Prostate specific membrane antigen (PSMA) was first discovered in prostate cancer cells and is an important target for the diagnosis and treatment of tumors with high expression of PSMA such as prostate cancer. The development and application of a variety of imaging and therapeutic radionuclide-labeled targeted PSMA ligands play an important role in the theranostics of prostate cancer. This article reviewed the relevant research and clinical applications theranostics of PSMA.

The application of fibroblast activation protein (FAP) in cancer-associated fibroblast (CAF) has garnered widespread attention in nuclear medicine. FAP is highly expressed in most cancer tissues and rarely expressed in healthy tissues. Therefore, radionuclide probes targeting FAP have significant diagnostic and therapeutic potential. Compared to  ¹⁸ F-FDG, widely used in clinical practice, FAP-targeted tracers exhibit superior target-to-background ratio (tumor-to-background ratio) across various indications. Unlike  ¹⁸ F-FDG, the clinical use of FAP-targeted tracers does not require complex preparations like dietary restrictions for patients and offers the possibility of radioligand therapy (RLT). While radiolabeled antibodies have been studied clinically since the 1990s, the introduction and clinical application of FAPI tracers in 2018 marked a breakthrough event in the development of FAP-targeted probes within nuclear medicine. Since then, the development and application of targeted FAP tracers have become a hot topic among pharmaceutical companies as well as within the radiopharmaceutical and nuclear medicine communities. This article reviewed the current status and research progress of FAP-targeted radiopharmaceuticals.

The molecular imaging technology of nuclear medicine is widely used in the diagnosis of tumors, neurological diseases, cardiovascular diseases and other diseases due to its non-invasiveness and high sensitivity. Fibroblast Activation Protein (FAP) is a type Ⅱ serine protease that is highly expressed in 90% of malignant solid tumors. A variety of FAP inhibitors (FAPI) have been developed to target FAP, most of which have nanomolar levels of FAP affinity as well as high FAP selectivity for positron emission tomography(PET)/computed tomography(CT) imaging of tumors. In addition to this, FAP is also highly expressed in activated fibroblasts, and some scholars have explored the value of FAPI PET/CT in non-tumor diseases. In this paper, we reviewed the progress of FAP-targeted molecular imaging probes and research in oncologic and non-oncologic diseases.

Objective: Based on magnetic resonance imaging of patients with brain metastases, using imaging omics methods to differentiate the primary lesion of brain metastases and determine the specific source of the patient’s brain metastases. Methods: The data of this study were collected from patients with brain metastasis who treated in Liaoning Cancer Hospital from January 2017 to September 2020. Experienced imaging doctors manually delineate the active area of the patient’s brain metastasis tumor, and obtain a 4 mm circular area containing the active area and the surrounding area through computer methods. And 1 967 imaging omics features were extracted from each region of the contrast-enhanced T1-weighted imaging (CE-T1WI) and T2-weighted imaging (T2WI) sequences. After merging the sequences, a three-step feature screening method was performed using U-test, least absolute shrinkage and selection operator (LASSO) logistic regression, and Akaike information criterion (AIC), draw the receive operating characteristic (ROC) curve to calculate the area under curve (AUC) value as an indicator of the classification performance of the discriminative model. Results: A total of 215 patients with brain metastases were identified, including 100 cases of lung origin, 50 cases of breast origin, 50 cases of gastrointestinal origin, and 15 cases of other origin. From each of the two sequences, 1 967 imaging histological features were extracted. Three radiomics models were successfully constructed to differentiate whether brain metastases arose from lung cancer lesions in the RS_Lung model, breast cancer lesions in the RS_breast model and gastrointestinal cancer lesions in the RS_Gastrointestic model, with training set AUC of 0.898, 0.872 and 0.938, sensitivity of 0.908, 0.744 and 0.860, specificity of 0.818, 0.879 and 0.909, respectively. Conclusion: This study achieved good results in the distinguishing task derived from brain metastases using an imaging omics model constructed based on a 4 mm annular region, which has the potential to be a noninvasive preoperative new marker and guide personalized treatment options for patients with brain metastases.

Objective: Radioligand therapy (RLT) is an emerging modality that combines targeted therapy with radiation-induced cytotoxicity. This study investigates the efficacy and safety of  ¹⁷⁷ Lu-fibroblast activation protein (FAP)-2286 RLT in patients with advanced lung cancer. A comprehensive assessment was conducted through clinical trials and patient outcome analyses to evaluate the therapeutic potential of this treatment, aiming to improve the prognosis of patients with advanced lung cancer. Methods: The study included patients with advanced lung cancer treated with  ¹⁷⁷ Lu-FAP-2286 RLT in the Affiliated Hospital of Southwest Medical University from September 2022 to April 2024. Baseline scans using  ⁶⁸ Ga-FAP-2286 positron emission tomography (PET)/ computed tomography (CT) confirmed high expression of FAP within the lesions. Each treatment cycle administered approximately 200 mCi (7.4 GBq) of  ¹⁷⁷ Lu-FAP-2286 via intravenous infusion over 4 h, with intervals of 8-12 weeks between cycles, for a total of 4-6 cycles. The evaluation of safety and efficacy included laboratory tests, adverse event documentation, and assessments according to response evaluation criteria in solid tumor (RECIST) 1.1 and adopted PET response criteria in solid tumor (PERCIST) 1.0 criteria. Data analysis was performed using SPSS version 26.0, with paired sample t-tests applied to compare pre- and post-treatment differences following normality tests. Results: Among the 10 patients included in the study (8 males and 2 females, aged 53-73), treatment cycles varied: one patient received six cycles, three patients received four cycles, one patient received three cycles, four patients received two cycles, and one patient received only one cycle. The median follow-up period was 13 months. Treatment with  ¹⁷⁷ Lu- FAP-2286 was well-tolerated, with the primary adverse effects being fatigue and abdominal distension. No severe hematological toxicity or significant impairment of liver and kidney function was observed. Efficacy evaluation revealed a partial response (PR) rate of 30.0%, a stable disease (SD) rate of 50.0%, and a progressive disease (PD) rate of 20.0%. The overall response rate was 30.0%, and the disease control rate was 80.0%. According to the adopted PERCIST 1.0 criteria, the PR rate was 30.0%, the SD rate was 50.0%, and the PD rate was 20.0%. Conclusion:  ¹⁷⁷ Lu-FAP-2286 RLT demonstrated good safety and significant efficacy in patients with advanced lung cancer, with high disease control and overall response rates. Although the sample size in this study was small, the results support  ¹⁷⁷ Lu-FAP-2286 RLT as a promising new strategy for treating advanced lung cancer. Further research involving larger sample sizes and longer follow-up periods is required to validate its efficacy and safety.

