Tag: statistics

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11752-5. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to show that spectral computed tomography (CT) can identify different patterns of airway wall thickening and contrast enhancement in lung-healthy controls, coronavirus disease 2019 (COVID-19), and non-COVID-19 pneumonia patients, reflecting airway inflammation in both pneumonia subtypes and airway neovascularization in COVID-19.

MATERIALS AND METHODS: 331 subjects (age 58.9 ± 17.2 years) with 218 arterial and 113 venous phase spectral CT acquisitions were retrospectively recruited: 119 lung-healthy controls, 45 with COVID-19 and 167 with non-COVID-19 pneumonia. Scientific software was used for segmenting the airway tree. Wall thickness (WT_5-10) and the difference in median maximum airway wall attenuation (slope of the spectral attenuation curve) between 40 keV and 100 keV display energy were calculated and aggregated for subsegmental airway generations 5-10 (λHU_5-10). Descriptive statistics, correlations, t-tests, and ANOVA analyses were performed.

RESULTS: Arterial phase WT_5-10 was similarly increased in COVID-19 (1.70 ± 0.44 mm) and non-COVID-19 (1.64 ± 0.53 mm) pneumonia compared to controls (1.18 ± 0.34 mm, p < 0.001). Arterial phase λHU_5-10 was significantly higher in patients with COVID-19 pneumonia (3.09 ± 2.27 HU/keV) than in non-COVID-19 pneumonia (2.18 ± 1.54 HU/keV, p < 0.01) and lung-healthy controls (2.06 ± 1.11 HU/keV, p < 0.01).

CONCLUSION: Spectral CT shows significant differences in segmental wall thickness and airway contrast enhancement between COVID-19 and non-COVID-19 pneumonia and lung-healthy controls. Airway contrast enhancement may be a feasible measure to detect airway inflammation in pneumonia and neovascularization in COVID-19 pneumonia.

KEY POINTS: Question Is spectral CT airway contrast enhancement a feasible quantitative method to detect airway inflammation or neovascularisation? Findings Spectral CT shows significant differences in segmental wall thickness and airway contrast enhancement between COVID-19 and non-COVID-19 pneumonia, and lung-healthy controls. Clinical relevance Spectral CT can be used to assess inflammatory airway diseases such as cystic fibrosis, COPD, asthma and bronchiectasis.

PMID:40536704 | DOI:10.1007/s00330-025-11752-5

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11776-x. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop and validate the chronic pancreatitis CT severity model (CATS), an artificial intelligence (AI)-based tool leveraging automated 3D segmentation and radiomics analysis of non-enhanced CT scans for objective severity stratification in chronic pancreatitis (CP).

MATERIALS AND METHODS: This retrospective study encompassed patients with recurrent acute pancreatitis (RAP) and CP from June 2016 to May 2020. A 3D convolutional neural network segmented non-enhanced CT scans, extracting 1843 radiomic features to calculate the radiomics score (Rad-score). The CATS was formulated using multivariable logistic regression and validated in a subsequent cohort from June 2020 to April 2023.

RESULTS: Overall, 2054 patients with RAP and CP were included in the training (n = 927), validation set (n = 616), and external test (n = 511) sets. CP grade I and II patients accounted for 300 (14.61%) and 1754 (85.39%), respectively. The Rad-score significantly correlated with the acinus-to-stroma ratio (p = 0.023; OR, -2.44). The CATS model demonstrated high discriminatory performance in differentiating CP severity grades, achieving an area under the curve (AUC) of 0.96 (95% CI: 0.94-0.98) and 0.88 (95% CI: 0.81-0.90) in the validation and test cohorts. CATS-predicted grades correlated with exocrine insufficiency (all p < 0.05) and showed significant prognostic differences (all p < 0.05). CATS outperformed radiologists in detecting calcifications, identifying all minute calcifications missed by radiologists.

CONCLUSION: The CATS, developed using non-enhanced CT and AI, accurately predicts CP severity, reflects disease morphology, and forecasts short- to medium-term prognosis, offering a significant advancement in CP management.

KEY POINTS: Question Existing CP severity assessments rely on semi-quantitative CT evaluations and multi-modality imaging, leading to inconsistency and inaccuracy in early diagnosis and prognosis prediction. Findings The AI-driven CATS model, using non-enhanced CT, achieved high accuracy in grading CP severity, and correlated with histopathological fibrosis markers. Clinical relevance CATS provides a cost-effective, widely accessible tool for precise CP severity stratification, enabling early intervention, personalized management, and improved outcomes without contrast agents or invasive biopsies.

