This review summarized the progress of clinical research on liver disease ultrasound in China in 2024, covering multiple fields, including precise diagnosis of focal liver lesions, prediction of biological characteristics of hepatocellular carcinoma (HCC), evaluation of therapeutic efficacy and prognosis, quantitative diagnosis of metabolic-associated fatty liver disease (MAFLD), and interventional ultrasound treatment. In the field of liver tumor diagnosis, the application scope of the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) has been further expanded, with significant improvement in diagnostic performance. The integration of artificial intelligence and multimodal data has played an important role in predicting the biological characteristics of HCC, enhancing the stability and generalizability of predictions. Ultrasound technology combined with multimodal models has shown significant advantages in evaluating the efficacy and prognosis of liver tumors. Additionally, ultrasound fat quantification techniques have achieved important breakthroughs in the diagnosis of MAFLD, transitioning from single-center to multi-center validation. In interventional ultrasound research, the application of irreversible electroporation and artificial intelligence-assisted navigation systems has significantly improved the precision and safety of interventional treatments. Overall, the research on liver ultrasound in China in 2024 has actively explored the application of artificial intelligence and multimodal data integration, significantly improving the accuracy and efficiency of liver disease diagnosis and treatment evaluation. Significant progress has been made in the directions of multi-center validation and precision medicine, providing new ideas and strategies for clinical practice.

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 explore the potential value of multiparametric magnetic resonance imaging (mpMRI) radiomics combined with machine learning models in predicting sentinel lymph node (SLN) metastasis in breast cancer. Methods: A retrospective analysis of imaging and clinical data from pathologically confirmed breast cancer patients was conducted, and the patients were divided into training and validation groups in a 7∶3 ratio. Radiomics features were extracted from T2-weighted imaging (T2WI), apparent diffusion coefficient (ADC), and the second phase of dynamic contrast-enhanced MRI (DCE-MRI), including the whole tumor (ROI_Whole) and subregions (ROI_Sub). Multiple machine learning models were constructed by integrating clinical, pathological, and imaging features, and their predictive performance was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis, and calibration curves. Results: This study analyzed 193 breast cancer patients, including 80 SLN-positive and 113 SLN-negative cases. Univariate and multivariate logistic regression analyses were performed on clinical, imaging, and pathological data to identify independent risk factors associated with SLN metastasis. Finally, it is analyzed that，peritumoral edema and lymphovascular invasion (LVI) showed significant differences between SLN-positive and SLN-negative groups (P<0.01), with LVI identified as an independent predictive factor (P<0.05). The MLP model, incorporating radiomics features from T2WI, ADC, ROI-Whole, ROI-Sub, and LVI, demonstrated the best performance, with an AUC of 0.947 in the training set and 0.932 in the validation set. Conclusion: The radiomics model based on breast mpMRI effectively predicts SLN metastasis in breast cancer preoperatively.

Objective: To investigate the value of quantitative parameters of dual-energy computed tomography (DECT) in the differential diagnosis of parotid gland tumors. Methods: The imaging data of patients with parotid gland tumors who attended the Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from March 2023 to July 2024 were reviewed and analyzed. Virtual non-contrast CT value (VNC), iodine concentration (IC), normalized iodine concentration (NIC), effective atomic number (Z_eff), electron density (Rho), virtual monochromatic CT values of 40-100 keV (interval of 20 keV) and slope of spectral curve (K) of enhanced phase were measured. The differences of quantitative parameters between benign parotid gland tumors and malignant parotid gland tumors, as well as between different pathological types of parotid gland tumors were compared. Univariate and multivariate logistic regression analysis was performed to screen for independent predictors among groups, and receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of quantitative parameters. Results: The DECT images of 72 parotid gland tumors in 71 cases were retrospectively analyzed. There were 58 cases of benign parotid gland tumors, including 33 pleomorphic adenomas in 33 cases, 26 Warthin tumors in 25 cases, and 13 malignant parotid gland tumors. There were no significant differences in any parameters between benign and malignant tumor groups (all P>0.05). Compared with Warthin tumors, pleomorphic adenomas had significantly lower K (0.87±0.50), VNC (27.28 HU±8.03 HU), IC (1.00 mg/mL±0.08 mg/mL), NIC (11.32%±5.64%), Z_eff (7.91±0.31), Rho (33.27±5.99), and virtual monochromatic CT values of 40-100 keV (91.39 HU±36.05 HU, 57.81 HU±17.48 HU, 44.96 HU±10.95 HU, and 39.31 HU±8.50 HU, respectively) (all P<0.05). Among these, Rho was an independent predictor for differentiating between the two, with an AUC of 0.978. VNC (37.17 HU±9.86 HU), Rho (42.89±6.64), and monochromatic CT values of 100 keV (50.34 HU±7.33 HU) in the malignant tumor group were significantly higher than those in the pleomorphic adenoma group (P<0.05). Rho was an independent predictor for differentiating between the two, with an AUC of 0.858. Compared with Warthin tumors, malignant tumors had significantly lower K (1.00±0.58), IC (1.05 mg/mL±0.18 mg/mL), NIC (13.00%±9.98%), Z_eff (7.89±0.34), and monochromatic CT values of 40-100 keV (110.46 HU±39.64 HU, 71.71 HU±17.85 HU, 56.87 HU±10.14 HU, 50.34 HU±7.33 HU, respectively) (all P<0.05). And the monochromatic CT value of 100 keV was an independent predictor for differentiating between the two, with an AUC of 0.852. Conclusion: DECT can provide reliable quantitative indicators for the differentiation of parotid gland tumors, possessing significant clinical application value.

Objective: To evaluate the diagnostic efficacy of the LR-M criteria in the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) classification system for distinguishing intrahepatic cholangiocarcinoma (ICC) from poorly differentiated hepatocellular carcinoma (HCC). Methods: A retrospective analysis was conducted on pathologically confirmed ICC patients and poorly differentiated HCC patients who underwent CEUS prior to treatment between January 2019 and December 2023. The conventional ultrasound features, CEUS characteristics, and CEUS LI-RADS classifications of the two groups were compared. Lesions were stratified into three subgroups based on maximum diameter: ≤5 cm, 5-10 cm, and >10 cm, and the diagnostic performance of the LR-M category in CEUS LI-RADS was analyzed within these subgroups. CEUS LI-RADS categories were assigned according to CEUS LI-RADS version 2017. Receiver operating characteristic curves were used to assess the diagnostic performance of LR-M. Results: A total of 50 patients with ICC and 50 patients with poorly differentiated HCC were included. Lesions were located in the left liver in 24 (48.0%) ICC patients and 10 (20.0%) poorly differentiated HCC patients (P=0.003). Biliary dilatation or biliary stones were observed in 23 (46.0%) ICC patients and 1 (2.0%) poorly differentiated HCC patient (P<0.001). In the arterial phase, 31 (62.0%) ICC patients and 1 (2.0%) poorly differentiated HCC patient exhibited typical peripheral, irregular rim-like enhancement (P<0.001). Significant washout was observed in 34 (68.0%) ICC patients and 3 (6.0%) poorly differentiated HCC patients in the portal or delayed phase (P<0.001). The mean washout time was 34.45 s for ICC and 74.08 s for poorly differentiated HCC (P<0.001). The overall area under curve (AUC), sensitivity, and specificity of LR-M were 0.730, 94.00%, and 52.00%, respectively. In the ≤5 cm, 5-10 cm, and >10 cm subgroups, the AUC values were 0.746, 0.667, and 0.833, respectively. Conclusion: The LR-M classification demonstrates high sensitivity in identifying ICC, but its specificity requires improvement. The accuracy of LR-M classification significantly increases when the lesion size exceeds 10 cm. The specificity of LR-M for distinguishing ICC from poorly differentiated HCC is significantly improved when the lesion size is ≤5 cm or >10 cm.

