Publications by authors named "Dengbin Wang"

43 Publications

Staging Liver Fibrosis: Comparison of Native T1 Mapping, T2 Mapping, and T1ρ: An Experimental Study in Rats With Bile Duct Ligation and Carbon Tetrachloride at 11.7 T MRI.

J Magn Reson Imaging 2021 Jul 13. Epub 2021 Jul 13.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: T1, T2, and T1ρ might be potential biomarkers for assessing liver fibrosis. However, few studies reported the value of them in different animal models.

Purpose: To investigate and compare the performances of T1, T2, and T1ρ for noninvasively staging liver fibrosis in bile duct ligation (BDL) or carbon tetrachloride (CCl ) model.

Study Type: Prospective animal model.

Subjects: Liver fibrosis was induced by BDL or injection of CCl in 120 rats.

Field Strength/sequence: 11.7 T, T1 mapping with 10 repetition times, T2 mapping with 32 echo times, and T1ρ with 10 spin-lock times.

Assessment: T1, T2, and T1ρ were measured and correlated with liver fibrosis stages, as well as the degree of inflammation, steatosis, iron deposition, and the expression of cytokeratin 19. The discriminative performance of T1, T2, and T1ρ for staging liver fibrosis was compared.

Statistical Tests: One-way analysis of variance (ANOVA), Spearman's correlation analysis, factorial design ANOVA, and receiver operating characteristic curves (P < 0.05 was considered statistically significant).

Results: T1, T2, and T1ρ (BDL: rho = 0.73, 0.85, 0.68; CCl : rho = 0.80, 0.29, 0.61) were significantly correlated with liver fibrosis stages, while there was no significant difference in T2 among stage F0-F4 in the CCl model (P = 0.204). The area under the curves (AUCs) range of T1, T2, and T1ρ for predicting ≥F1, ≥F2, ≥F3, and F4 were 0.76-0.95, 0.89-0.98, and 0.80-0.94 in the CCl model. For the CCl model, the AUCs range of T1, T2, and T1ρ for predicting ≥F1, ≥F2, ≥F3, and F4 were 0.83-0.95, 0.61-0.74, and 0.73-0.89, respectively. T2 had significantly higher AUC in the BDL model than CCl model for diagnosing liver fibrosis.

Data Conclusion: The most sensitive and accurate method for staging liver fibrosis appeared to be T1 in our animal models followed by T1ρ. T2 may not be suitable for evaluating liver fibrosis.

Level Of Evidence: 1 TECHNICAL EFFICACY STAGE: 2.
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http://dx.doi.org/10.1002/jmri.27822DOI Listing
July 2021

Quantifying magnetic resonance imaging features to classify placenta accreta spectrum (PAS) in high-risk gravid patients.

Clin Imaging 2021 Apr 29;80:50-57. Epub 2021 Apr 29.

Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China; Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, 25 South Gate Road, Shanghai 202150, China. Electronic address:

Objective: This study aimed to quantify the magnetic resonance imaging (MRI) features of placenta accreta spectrum (PAS) and to use MRI-based scores to classify them in high-risk gravid patients.

Materials And Methods: The clinical data and MRI features of 65 high-risk gravid patients diagnosed with PAS were retrospectively reviewed. The MRI features of PAS were analysed and compared using the chi-squared test, and the odds ratios (ORs) for significant risk factors for classification of PAS were identified via a multivariate logistic regression model. A receiver-operating characteristic (ROC) curve was used to calculate cut-off values and their corresponding sensitivity, specificity, and accuracy in classifying PAS.

Results: We identified 3 significant risk features for classification of PAS, including placental heterogeneity (OR = 13.604), abnormal vascularization at the placental-maternal interface (OR = 9.528), and focal myometrial interruption (OR = 118.779). The significant risk features for classification of PAS were scored according to their OR values, as 3 points (OR ≥ 20), 2 points (10 ≤ OR < 20), or 1 point (OR < 10). Based on the scores of the 3 risk features, a cut-off score of 4.5 points achieved optimal sensitivity (94.3%), specificity (90%), and accuracy (92.3%) for classifying PAS in high-risk gravid patients.

Conclusion: Quantifying these MRI features including placental heterogeneity, abnormal vascularization at the placental-maternal interface, and focal myometrial interruption can make a classification of PAS in high-risk gravid patients.
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http://dx.doi.org/10.1016/j.clinimag.2021.04.025DOI Listing
April 2021

Correlative investigation between routine clinical parameters of dual-energy computed tomography and the outcomes of extracorporeal shock wave lithotripsy in children with urolithiasis: a retrospective study.

Abdom Radiol (NY) 2021 Jun 10. Epub 2021 Jun 10.

Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China.

Purpose: To evaluate the associations of DECT parameters with extracorporeal shock wave lithotripsy (ESWL) outcomes in pediatric patients.

Methods: A retrospective study of consecutive patients with calculi who underwent ESWL and DECT in our hospital was performed in 2011-2019. The primary outcome was DECT imaging's correlation with ESWL outcomes. The secondary outcome was to determine DECT parameters independently predicting ESWL outcomes, including stone-free (SF) and residual stone (RS) statuses.

Results: The study included 207 patients. The mean CT attenuations at 140 kVp, 80 kVp, and 120 kVp and effective atomic number (Zeff) were significantly correlated with stone free (SF) and residual stone (RS) (P < 0.05). Areas under the curves (AUCs) of CT attenuations at 120 kVp, 80 kVp, 140 kVp, and dual-energy index (DEI) were 0.784 (95% CI 0.672-0.897), 0.780 (95% CI 0.677-0.884), 0.766 (95% CI 0.658-0.885), and 0.709 (95% CI 0.578-0.840) (all P < 0.05). With cutoffs of 882.5, 1330.5, 1042.5, and 0.103 for CT attenuations at 140 kVp, 80 kVp, 120 kVp, and DEI, respectively, sensitivities and specificities were 75.0% and 31.1%, 83.3% and 31.8%, 80.3% and 31.1%, and 58.3% and 44.7%, respectively.

Conclusion: Our results demonstrated that the parameters of DECT could be used to predict ESWL outcomes (especially the SF status) in children with urolithiasis. ESWL success can be accurately predicted by DECT, and it is hard to predict ESWL failure.
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http://dx.doi.org/10.1007/s00261-021-03162-0DOI Listing
June 2021

Simultaneous Head and Spine MR Imaging in Children Using a Dedicated Multichannel Receiver System at 3T.

IEEE Trans Biomed Eng 2021 May 20;PP. Epub 2021 May 20.

Objective: The purpose of this work was to enable simultaneous head and spine Magnetic Resonance imaging (MRI) in children at 3T by using a dedicated multichannel radiofrequency coil array system.

Methods: A 24-channel head and spine pediatric coil system was developed and constructed. The coils performance was compared with a commercially available 24-channel adult head-neck coil and a spine coil (1-4 spine of 16-channel were selected). Signal-to-noise ratio (SNR) and parallel imaging capability were quantitatively evaluated by phantom studies and in vivo imaging experiments. With Institutional Review Board and Ethics Committee approval, the designed coil was used to acquire head and spine images on 27 children in clinical settings.

