor antagonists use showed a declining trend in both groups. Although the core hospital-treated group had higher target dose achievement rates for β-blockers (65.4% vs. 49.3%, P=0.042) and ACEI/ARB/ARNI (79.8% vs. 65.8%, P=0.046) than the two-way referral group, multivariate logistic regression indicated that the two-way referral model was not a negative predictor for these outcomes (all P>0.05). Both groups showed improved NT-proBNP, LVEDd, and LVEF from baseline (all P<0.001) with no significant difference in trends between groups (all P>0.05). There was no significant difference in the composite incidence (7.6% vs. 6.5%, P=0.674) and cumulative incidence (log-rank P=0.684) of cardiovascular death and heart failure rehospitalization at 12 months between two groups. Conclusion:The two-way referral model demonstrates advantages in improving medication adherence, drug utilization rates, and targetdoseachievement rates among CHF patients. This model not only promotes cardiac functional recovery but also reduces risks of cardiovascular mortality and heart failure rehospitalization, achieving comparable therapeutic and management outcomes to those observed in core hospital-treated patients.

Objective:To analyze the clinical value of 18F-FDG PET/MR for precise localization of epileptogenic foci in patients with refractory epilepsy. Methods:From February 2019 to December 2021, 81 patients (52 males, 29 females; age (30.0±10.9) years) with refractory epilepsy confirmed in Ruijin Hospital Shanghai Jiao Tong University School of Medicine were retrospectively enrolled. All patients underwent preoperative PET/MR exam, and the possible position of the epileptogenic foci were determined by PET/MR imaging and pre-surgical evaluation, then the stereoelectroencephalography (SEEG) electrodes were implanted. Surgery was performed, and outcome was assessed by using a modified Engel classification two years after surgery. χ2 test was used to compare the detection rates of MRI and PET/MR fusion imaging in localizing epileptogenic foci and the detection rates of epileptogenic foci in temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE) by PET/MR. Results:MRI correctly localized seizure foci in 38 patients, with the detection rate of 46.91%(38/81), while PET/MR detected seizure foci in 73 patients, with the detection rate of 90.12%(73/81; χ2=35.05, P<0.001). There were 63 TLE and 18 ETLE patients. The detection rate of PET/MR in localizing seizure foci in TLE patients was 95.24%(60/63), which was significantly higher than that in ETLE patients (13/18; χ2=5.94, P=0.015). After 2 years follow-up, the postoperative efficacy rate of TLE patients with Engel grades Ⅰ-Ⅱ was 76.19%(48/63), which was 13/18 of ETLE patients ( χ2=0.12, P=0.731). Conclusion:Hybrid PET/MR imaging can accurately locate epileptogenic foci, especially for MRI negative lesions, which provides precision imaging information for surgical planning and improves surgical success rate.

Objective:To explore the added value of T 1-weighted stack-of-stars volumetric interpolated body examination (StarVIBE) sequence on PET/MR image quality. Methods:A retrospective analysis was performed on 60 patients (42 males, 18 females; age 11-86 (58±12) years) who underwent 18F-FDG PET/MR examination and with positive PET results in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from April 2020 to April 2021. All patients completed StarVIBE sequence collection, and volumetric interpolated body examination (VIBE) sequence was used as control. StarVIBE and VIBE sequence images were evaluated independently using five-point method by two physicians. The evaluation was carried out from six aspects: lesion display, lesion boundary display, vascular around lesions display, fusion level with PET image, image artifact and overall image quality. Wilcoxon signed rank test was used to compare the image quality of the two sequences, and Kappa test was performed to assess the consistency of the image quality scores between the two physicians. Results:There were 26 cases with cervical lesions, 14 cases with chest lesions, 7 cases with abdomen lesions and 13 cases with pelvic lesions. The scores of lesion display (4.0(3.8, 4.5) vs 3.5(3.0, 4.0)), lesion boundary display (4.0(4.0, 4.0) vs 3.0(3.0, 3.5)), vascular around lesions display (5.0(4.0, 5.0) vs 4.0(3.5, 4.5)), fusion level with PET image (5.0(5.0, 5.0) vs 4.5(4.0, 5.0)), image artifact (4.5(4.0, 5.0) vs 4.5(4.0, 5.0)) and overall image quality (5.0(4.0, 5.0) vs 4.0(4.0, 4.0)) of StarVIBE sequences were better than those of VIBE sequences ( z values: 3.77-6.54, all P<0.001). On the vascular around the lesions display, the scores of StarVIBE were significantly better than those of VIBE sequence in the neck (5.0(4.5, 5.0) vs 3.0(2.7, 3.5); z=4.49, P<0.001) and chest (4.5(4.3, 4.7) vs 4.0(3.6, 4.3); z=3.10, P=0.002). As for image quality, the scores of StarVIBE were also significantly better than those of VIBE in neck (5.0(4.5, 5.0) vs 4.0(3.7, 4.5); z=4.36, P<0.001) and chest (5.0(5.0, 5.0) vs 4.0(4.0, 4.5); z=3.02, P=0.003). In abdominal lesions, the score of StarVIBE was higher than that of VIBE in blood vessels (4.5(3.5, 5.0) vs 4.0(3.5, 4.5); z=2.07, P=0.038), and there was no difference between score of overall image quality (4.0(3.7, 4.5) vs 4.0(3.5, 4.5); z=0.27, P=0.785). The score of overall image quality of pelvic StarVIBE sequence was better than that of VIBE sequence (5.0(4.5, 5.0) vs 4.0(4.0, 4.5); z=2.12, P=0.034). Kappa value of image quality score between two physicians was 0.554, indicating moderate consistency. Conclusion:In whole-body PET/MR imaging, StarVIBE sequence can significantly improve the image quality of cervical, thoracic and pelvic lesions when comparing with VIBE sequence.

