Objective:To investigate the value of intratumoral and peritumoral radiomics models based on 18F-FDG PET-CT in predicting epidermal growth factor receptor (EGFR) mutation status in lung adenocarcinoma and interpret peritumoral radiomics features. Methods:This study was a cross-sectional study. Patients with lung adenocarcinoma who underwent 18F-FDG PET-CT at the Third Affiliated Hospital of Soochow University between January 2018 and April 2022 were retrospectively collected and samplied into a training set (309 cases) and a test set (206 cases) in a 6∶4 ratio randomly. Radiomics features were extracted from the intratumoral and peritumoral regions of interest based on PET and CT images, respectively, and the optimal feature sets were selected. Radiomics models were established using the XGBoost algorithm, and radiomics scores (intratumoral CT label, peritumoral CT label, intratumoral PET label, peritumoral PET label) were calculated. Logistic regression analysis was used to construct a clinical model and a combined model (incorporating PET-CT intratumoral and peritumoral radiomics, clinical features, and CT semantic features). The predictive performance of the models was evaluated using receiver operating characteristic curves and the area under the curve (AUC). Unsupervised clustering, Spearman correlation analysis, and visualization methods were used for the interpretability of peritumoral radiomics features. Results:In both the training and test sets, the AUC value of CT peritumoral labels was greater than that of CT intratumoral labels for predicting EGFR mutation status in lung adenocarcinoma (training set: Z=3.84, P<0.001; test set: Z=1.99, P=0.046). In the test set, the AUC value of PET intratumoral labels (0.684) was slightly higher than that of PET peritumoral labels (0.672) for predicting EGFR mutation status, but the difference was not statistically significant ( P>0.05). The combined model had the highest AUC value for predicting EGFR mutation status of lung adenocarcinoma in both the training and test sets and was significantly better than the clinical model (training set: Z=6.52, P<0.001; test set: Z=2.31, P=0.021). Interpretability analysis revealed that CT peritumoral radiomics features were correlated with CT shape features, and there were significant differences in CT peritumoral features between different EGFR mutation statuses. Conclusions:The value of CT peritumoral labels is superior to that of CT intratumoral labels in predicting EGFR mutation status in lung adenocarcinoma. The predictive performance of the model can be improved by combining PET-CT intratumoral and peritumoral radiomics, clinical features, and CT semantic features.

Objective:To explore the relationship between the maximum standard uptake value (SUV max) based on 18F-fluorodeoxyglucose (FDG) PET-CT and the epidermal growth factor receptor (EGFR) mutation status of lung adenocarcinoma appearing as ground glass nodules (GGN). Methods:A total of 103 patients with lung adenocarcinoma from October 2011 to December 2020 in the Third Affiliated Hospital of Soochow University were retrospectively enrolled. All patients underwent 18F-FDG PET-CT and high-resolution CT, and underwent surgical resection and EGFR detecting within one month. The patients were divided into EGFR mutation group and wild group according to the EGFR test results. The GGN number, type, location, shape, lobulation sign, spicule sign, abnormal bronchial sign, vacuole sign, pleural indentation, diameter of GGNs (D GGN), diameter of solid component (D solid) and nodule ground-glass opacity component CT mean (CT GGO) were analyzed on CT images. The maximum standard uptake value (SUV max) of nodules was measured on PET-CT images. The t test, Mann-Whitney U test or χ 2 test were used to compare the differences of clinical data, pathological data, CT imaging parameters and SUV max between the two groups. Hierarchical binary logistic regression model was used to assess whether there was any association between SUV max and EGFR mutation status in different subgroups. Generalized additive model and smooth curve fitting were applied to solve nonlinear problems, and piecewise binary logistic regression model was used to explain nonlinearity. Results:A total of 103 patients with 106 nodules were finally included. There were 75 patients (78 nodules) in the EGFR mutation group and 28 patients (28 nodules) in the EGFR wild group. Adenocarcinomas with EGFR mutation showed significantly higher spiculated edge, pleural depression sign and invasive adenocarcinoma proportions than those in EGFR wild group ( P<0.05). There were no significant differences in other indicators between groups ( P>0.05). After adjusting for age and fasting blood glucose, gender and the number of GGNs significantly affected the relationship between SUV max and EGFR mutation ( P<0.05), which suggested that there was an interaction. After adjusting for confounding factors, there was a non-linear relationship between SUV max and EGFR mutation status in female subgroup (degree of freedom was 1.817, P=0.026). When SUV max<2.4, the risk of EGFR mutation increased significantly with the increase of SUV max (OR=43.621, 95%CI 4.686-406.042), P<0.001]. When SUV max>2.4, the risk of EGFR mutation increased insignificantly ( P=0.392). Conclusions:Lung adenocarcinoma appearing as GGN has a higher risk of EGFR mutation. The risk of EGFR mutation in female patients increases with increasing SUV max, but there is saturation effect.