Results: The pediatric coil provided substantial SNR improvements with an increase of 32 % to 40 % in the brain region and up to a two-fold increase in the surface. SNR increased by at least 18 % in the spine region. The coil enabled higher resolution and a faster imaging speed, owing to significantly improved SNR. Extensive coverage of the coil enabled high-quality fast imaging from head-neck to the whole spine. Good image quality with an average score 4.63 out of 5 was achieved using the developed pediatric coil in clinical studies.

Conclusion: Simultaneous head and spine MRI with superior performance have been successfully acquired in children subjects at 3T using the dedicated 24-channel head and spine pediatric coil system.

Significance: The 24-channel pediatric coil system potentially can enhance pediatric head and spine MRI in clinical research and diagnosis.
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http://dx.doi.org/10.1109/TBME.2021.3082149DOI Listing
May 2021

Clinical-MRI radiomics enables the prediction of preoperative cerebral spinal fluid dissemination in children with medulloblastoma.

World J Surg Oncol 2021 Apr 22;19(1):134. Epub 2021 Apr 22.

Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: Medulloblastoma (MB) is the most common pediatric embryonal tumor. Accurate identification of cerebral spinal fluid (CSF) dissemination is important in prognosis prediction. Both MRI of the central nervous system (CNS) and CSF cytology will appear false positive and negative. Our objective was to investigate the added value of preoperative-enhanced T1-weighted image-based radiomic features to clinical characteristics in predicting preoperative CSF dissemination for children with MB.

Materials And Methods: This retrospective study included 84 children with histopathologically confirmed MB between November 2006 and November 2018 (training cohort, n=60; internal validation cohort, n=24). A set of cases between December 2018 and February 2020 were used for external validation (n=40). The children with normal head and spine magnetic resonance images (MRI) and no subsequent dissemination in 1 year were diagnosed as non-CSF dissemination. The CSF dissemination was manifested as intracranial or intraspinal nodular-enhanced lesions. Clinical features were collected, and conventional MRI features of preoperative head MRI examinations were evaluated. A total of 385 radiomic features were extracted from preoperative-enhanced T1-weighted images. Minimum redundancy, maximum correlation, and least absolute shrinkage and selection operator were performed to select the features with the best performance in predicting preoperative CSF dissemination. A combined clinical-MRI radiomic prediction model was developed using multivariable logistic regression. Receiver operating curve analysis (ROC) was used to validate the predictive performance. Nomogram and decision curve analysis (DCA) were developed to evaluate the clinical utility of the combined model.

Results: One clinical and nine radiomic features were selected for predicting preoperative CSF dissemination. The combined model incorporating clinical and radiomic features had the best predictive performance in the training cohort with an AUC of 0.89. This was validated in the internal and external cohorts with AUCs of 0.87 and 0.73. The clinical utility of the model was confirmed by a clinical-MRI radiomic nomogram and DCA.

Conclusions: The combined model incorporating clinical, conventional MRI, and radiomic features could be applied to predict preoperative CSF dissemination for children with MB as a noninvasive biomarker, which could aid in risk evaluation.
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http://dx.doi.org/10.1186/s12957-021-02239-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063474PMC
April 2021

Clinical and magnetic resonance imaging features of 14 patients with trilateral retinoblastoma.

Quant Imaging Med Surg 2021 Apr;11(4):1458-1469

Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

Background: Our study aimed to comprehensively investigate the age of onset, magnetic resonance imaging (MRI) features, and prognosis of children with trilateral retinoblastoma (TRB).

Methods: We included 14 patients with TRB diagnosed or followed up in our hospital. The age of onset and MRI features of the intraocular tumor and intracranial lesions were evaluated. A follow-up study was also conducted.

Results: A total of 11 participants were diagnosed with concurrent TRB at the age of 11.1±7.4 months, and 3 participants had late-onset TRB at age 37±19.1 months. The incidence of TRB with unilateral eye involvement was 7.1% (1/14). The intraocular tumors showed intense enhancement in contrast-enhanced T1-weighted images (WI) and significant diffusion restriction in diffusion WI (DWI) with an apparent diffusion coefficient (ADC) of (0.619±0.22)×10 mm/s. The intracranial lesions showed similar DWI aspects with an ADC value of (0.680±0.206)×10 mm/s. Therapeutically, 8 participants had a period of intraocular tumor stabilization and significant intracranial lesion volume reduction after chemotherapy, and 6 participants had given up treatment. Only 2 participants who simultaneously received high-dose chemotherapy and autologous hematopoietic stem cell rescue were still alive with no recurrence at 24 and 54 months of follow-up. The 1-, 2-, and 3-year overall survival (OS) rates were 80%, 18.75%, and 12.5%, respectively.

Conclusions: Patients with unilateral or bilateral RB can develop TRB. The intraocular and intracranial tumors showed slightly different ADC values. High-dose chemotherapy, combined with stem cell rescue can significantly improve survival. A long term and scheduled follow-up before 60 months of age is necessary for screening later-onset TRB patients.
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http://dx.doi.org/10.21037/qims-20-605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930672PMC
April 2021

A deep learning model integrating mammography and clinical factors facilitates the malignancy prediction of BI-RADS 4 microcalcifications in breast cancer screening.

Eur Radiol 2021 Aug 26;31(8):5902-5912. Epub 2021 Jan 26.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China.

Objectives: To investigate the value of full-field digital mammography-based deep learning (DL) in predicting malignancy of Breast Imaging Reporting and Data System (BI-RADS) 4 microcalcifications.

Methods: A total of 384 patients with 414 pathologically confirmed microcalcifications (221 malignant and 193 benign) were randomly allocated into the training, validation, and testing datasets (272/71/71 lesions) in this retrospective study. A combined DL model was developed incorporating mammography and clinical variables. Model performance was evaluated by using areas under the receiver operating characteristic curve (AUC) and compared with the clinical model, stand-alone DL image model, and BI-RADS approach. The predictive performance for malignancy was also compared between the combined model and human readers (2 juniors and 2 seniors).

Results: The combined DL model demonstrated favorable AUC, sensitivity, and specificity of 0.910, 85.3%, and 91.9% in predicting BI-RADS 4 malignant microcalcifications in the testing dataset, which outperformed the clinical model, DL image model, and BI-RADS with AUCs of 0.799, 0.841, and 0.804, respectively. The combined model achieved non-inferior performance as senior radiologists (p = 0.860, p = 0.800) and outperformed junior radiologists (p = 0.155, p = 0.029). The diagnostic performance of two junior radiologists was improved after artificial intelligence assistance with AUCs increased to 0.854 and 0.901 from 0.816 (p = 0.556) and 0.773 (p = 0.046), while the interobserver agreement was improved with a kappa value increased to 0.843 from 0.331.

Conclusions: The combined deep learning model can improve the malignancy prediction of BI-RADS 4 microcalcifications in screening mammography and assist junior radiologists to achieve better performance, which can facilitate clinical decision-making.

