Search

Topological properties, which serve as the core of the neural network, and their couplings can reflect different therapeutic effects in tinnitus patients. We hypothesized that tinnitus patients with different outcomes after sound therapy (narrowband noise) would have distinct brain network topological alterations. Diffusion tensor imaging and resting-state functional magnetic resonance imaging (fMRI) were prospectively performed in 60 patients with idiopathic tinnitus and 57 healthy controls (HCs). Graph-theoretical network analyses of structural connectivity (SC), functional connectivity (FC), and SC and FC coupling were performed. Associations between clinical performance and graph-theoretical features were also analyzed. Treatment was effective (effective group; EG) in 28 patients and ineffective (ineffective group; IG) in 32 patients. For FC, the patients in the EG showed higher local efficiency than patients in the IG. For SC, patients in both the EG and IG displayed lower normalized characteristic path length, characteristic path length, and global efficiency than the HCs. More importantly, patients in the IG had higher coupling than the HCs, whereas there was no difference in coupling between patients in the EG and HCs. Additionally, there were significant associations between the SC features and clinical performance in patients in the EG. Our findings demonstrate that tinnitus patients exhibited significant brain network topological alterations, especially in the structural brain network. More importantly, patients who demonstrated different curative effects showed distinct SC-FC topological coupling properties. SC-FC coupling could be an indicator that could be used to predict prognoses in patients with idiopathic tinnitus before sound therapy.

Background It is difficult to detect optic nerve changes in patients with thyroid-associated ophthalmopathy (TAO) before the development of optic neuropathy. Purpose To detect changes in the intraorbital segment of the optic nerve in patients with TAO using diffusion tensor imaging (DTI) and determine any correlations with disease severity. Material and Methods A total of 74 participants (17 normal, 22 mild, and 35 moderate-severe TAO) were organized to be given 3-T DTI to measure fractional anisotropy (FA) and mean diffusivity (MD) for the orbital segments of their optic nerves. All underwent ophthalmological examinations for visual acuity, intraocular pressure, exophthalmos, and fundoscopy, and were assessed based on the Clinical Activity Score (CAS). Univariate analysis of variance and Pearson's correlation coefficients were carried out. Results Patients with moderate-to-severe TAO had significantly lower FA values and higher MD values ( P Conclusion DTI parameters of the intraorbital optic nerves were significantly altered in moderate-to-severe patients before onset of clinical optic nerve dysfunction and may, therefore, be used as an imaging biomarker for assessing the disease.

Introduction. In clinical settings, nodular projection (NP) and cord sign (CS) at the tumor edge and irregular nodules (IN) in the mesorectum often appeared together with extramural vascular invasion (EMVI). We aim to evaluate the diagnostic efficiency of the MRI morphology of primary tumor in predicting EMVI in patients with rectal cancer (RC). Methods. This retrospective study included 156 patients with RC. Clinical and imaging factors including NP at the primary tumor’s edge, CS at the primary tumor’s edge, maximal extramural depth (EMD), IN in the mesorectum, growth pattern, tumor length, range of rectal wall invaded (RRWI) by tumor, peritoneal reflex invasion by surgery, and pathology-proven local node involvement (PLN) were evaluated. Then, ROC curve was drawn to depict the meaningful indicators in multivariate analyses. Results. There were 53 (34%) patients with pathological extramural venous invasion (pEMVI). Among the clinical and imaging factors evaluated, NP, CS, IN, EMD, PLN, differentiation, and peritoneal reflex invasion were significantly associated with pEMVI. NP and PLN were independent predictors of EMVI. Areas under the ROC curve (AUC) of NP for prediction of EMVI was 0.82 (95% CI, 0.74–0.90), with a sensitivity of 73.58%, a specificity of 90.29%, a positive predictive value (PPV) of 75.59%, a negative predictive value (NPV) of 86.92%, and an accuracy of 84.62%, respectively. Conclusions. Patients with primary tumor with EMVI usually showed NP and CS. NP was an independent predictor of EMVI and helpful for the diagnosis of EMVI in RC patients.