Objective: To develop a small-molecule-based theragnostic pair of vascular endothelial growth factor receptor (VEGFR)-targeted radionuclides, explore its diagnostic and therapeutic value in triple-negative breast cancer (TNBC), and provide a new therapeutic strategy for “immunogenically cold” TNBC. Methods: Based on the high-affinity VEGFR-targeting agent diZD, the diagnostic radionuclide ⁶⁴Cu and therapeutic radionuclide ¹⁷⁷Lu were conjugated via the DOTA chelator to prepare ⁶⁴Cu-DOTA-diZD [positron emission tomography (PET) imaging agent] and ¹⁷⁷Lu-DOTA-diZD (targeted radionuclide therapy agent). Cell-free binding assay and cell binding assay were used to verify the VEGFR binding affinity and specificity of the two agents. In the 4T1 TNBC tumor-bearing mouse model, small-animal PET/computed tomography (CT) was used to observe the tumor targeting and biodistribution of ⁶⁴Cu-DOTA-diZD. Tumor-bearing mice were divided into control group (saline), “cold” DOTA-diZD group, anti-programmed death-1 (PD-1) antibody group, and ¹⁷⁷Lu-DOTA-diZD group. The tumor volume change and median survival time of each group were compared, and the therapeutic mechanism was analyzed by immunohistochemistry and flow cytometry. Results: The Kd value of ⁶⁴Cu-DOTA-diZD and ¹⁷⁷Lu-DOTA-diZD for VEGFR2 was 0.45 nmol/L and (0.54±0.05) nmol/L, respectively. Specific blocking experiments confirmed that both could specifically bind to VEGFR. PET/CT showed that ⁶⁴Cu-DOTA-diZD gradually accumulated in 4T1 tumors over time, reaching a peak tumor uptake (2.25±0.09) at 48 h after injection, and could identify lung metastases. In the treatment experiment, the median survival time of mice in the ¹⁷⁷Lu-DOTA-diZD group (28 d) was significantly longer than that in the control group (18 d), “cold” DOTA-diZD group (20 d), and anti-PD-1 antibody group (16 d). Immunohistochemistry showed that the expression of the tumor proliferation marker Ki-67 in this group was significantly reduced, and flow cytometry confirmed that it could double the number of CD4⁺ and CD8⁺ T cells in the tumor. Conclusion: The ⁶⁴Cu/¹⁷⁷Lu-DOTA-diZD theranostic pair has good VEGFR targeting. It can not only achieve accurate diagnosis of TNBC and identification of metastases through ⁶⁴Cu-DOTA-diZD, but also effectively inhibit tumor growth and prolong survival through ¹⁷⁷Lu-DOTA-diZD, which is a potential strategy for the treatment of TNBC.

T1 mapping technology is a quantitative magnetic resonance imaging technique. With the development of this technology, methods for achieving T1 mapping have continually evolved, from traditional T1 mapping techniques to synthetic magnetic resonance imaging that can obtain multiple parameters in once scan. Each method has its own advantages and disadvantages. At present, this technology is widely used in the research of tumor lesions in various regions, including head and neck, chest, breast, liver, cervix, and rectum. This article primarily provided a review of the application of T1 mapping technology in the diagnosis, differential diagnosis, and prognosis evaluation of tumor lesions across different organ systems.

Objective: To explore the clinical application value of the contrast-enhanced ultrasound (CEUS) scoring method in reclassifying Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions. Methods: The data of patients with breast nodules diagnosed by postoperative pathology or puncture biopsy in Shanghai Yangpu District Shidong Hospital and Shanghai Fourth People’s Hospital from May 2021 to April 2024 were retrospectively analyzed. All nodules underwent routine ultrasound examination and were indicated as BI-RADS category 4. Each nodule underwent CEUS and was assigned a score. The BI-RADS classification was adjusted according to the score results, and the diagnostic efficiency before and after adjustment was compared. In addition, breast nodules were divided into 3 groups according to the maximum diameter, and the diagnostic efficacy of CEUS scoring was evaluated for nodules of different sizes. Results: A total of 105 patients with 109 nodules were included, comprising 59 benign nodules and 50 malignant nodules. BI-RADS 4b and above were considered as malignant, and the sensitivity and accuracy of diagnosis combined with CEUS scoring method (94.00% and 92.66%) were significantly higher than those of conventional ultrasound (52.00% and 75.23%, P<0.05). The area under the receiver operating characteristic (ROC) curve after adjustment was 0.95, significantly higher than that of conventional ultrasound (0.76). After integrating the CEUS scoring method, the diagnostic sensitivity significantly improved across all three groups of breast nodules stratified by size (P<0.05). The diagnostic accuracy in all three groups increased to over 90%, with the most notable improvement observed in the ≥2 cm group (65.38% vs 96.15%, P< 0.05). Conclusion: The CEUS scoring method has high diagnostic efficiency and is valuable for the readjustment of BI-RADS category 4 nodules, and has extensive clinical application value.

In the contemporary medical field, the incidence of cancer is on the rise, and cancer therapy - related cardiovascular toxicity (CTR-CVT) has become a crucial issue that cannot be overlooked, having a significant impact on the prognosis of patients. With the increasing diversification and sophistication of cancer treatment methods, including chemotherapy, radiotherapy, targeted therapy, and immunotherapy, while these offer hope for anti-tumor treatment to patients, they also carry the potential risk of cardiovascular toxicity, affecting treatment effectiveness and patients’ quality of life. Therefore, it is of particular importance to accurately and comprehensively assess CTR-CVT. This article evaluated cardiovascular toxicity from multiple dimensions such as clinical manifestations, electrocardiogram, imaging, and biomarkers, aiming to provide precise and practical assessment strategies for clinical practice. These strategies are intended to balance the efficacy of cancer treatment and cardiac safety, improve patients’ quality of life, optimize long-term outcomes, and enhance patients’ living standards.

Radionuclide imaging targeting fibroblast activation protein inhibitor (FAPI) has shown notable advantages in the early diagnosis and staging of various tumors. The continuous development of novel FAPI-based radiotracers has significantly enhanced imaging performance and propelled the advancement of FAPI-targeted radionuclide therapy (TRT). Preliminary clinical trials have confirmed the efficacy of various FAPI-TRT agents, demonstrating not only effective disease control but also synergistic benefits when combined with immunotherapy and chemotherapy. These advantages have contributed to the establishment of a closed-loop “diagnosis-treatment-reassessment” theranostic pathway. However, several challenges remain, including non-specific uptake in inflammatory and fibrotic lesions, rapid systemic clearance, and unintended radiation exposure to normal tissues. This review systematically summarized the latest applications and research progress of FAPI in pan-cancer theranostics, provided an in-depth discussion of existing challenges, and seeks to facilitate the full potential of FAPI, thereby expediting the establishment of a new paradigm for integrated radionuclide-based theranostics.

Objective: To investigate the efficiency of preoperative contrast-enhanced ultrasound (CEUS) combined with clinical and pathological features in predicting early recurrence (ER) after surgical resection of hepatocellular carcinoma (HCC). Methods: Patients who underwent initial surgical resection of HCC in the First Affiliated Hospital with Nanjing Medical University from October 2019 to November 2021 were retrospectively analyzed. All patients received preoperative routine ultrasound and CEUS, and were pathologically diagnosed with HCC after surgery. They were divided into ER group and non-ER group according to whether the recurrence occurred within two years after operation. Univariate analysis was used to compare the differences in clinical data, conventional ultrasound characteristics, CEUS parameters, and pathologic features among the different subgroups. Independent risk factors were selected by multivariate logistic regression. Subsequently, the dataset was randomly divided into training and validation sets in a 7∶3 ratio to develop a combined CEUS-clinic-pathology risk prediction model. The predictive efficacy of the model was quantified using the area under curve (AUC) of receiver operating characteristic (ROC) curve. Finally, the risk prediction model was transformed into a nomogram model and its application value was verified. Results: A total of 136 patients were included. The univariate analysis showed that alpha fetoprotein level, capsule, wash-out time, wash-out phase, differentiation grade, microvascular invasion (MVI), liver cirrhosis were significantly different between the two groups (all P<0.05), with the wash-out time, and MVI was the independent risk of ER in patients after surgical resection of HCC. The AUC of training set and validation set were 0.858 and 0.903, with the sensitivity of 94.1%, specificity of 57.1%, Youden index of 0.878 in validation set. The nomogram prediction model showed good calibration in internal validation. Conclusion: The combined model is useful to monitor the risk of ER in high-risk population after surgical resection of HCC, so that timely intervention can be made to improve patient prognosis.

Objective: To investigate the imaging characteristics of ¹⁸F-FDG positron emission tomography (PET)/ computed tomography (CT) in prostate cancer patients at different treatment stages and their predictive value for prognosis. Methods: Prostate cancer patients who underwent ¹⁸F-FDG PET/CT at Peking Union Medical College Hospital from January 2016 to December 2022 were retrospectively analyzed. According to their treatment status, patients were divided into the pre-treatment group, the hormone-sensitive prostate cancer (HSPC) group, and the castration-resistant prostate cancer (CRPC) group. Clinical data and PET/CT semi-quantitative parameters, including maximum standard uptake value (SUV_max), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and target-to-background ratio (TBR) were collected. Cut-off values for prognostic factors were determined using receiver operating characteristic (ROC) curve analysis. Intergroup comparisons were performed using the Mann-Whitney U test, and survival analysis was conducted using the Kaplan-Meier method with log-rank testing. All statistical analyses were performed using SPSS Statistics (version 22.0) and R, with a P value <0.05 considered statistically significant. Results: A total of 117 patients with prostate cancer were included, among which 78 cases were in the initial treatment group, 18 cases in the HSPC group, and 21 cases in the CRPC group. ¹⁸F-FDG PET/CT revealed significant metabolic heterogeneity among prostate cancer patients across different treatment stages and demonstrated substantial prognostic value. The vast majority (92.3%) of pre-treatment patients exhibited FDG-avid primary lesions. Following androgen deprivation therapy (ADT), the positivity rate significantly decreased to 5.6% in the HSPC group, although 23.8% of CRPC patients still showed primary lesion uptake. The SUV_max of primary lesions was significantly higher in patients with metastases than in those without (P<0.05). Within the treated cohorts, the FDG-positivity rate was significantly higher in the CRPC group than in the HSPC group (95.2% vs 11.1%, P<0.001). Patients receiving ADT combined with other therapies (radical surgery, chemotherapy, radiotherapy et al.) had a significantly higher FDG-positivity rate than those receiving ADT alone (85.7% vs 40%, P=0.006). At the lesion level, no significant differences in SUV_max or TBR were observed between the pre-treatment and CRPC groups, though both were significantly higher than those in the HSPC group (P<0.05). MTV and TLG were significantly higher in the pre-treatment group than in the CRPC group (P<0.01). Survival analysis indicated the poorest prognosis in the CRPC group, with a median overall survival (OS) of only 35 months, whereas the median OS was not reached in the pre-treatment and HSPC groups within 100 months of follow-up. The survival rate was significantly lower in the CRPC group, with 3-year survival rates of 86%, 100%, and 40%, and 5-year survival rates of 70%, 85.7%, and 0 for the pre-treatment, HSPC, and CRPC groups, respectively. Multivariate analysis identified prostate-specific antigen (PSA) ≤54.4 ng/mL, number of distant metastases >5, total number of lesions ≤6, MTV ≤84.8 mL, and TLG ≤134.9 g as significant independent prognostic factors in pre-treatment patients (all P<0.05). The presence of FDG-avid lesions after ADT was a significant predictor of poor prognosis, associated with markedly shortened median OS (P=0.001 9). Conclusion: ¹⁸F-FDG PET/CT parameters can be used to assess tumor burden and metabolic status in prostate cancer patients across different stages, serving as effective indicators for prognostic prediction.