Objective: To investigate the value of multiple radiomics models constructed by combining clinical risk factors and multiparametric magnetic resonance imaging (MRI) radiomics features to predict microsatellite instability (MSI) in rectal cancer. Methods: A total of 149 rectal cancer patients were included in the First Affiliated Hospital of Bengbu Medical University from December 2020 to November 2023, including 34 patients with MSI and 115 patients with microsatellite stability (MSS). Based on MRI examination of multiple sequence images, 3D regions of interest were delineated, radiomics features were extracted and dimensionality was reduced to select the best features. Then, five different machine learning algorithms, including logistic regression (LR), random forest (RF), support vector machine (SVM), k-nearest neighbor (KNN), and naive Bayes tree (NBT) were used to construct different imaging radiomics models using the optimal radiomics features. And receiver operating characteristic (ROC) curves were drew to evaluate the diagnostic performance of different models. Results: The RF model showed the most stable performance, and the clinical imaging radiomics joint model nomogram based on clinical independent risk factors and imaging radiomics showed high diagnostic efficiency for MSI in rectal cancer. The area under curve (AUC) of the training group and the validation group were 0.923 and 0.914, respectively, indicating the most significant evaluation of MSI in rectal cancer. Conclusion: Combining different machine learning algorithms, a clinical imaging radiomics nomogram constructed from clinical risk factors and multi-parameter MRI radiomics features can effectively predict the unstable state of preoperative rectal cancer.

Objective: To evaluate the relationship between International Association for the Study of Lung Cancer (IASLC) classification system and traditional computed tomography (CT) imaging features, and to construct a hierarchical prognosis model based on CT imaging features. Methods: The study retrospectively analyzed the medical records of 102 consecutive patients with primary pathological (p) stage I (T1N0M0 or T2aN0M0) LUAD in Nanjing Chest Hospital from January 2019 to May 2022. According to the 2020 IASLC grading system, patients were classified and the clinical pathological and imaging features were compared between different IASLC histological grades, as well as between recurrent and non recurrent groups. Logistic regression analysis was used to determine CT signs related to IASLC grading, and to determine influencing factors for disease-free survival (DFS) of patients through a multivariate Cox regression model. Results: A total of 102 patients with LUAD were divided into grade 1 (15 cases, 14.7%), grade 2 (63 cases, 61.8%) and grade 3 (24 cases, 23.5%). During the 30.4 months follow-up, 16 patients (15.7%) relapsed. Higher CTR (OR=2.152, 95% CI 1.530-3.264, P=0.005) and higher CT value (OR=3.730, 95% CI 2.841-6.353, P=0.001) were independent risks of higher histological grade. The AUC value for conjoining the above two independent factors to predict grade 3 was 0.912 (95% CI 0.877-0.937, P＜0.001), and it was not significantly different from the AUC for using the mean CT value or CTR alone. Multivariate Cox regression analysis showed age (HR=1.05, 95% CI 1.02-1.09, P=0.003), CTR (HR=2.81, 95% CI 1.16-6.77, P=0.022), CT value (HR=2.49, 95% CI 2.30-15.43, P<0.001) and histological grade (HR=4.31, 95% CI 2.28-8.14, P＜0.001) were independent risk factors for DFS. Conclusion: Larger CTR and higher average CT value are independent predictors of higher IASLC histological grade. CTR (truncation values＜0.25 and ≥0.75) and average CT values (truncation values＜-410 HU and ≥-210 HU) can be used as preoperative substitutes for IASLC grading system.

Breast cancer is a highly heterogeneous malignancy, and molecular functional imaging techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT) play a critical role in its accurate diagnosis. While imaging provides a crucial foundation for precise breast cancer diagnosis, the most used imaging agent,  18 F-FDG, presents certain limitations in this context. Consequently, there has been an increased focus on the research and development of novel radiolabeled probes for both in situ imaging of primary tumors and the detection of distant metastases. This paper reviewed the recent advancements in radiolabeled probes for breast cancer diagnosis and treatment, with an emphasis on novel targets that exploit specific surface markers on tumor cells and elements of the tumor microenvironment and categorized their practical applications in clinical settings.

Ultrasound, characterized by its safety, non-invasive, economy, and convenience, is the preferred modality for the evaluation of thyroid nodules. Currently, several versions of the Thyroid Imaging Reporting and Data System (TI-RADS) have been developed for the risk stratification and management of thyroid nodules. Classifications of the same nodule can vary across different TI-RADS versions, leading to discrepancies in the management strategies, particularly regarding the necessity for fine- needle aspiration biopsy (FNAB) for suspected malignant nodules. This article provided a review of the application, advantages, and limitations of various TI-RADS versions in thyroid nodule risk stratification management, as well as the latest research progress.

 In the year 2023, high-frequency ultrasound technology has seen significant progress in the field of skin diseases. It has made notable achievements in both basic research and clinical applications. Particularly, it has been successful in skin disease diagnosis, pre- and post-treatment evaluations, artificial intelligence-based diagnosis, the transformation of basic research results, and new tumor treatment methods. This technology provides dermatologists with more accurate and multi-dimensional clinical diagnosis and treatment information. This article provided a comprehensive review of the latest progress in skin ultrasound technology in 2023.

 In recent years, China has made significant progress in the field of liver ultrasound research, providing more accurate and reliable means for clinical diagnosis and treatment. Reviewing the clinical research on liver ultrasound in China in 2023, the hotspots in clinical research on diffuse liver diseases are mainly the quantitative assessment of fatty liver and the diagnosis of liver fibrosis with new ultrasound technologies. The clinical research on focal liver diseases focuses on the precise diagnosis of liver tumors and the related applications of artificial intelligence technology. In the field of diagnosis and treatment of liver disease with minimally invasive interventional ultrasound, it covers the optimization of ablation treatment strategies in liver tumors, the risk assessment of post-ablation complications, and prognosis evaluation, etc. The achievements in the field of liver guidelines and consensus in 2023 will also be introduced in this article.

