Current Medical Imaging - Volume 21, Issue 1, 2025

Brain tumor is characterized by its aggressive nature and low survival rate and therefore, it is regarded as one of the deadliest diseases. Thus, misdiagnosis or miss-classification of brain tumors can lead to miss-treatment or incorrect treatment and reduce survival chances. Therefore, there is a need to develop a technique that can identify and detect brain tumors at early stages.

Here, we proposed a framework titled I-Brainer which is an Artificial Intelligence/Internet of Things (AI/IoT)-powered classification of MRI into 4 classes. We employed a Br35H+SARTAJ brain MRI dataset which contains 7023 total images including no tumor, pituitary, meningioma, and glioma. To accurately classify MRI into 4 classes, we developed the LeNet model from scratch, and implemented 2 pre-trained models which include EfficientNet and ResNet-50 as well as feature extraction of these models coupled with 2 Machine Learning (ML) classifiers namely; k-Nearest Neighbours (KNN) and Support Vector Machine (SVM).

Evaluation and comparison of the performance of the 3 models have shown that ResNet-50 achieved the best result in terms of AUC (99%) and ResNet-50-KNN ranked higher in terms of accuracy (94%) on the testing set.

This framework can be harnessed by patients residing in remote areas and as a confirmatory approach for medical experts.

The study aimed to investigate the association of CT-relevant skeletal muscle parameters, such as sarcopenia and myosteatosis, with survival outcomes in patients receiving chemotherapy for unresectable pancreatic ductal adenocarcinoma (PDAC).

In this retrospective analysis, patients who began chemotherapy for unresectable PDAC were included. Sarcopenia and myosteatosis were assessed on pretreatment CT at the L3 level by skeletal muscle index and mean muscle attenuation with predefined cutoff values. The Cox proportional hazards model was used to analyze the factors associated with progression-free survival (PFS) and overall survival (OS).

A total of 150 patients were enrolled. Compared to patients without sarcopenia, patients with sarcopenia had significantly worse PFS (p=0.003) and OS (p<0.001). Patients with myosteatosis had significantly worse PFS (p=0.01) and OS (p=0.002) compared to those without myosteatosis. In multivariate analysis, after adjusting for age, sex, tumor size, location, treatment modality, smoking, drinking, underlying diseases, and partial laboratory tests, sarcopenia remained an independent predictor of PFS (p=0.006) and OS (p<0.001). Myosteatosis remained an independent predictor of OS (p=0.008), but not of PFS.

Sarcopenia and myosteatosis are independent prognostic factors for patients with unresectable pancreatic ductal adenocarcinoma after chemotherapy.

The objective of this study was to comprehensively review the literature on Shear Wave Elastography (SWE), a non-invasive imaging technique prevalent in medical ultrasound. SWE is instrumental in assessing superficial glandular tissues, abdominal organs, tendons, joints, carotid vessels, and peripheral nerve tissues, among others. By employing bibliometric analysis, we aimed to encapsulate the scholarly contributions over the past two decades, identifying key research areas and tracing the evolutionary trajectory of SWE.

For this study, we selected research articles related to SWE published between 2004 and March 2024 from the Web of Science Core Collection (WOSCC). We utilized sophisticated bibliometric tools, such as CiteSpace, VOSviewer, and SCImago Graphica, to analyze the trends in annual publications, contributing countries and institutions, journals, authors, co-cited authors, co-cited references, and keywords.

Our analysis yielded a total of 3606 papers. China emerged as the leading country in terms of publication output, with a strong collaborative relationship with the United States. Sun Yat-Sen University was identified as the institution with the highest number of publications. The keyword “transient elastography” was the most prevalent, with “acoustic radiation force” being a focal point in the initial stages of SWE research. Recently, Contrast-enhanced Ultrasound (CEUS) has emerged as a new research focus, signaling a potential direction for future research and development.