Key Points: • The combined deep learning model demonstrated high diagnostic power, sensitivity, and specificity for predicting malignant BI-RADS 4 mammographic microcalcifications. • The combined model achieved similar performance with senior breast radiologists, while it outperformed junior breast radiologists. • Deep learning could improve the diagnostic performance of junior radiologists and facilitate clinical decision-making.
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http://dx.doi.org/10.1007/s00330-020-07659-yDOI Listing
August 2021

CT radiomics facilitates more accurate diagnosis of COVID-19 pneumonia: compared with CO-RADS.

J Transl Med 2021 01 7;19(1):29. Epub 2021 Jan 7.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China.

Background: Limited data was available for rapid and accurate detection of COVID-19 using CT-based machine learning model. This study aimed to investigate the value of chest CT radiomics for diagnosing COVID-19 pneumonia compared with clinical model and COVID-19 reporting and data system (CO-RADS), and develop an open-source diagnostic tool with the constructed radiomics model.

Methods: This study enrolled 115 laboratory-confirmed COVID-19 and 435 non-COVID-19 pneumonia patients (training dataset, n = 379; validation dataset, n = 131; testing dataset, n = 40). Key radiomics features extracted from chest CT images were selected to build a radiomics signature using least absolute shrinkage and selection operator (LASSO) regression. Clinical and clinico-radiomics combined models were constructed. The combined model was further validated in the viral pneumonia cohort, and compared with performance of two radiologists using CO-RADS. The diagnostic performance was assessed by receiver operating characteristics curve (ROC) analysis, calibration curve, and decision curve analysis (DCA).

Results: Eight radiomics features and 5 clinical variables were selected to construct the combined radiomics model, which outperformed the clinical model in diagnosing COVID-19 pneumonia with an area under the ROC (AUC) of 0.98 and good calibration in the validation cohort. The combined model also performed better in distinguishing COVID-19 from other viral pneumonia with an AUC of 0.93 compared with 0.75 (P = 0.03) for clinical model, and 0.69 (P = 0.008) or 0.82 (P = 0.15) for two trained radiologists using CO-RADS. The sensitivity and specificity of the combined model can be achieved to 0.85 and 0.90. The DCA confirmed the clinical utility of the combined model. An easy-to-use open-source diagnostic tool was developed using the combined model.

Conclusions: The combined radiomics model outperformed clinical model and CO-RADS for diagnosing COVID-19 pneumonia, which can facilitate more rapid and accurate detection.
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http://dx.doi.org/10.1186/s12967-020-02692-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790050PMC
January 2021

Age-related Brain Morphological Alteration of Medication-naive Boys With High Functioning Autism.

Acad Radiol 2020 Nov 4. Epub 2020 Nov 4.

Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address:

Rationale And Objective: To investigate age-related brain morphological changes of boys with high functioning autism (HFA).

Materials And Methods: Forty-six medication-naive boys with HFA and 48 age-matched typically developing boys (4-12 years old) were included in this study. Structural brain images were processed with FreeSurfer to calculate the brain morphometric features including regional volume, surface area, average cortical thickness, and Gaussian curvature. General linear model was used to identify significant effects of diagnosis and age-by-diagnosis interaction. Correlations between age and the brain morphometric variables of significant clusters were explored.

Results: Primarily, most of the regions with statistically significant intergroup differences were located in the temporal lobe gyri. Importantly, the volume of bilateral superior temporal gyrus (STG) and the average cortical thickness of the right STG demonstrated significantly age-related intergroup differences. Further age-stratified analysis also revealed morphological alterations of STG among subgroups of preschool and school-aged children with or without HFA.

Conclusion: The findings demonstrated abnormal age-related volume and cortical thickness atrophy of the STG in HFA children, which reflect brain development trajectories of ASD may initiate to diverge from early overgrowth in childhood period. The anatomical localization of specific brain regions would help us better understand the neurobiology alterations of HFA patients and indicate the effect of age should be carefully delineated and examined in future studies about HFA.
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http://dx.doi.org/10.1016/j.acra.2020.10.007DOI Listing
November 2020

Radiogenomics of neuroblastoma in pediatric patients: CT-based radiomics signature in predicting MYCN amplification.

Eur Radiol 2021 May 29;31(5):3080-3089. Epub 2020 Oct 29.

Department of Radiology, Xinhua Hospital affiliated of Shanghai Jiao Tong University School of Medicine, No.1665 Kongjiang Road, Yangpu District, Shanghai City, 200082, China.

Objectives: To construct a CT-based radiomics signature and assess its performance in predicting MYCN amplification (MNA) in pediatric patients with neuroblastoma.

Methods: Seventy-eight pediatric patients with neuroblastoma were recruited (55 in training cohort and 23 in test cohort). Radiomics features were extracted automatically from the region of interest (ROI) manually delineated on the three-phase computed tomography (CT) images. Selected radiomics features were retained to construct radiomics signature and a radiomics score (rad-score) was calculated by using the radiomics signature-based formula. A clinical model was established with clinical factors, including clinicopathological data, and CT image features. A combined nomogram was developed with the incorporation of a radiomics signature and clinical factors. The predictive performance was assessed by receiver operating characteristics curve (ROC) analysis and decision curve analysis (DCA).

Results: The radiomics signature was constructed using 7 selected radiomics features. The clinical radiomics nomogram, which was based on the radiomics signature and two clinical factors, showed superior predictive performance compared with the clinical model alone (area under the curve (AUC) in the training cohort: 0.95 vs. 0.82, the test cohort: 0.91 vs. 0.70). The clinical utility of clinical radiomics nomogram was confirmed by DCA.

Conclusions: This proposed CT-based radiomics signature was able to predict MNA. Combining the radiomics signature with clinical factors outperformed using clinical model alone for MNA prediction.

Key Points: • A CT-based radiomics signature has the ability to predict MYCN amplification (MNA) in neuroblastoma. • Both pre- and post-contrast CT images are valuable in predicting MNA. • Associating the radiomics signature with clinical factors improved the predictive performance of MNA, compared with clinical model alone.
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http://dx.doi.org/10.1007/s00330-020-07246-1DOI Listing
May 2021

Clinico-Radiological Features and Outcomes in Pregnant Women with COVID-19 Pneumonia Compared with Age-Matched Non-Pregnant Women.

Infect Drug Resist 2020 13;13:2845-2854. Epub 2020 Aug 13.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, People's Republic of China.

Purpose: To investigate the clinico-radiological findings and outcomes in pregnant women with COVID-19 pneumonia compared to age-matched non-pregnant women.

Methods: A retrospective case-controlled study was conducted to review clinical and CT data of 21 pregnant and 19 age-matched non-pregnant women with COVID-19 pneumonia. Four stages of CT images were analyzed and compared based on the time interval from symptom onset: stage 1 (0-6 days), stage 2 (7-9 days), stage 3 (10-16 days), and stage 4 (>16 days). The initial and follow-up data were analyzed and compared.

Results: Compared with age-matched non-pregnant women, initial absence of fever (13/21, 62%) and normal lymphocyte count (11/21, 52%) were more frequent in pregnant group. The predominant patterns of lung lesions were pure ground-glass opacity (GGO), GGO with consolidation or reticulation, and pure consolidation in both groups. Pure consolidation on chest CT was more common at presentation in pregnant cases. Pregnant women progressed with a higher consolidation frequency compared with non-pregnant group in stage 2 (95% vs 82%). Improvement was identified in stages 3 and 4 for both groups, but consolidation was still more frequent for pregnant women in stage 4. Most patients (38/40, 95%) were grouped as mild or common type. The length of hospitalization between the two groups was similar.

