Journal of Computer Assisted Tomography最新文献

{"title":"Prediction of Ki-67 Status in Breast Cancer Using a Habitat-Guided 2.5D Multiparametric MRI Deep Learning Model.","authors":"Zeyang Miao, Run Xu, Mengyao Guo, Hong Chen, Xuting Fang, Qiong Li, Peng Luo, Guanwu Li","doi":"10.1097/RCT.0000000000001923","DOIUrl":"https://doi.org/10.1097/RCT.0000000000001923","url":null,"abstract":"<p><strong>Objective: </strong>Intratumoral heterogeneity may limit the representativeness of biopsy-based Ki-67 assessment in breast cancer. We therefore developed and validated a habitat-guided 2.5D deep learning (DL) model based on multiparametric MRI for noninvasive preoperative prediction of high versus low Ki-67 expression.</p><p><strong>Methods: </strong>This retrospective study enrolled 333 patients with invasive breast carcinoma from 2 distinct MRI vendor cohorts (Siemens, training set, n=233; United Imaging, independent test set, n=100). All patients underwent preoperative multiparametric MRI, including DCE-MRI and DWI. Hemodynamic parametric maps (wash-in, wash-out) and ADC maps were generated and subsequently clustered using a K-means algorithm (k=3) to create a functional habitat mask that quantitatively encodes intratumoral heterogeneity. A 7-channel 2.5D input tensor was then constructed by concatenating the central habitat-guided slice with its 6 adjacent anatomic slices. A ResNet18 backbone was trained to classify high (≥20%) versus low Ki-67 expression. The model's performance was rigorously evaluated against conventional 2D DL, clinical, and combined (DL+clinical) models using AUC, the DeLong test, and decision curve analysis (DCA).</p><p><strong>Results: </strong>In the challenging independent cross-vendor test set, our habitat-guided DL25D model demonstrated superior performance, achieving an AUC of 0.821 (95% CI: 0.736-0.906) and a sensitivity of 0.804. It significantly outperformed both the conventional DL2D model (AUC: 0.654, P=0.002) and the clinical model (AUC: 0.686, P=0.019). The incorporation of clinical variables failed to yield further improvement (combined model AUC: 0.837, P=0.483 vs. DL25D; NRI=0.021, P>0.05). DCA confirmed the superior net clinical benefit of our approach across a wide spectrum of threshold probabilities. Importantly, Grad-CAM visualizations revealed that the habitat-guided model strategically focused its attention on intratumoral core regions, whereas the conventional 2D model was distracted by tumor margins and background tissue.</p><p><strong>Conclusions: </strong>The habitat-guided 2.5D deep learning model showed potential as a noninvasive imaging adjunct for preoperative Ki-67 status prediction in breast cancer. Multicenter prospective validation is required before clinical use.</p>","PeriodicalId":15402,"journal":{"name":"Journal of Computer Assisted Tomography","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole-Body MRI of Primary Bone Tumors.","authors":"Vivek Kiyawat, Jonathan Gibson, Eelin Tan, A Mark Davies, Rajesh Botchu","doi":"10.1097/RCT.0000000000001922","DOIUrl":"https://doi.org/10.1097/RCT.0000000000001922","url":null,"abstract":"<p><p>Magnetic resonance imaging (MRI) is the established gold standard for the staging of primary bone tumors; however, conventional protocols typically use a site-specific model supplemented by ionizing radiation for systemic screening. Recent advancements in whole-body MRI (WB-MRI) have enabled a \"marrow-first\" diagnostic approach, allowing for the comprehensive assessment of the primary intraosseous lesion and the entire skeleton in a single, radiation-free study. Technical developments, including Dixon fat suppression and diffusion-weighted imaging (DWI), have significantly enhanced the detection of occult skip metastases, which occur in ∼7.5% of high-grade osteosarcomas and 4.5% of Ewing sarcomas. Beyond malignant staging, WB-MRI offers distinct advantages for the longitudinal surveillance of syndromic conditions such as Ollier disease and hereditary multiple exostoses, where it facilitates a shift toward patient-initiated, symptom-led monitoring. Despite these advances, challenges remain, specifically the \"chest gap\" in pulmonary nodule detection and the potential for false positives from hematopoietic marrow mimics. This review discusses the technical principles, clinical applications, and diagnostic pitfalls of WB-MRI in bone tumors, emphasizing its role in optimizing staging accuracy while minimizing cumulative radiation exposure.