Objective: To investigate the feasibility of fusion registration of high-frequency ultrasound (HFUS)-pathology images and predictive value of model for predicting the pathological tissue components in in vitro models based on deep learning (DL) networks. Methods: Sixty in vitro mimetic tumor models containing four different biological tissues and localized particles were prepared. HFUS images and wide slide images (WSI) of the same slide were obtained under physical registration. The obtained images were quality controlled and selected, and the region of interest (ROI) was manually outlined along the edges of the tissues in the WSI and then transferred to HFUS images. The datasets were consisted of original images and corresponding ROIs and were divided into the training set (n=462), validation set (n=34) and testing set (n=38) at the ratio of 13∶1∶1. DL models were developed via transfer learning DeepLabV3, FCN-50 and MobileNetV3 networks. The pixel accuracy (PA), precision, recall and F1-score were used to quantify and compare the performance of each model in the training and testing datasets. The automatically segmented images were output. Results: The DL models based on DeepLabV3, FCN-50 and MobileNetV3 networks had high accuracy and similarity for automatically segmentation of different tissue components in the testing set, and the MobileNetV3 model outperformed others with the PA of 91.4% and F1-score of 87.1%. There was no significant difference between performance of models (all P> 0.05). There were statistically significant differences between the efficiencies of models for predicting different in vitro biological tissue components (all P<0.001), with the best of liver tissue. Conclusion: The constructed ultrasound-pathology fusion models in this study can effectively recognize the in vitro tissue components in ultrasound images and provide the methodological basis for further clinical applications.

Objective: To explore the value of multimodal ultrasound imaging in predicting central lymph node metastasis of papillary carcinoma of the thyroid (PTC). Methods: Patients with PTC confirmed by operation and pathology were selected in The First People’s Hospital of Foshan from March 2022 to February 2024. The patients were examined by conventional ultrasound, shear wave elastography (SWE) and superb microvascular imaging (SMI) before surgery. Conventional ultrasound was used to evaluate lesion maximum diameter, location, shape, internal parenchymal echo, microcalcification, the ratio of longitudinal and transverse diameter, capsule continuity. SWE was used to measure the mean of Young’s modulus (E_mean). SMI was used to measure vascular index (VI). Single-factor and multi-factor logistic regression analysis were used to analyze the risk factors of the central lymph node metastasis in PTC patients. Results: A total of 110 patients included 52 patients with central lymph node metastasis (metastatic group) and 58 patients without central lymph node metastasis (non-metastatic group). There were significant differences in age, maximum diameter, shape, parenchymal echo, microcalcification, capsule continuity, E_mean and VI between the two groups (all P<0.05). Multi-factor logistic regression analysis showed that age, maximum diameter, parenchymal echo and E_mean were the independent risk factors of central lymph node metastasis (all P<0.05). Conclusion: Multimodal ultrasound has a certain value in predicting the central lymph node metastasis of PTC.

With the increasing detection rate of papillary thyroid microcarcinoma (PTMC), the treatment methods are changing rapidly, especially in recent years, some alternatives to surgical treatment have been gradually put forward and practiced. This paper summarized and analyzed the evolution process, current state, trend and key issues of PTMC treatment. From the way of surgery to the concept of active surveillance, to the wide application of thermal ablation. Through comparative analysis, thermal ablation is a promising alternative treatment. However, the indications for PTMC thermal ablation cannot meet the concept of individualized, multidisciplinary and multimodal treatment. By summarizing the status of thyroid cancer thermal ablation and research progress, this article provided a new perspective for the clinical research outside PTMC thermal ablation indications, and provided direction for future research development.

Targeted radionuclide therapy (TRT) leveraging the unique properties of radioactive pharmaceuticals to concentrate therapeutic effects within tumor tissues. TRT can be principally categorized into two distinct approaches based on the differences in targeting mechanisms: chemical/biological targeting internal radiotherapy and physical targeting internal radiotherapy. Generally, TRT refers to the systemic administration of targeted radionuclide drugs. The continuous advancement of nuclear medicine diagnostic and therapeutic technologies, coupled with the advocacy of precision medicine, has led to an innovative integration in clinical practice: integrated physical targeted radionuclide theranostics. This article explored the current status and development of theranostics in physically targeted radionuclide treatment, highlighting some common and emerging therapies in clinical practice.

Objective: To investigate the clinical and ultrasonic characteristics of papillary carcinoma of the thyroid (PTC) for predicting central lymph node metastasis (CLNM), and the correlation between clinical and ultrasonic characteristics and BRAF V600E mutations. Methods: A retrospective study was conducted in 534 patients with PTC. Groups were grouped according to the size of suspected PTC lesions on preoperative ultrasound. Clinical information and ultrasound characteristics of suspected lesions were collected, and risk factors associated with CLNM and BRAF V600E mutations were screened by multi-factor analysis and stratified analysis. Results: Multi-factor and stratified analysis showed that the close contact between the lesion and the capsule, as well as the BRAF V600E gene mutation, were risk factors for CLNM in patients with PTC＞10 mm. The presence of microcalcifications in the lesion or male patients with papillary thyroid microcarcinoma (PTMC) were risk factors for CLNM (P＜0.05). The occurrence of BRAF V600E gene mutations is significantly associated with the absence of Hashimoto’s thyroiditis (P＜0.001). Conclusion: When the patient has a suspicious ＞10 mm PTC lesion that is close to the capsule, the BRAF V600E gene test can be performed to predict the occurrence of CLNM. When the suspected lesion is ＜10 mm, men or patients with microcalcification of the lesion are more likely to develop CLNM. The probability of BRAF V600E gene mutation is higher in PTC patients with larger lesions or without Hashimoto thyroiditis (HT). The clinical and focal ultrasound features of PTC have predictive value for central lymph node metastasis, and are associated with BRAF V600E gene mutation, which is helpful for clinical selection of reasonable surgical methods for patients.