Objective This study aimed to establish a new scoring system that includes histological quantitative features derived from coronary computed tomographic angiography (CCTA) to predict the efficiency of chronic total occlusion percutaneous coronary intervention (CTO-PCI). Methods This study analyzed clinical, morphological, and histological characteristics of 207 CTO lesions in 201 patients (mean age 60.0 [52.0–65.0] years, 85% male), which were recruited from two centers. The primary endpoint was a guidewire successfully crossing the lesions within 30 m. The new predictive model was generated by factors that were determined by multivariate analysis. The CCTA plaque (CTAP) score that included a quantitative plaque characteristic was developed by assigning an appropriate integer score to each independent predictor, then summing all points. In addition, the CTAP score was compared with other predictive scores based on CCTA. Results The endpoint was achieved in 63% of the lesions. The independent predictors included previous CTO-PCI failure, the proximal blunt stump, proximal side branch, distal side branch, occluded segment bending > 45°, and high-density plaque volume (fibrous volume + calcified volume) ≥ 19.9 mm3. As the score increased from 0 to 5, the success rate of the guidewire crossing within 30 m decreased from 96 to 0%. Comparing the CTAP score with other predictive scores, the CTAP score showed the highest discriminant power (c-statistic = 0.81 versus 0.73–0.77, p value 0.02–0.07). The CTAP score showed similar results for procedural success. Conclusion The CTAP score efficiently predicted the guidewire crossing efficiency and procedural success. Key Points • An increase in high-density plaque volume (fibrous + dense calcium) was more probable to reduce the efficiency of crossing and lead to procedural failure. • The new prediction scoring system with the addition of the quantitative characteristics of plaques had an improved predictive ability compared with the traditional prediction scoring system.

The thyroid gland normally presents as a hyperdense organ on noncontrast computed tomography (CT) in adults. The correlation between thyroid gland CT density and its functional status has been studied; however, little is known regarding its density in children with normal thyroid functions. We aimed to assess the correlation between thyroid gland CT density and age in children with normal thyroid functions.From April 2017 to March 2021, we enrolled 74 patients who had normal thyroid functions within 1 month before or after undergoing neck or cervical spine CT for trauma, neck masses, congenital diseases, and airway stenosis. Their CT images were retrospectively analyzed by 2 independent radiologists. Based on age, patients were divided into 4 groups: infant, preschool-aged, school-aged, and adolescence groups.Patients with thyroid gland hypodensity in the infant group (70%, 14 of 20) were significantly more numerous than those in preschool-aged (25%, 4 of 16), school-aged (20%, 5 of 25), and adolescence (15.4%, 2 of 13) groups (P = 0.007, 0.001, and 0.002, respectively, Fisher exact test). The mean CT density of the thyroid gland was also lower in the infant group compared with the densities in other age groups. There was a weak positive correlation between thyroid CT density and age (r = 0.264, P = 0.023, linear regression analysis).Thyroid CT density is related to age in children. The thyroid gland normally has a low density on noncontrast CT in most infants with normal thyroid function.

Background Pulsatile tinnitus (PT) is an annoying sound that can be eliminated with targeted treatment of the cause. However, the causes of PT have not been fully elucidated. Case summary A 38-year-old woman with right-sided objective PT underwent preoperative computed tomography arteriography and venography (CTA/V). A 3.8 mm vine diploic vein (DV), which passed through the mastoid air cells posteriorly in a dehiscent canal and was continuous with the transverse-sigmoid sinus, was thought to be the causative finding. Four-dimensional flow magnetic resonance (4D flow MR) imaging showed that the blood in the DV flowed toward the transverse-sigmoid sinus. The closer the blood was to the transverse-sigmoid sinus, the higher the velocity. No vortex or turbulence was found in the DV or adjacent transverse sinus. The sound was eliminated immediately after ligation of the DV with no recurrence during a three-month follow-up. No flow signal of the DV was noted on postoperative 4D flow MR. Conclusion A DV may be a treatable cause of PT. CTA/V and 4D flow MR could be utilized to determine the morphological and hemodynamic characteristics of the DV.