Objective: To explore the clinical and imaging features of diffuse high-grade gliomas in the brainstem of children based on multi parameter sequences, so as to improve the comprehensive understanding of the disease. Methods: The clinical and imaging data of pediatric brain stem diffuse high-grade gliomas confirmed by pathology from January 2022 to January 2024 were retrospectively analyzed. Results: A total of 45 children in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine with diffuse high-grade gliomas in the brainstem (19 males and 26 females, aged 6.48±2.34 years) were included in this study. Among them, 4.4% (2/45) had cerebrospinal fluid dissemination, while the rest had localized or nearby infiltration and growth in the brainstem. 45 cases underwent computed tomography (CT) plain scan+ magnetic resonance imaging (MRI) plain scan/enhanced scan+diffusion-weighted imaging (DWI) basic scan, 6 cases underwent CT perfusion imaging (CTP) scan simultaneously, 8 cases underwent magnetic resonance spectroscopy (MRS) scan simultaneously, 7 cases underwent diffusion tensor imaging (DTI) scan simultaneously, and 2 cases underwent susceptibility weighted imaging (SWI) scan simultaneously. All 45 cases had endogenous swelling growth, including 36 cases with uniform swelling growth on both sides and 9 cases with lateral swelling growth (7 cases crossed the midline during the growth process, and 2 cases with diffuse growth on one side of the head and tail); 28.9% (13/45) limited brainstem growth, 2.2% (1/45) limited medullary growth, 68.9% (31/45) grew towards the head and tail (midbrain/thalamus/medulla oblongata, 21/31, 67.7%) and laterally (pons/cerebellum, 10/31, 32.3%), and 26.7% (12/45) progressed to exogeneity (including 11 cases involving the basilar artery, 11/12, 91.7%). The CT plain scan sequence showed low-density thickening shadows in the brainstem area, with a density lower than that of the normal brainstem (P<0.001). CT perfusion sequence scan showed a decrease in cerebral blood flow (CBF) in the tumor area of 83.3% (5/6) of patients (1 case showed a significantly lower than average level in the tumor center area), and 1 case showed an increase. Bilateral cerebral hemisphere perfusion abnormalities, with delayed peak time, mainly around the lateral ventricles. The MRI structural sequence showed that 8.9% (4/45) of the tumor solid components on T1-weighted imaging (T1WI) showed equal signal intensity, 11.1% (5/45) showed low signal intensity, and 80.0% showed mixed signal intensity (36/45). The T2-fluid suppressed inversion recovery (FLAIR) sequence showed slightly high to high signal intensity, and the pattern after T1WI enhancement showed diverse changes. Six cases did not show enhancement, while the rest showed varying degrees of mild to moderate enhancement. 28.2% (11/39) showed local circular enhancement, 38.5% (15/39) showed local nodular enhancement, 10.3% (4/39) showed patchy enhancement, and 23.1% (9/39) showed patchy enhancement. Manifested as gravel like enhancement, 7.7% (3/39) showed mixed mode enhancement, and some patients with unclear T1WI enhancement had better T2-FLAIR enhancement sequence contrast. In the MRI functional sequence, MRS showed varying degrees of increase in Cho peak and decrease in NAA peak, with one case showing a significant inversion of Lac peak; DTI scan showed that the nerve fiber bundles in the lesion area were pushed to the periphery by the tumor, with 5 cases showing partial interruption of the fiber bundles and 1 case only showing compression and pushing of the fiber bundles. Local low signal can be seen on the SWI phase map, indicating intratumoral microbleeds. Conclusion: The conventional CT findings of diffuse high-grade gliomas in the brain stem of children are low-density brain stem thickening, and quantification is helpful for early detection and prevention of missed diagnosis. The growth mainly occurred in the diffuse endogenetic pontine, and most of them infiltrated and grew to other brain regions along the direction of nerve fiber bundles, pushing or destroying the nearby fiber bundles. The enhancement patterns were various, and most of them were scattered mild to moderate enhancement. There may be cystic image signals inside, which may be related to the reduction of necrosis by local perfusion and absorption after microbleeds;

Objective: To investigate the predictive value of combining preoperative ultrasonographic imaging characteristics with BRAF V600E mutation testing for central lymph node metastasis (CLNM) risk in clinically node-negative (cN0) papillary thyroid microcarcinoma (PTMC) patients, aiming to guide individualized surgical decision-making. Methods: Clinical data from cN0 PTMC patients preoperatively diagnosed and undergoing thyroidectomy with central lymph node dissection at Shanxi Cancer Hospital from March 2022 to February 2024 were retrospectively analyzed. Preoperative color Doppler ultrasound was performed to evaluate tumor characteristics. Thyroid function indicators were detected, and BRAF V600E mutation status was detected via fine-needle aspiration biopsy specimens. Based on postoperative pathology, patients were categorized into non-metastatic and metastatic groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of CLNM, followed by the construction of a combined prediction model. Receiver operating characteristic (ROC) curves were used to evaluate predictive performance, and DeLong’s test was applied to compare diagnostic efficacy between the combined model and individual predictors. Results: Univariate analysis revealed significant differences between the two groups in age, multifocality, tumor size >6 mm, capsular invasion, and BRAF V600E mutation status (P<0.05). Multivariate logistic regression identified age ≤45 years, multifocality, tumor size >6 mm, capsular invasion, and BRAF V600E mutation as independent predictors of CLNM. The combined prediction model achieved an area under the ROC curve (AUC) of 0.925 (95% CI 0.878-0.972), significantly higher than ultrasound features alone (AUC=0.681, 95% CI 0.588-0.774) or BRAF V600E mutation testing alone (AUC=0.618, 95% CI: 0.520-0.716) (P<0.05). Conclusion: The combination of preoperative ultrasonographic features and BRAF V600E mutation testing significantly improves the predictive accuracy for CLNM risk in cN0 PTMC patients. This integrated approach facilitates the identification of high-risk candidates for prophylactic central lymph node dissection, thereby optimizing surgical strategies and minimizing overtreatment risks.

Intrahepatic cholangiocarcinoma (ICC) is a highly aggressive liver malignancy with a poor prognosis, and early diagnosis is critical for improving patient survival. Conventional ultrasound has limited diagnostic value for ICC, and clinical diagnosis primarily relies on contrast-enhanced computed tomography (CECT) or contrast-enhanced magnetic resonance imaging (CEMRI). Contrast-enhanced ultrasound (CEUS), as a real-time, non-invasive, and convenient imaging technique, has demonstrated significant value in the diagnosis of focal liver lesion (FLL). This article systematically reviewed the current applications of CEUS in the diagnosis of ICC, with a particular focus on the controversies and latest advances in its development. Due to the overlapping imaging features of ICC and hepatocellular carcinoma (HCC) on CEUS, the diagnostic capability of CEUS was once questioned and even removed from the diagnostic tools for HCC in the guidelines of the American Association for the Study of Liver Diseases (AASLD). Subsequently, the academic community has engaged in extensive discussions on the value of CEUS in the differential diagnosis of ICC and HCC. Recent studies have shown that by optimizing the Liver Imaging Reporting and Data System (LI-RADS) criteria, incorporating dynamic quantitative analysis, and leveraging radiomics and artificial intelligence technologies, the accuracy and specificity of CEUS in diagnosing ICC have significantly improved. With the development of more high-quality studies, CEUS is expected to play an increasingly important role in the early diagnosis, classification, and treatment monitoring of ICC.