With the rapid advancement of computer science, artificial intelligence has become an important role in the medical field. Machine learning, based on medical imaging, plays a significant complementary role in clinical decision-making. Moreover, the integration of imaging data with genomic information has introduced innovative avenues for genetic testing. The primary focus of this article was on the current state, limitations, and future trends of machine learning based on medical imaging for predicting epidermal growth factor receptor (EGFR) mutations in patients with non-small cell lung cancer (NSCLC).

Objective: To evaluate the performance of a deep learning model based on the Kupffer phase of perflubutane  microspheres for injection (product name Sonazoid) contrast-enhanced ultrasound in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC), comparing it with radiomics model and clinical model. Methods: This study retrospective included 146 patients with primary HCC who underwent Sonazoid contrast-enhanced ultrasound examination in The First Affiliated Hospital of Guangxi Medical University from July 2020 to September 2022, randomly divided into a training set of 102 and a validation set of 44 in a 7∶3 ratios. Based on the region of interest in tumors, ResNet101 model was used to extract deep learning features through transfer learning, and PyRadiomics was utilized to extract radiomics features. Mann-Whitney U test and least absolute shrinkage and selection operator (LASSO) algorithm were employed to reduce features dimension. LASSO regression was used to construct both the deep learning model and radiomics model, a clinical model was also built based on clinical features. The diagnostic performance of models was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. DeLong testing algorithm was used to compare the diagnostic performance between models. Results: In the training set, the AUC (95% CI) for the deep learning model, radiomics model, clinical model was 0.931 (0.880-0.981), 0.823 (0.744-0.903) and 0.719 (0.614-0.824), respectively. In the validation set, the
AUC (95% CI) for the deep learning model, radiomics model, clinical model was 0.895 (0.757-1.000), 0.711 (0.514-0.909) and 0.606 (0.390-0.822), respectively. DeLong testing indicated that in both the training and validation sets, the diagnostic performance of the deep learning model was superior to that of the radiomics model and clinical model (P＜0.05). Both univariate and multivariate logistic regression analyses showed that AFP (P＜0.05) and Barcelona Clinic Liver Cancer staging (P＜0.001) could be used as independent predictors of MVI in HCC patients. Conclusion: The deep learning model based on the Kupffer phase of Sonazoid contrast-enhanced ultrasound demonstrates excellent performance in predicting MVI in HCC patients. It has the potential to become a non-invasive imaging biomarker for predicting MVI.

Hypoxia, a common status of most solid tumors, is associated with tumor progression, metastasis, radiotherapy and chemotherapy resistance. Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) using hypoxic-targeting radiopharmaceuticals have been applied to non-invasive monitoring of tumor hypoxia. Nitroimidazole, which could be selectively trapped within hypoxia cells, has become an important pharmacophore for targeting hypoxia. Recently, hypoxic-targeting radiopharmaceuticals containing nitroimidazole have been developed for detecting tumor hypoxia. In this review, the progress of hypoxic-targeting radiopharmaceuticals containing nitroimidazole in recent ten years was introduced and the future development direction was also prospected.

Objective: To explore the factors related to lateral lymph node metastasis in papillary thyroid microcarcinoma (PTMC) and their predictive value, so as to provide reference for clinical treatment. Methods: A total of 158 PTMC patients who underwent surgery in the Affiliated Cancer Hospital of Zhengzhou University from June 2022 to June 2023 were divided into non-metastatic group (95 cases) and metastatic group (63 cases) according to postoperative pathological results. Their clinical data and preoperative ultrasound data were analyzed and compared. Single factor analysis and multiple logistic regression analysis were used to screen out the independent correlation factors of lateral lymph node metastasis. Receiver operating characteristic (ROC) curve was drawn to evaluate the prediction efficiency of each factor and the combined index. Results: The results of single factor analysis showed there were statistically significant differences in age, gender, maximum tumor diameter, location, transverse-longitudinal axis ratio ＞1, microcalcification, invasion capsule, ultrasonography indicating abnormal central lymph nodes, the ratio of length to diameter of lymph nodes in the lateral region≤2, uneven hilum of lymph node echo, cystic change, microcalcification, and marginal or mixed blood flow signals between the two groups (P＜0.05). Multivariate logistic regression analysis showed that age≤45 years, tumor in the upper pole, invasion of capsule, ultrasonography indicating abnormal central lymph nodes, and uneven hilum of lymph node echo of lateral lymph nodes were independent risk factors for lateral lymph node metastasis in PTMC patients. The sensitivity, specificity and accuracy of the combined index composed by independent risk factors in predicting lateral lymph node metastasis respectively were 81.0%, 86.3% and 84.2%, and the area under ROC curve was 0.918. Conclusion: The combination of age, tumor location, capsular invasion, ultrasonography indicating abnormal central lymph nodes, and uneven hilum of lymph node echo of lateral lymph nodes can effectively predict the metastasis of lateral lymph nodes in PTMC patients, and provide help for the selection of clinical treatment.

Objective: To evaluate and compare the diagnostic value of contrast-enhanced ultrasound (CEUS), ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and the combination of the two in the diagnosis of Thyroid Imaging Reporting and Data System (TI-RADS) 4 nodules of the thyroid gland. Methods: Patients with TI-RADS 4 thyroid nodules having clear pathological findings from February 2019 to November 2023 in Tangshan Central Hospital and Tangshan Gongren Hospital were retrospectively analyzed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS, US-FNAB, and the combination of the two methods were calculated by using postoperative pathology as a criterion, and the diagnostic efficacy of CEUS, US-FNAB and their combination was compared by drawing the receiver operating characteristic (ROC) curve. Results: In the differential diagnosis of seventy-five patients benign and malignant thyroid TI-RADS 4 nodules, the diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CEUS were 70.7%, 70.6%, 70.6%, 74.4%, and 66.7%, respectively, and of US-FNAB were 75.6%, 79.4%, 77.3%, 81.6% and 73.0%, respectively, and the combination of the two were 97.6%, 58.8%, 80.0%, 74.1%, and 95.2%, respectively. The false-positive rates of CEUS, US-FNAB, and the combination of the two were 29.3%, 24.4%, and 2.4%, respectively. The false-negative rates of CEUS, US-FNAB and the combination of the two were 29.4%, 20.6% and 41.2%, respectively. The AUC of CEUS, US-FNAB and the combination of the two applied diagnostics were 0.707, 0.775, and 0.782, respectively, as derived from plotting the ROC curve. Conclusion: Both CEUS and US-FNAB have a certain value in the differential diagnosis of benign and malignant thyroid TI-RADS 4 nodules, and their diagnostic value can be improved when they are combined, which can be combined when it is difficult to distinguish between benign and malignant in the clinical situation.