Objective:To explore the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/MR imaging for liver metastasis. Methods:A retrospective analysis of 75 cases (46 males, 29 females; age (58.9±14.3) years) with suspected liver metastases from January 2020 to October 2020 in Ruijin Hospital were performed. All patients underwent PET/MR and enhanced upper abdominal CT scans. Diagnostic efficacies of enhanced CT, PET, MR and PET/MR for liver metastases (based on lesions and patients respectively) were calculated and compared (McNemar test).Results:A total of 306 liver lesions were detected in 75 patients, of which 179 lesions in 45 patients were confirmed as liver metastases through follow-up or pathology. In lesion-based analysis, the sensitivities of enhanced CT, PET, MR and PET/MR were 74.9%(134/179), 60.3%(108/179), 98.9%(177/179) and 100%(179/179), with specificities of 96.9%(123/127), 100%(127/127), 92.9%(118/127) and 92.1%(117/127), respectively. The diagnostic efficacy of PET/MR was significantly higher than that of enhanced CT and PET ( χ2 values: 51.000 and 81.000, both P<0.001), but there was no statistical difference between PET/MR and MR ( χ2=2.000, P=0.368). In patient-based analysis, the sensitivities of enhanced CT, PET, MR and PET/MR were 82.2%(37/45), 84.4%(38/45), 95.6%(43/45) and 100%(45/45), with specificities of 86.7%(26/30), 100%(30/30), 70.0%(21/30) and 70.0%(21/30), respectively. The diagnostic efficacies of enhanced CT and PET were statistically different from PET/MR ( χ2 values: 13.000 and 16.000, both P<0.05), but there was no statistical difference between MR and PET/MR ( χ2=2.000, P=0.368). Conclusions:Compared with enhanced CT, PET and MR, 18F-FDG PET/MR has a higher detective rate for liver metastases. The overall diagnostic efficacy of 18F-FDG PET/MR is better than enhanced CT and PET alone, but similar to MR.

Objective:To investigate the effects of severe famine exposure during early life on their later adult obesity/central obesity.Methods:We recruited 4 495 subjects who were born before and during 3 years of unpredictable natural disasters in China and from Guiyang subcenter of the Risk Evaluation of cAncers in Chinese diabeTic Individual: a lONgitudinal (REACTION) Study for data analysis. The subjects were divided into childhood exposure group(born from October 1, 1954 to September 30, 1956, n=947), infant exposure group(born from October 1, 1956 to September 30, 1958, n=939), fetal exposure group(born from October 1, 1959 to September 30, 1961, n=525), and control group(born from October 1, 1952 to September 30, 1954 and from October 1, 1962 to September 30, 1964, n=1 525) according to their birth date. Obesity was defined as body mass index (BMI)≥28 kg/m 2, and central obesity was defined as waist circumference≥90 cm in men and ≥85 cm in women. We used logistic regression models to assess the effect of severe famine exposure on adult obesity/central obesity. Results:After adjusting for confounding factors, we found that men in the fetal exposure group had higher risk of adult obesity than the control group( OR=2.817, 95% CI 1.120-7.088, P=0.028), women in the fetal exposure group( OR=2.383, 95% CI 1.517-3.743, P=0.000), and infant exposure group( OR=1.554, 95% CI 1.039-2.324, P=0.032) had higher risk of adult obesity than the control group. In addition, compared with the control group, the male fetal exposure group had an increased risk of adult central obesity ( OR=2.440, 95% CI 1.253-4.752, P=0.009), which was unfound in females. Conclusion:Severe famine exposure during earlylife, especially in fetus and female infancy, increases the risk of obesity in their adulthood. In addition, males who experienced severe famine in their fetuses period may have higher risks of central obesity when reaching adulthood.