</p>","PeriodicalId":15402,"journal":{"name":"Journal of Computer Assisted Tomography","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Spiderweb Sign: A Pulmonary CT Finding After Intranodal Lymphangiography.","authors":"Doyle Lang, Sadeer J Alzubaidi, Sayf Al-Katib","doi":"10.1097/RCT.0000000000001920","DOIUrl":"https://doi.org/10.1097/RCT.0000000000001920","url":null,"abstract":"<p><p>This case series describes an imaging finding seen in patients following lymphangiography-lace-like hyperdensities outlining the pulmonic lymphatic pathways-termed the spiderweb sign. In a retrospective review of patients who underwent lymphangiograms at a large tertiary care hospital from January 2022 to December 2025, 11 patients had CT thorax images within 1 week of the procedure, and 4 of these patients demonstrated the spiderweb sign. Specifically, the spiderweb sign manifests as hyperdense linear opacities outlining the interlobular septa, peribronchovascular interstitium, and visceral pleura. We present the 4 representative cases illustrating the imaging findings. For the cohort, procedural parameters were collected to assess associations with the presence or absence of the imaging finding, but no definitive association was found. While the exact mechanism remains unclear, these findings parallel patterns seen in prior studies and appear clinically benign. An additional literature review of pulmonary findings following lymphangiography was conducted to contextualize the spiderweb sign. Awareness of these postprocedural imaging findings as expected findings rather than developing pathology is essential to prevent misinterpretation. Larger multicenter studies are needed to clarify procedural factors and the underlying pathophysiology.</p>","PeriodicalId":15402,"journal":{"name":"Journal of Computer Assisted Tomography","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Imaging-Defined Deep Invasion and Tumor Volume With Clinical Cervical Lymph Node Metastasis in Hypopharyngeal Carcinoma.","authors":"Hinano Anaba, Yohei Morishita, Ryo Ishii, Takuma Usuzaki, Tomo Kinoshita, Yoshitaka Toyama, Akira Ohkoshi, Yukio Katori, Kei Takase","doi":"10.1097/RCT.0000000000001919","DOIUrl":"https://doi.org/10.1097/RCT.0000000000001919","url":null,"abstract":"<p><strong>Objective: </strong>Deep tumor invasion is a recognized pathologic risk factor for cervical lymph node metastasis in patients with hypopharyngeal carcinoma, but the relationship between imaging findings of the primary tumor and clinical lymph node metastasis has not been fully defined. In this study, we assessed whether imaging-defined deep invasion and tumor volume are associated with clinical lymph node metastasis.</p><p><strong>Methods: </strong>This retrospective study included 142 consecutive patients with newly diagnosed hypopharyngeal squamous cell carcinoma who underwent contrast-enhanced CT and MRI before treatment. Deep anterior wall (paraglottic space) invasion was graded according to tumor contact with the superior laryngeal neurovascular bundle. Deep posterior wall invasion was evaluated on MRI. Tumor diameter and volume were measured, and associations with lymph node status were assessed. Multivariable logistic regression was used to identify independent factors of clinical lymph node metastasis.</p><p><strong>Results: </strong>Clinical cervical lymph node metastasis was present in 78/142 patients (54.9%). The median tumor volume was greater in node-positive than in node-negative tumors (3.92 vs. 0.22 cm3, P<0.001). Deep anterior wall invasion was detected in 82 patients, and was more common in node-positive cases (73.1% vs. 39.1%, P<0.001). In multivariable analysis, deep anterior wall invasion (OR=2.42; 95% CI: 1.02-5.78; P=0.04) and tumor volume (OR=1.32 per cm3; 95% CI: 1.08-1.73; P=0.025) were independently associated with clinical cervical lymph node metastasis.</p><p><strong>Conclusion: </strong>Deep anterior wall invasion and larger tumor volume were associated with clinical cervical lymph node metastasis in hypopharyngeal carcinoma.</p>","PeriodicalId":15402,"journal":{"name":"Journal of Computer Assisted Tomography","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Value of HRCT and Non-EPI DWI-MRI in Middle Ear Cholesteatoma: Accuracy and Preoperative Impact.","authors":"Xu Huimin, Gao Gang, Lu Xinhong, Hu Songqun, Jin Jiaxin, Wang Yaojun","doi":"10.1097/RCT.0000000000001854","DOIUrl":"https://doi.org/10.1097/RCT.0000000000001854","url":null,"abstract":"<p><strong>Objective: </strong>To compare the diagnostic performance of high-resolution computed tomography (HRCT) and non-echo-planar diffusion-weighted magnetic resonance imaging (non-EPI DWI-MRI) for middle ear cholesteatoma and to assess the added value of their combined use in preoperative evaluation.