Objective: To explore the ultrasound imaging evaluation of breast cancer microcalcifications under the expression status of different SOX gene family transcription factors. Methods: The study selected breast cancer patients diagnosed through pathological examination in Xingtai Central Hospital from January 2020 to October 2023. All patients underwent surgical treatment. Breast cancer tissue was obtained from the tumor site, along with adjacent normal tissue at least 5 cm away from the cancerous tissue. The collected tissues were immediately preserved in liquid nitrogen at -196℃ for subsequent research. Preoperative ultrasound examinations, including routine ultrasound, shear wave elastography, and contrast-enhanced ultrasound were performed. Postoperative pathological histological testing was conducted to detect SOX4 expression, and the relationship between ultrasonographic microcalcifications and SOX4 protein expression was analyzed. Results: In 215 patients, the proportion of high SOX4 expression in breast cancer tissue was 86.05%, significantly higher than that in adjacent normal tissue, which was 48.84% (χ²=67.783, P=0.000). Breast cancer microcalcifications were closely associated with clinical pathological features such as tumor differentiation and lymph node metastasis (P<0.05). High SOX4 expression in breast cancer was closely correlated with microcalcifications, Alder blood flow grading, peripheral radial enhancement, and the rim sign (P<0.05). Logistic regression analysis showed that microcalcifications (OR=1.839, 95% CI 1.538-2.198), peripheral radial enhancement (OR=1.795, 95% CI 1.089-2.959), and rim sign (OR=1.496, 95% CI 1.007-2.223) were risk factors for high SOX4 expression in breast cancer (P<0.05). Conclusion: SOX4 is implicated as a pivotal contributor to the pathogenesis and progression of breast cancer. The manifestation of microcalcifications in ultrasound imaging exhibits a significant correlation with tumor differentiation and lymph node metastasis, underscoring microcalcification as a prognostic marker for elevated SOX4 expression. Clinically, the identification of microcalcification patterns serves as a predictive tool for the expression of SOX4 transcription factors, which is anticipated to augment the precision of early diagnostic modalities and inform the development of targeted therapeutic strategies in breast cancer management.

 Objective: To explore the application value of radiomics model based on multi-parameter magnetic resonance imaging (mpMRI) in Gleason grading of prostate cancer. Methods: The data of patients who underwent prostate mpMRI examination with surgical or pathological puncture results confirming prostate cancer at Ma’anshan People’s Hospital from November 2020 to August 2023 were retrospectively analyzed. MpMRI data were extracted, including T2- weighted imaging (T2WI), zoomed imaging technique with parallel transmission diffusion-weighted imaging (ZOOMit DWI) and apparent diffusion coefficients (ADC). Spearman’s correlation coefficient was used to preliminarily screen the histological features, the least absolute shrinkage and selection operator (LASSO) algorithm and ten-fold cross-validation were used to further screen, logistic regression was used to construct the model, and the receiver operating characteristic (ROC) curve was used to judge the results. And the area under the ROC curve (AUC) was compared between models using the DeLong test. Results: A total of 176 patients were included, including 72 patients in the low-grade group (Gleason score≤3+4) and 104 patients in the high-grade group (Gleason score≥4+3), who werer andomly divided into training group (n=141) and test group (n=35) according to 7∶3. A variety of classifiers were used to construct the multi-parameter model, and the results showed that the AUC of support vector machine (SVM) in the test set was 0.891, and the AUC in the training set was 0.905. Light gradient boosting machine (LightGBM) had the highest AUC of 0.931 in the training set, but it performed poorly in the test set with an AUC of 0.808. The AUCs of multilayer perceptron (MLP) in the test set and the training set were 0.883 and 0.855, respectively, which were weaker than that of SVM, which showed that the stability of LightGBM and MLP models were slightly worse than that of SVM. In addition, the overall performance of the four methods ［k-nearest neighbor (KNN), extra trees (ET), random forest (RF), extreme gradient boosting (XGBoost)］were not as good as SVM, and some of them are overfitted. In general, in terms of Gleason grading of prostate cancer, the SVM model had a higher AUC in both the test set and the training set, and its stability and model classification ability were better. Conclusion: Constructing a multimodal imaging histology model based on mpMRI has significant clinical application value in Gleason grading of prostate cancer, of which the SVM model is the best.

Objective: To compare dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in evaluating microvascular content in rectal cancer. Methods: This study was conducted on 23 patients with rectal adenocarcinoma confirmed by preoperative endoscopic pathology in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from December 2019 to December 2022. All subjects underwent IVIM-DWI and DCE-MRI scans before surgery. The DCE-MRI parameters calculated by the Tofts model were extracellular space volume fraction (V _e ), space transport coefficient (K ^trans ), and rate constant of extracellular space return to intravascular space (K _ep ). The IVIM-DWI parameters were calculated by the double exponential model: simple diffusion coefficient (D), perfusion related diffusion coefficient (D*), and perfusion fraction (f). The correlation between DCE-MRI and IVIM-DWI quantitative parameters and microvascular content in rectal cancer was analyzed and compared. Results: There were significant differences in K ^trans and D values of colorectal cancer in different pathological grades (F=9.159, P=0.002; F=5.106, P=0.016). K ^trans was superior to the D value in evaluating rectal cancer grading. K ^trans , K _ep and D* were positively correlated with microvascular content in rectal cancer (r=0.734, P=0.000; r=0.617, P=0.002; r=0.456, P=0.029). DCE-MRI quantitative parameters were superior to IVIM-DWI quantitative parameters in evaluating microvascular content in rectal cancer. Conclusion: DCE-MRI was superior to IVIM-DWI in evaluating the differentiation degree and microcycle status of rectal cancer. However, considering that IVIM-DWI does not require injection of contrast agents, IVIM-DWI can still be recommended for the microcirculation of rectal cancer.