The global research landscape for SWE is projected to expand continuously. Future research is likely to concentrate on the integrated application of SWE and CEUS for diagnostic purposes, along with exploring the clinical utility of multimodal ultrasound that synergistically combines SWE with other ultrasound technologies. This bibliometric research offers a comprehensive overview of the SWE literature, guiding researchers in their pursuit of further exploration and discovery.

Bronchogenic cysts are congenital cystic anomalies of the bronchus that originate from abnormal development of the bronchial tree during the embryonic period. Their common manifestation is a space-occupying lesion in the lungs or mediastinum. Common imaging modalities for detecting bronchogenic cysts include chest X-ray and chest computed tomography (CT) scans.

A 24-year-old female presented with an abnormal space-occupying lesion in the mediastinum detected through imaging examinations. Echocardiography revealed a cystic mass located between the descending aorta and the right pulmonary artery. A CT scan identified a low-density mass with a distinct density relative to adjacent tissues, situated near the left main bronchus. The final diagnosis of a bronchogenic cyst was established following surgical intervention and pathological examination.

Bronchogenic cysts are rare congenital anomalies. Common clinical symptoms include chest pain, cough, and dyspnea. On standard chest radiographs and CT scans, most cysts present as homogenous water-density shadows, with the mediastinum being the most frequently affected location. The diagnosis is confirmed through pathological examination. Surgical intervention remains the most effective treatment method, typically resulting in a favorable prognosis.

The aim of this study is to evaluate the potential of black tea as a negative oral contrast agent in Magnetic Resonance Cholangiopancreatography (MRCP) to improve image quality by reducing gastrointestinal fluid signals.

Retained gastrointestinal fluids can interfere with ductal imaging during MRCP, and suitable oral negative contrast agents are not widely available.

Two types of black tea (Lapsang Souchong and Yinghong NO9) were tested in vitro at different concentrations (3g, 6g, and 9g) to assess their T2 signal suppression. The tea with the best signal suppression was selected for a prospective clinical study involving 51 patients undergoing MRCP. Signal intensity, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured before and after black tea administration.

In vitro experiments showed that the 9g concentration of Lapsang Souchong tea provided the most effective T2 signal suppression, with manganese and iron ion concentrations of 4.705 mg/L and 0.040 mg/L, respectively. In the clinical study, paired T-tests revealed a significant decrease in gastrointestinal fluid signals after black tea administration, with a mean signal intensity reduction in the stomach and duodenum. The SNR in the duodenal bulb increased significantly, while no significant differences were observed in SNR and CNR in other gastrointestinal segments.

Black tea, rich in iron and manganese, effectively reduces gastrointestinal fluid signals, potentially enhancing MRCP image quality. Further research is warranted to explore its clinical application.

The global incidence of lung cancer highlights the need for improved assessment of nodule characteristics to enhance early detection of lung adenocarcinoma presenting as ground-glass nodules (GGNs). This study investigated the applicability of radiomics features of vascular structures within GGNs for predicting invasiveness of GGNs.

In total, 165 pathologically confirmed pulmonary GGNs were retrospectively analyzed. The nodules were classified into preinvasive and invasive groups and randomly categorized into training and validation sets in a 7:3 ratio. Four models were constructed and evaluated: radiomics-GGN, radiomics-vascular, clinical-radiomics-GGN, and clinical-radiomics-vascular. The predictive performance of these models was assessed using receiver operating characteristic curves, decision curve analysis, calibration curves, and DeLong’s test.

Significant differences and density were observed between the preinvasive and invasive groups in terms of age, nodule length, average diameter, morphology, lobulation sign (P = 0.006, 0.038, 0.046, 0.049, 0.002 and0.008 respectively). In the radiomics-GGN model, the support vector machine (SVM) approach outperformed logistic regression (LR), achieving an area under the curve (AUC) of 0.958 in the training set and 0.763 in the validation set. Similarly, in the radiomics-vascular model, the SVM approach outperformed LR. Furthermore, the clinical-radiomics-vascular model demonstrated superior predictive performance compared with the clinical-radiomics-GGN model, with an AUC of 0.918 in the training set and 0.864 in the validation set. DeLong’s test indicated significant differences in predicting the invasiveness of pulmonary nodules between the clinical-radiomics-vascular model and the clinical-radiomics-GGN model, both in the training and validation sets (P < 0.01).