Objective: ¹⁷⁷Lu-DOTA-ibandronate (IBA), a bone-targeting radiopharmaceutical, has demonstrated favorable therapeutic responses in bone metastases from various tumors. This study aimed to evaluate the efficacy and safety of ¹⁷⁷Lu-DOTA-IBA in the treatment of bone metastases from lung cancer. Methods: This prospective study included 45 patients with lung cancer and bone metastasis who were treated at the Affiliated Hospital of Southwest Medical University from November 2021 to May 2025 [24 males and 21 females, with an age of (55.0±10.5) years]. All patients underwent ⁶⁸Ga-DOTA-IBA PET/CT imaging before treatment, and those meeting the inclusion and exclusion criteria received ¹⁷⁷Lu-DOTA-IBA therapy. Functional status and pain intensity were assessed at baseline and at 3 days, 1 week, 2 weeks, 4 weeks, and 8 weeks post-treatment using the Eastern Cooperative Oncology Group (ECOG) performance status and the numerical rating scale (NRS) for pain. Hematologic and biochemical parameters (including complete blood count, liver function, and renal function) were evaluated at baseline and repeatedly within 8 weeks after treatment according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. At 8 weeks post-treatment, ⁶⁸Ga-DOTA-IBA PET/CT was repeated to assess therapeutic response. Data were analyzed using SPSS version 26.0, and differences before and after treatment were compared with the Wilcoxon signed-rank test. Results: Sixteen patients received one cycle of treatment, nine received two cycles, five received three cycles, five received four cycles, six received five cycles, one received six cycles, and three received seven cycles. The median administered activity of ¹⁷⁷Lu-DOTA-IBA per cycle was 1 110 MBq (range: 370-1 850 MBq). Compared with baseline, pain scores and ECOG performance status at 8 weeks after the final treatment showed an overall pain relief rate of 82.2% and an improvement rate in performance status of 64.4%. ⁶⁸Ga-DOTA-IBA PET/CT revealed a partial metabolic response in 37.8% of patients. The overall incidence of hematologic adverse events was 28.9%, while renal toxicity occurred in 6.7% of patients; no hepatic toxicity was observed. Conclusion: ¹⁷⁷Lu-DOTA-IBA, as a bone-targeting radiopharmaceutical reagent, demonstrated promising therapeutic efficacy and a favorable safety profile in patients with lung cancer bone metastases.

Objective: To compare and analyze the diagnostic performance of ⁶⁸Ga-TBM-001 positron emission tomography (PET)/computed tomography (CT) and ^99mTc-MDP bone scintigraphy (BS) for bone metastases of prostate cancer. Methods: Patients with prostate cancer who underwent ⁶⁸Ga-TBM-001 PET/CT and ^99mTc-MDP BS from September 2021 to October 2023 at the Affiliated Hospital of Southwest Medical University were retrospectively included[Ethics No. KY2022114]. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the two imaging were compared and analyzed. Results: A total of 43 patients with suspected bone metastases of prostate cancer were included, 27 patients were positive for bone metastasis, and 16 patients were negative for bone metastasis. A total of 389 suspicious lesions were included, 338 were bone metastases and 51 were non-bone metastases. ⁶⁸Ga-TBM-001 PET/CT accurately diagnosed 42 cases and 1 false positive,^99mTC-MDP BS accurately diagnosed 35 cases, 6 false positives, and 2 false negatives. ⁶⁸Ga-TBM-001 PET/CT accurately diagnosed 366 lesions, 5 false-positive lesions, and 18 false-negative lesions, ^99mTc-MDP BS accurately judged 324 lesions, 15 false-positive lesions, and 50 false-negative lesions. At the case level, the sensitivity, specificity, accuracy, PPV, and NPV of ⁶⁸Ga-TBM-001 PET/CT and ^99mTc-MDP bone scintigraphy were 100.00% vs 92.59%, 93.75% vs 62.50%, 97.67% vs 81.40%, 96.43% vs 80.65%, 100.00% vs 83.33%, and the AUC values of the two methods were 0.969 (95% CI 0.865-0.998) vs 0.775 (95% CI 0.623-0.888), except for sensitivity and NPV, the differences among all other indicators were statistically significant. At the lesion level, the sensitivity, specificity, accuracy, PPV, and NPV of ⁶⁸Ga-TBM-001 PET/CT versus ^99mTc-MDP bone scintigraphy were 94.67% vs 85.21%, 90.20% vs 70.59%, 94.09% vs 87.15%, 98.46% vs 95.05%, 71.88% vs 41.86%, and the AUC values were 0.924 (95% CI 0.893-0.949) vs 0.779 (95% CI 0.734-0.819), with differences that were statistically significant. Conclusion: ⁶⁸Ga-TBM-001 PET/CT demonstrates superior sensitivity, specificity, accuracy, PPV, NPV, and AUC values compared to ^99mTc-MDP BS in the diagnosis of bone metastases in prostate cancer, suggesting that ⁶⁸Ga-TBM-001 PET/CT may have higher clinical application value.

Objective: To compare the value of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computer tomography (CT) and ⁶⁸GA-fibroblast activation protein inhibitor (FAPI) PET/CT in the diagnosis of different types of lymphoma. Methods: The clinical, pathological and imaging data of patients with lymphoma who received ¹⁸F-FDG and ⁶⁸Ga-FAPI PET/CT in Fudan University Shanghai Cancer Center within one week from November 2020 to October 2022 were retrospectively analyzed, and the detection rates of the two imaging agents for lesions were compared. At the same time, the differences of maximum standard uptake value (SUV_max), target-to-background ratio (TBR) and target-to-liver ratio (TLR) between the two groups were compared. Results: A total of 197 lymphomas (167 lymph node lesions and 30 extranodal lesions) were detected in 28 patients with pathologically confirmed lymphoma, and 191 lesions (161 lymph node lesions and 30 extranodal lesions) were detected by ¹⁸F-FDG PET/CT. ⁶⁸Ga-FAPI PET/CT detected 98 lesions (including 74 lymph node lesions and 24 extranodal lesions), and the detection rate of ¹⁸F-FDG PET/CT was significantly higher than that of ⁶⁸Ga-FAPI PET/CT. But for gastrointestinal infiltrating lesions, ¹⁸F-FDG PET/CT has a higher false positive rate. In lymphoma patients, SUV_max-FDG > SUV_max-FAPI, TBR-FDG > TBR-FAPI, the difference was statistically significant (14.4 vs 6.5, 13.3 vs 3.4, P<0.05). However, the SUV_max and TBR of Hodgkin’s lymphoma (HL) were 12.3 vs 6.5, 11.6 vs 5.1 (P>0.05) and indolent lymphoma 10.2 vs 10.9, 21.4 vs 5.1 (P>0.05), the difference was not statistically significant. There was no significant difference in TLR between the two examinations in all lymphoma patients (5.2 vs 5.2, P>0.05). Conclusion: The diagnostic value of ¹⁸F-FDG PET/CT for lymphoma is better than ⁶⁸Ga-FAPI PET/CT. But for HL and inert lymphoma, there was no significant difference in metabolic parameters between the two groups, and ⁶⁸Ga-FAPI PET/CT has higher diagnostic accuracy for gastrointestinal infiltration.

Objective: To compare the diagnostic value of qualitative and quantitative parameters of sound touch elastography (STE) and strain elastography (SE) in differentiating benign and malignant Breast Imaging Reporting and Data System (BI-RADS) 4 breast lesions, and to explore the correlation between the parameters and the expression of human epidermal growth factor receptor 2 (HER2) in BI-RADS 4 breast malignant lesions. Methods: The clinicopathological data of patients with BI-RADS 4 breast lesions diagnosed by ultrasound examination in The First Hospital of Shanxi Medical University were selected. The quantitative and qualitative parameters of STE and SE were obtained: STE maximum elasticity (E_max), STE qualitative score, SE strain ratio (SR) and SE qualitative score. To compare the value of two ultrasonic elastography parameters in differentiating benign and malignant BI-RADS 4 breast lesions and their correlation with HER2 expression in BI-RADS 4 breast malignant lesions. Results: A total of 106 patients with 106 lesions were included. The difference of E_max, STE score, SR and SE score between benign and malignant lesions of BI-RADS 4 breast was statistically significant (P<0.05). Compared with the pathological results, the difference of E_max, STE score, SR and SE score in the diagnosis of benign and malignant BI-RADS 4 breast lesions according to the cut-off value was statistically significant (P<0.05). The diagnostic efficacy of E_max, STE score and SR was generally consistent with that of the gold standard (Kappa=0.436, 0.420, 0.502), and the diagnostic efficacy of SE score was more consistent with that of the gold standard (Kappa=0.626). The area under the receiver operating characteristic (ROC) curve (AUC) of SE score (AUC=0.883) was higher than that of E_max (AUC=0.743), STE score (AUC=0.756) and SR (AUC=0.783) diagnosis, with the greatest diagnostic efficiency, and the difference was statistically significant (P<0.05). In BI-RADS 4 breast malignant lesions, the difference of E_max and SE scores between HER2 positive expression and negative expression was statistically significant (P<0.05). E_max and SE scores were positively correlated with HER2 positive expression (r=0.458, 0.356). The best cut-off value of E_max and SE score in the diagnosis of HER2 positive expression was 123.75 kPa and 4 points, the sensitivity was 81.2% and 62.5%, the specificity was 60.5% and 68.4%, and the AUC was 0.766 and 0.689. Conclusion: The diagnostic efficacy of SE score was higher when STE and SE techniques were used to identify BI-RADS 4 breast lesions. E_max and SE scores were positively correlated with HER2 positive expression. E_max and SE score are of great value in identifying HER2 positive expression in BI-RADS 4 breast malignant lesions.