Objective: To explore and analyze the current situation of quality control of radioactive  ¹²⁵ I seeds implantation technology in Shanghai. Methods: According to the evaluation sheet of  ¹²⁵ I seeds implantation technology established by Shanghai Nuclear Medicine Quality Control Center, the data of 20 departments from 16 medical institutions was analyzed. Results: Among the 36 quality control contents evaluated for the basic requirements of medical institutions, personnel, and technical management, the highest compliance rate was 100.0% (36/36), and the lowest compliance rate was 83.33% (30/36), the management and quality situation of different departments in the same hospital also varies. For various indicators related to quality control, the average accuracy rate of implantation indications was 98.75%, the average preoperative treatment plan formulation rate was 94.74%, the average particle activity retest rate was 25.13%, the postoperative radiation dose verification average rate was 83.81%, the average incidence rate of major complications related to puncture within 30 d was 5.67%, the average incidence rate of major complications related to radiation injury within 30 d was 0.85%, and the average effective rate of particle implantation treatment was 92.2%, The all-cause mortality average rate within 30 days was 0.87%. The average follow-up rates for 2 months, 4 months, 6 months, and 1 year were 97.24%, 91.9%, 85.31%, and 71.91%, respectively. The average survival rates for 2 months, 4 months, 6 months, and 1 year were 96.81%, 89.74%, 81.31%, and 66.07%, respectively. Conclusion: In 2022, there were many problems in the quality control of  ¹²⁵ I particle implantation therapy technology in all medical centers in Shanghai. All medical centers should pay attention to it. According to the requirements of the  ¹²⁵ I particle implantation therapy technology evaluation form of nuclear medicine quality control center, medical centers should improve the department rules and regulations, and carry out the technology in full accordance with the diagnostic and therapeutic specifications.

Objective: To construct a positron emission tomography (PET) probe,  ⁶⁸ Ga-NOTA-376, targeting CLDN18.2 using a non-site-specific labeling method, and to evaluate its in vitro and in vivo properties. Methods: The chelating agent p-SCN-Bn-NOTA was used to non-site-specifically conjugate the nanobody 376 targeting CLDN18.2, resulting in the precursor NOTA-376, which was then radiolabeled with  ⁶⁸ Ga. The labeling efficiency, radiochemical purity, and in vitro stability of the probe were determined by radio- thin layer chromatography (Radio-TLC), and micro-PET/ computed tomography (CT) imaging experiments were conducted in a nude mouse model of human gastric adenocarcinoma. Results:  ⁶⁸ Ga-NOTA-376 demonstrated a high labeling yield (89.98±0.07) %, high radiochemical purity (97.67±0.02)% and high specific activity (16.69±6.60) GBq/μmol, and remained stable in 5% human serum albumin (HSA) and phosphate-buffered saline (PBS). Micro-PET/CT results indicated that the maximum standardized uptake value (SUV _max ) of the probe in CLDN18.2-positive tumors was significantly higher than in CLDN18.2-negative tumors. At 4.0 h, the SUV _max of CLDN18.2- positive tumors and CLDN18.2-negative tumors were 9.08±0.33 and 1.92±0.32, respectively. Conclusion: This study successfully constructed a CLDN18.2-targeting probe  ⁶⁸ Ga-NOTA-376 using a non-site-specific labeling method, which showed high labeling efficiency, good stability, and targeting capability, making it a potential PET probe for the detection of CLDN18.2 protein expression levels.

Objective: To investigate the analgesic effect and safety of ultrasound-guided transversus abdominis plane (TAP) block combined with local anesthesia for microwave ablation (MWA) of liver cancer. Methods: Patients with primary liver cancer and metastatic liver cancer who underwent ultrasound-guided MWA after ultrasound-guided TAP block combined with local anesthesia in Jiangsu Cancer Hospital from November 2021 to June 2023 were retrospectively analyzed. According to the ablation site and range of preoperative ipsilateral subcostal margin + Petit triangle dual access TAP block combined with local anesthesia, and ultrasound-guided TAP in-plane injection of 0.375% ropivacaine 20 mL, and patients were evaluated by using numerical rating scale (NRS) to assess the pain level in the intraoperative period, and the postoperative period of 30 min, 1 h, 3 h, 6 h, 12 h and 24 h. The pain level of the block was observed. The pain level of the patients was evaluated using the numerical rating scale (NRS) during the operation, 30 min, 1 h, 3 h, 6 h, 12 h and 24 h after the operation, and the block efficiency, complication occurrence, and the amount of remedial analgesic used during and after the operation were observed. Results: All 13 patients with primary liver cancer and metastatic liver cancer underwent MWA in 1 session, and TAP block combined with local anesthesia was successfully performed. Three (23.1%) patients had mild pain (NRS) without intervention; one (7.7%) patient had moderate pain, and the ablation was completed with intramuscular analgesic drugs. Postoperatively, 3 (23.1%) patients had mild pain without intervention, all of which resolved spontaneously within 6 h. There were no intraoperative or postoperative complications related to TAP block. All patients were 100.0% satisfied with the effect of TAP block combined with local anesthesia for 24 h after ablation. Conclusion: Ultrasound- guided TAP block combined with local anesthesia is safe and effective in MWA of liver cancer, broadening the application range of MWA of liver cancer.