PMID:40536703 | DOI:10.1007/s00330-025-11776-x

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11746-3. Online ahead of print.

ABSTRACT

OBJECTIVES: Body composition analysis (BCA) is a recognized indicator of patient frailty. Apart from the established bioelectrical impedance analysis (BIA), computed tomography (CT)-derived BCA is being increasingly explored. The aim of this prospective study was to directly compare BCA obtained from BIA and CT.

MATERIALS AND METHODS: A total of 210 consecutive patients scheduled for CT, including a high proportion of cancer patients, were prospectively enrolled. Immediately prior to the CT scan, all patients underwent BIA. CT-based BCA was performed using a single-slice AI tool for automated detection and segmentation at the level of the third lumbar vertebra (L3). BIA-based parameters, body fat mass (BFM_BIA) and skeletal muscle mass (SMM_BIA), CT-based parameters, subcutaneous and visceral adipose tissue area (SATA_CT and VATA_CT) and total abdominal muscle area (TAMA_CT) were determined. Indices were calculated by normalizing the BIA and CT parameters to patient’s weight (body fat percentage (BFP_BIA) and body fat index (BFI_CT)) or height (skeletal muscle index (SMI_BIA) and lumbar skeletal muscle index (LSMI_CT)).

RESULTS: Parameters representing fat, BFM_BIA and SATA_CT + VATA_CT, and parameters representing muscle tissue, SMM_BIA and TAMA_CT, showed strong correlations in female (fat: r = 0.95; muscle: r = 0.72; p < 0.001) and male (fat: r = 0.91; muscle: r = 0.71; p < 0.001) patients. Linear regression analysis was statistically significant (fat: R² = 0.73 (female) and 0.74 (male); muscle: R² = 0.56 (female) and 0.56 (male); p < 0.001), showing that BFI_CT and LSMI_CT allowed prediction of BFP_BIA and SMI_BIA for both sexes.

CONCLUSION: CT-based BCA strongly correlates with BIA results and yields quantitative results for BFP and SMI comparable to the existing gold standard.

KEY POINTS: Question CT-based body composition analysis (BCA) is moving more and more into clinical focus, but validation against established methods is lacking. Findings Fully automated CT-based BCA correlates very strongly with guideline-accepted bioelectrical impedance analysis (BIA). Clinical relevance BCA is currently moving further into clinical focus to improve assessment of patient frailty and individualize therapies accordingly. Comparability with established BIA strengthens the value of CT-based BCA and supports its translation into clinical routine.

PMID:40536702 | DOI:10.1007/s00330-025-11746-3

Eur Radiol. 2025 Jun 19. doi: 10.1007/s00330-025-11761-4. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to explore the prognostic value of primary tumor [¹⁸F]fluorodeoxyglucose (FDG) uptake in non-small cell lung cancer (NSCLC) patients treated with curative therapy, particularly when considered alongside the new 9th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system.

MATERIALS AND METHODS: A single-center retrospective study analyzed 3070 NSCLC patients who underwent pretherapeutic FDG PET/CT for initial staging. The survival analyses considered clinical variables, disease stage, and the primary tumor’s maximum standardized uptake value (SUVmax). Univariate and multivariate analyses evaluated the prognostic significance of disease stage and SUVmax in predicting overall and disease-free survival. A new staging system incorporating SUVmax is proposed and compared with the conventional staging.

RESULTS: Two thousand nine hundred seventy-two patients (mean age, 64.5 ± 10.1 years; 1888 men) were evaluated. Primary tumor SUVmax was an independent prognostic factor in the univariate and multivariate analyses for overall and disease-free survival, alongside disease stages. Integrating SUVmax into the staging system improved prognostic stratification, especially in intermediate stages (stage IIA vs IIB, hazard ratio [HR] = 1.06, p = 0.72 for the conventional stage; HR = 1.27, p = 0.04 for the new proposed stage with SUVmax). Survival analyses revealed significant distinctions between reclassified groups based on SUVmax, highlighting its potential for risk assessment refinement.

CONCLUSIONS: The primary tumor SUVmax adds prognostic value to the 9th AJCC/UICC staging system for NSCLC. The proposed staging system incorporating SUVmax demonstrates enhanced prognostic accuracy compared with the conventional system.