Conclusion: Pregnant women with COVID-19 pneumonia did not present typical clinical features, while developing a relatively more severe disease at imaging with a slower recovery course and experiencing similar outcomes compared with the non-pregnant women.
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http://dx.doi.org/10.2147/IDR.S264541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434520PMC
August 2020

Type 2 diabetes mellitus worsens the prognosis of intermediate-stage hepatocellular carcinoma after transarterial chemoembolization.

Diabetes Res Clin Pract 2020 Nov 19;169:108375. Epub 2020 Aug 19.

Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address:

Aims: The aim of this study was to investigate the impact of type 2 diabetes mellitus (T2DM) on the prognosis of hepatocellular carcinoma (HCC) patients following transarterial chemoembolization (TACE).

Methods: Time to progression (TTP) and cancer-specific mortality (CSM) in competing risk model were compared in patients with (n = 289) or without (n = 763) T2DM. Propensity score matching (PSM) was used to reduce bias between the two groups. Multivariate competing risk regression was used to evaluate independent risk factors for TTP and CSM.

Results: The T2DM group showed significantly worse 5-year TTP and CSM rates than the non-T2DM group both in the whole cohort (n = 1052) and the PSM cohort (n = 514) (81.3% vs. 70.9%, P < 0.001, and 61.5% vs. 49.3%, P = 0.006; 81.4% vs. 68.6%, P = 0.003, and 61.7% vs. 43.2%, P = 0.014, respectively). Multivariate competing risk regression identified T2DM as an independent risk factor for TTP and CSM before and after PSM (hazard ratio: 1.37 [95% confidence interval: 1.07-1.77] and 1.36 [1.05-1.75]; 1.29 [1.04-1.60] and 1.24 [1.02-1.52], respectively). T2DM worsened the long-term outcomes of patients in the cirrhosis subgroup but not those in the noncirrhosis subgroup.

Conclusions: T2DM worsened the long-term survival of intermediate-stage HCC patients who underwent TACE, especially in patients with cirrhosis.
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http://dx.doi.org/10.1016/j.diabres.2020.108375DOI Listing
November 2020

Fibronectin-Targeting and Cathepsin B-Activatable Theranostic Nanoprobe for MR/Fluorescence Imaging and Enhanced Photodynamic Therapy for Triple Negative Breast Cancer.

ACS Appl Mater Interfaces 2020 Jul 20;12(30):33564-33574. Epub 2020 Jul 20.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.

Because of the lack of specific targets, the highly aggressive triple negative breast cancer (TNBC) is unable to benefit from endocrine therapy or conventional targeting therapy. Even worse, current diagnostic and therapeutic approaches have limited value for TNBC. Therefore, developing TNBC-specific theranostic probes for accurate diagnosis and further selective therapy will build a powerful toolbox for TNBC management. In this contribution, we developed a sequential strategy to enhance the specificity of TNBC theranostics. In this theranostic system, a versatile nanoprobe ([email protected]) was integrated legitimately for the fibronectin-targeting MR imaging and CTSB-activatable fluorescence imaging, followed with enhanced photodynamic therapy (PDT) of TNBC. First, the fibronectin overexpressed in the extracellular matrix (ECM) of TNBC was used as a biomarker for targeting theranostics using the Cys-Arg-Glu-Lys-Ala (CREKA) peptide. For another, the fluorescence and PDT capacity of self-developed squaraine photosensitizer (SQ) were prequenched by ultrasmall superparamagnetic iron oxide (USPIO), an MR imaging contrast agent. Once the linker, Gly-Phe-Leu-Gly (GFLG) peptide, was selectively cleaved by TNBC-derived CTSB, the liberated SQ photosensitizer allowed light-up fluorescence imaging and enhanced PDT of TNBC. Remarkably, this research demonstrates that tumor-ECM-targeting and endogenous enzyme-activated nanoprobes open a new avenue for TNBC theranostics.
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http://dx.doi.org/10.1021/acsami.0c10397DOI Listing
July 2020

Pure dysgerminoma of the ovary: CT and MRI features with pathological correlation in 13 tumors.

J Ovarian Res 2020 Jun 17;13(1):71. Epub 2020 Jun 17.

Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.

Background: To investigate the spectrum of CT and MRI findings of dysgerminoma of the ovary.

Methods: CT and MRI imaging of 12 patients with 13 histologically proven dysgerminomas of the ovary were retrospectively reviewed. Patients ages ranged from 6 ~ 27 years (mean, 17.2 years). Two observers evaluated the following CT and MRI features of the tumor by consensus: (i) location, shape, and size; (ii) attenuation, T2 signal intensity, and ADC value; (iii) patterns of contrast enhancement; (iv) presence of fibrovascular septa; (v) presence of necrosis, hemorrhage, and calcification; (vi) presence of "ovarian vascular pedicle" sign. We also noted the extent or stage of the tumors.

Results: 75% lesions arised in the right ovary. Bilateral ovaries were involved in one case. Tumors displayed as a purely or predominantly solid mass (mean size, 17.0 ± 7.8 cm). Ten tumors were shaped multilobulated. The mean ADC value of lesions was 0.830 ± 0.154 × 10 mm/s. Characteristic fibrovascular septa were observed in all lesions. Among them, classic septa were present in 69% lesions. They were thin, hypointense on T2WI with a linear intense enhancement indicating the blood vessels in septa. Due to the stromal edema, fibrovascular septa may become thick even amorphous in shape, hyperintense on T2WI and even low attenuation on CT with a slight enhancement except for a bright blood vessel on the edge. Massive necrosis was observed only in one lesion. Calcification was present in 3 of the 5 tumors on CT. "Ovarian vascular pedicle" sign was present in 12 lesions. Lymphadenopathy, retroperitoneal spread, and distant metastases combined with an implantation in Douglas' cul-de-sac were present in one patient respectively.

Conclusion: On CT and MR images, ovarian dysgerminoma often appears as a large solid mass. The edematous condition of characteristic fibrovascular septa can be well displayed by imaging which then can guide the radiologists to make an accurate diagnosis. Calcifications often occur in the tumor. Nonspecific low ADC value and "ovarian vascular pedicle" sign may narrow the differential diagnosis.
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http://dx.doi.org/10.1186/s13048-020-00674-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301981PMC
June 2020

An aggregation-induced emission dye-powered afterglow luminogen for tumor imaging.

Chem Sci 2020 Jan 11;11(2):419-428. Epub 2019 Nov 11.

