With the widespread application of chemotherapy, immunotherapy, and targeted therapy, cardiotoxicity associated with anti-tumor treatment has gained increasing attention. Drug-induced cardiac injury can significantly impact patients’ quality of life and may even limit the overall efficacy of anti-tumor therapy. The underlying mechanisms include oxidative stress, inflammatory responses, mitochondrial dysfunction, apoptosis, and immune dysregulation. Owing to multitarget effects, low toxicity, and holistic regulatory properties, Chinese traditional medicines have demonstrated considerable potential in cardioprotection. This review summarizes the principal mechanisms of drug-induced myocardial injury related to anti-tumor therapy and highlights recent advances in the prevention and treatment of cardiotoxicity using Chinese medical formulae, such as compound danshen dripping pills, nuanxinkang, qili qiangxin capsules, and shengmai powder, as well as their bioactive constituents. The cardioprotective effects of these agents are discussed in terms of their antioxidative, anti-inflammatory, immunomodulatory, and mitochondrial-protective actions. Furthermore, it highlights certain traditional medicines that exhibit unique advantages in synergistic cardioprotective and anti-tumor therapy. Future efforts should focus on well-designed, systematic clinical studies to facilitate the translational application of integrated Chinese and Western medicine in cardio-oncology.

Ultrasound-guided percutaneous lung needle biopsy (US-PLNB) is a pivotal diagnostic technique for subpleural pulmonary lesions, offering significant advantages such as real-time imaging, absence of ionizing radiation, and high operational flexibility. To standardize its clinical application and enhance both procedural safety and diagnostic accuracy, a multidisciplinary panel of experts was convened by eleven authoritative Chinese academic societies, including Chinese Society of Ultrasound in Medicine. Based on the latest domestic and international evidence-based medicine, this panel developed Chinese expert consensus on ultrasound-guided percutaneous lung needle biopsy (2025 edition). This consensus systematically elaborates on the indications and contraindications, preprocedural assessment and preparation, intraoperative techniques, complication prevention and management, and post-procedural care for US-PLNB. Furthermore, it puts forward 18 specific evidence-based recommendations. The primary aim of this consensus is to provide radiologists and clinicians with standardized operational guidance, promote the standardized application of US-PLNB, and ultimately improve patient care for individuals with pulmonary diseases.

Objective To explore the feasibility and image quality of respiratory-gated total-body ¹⁸F-FDG PET/CT imaging with a 4-minute acquisition in patients with malignant tumors. Methods Sixty-two patients with pathologically confirmed malignant tumors (118 lesions measured) who underwent total-body ¹⁸F-FDG PET/CT examination were consecutively enrolled at the Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, from September 23, 2021 to November 23, 2021, and their clinical and imaging data were retrospectively collected. PET data was acquired over 12 minutes with simultaneous respiratory waveform recorded. The data were reconstructed into four image sets: gated-12 group and gated-4 group (using all counts and the first 4-minute counts, respectively) and ungated-12 group and ungated-6 group (using all counts and the first 6-minute counts, respectively) reconstructed with respiratory gating that retained counts corresponding to the half respiratory window near end-expiration. Image quality assessment and quantitative analysis of lesions were performed and compared among the four image sets, and subgroup analyses were performed according to lesion location, size, and metabolic activity. Results The effective counts of 4 sets of PET images were highest in ungated-12 group, followed by ungated-6 group and gated-12 group, and lowest in gated-4 group (P＜0.001). Regardless of the metabolic level and size of the lesions, compared with the ungated-12 group and the ungated-6 group, the lesions in the gated-12 group showed higher maximum, average, and peak standardized uptake values (SUV_max, SUV_mean, and SUV_peak), tumor liver uptake ratio, tumor blood pool uptake ratio, and smaller metabolic volume (P＜0.05); There was no statistically significant difference in the above indicators between the gate-12 group and the gate-4 group. The background noise of gate-4 group images is slightly higher than that of gate-12 group images (Liver SUV_SD: [0.17＋0.05] vs [0.14＋0.04]); Blood pool SUV_SD: (0.08 ± 0.03) vs (0.06 ± 0.03). There was a statistically significant difference in subjective scores of PET image quality among the four groups (P＜0.001). The subjective scores of image quality in the gated-12 group (4.79 ± 0.41) were not significantly different from those in the non gated-12 group (4.97 ± 0.17) and non gated-6 group (4.79 ± 0.45), but were higher than those in the gated-4 group ([4.17 ± 0.45], P＜0.001)， And the scores have good consistency (Kappa＞0.75). Conclusion In total-body PET/CT imaging for malignant tumors, 4-minute respiratory-gated acquisition can achieve comparable quantitative performance to longer respiratory gating imaging while significantly shortening acquisition time. This approach demonstrates promising potential for clinical application.