Objective: To investigate the predictive value of a scoring model based on conventional ultrasound combined with clinicopathological features for pathologic complete response (pCR) in human epidermal growth factor receptor 2 (HER2) positive breast cancer after neoadjuvant chemotherapy (NAC). Methods: A retrospective analysis was performed in patients who confirmed as HER2 positive breast cancer by ultrasound-guided coarse needle biopsies and followed by eight cycles of NAC from January 2022 to August 2023 in The First Affiliated Hospital of Nanjing Medical University. According to the Miller-Payne grading system, the patients were divided into pathological complete response (pCR) group and non-pathological complete response (non-pCR) group. The differences of clinical and pathological data and ultrasound imaging features between the two groups were analyzed by t test or χ²/Fisher test. Multivariate regression analysis was used to determine the independent predictors of pCR in HER2 positive breast cancer, and a nomogram was established to visualize the predictive efficacy of related factors for pCR. Results: A total of 103 patients were included, 51 in the pCR group and 52 in the non-pCR group. Univariate analysis revealed significant differences between pCR and non-pCR groups regarding tumor molecular classification (χ²=12.266, P<0.001), as well as the ultrasound features including the rate of longest diameter change ΔD₂, ΔD₄, ΔD₆, ΔD₈ (t=-2.760, P=0.007; t=-2.557, P=0.012; t=-4.006, P<0.001; t=-2.872, P=0.005) and volume change rate ΔV₂, ΔV₄, ΔV₆, ΔV₈ (t=-4.167, P<0.001; Z=-3.443, P<0.001; Z=-4.518, P<0.001; Z=-3.708, P<0.001) along with resistance index (RI) measurements in the 4th, the 6th and the 8th cycle (Z=-2.108, P=0.035; Z=-2.386, P=0.017; Z=-3.708, P<0.001). Multivariate analysis showed that tumor molecular type (OR=0.15, 95% CI 0.03-0.64, P=0.005) and tumor volume change rate after the second cycle of NAC ΔV₂ (OR=121.47, 95% CI 4.25-3468.72, P=0.010) were independent predictors of pCR in HER2 positive breast cancer after NAC (P<0.05). The area under the receiver operating characteristic (ROC) curve (AUC) of the nomogram model was 0.82 (95% CI 0.74-0.91), the sensitivity was 85%, and the specificity was 75%. Calibration chart and decision curve analysis (DCA) showed it has good application value in clinical evaluation. Conclusion: The developed nomogram scoring model integrating ultrasound and clinicopathological features demonstrates strong predictive potential for identifying pCR among HER2 positive breast cancer patients post-NAC, thereby offering valuable insights into subsequent treatment decisions.

Objective: To evaluate the size and internal changes of bone metastases in breast cancer by spectral computed tomography (CT) images, to explore the predictive value of these multiple parameters for progression-free survival (PFS), and to overcome the limitations of conventional CT and existing criteria in the evaluation of bone metastases. Methods: The clinical and imaging data of patients with breast cancer with bone metastasis who were treated in Fudan University Shanghai Cancer Center from June 2019 to December 2022 were retrospectively analyzed. All patients underwent two contrast-enhanced spectral CT examinations, and the size indexes of bone metastases were recorded on the venous stage images: long diameter, short diameter, sum of long diameter and short diameter, and area of interest. Internal indicators of bone metastasis were CT value of conventional image (bone window) (CTv), CT value of single-level image (CT_{40 keV}, CT_{80 keV}, CT_{120 keV}), CT value of calcium suppression image (CT_CaSupp30, CT_CaSupp50, CT_CaSupp70, CT_CaSupp90). Each index of all the bone metastatic target lesions measured in the patient was summed respectively, and the change rate and monthly change rate of each index were calculated. The independent risk factors of PFS were determined by univariate and multifactor Cox proportional risk regression analysis combined with stepwise regression method. Cox proportional hazard regression model was used to construct the model, and the area under the time-dependent receiver operating characteristic curve (AUC) was used to evaluate its predictive performance. DeLong test compared AUC. The threshold was determined by X-tile method and divided into high and low risk groups according to the threshold. Kaplan-Meier (KM) survival curve and log-rank test were used to analyze the difference in prognosis between groups. Results: A total of 30 patients with breast cancer with bone metastases were included. The monthly rate of change of the sum of length and diameter of bone metastases and the monthly rate of change of CT_CaSupp70 are effective predictors of PFS in breast cancer patients with bone metastases. PFS was significantly prolonged in patients with the monthly change rate of the sum of length and diameter < 0.39% and the monthly change rate of CT_CaSupp70>-9.75%. The AUC of 1-year PFS predicted by the sum of long and short diameters model, CT_CaSupp70 model, combined model and response criteria of bone metastases at MD Anderson Cancer Center (MDA criteria) were 0.751, 0.702, 0.827 and 0.600, respectively. The predictive performance of the combined model was significantly better than that of the MDA standard (P=0.003). The PFS of high risk group were significantly lower than those of low risk group (P<0.05). There was no significant difference in PFS survival curve under MDA (P=0.091). Conclusion: The monthly rate of change in the sum of long and short diameters of bone metastases and the monthly rate of change in CT_CaSupp70 are effective predictive indicators for the prognosis of breast cancer patients with bone metastasis, and their combined application can enhance predictive performance.

The Chinese Anti-Cancer Association Society of Integrative Cardio-oncology, the Ultrasound Branch of the Chinese Medical Association, and the Chinese Society of Echocardiography convened experts formulated the Chinese guideline for the clinical application of noninvasive imaging technology in accessing cancer therapy-related cardiovascular toxicity (2023 edition). The guideline highlighted that cancer therapy-related cardiovascular toxicity (CTR-CVT) has become one of the major threats to the survival of cancer patients. Non-invasive imaging technologies play crucial roles in the risk stratification, early diagnosis, monitoring and follow-up of CTR-CVT. This article provided an interpretation of the non-invasive imaging examination methods and monitoring strategies for common CTR-CVT as proposed in the guideline, offering practical and effective guidance for the clinical management of CTR-CVT.

Objective: To utilize the advantages of digital breast tomosynthesis (DBT) in assessing lesion margins and to explore the relationship between the burr sign of DBT images and Ki-67 proliferation index. Methods: DBT imaging data of 99 patients with invasive breast cancer who in the First Affiliated Hospital of Zhengzhou University from March 2022 to April 2023 were retrospectively included, and all of the patients showed a burr-type mass in DBT images. Lump size, length and width of the burr, coverage of the burr at the tumor margin, and number of burrs were analyzed in 99 cases of breast burr-type lumps, and general clinical data of the patients were collected to compare the differences of each parameter between the Ki-67 proliferation index expression states. Independent predictors of Ki-67 proliferation index were analyzed using multifactorial logistic regression, and the diagnostic efficacy was evaluated using subject working curves. Results: The differences in DBT image burr characteristics including burr length and burr width were statistically significant when comparing Ki-67 proliferation index high patients and low patients (P＜0.05), whereas the differences in the number of burrs, age of patients, menopausal status, and size of the mass were not statistically significant (P=0.060, P=0.175, P=0.507, and P=0.050, respectively). Multifactorial logistic regression model analysis showed that burr length (OR=0.036, P＜0.001) and burr width (OR=8.829, P＜0.001) were independent predictors of Ki-67 proliferation index. The best diagnostic efficacy was achieved when combining burr length with burr width, with an AUC of 0.897. Conclusion: Burr sign analysis in DBT images of breast cancer can be used as a noninvasive predictor of the proliferative activity of malignant tumors to determine patient prognosis.