Background Positron emission tomography (PET) imaging is a non-invasive method to visualize and quantify the tumor microenvironment. This study aimed to explore the feasibility of 18F-AIF-NOTA-E[PEG4-c(RGDfk)]2 (denoted as 18F-RGD) PET quantitative parameters to distinguish the angiogenesis in colorectal cancer (CRC) mice which has different metastatic potential. Methods Twenty LoVo and twenty LS174T of CRC liver metastases animal models were established by implantation of human CRC cell lines via intrasplenic injection. Radiotracer-based micro-PET imaging of animal model was performed and the uptake of 18F-RGD tracer in the tumor tissues was quantified as tumor-to-liver maximum or mean standardized uptake value (SUVmax or SUVmean) ratio. Pearson correlation was used to analyze the relationship between radioactive parameters and tumor markers. Results The SUVmax and SUVmean ratios of LoVo model were significantly higher than those of LS174T in both liver metastasis and primary tumor lesions (P Conclusions The tumor-to-liver SUVmean ratio of 18F-RGD was a promising image parameter for the process of monitoring tumor angiogenesis in CRC xenograft mice model.

BACKGROUND MRI is the most effective diagnostic tool of osteonecrosis of the femoral head (ONFH), especially for early diagnosis, but its detection of subchondral or cortical fractures is less accurate than CT. Therefore, it is difficult to accurately stage ONFH in the peri-collapse period by MRI. PURPOSE To improve the accuracy of MR for distinguishing between Association Research Circulation Osseous (ARCO) stages 2 and 3A in ONFH. STUDY TYPE Retrospective. SUBJECTS One hundred and fifty five cases of ARCO stage 2/3A of ONFH underwent MR examinations, M/F = 72/83. CT was used as reference standard for collapse, which was decided by an orthopedist and a radiologist in consultation. FIELD STRENGTH/SEQUENCE 3 T/axial and coronal T1 -weighted Turbo Spin Echo (T1 W TSE) sequence, axial T2 -weighted fat-saturated (T2 W FS) TSE sequence, and coronal proton density-weighted imaging (PDWI)-FS-Dixon fat/water image. ASSESSMENT Five potential MR signs (the maximum width of the necrotic-viable interface, bone marrow edema (BME), irregular articular surface of the femoral head, T2 heterogeneous high signal, and the absence of a necrotic-viable interface with the morphology of closed loop) were evaluated blindly by five radiologists independently and the total scores of different combinations of MR signs were calculated. STATISTICAL TESTS Mann-Whitney U test and Chi-square test were used to evaluate age, gender, and MR signs differences between the two groups. ROC curve was used to access the distinguishing value of MR signs. The consistency of the five radiologists was analyzed by intraclass correlation coefficient. RESULTS The area under the curve of the combined MR signs 2 for distinguishing between ARCO stages 2 and 3A was the greatest (0.967), sensitivity and specificity were 100.00% and 88.71% respectively, and greater than 1 was the threshold. DATA CONCLUSION Combined MR signs 2 has great values in distinguishing between ARCO stages 2 and 3A in ONFH, thus helping clinical therapy. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.