The radiomics models based on internal vascular structures of GGNs outperformed those based on GGNs alone, suggesting that incorporating vascular radiomics analysis can improve the noninvasive assessment of GGN invasiveness, thereby aiding in clinical decision-making and guiding biopsy selection and treatment planning.

Complications of Post-Reversible Encephalopathy Syndrome (PRES) following interventional embolization of aneurysms are rarely reported, and PRES disease can be reduced or resolved through prompt and aggressive treatment, resulting in minimal or no residual neurological deficits.

A 51-year-old female patient with an aneurysm in the pericallosal segment of the left anterior cerebral artery experienced prolonged status epilepticus following aneurysm embolization, attributed to PRES. The diagnosis of PRES was confirmed by symptom improvement and resolution of lesions on imaging studies after one month of treatment involving blood pressure management and prevention of cerebral vasospasm. At the 7-month post-discharge follow-up, the patient's examination indexes were normal without any residual neurological deficits.

This case underscores the importance of promptly identifying and diagnosing PRES, as timely intervention can prevent permanent neurological deficits and mitigate the risk of more severe outcomes.

This study aimed to develop and assess the performance of a YOLOv8 algorithm-aided detection model for identifying rib fractures on multiplane reconstruction (MPR) images, addressing the limitations of current AI models and the labor-intensive nature of manual diagnosis.

Ethical approval was obtained, and a dataset comprising 624 MPR images, confirmed by CT, was collected from three regions of Tongji Hospital between May 2020 and May 2023. The images were categorized into training, validation, and external test sets. A musculoskeletal radiologist labeled the images, and a YOLOV8n model was trained and validated using these datasets. The performance metrics, including sensitivity, specificity, accuracy, precision, recall, and F1 score, were calculated.

The refined YOLO model demonstrated high diagnostic accuracy, with sensitivity, specificity, and accuracy rates of 96%, 97%, and 97%, respectively. The AI model significantly outperformed the radiologist in terms of diagnostic speed, with an average interpretation time of 2.02 seconds for 144 images compared to 288 seconds required by the radiologist.

The YOLOv8 algorithm shows promise in expediting the diagnosis of rib fractures on MPR images with high accuracy, potentially improving clinical efficiency and reducing the workload for radiologists. Future work will focus on enhancing the model with more feature learning capabilities and integrating it into the PACS system for human-computer interaction.

Recurrent pleomorphic adenoma (PA) in the submandibular gland is a rare tumor that may be misdiagnosed as an inflammatory lesion. The imaging manifestations of the submandibular gland recurrent PA are unclear, with only three case reports reporting CT and MRI imaging, respectively. Our report is the first case report that comprehensively describes the imaging manifestations of recurrent PA in the submandibular gland.

A 28-year-old woman had a right submandibular gland pleomorphic adenoma that recurred 5 years after resection and gradually grew larger. She had no special discomfort and was diagnosed with a recurrence of pleomorphic adenoma. The patient underwent CT and MRI examinations and tumor resection, and postoperative pathology showed tumor recurrence.

This case report provides substantial and comprehensive CT and MRI data, which is conducive to the diagnosis of the recurrence of submandibular gland pleomorphic adenoma and the avoidance of misdiagnosis to the greatest extent possible.

The study aimed to evaluate the clinical efficacy of CT-guided radiofrequency ablation in conjunction with targeted therapy in lung cancer patients.

We retrospectively analyzed 80 lung cancer patients. They were stratified into the Observation Group (OG; n=40, treated with CT-guided radiofrequency ablation in conjunction with targeted therapy) and the Control Group (CG; n=40, treated solely with targeted therapy).