Objective:To construct and verify of the predictive models for pathologic invasion of early lung adenocarcinoma with ground glass nodules (GGNs) based on 18F-FDG PET/CT. Methods:A retrospective analysis was conducted on 149 patients (44 males, 105 females; age (61.1±8.9) years) with pre-invasive lesions/minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) confirmed by pathology after surgery in the First People′s Hospital of Changzhou from October 2011 to October 2019. All patients underwent PET/CT for GGNs. GGNs were randomly divided into a modeling group and validation group with the proportion of 1∶1. Mann-Whitney U test or χ2 test was used to compare the qualitative morphological characteristics (shape, edge characteristics, etc.), quantitative parameters (consolidation-to-tumor ratio, attenuation value of the ground glass opacity (GGO) component on CT (CT GGO), etc.) and quantitative functional parameters (SUV max and SUV index(GGNs SUV max/liver SUV mean) of pre-invasive lesions/MIA and IAC. Logistic regression analysis was used to construct the models, and the ROC curve was used to verify the models′ robustness. Different AUCs were compared by Delong test. Results:A total of 170 GGNs were removed by surgery and confirmed pathologically. In the modeling group ( n=89), the proportion of mixed GGNs, irregular shape, edge characteristics, bronchiectasis/twist/truncation sign, GGNs maximum diameter and solid component maximum diameter, consolidation-to-tumor ratio, CT GGO, SUV max and SUV index in IAC group were significantly higher than those in pre-invasive/MIA group ( χ2 values: 5.00-23.40, z values: from -6.53 to -2.70, all P<0.05). Models 1-3 were constructed based on the qualitative parameters (GGNs type, edge characteristics), quantitative parameters (CT GGO, SUV index), combined qualitative and quantitative parameters (GGNs type, edge characteristics, SUV index) of PET/CT, respectively, and the AUCs of ROC were 0.896, 0.880 and 0.931 in the modeling group, respectively. And the AUC of model 2 was not decreased significantly in the validation group ( n=81; AUC=0.802; z=0.81, P=0.417). Conclusion:The model combined with morphological and functional quantitative parameters of 18F-FDG PET/CT can effectively predict the pathological invasion of early lung adenocarcinoma, and the constructed model is robust.

Objective:To analyze the postoperative paravertebral muscle degeneration and its correlations with health related quality of life (HRQL) in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).Methods:The clinical data of the 50 patients were retrospectively analyzed who had undergone single-segmental MIS-TLIF at Department of Spinal Cord Surgery, The People's Hospital of Henan Province from January 2019 to December 2021. The relative volumes of lumbar posterior muscle (LM), the relative volumes of the psoas major (PM), and the rates of fatty degeneration (FD) of the fused segment and its adjacent segments were compared respectively between preoperation, 6 and 12 months postoperation. The correlations were analyzed between the HRQL scores [visual analog scale (VAS) for pain and Oswestry disability index (ODI)] and the relative LM volumes, the relative PM volumes, and the FD rates of the fused segment and its adjacent segments at 12 months postoperation.Results:Compared with the preoperative values, the relative LM volumes and the relative PM volumes of the fused segment and its adjacent segments at 6 and 12 months postoperation were significantly reduced while the FD rates significantly increased. However, the FD rate of the fused segment at 12 months postoperation (20.6% ± 6.1%) was significantly lower than that at 6 months postoperation (29.7% ± 8.2%) ( P < 0.05). The VAS score was strongly negatively or positively correlated with the relative LM volume ( r = -0.819, P < 0.001) and the FD rate ( r = 0.86, P < 0.001) of the fused segment, and moderately negatively correlated with the relative PM volume ( r = -0.435, P = 0.016). The ODI index was moderately negatively correlated with the relative LM volume ( r = -0.512, P = 0.004) and the relative PM volume ( r = -0.402, P = 0.020) of the fused segment, but moderately positively correlated with the FD rate of the fused segment ( r = 0.565, P = 0.001). There was a moderate negative correlation between the ODI index and the relative LM volume of the adjacent segments ( r = -0.478, P = 0.012). Conclusions:After MIS-TLIF, the volume of the paravertebral muscles decreases and the dorsal muscles develop fatty degeneration. The improvement of LM fatty degeneration may be observed by 12-month follow-up in the fused segment, but not in the adjacent segments. The LM volume and the FD rate of the fused segment are the most closely related to the postoperative HRQL.