Department of Medical Ultrasound , Shanghai Tenth People's Hospital , Tongji University Cancer Center , Tongji University School of Medicine , Shanghai 200072 , China . Email:

Semiconducting polymer (SP)-based afterglow luminogens are showing increasing potential for imaging because of their long-life luminescence and the associated benefits (, zero-autofluorescence background and high signal-to-noise ratio). However, such organic afterglow luminescence agents are still rare and their application is usually limited by their relatively low afterglow intensity and short afterglow duration. Herein, we report an aggregation-induced emission (AIE) dye-powered SP afterglow luminogen by leveraging on the unique characteristics of an AIE dye to circumvent the concentration-quenching effect, enhance afterglow intensity and prolong afterglow duration. The underlying working mechanism is investigated by a series of experiments and it is found that the AIE dye provides sufficient O to excite SPs and form massive amounts of high-energy intermediates, and then the SP intermediates emit photons that can activate the AIE dye to generate O and simultaneously trigger the energy transfer process between the SPs and AIE dye, resulting in a deep-red emission. It is this closed-loop of "photon-O-SP intermediates-photon" that provides the afterglow emission even after the cessation of the excitation light. The as-prepared luminogen shows good performance in tumour imaging. This study demonstrates the advantages of AIE-facilitated afterglow luminescence and discloses its mechanism, and hopefully it could inspire the development of other innovative designs for cancer theranostics.
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http://dx.doi.org/10.1039/c9sc04901kDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067237PMC
January 2020

Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children.

J Infect 2020 05 21;80(5):e7-e13. Epub 2020 Mar 21.

Department of Radiology, Maternal and Child Health Hospital of Hubei Province, No.745 Wuluo Road, Hongshan District, Wuhan 430070, Hubei Province, China. Electronic address:

Background: The ongoing outbreak of COVID-19 pneumonia is globally concerning. We aimed to investigate the clinical and CT features in the pregnant women and children with this disease, which have not been well reported.

Methods: Clinical and CT data of 59 patients with COVID-19 from January 27 to February 14, 2020 were retrospectively reviewed, including 14 laboratory-confirmed non-pregnant adults, 16 laboratory-confirmed and 25 clinically-diagnosed pregnant women, and 4 laboratory-confirmed children. The clinical and CT features were analyzed and compared.

Findings: Compared with the non-pregnant adults group (n = 14), initial normal body temperature (9 [56%] and 16 [64%]), leukocytosis (8 [50%] and 9 [36%]) and elevated neutrophil ratio (14 [88%] and 20 [80%]), and lymphopenia (9 [56%] and 16 [64%]) were more common in the laboratory-confirmed (n = 16) and clinically-diagnosed (n = 25) pregnant groups. Totally 614 lesions were detected with predominantly peripheral and bilateral distributions in 54 (98%) and 37 (67%) patients, respectively. Pure ground-glass opacity (GGO) was the predominant presence in 94/131 (72%) lesions for the non-pregnant adults. Mixed consolidation and complete consolidation were more common in the laboratory-confirmed (70/161 [43%]) and clinically-diagnosed (153/322 [48%]) pregnant groups than 37/131 (28%) in the non-pregnant adults (P = 0·007, P < 0·001). GGO with reticulation was less common in 9/161 (6%) and 16/322 (5%) lesions for the two pregnant groups than 24/131 (18%) for the non-pregnant adults (P = 0·001, P < 0·001). The pulmonary involvement in children with COVID-19 was mild with a focal GGO or consolidation. Twenty-three patients underwent follow-up CT, revealing progression in 9/13 (69%) at 3 days whereas improvement in 8/10 (80%) at 6-9 days after initial CT scans.

Interpretation: Atypical clinical findings of pregnant women with COVID-19 could increase the difficulty in initial identification. Consolidation was more common in the pregnant groups. The clinically-diagnosed cases were vulnerable to more pulmonary involvement. CT was the modality of choice for early detection, severity assessment, and timely therapeutic effects evaluation for the cases with epidemic and clinical features of COVID-19 with or without laboratory confirmation. The exposure history and clinical symptoms were more helpful for screening in children versus chest CT.
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http://dx.doi.org/10.1016/j.jinf.2020.03.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156118PMC
May 2020

Development and validation of a MRI-based radiomics signature for prediction of KRAS mutation in rectal cancer.

Eur Radiol 2020 Apr 15;30(4):1948-1958. Epub 2020 Jan 15.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.

Objective: To develop a T2-weighted (T2W) image-based radiomics signature for the individual prediction of KRAS mutation status in patients with rectal cancer.

Methods: Three hundred four consecutive patients from center I with pathologically diagnosed rectal adenocarcinoma (training dataset, n = 213; internal validation dataset, n = 91) were enrolled in our retrospective study. The patients from center II (n = 86) were selected as an external validation dataset. A total of 960 imaging features were extracted from high-resolution T2W images for each patient. Five steps, mainly univariate statistical tests, were applied for feature selection. Subsequently, three classification methods, i.e., logistic regression (LR), decision tree (DT), and support vector machine (SVM) algorithm, were applied to develop the radiomics signature for KRAS prediction in the training dataset. The predictive performance was evaluated by receiver operating characteristics curve (ROC) analysis, calibration curve, and decision curve analysis (DCA).

Results: Seven radiomics features were screened as a KRAS-associated radiomics signature of rectal cancer. Our best prediction model was obtained with SVM classifiers with AUC of 0.722 (95%CI, 0.654-0.790) in the training dataset. This was validated in the internal and external validation datasets with good calibration, and the corresponding AUCs were 0.682 (95% CI, 0.569-0.794) and 0.714 (95% CI, 0.602-0.827), respectively. DCA confirmed its clinical usefulness.

Conclusions: The proposed T2WI-based radiomics signature has a moderate performance to predict KRAS status, and may be useful for supplementing genomic analysis to determine KRAS expression in rectal cancer patients.

Key Points: • T2WI-based radiomics showed a moderate diagnostic significance for KRAS status. • The best prediction model was obtained with SVM classifier. • The baseline clinical and histopathological characteristics were not associated with KRAS mutation.
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http://dx.doi.org/10.1007/s00330-019-06572-3DOI Listing
April 2020

Molecular Engineered Squaraine Nanoprobe for NIR-II/Photoacoustic Imaging and Photothermal Therapy of Metastatic Breast Cancer.

ACS Appl Mater Interfaces 2020 Jan 14;12(4):4276-4284. Epub 2020 Jan 14.

Department of Radiology, Xinhua Hospital , Shanghai Jiao Tong University School of Medicine , 200092 Shanghai , China.

Various squaraine dyes have been developed for biological imaging. Nevertheless, squaraine dyes with emission in the second window (NIR-II, 1000-1700 nm) have few reports largely due to the short of a simple and universal design strategy. In this contribution, molecular engineering strategy is explored to develop squaraine dyes with NIR-II emission. First, NIR-I squaraine dye SQ2 is constructed by the ethyl-grafted 1,8-naphtholactam as donor units and square acid as acceptor unit in a donor-acceptor-donor (D-A-D) structure. To red-shift the fluorescence emission into NIR-II window, malonitrile, as a forceful electron-withdrawing group, is introduced to strengthen square acid acceptor. As a result, the fluorescence spectrum of acceptor-engineered squaraine dye SQ1 exhibits a significant red-shift into NIR-II window. To translate NIR-II fluorophores SQ1 into effective theranostic agents, fibronectin-targeting SQ1 nanoprobe was constructed and showed excellent NIR-II imaging performance in angiography and tumor imaging, including lung metastatic foci in deep tissue. Furthermore, SQ1 nanoprobe can be used for photoacoustic imaging and photothermal ablation of tumors. This research demonstrates that the donor-acceptor engineering strategy is feasible and effective to develop NIR-II squaraine dyes.
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http://dx.doi.org/10.1021/acsami.9b20147DOI Listing
January 2020

Diffusion Metrics for Staging Pancreatic Fibrosis and Correlating With Epithelial-Mesenchymal Transition Markers in a Chronic Pancreatitis Rat Model at 11.7T MRI.