The Overall Response Rate (ORR) and Disease Control Rate (DCR) in the OG group (70.00%, 95.00%) were significantly higher than those in the CG group (57.50%, 87.50%). After 6 weeks of treatment, the OG group had significantly lower levels of SCC, CEA, and CA125, higher CD4+ levels, and lower CD8+ levels, compared to the CG group. The 24-month follow-up survival rate of the OG group (47.50%) was significantly higher than that of the CG group (27.50%).

CT-guided radiofrequency ablation and targeted therapy have been proven effective in treating lung cancer.

There remains a lack of methods to accurately assess the efficacy of neoadjuvant chemoradiotherapy for locally advanced rectal cancer.

This study aimed to investigate the value of shear-wave elastography in evaluating the treatment response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer.

This prospective observational study enrolled 275 patients with locally advanced rectal cancer who received neoadjuvant chemoradiotherapy during September 2021–March 2023. All patients underwent endorectal ultrasound and shear-wave elastography examination before total mesorectal excision. Clinical baseline data, endorectal ultrasound, and shear-wave elastography examination data were collected from all patients. The independent predictors of complete response were analyzed and screened, followed by the establishment of a logistic regression model. The diagnostic efficacy of the model was compared with that of radiologists.

The results of binary multivariate logistic regression suggested that the mean elastography value of the tumor lesion acted as an independent predictor for the diagnosis of complete response [OR: 0.894 (0.816, 0.981)]. The optimal cutoff value was 14.6 kPa. The area under the receiver operating characteristic curve of the model for predicting complete response in the training and test cohorts was 0.850 and 0.824, respectively. The diagnostic accuracy of the model was significantly higher than that of radiologists (P < 0.001).

Shear-wave elastography can be used as a feasible method to evaluate the complete response of locally advanced rectal cancer after neoadjuvant chemoradiotherapy.

Glaucoma is a leading cause of irreversible visual impairment and blindness worldwide, primarily linked to increased intraocular pressure (IOP). Early detection is essential to prevent further visual impairment, yet the manual diagnosis of retinal fundus images (RFIs) is both time-consuming and inefficient. Although automated methods for glaucoma detection (GD) exist, they often rely on individual models with manually optimized hyperparameters. This study aims to address these limitations by proposing an ensemble-based approach that integrates multiple deep learning (DL) models with automated hyperparameter optimization, with the goal of improving diagnostic accuracy and enhancing model generalization for practical clinical applications.

The RFIs used in this study were sourced from two publicly available datasets (ACRIMA and ORIGA), consisting of a total of 1,355 images for GD. Our method combines a custom Multi-branch convolutional neural network (CNN), pretrained MobileNet, and DenseNet201 to extract complementary features from RFIs. Moreover, to optimize model performance, we apply Bayesian Optimization (BO) for automated hyperparameter tuning, eliminating the need for manual adjustments. The predictions from these models are then combined using a Dirichlet-based Weighted Average Ensemble (Dirichlet-WAE), which adaptively adjusts the weight of each model based on its performance.

The proposed ensemble model demonstrated state-of-the-art performance, achieving an accuracy (ACC) of 95.09%, precision (PREC) of 95.51%, sensitivity (SEN) of 94.55%, an F1-score (F1) of 94.94%, and an area under the curve (AUC) of 0.9854. The innovative Dirichlet-based WAE substantially reduced the false positive rate, enhancing diagnostic reliability for GD. When compared to individual models, the ensemble method consistently outperformed across all evaluation metrics, underscoring its robustness and potential scalability for clinical applications.

The integration of ensemble learning (EL) and advanced optimization techniques significantly improved the ACC of GD in RFIs. The enhanced WAE method proved to be a critical factor in achieving well-balanced and highly accurate diagnostic performance, underscoring the importance of EL in medical diagnosis.