With the continuous deepening of the concept of precision diagnosis and treatment for lung cancer, how to achieve higher efficiency and accuracy in the screening, diagnosis, and treatment pathways in clinical practice has become an important issue that urgently needs to be overcome. The current clinical difficulty lies in the fact that despite continuous advancements in imaging and molecular diagnostic technologies, there are still limitations in manual efficiency and subjective experience when it comes to massive data analysis and multi-scale feature extraction. Artificial intelligence (AI), especially algorithm systems based on deep learning, is an innovative technology capable of deeply empowering medical big data. This method utilizes algorithms such as convolutional neural networks, combined with radiomics, pathomics, and multi-modal data fusion analysis, demonstrating immense potential in early precise detection and benign-malignant differentiation of pulmonary nodules, digital pathological subtype recognition and non-invasive prediction of driver genes, precise 3D surgical planning and automatic delineation of radiotherapy target volumes, as well as dynamic risk warning during follow-up. This innovative technology provides a brand-new solution for realizing intelligent and individualized lung cancer diagnosis and treatment models. This consensus, based on the latest evidence from evidence-based medicine and combined with the development trends in the AI field and real-world clinical needs, was ultimately formed by gathering the consensus opinions of multidisciplinary experts in radiology, pathology, thoracic surgery, and other fields. The main content covers the application specifications of AI in the three core scenarios of lung cancer screening, diagnosis, and treatment, the technical standards for data collection and algorithm validation, as well as the ethical and regulatory challenges faced at the current stage. It aims to clarify the applicable boundaries of AI as a clinical auxiliary decision support tool, providing scientific guidance and standardized exploration directions for peers currently engaged in or planning to carry out AI-assisted clinical diagnosis, treatment, and translation of lung cancer.

Objective To investigate predictive value of soluble growth stimulation-expressed gene 2 protein (sST2), cardiac troponin T (cTnT), and creatine kinase-myocardial band (CK-MB) for steroid resistance and prognosis in patients with immune checkpoint inhibitor-associated myocarditis (ICIAM). Methods A total of 28 patients with ICIAM were prospectively enrolled from March 2023 to February 2024 at Zhongshan Hospital, Fudan University. All participants were divided into the steroid-resistant ICIAM (srICIAM) group and the non-srICIAM group. Baseline serum levels of sST2, cTnT and CK-MB were detected prior to treatment initiation. ROC curve analysis was applied to evaluate the predictive value of these biomarkers, and Kaplan-Meier survival analysis was performed to explore the relationship between sST2 and all-cause mortality. Results Baseline sST2, cTnT, and CK-MB levels were significantly higher in the srICIAM group (n＝15) than in the non-srICIAM group (n＝13, P＜0.05). Combination of cTnT and sST2 improved predictive performance for srICIAM (AUC＝0.857, sensitivity 0.714, specificity 1.000). After 6 months of follow-up, the high sST2 group had a significantly higher all-cause mortality than the low sST2 group (P＝0.016). Conclusions The combination of sST2 and cTnT could effectively predict srICIAM, and elevated sST2 is associated with increased higher all-cause mortality in ICIAM patients, providing a basis for early risk stratification and treatment optimization.

Objective To analyze the clinical and imaging features of primary anorectal malignant melanoma (ARMM) and to improve the level of its early diagnosis and clinical management. Methods A retrospective analysis was performed on the clinical data, multimodal imaging features, treatment methods, pathological results, and follow-up information of 31 patients with pathologically diagnosed ARMM at Zhongshan Hospital, Fudan University from December 2016 to October 2025. Results Among the 31 patients, there were 11 males and 20 females, with age of 65 (55, 71) years. Twenty-one patients presented with hematochezia as the initial symptom (67.7%), and four asymptomatic patients were detected incidentally by physical examination. All the patients showed negative alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9. All 31 cases were solitary ARMM, of which 14 (45.2%) were located in the anorectal region. CT was characterized by polypoid or fungating masses, absence of intestinal obstruction, moderate to marked enhancement; MRI was characterized by specific T₁WI hyperintensity and restricted diffusion; PET/CT is characterized by high metabolism. According to Ballantyne staging, 10 cases of stage Ⅰ, 11 cases of stage Ⅱ and 10 cases of stage Ⅲ were found. Endoscopic resection was performed in 1 patient, transanal resection in 2 patients, and abdominoperineal resection (Miles operation) with routine lymph node dissection in 17 patients. The positive rates of S-100, HMB-45 and Melan-A in 20 surgical patients were 100%, 95% and 100%, respectively, with a median Ki-67 proliferation index of 65%. Median postoperative follow-up duration of surgical patients was 34.5 (2−90) months. During follow-up, 8 patients (40%) developed recurrence and/or metastasis (median time was 11 months after surgery), with the liver and lungs being the most common metastatic sites. Conclusions Primary ARMM predominantly occurs in middle-aged and elderly women, hematochezia is the most common initial symptom. Diagnostic efficacy can be improved by combining characteristic imaging manifestations and immunohistochemical findings. ARMM is a highly malignant tumor with an overall poor prognosis, surgery remains the main therapeutic approach.