Objective: To explore the diagnostic value of ultra-microangiography (UMA) for the classification of breast tumors categorized as Breast Imaging Reporting and Data System (BI-RADS) category 4. Methods: Data of female patients with breast tumors who underwent conventional two-dimensional ultrasound and UMA examinations at the First Hospital of Shanxi Medical University from January 2023 to February 2024 were retrospectively reviewed and collected. The differences in UMA blood flow pixel ratios and blood flow characteristics between benign and malignant breast tumors were analyzed. Indicators with statistical significance and high positive predictive values were assigned scores. Based on these scores, receiver operating characteristic (ROC) curves were generated, and the optimal cutoff values were selected to adjust the BI-RADS grading for benign and malignant breast tumors. ROC curves before and after adjustment were plotted to investigate the differential diagnostic value of UMA for BI-RADS category 4 breast nodules. Results: A total of 101 breast patients were included. There were no statistically significant differences in the blood flow pixel ratios of cUMA, pUMA, and sUMA between benign and malignant tumors (Z-values were -0.194, -1.202, and -1.117, respectively; P-values were 0.846, 0.229, and 0.264, respectively). Among the UMA blood flow characteristics, the presence or absence of penetrating blood flow (χ²=8.394, P=0.004), whether the marginal blood flow course was distorted (χ²=7.317, P=0.007), the marginal blood flow distribution (χ²=55.733, P<0.001), whether the central blood flow course was distorted (χ²=4.178, P=0.041), and the presence or absence of central blood flow defects (χ²=6.051, P=0.014) showed statistically significant differences between benign and malignant breast tumors. One point was assigned when the tumor had penetrating blood flow, distorted marginal blood flow course, marginal blood flow distribution characterized by peripheral penetrating blood flow or radial blood flow, distorted central blood flow course, or central blood flow defects. The area under the curve (AUC) was 0.871, with a 95% CI of 0.799 to 0.943. After scoring, the AUC for BI-RADS category 4 breast tumors increased from 0.741 to 0.825. Conclusion: UMA can improve the diagnostic accuracy of benign and malignant BI-RADS 4 breast tumors and serve as an effective blood flow imaging modality for the diagnosis of breast cancer.

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.

Intrahepatic cholangiocarcinoma (ICC), the second most common primary malignant liver tumor accounting for 10%~20% of cases, presents significant diagnostic challenges and poor prognosis. The insidious clinical presentation and imaging heterogeneity of ICC often lead to late-stage diagnosis, resulting in missed opportunities for curative surgery. While conventional imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI) excel in lesion detection and metastasis evaluation, they also demonstrate some limitations. Contrast-enhanced ultrasound (CEUS) has become an effective imaging method for the diagnosis of ICC due to its characteristics of real-time dynamic observation, radiation-free nature, high spatiotemporal resolution, and repeatability. Typical CEUS features of ICC include rim arterial phase hyperenhancement (APHE) or non-rim APHE followed by early washout (within 60 s) in the portal phase and marked washout (“black hole sign”) in the delayed phase. In contrast, hepatocellular carcinoma (HCC) typically demonstrates non-rim APHE with iso-enhancement in the portal phase and mild delayed phase washout, where differences in washout timing and degree serve as key discriminators. The CEUS Liver Imaging Reporting and Data System (LI-RADS) version 2017 categorizes lesions with rim APHE, early washout, or marked washout as LR-M (indicative of non-HCC malignancies), effectively reducing ICC misdiagnosis as HCC. The novel Kupffer cell-specific contrast agent perfluorobutane extends imaging duration significantly. Its Kupffer-phase defect demonstrates 100% sensitivity for ICC, offering new perspectives for lesion detection in cirrhotic livers. CEUS and CT/MRI exhibit complementary diagnostic value for ICC, with multimodal integration improving diagnostic accuracy and providing reliable solutions for complex cases. Current challenges for CEUS LI-RADS include refining LR-M classification to better distinguish HCC from ICC, particularly through adjustments in diagnostic thresholds for different hepatic backgrounds (cirrhotic vs non-cirrhotic) and tumor sizes. The clinical potential of Kupffer phase in perfluorobutane CEUS requires larger validation studies, along with investigations into the correlation between washout timing and hepatic background characteristics.

Objective: To identify risk factors for central lymph node metastasis (CLNM) in papillary carcinoma of the thyroid (PTC) and establish a prediction model to guide surgical decision-making for PTC patients. Methods: A retrospective analysis was conducted on the clinical features, ultrasonic characteristics, and genetic information of 1 125 PTC patients who underwent thyroidectomy in Nanjing Drum Tower Hospital. The independent risk factors of CLNM were screened by univariate and multivariate logistic regression analysis, and a nomogram model was established based on these factors. The calibration accuracy, accuracy, and clinical utility of the prediction model were evaluated using corrected curves, receiver operating characteristic (ROC) curves, and decision curves. Subsequently, the data of 483 PTC patients who underwent thyroidectomy in Nanjing University Affiliated Jinling Hospital were collected for external validation of the model. Results: Among the 1 125 PTC patients, univariate regression analysis showed significant differences between CLNM positive and negative groups in terms of gender, age, thyroglobulin levels and ultrasonic characteristics of the lesion (maximum diameter, aspect ratio, edge, and microcalcification) (P<0.05). Multivariate logistic regression confirmed gender, age, and ultrasonic characteristics of the lesions (maximum diameter, edge, and microcalcification) as independent risk factors of CLNM. Based on these independent risk factors,a nomogram was Constructed. The area under the ROC curve (AUC) of the model was 0.768 (95% CI 0.741-0.796) in the training set and 0.822 (95% CI 0.784-0.859) in the validation set. Conclusion: The established model has good prediction and generalization abilities and is expected to assist clinicians in making individualized surgical plans for PTC patients.

Objective: To assess the injuries of left ventricular function in breast cancer patients following anthracycline-based chemotherapy using ultrasonic vector flow mapping (VFM) combined with layer-specific two-dimensional speckle tracking imaging (LS2D-STI). Methods: A retrospective analysis was conducted on breast cancer patients who underwent chemotherapy with the TEC regimen (docetaxel 75 mg/m², epirubicin 90 mg/m², and cyclophosphamide 500 mg/m²) for the injuries of left ventricular function in Sichuan Provincial People’s Hospital from January to June 2017. A self-controlled study design was employed, with transthoracic echocardiography (TTE) performed before chemotherapy and at 48 h after each chemotherapy cycle, for a total of seven assessments (denoted as T0, T1, T2, T3, T4, T5, and T6) for parameters of intra-ventricular hemodynamic and transmural strain. Conventional echocardiographic parameters were collected, along with myocardial layer-specific global longitudinal strain, including endocardial global longitudinal strain (GLSendo), mid-myocardial global longitudinal strain (GLSmid), and epicardial global longitudinal strain (GLSepi). Additionally, left intra-ventricular hemodynamic parameters were measured, including global energy loss (EL), comprising early diastolic energy loss (EDC_EL), late diastolic energy loss (LDC_EL), isovolumic contraction energy loss (IVC_EL), and rapid ejection period energy loss (REP_EL). Left ventricular global circulation intensity (CIR) was also analyzed, including early diastolic circulation (EDC_CIR), late diastolic circulation (LDC_CIR), isovolumic contraction circulation (IVC_CIR), and rapid ejection period circulation (REP_CIR). The collected data were analyzed to assess changes in left ventricular function over the course of chemotherapy. Results: ① There were no significant differences in left ventricular ejection fraction (LVEF) between T1-T6 and T0 (P>0.05). The mitral inflow early diastolic peak velocity to mitral annular early diastolic peak velocity ratio (E/e’) gradually increased from T1 onward, with statistically significant differences observed (T0: 5.64 to T6: 8.76, P<0.05). ② There were no significant differences in GLSendo, GLSmid, or GLSepi at any time point compared to baseline (P>0.05). However, these parameters showed a trend of initially increasing and then decreasing, with strains at T6 being lower than baseline values. ③ EL showed an overall downward trend, while CIR exhibited an upward trend. Specifically, LDC_EL at T2-T6 was significantly lower than T0, whereas LDC_CIR at T2, T4, and T6 was higher than T0. EDC_EL and IVC_EL were significantly lower at T5 and T6, and REP_EL at T5 and T6 was significantly lower than baseline (P<0.05). Changes in LDC-phase parameters occurred earlier than those in other phases. EL and CIR changes occurred later than changes in E/e’. Conclusion: Ultrasonic VFM and LS2D-STI contribute to comprehensive assessment of cardiotoxicity in breast cancer patients undergoing anthracycline-based chemotherapy. Among these, the combination of E/e’ with EL and CIR may have more significant clinical value in evaluating changes in left ventricular diastolic function.