Lipomas represent a rare benign etiology of intussusception in adults, affecting both the small intestine and the colon. Diagnosing intussusception in adults can be challenging, and there are no reports on the use of positron emission tomography/CT (PET/CT) in the diagnosis of lipoma-induced intussusception. This study aimed to preliminarily explore the potential diagnostic utility of ¹⁸F-FDG PET/CT in the diagnosis of intussusception caused by lipomas.

We conducted a retrospective review of the clinical characteristics and imaging findings of three patients diagnosed with lipoma-induced intussusception using ¹⁸F-FDG PET/CT from 2019 to 2023 at our hospital.

The three cases presented with diverse clinical presentations and were diagnosed based on PET/CT imaging. Surgical confirmation was obtained in two cases. Lipomas were identified in both the small intestine and the colon, with one case displaying increased metabolic activity on FDG uptake, suggesting a possible link between FDG uptake and clinical severity.

Lipoma is a benign cause of intussusception that can occur in both the small intestine and the colon. The symptoms of adult intussusception are often atypical and variable. Imaging modalities, particularly PET/CT, are instrumental in diagnosing intussusception due to lipomas, differentiating between benign and malignant causes, and assessing the severity to inform treatment strategies.

MRI could be considered as a non-destructive disease diagnosis procedure, this procedure does not allow directly molecular types of cancer. Herein, we aimed to evaluate the correlation of breast MRI background parenchymal enhancement (BPE) and fibroglandular tissue (FGT) with the molecular subtypes and immunohistochemical markers of breast cancer.

This was a single-cross-sectional retrospective study.Fifty-six patients diagnosed with unilateral breast cancer who underwent breast MRI scans before needle biopsy or surgery were selected. The relationship between qualitative and quantitative BPE/FGT ratios and the expression of breast cancer molecular subtypes and immunohistochemical markers were evaluated in patients with breast cancer.

Quantitative BPE (BPE%) of luminal A and luminal B was significantly lower than that of triple-negative breast cancer. There was no significant difference in the qualitative BPE/FGT between the different breast cancer subtypes. The quantitative BPE (BPE%) of estrogen receptor (ER)-negative tumors was higher than that of the ER-positive tumors, and the expression of FGT%, BPE%, and other immunohistochemical markers (human epidermal growth factor receptor-2(HER-2), progesterone receptor (PR), and Ki-67) were not significantly different. The proportion of high BPE distribution in HER-2 positive tumors was higher than that in the HER-2 negative group; however, there was no significant difference in the expression of qualitative BPE/FGT and other immunohistochemical markers (ER, PR, and Ki-67).

There were significant differences in the levels of BPE among the different molecular subtypes. Therefore, BPE may be a potential imaging biomarker for the diagnosis of the molecular subtypes of breast cancer.

Although the “conventional” autopsy is still considered the “gold standard” for the definition of the cause of death, an emerging interest in non-invasive cadaveric investigations is spreading. Among all these, the application of post-mortem magnetic resonance imaging of the heart is increasingly gaining ground in the study of sudden cardiac death.

Using the diffusion tensor imaging sequence, the present study aimed to demonstrate how through the fractional anisotropy value it is possible to qualitatively and quantitatively define sudden cardiac death, particularly in cases of sudden arrhythmic death syndrome. Four hearts were collected for the present pilot study: the first from a subject who died from a brain injury caused by a gunshot, and the other three hearts from subjects who died of sudden cardiac death. In all cases examined, the extracted hearts were hung inside a container containing 10% formalin solution and placed inside a 1.5T scanner with a 16-channel chest coil. Then, the cardiac diffusion tensor imaging sequence was performed and the quantitative maps of fractional anisotropy and apparent diffusion coefficient were obtained. After imaging analysis, the samples were processed, paraffin-embedded, and stained with hematoxylin and eosin and trichrome staining. Cases B, C, and D showed lower fractional anisotropy values than non-pathological one.

Histological investigation revealed extensive areas of fibrosis and foci of contraction band necrosis in heart B, myofiber disarray and interstitial fibrosis in heart C, and findings consistent with atonic death in heart D.

