Objective: This study investigates the potential of radiomics to predict postoperative progression of ossification of the posterior longitudinal ligament (OPLL) after posterior cervical spine surgery. Methods: This retrospective study included 473 patients diagnosed with OPLL at Peking University Third Hospital between October 2006 and September 2022. Patients underwent posterior spinal surgery and had at least 2 computed tomography (CT) examinations spaced at least 1 year apart. OPLL progression was defined as an annual growth rate exceeding 7.5%. Radiomic features were extracted from preoperative CT images of the OPLL lesions, followed by feature selection using correlation coefficient analysis and least absolute shrinkage and selection operator, and dimensionality reduction using principal component analysis. Univariable analysis identified significant clinical variables for constructing the clinical model. Logistic regression models, including the Rad-score model, clinical model, and combined model, were developed to predict OPLL progression. Results: Of the 473 patients, 191 (40.4%) experienced OPLL progression. On the testing set, the combined model, which incorporated the Rad-score and clinical variables (area under the receiver operating characteristic curve [AUC] = 0.751), outperformed both the radiomics-only model (AUC = 0.693) and the clinical model (AUC = 0.620). Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis confirmed the clinical utility of the combined model. SHAP (SHapley Additive exPlanations) analysis indicated that the Rad-score and age were key contributors to the model’s predictions, enhancing clinical interpretability. Conclusion Radiomics, combined with clinical variables, provides a valuable predictive tool for assessing the risk of postoperative progression in cervical OPLL, supporting more personalized treatment strategies. Prospective, multicenter validation is needed to confirm the utility of the model in broader clinical settings.

Objective: This study investigates the potential of radiomics to predict postoperative progression of ossification of the posterior longitudinal ligament (OPLL) after posterior cervical spine surgery. Methods: This retrospective study included 473 patients diagnosed with OPLL at Peking University Third Hospital between October 2006 and September 2022. Patients underwent posterior spinal surgery and had at least 2 computed tomography (CT) examinations spaced at least 1 year apart. OPLL progression was defined as an annual growth rate exceeding 7.5%. Radiomic features were extracted from preoperative CT images of the OPLL lesions, followed by feature selection using correlation coefficient analysis and least absolute shrinkage and selection operator, and dimensionality reduction using principal component analysis. Univariable analysis identified significant clinical variables for constructing the clinical model. Logistic regression models, including the Rad-score model, clinical model, and combined model, were developed to predict OPLL progression. Results: Of the 473 patients, 191 (40.4%) experienced OPLL progression. On the testing set, the combined model, which incorporated the Rad-score and clinical variables (area under the receiver operating characteristic curve [AUC] = 0.751), outperformed both the radiomics-only model (AUC = 0.693) and the clinical model (AUC = 0.620). Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis confirmed the clinical utility of the combined model. SHAP (SHapley Additive exPlanations) analysis indicated that the Rad-score and age were key contributors to the model’s predictions, enhancing clinical interpretability. Conclusion Radiomics, combined with clinical variables, provides a valuable predictive tool for assessing the risk of postoperative progression in cervical OPLL, supporting more personalized treatment strategies. Prospective, multicenter validation is needed to confirm the utility of the model in broader clinical settings.

Objective: This study investigates the potential of radiomics to predict postoperative progression of ossification of the posterior longitudinal ligament (OPLL) after posterior cervical spine surgery. Methods: This retrospective study included 473 patients diagnosed with OPLL at Peking University Third Hospital between October 2006 and September 2022. Patients underwent posterior spinal surgery and had at least 2 computed tomography (CT) examinations spaced at least 1 year apart. OPLL progression was defined as an annual growth rate exceeding 7.5%. Radiomic features were extracted from preoperative CT images of the OPLL lesions, followed by feature selection using correlation coefficient analysis and least absolute shrinkage and selection operator, and dimensionality reduction using principal component analysis. Univariable analysis identified significant clinical variables for constructing the clinical model. Logistic regression models, including the Rad-score model, clinical model, and combined model, were developed to predict OPLL progression. Results: Of the 473 patients, 191 (40.4%) experienced OPLL progression. On the testing set, the combined model, which incorporated the Rad-score and clinical variables (area under the receiver operating characteristic curve [AUC] = 0.751), outperformed both the radiomics-only model (AUC = 0.693) and the clinical model (AUC = 0.620). Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis confirmed the clinical utility of the combined model. SHAP (SHapley Additive exPlanations) analysis indicated that the Rad-score and age were key contributors to the model’s predictions, enhancing clinical interpretability. Conclusion Radiomics, combined with clinical variables, provides a valuable predictive tool for assessing the risk of postoperative progression in cervical OPLL, supporting more personalized treatment strategies. Prospective, multicenter validation is needed to confirm the utility of the model in broader clinical settings.