Objective: To evaluate the value of combining multi-region radiomics features from enhanced computed tomography (CT) with clinical risk factors for predicting preoperative lymphovascular invasion (LVI) in colon cancer. Methods: A retrospective analysis was conducted on pathologically confirmed colon cancer patients at Puning People’s Hospital from January 2018 to October 2024. Patients were randomly divided into a training set and a validation set. Radiomics features were extracted from venous-phase CT images by delineating the tumor core and peritumoral 3 mm region. Features were selected using t-tests, Spearman correlation analysis, and the least absolute shrinkage and selection operator (LASSO) regression to construct three radiomics models: tumor core, peritumoral, and combined dual-region models. Independent clinical risk factors were identified using logistic regression and integrated with the optimal radiomics model to develop a clinical-radiomics combined model. Model performance was evaluated using receiver operating characteristic (ROC) curve, with the area under curve (AUC), sensitivity, specificity, F1-score, and accuracy as metrics. Results: A total of 136 patients were included and randomly allocated to the training set (95 cases) and the validation set (41 cases) at a ratio of 7∶3. The dual-region radiomics model (Model 3) demonstrated the best performance, with a validation AUC of 0.863 (95% CI 0.720-1.000). The clinical-radiomics combined model further improved predictive performance, achieving a validation AUC of 0.873 (95% CI 0.740-1.000), with sensitivity and specificity of 0.808 and 0.800, respectively. Logistic regression identified gender (OR=2.446, 95% CI 1.056-5.665, P=0.037) and clinical stage (OR=3.838, 95% CI 1.045-14.096, P=0.043) as independent risk factors for LVI. Conclusion: The prediction model combining multi-region radiomics features from enhanced CT with clinical risk factors effectively assesses preoperative LVI status in colon cancer, providing valuable reference for individualized treatment decision-making.

Objective: To construct a Claudin 18.2 (CLDN18.2)-targeted positron emission tomography (PET) probe, ⁶⁸Ga-THP-ACN376, using a site-specific labeling technique, and to evaluate its in vitro and in vivo biological performance. Methods: The chelator THP-Mal was site-specifically conjugated to the CLDN18.2-targeting nanobody ACN376 to synthesize the precursor compound THP-ACN376, which was subsequently radiolabeled with ⁶⁸Ga. The labeling efficiency, radiochemical purity, and in vitro stability of the probe were determined by radio thin layer chromatography (Radio-TLC). Micro-PET/computed tomography (CT) imaging was performed in BALB/c nude mice to assess its in vivo pharmacokinetic properties and targeting capability. Results: ⁶⁸Ga-THP-ACN376 exhibited high labeling efficiency (>99%), high radiochemical purity (>99%), and a high specific activity of 16 GBq/μmol. It remained stable in saline, 5% human serum albumin (HSA), and phosphate buffered saline (PBS). Micro-PET/CT results demonstrated that the metabolism of the probe in mice followed the typical profile of nanobodies, with tracer uptake in the stomach gradually increasing from 0.5 to 2 h. The maximum standardized uptake value SUV_max in the stomach at 2 h was 1.35±0.07. Conclusion: This study successfully constructed a CLDN18.2-targeted PET probe, ⁶⁸Ga-THP-ACN376, using a site-specific labeling method. The probe demonstrates high labeling efficiency, remarkable stability, and significant targeting ability, showing great potential for detecting CLDN18.2 protein expression levels.

Trophoblast cell surface antigen 2 (TROP2) is a single-pass transmembrane glycoprotein encoded by the tumor-associated calcium signal transducer 2 (TACSTD2) gene. It is overexpressed in various malignant tumor cells and exhibits significant tissue specificity, with almost no expression in normal tissues. TROP2 is considered a potential ideal target for cancer diagnosis and treatment, particularly in antibody-drug conjugate (ADC) therapies. The efficacy of TROP2-targeted therapies is closely related to TROP2 expression levels. Detecting its expression levels can effectively screen potential patients who will benefit from treatment and predict therapeutic responses accurately, helping to improve efficacy, reduce toxicity, and lower the economic burden on patients. A key challenge that needs to be addressed is the systemic, real-time, dynamic, and visualized quantitative monitoring of the spatiotemporal heterogeneity of TROP2 expression. While immunohistochemistry staining is the gold standard for detecting its expression, it has limitations such as being localized, invasive, and difficult for repeated or multi-site biopsies. Non-invasive nuclear medicine molecular imaging based on radiopharmaceuticals provides the potential to overcome these limitations, offering valuable guidance for subsequent treatment strategies. Conventional radiopharmaceutical molecular probes targeting TROP2 include radiolabeled monoclonal antibodies, nanobodies, and nucleic acid aptamers, making the visualized and quantitative monitoring of TROP2 dynamic expression possible. This article systematically summarized the research progress of TROP2-targeted molecular imaging for tumor diagnosis and treatment, while also discussing current challenges and innovative approaches to overcome technical limitations and accelerate clinical implementation.

Objective: To explore the effect of deep learning-based reconstruction (DLR) on the quality and diagnostic value of T2-weighted imaging FatSat (T2WIFS) sequences. Methods: A retrospective analysis of clinical data from patients with suspected prostate cancer (PCa) at Fudan University Shanghai Cancer Center from March to December 2024 was conducted. Patients were divided into a PCa group and a benign prostatic hyperplasia (BPH) group based on needle biopsy and postoperative pathological examination. Scanning suppression sequences included conventional T2 FatSat (T2FSC) and deep learning-based reconstruction T2 FatSat (T2FSDL) of DLR. The overall image quality and image artifacts of prostate imaging were evaluated by two physicians on a five-point scale. The objective evaluation was the signal intensity (S) and standard deviation (SD) of the prostate images of T2FSDL and T2FSC, where the SD was regarded noise (N), and the signal noise ratio (SNR) was calculated. T test was performed for normally distributed data, and Wilcoxon rank sum test was performed for non-normally distributed data. The subjective scores and objective indexes of T2FSDL images and T2FSC images were compared and analyzed. Weighted-Kappa test was used to compare the inter-group and intra-group subjective rating consistency. The prostate lesions in T2FSDL images and T2FSC images were scored by PI-RADS by two film readers using double-blind method. Receiver operating characteristic (ROC) curve was drawn based on pathological results. The area under curve (AUC) was calculated to analyze the diagnostic value of each image for prostate cancer. Results: A total of 116 patients with suspected PCa were included in the retrospective study of this experiment, including 68 patients with malignant PCa and 48 patients with BPH. The subjective scores and objective measurement data of the two groups of images (T2FSDL and T2FSC sequences) were in good agreement between the two physicians (Kappa>0.8). In terms of subjective scores, the overall quality scores of T2FSC and T2FSDL images were (4.04±0.68) and (4.53±0.54), with statistical significance(P<0.01); pseudo-film ratings were (4.44±0.68) and (4.35±0.66), with no statistical significance (P=0.34). In terms of objective evaluation, the SD of T2FSDL images (0.65±0.19) was lower than that of T2FSC images (1.09±0.24), with statistical significance(P<0.01), and the SNR of T2FDL images (95.61±14.25) was higher than that of T2FSC images (56.48±9.72), with statistical significance (P<0.01). In terms of diagnostic value of prostate cancer, the AUC corresponding to T2FSDL images (0.866) was greater than that corresponding to T2FSC images (0.819), with statistical significance (P<0.01). The scanning time of T2FSDL sequence was 100 s, which was significantly faster than that of T2FSC sequence 150 s. Conclusion: T2FSDL technology based on deep learning reconstruction can effectively improve the quality of MRI and the diagnostic value of T2FSDL images is also higher than that of T2FSC images, and can significantly shorten the scanning time and optimize the efficiency of prostate scanning, which has a good clinical application prospect.

Objective: To evaluate the diagnostic efficacy of multiparameter magnetic resonance imaging (mpMRI) fusion with transrectal ultrasound (TRUS) navigation combined with strain elastography (SE) guided prostate biopsy for the detection of prostate cancer. Methods: From January 1, 2022 to April 1, 2024, patients with suspected prostate cancer were collected and analyzed in the Second Affiliated Hospital of Soochow University. All patients underwent mpMRI, SE, and TRUS examinations. Following the identification of suspected prostate cancer lesions, both a standard prostate biopsy consisting of ten systematic needle punctures and a targeted biopsy guided by fusion software combining mpMRI-TRUS images were performed. The diagnostic efficacy of each individual biopsy method as well as their combined application in differentiating benign from malignant prostate lesions was evaluated. Results: A total of 96 suspected lesions were identified in 66 patients suspected of prostate cancer. The positive rate of systematic puncture was found to be 63.64%. The accuracy of the mpMRI group was determined to be 71.88%, while the SE group had an accuracy rate of 66.67%. In comparison, the TRUS group showed an accuracy rate of 60.42%. However, when combining mpMRI fusion navigation with SE imaging, a higher accuracy rate of 86.46% was achieved. Comparative analysis of the diagnostic performance among SE, mpMRI, and combined imaging using receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the combined imaging group was 0.717, which was higher than that of the SE and mpMRI groups. The difference was statistically significant. Furthermore, in terms of sensitivity and negative predictive value (NPV), the combined imaging group exhibited values at 94.03% and 69.23%, respectively. In systemic biopsy, a total number of 660 needles were punctured resulting in a single needle positive rate at 27.73%. Conversely, within the combined imaging group where a total number of only 200 needles were used for puncture procedures, there was a significantly higher single needle positive rate recorded at 81.50% (P<0.001). Conclusion: Targeted prostate biopsy guided by TRUS-fused mpMRI combined with SE demonstrates a significantly higher prostate cancer detection rate compared to conventional biopsy techniques, while simultaneously reducing the number of biopsy cores required. This approach offers notable clinical value in the diagnosis of prostate cancer.