Objective:To investigate the correlation between the SUV index (SUV max of the lesion/SUV mean of the liver) in 18F-FDG PET/CT imaging and the invasiveness of early lung adenocarcinoma presenting as ground-glass nodule (GGN). Methods:From January 2012 to March 2020, 167 GGN patients (49 males, 118 females; age: (61.5±9.0) years) with early lung adenocarcinoma who underwent PET/CT imaging in Changzhou First People′s Hospital were retrospectively enrolled. The image parameters including the GGN number, location, type, edge, shape, abnormal bronchus sign, vacuole sign, pleural depression, vessel convergence sign, GGN diameter ( DGGN), solid component diameter ( Dsolid), consolidation to tumor ratio (CTR, Dsolid/ DGGN), CT values (CT value of ground-glass opacity (CT GGO), CT value of lung parenchyma (CT LP), ΔCT GGO-LP (CT GGO-CT LP)) and SUV index were analyzed. Single and multivariate logistic regressions were used to analyze the correlation between SUV index and infiltration. The generalized additive model was used for curve fitting, and the piece-wise regression model was used to further explain the nonlinearity. Results:In 189 GGNs, invasive adenocarcinoma accounted for 85.2% (161/189). Single logistic regression showed that the GGN number, type, shape, edge, abnormal bronchus sign, pleural depression, vessel convergence sign, DGGN, Dsolid, CTR, CT GGO, ΔCT GGO-LP and SUV index were related factors of infiltration (odds ratio ( OR) values: 0.396-224.083, P<0.001 or P<0.05). After fully adjusting for confounding factors, SUV index was significantly correlated with increased risk of invasion ( OR=2.162 (95% CI: 1.191-3.923), P=0.011). Curve fitting showed that the SUV index was non-linearly related to the risk of infiltration, and the risk of infiltration increased significantly only when the SUV index was greater than 0.43 ( OR=3.509 (95% CI: 1.429-8.620), P=0.006). The correlation between SUV index and infiltration had no interaction between age, vacuoles, pleural depression and CTR subgroups (all P>0.05). Conclusions:SUV index is an independent factor related to the invasiveness of early lung adenocarcinoma. The higher the SUV index, the greater the risk of invasion; but the two are not simply linearly correlated.

Purpose: Neoadjuvant therapy modality can increase the operability rate and mitigate pathological risks in locally advanced cervical cancer, but treatment response varies widely. It remains unclear whether genetic alterations correlate with the response to neoadjuvant therapy and disease-free survival (DFS) in locally advanced cervical cancer. Materials and Methods: A total of 62 locally advanced cervical cancer (stage IB-IIA) patients who received neoadjuvant chemoradiation plus radical hysterectomy were retrospectively analyzed. Patients’ tumor biopsy samples were comprehensively profiled using targeted next generation sequencing. Pathologic response to neoadjuvant treatment and DFS were evaluated against the association with genomic traits. Results: Genetic alterations of PIK3CA were most frequent (37%), comparable to that of Caucasian populations from The Cancer Genome Atlas. The mutation frequency of genes including TERT, POLD1, NOS2, and FGFR3 was significantly higher in Chinese patients whereas RPTOR, EGFR, and TP53 were underrepresented in comparison to Caucasians. Germline mutations were identified in 21% (13/62) of the cohort and more than half (57%) had mutations in DNA damage repair genes, including BRCA1/2, TP53 and PALB2. Importantly, high tumor mutation burden, TP53 polymorphism (rs1042522), and KEAP1 mutations were found to be associated with poor pathologic response to neoadjuvant chemoradiation treatment. KEAP1 mutations, PIK3CA-SOX2 co-amplification, TERC copy number gain, and TYMS polymorphism correlated with an increased risk of disease relapse. Conclusion We report the genomic profile of locally advanced cervical cancer patients and the distinction between Asian and Caucasian cohorts. Our findings highlight genomic traits associated with unfavorable neoadjuvant chemoradiation response and a higher risk of early disease recurrence.