Objective: This study investigates the potential of radiomics to predict postoperative progression of ossification of the posterior longitudinal ligament (OPLL) after posterior cervical spine surgery. Methods: This retrospective study included 473 patients diagnosed with OPLL at Peking University Third Hospital between October 2006 and September 2022. Patients underwent posterior spinal surgery and had at least 2 computed tomography (CT) examinations spaced at least 1 year apart. OPLL progression was defined as an annual growth rate exceeding 7.5%. Radiomic features were extracted from preoperative CT images of the OPLL lesions, followed by feature selection using correlation coefficient analysis and least absolute shrinkage and selection operator, and dimensionality reduction using principal component analysis. Univariable analysis identified significant clinical variables for constructing the clinical model. Logistic regression models, including the Rad-score model, clinical model, and combined model, were developed to predict OPLL progression. Results: Of the 473 patients, 191 (40.4%) experienced OPLL progression. On the testing set, the combined model, which incorporated the Rad-score and clinical variables (area under the receiver operating characteristic curve [AUC] = 0.751), outperformed both the radiomics-only model (AUC = 0.693) and the clinical model (AUC = 0.620). Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis confirmed the clinical utility of the combined model. SHAP (SHapley Additive exPlanations) analysis indicated that the Rad-score and age were key contributors to the model’s predictions, enhancing clinical interpretability. Conclusion Radiomics, combined with clinical variables, provides a valuable predictive tool for assessing the risk of postoperative progression in cervical OPLL, supporting more personalized treatment strategies. Prospective, multicenter validation is needed to confirm the utility of the model in broader clinical settings.

Objective: This study investigates the potential of radiomics to predict postoperative progression of ossification of the posterior longitudinal ligament (OPLL) after posterior cervical spine surgery. Methods: This retrospective study included 473 patients diagnosed with OPLL at Peking University Third Hospital between October 2006 and September 2022. Patients underwent posterior spinal surgery and had at least 2 computed tomography (CT) examinations spaced at least 1 year apart. OPLL progression was defined as an annual growth rate exceeding 7.5%. Radiomic features were extracted from preoperative CT images of the OPLL lesions, followed by feature selection using correlation coefficient analysis and least absolute shrinkage and selection operator, and dimensionality reduction using principal component analysis. Univariable analysis identified significant clinical variables for constructing the clinical model. Logistic regression models, including the Rad-score model, clinical model, and combined model, were developed to predict OPLL progression. Results: Of the 473 patients, 191 (40.4%) experienced OPLL progression. On the testing set, the combined model, which incorporated the Rad-score and clinical variables (area under the receiver operating characteristic curve [AUC] = 0.751), outperformed both the radiomics-only model (AUC = 0.693) and the clinical model (AUC = 0.620). Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis confirmed the clinical utility of the combined model. SHAP (SHapley Additive exPlanations) analysis indicated that the Rad-score and age were key contributors to the model’s predictions, enhancing clinical interpretability. Conclusion Radiomics, combined with clinical variables, provides a valuable predictive tool for assessing the risk of postoperative progression in cervical OPLL, supporting more personalized treatment strategies. Prospective, multicenter validation is needed to confirm the utility of the model in broader clinical settings.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Imaging plays a significant role in diagnosis and treatment of musculoskeletal diseases.With the development of medical imaging technology,both clinical application and research depth of musculoskeletal imaging achieved remarkable progresses.The application advancements and future developing trends of musculoskeletal imaging were reviewed in this article.