Breast cancer is highly heterogeneous at the molecular level, and molecular classification of breast cancer is very important for treatment selection and prognosis assessment. As a non-invasive and convenient diagnostic method, ultrasound plays an important role in breast cancer screening and diagnosis. By analyzing ultrasound image features and artificial intelligence modeling, medical personnel are expected to achieve non-invasive and accurate diagnosis of breast cancer molecular subtypes. This article reviewed the progress of ultrasonography in determining molecular typing of breast cancer.

Objective: To assess the effectiveness of dual-layer detector spectral computed tomography (DLCT) in predicting the expression of programmed death ligand-1 (PD-L1) in patients with esophageal squamous cell carcinoma (ESCC) prior to surgical intervention. Methods: Patients with histopathologically confirmed esophageal squamous cell carcinoma (ESCC) at Liaoning Cancer Hospital between February 2022 and December 2023 were retrospectively collected. The combined positive score (CPS) was employed to evaluate PD-L1 expression in ESCC tumor cells, with scores ranging from 0-100. Patients with a CPS of 10 or greater were categorized into the high PD-L1 expression group, while those with a CPS of less than 10 were placed in the low PD-L1 expression group. Various quantitative spectral parameters, including Conventional CT values and CT values from 40 keV virtual monoenergetic images during both arterial and venous phases, iodine density (ID), normalized iodine density (NID), and effective atomic number (Z_eff) was record. Independent samples t-tests were utilized to compare the differences in parameters between the high and low expression groups. Additionally, receiver operating characteristic (ROC) curves were generated to assess the predictive capability of each parameter concerning CPS score expression, with comparisons of the area under the curve (AUC) conducted using the DeLong test. Results: Among 140 ESCC patients, 78 were classified as PD-L1 high-expression (CPS≥10) and 62 as low-expression (CPS<10). The PD-L1 high expression group showed significantly higher values in conventional CT, 40 keV CT, ID, NID, and Z_eff during both the arterial and venous phases compared to the PD-L1 low expression group, with statistically significant differences (P<0.05). The venous phase NID had the best predictive effect for ESCC PD-L1 expression, with an AUC of 0.954 (95% CI 0.916-0.992) and a cutoff value of 0.298, yielding a sensitivity of 94.8% and a specificity of 93.5%. The AUC of venous phase NID was statistically significantly different from the venous phase ID, conventional CT values, and 40 keV CT values (AUCs of 0.848, 0.779, and 0.830; Z=-3.504, 4.520, 3.828; all P<0.001), while the difference compared to the Z_eff in the venous phase (AUC=0.853, Z=3.401, P=0.001) was not statistically significant. The AUC of venous phase NID was also statistically significantly different from the arterial phase ID, Z_eff, conventional CT values, and 40 keV CT values (AUCs of 0.798, 0.784, 0.748, and 0.782; Z=-3.575, -3.826, -4.427, -3.843; all P<0.001), but the difference compared to arterial phase NID (AUC=0.833, Z=-2.938, P=0.003) was not statistically significant. Conclusion: The venous phase NID got form DLCT demonstrates a high predictive efficacy for the expression of PD-L1 in ESCC.

Objective: To evaluate the protective effects of astragaloside Ⅳ (AS-Ⅳ) against epirubicin (Epb)-induced cardiac injury in rats using speckle tracking imaging. Methods: Thirty-two SD rats were randomly assigned to four groups (n=8 per group): normal control, Epb model, low-dose AS-Ⅳ, and high-dose AS-Ⅳ. Transthoracic echocardiography (TTE) was performed at baseline and at 2, 4, and 6 weeks post-treatment to assess left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). At week 6, serum levels of CK-MB, LDH, and IL-17 were measured, and heart tissues were collected for Masson staining to evaluate myocardial fibrosis. Results: LVEF showed no significant changes across groups or over time (P>0.05). GLS, however, was significantly influenced by both factors [F group (3, 21)=11.014 2, P<0.000 1] and time [F time (3, 21)=7.215 4, P=0.001 7], with a near-significant interaction effect [F interaction (9, 63)=1.876 1, P=0.072 0]. Serum CK-MB and LDH levels showed no significant differences among groups (P>0.05). IL-17 levels were significantly elevated in the Epb model group compared to the control group, while both AS-Ⅳ treatment groups exhibited significantly reduced levels compared to the Epb model group (P<0.05). The heart weight index did not differ significantly among groups, but myocardial fibrosis area showed significant variations, worsening progressively from control to high-dose AS-Ⅳ, low-dose AS-Ⅳ and Epb model groups（P<0.000 1）. Conclusion: AS-Ⅳ may attenuate myocardial fibrosis and reduce inflammation in Epb-induced myocardial damage. GLS proved to be a more sensitive and accurate indicator than LVEF for detecting subclinical myocardial injury.

Objective: To explore the value of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of cystic-solid ovarian masses in children. Methods: A retrospective analysis of pediatric patients with ovarian cystic-solid masses confirmed by pathological examination at the Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2012 to April 2025 was performed. Tumor characteristics on CT and MRI images of pediatric patients, including side, size, calcification, fat content, hemorrhage, diffusion-weighted imaging (DWI) signal, apparent diffusion coefficient (ADC), and enhancement degree were analyzed. Enhanced images were observed for ovarian vascular pedicle signs, as well as enlarged abdominal and pelvic lymph nodes, pelvic effusion, and hydronephrosis. Results: A total of 22 pediatric patients with ovarian cystic-solid masses were included in the study, aged 3 to 12 years. Among them, 5 cases were benign tumors, 6 cases were borderline tumors, and 11 cases were malignant tumors; 14 cases were germ cell tumors, 7 cases were sex cord-stromal tumors, and 1 case was an epithelial tumor. Abdominal and pelvic CT scans were performed alone in 14 cases, pelvic MRI scans were performed alone in 6 cases, and both abdominal and pelvic CT scans and pelvic MRI scans were performed simultaneously in 2 cases. The display rates of the vascular pedicle sign of the affected side of the ovary by enhanced CT and MRI were 86.7% and 71.4%, respectively. The preoperative diagnostic accuracy of CT and MRI for cystic-solid ovarian lesions in children was 75.0%. There was no significant difference in tumor size among benign, borderline and malignant groups (F=0.490, P>0.05). Conclusion: In this study, approximately half of the ovarian cystic and solid lesions in children were malignant tumors. Some tumors exhibited characteristic features on CT and MRI scans. Combining tumor markers or sex hormone levels can improve the accuracy of preoperative diagnosis.

Nuclear medicine molecular imaging techniques [Positron emission tomography (PET)/Single-photon emission computed tomography (SPECT)] play a pivotal role in precision oncology diagnostics and therapeutics by leveraging high sensitivity and functional imaging capabilities, with their efficacy critically dependent on the development of targeted molecular probes. Ephrin type-A receptor 2 (EphA2), a key member of the receptor tyrosine kinase family, is aberrantly overexpressed in multiple malignancies and has emerged as a promising therapeutic target. Through years of development, EphA2-targeting drugs primarily encompass three categories: antibody-based drugs, small-molecule drugs, and bicyclic peptide drugs. These agents exhibit distinct pharmacological profiles and demonstrate excellent diagnostic or therapeutic potential across diverse models. Encouraged by positive preclinical results, several agents have advanced to Phase Ⅰ clinical trials, showing preliminary efficacy while confronting challenges such as nonspecific accumulation and tumor heterogeneity. This review systematically summarized recent advances in EphA2-targeted nuclear molecular probes, analyzing optimization strategies and future research priorities for EphA2-targeted investigations.