Radiogenomics, an extension of radiomics, explores the relationship between imaging features and underlying gene expression patterns. This field is instrumental in providing reliable imaging surrogates, thus potentially representing an alternative to genetic testing. The rapidly growing area of radiogenomics that utilizes ultrasound (US) imaging seeks to elucidate the connections between US image characteristics and genomic data. In this review, the authors outline the radiogenomics workflow and summarize the applications of US-based radiogenomics. These include the prediction of gene variations, molecular subtypes, and other biological characteristics, as well as the exploration of the relationships between US phenotypes and cancer gene profiles. Although the field faces various challenges, US-based radiogenomics offers promising prospects and avenues for future research.

Cardiomyopathy refers to a group of diseases characterized by structural and functional abnormalities of the myocardium, which often leads to severe outcomes such as heart failure, arrhythmias, and sudden cardiac death. The etiology of cardiomyopathies is multifactorial and includes genetic predispositions, metabolic and endocrine disorders, infections, toxic exposures, autoimmune diseases, physical, and chemical factors. Early and accurate diagnosis is crucial for effective treatment and disease management. Among the various diagnostic modalities, echocardiography has become the preferred tool for clinical diagnosis of cardiomyopathies due to its non-invasive nature, real-time imaging capabilities, and ease of use. It plays a pivotal role in the management guidelines for cardiomyopathies both nationally and internationally. This comment aims to explore the diagnostic and prognostic value of echocardiography in cardiomyopathy, discusses its advantages and limitations, and consider future directions for its development in clinical practice.

Objective To explore the sex difference in clinical manifestations, echocardiographic features and prognosis of patients with bicuspid aortic valve (BAV) combined with moderate to severe aortic stenosis (AS). Methods The clinical data and echocardiographic follow-up parameters of patients diagnosed with BAV combined with moderate to severe AS at Zhongshan Hospital, Fudan University, from July 30, 2010 to August 1, 2015 were retrospectively collected. The composite endpoint was defined as all-cause mortality or surgical intervention. Kaplan-Meier survival curve and log-rank test were used to compare the risk of composite endpoint events between male and female patients, and Cox regression models were used to analyze independent risk factors for composite endpoint events. Results A total of 144 patients were included, with 69 males and 75 females, and a median age of 60 years. Compared to males, female patients were younger (58[46, 65] years vs 61[54, 67] years, P＝0.046), had a lower proportion of aortic valve calcification (61.1% vs 81.1%, P＝0.009), and a higher peak transvalvular pressure gradient (72[59, 88] mmHg vs 63[55, 72] mmHg, P＝0.002). In terms of left ventricular remodeling types, the proportion of concentric remodeling was higher in females than in males (36.0% vs 15.9%, P＝0.006), while the proportion of eccentric hypertrophy was lower in females than in males (10.7% vs 29.0%, P＝0.006). The proportion of female patients classified as New York Heart Association (NYHA) functional class Ⅲ-Ⅳ was higher than that of males (45.3% vs 17.4%, P＜0.001), and left ventricular ejection fraction was higher in females (68%[65%, 72%] vs 65%[60%, 70%], P＝0.003). With a median follow-up of 49 months, Kaplan-Meier survival analysis showed that the risk of composite endpoint events was higher in females than in males (P＜0.001). Independent risk factors for composite endpoint events included female (HR＝1.74, 95%CI 1.02-2.96, P＝0.042), severe AS (HR＝1.99, 95%CI 1.18-3.36, P＝0.010), and NYHA functional class Ⅲ-Ⅳ (HR＝2.08, 95% CI 1.24-3.47, P＝0.005). Conclusions Sex significantly affects the clinical manifestations, echocardiographic characteristics, and prognosis of patients with BAV combined with moderate to severe AS, suggesting that sex-specific echocardiographic assessment and follow-up monitoring should be conducted for these patients.

Objective To evaluate the value of an optimized three-dimensional inversion-recovery with real reconstruction (3D-real IR) sequence with a longer repetition time (TR, 16 000 ms) based on modulated flip angle technique in refocused imaging with extended echo train (MATRIX) in the endolymphatic hydrops (EH) imaging after intratympanic gadolinium (Gd) administration, and to compare it with a conventional 3D-real IR based on the turbo spin echo (TSE) sequence. Methods From July 2021 to November 2022, twenty-seven patients received both the conventional and optimized 3D-real IR sequences after bilateral intratympanic Gd administration. Images of the two sequences were qualitativly evaluated and compared. Contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and area ratio of endolymph against the total lymphatic space from the two sequences were measured and compared. Results 14(25.9%) ears with insufficient contrast for the EH diagnosis on the conventional sequence were clearly displayed on the optimized sequence. Image score, CNR and SNR of the optimized sequence were significantly higher than those of the conventional sequence (P ＜ 0.001). The scanning time of two sequences was similar. The area ratio of endolymph against the total lymphatic space in the cochlear was significantly higher on the conventional 3D-real IR than that on the optimized 3D-real IR (P ＜ 0.001); there was no statistical difference in the vestibule between the two sequences. Conclusions Compared with conventional sequence, optimized 3D-real IR sequence with a longer TR may be better for evaluation of EH after intratympanic Gd administration.