KEY POINTS: Question The new NSCLC staging system does not incorporate tumor metabolism, which may enhance prognostic accuracy and improve risk stratification. Findings Primary tumor FDG uptake was an independent prognostic factor for survival in NSCLC. Its integration into staging improved risk stratification. Clinical relevance Primary tumor FDG uptake provides prognostic information in NSCLC. Its incorporation into staging improved risk classification, particularly in intermediate stages, allowing for more precise prognostication based on metabolic activity.

PMID:40536701 | DOI:10.1007/s00330-025-11761-4

Eur J Orthop Surg Traumatol. 2025 Jun 19;35(1):260. doi: 10.1007/s00590-025-04381-7.

ABSTRACT

INTRODUCTION: Graft re-rupture is a devastating complication after revision ACLR surgery. The literature regarding the risk factors of graft re-rupture is sparse and not definitive. Studies have suggested that a smaller graft diameter is associated with poorer outcomes after primary ACLR, however there is a paucity of literature regarding the effects of graft size on revision ACLR outcomes. This study aims to determine the risk factors for graft re-rupture after revision ACLR, and investigate the optimum graft diameter for revision ACLR.

METHODS: The records of all patients who underwent revision ACLR from 2013 to 2021 were reviewed. Data collected included patient demographics, operative variables, and demographic details. To determine the optimal graft diameter, receiver operating characteristic (ROC) analysis was performed. Associations between re-rupture rate and return to pivoting sport, intra-articular knee pathologies, and graft diameter were assessed using contingency tables. Data were examined using univariable logistic regression models to explore the association between graft re-rupture after revision ACLR and prognostic variables. Co-variates with a p value p < 0.100 were included in a multivariable logistic regression model to identify independent associations with graft re-rupture.

RESULTS: In total, 132 revision ACLR were identified with a mean follow-up time of 3.22 ± 3.26 years. The graft re-rupture rate was 16.7% (n = 22). There were 91 (68.9%) males and 41 (31.1%) female with a mean age of 27.4 years (range 17.3-50.8 years) at revision. 87.9% (n = 116) were involved in one or more types of pivoting sports. Kaplan-Meier analysis showed that the mean survival time for revision ACL grafts was 148 months (95% CI 130-166). The mean graft diameter during revision ACLR was 9.26 mm (range 7.0-10.5 mm) and mean graft length was 43.6 mm (range 22.0-60.0 mm). No associated procedure such as anterolateral (ALL) reconstruction were performed. At the time of revision ACLR, MRI detected concomitant knee pathologies: medial meniscus pathology (n = 45; 34.1%), lateral meniscus pathology (n = 41; 31.1%), chondral pathology (n = 26; 19.7%). None were associated with an increased rate of re-rupture. Risk factors determined by the multivariable logistic regression model were graft diameter < 9 mm (OR: 3.873; 95% CI 1.128-13.293; p = 0.031) and return to pivoting sport after revision ACLR surgery (OR: 4.105; 95%CI 1.008-16.721; p = 0.049).

CONCLUSION: A graft diameter < 9 mm and return to pivoting sports after revision ACLR are risk factors for graft re-rupture. Meniscus pathology and chondral lesion were not associated with graft re-rupture. The findings of this study can be used to improve revision ACLR results for patients, but needs to be expanded in multi-centre trials with larger sample sizes.

PMID:40536685 | DOI:10.1007/s00590-025-04381-7

Eur J Orthop Surg Traumatol. 2025 Jun 19;35(1):257. doi: 10.1007/s00590-025-04355-9.

ABSTRACT

PURPOSE: Although surgical stabilization for displaced extra-articular scapular fractures is increasingly utilized, there remains limited evidence on predictors of functional recovery. This study aimed to evaluate long-term functional and radiographic outcomes after stabilization using the Brodsky posterior approach and to determine whether glenopolar angle or lateral border medialization independently predicts postoperative function. We hypothesized that improved radiographic parameters would be associated with better outcomes.

METHODS: This retrospective cohort included 16 patients with displaced extra-articular scapular fractures treated with open reduction and internal fixation via the Brodsky approach. Functional recovery was assessed using the Constant score at 48 months postoperatively. Pre- and postoperative glenopolar angle and lateral border medialization were measured. Paired comparisons and multiple linear regression were used to identify predictors of outcome.