J Magn Reson Imaging 2020 07 21;52(1):197-206. Epub 2019 Nov 21.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: Chronic pancreatitis (CP) is characterized by pancreatic fibrosis, in which a epithelial-mesenchymal transition (EMT)-like process is observed. However, few noninvasive approaches have been reported to evaluate pancreatic fibrosis and EMT in an animal model based on diffusion imaging.

Purpose: To evaluate pancreatic fibrosis in CP by conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) and then explore the correlation between diffusion parameters and the EMT markers in an animal model.

Study Type: Prospective controlled imaging histological correlation.

Population: Forty-five rats with CP induced by injecting dibutyltin dichloride solution and 10 normal rats comprised the control group.

Field Strength/sequence: 11.7T MR, diffusion imaging with 10 b-values.

Assessment: Apparent diffusion coefficient (ADC), IVIM-associated perfusion fraction (f), pseudodiffusion coefficient (D*), diffusion coefficient (D), DKI-associated mean kurtosis (MK), and mean corrected diffusion coefficient (MD) were quantitatively measured and correlated with pancreatic fibrosis stages as well as the EMT markers E-cadherin and α-smooth muscle actin (α-SMA) expression. The discriminative performance of diffusion parameters for staging fibrosis was compared.

Statistical Tests: Spearman's correlation, Student's t-test, and a receiver operating characteristic curve was conducted for statistical analysis.

Results: ADC, D, and MD (r = -0.637, -0.688, and -0.535; P < 0.001) were negatively correlated with pancreatic fibrosis staging, but MK (r = 0.740, P < 0.001) had a positive correlation. ADC, D, MD, and MK were significantly correlated with α-SMA (r = -0.684, -0.728, -0.627, and 0.721, all P < 0.001), while MK was significantly correlated with E-cadherin (r = -0.606, P < 0.001). The area under the curve (AUC) was not significantly different (P > 0.05) among ADC (0.797, 0.816, 0.873), D (0.862, 0.810, 0.895), MD (0.767, 0.772, 0.801), and MK (0.836, 0.893, 0.951) for F1 or greater, F2 or greater, and F3 pancreatic fibrosis separately.

Data Conclusion: ADC, D, MD, and MK were helpful for assessing pancreatic fibrosis staging, and these diffusion parameters were also significantly correlated with the expression of EMT markers in pancreatic fibrosis.

Level Of Evidence: 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;52:197-206.
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http://dx.doi.org/10.1002/jmri.26995DOI Listing
July 2020

F-labeled magnetic nanoparticles for monitoring anti-angiogenic therapeutic effects in breast cancer xenografts.

J Nanobiotechnology 2019 Oct 11;17(1):105. Epub 2019 Oct 11.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.

Purpose: To develop a novel fluorine-18 (F)-labeled arginine-glycine-aspartic acid (RGD)-coupled ultra-small iron oxide nanoparticle (USPIO) (hereafter, referred to as [email protected]) and conduct an in-depth investigation to monitor the anti-angiogenic therapeutic effects by using a novel dual-modality PET/MRI probe.

Methods: The RGD peptide and F were coupled onto USPIO by click chemistry. In vitro experiments including determination of stability, cytotoxicity, cell binding of the obtained [email protected]PIO were carried out, and the targeting kinetics and bio-distribution were tested on an MDA-MB-231 tumor model. A total of 20 (n = 10 per group) MDA-MB-231 xenograft-bearing mice were treated with bevacizumab or placebo (intraperitoneal injections of bevacizumab or a volume-equivalent placebo solution at the dose of 5 mg/kg for consecutive 7 days, respectively), and underwent PET/CT and MRI examinations with [email protected] before and after treatment. Imaging findings were validated by histological analysis with regard to β-integrin expression (CD61 expression), microvascular density (CD31 expression), and proliferation (Ki-67 expression).

Results: Excellent stability, low toxicity, and good specificity to endothelial of [email protected] were confirmed. The best time point for MRI scan was 6 h post-injection. No intergroup differences were observed in tumor volume development between baseline and day 7. However, [email protected] binding was significantly reduced after bevacizumab treatment compared with placebo, both on MRI (P < 0.001) and PET/CT (P = 0.002). Significantly lower microvascular density, tumor cell proliferation, and integrin β expression were noted in the bevacizumab therapy group than the placebo group, which were consistent with the imaging results.

Conclusion: PET/MRI with the dual-modality nanoprobe, [email protected], can be implemented as a noninvasive approach to monitor the therapeutic effects of anti-angiogenesis in breast cancer model in vivo.
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http://dx.doi.org/10.1186/s12951-019-0534-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788012PMC
October 2019

Noninvasive Stereotactic Radiotherapy for Renal Denervation in a Swine Model.

J Am Coll Cardiol 2019 10;74(13):1697-1709

Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address:

Background: Catheter-based renal denervation (RDN) has achieved promising outcomes to treat hypertension in recent randomized controlled trials.

Objectives: The purpose of this study was to assess the feasibility, efficacy, and safety of noninvasive stereotactic body radiotherapy (SBRT) as an approach for RDN.

Methods: SBRT was performed in 24 renal arteries from 12 normotensive swine at doses of 25, 35, and 45 Gy (n = 4 each), and an additional 4 swine served as controls. Blood pressure (BP), renal function, and serum norepinephrine (NE) values were obtained at baseline and at 7 days, 1 month, and 3 months after SBRT. Abdominal contrast-enhanced computed tomography (CT) was performed after 3 months before euthanasia. Renal NE concentration was determined, and histological analysis and immunohistochemistry against tyrosine hydroxylase were performed.

Results: SBRT procedure was successful in all 12 swine. BP was comparable among groups. Serum and renal NE levels at 3 months were significantly lower in treatment groups compared with control group. Furthermore, SBRT resulted in significantly greater nerve injury score and lower tyrosine hydroxylase score compared with control subjects, whereas there were no statistical differences between SBRT groups. Circumferential lesions created with 35 and 45 Gy were significantly greater than with 25 Gy. CT and histology analysis revealed that animals receiving 35 and 45 Gy experienced more collateral damage, which was minimal in the 25-Gy group.

Conclusions: Noninvasive SBRT was feasible and effective for complete, circumferential RDN in a swine model, with dosage at 25 Gy providing the safest short-term profile.
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http://dx.doi.org/10.1016/j.jacc.2019.07.053DOI Listing
October 2019

Combining Clinical Characteristics and Specific Magnetic Resonance Imaging Features to Predict Placenta Accreta.

J Comput Assist Tomogr 2019 Sep/Oct;43(5):775-779

From the Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai, China.