This work aimed to investigate the effect of blood flow pulsation in patients with pulsatile tinnitus (PT). Nine blood flow patterns with different pulsations were designed on the basis of the blood flow data of a patient with PT (control group; cases with blood flow pulsation indexes that had decreased by 20%, 40%, 60%, and 80%; and cases with blood flow pulsation indexes that had increased by 20%, 40%, 60%, and 80%). The transient-state multiphysics coupling method was used to clarify the biomechanical and acoustic changes that had occurred under different blood flow pulsations. Results showed that blood flow impacted directly the vessel wall in the sigmoid sinus wall dehiscence (SSWD) area. The impact velocity of the blood flow slowed with the decrement in blood flow pulsation index but increased with the increase in blood flow pulsation index. With the reduction in blood flow pulsation index, the average pressure of the SSWD area decreased by 1.84, 3.93, 6.23, and 8.31 Pa; the average displacement of the vessel wall in the SSWD area decreased by 0.11, 0.23, 0.36, and 0.48 µm; and the average sound pressure level at the tympanum decreased by 2.2, 4.16, 7.14, and 12.97 dB. By contrast, with the increase in blood flow pulsation index, the average pressure increased by 2.46, 4.21, 6.28, and 8.56; the average displacement increased by 0.14, 0.2, 0.36, and 0.49 µm; and the average sound pressure level increased by 1.32, 2.87, 4.15, and 5.19 dB. Statistical analysis revealed that the pathological induction of PT had a strong quadratic correlation with the pulsation of blood flow. The degree of PT could be attenuated by reducing blood flow pulsation. Such an approach would aid clinical treatment. The conclusion obtained in this work would present a theoretical basis for the treatment of patients with PT.

Background and Aims Liver imaging reporting and data system (LI-RADS) provides standardized lexicon and categorization for diagnosing hepatocellular carcinoma (HCC). However, there is limited knowledge about the effect of LI-RADS training. We prospectively explored whether the systematic training of LI-RADS v2018 on magnetic resonance imaging (MRI) can effectively improve the diagnostic performances of different radiologists for HCC. Methods A total of 20 visiting radiologists and the multiparametric MRI of 70 hepatic observations in 61 patients with high risk of HCC were included in this study. The LI-RADS v2018 training procedure included three times of thematic lectures (each lasting for 2.5 h) given by a professor specialized in imaging diagnosis of liver, with an interval of a month. After each seminar, the radiologists had a month to adopt the algorithm into their daily work. The diagnostic performances and interobserver agreements of these radiologists adopting the algorithm for HCC diagnosis before and after training were compared. Results A total of 20 radiologists (male/female, 12/8; with an average age of 36.75±4.99 years) were enrolled. After training, the interobserver agreements for the LI-RADS category for all radiologists (p=0.005) were increased. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of all radiologists for HCC diagnosis before and after training were 43% vs. 54%, 86% vs. 88%, 74% vs. 81%, 62% vs. 67%, and 65% vs. 71%, respectively. The diagnostic performances of all radiologists (p

Objective To evaluate the performance of a fully automatic algorithm for labeling coronary arteries in CCTA images using deep learning based on the two 3-dimensional (3D) U-Net architectures for myocardium structure extraction. Methods In total, 157 patients who underwent CCTA scanning were retrospectively included. An automatic coronary artery labeling algorithm based on the distance transformation algorithm was proposed to identify the anatomical segments of the centerlines extracted from CCTA images. Sixteen segments were identified and labeled. The results obtained via the algorithm were recorded and reviewed by three experts. The performance of segment detection and labeling of each segment was evaluated, and the proportion of agreement between the two experts on the manually labeled segments was also calculated. Results Compared with the labels of the experts, 117 labels (5.4%) (2180 segments) from the algorithm needed to be changed or removed. The overall accuracy of label presence was 96.2%. The average overlap between the expert reference and algorithm labels was 94.0%. The average agreement between the two experts was 95.0%. Conclusions The proposed deep learning algorithm provided a high accuracy of the automatic labeling with respect to the labels from the clinical experts. This method is promising for labeling coronary arteries automatically and alleviating the workload of radiologists in the near future.

BACKGROUND The relationship between trans-stenotic blood flow velocity differences and the cerebral venous pressure gradient (CVPG) in transverse sinus (TS) stenosis (TSS) has not been studied. OBJECTIVE To evaluate the hemodynamic manifestations of TSS and the relationship between trans-stenotic blood flow velocity differences and the CVPG. METHODS Thirty-three patients with idiopathic intracranial hypertension (IIH) or pulsatile tinnitus (PT) and TSS who had undergone diagnostic venography using venous manometry were included in the patient group. Thirty-three volunteers with no stenosis and symptoms were included in the control group. All the 2 groups underwent prospective venous sinus 4-dimensional (4D) flow magnetic resonance imaging (MRI). The average velocity (Vavg) difference and maximum velocity (Vmax) difference between downstream and upstream of the TS in 2 groups were measured and compared. Correlations between the CVPG and trans-stenotic Vavg difference/Vmax difference/index of transverse sinus stenosis (ITSS) were assessed in the patient group. RESULTS The differences in Vavg difference and Vmax difference between the patient and control groups showed a statistical significance (P