The study aimed to demonstrate that in cases of sudden cardiac death, lower fractional anisotropy values, as already observed in clinical trials, are associated with arrhythmic heart disease or myocardial infarction. Quantitative, appreciable, and reproducible data could support such diagnoses.

In this case series, we present two male cases with renal parenchymal perforation without perirenal hematoma after D-J ureteral stent insertion, one with nutcracker renal vein syndrome. Our study provides new and important contributions to the field of science regarding what to consider during D-J stent insertion in similar cases and in patients with obstruction in the urinary collecting system for more than 2 months.

Two patients, 30 and 37 years old, who were inserted a D-J catheter after endoscopic ureteral stone treatment, suffered from severe ipsilateral flank pain and hematuria after the operation. The Kidney Urine Bladder (KUB) radiography showed that the proximal part of the D-J stent was protruding from the upper calyx and parenchyma of the kidney in both patients. One of the patients had an ipsilateral nutcracker renal vein syndrome, and the clinical progression was more severe. In both cases, conventional follow-up with bed rest, nonsteroidal anti-inflammatory (NSAI) therapy, intravenous (IV) fluid infusion, and anti-biotherapy after the D-J stent reposition was sufficient. The patients had no clinical problems during the next outpatient clinic visits.

Double-j (D-J) ureteral stent insertion procedure may cause many life-threatening complications, from subcapsular hematoma to pulmonary embolism. In this case series, conventional follow-up was sufficient for the treatment of patients with renal parenchymal damage without perirenal hematoma due to D-J stent insertion, including nutcracker renal vein syndrome cases. More care should be taken when placing D-J stents, especially in patients with obstruction in the urinary collecting system for more than 2 months and with nutcracker renal vein syndrome. In these patients, the soft proximal end of the guidewire should not be pushed and forced too hard to the upper part of the kidney and upper collecting system. Additionally, the D-J stent placement procedure should be performed under fluoroscopy as much as possible to avoid complications.

The purpose of this study was to investigate the morphology and distribution characteristics of fat globules in osteomyelitis on magnetic resonance imaging (MRI).

Patients with pathologically-confirmed osteomyelitis and MRI scans were retrospectively enrolled, and fat globules on the MRI images were analyzed.

Among 103 patients with non-traumatic osteomyelitis, 75 were fat globule negative and 28 were positive. There was no statistically significant difference in age and gender between patients with and without fat globules (p>0.05). The inflammatory indicators (CRP, ESR, WBC, and NEUT) in the fat globule positive group were significantly higher (p<0.05) than those in the negative group. The lesions were mainly located in the long bones of the limbs in patients with positive fat globules. Twenty-eight patients (27.2% or 28/103) were detected to have fat globules on MRI images, including 20 males (71%) and 8 females (29%) aged 5-64 years (mean 16 years). The time from onset to MRI examination was 8 days to 4 months. The location of fat globules was in the tibia in 10 patients (35.7%), femur in 8 (28.6%), humerus in 4 (14.3%), radius in 2 (7.1%), ulna in 1 (3.6%), calcaneus in 1 (3.6%), sacrum in 1 (3.6%), and fibula in 1 patient (3.6%). On MRI imaging, 28 cases (100%) showed widely distributed patches or tortuous and sinuous abnormal signals in the bone marrow. In 25 cases (89.2%), a grid-like abnormal signal was found in the subcutaneous soft tissue. In 21 patients (75%), pus was found in the adjacent extraosseous soft tissues. Among 28 patients with fat globules, 17 patients (60.7%) had fat globules only in the adjacent extraosseous soft tissue, 6 patients (21.4%) had only intraosseous fat globules (including 5 cases with halo signs around the fat globules and 1 case (3.6%) with fat globules located at the edge of the pus cavity inside the bone without a halo sign), and 5 patients (17.8%) had both intraosseous and extraosseous fat globules. Of 6 patients (21.4% or 6/28) with liquid levels, the liquid level appeared outside the bone.