Objective: The aim of this study was to explore the independent clinical and magnetic resonance imaging (MRI) performance risk factors for predicting placenta accreta.

Methods: From January 2012 to December 2015, we retrospectively reviewed the clinical characteristics and MRI features of 97 patients. Of these, 42 were confirmed to be placenta accreta by pathological results or cesarean delivery findings. We tried to identify the independent risk factors by multivariate logistic regression model for significant differences in variables determined by univariate analysis.

Results: The multivariate logistic regression model indicated that 2 or more instances of previous cesarean deliveries and/or abortions, placenta previa, and placenta-myometrial interface interruption were independent risk factors for placenta accreta. The odd ratios were 3.79 for patients who had 2 or more instances of previous cesarean deliveries and/or abortions, 0.04 for marginal/partial placenta previa, 0.024 for complete placenta previa, and 6.56 for placenta-myometrial interface interruption. The values of accuracy and positive prediction by combination of a single clinical risk factor and placenta-myometrial interface interruption and of positive prediction by a combination of all 3 risk factors for predicting placenta accreta were raised to 83.5%, 75%, and 92.9%, respectively. We obtained 3 different risk groups by different combinations of all 3 risk factors.

Conclusions: The study suggested that 2 or more instances of previous cesarean deliveries and/or abortion, placenta previa, and placenta-myometrial interface interruption were independent risk factors for placenta accreta. A combination of a single clinical risk factor and an MRI risk factor can improve the diagnosis of placenta accreta, and a combination of all 3 risk factors could help recognize patients with placenta accreta.
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http://dx.doi.org/10.1097/RCT.0000000000000894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752690PMC
October 2019

Native T1 mapping compared to ultrasound elastography for staging and monitoring liver fibrosis: an animal study of repeatability, reproducibility, and accuracy.

Eur Radiol 2020 Jan 23;30(1):337-345. Epub 2019 Jul 23.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China.

Objectives: To investigate the repeatability, reproducibility, and staging and monitoring of the performance of native T1 mapping for noninvasively assessing liver fibrosis in comparison with acoustic radiation force impulse (ARFI) elastography.

Methods: The repeatability and reproducibility were explored in 8 male Sprague-Dawley rats with intraclass correlation coefficient (ICC). Different degrees of fibrosis were induced in 52 rats by carbon-tetrachloride (CCl4) insult. Another 16 rats were used to build fibrosis progression and regression models. The native T1 values and shear wave velocity (SWV) were quantified by using native T1 mapping and ARFI elastography, respectively. The METAVIR system (F0-F4) was used for the staging of fibrosis. The area under the receiver operating characteristic curve (AUC) was determined to assess the performance of quantitative parameters for staging and monitoring fibrosis.

Results: Native T1 values shared similar good repeatability (ICC = 0.93) and reproducibility (ICC = 0.87) with SWV (ICC = 0.84-0.93). The AUC of native T1 values were 0.84, 0.84, and 0.75 for diagnosing significant fibrosis (≥ F2) and liver cirrhosis (F4) and detecting fibrosis progression, and those of SWV were 0.81, 0.86, and 0.7, respectively. No significant difference in performance was found between the two quantitative parameters (p ≥ 0.496). For detecting fibrosis regression, native T1 values had a better accuracy (AUC = 0.99) than SWV (AUC = 0.56; p = 0.002).

Conclusion: Native T1 mapping may be a reliable and accurate method for noninvasively assessing liver fibrosis. Compared with ARFI elastography, it provides similar good repeatability and reproducibility, a similar high accuracy for staging fibrosis, and a better accuracy for detecting fibrosis regression.

Key Points: • Native T1 mapping is a valuable tool for noninvasively assessing liver fibrosis and can be measured on virtually all clinical MRI machines without additional hardware or gadolinium chelate injection. • Compared with acoustic radiation force impulse elastography, native T1 mapping yields similar good repeatability and reproducibility and a similar high accuracy for staging fibrosis. • Native T1 mapping provides a significantly better performance for detecting fibrosis regression than acoustic radiation force impulse elastography.
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http://dx.doi.org/10.1007/s00330-019-06335-0DOI Listing
January 2020

An ALP-activatable and mitochondria-targeted probe for prostate cancer-specific bimodal imaging and aggregation-enhanced photothermal therapy.

Nanoscale 2019 Mar;11(13):6307-6314

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China.

Tumor-derived alkaline phosphatase (ALP) is over-expressed in metastatic prostate cancer. The development of selective probes for ALP detection is therefore critical for early diagnosis and therapy of metastatic prostate cancer. Herein, we develop a mitochondria-targeted near-infrared activatable fluorescent/photoacoustic (NIR FL/PA) probe for the selective detection of prostate cancer-derived ALP and aggregation-enhanced photothermal therapy. Upon dephosphorylation, the probes are activated and they provide a red-shifted strong absorption and emission in the NIR window and thus enable NIR FL and PA imaging of ALP activity in tumor tissues. Particularly, the activated probes self-assemble in situ into a supramolecular network structure which induces cell apoptosis and significantly enhances the photothermal therapy efficacy.
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http://dx.doi.org/10.1039/c9nr00913bDOI Listing
March 2019

MRI radiomics analysis for predicting preoperative synchronous distant metastasis in patients with rectal cancer.

Eur Radiol 2019 Aug 9;29(8):4418-4426. Epub 2018 Nov 9.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China.

Objectives: To investigate the value of MRI radiomics based on T2-weighted (T2W) images in predicting preoperative synchronous distant metastasis (SDM) in patients with rectal cancer.

Methods: This retrospective study enrolled 177 patients with histopathology-confirmed rectal adenocarcinoma (123 patients in the training cohort and 54 in the validation cohort). A total of 385 radiomics features were extracted from pretreatment T2W images. Five steps, including univariate statistical tests and a random forest algorithm, were performed to select the best preforming features for predicting SDM. Multivariate logistic regression analysis was conducted to build the clinical and clinical-radiomics combined models in the training cohort. The predictive performance was validated by receiver operating characteristics curve (ROC) analysis and clinical utility implementing a nomogram and decision curve analysis.

Results: Fifty-nine patients (33.3%) were confirmed to have SDM. Six radiomics features and four clinical characteristics were selected for predicting SDM. The clinical-radiomics combined model performed better than the clinical model in both the training and validation datasets. A threshold of 0.44 yielded an area under the ROC (AUC) value of 0.827 (95% confidence interval (CI), 0.6963-0.9580), a sensitivity of 72.2%, a specificity of 94.4%, and an accuracy of 87.0% in the validation cohort for the combined model. A clinical-radiomics nomogram and decision curve analysis confirmed the clinical utility of the combined model.

Conclusions: Our proposed clinical-radiomics combined model could be utilized as a noninvasive biomarker for identifying patients at high risk of SDM, which could aid in tailoring treatment strategies.

Key Points: • T2WI-based radiomics analysis helps predict synchronous distant metastasis (SDM) of rectal cancer. • The clinical-radiomics combined model could be utilized as a noninvasive biomarker for predicting SDM. • Personalized treatment can be carried out with greater confidence based on the risk stratification for SDM in rectal cancer.
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http://dx.doi.org/10.1007/s00330-018-5802-7DOI Listing
August 2019

Blue Te Nanoneedles with Strong NIR Photothermal and Laser-Enhanced Anticancer Effects as "All-in-One" Nanoagents for Synergistic Thermo-Chemotherapy of Tumors.