Objective: To investigate the conventional magnetic resonance imaging (MRI) findings of borderline ovarian tumor (BOT) and to improve the diagnostic accuracy preoperatively. Methods: The clinical and conventional MRI data of patients confirmed by surgery and pathology at Fudan University Shanghai Cancer Center and Obstetrics & Gynecology Hospital, Fudan University from February 2011 to January 2025 were retrospectively analyzed. Conventional MRI features of the tumors were evaluated including size, location, mass characteristics, loculi, signal intensity of the cystic fluid, the signal intensity of solid component on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), enhancement, ascites, peritoneal seedings, lymph-node involvement and the display of ipsilateral normal ovarian. The differences of these conventional MRI features between serous BOT (SBOT) and mucinous BOT (MBOT) were also compared. Results: A total of 148 BOT patients were included. BOT occurred predominantly in younger women (mean age 40±15). SBOT and MBOT were the two commonest histological subtypes, accounting for 55.4% (82/148) and 29.1% (43/148), respectively. Among the 82 cases of SBOT, 41.5% (34/82) showed bilateral ovarian masses, and 116 masses were found on conventional MRI. Most showed mainly cystic masses (47.4%, 55/116), followed by solid masses (31.0%, 36/116) and mixed cystic-solid masses (21.6%, 25/116). Of all cystic and mixed cystic-solid masses, most were unilocular (75.0%, 60/80) and the signal of cystic fluid was uniformity. The solid component in all mass appeared as papillary projections, most showed a heterogeneous hyper-intensity on T2WI (83.6%, 97/116) and hypo-/iso-intensity on DWI (65.5%, 76/116). The branching papillary projections with hypo-intense fibrous stalks on T2WI were observed in 45 of all masses (38.8%, 45/116) and all 36 solid masses displayed this sign. The ipsilateral normal ovarian tissues were seen in 76.7% (89/116) masses. All patients with MBOT were unilateral cystic tumors with a bulky volume (100.0%, 43/43). Honeycomb loculi were seen 79.1% (34/43) masses. The signal of cystic fluid was heterogeneous, with a mixed low-high signal on T1WI (83.7%, 36/43) and a contained hypo-intensity (41.9%, 18/43) or a heterogeneous iso- to hyper-intensity on T2WI (37.2% 16/43). Most solid components appeared as irregularly thickened septa (81.4%, 35/43), which showed mild-to-moderate enhancement. And 10 masses (23.3%, 10/43) contained “pseudo-solid” areas- T2WI low signal zones rich in mucinous microcysts. Other less common type of BOT did not show some characteristic features, most of which were similar to SBOT. Tumor size, location, mass characteristics, loculi, signal intensity of the cystic fluid, the signal intensity of solid component on T2WI and DWI, enhancement, peritoneal seedings, and the display of ipsilateral normal ovarian differed significantly between SBOTs and MBOTs (all P<0.001). Conclusion: On conventional MRI, BOT have some characteristic features, which are helpful for the accurate diagnosis preoperatively, and can also effectively distinguish SBOT from MBOT.

Surgical treatment remains the cornerstone of treatment for advanced ovarian cancer patients, where achieving optimal cytoreductive surgery directly determines clinical prognosis. Imaging modalities serve as critical tools for preoperative evaluation of resectability, providing essential guidance for optimal surgical planning. The primary objective of preoperative imaging is to assess both the extent of tumor metastasis and the likelihood of complete resection, thereby maximizing surgical benefits and improving patient outcomes. Approximately 70% of ovarian cancer patients present with advanced-stage disease at initial diagnosis, often accompanied by extensive pelvic-abdominal metastases and peritoneal seeding, which significantly increases surgical complexity. Consequently, precise radiological assessment of tumor burden and critical organ involvement is imperative. Currently, computed tomography (CT) stands as the first-line imaging modality for preoperative evaluation due to its widespread availability and comprehensive visualization of peritoneal metastases and lymphadenopathy. However, CT demonstrates limited resolution for detecting subcentimeter peritoneal implants (<5 mm) and mesenteric infiltration. Magnetic resonance imaging (MRI), with its superior soft tissue contrast and multiparametric/multidirectional imaging capabilities, offers enhanced accuracy in evaluating pelvic organ invasion, particularly at critical sites like the rectosigmoid junction and bladder. Diffusion-weighted imaging (DWI) further improves detection rates for occult metastases and surgically challenging lesions. While ¹⁸F-FDG positron emission tomography (PET)/CT exhibits higher specificity for distant and lymph node metastases, its sensitivity for peritoneal dissemination does not surpass CT or MRI. Emerging advances in radiomics and artificial intelligence promise revolutionary progress in resectability assessment for advanced ovarian cancer. These technologies enable not only the extraction of quantitative imaging features reflecting tumor heterogeneity (combined with clinical data to construct predictive models) but also leverage deep learning algorithms for automated metastasis segmentation/identification and three-dimensional visualization modeling. Nevertheless, comprehensive surgical resectability evaluation must ultimately integrate patient fitness, surgeon expertise, and multidisciplinary team discussions to optimize decision-making.

Objective: To analyze the ultrasonic characteristics of jaw bone lesions and compare the diagnostic accuracy of high-frequency ultrasound with cone beam computed tomography (CBCT), and to explore the diagnostic value of ultrasound in jaw bone lesions. Methods: A retrospective analysis was conducted on patients diagnosed with jaw lesions at Jiangsu Provincial Hospital of Traditional Chinese Medicine from May 2019 to September 2022. According to the histopathological results of cysts and tumors/tumor-like lesions, the ultrasonic characteristics of the two groups of lesions were analyzed. The correlation between high-frequency ultrasound, CBCT, and histopathology was analyzed, and the diagnostic efficiency of high-frequency ultrasound and CBCT for jaw bone lesions was compared using receiver operating characteristic (ROC) curves. Results: Among the 30 patients, 12 cases were cysts, and 18 cases were tumors/tumor-like lesions. High-frequency ultrasound was correlated with the histopathological results of jaw bone lesions (P<0.05，r=0.747), and the correlation was positive. The comparison of the ROC curve areas of the two examination methods showed statistically significant differences (P<0.05), and the sensitivity and specificity of high-frequency ultrasound for the diagnosis of jaw bone lesions were 83.3% and 58.3%, respectively. Conclusion: High-frequency ultrasound has higher diagnostic efficiency than CBCT in evaluating soft tissue components within mandibular lesions, and can be used as a supplement to CBCT, providing effective reference for preoperative auxiliary diagnosis, monitoring treatment, or disease progression of clinical jaw bone lesions.

Objective: To analyze the imaging characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) multimodal imaging techniques in children with hepatoblastoma (HB), and to explore the application value of CT and MRI parameters in HB diagnosis and pre-treatment extent of tumor (PRETEXT) staging. Methods: Children with HB diagnosed at Xuzhou Children's Hospital from January 1, 2019 to December 31, 2023 were selected and analyzed. The children were categorized into two groups according to the pathological type of the surgical and puncture biopsy findings: complete epithelial and mixed epithelial-mesenchymal. The differences in birth history, general characteristics of the lesion, internal characteristics of the lesion, mode of enhancement, and perihepatic effusion between the 2 groups were compared. Children with HB were divided into two groups according to PRETEXT staging: stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ. The differences in CT values of tumors between plain CT scans and enhanced CT scans of lesions, as well as the apparent diffusion coefficient (ADC) of lesions on MRI scans were compared. Logistic multivariable regression analysis were used to identify predictive factors for PRETEXT staging in HB patients. The predictive value of PRETEXT staging in HB patients was analyzed using receiver operating characteristic (ROC) curves. Results: Sixty HB pediatric patients were included, with 30 cases each of complete epithelial type and mixed epithelial-mesenchymal type. There was no significant difference in the birth histories of children with HB between the two groups (P>0.05). However, the proportions of intra-tumor hemorrhage, tumor calcification, and perihepatic effusion were higher in the mixed type of HB than in the complete type of HB (P<0.05). Logistic regression analysis showed that intra-tumor hemorrhage, tumor calcification, and perihepatic effusion were of value in determining the pathological type of children with HB (OR=1.10、3.81、1.07, P<0.05); children with stage Ⅲ-Ⅳ HB had higher plain CT values [(46.95±5.28) HU], enhanced scan CT values in the arterial and delayed stages [(98.04±21.91) HU, 92.64±14.33) HU], and ADC values [(1.22±0.15)×10^-3 mm²/s] than those in stage Ⅰ-Ⅱ (P<0.05), and enhanced scan CT values in the venous stage [(94.12±20.28) HU] were lower than those of stage I~Ⅱ (P<0.05). Logistic multifactorial regression analysis showed that high plain CT values, high CT values on arterial phase enhancement scans, and high ADC values were independent influences on PERTEXT staging (OR=1.14, 1.04, and 15.97, P<0.05). ROC curves analysis showed that the area under curve (AUC) of the three combined tests for PERTEXT staging was 0.890 higher than that of 0.663, 0.718, and 0.791 (P<0.05). ROC curve analysis showed that the AUC of the three combined detections for PRETEXT staging was 0.890, which was higher than the 0.663, 0.718 and 0.791 predicted separately (P<0.05). Conclusion CT and MRI multimodal imaging technology can accurately predict the pathological staging and PRETEXT staging of HB through the combined analysis of quantitative parameters (plain CT value, arterial phase CT value, ADC value) and morphologic features (calcification, hemorrhage, and periportal hepatic effusion), which can provide a key basis for the selection of preoperative chemotherapy regimen, planning of surgical scope, and prognostic assessment, and has a good clinical translational value.