RESULTS: All patients achieved full fracture union without complications or need for reoperation. The median Constant score of the operated shoulder was 94 (IQR 88-95), compared to 96 (IQR 93-96) in the contralateral shoulder (p = 0.002). Despite statistical significance, the 2-point difference did not exceed the minimal clinically important difference for shoulder function. Postoperative improvements in glenopolar angle and medialization were significant. The contralateral Constant score was the only independent predictor of postoperative outcome (β = 1.52, p = 0.001). Radiographic variables were not predictive.

CONCLUSION: The Brodsky approach yields excellent long-term outcomes. Although radiographic correction is achieved, the preoperative function of the contralateral shoulder remains the most reliable indicator of postoperative recovery potential.

PMID:40536675 | DOI:10.1007/s00590-025-04355-9

J Cancer Surviv. 2025 Jun 19. doi: 10.1007/s11764-025-01850-0. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to explore the integration of American Society of Clinical Oncology (ASCO) guidelines for fertility discussion in clinical practice.

METHODS: A concurrent triangulation mixed methods design was used. We recruited oncologists from an NCI-designated Comprehensive Cancer Center who treat adolescents and young adults (AYAs) at risk for infertility to participate in a semi-structured qualitative interview and conducted a thematic analysis. Simultaneously, self-report fertility-related data were collected from AYAs (age 18-39) diagnosed at the same institution via self-report survey and were analyzed using descriptive statistics.

RESULTS: Themes reported by oncologists (N = 12; 66.7% female, on average in practice for 14.3 years) included a lack of oncofertility-related training and limited knowledge surrounding fertility discussion guidelines. Those who were aware of guidelines stated that they informed their discussions. Oncologists’ perceptions of fertility discussion guidelines were largely positive, though reservations were expressed. Discussions were primarily informed by patient needs and research/literature, but seldom by oncologists’ explicit training or experience in oncofertility. Among AYAs (N = 58; 53.5% female, 35.1% Hispanic, on average 32.0 years at diagnosis), 82.3% had a fertility discussion, 62.6% of which occurred with their oncologist. Fertility discussions occurred at some visits (66.7%), and AYAs were very (39.4%) or moderately (27.3%) satisfied with counseling received. Components of ASCO guidelines most often discussed were the timing of preservation and consideration of individual factors in fertility preservation (66.7% each). Patient advocacy resources (33.3%) and informing them that their cancer history does not increase risk of cancer or birth defects in a child (30.3%) were least often discussed.

CONCLUSION: Awareness of fertility discussion guidelines among oncologists was low, and more than half of AYAs reported only two components of ASCO guidelines were included in fertility discussions with their oncologists. Despite this, AYAs’ overall satisfaction with discussions was moderate to high, suggesting adherence to all guideline components may not be necessary for AYAs to derive benefit. While oncologists reported largely positive perceptions of fertility discussion guidelines, several shared that the guidelines themselves may hinder implementation if they do not capture diverse patient scenarios and/or are outdated.

IMPLICATIONS FOR CANCER SURVIVORS: Findings suggest a need to improve oncologists’ knowledge surrounding guidelines, refine recommendations to optimize oncofertility counseling, and subsequently improve their integration in practice to ensure AYAs are provided with desired and actionable information to support goal-concordant reproductive decisions.

PMID:40536662 | DOI:10.1007/s11764-025-01850-0

Neurol Sci. 2025 Jun 19. doi: 10.1007/s10072-025-08305-5. Online ahead of print.

ABSTRACT

PURPOSE: Sensory impairments are significant contributors to cognitive dysfunction, but the relationship between cognitive decline and various forms of neurosensory degeneration remains poorly understood. This study aimed to evaluate retinal layer neurodegeneration and hearing impairment in the general Korean population using cognitive assessments.

METHODS: This cross-sectional, retrospective study included participants who underwent Optical Coherence Tomography (OCT), Pure Tone Audiometry (PTA), and the Mini-Mental State Examination (MMSE). Participants were categorized into three groups based on MMSE scores: control group (MMSE > 27), mild cognitive impairment (MCI, MMSE 23-27), and dementia group (MMSE < 23). PTA thresholds were computed using the weighted four-frequency average formula (0.5 kHz, 1 kHz, 2 kHz, and 4 kHz). OCT images were analyzed to measure the Ganglion Cell Inner Plexiform Layer (GC-IPL), Peripapillary Retinal Nerve Fiber Layer (ppRNFL), and total macular thickness. These sensory parameters were compared across the three groups.