BACKGROUND Pulsatile tinnitus (PT) is a potentially disabling symptom that has received increasing attention. Multiple causes of PT have been confirmed by targeted treatment. However, dynamic changes of related structures in PT patients with multiple causes after stenting for ipsilateral transverse sinus stenosis (TSS) have not been previously reported. We report such a case and present postoperative computed tomography venography (CTV) follow-up findings to demonstrate the decreased sigmoid sinus diverticulum and bone remodeling. CASE SUMMARY A 45-year-old man suffered from left-sided PT for 15 years that was occasionally accompanied by headache and dizziness. Pre-operative CTV revealed left-sided sigmoid sinus wall anomalies (SSWAs), TSS, outflow dominance, large posterior condylar emissary vein, and an empty sella turcica. A cerebrospinal fluid pressure of 270 mmH2O was further detected. The sound disappeared immediately after stenting for ipsilateral TSS, with no recurrence during 2 years of follow-up. After the procedure, the patient underwent four consecutive CTV examinations. The diverticulum decreased 6 mo after the procedure with new bone remodeling. The density of the remodeled bone was further increased 1 year later, and a hardened edge was formed 2 years later. CONCLUSION PT associated with SSWAs, TSS, and idiopathic intracranial hypertension can be cured by stenting for TSS alone. And bone remodeling around SSWAs is a more significant finding.

As a typical advanced oxidation process, Fe

The

Objectives Facial canal dehiscence (FCD), typically found in the tympanic segment, is a risk factor for facial nerve injury. An imaging scoring method was proposed to identify FCD based on ultra-high-resolution CT. Methods Forty patients (21 females and 19 males, mean age 44.3 ± 17.4 years), whose tympanic facial canal (FC) was examined during otological surgery, were divided into the FCD group (n = 29) and the control group (n = 11) based on surgical findings. Imaging appearance of tympanic FC was scored 0–3: 0 = no evident bony covering, 1 = discontinuous bony covering with linear deficiency, 2 = discontinuous bony covering with dotted deficiency, and 3 = continuous bony covering. Both lateral and inferior walls were assigned a score as LFCD and IFCD, respectively. An FCD score was calculated as LFCD + IFCD. The diagnostic value of the FCD score was tested using the ROC curve. Results The inter-observer agreement was moderate for the lateral wall (Cohen’s κ coefficient 0.416, 95% CI 0.193–0.639), and good for the inferior wall (Cohen’s κ coefficient 0.702, 95% CI 0.516–0.888). In the FCD group, the most common appearance for both walls was discontinuous bony covering with linear deficiency (LFCD = 1, 22/29, 75.9%; IFCD = 1, 15/29, 51.7%). An FCD score of less than 4 was associated with high sensitivity (0.82) and specificity (0.93) for identifying FCD, with an AUC of 0.928. Conclusions Using the proposed scoring method, FCD score < 4 could identify FCD of the tympanic segment with high concordance with surgical findings. Key Points • Imaging appearance of the tympanic facial canal (FC) is divided into four types based on ultra-high-resolution CT images. • The most common appearance of FC with facial canal dehiscence (FCD) is discontinuous bony covering with linear deficiency. • An FCD score, consisting of scores of the lateral and inferior walls, less than 4 is highly indicative of FCD.

BACKGROUND Nasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint, and it may derive from amyloidosis in rare cases. There are a few reports about localized amyloidosis, and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare. CASE SUMMARY A 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year. Physical examination touched a firm lump in the left lacrimal sac. Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus. Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct. During an endoscopic exploration and excision, a large number of dacryoliths were exposed. Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue. CONCLUSION This case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction. In clinical practice, we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.