Objective To improve the safety of surgery,the application of indocyanine green fluorescein(ICG)angiography in intracranial aneurysm surgery was investigated.Methods Fifty cases of intracranial aneurysms were retrospectively analyzed.All the patients were received ICG angiography before and after intracranial aneurysm clipping.The efficiency of the surgery was evalu-ated with CT angiography(CTA)and(or)digital subtraction angiography(DSA).The postoperative follow-up was conducted using Glasow outcomes score(GOS).Results Of the 50 patients,3 cases of aneurysmal neck remnant,one case of parent arteries steno-sis,one case of nearby branch stenosis and two cases of “false-negative”were observed after ICG angiography.The clips were adjus-ted until the satisfactory blood flew was restored.Postoperative CTA and(or)DSA confirmed the results of intraoperative ICG an-giography.Of the 40 patients underwent follow-up,GOS score was 5 in 30 cases,4 in 7 case,3 in 2 case and 2 in 1 case.Conclusion ICG angiography is a useful way to assess the clipping of aneurysms,blood flew of parent arteries and nearby branches during the aneurysm surgery.It could raise the safety of surgery and further improve the clinical outcomes of intracranial aneurysms.

Objective To investigate N-terminal pro-B-type natriuretic peptide (NT-proBNP) cutoff value for the mortality in different age groups in critically ill patients.Methods A retrospective study was conducted.295 patients admitted to the intensive care unit (ICU) of 401st Hospital of PLA from January 2011 to October 2012 were divided into two groups according to age [group with age＜65 years old (n=105) and group with age≥ 65 years old (n =190)].The concentrations of serum NT-proBNP,hematocrit (HCT),procalcitonin (PCT),C-reactive protein (CRP),serum creatinine (SCr),estimated glomerular filtration rate (eGFR),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and probability of survival (PS) were recorded within 24 hours.The primary outcome was ICU mortality.Receiver operator characteristic curve (ROC curve) was used to evaluate the value of NT-proBNP for predicting the mortality.Results ① There were no significant differences in the length of stay in ICU,mechanical ventilation rate,the mortality,the incidence of cardiovascular disease,digestive disease,neurologic disease,and the number of patients having received operation,HCT,PCT and CRP between the two groups (all P＞0.05).The percentage of the male,the APACHE Ⅱ score,the percentage of respiratory disease,and NT-proBNP in group with age ≥ 65 years old were higher than those of the group with age ＜ 65 years old [the percentage of the male:51.6％ vs.33.0％,x2=9.093,P=0.003; APACHE Ⅱ score:22.94 ±8.10 vs.19.44 ±8.51,Z=-3.259,P=0.001; the percentage of respiratory disease:29.47％ vs.17.14％,x2=5.472,P=0.024; NT-proBNP(ng/L):5 859.00(2 050.75,23 802.75) vs.2 882.00 (275.15,6 236.00),Z=-5.514,P=0.000]; PS,the percentage of patients having multiple injuries and other diseases and eGFR in group with age ≥65 years old were lower than those of the group with age ＜65 years old [PS:59.0 (31.5,79.0)％ vs.70.0 (40.0,84.0),Z=-3.431,P=0.001; the percentage of multiple injuries:0.53％ vs.17.14％,x2=30.987,P=0.000; the percentage of other disease:5.79％ vs.13.33％,x2=4.962,P=0.030; eGFR (ml·min-1· 1.73 m-2):81.07 (45.77,131.80) vs.95.54 (33.64,165.55),Z=-2.214,P=0.027].② The area under the ROC curve (AUC) [95％ confidence interval (95％ CI)] of NT-proBNP in patients with age＜65 years old was significantly higher than that of group with age≥65 years old and the entire group [0.825(0.738-0.892) vs.0.664 (0.592-0.731) and 0.725 (0.670-0.775),Z1 =-2.835,P1 =0.005; Z2=-1.995,P2=0.046].③ The sensitivity (76.]0％ vs.64.10％),specificity (82.35％ vs.67.12％),positive predictive value (90.0％ vs.75.8％),and negative predictive value (62.2％ vs.53.8％) with cutoff value of NT-proBNP (2 882 ng/L) in group with age ＜65 years old were significantly higher than those with NT-proBNP cutoff value (6 062 ng/L) in group with age ≥ 65 years old.Conclusion NT-proBNP cutoff value in different age groups for the prediction of mortahty in the critically ill patients maybe more objective and accurate.