Objective:To investigate the feasibility of the combination of free breathing with the high-threshold, short-delay technique in reducing radiation dose and the volumes of iodinated contrast agent in coronary computed tomography angiography (CCTA) for obese patients.Methods:The data of 73 obese patients with weights > 85 kg and body mass indices (BMIs) > 30 kg/m 2 who received CCTA in the Radiology Department of the Peking University Third Hospital from February 2023 to May 2024 were prospectively collected. These patients were divided into a control group (31 patients) and an experimental group (42 patients). Data were collected from the control group and experimental groups under breath-holding and free-breathing conditions, respectively. The bolus tracking thresholds, delay times, and ICA injection durations were set at 100 HU, 7 s, and 12 s for the control group and at 250 HU, 2 s, and 8 s for the experimental group, respectively. Other scanning and reconstruction parameters of both groups were consistent. The CT values and their standard deviations ( SD) of both groups were assessed and compared, with the CT values involving the lumens of the aorta (AO) root, left anterior descending (LAD), left circumflex artery (LCX), and right coronary artery (RCA). The signal-to-noise ratios (SNR) and contrast-to-noise ratio (CNR) were also calculated. The subjective assessment of image quality was performed for the 18 coronary artery segments using a 4-point scale. The effective radiation doses ( E) and the volumes of iodinated contrast agent of both groups were recorded and compared. The statistical differences in the aforementioned parameters between the groups were tested and analyzed using the analysis of variance (ANOVA), the Mann-Whitney U test, or the χ 2 test. With the results of the ICA as the gold standard, the diagnostic performance of the combination of free-breathing with the high-threshold, short-delay technique in CCTA for obese patients was assessed. Results:There was no statistically significant difference ( P > 0.05) in coronary artery images between both groups, specifically regarding the CT, SNR, and CNR values of the lumens of the AO roots, LAD, LCX, and RCA, as well as the SD values of the AO roots. Both groups received subjective scores of ≥ 3 for coronary artery images, meeting the diagnostic criteria, with no statistically significant differences ( P > 0.05). Compared with the results of the ICA, the analyses of the coronary artery segments of 23 patients from the experimental group, revealed that the accuracy, sensitivity, and specificity of CCTA in the diagnosis of > 50% stenosis were 89%, 86%, and 97%, respectively. Compared to that (45 ml) of the control group, the volume (30 ml) of iodinated contrast agent of the experimental group decreased by 33.3%, with no statistically significant difference in the effective radiation dose ( E) between both groups ( P > 0.05). Conclusions:The combination of free breathing with the high-threshold, short-delay technique can further reduce the volume of the ICA for obese patients while maintaining high CCTA image quality and diagnostic performance.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To investigate the feasibility of the combination of free breathing with the high-threshold, short-delay technique in reducing radiation dose and the volumes of iodinated contrast agent in coronary computed tomography angiography (CCTA) for obese patients.Methods:The data of 73 obese patients with weights > 85 kg and body mass indices (BMIs) > 30 kg/m 2 who received CCTA in the Radiology Department of the Peking University Third Hospital from February 2023 to May 2024 were prospectively collected. These patients were divided into a control group (31 patients) and an experimental group (42 patients). Data were collected from the control group and experimental groups under breath-holding and free-breathing conditions, respectively. The bolus tracking thresholds, delay times, and ICA injection durations were set at 100 HU, 7 s, and 12 s for the control group and at 250 HU, 2 s, and 8 s for the experimental group, respectively. Other scanning and reconstruction parameters of both groups were consistent. The CT values and their standard deviations ( SD) of both groups were assessed and compared, with the CT values involving the lumens of the aorta (AO) root, left anterior descending (LAD), left circumflex artery (LCX), and right coronary artery (RCA). The signal-to-noise ratios (SNR) and contrast-to-noise ratio (CNR) were also calculated. The subjective assessment of image quality was performed for the 18 coronary artery segments using a 4-point scale. The effective radiation doses ( E) and the volumes of iodinated contrast agent of both groups were recorded and compared. The statistical differences in the aforementioned parameters between the groups were tested and analyzed using the analysis of variance (ANOVA), the Mann-Whitney U test, or the χ 2 test. With the results of the ICA as the gold standard, the diagnostic performance of the combination of free-breathing with the high-threshold, short-delay technique in CCTA for obese patients was assessed. Results:There was no statistically significant difference ( P > 0.05) in coronary artery images between both groups, specifically regarding the CT, SNR, and CNR values of the lumens of the AO roots, LAD, LCX, and RCA, as well as the SD values of the AO roots. Both groups received subjective scores of ≥ 3 for coronary artery images, meeting the diagnostic criteria, with no statistically significant differences ( P > 0.05). Compared with the results of the ICA, the analyses of the coronary artery segments of 23 patients from the experimental group, revealed that the accuracy, sensitivity, and specificity of CCTA in the diagnosis of > 50% stenosis were 89%, 86%, and 97%, respectively. Compared to that (45 ml) of the control group, the volume (30 ml) of iodinated contrast agent of the experimental group decreased by 33.3%, with no statistically significant difference in the effective radiation dose ( E) between both groups ( P > 0.05). Conclusions:The combination of free breathing with the high-threshold, short-delay technique can further reduce the volume of the ICA for obese patients while maintaining high CCTA image quality and diagnostic performance.