BACKGROUND Metabolic syndrome increases the risk of chronic diseases such as cardiovascular disease and diabetes. Metabolic syndrome also has an impact on bone mineral density. However, the relationship between metabolic syndrome and bone marrow fat is unclear. PURPOSE To determine factors associated with bone marrow fat concentration in subjects with and without metabolic syndrome. STUDY TYPE Retrospective. POPULATION One hundred and one women with metabolic syndrome (31.0 years ±5.1) and 96 female living liver transplant donors (32.0 years ±3.7). Our institutional review board approved the study. Each subject signed written informed consent. FIELD STRENGTH/SEQUENCE 3.0 T MRI system and a commercially available chemical shift-encoded 3D sequence (Iterative Decomposition of water and fat with Echo asymmetry and Least Square Estimation). ASSESSMENT Proton density fat fraction (PDFF) in liver, vertebral body, and paraspinal muscle (erector spinae) were measured from a single acquisition by a 15-year-experience orthopedic radiologist. The factors associated with PDFF were acquired. STATISTICAL TESTS The analysis of covariance test, after adjustment for body mass index and age, was used to analyze the differences between metabolic syndrome and non-metabolic syndrome groups. A stepwise multiple regression analysis was used to determine which variables were independently associated with PDFF. RESULTS Mean vertebral PDFF and alanine aminotransferase (ALT) were significantly lower in donors than subjects with metabolic syndrome (both P

Cancer has thwarted as a major health problem affecting the global population. With an alarming increase in the patient population suffering from diverse varieties of cancers, the global demographic data predicts sharp escalation in the number of cancer patients. This can be expected to reach 420 million cases by 2025. Among the diverse types of cancers, the most frequently diagnosed cancers are the breast, colorectal, prostate and lung cancer. From years, conventional treatment approaches like surgery, chemotherapy and radiation therapy have been practiced. In the past few years, increasing research on molecular level diagnosis and treatment of cancers have significantly changed the realm of cancer treatment. Lately, uses of advanced chemotherapy and immunotherapy like treatments have gained significant progress in the cancer therapy, but these approaches have several limitations on their safety and toxicity. This has generated lot of momentum for the evolution of new drug delivery approaches for the effective delivery of anticancer therapeutics, which may improve the pharmacokinetic and pharmacodynamic effect of the drugs along with significant reduction in the side effects. In this regard, the protein-based nano-medicines have gained wider attention in the management of cancer. Proteins are organic macromolecules essential, for life and have quite well explored in developing the nano-carriers. Furthermore, it provides passive or active tumour cell targeted delivery, by using protein based nanovesicles or virus like structures, antibody drug conjugates, viral particles, etc. Moreover, by utilizing various formulation strategies, both the animal and plant derived proteins can be converted to produce self-assembled virus like nano-metric structures with high efficiency in targeting the metastatic cancer cells. Therefore, the present review extensively discusses the applications of protein-based nano-medicine with special emphasis on intracellular delivery/drug targeting ability for anticancer drugs.

Response evaluation criteria in solid tumors (RECIST) often fail to identify clinically meaningful response to bevacizumab-containing therapy in colorectal liver metastasis (CRLM). This study aimed to develop RECIST by combining contrast-enhanced and diffusion-weighted magnetic resonance imaging (MRI). A total of 126 patients with CRLM who underwent hepatic resection after bevacizumab-containing chemotherapy were split into initial analyses cohort (N = 42, with 76 indexed liver metastases) and validation cohort (N = 84). In lesion-based analyses, percentage decrease of arterial enhancement area and percentage increase of apparent diffusion coefficient (ADC) value from baseline to post-chemotherapy were measured. Their optimal cutoff values for distinguishing pathology-confirmed major and minor response were determined. Then, the developed RECIST (D-RECIST) was established by combining functional and size-based items. Survival relevance of D-RECIST and RECIST was examined in the validation cohort. Percentage decrease of arterial enhancement area and increase of ADC value significantly differed between lesions of pathologic major or minor response, with optimal cutoffs of approximately 33% and 19%, respectively. Patients defined as responders by D-RECIST had a significantly longer median disease-free survival (DFS) than non-responders (p = 0.021; 12.9 versus 8.6 months). No significant difference was observed with RECIST (p = 0.524). In a Cox regression model, D-RECIST- but not RECIST-defined responses independently predicted the DFS (p = 0.034 and 0.811). D-RECIST-defined responses provided significant prognostic information, and thus may serve as a better response evaluation approach than RECIST in CRLM treated with bevacizumab-containing therapy. • Changes in arterial enhancement area and apparent diffusion coefficient value are associated with pathological response in colorectal liver metastases treated with bevacizumab. • The MRI-based response criteria developed by combining size-based and functional features can provide significant prognostic information.