Objective: To develop a prediction model for central cervical lymph node metastasis (CLNM) in papillary carcinoma of the thyroid (PTC) by combining the patients’ basic clinical information, laboratory indexes, and ultrasound features. This model assists clinical preoperative evaluation and selects personalized treatment plans for patients. Methods: A total of 912 patients who underwent surgery for PTC were enrolled in the study. The enrolled patients were randomly divided into a training dataset (n=727) and a validation dataset (n=185). Univariate and multivariate analysis were performed to examine risk factors associated with CLNM. A nomogram comprising the prognostic model to predict the CLNM was established, and validation was performed in the validation cohort. Finally, clinical decision curve was used to evaluate its clinical application. Results: We developed a prediction model that included gender, age, total tumor diameter (TTD), thyroid stimulating hormone (TSH), calcification, and the thyroid lesion in contact with the thyroid capsule and Hashimoto’s thyroiditis. The nomogram showed area under curve (AUC) of 0.746 and 0.826 in the training cohort and validation cohort. Therefore, the model had higher sensitivity than preoperative ultrasound. Conclusion: The nomogram prediction model developed by logistic regression showed a good performance in predicting CLNM in PTC patients, and addressed the shortcomings of ultrasound diagnosis.

Objective: To explore the feasibility of optical navigation combined with ultrasound navigation for thyroid nodule ablation through animal experiments, selecting cryoablation as a means, and verifying the accuracy of localization and ablation safety in animal experiments. Methods: Three Bama Xiaoxiang pigs were ablated with ultrasound guidance to establish an animal model of thyroid nodules. Using optical navigation for three-dimensional ultrasound reconstruction of “nodules” and thyroid, young ultrasound intervention physicians used optical navigation to guide precise ablation needles puncture. The ablation needles passed through the center of the “nodules” to the front edge of the “nodules”, and cryoablation was initiated until the range of the ice balls exceeded the edge of the nodules by more than 5 mm. Recorded the size of the nodules, ablation parameters, ice hockey and ablation range, and postoperative complications separately. Results: With the assistance of optical and ultrasound navigation, inexperienced ultrasound interventional physicians could smoothly pass the ablation needles through the center of the “nodules” to the front edge target of the “nodules”. The average diameter of the ice balls was about (24.3±3.8) mm. After 30 min of ablation, the ice balls completely melt. Follow up thyroid ultrasound showed that the maximum diameter of the ablation lesions was on average (18.7±5.1) mm, and the volume was (2 215.4±1 470.3) mm ³ . All experimental animals had no complications. Conclusion: The combination of optical and ultrasound navigation for thyroid nodule cryoablation was safe and effective, with minimal damage to adjacent critical structures. Optical navigation can help inexperienced ultrasound interventional physicians successfully complete thyroid nodule cryoablation, and has good application prospects.

Objective: To appropriately extend the in vivo circulation time of ginsenoside-like prostate-specific membrane antigen (PSMA) targeting probes and develop a novel  ⁶⁸ Ga-labeled diagnostic probe for prostate cancer. Methods: The ligand P214 (using p-SCN-Bn-DOTA as a bifunctional chelator) was synthesized using solid-phase synthesis, and its affinity was measured. The ligand was added to a buffer containing  ⁶⁸ Ga ³⁺ ions, reacted at 95 ℃ for 5 min, and then purified. The radiochemical purity was determined using radioactive thin-layer chromatography. The in vitro stability, lipophilicity and human serum protein binding rate of  ⁶⁸ Ga-P214 were evaluated, followed by cell uptake experiments.  ⁶⁸ Ga-P214 was injected into 22Rv1 tumor-bearing mice, and micro-positron emission tomography (PET)/computed tomography (CT) imaging was performed at specific time points, with comparative imaging using  ⁶⁸ Ga-P137. Mice were sacrificed at 30, 60 and 120 min post-injection via tail vein, and organs of interest were weighed, counted, and the percentage of injected dose per gram of tissue (%ID/g) was calculated. Results: The target ligand P214 was successfully synthesized with a K i value of 0.085 nmol/L, and the radiochemical purity exceeded 95%. The labeled product  ⁶⁸ Ga-P214 remained stable in saline and 37 ℃ mouse serum for 2 h. The lipophilicity (partition coefficient) of  ⁶⁸ Ga-P214 was -3.17±0.09, and the human serum albumin binding rate was (88.86±0.51)%, significantly higher than that of  ⁶⁸ Ga-P137 (74.01±1.17)%. Cell experiments demonstrated that  ⁶⁸ Ga-P214 was effectively taken up by PSMA+cells (22Rv1), with uptake rates of (0.39±0.14), (0.55±0.09), and (0.54±0.12) %ID/10 5 cells at 30, 60, and 120 min of incubation, respectively, which could be inhibited by the PSMA inhibitor ZJ43. At 60 min post-injection,  ⁶⁸ Ga-P214 had a higher maximum standard uptake value (SUV _max ) in the tumor region (1.40±0.11 vs 0.80±0.04), which increased over time. Biodistribution in tumor-bearing mice showed that ⁶⁸ Ga-P214 had significantly higher uptake in tumors compared to  ⁶⁸ Ga-P137 ［(44.15±6.25)%ID/g vs (19.76±3.56)%ID/g at 120 min post-injection］, with superior tumor/muscle, tumor/blood, and tumor/liver ratios (127.63, 33.87, and 12.68, respectively). Conclusion:  ⁶⁸ Ga-P214 exhibits ideal biodistribution, appropriately extends the in vivo circulation time of ginsenoside-like probes, and significantly increases uptake in PSMA-positive tumors, making it a promising candidate for prostate cancer diagnosis with considerable potential to be developed into a therapeutic probe.