</p><p><strong>Methods: </strong>Imaging data sets from 85 subjects (65 with surgically or histopathologically confirmed cholesteatoma, 20 controls) were retrospectively analyzed. HRCT, non-EPI DWI-MRI, and combined HRCT+DWI-MRI interpretations were compared against reference standards. Diagnostic metrics included sensitivity, specificity, accuracy, localization error, and interobserver agreement (κ).</p><p><strong>Results: </strong>HRCT demonstrated high sensitivity (95.4%) for detecting bony erosions and ossicular abnormalities, whereas non-EPI DWI-MRI showed greater specificity (85.0%) in distinguishing cholesteatoma from other soft tissues. The combined approach yielded optimal diagnostic performance (sensitivity 93.8%, specificity 92.0%, accuracy 93.2%) and the lowest localization error (mean 1.8 mm). Interobserver agreement was excellent (κ=0.88).</p><p><strong>Conclusion: </strong>High-resolution computed tomography and non-echo-planar diffusion-weighted MRI provide complementary diagnostic information in the evaluation of middle ear cholesteatoma. Their combined interpretation may improve diagnostic confidence and radiologic assessment of lesion extent; however, the direct impact on surgical outcomes requires further prospective validation.</p>","PeriodicalId":15402,"journal":{"name":"Journal of Computer Assisted Tomography","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Imaging Characteristics of Chronic Calcific Pancreatitis in Patients With Newly Diagnosed Pancreatic Ductal Adenocarcinoma.","authors":"Rubab F Malik, Zahra Yousefli, Mahya Faghih, Hana Tujjar, Merve Gurakar, Jin He, Richard Burkhart, Khadija Sami, Thomas McPhaul, Javad R Azadi, Satomi Kawamoto, Venkata S Akshintala, Elham Afghani, Vikesh K Singh, Atif Zaheer","doi":"10.1097/RCT.0000000000001916","DOIUrl":"https://doi.org/10.1097/RCT.0000000000001916","url":null,"abstract":"<p><strong>Objective: </strong>Chronic pancreatitis (CP) is a risk factor for pancreatic ductal adenocarcinoma (PDAC), with a cumulative risk of ~4% over 20 years. Most prior studies have evaluated the risk of PDAC among patients with CP. The frequency and imaging characteristics of chronic calcific pancreatitis (CCP) in patients presenting with PDAC are unknown.</p><p><strong>Methods: </strong>A retrospective review of the clinical history and staging computed tomography (CT) scans of patients diagnosed with resectable or borderline resectable/locally advanced PDAC between 2011 and 2022 was conducted. CCP and ductal dilatation were defined by the presence of pancreatic calcifications and a maximal pancreatic ductal diameter >5 mm on CT, respectively. Two independent radiologists reviewed all imaging studies, and discrepancies were adjudicated by a third radiologist.</p><p><strong>Results: </strong>Among 1008 patients with PDAC, CCP was found in 34 (3.4%), with a mean age of 69.9±8 years, 50% men, 91% White, and 59% with a history of smoking, with 26.95±18.5 pack-years. Only 7 (21%) patients had a documented history of chronic abdominal pain before PDAC diagnosis. The presence of ductal dilation, pseudocysts, or pancreatic atrophy was observed in nearly 40%, 10%, and 40% of patients, respectively, and 7 (21%) showed none of these features. Ductal dilation was associated with higher levels of CA 19-9 (349.8 U/mL [IQR; 238.3, 455.0] vs. 90.0 U/mL [IQR; 58.3, 162.2], P=0.003). Intratumoral and extratumoral-only calcifications were found in 14 (41%) and 20 (59%) patients, respectively. Extratumoral-only calcifications were associated with pancreatic atrophy (P=0.02). Radiologist inter-rater agreement was highest for tumor location, calcification location, maximal size, and number, and side branch dilatation, and was lowest for the percentage of pancreas with abnormal findings and PD contour.</p><p><strong>Conclusion: </strong>CCP is found in 3% of patients presenting with PDAC, and most have primary painless disease. Further studies are required to determine optimal PDAC screening strategies and surveillance in patients found to have primary painless CCP.</p>","PeriodicalId":15402,"journal":{"name":"Journal of Computer Assisted Tomography","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging Features to Distinguish Intralobar Versus Extralobar Bronchopulmonary Sequestration.","authors":"Kenneth O'Riordan, Mark M Hammer","doi":"10.1097/RCT.0000000000001917","DOIUrl":"https://doi.org/10.1097/RCT.0000000000001917","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the CT characteristics of bronchopulmonary sequestration (BPS) and determine the imaging features in predicted hybrid lesions and sequestration subtypes (intralobar vs. extralobar sequestration).