Objective:To investigate the predictive value of 18F-fluorodeoxyglucose (FDG) PET/CT metabolic parameters for occult lymph node metastasis (OLM) in non-small cell lung cancer (NSCLC). Methods:A total of 183 patients (72 males, 111 females; age (61.5±8.4) years) who underwent 18F-FDG PET/CT and preoperatively diagnosed with clinical N0 stage (cN0) in Third Affiliated Hospital of Soochow University from January 2013 to December 2018 were retrospectively enrolled. All patients underwent anatomical pulmonary resection with systematic lymph node dissections within 3 weeks after 18F-FDG PET/CT examinations. According to the presence or absence of lymph node metastasis, patients were divided into OLM positive (OLM+ ) group and OLM negative (OLM-) group. Parameters of primary lesions, such as the maximum diameter (D max), tumor sites, morphological features, maximum standardized uptake value (SUV max), mean standardized uptake value (SUV mean), metabolic total volume (MTV), total lesion glycolysis (TLG), tumor SUV max to liver SUV mean (TLR max), tumor TLG to liver SUV mean (TLR TLG) were analyzed. Mann-Whitney U test and χ2 test were used to compare the parameters between groups. Multivariable logistic regression was used to analyze the independent risk factors for OLM. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of different parameters. Results:Among 183 patients, 25 (13.7%, 25/183) of them were diagnosed as OLM. In OLM+ group, 46 lymph nodes were pathologically positive for metastasis, including 15 N1 disease and 31 N2 disease. D max (2.9(2.3, 3.7) vs 2.3(1.7, 2.8) cm), lobulation ((76.0%(19/25) vs 37.3%(59/158)), SUV max (11.1(7.9, 17.7) vs 4.7(2.3, 9.2)), TLG (41.5(10.2, 91.1) vs 15.6(6.5, 23.8) ml), TLR max (4.7(3.5, 7.6) vs 2.1(0.9, 4.0)) and TLR TLG (18.1(5.0, 44.3) vs 6.1(3.0, 11.4) ml) of the primary lesions in OLM+ group were significantly higher than those in OLM-group ( z values: from -4.709 to -3.247, χ2=13.190, all P<0.05). Multivariable logistic regression analysis showed that TLR max (odds ratio ( OR)=15.145, 95% CI: 3.381-67.830, P<0.001) and D max ( OR=3.220, 95% CI: 1.192-8.701, P=0.021) were independent risk factors for OLM. TLR max yielded the highest area under curve (AUC; AUC=0.794) with the threshold of 3.12, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value for predicting OLM were 92.0%(23/25), 63.3%(100/158), 67.2%(123/183), 28.4%(23/81) and 98.0%(100/102), respectively. Conclusions:TLR max of tumor is the independent risk factor for OLM in NSCLC patients. TLR max can sensitively predict OLM preoperatively in patients with NSCLC.