RESULTS: A total of 196 participants were included, with a mean age of 67.0 ± 10.4 years. MMSE scores showed an inverse correlation with both age and PTA thresholds, and a positive correlation with OCT parameters (all P <.05). After adjusting for age, significant differences in PTA thresholds were observed across all groups. However, significant reductions in OCT parameters and best-corrected visual acuity were only seen in the dementia group compared to the control and MCI groups (all P <.05).

CONCLUSIONS: Sensory assessments are reliable indicators of cognitive function, with hearing loss emerging as a more consistent and sensitive predictor of early functional decline than retinal thickness measurements. Advanced stages of cognitive impairment are closely linked to retinal neurodegeneration and visual impairment, underscoring the importance of careful monitoring and early intervention.

PMID:40536657 | DOI:10.1007/s10072-025-08305-5

Int J Clin Oncol. 2025 Jun 19. doi: 10.1007/s10147-025-02802-5. Online ahead of print.

ABSTRACT

BACKGROUND: Comprehensive genomic profiling (CGP) is essential for precision medicine, but early mortality remains a concern for patients undergoing CGP. This study aimed to identify risk factors for early mortality and develop a prediction model for gastrointestinal (GI) malignancies on the basis of data from the Japanese C-CAT database.

METHODS: Data from 18,657 patients with pancreatic, biliary, colorectal, and upper GI cancers were collected from the C-CAT database and retrospectively analyzed. Early mortality was defined as mortality within 90 days after CGP submission. A prediction model was constructed via weighted scoring of clinical factors, and the model was subsequently validated. Survival analysis was conducted to assess the utility of this model for prognostic stratification.

RESULTS: The early mortality rate was 14.2%. Independent predictors of early mortality included cancer type (pancreatic/biliary), Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥2, metastases, disease progression, and male sex. The prediction model stratified patients into low- (6.1%), intermediate- (17.6%), high-risk (39.2%), and very high-risk (75.6%) groups with a moderate level of discrimination (C statistic: 0.70-0.73). Survival analysis revealed that the median survival times after CGP submission for each group were 384.0 days, 199.0 days, 114.0 days, and 48.0 days, respectively. We developed a web-based application for the prediction of early mortality via the link: https://mortality-within-90days-cgp.shinyapps.io/mortality_treatment_20250130/ .

CONCLUSIONS: The prediction model effectively stratified patients on the basis of the risk of early mortality, thus supporting better patient selection and CGP timing.

PMID:40536622 | DOI:10.1007/s10147-025-02802-5

J Nephrol. 2025 Jun 19. doi: 10.1007/s40620-025-02286-6. Online ahead of print.

ABSTRACT

BACKGROUND: The Kidney Failure Risk Equation (KFRE) estimates the risk of kidney replacement therapy (KRT) at 5 years. Patients with diabetes mellitus are at high risk of KRT and death, a competing event. This study assesses the performance of the 5-year KFRE in patients with diabetes mellitus, compared to non-diabetic patients and considering age, in a cohort of patients evaluated by a nephrologist at a tertiary care center.

METHODS: The CKD-CAREMEAU cohort included all patients who visited a nephrologist for chronic kidney disease (CKD) before KRT between 2008 and 2017. The 5-year KFRE was calculated for each patient, based on their baseline characteristics. The study evaluated performance regarding discrimination and calibration, taking the patient’s diabetic status and age into account.

RESULTS: The study included 2935 patients with a median age of 73 [65-80] years, 1800 of whom were men (61%), and 1249 (43%) who were affected by diabetes. The incidence of KRT was higher in diabetic patients (167 (13%)) than in non-diabetic patients (184 (11%))(p = 0.04). Additionally, the death rate within five years after inclusion was not statistically higher for diabetic patients (351 (28%)) than non-diabetic patients (443 (26%))(p = 0.3). Diabetic status affected neither discrimination nor calibration. However, the equation overestimated the risk for higher-risk patients, especially among the elderly.

CONCLUSIONS: Our study found no difference in the 5-year KFRE performance between diabetic and non-diabetic patients. However, performance was worse for patients over 75 years old.

PMID:40536612 | DOI:10.1007/s40620-025-02286-6