</p><p><strong>Materials and methods: </strong>This was a multicenter retrospective study in which all surgical pathology specimens of lung sequestration performed in a tertiary hospital system were reviewed from January 2008 to January 2026. In total, 52 pathologic samples of lung sequestrations were analyzed and compared with preoperative imaging features. Imaging features including anatomic and vascular anatomy, parenchymal changes and relationship to the pleural were noted. BPS with coexistingcongenital pulmonary airway malformation, also called a hybrid lesion, on pathology was correlated with imaging findings.</p><p><strong>Results: </strong>Venous drainage patterns differed significantly between the intralobar sequestration (ILS) and extralobar sequestration (ELS) groups, with 11% of the ILS group draining to the systemic venous system versus 57% of the ELS group (P=0.013). In addition, 98% of ILS were inseparable from the surrounding lung, whereas 57% were separate from the normal lung (P<0.001). Cystic changes were common; 7/12 cases of hybrid lesions had cystic abnormalities on CT, whereas 17 out of the 40 cases without pathologic evidence of hybrid lesions had cystic changes on CT.</p><p><strong>Conclusion: </strong>Distinguishing intralobar from extralobar sequestration is imperfect based on venous drainage and separability from the normal lung parenchyma. Our data also showed a discrepancy between cystic abnormalities on CT and pathologically proven hybrid lesions, with a higher proportion of sequestrations with cystic changes on CT than were reported on pathologic analysis. Thus, hybrid lesions may be underdiagnosed on pathologic analysis.</p>","PeriodicalId":15402,"journal":{"name":"Journal of Computer Assisted Tomography","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complementary Role of Whole-Body MRI and CT in Hematologic Malignancies and Bone Marrow Disorders.","authors":"Elena Ghotbi, Matthew Frick, Joselle Cook, Francis Baffour","doi":"10.1097/RCT.0000000000001918","DOIUrl":"https://doi.org/10.1097/RCT.0000000000001918","url":null,"abstract":"<p><p>Whole-body cross-sectional imaging has largely replaced skeletal survey as the standard for evaluating hematologic malignancies and bone marrow disorders, but the practical choice between whole-body low-dose CT (WBCT) and whole-body MRI (WBMRI) remains incompletely resolved. This clinical review provides a practical, scenario-based comparison of WBCT and WBMRI across diagnosis, staging, treatment response, and surveillance. We emphasize real-world practical considerations, including scanner access, expertise, patient tolerance, radiation considerations, and cost. In multiple myeloma, with available comparative evidence, we include a focused research synthesis of 3 studies (152 patients) demonstrating high pooled CT-MRI concordance of 0.895 (95% CI: 0.834-0.935) with no detectable heterogeneity (I2=0%), supporting either modality as a reasonable first-line depending on the clinical question. Across all included disease categories, the broader pooled concordance estimate was 0.797 (95% CI: 0.667-0.885) with substantial heterogeneity reflecting variability in clinical context, reference standard, and protocol. WBMRI dominates in non-neoplastic marrow disorders where marrow characterization is essential. In lymphoma, FDG-PET/CT remains the standard for adult disease, with WBMRI most indicated in pediatrics and adolescents. Emerging CT techniques, including dual-energy CT with virtual noncalcium images and photon-counting detector CT, are extending CT into the marrow imaging space and narrowing the historical gap with MRI. Modality selection should be guided by the specific clinical scenario, available resources, and patient factors rather than by global judgments of modality superiority.</p>","PeriodicalId":15402,"journal":{"name":"Journal of Computer Assisted Tomography","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Antiangiogenic Agents on CT Perfusion Parameters in Liver Metastases From Renal Cell Carcinoma and Normal Liver.","authors":"Chaan S Ng, Yanwen Chen, Adam G Chandler, Nizar M Tannir","doi":"10.1097/RCT.0000000000001911","DOIUrl":"https://doi.org/10.1097/RCT.0000000000001911","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of targeted antiangiogenic agents on CT perfusion parameter values in liver metastases from renal cell carcinoma (mRCC) and on normal liver, before and after initiation of therapy.