Objective:To evaluate the diagnostic value of circulating microRNA-1 (miR-1) in early coronary artery plaque rupture in patients with stable coronary artery disease (SCAD).Methods:A prospective cohort study was conducted. Sixty-seven patients with SCAD admitted to the department of cardiology of the Third Affiliated Hospital of Soochow University from January to June in 2019 were enrolled. All patients had completed coronary angiography (CAG), percutaneous coronary intervention (PCI) single stent implantation or only CAG was performed according to the CAG results. Blood samples were collected before (0 hour) and 3 hours after the procedure. The expression of plasma miR-1 was detected by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR), and electrocardiogram was used to detect cardiac troponin I (cTnI) levels. The difference of miR-1 and cTnI levels in PCI or CAG patients before and after procedure were compared, and the value for early diagnosis of coronary artery plaque rupture in SCAD patients was evaluated. The diagnostic efficacy was evaluated by the receiver operating characteristic curve (ROC curve).Results:There were 38 CAG patients and 29 PCI patients. There were no significant differences in gender, age, previous history (without hypertension history) and baseline data of cardiac function between the two groups. The expression of miR-1 after PCI was significantly higher than that before PCI [2 -ΔΔCt: 2.11 (1.56, 2.73) vs. 1.26 (1.07, 1.92), P < 0.01], and there was no significant difference in cTnI level before and after PCI [μg/L: 0.00 (0.00, 0.02) vs. 0.00 (0.00, 0.02), P > 0.05]. There were no significant differences in miR-1 and cTnI levels before and after procedure in the CAG group [miR-1 (2 -ΔΔCt): 1.09 (1.00, 1.40) vs. 1.21 (1.00, 1.71), cTnI (μg/L): 0.00 (0.00, 0.02) vs. 0.00 (0.00, 0.02), both P > 0.05]. ROC curve analysis showed that the area under ROC curve (AUC) and 95% confidence interval (95% CI) of miR-1 in the diagnosis of coronary plaque rupture were 0.794 (0.687-0.900), P < 0.01, the sensitivity was 82.8%, the specificity was 68.4%, and the optimal cut-off value was 1.51. The AUC and 95% CI of the difference of miR-1 before and after operation (ΔmiR-1) were 0.704 (0.567-0.842), P = 0.004, the sensitivity was 62.1%, the specificity was 84.2%, and the optimal cut-off value was 0.39. The efficancy of miR-1 and ΔmiR-1 after procedure to diagnose coronary plaque rupture in patients with SCAD was similar ( Z = 1.287, P = 0.198). However, baseline miR-1 might not predict whether patients with SCAD need PCI or not (AUC = 0.630, P > 0.05). Multivariate binary Logistic regression analysis showed that increased postoperative miR-1 expression was an independent risk factor for coronary plaque rupture in SCAD patients [odds ratios ( OR) = 2.887, 95% CI was 1.044-7.978, P = 0.041]. Conclusion:Circulating miR-1 might have the value for early diagnosis of coronary artery plaque rupture in SCAD patients.

Objective:To explore the value of 18F-deoxyglucose (FDG) PET and high resolution CT (HRCT) combined prediction model in the identification of invasiveness of early lung adenocarcinoma with consolidation-to-tumor ratio (CTR)≤0.5. Methods:A retrospective analysis was performed on 91 patients with early lung adenocarcinoma with CTR≤0.5 who underwent PET/CT and HRCT before surgery in the Third Affiliated Hospital of Soochow University from October 2011 to October 2019, including 110 ground-glass nodules (GGNs). According to the pathological subtypes, they were divided into preinvasive-minimally invasive adenocarcinoma (MIA) group ( n=22) and invasive adenocarcinoma (IAC) group ( n=88). The image feature parameters of GGNs of the two groups were compared, and the HRCT model and PET-HRCT combined model were constructed using Logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic efficacy of different models. The Bootstrap resampling (times = 500) method was used for internal verification of the model, and we also performed interaction and hierarchical analysis on the model. Results:The proportions of mixed GGN, irregular shape, lobulation sign, dilated/distorted/cutoff bronchial sign, pleural indentation and vascular convergence in IAC group were significantly higher than those in preinvasive-MIA group (all P<0.05). Nodule diameter, solid component diameter, solid component ratio, CT value of ground glass attenuation component (CT GGO), and SUVindex of the IAC group were larger than those of the preinvasive-MIA group, and the differences were statistically significant ( P<0.001). Among the quantitative parameters of HRCT, CT GGO had the best diagnostic efficacy (AUC=0.775), with a sensitivity of 0.580 and a specificity of 0.909. The diagnostic efficacy of HRCT model and PET-HRCT combined model were better than CT GGO (AUC: 0.907 vs. 0.775, 0.931 vs. 0.775; P=0.027, 0.002, respectively), but the diagnostic efficacy of the former two was not statistically different ( P=0.210).When the specificity was 0.909, the sensitivity of the HRCT model and the PET-HRCT model (0.784 and 0.875, respectively) were significantly higher than that of the CT GGO (0.580), and the combined PET-HRCT model had a more significant increase in sensitivity. The PET-HRCT combined model showed no significant interaction between different nodule types, between groups with or without pleural indentation, and among nodule diameter subgroups (all P>0.05). Conclusion:PET-HRCT combined model has a good predictive value for the invasiveness of early lung adenocarcinoma with CTR≤0.5, and it can be used for GGN risk stratification to guide clinical decision-making.

Diabetes, obesity, and metabolic diseases are globally prevalent, and induction and increase of endogenous energy consumption, especially activation of brown adipose tissue (BAT), is a new therapeutic target. Non-invasive imaging techniques, including radionuclide imaging, MRI, ultrasound imaging, and optical imaging, have attracted wide attention in BAT monitoring and have good application prospects. This article reviews the progress and application of these imaging techniques in BAT monitoring.