The appearance of fat globules on MRI in patients with osteomyelitis indicates severe infection. Fat globules of osteomyelitis may present with diverse shapes inside and outside the bone marrow as one of the MRI signs of osteomyelitis, with a probability of approximately 27.2%. They have high specificity in diagnosing osteomyelitis and can be used for diagnosis and differential diagnosis.

Delphian lymph node (DLN) metastasis is common in papillary thyroid cancer (PTC). However, few studies have specifically investigated the clinicopathologic characteristics of DLN metastasis in PTC. This study aimed to examine the incidence, risk factors, and predictive value of DLN in papillary thyroid carcinoma.

In the present study, the clinicopathologic features and metastatic risks were statistically analyzed by reviewing 1837 patients with papillary thyroid carcinoma who underwent initial surgery in our department between January, 2022 and July, 2024.

Among the 1837 patients included in the study, DLN was detected in 925 patients (50.3%), of which 409 patients (22.3%) had confirmed DLN metastasis. In univariate analysis, DLN metastasis was correlated with age (≥55 years), bilateral cancer, multifocality, tumor location (isthmus cancer), central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM). However, it was not correlated with gender distribution, tumor size, thyroiditis, thyroid-stimulating hormone (TSH) level, and BRAF mutation. Multivariate analysis showed that CLNM (p=0.03), LLNM (p=0.025), bilateral cancer, and tumor location (p=0.012) were independent risk factors for DLN metastasis. DLN involvement was mildly predictive of CLNM (sensitivity=29.76%, specificity=87.06%, positive predictive values=74.08%, negative predictive values=49. 93%, positive likelihood ratio=2.30, negative likelihood ratio=0.81) and moderately predictive of LLNM (sensitivity=49.36%, specificity=85.01%, positive predictive values=46.94%, negative predictive values=86.20%, positive likelihood ratio=3.29, negative likelihood ratio=0.60).

Bilateral cancer, CLNM, LLNM, and isthmus cancer were independent risk factors for DLN metastasis. DLN metastasis could be used as a predictor for central and lateral lymph node metastasis. Positive DLN should be a warning signal to carefully evaluate central and lateral lymph nodes during thyroidectomy.

This study aimed to determine the relationship between Radiation-Induced Lung Injury (RILI) and the clinical outcome of Non-Small Cell Lung Cancer (NSCLC) following Stereotactic Ablative Radiotherapy (SABR).

Clinical data and follow-up CT scanning of 101 patients with early NSCLC who received SABR treatment from January 2012 to December 2018 were retrospectively collected, and the Progression Free Survival (PFS) was calculated. CT features of peritumoral RILI were observed by 3 radiologists, each with 10 to 15 years of experience, based on consensus among 3 radiologists and divided into 3 types. Type 1: Diffuse consolidation surrounding the tumor, including the tumor boundary. Type 2: Ground Glass Opacities (GGOs) covering more than 180 degrees around the tumor. Type 3: GGOs surrounding the tumor but covering less than 180 degrees. Log-rank test was used to analyze the correlation between the classification of radiation-induced lung injury CT findings and PFS. Independent predictors of PFS rate were analyzed by COX multivariate regression.

The 5-year PFS rates based on RILI types observed at 6-8 months post-SABR were: Type 1 = 69.5%, Type 2 = 50.9%, and Type 3 = 36.1%. A statistically significant difference was observed among the three RILI types (p=0.025). COX multivariate regression analysis showed that RILI were independent factors influencing PFS (at 6-8 months follow-up after radiotherapy (p=0.041).

Patients with more extensive and denser RILI tend to have a longer PFS. Data from our cohort study indicate that the 6- 8 months post-SABR period represents the optimal follow-up window, as evidenced by significant progression-free survival rate dynamics during this interval (HR = 1.5, 95% CI 1.0-2.2, p < 0.05).