</p><p><strong>Methods: </strong>CT perfusion parameter values of liver metastases from RCC and adjacent normal liver were evaluated before and after 8 weeks of bevacizumab and pazopanib. Perfusion parameters blood flow (BF), blood volume (BV), mean transit time (MTT), permeability surface area product (PS), portal venous perfusion (PVP), hepatic arterial perfusion (HAP), and hepatic arterial fraction (HAF) were derived from General Electric CT Perfusion (4D) software. Differences between tissues at baseline and percent changes (Δ) in perfusion values after therapy were evaluated by the Wilcoxon signed-rank test.</p><p><strong>Results: </strong>There were 9 patients in the study (6 bevacizumab, 3 pazopanib). BF, HAP, and HAF were significantly higher, and MTT significantly lower, in untreated metastases than normal liver (all P<0.02); and PS was borderline significantly higher (P=0.058). For the liver metastases 8 weeks after therapy, there were significant reductions in ΔBF, ΔBV, ΔHAP and ΔHAF compared with baseline: -27.4% (P=0.05), -54.9% (P=0.008), -80.6% (P=0.004), and -46.6% (P=0.019), respectively. No significant changes after 8 weeks of therapy were observed in normal liver for any of the 7 perfusion parameters.</p><p><strong>Conclusion: </strong>This small preliminary data set suggests that targeted antiangiogenic agents might have significant effects on tumor perfusion, which can be detected by CT perfusion just 8 weeks after initiation of therapy. The agents have differential effects on tumor and normal liver. CT perfusion may assist in monitoring therapies and offer insights into pathophysiological aspects of tumors.</p>","PeriodicalId":15402,"journal":{"name":"Journal of Computer Assisted Tomography","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Anatomic and Hemodynamic Analysis Based on Coronary Computed Tomography Angiography in Type 2 Diabetes Mellitus Patients With Stable Coronary Artery Disease.","authors":"Xinying Fu, Kaiyue Zhi, Yan Deng, Xiangling Lin, Xinxin Yu, Shuo Zhang, He Zhu, Pei Nie","doi":"10.1097/RCT.0000000000001915","DOIUrl":"https://doi.org/10.1097/RCT.0000000000001915","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the additional prognostic value of anatomic and hemodynamic parameters derived from coronary computed tomography angiography (CCTA) over clinical characteristics in type 2 diabetes mellitus (T2DM) patients with stable coronary artery disease (CAD).</p><p><strong>Materials and methods: </strong>A multicenter cohort of 798 T2DM patients with stable CAD (training/test cohort: 478/320) was retrospectively included. The endpoints were major adverse cardiovascular events (MACE). Univariate and multivariate Cox regression analyses were used to identify independent clinical and CCTA-derived predictors. These independent predictors were subsequently used to construct the clinical model and the imaging model, respectively. The Coronary Artery Disease-Reporting and Data System (CAD-RADS) was used in combination with significant clinical and CCTA features to establish the combined model. The performance of the 3 models was evaluated with concordance index (C-index) and time-dependent area under the curve (time-AUC). Net reclassification improvement (NRI) was used to assess the additional prognostic value of CCTA parameters.</p><p><strong>Results: </strong>In the test cohort, the clinical model, which incorporated previous myocardial infarction (prior MI) and hyperlipidemia, achieved a C-index of 0.631 (95% CI, 0.503-0.760). The imaging model constructed by the change in CT-derived fractional flow reserve (ΔCT-FFR) achieved a C-index of 0.744 (95% CI, 0.623-0.866). The combined model obtained the highest C-index of 0.755 (95% CI, 0.562-0.849). Compared with the clinical model, the combined model demonstrated superior diagnostic performance (P = 0.014; P = 0.042) in the test cohort, achieving time-AUC values of 0.683 and 0.637 for 1-year and 5-year MACE, respectively.</p><p><strong>Conclusions: </strong>The combined model based on prior MI, hyperlipidemia, ∆CT-FFR and CAD-RADS can effectively predict the risk of MACE in T2DM patients with stable CAD. CCTA-based anatomic and hemodynamic parameters have additional value in predicting MACE compared with clinical characteristics.</p>","PeriodicalId":15402,"journal":{"name":"Journal of Computer Assisted Tomography","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}