Adv Healthc Mater 2018 11 30;7(21):e1800643. Epub 2018 Aug 30.

State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, 201620, China.

The conventional blue Te nanostructures exhibit strong photoabsorption in the near-infrared (NIR) region but have ultralong lengths (tenths of micrometers), while purple Te nanostructures with short lengths (such as nanodots and nanorods) show extremely low intensity of the NIR band. These Te nanostructures cannot achieve simultaneously both the suitable size and high NIR absorption, undoubtedly hindering their bioapplication. Herein, blue Te nanoneedles are prepared through a facile one-pot reduction route for the first time, and they have strong NIR absorbance while maintaining the shortened length (<500 nm). Compared to purple Te nanorods, blue Te nanoneedles have higher photothermal conversion efficiency using a 915 nm laser and exhibit laser-enhanced antioxidative activity toward scavenging of free radicals. These blue nanoneedles show significant discrimination in cytotoxicity toward different cell-lines, and demonstrate anticancer activity induced by mitochondrial dysfunction. Furthermore, when blue Te nanoneedles are injected in tumors of mice, tumors can be detected by thermal/photoacoustic imaging, and satisfactory therapeutic effects are achieved through the synergistic thermo-chemotherapy in contrast to the limited therapeutic effect of  Te-alone treatment. Therefore, these blue Te nanoneedles can be served as a novel theranostic nanoagent for simultaneous multimodal imaging and synergistic thermo-chemotherapy for tumors.
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http://dx.doi.org/10.1002/adhm.201800643DOI Listing
November 2018

Enzyme-triggered self-assembly of gold nanoparticles for enhanced retention effects and photothermal therapy of prostate cancer.

Chem Commun (Camb) 2018 Aug;54(70):9841-9844

Department of Radiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China.

A peptide-modified gold nanoparticle was developed for tumour-targeted therapy. Triggered by alkaline phosphatase, the CREKA-YPFFK(Nph) peptide can self-assemble and further result in accumulation of gold nanoparticles in tumour cells. The large-sized gold nanoparticle aggregates cannot escape from the tumour tissue, therefore realizing the goal of tumour-specific targeting, enhanced retention and photothermal effects.
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http://dx.doi.org/10.1039/c8cc05136dDOI Listing
August 2018

Alpha-fetoprotein response following transarterial chemoembolization indicates improved survival for intermediate-stage hepatocellular carcinoma.

HPB (Oxford) 2019 01 14;21(1):107-113. Epub 2018 Jul 14.

Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. Electronic address:

Background: To investigate the clinical value of the alpha-fetoprotein (AFP) response following transcatheter arterial chemoembolization (TACE) in intermediate-stage hepatocellular carcinoma (HCC).

Methods: Data on patients with Barcelona Clinic Liver Cancer B staging system were analyzed. An AFP response was defined as a decrease in AFP of more than 20% after a TACE session. The association between AFP response and treatment outcome regarding imaging response and overall survival (OS) was explored. Cox proportional hazards models were applied to identify independent risk factors for OS after TACE.

Results: Of the enrolled 376 patients with elevated serum AFP >20 ng/mL, 214 (57%) with AFP responses were identified. AFP responders had improved median survival than non-responders (20 vs. 12 months, P = 0.002). AFP response was significantly correlated with imaging response (P < 0.001). The Cox proportional hazards model revealed that AFP response was an independent factor for OS (hazard ratio, 0.59; 95% confidence interval, 0.45-0.78; P < 0.001). In stratified analyses, an AFP response achieved improved survival in patients with tumor diameters ≤5 cm, diameters >5 cm, tumor number ≤3 and without underlying cirrhosis.

Conclusions: The AFP response indicates enhanced survival after TACE in patients with intermediate-stage BCLC.
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http://dx.doi.org/10.1016/j.hpb.2018.06.1800DOI Listing
January 2019

Intravoxel incoherent motion diffusion-weighted MR imaging of the liver using respiratory-cardiac double triggering.

Oncotarget 2017 Nov 11;8(55):94959-94968. Epub 2017 Oct 11.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.

To investigate the influence of respiratory-cardiac double triggering (RCT) on intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for the liver, twelve healthy volunteers underwent liver DWI twice respectively with respiratory triggering (RT) and RCT schemes. Signal-to-noise ratios (SNRs) of the images, values, repeatability (evaluating with within-subject coefficient of variation), and variability of quantitative parameters, including apparent diffusion coefficient (ADC), pure diffusion coefficient (), perfusion fraction (), and perfusion-related diffusion coefficient (*), were evaluated for each DWI sequence. Results showed that the use of RCT scheme significantly enhanced SNRs ( < 0.001), improved the measurement precision ( ≤ 0.023) and repeatability ( ≤ 0.009) of ADC, , and values, decreased the variability of ADC and D values ( ≤ 0.015). Furthermore, this improvement was not completely confined to the left liver lobe, but also observed for the right liver lobe. Moreover, the precision of * values in the right lobe ( < 0.001) and its repeatability in the left lobe ( 0.002) were also significantly improved. Thus, our findings suggest that RCT is a more effective physiological scheme for improving SNRs, the precision, repeatability, and variability of quantitative parameters than RT for IVIM-DWI in the liver.
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http://dx.doi.org/10.18632/oncotarget.21824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706928PMC
November 2017

Diffusion kurtosis imaging evaluating epithelial-mesenchymal transition in colorectal carcinoma xenografts model: a preliminary study.

Sci Rep 2017 09 12;7(1):11424. Epub 2017 Sep 12.

Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, 200092, China.

Epithelial-mesenchymal transition (EMT) plays an important role in aggravating invasiveness and metastatic behavior of colorectal cancer (CRC). Identification of EMT is important for structuring treatment strategy, but has not yet been studied by using noninvasive imaging modality. Diffusion kurtosis imaging (DKI) is an advanced diffusion weighted model that could reflect tissue microstructural changes in vivo. In this study, EMT was induced in CRC cells (HCT116) by overexpressing Snail1 gene. We aimed to investigate the value of DKI in identifying EMT in CRC and decipher the correlations between DKI-derived parameters and EMT biomarker E-cadherin and cell proliferative index Ki-67 expression. Our results revealed that HCT116/Snail1 cells presented changes consistent with EMT resulting in significant increase in migration and invasion capacities. DKI could identify CRC with EMT, in which the DKI-derived parameter diffusivity was significantly lower, and kurtosis was significantly higher than those in the CRC/Control. Diffusivity was negatively and kurtosis was positively correlated with Ki-67 expression, whereas diffusivity was positively and kurtosis was negatively correlated with E-cadherin expression. Therefore, our study concluded that DKI can identify EMT in CRC xenograft tumors. EMT-contained CRC tumors with high Ki-67 and low E-cadherin expression were vulnerable to have lower diffusivity and higher kurtosis coefficients.
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http://dx.doi.org/10.1038/s41598-017-11808-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595886PMC
September 2017
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