BACKGROUND Distinguishing between the two broad categories of diabetic retinopathy (DR), nonproliferative DR (NPDR) and proliferative DR (PDR), is significant, as the therapeutic strategies for each are completely different. PURPOSE To characterize the ocular blood flow (OBF) of DR patients and evaluate the potential utility of OBF values in categorizing DR. STUDY TYPE Prospective. SUBJECTS A total of 41 DR patients (82 eyes) were recruited in our study. Group 1 comprised 48 eyes with NPDR, and Group 2 comprised 34 eyes with PDR. FIELD STRENGTH/SEQUENCE 3D pseudocontinuous arterial spin labeling (3D-pcASL) with two postlabeling delays (PLDs) was acquired at 3.0T MR. ASSESSMENT OBF values were independently obtained by two doctors from the OBF map. STATISTICAL TESTS OBF values and clinical characteristics were compared between the groups using two-sample t-tests and chi-square tests. Receiver operating characteristic (ROC) curves were obtained, and the area under the curve (AUC) was calculated. The consistency of OBF values reported by the two doctors was evaluated using the intraclass correlation coefficient (ICC). RESULTS OBF values at PLDs of 1.5 seconds and 2.5 seconds were significantly lower in Group 2 than in Group 1 (P

This study aimed to explore brain structural and white matter microstructural reorganization in the early stage of tinnitus and identify brain alterations that contribute to its relief after 6 months of sound therapy. We studied 64 patients with idiopathic tinnitus, including 29 patients who were categorized into an effective group (EG) and 35 who were categorized into an ineffective group (IG) according to the 6‐month follow‐up improvement of the Tinnitus Handicap Inventory score, along with 63 healthy controls (HCs). All participants underwent structural and diffusion tensor imaging scanning on a 3‐T magnetic resonance system. Differences in brain gray/white matter volume and white matter microstructure were evaluated using voxel‐based morphometry analysis and tract‐based spatial statistics among the three groups. Associations between brain reorganization and the improvement of tinnitus symptoms were also investigated. Compared with EG patients, IG patients experienced a significant gray matter volume decrease in the right middle frontal gyrus (MFG)/right precentral gyrus (PreCG). Meanwhile, both EG and IG patients showed significant changes (decrease or increase) in brain white matter integrity in the auditory‐related or nonauditory‐related white matter fiber tracts compared with HCs, while EG patients showed decreased axial diffusivity in the bilateral middle cerebellar peduncle (MCP) compared with IG patients. We combined the gray matter change of the MFG/PreCG and the white matter integrity of the bilateral MCP as an imaging indicator to evaluate the patient's prognosis and screen patients before treatment; this approach reached a sensitivity of 77.1% and a specificity of 82.8%. Our study suggests that there was a close relationship between brain reorganization and tinnitus improvement. The right MFG/PreCG and bilateral MCP may be indicators that can be used to predict prognoses in patients with idiopathic tinnitus and may be used to screen patients before sound therapy. These findings may provide new useful information that can lead to a better understanding of the tinnitus mechanism., We found that effective group and ineffective group patients showed distinct brain reorganization patterns. We observed that associations exist between the brain reorganizations and the improvement of tinnitus. The brain reorganizations may be indicators to predict prognosis and screen patients before sound therapy.

To explore the morphological brain changes among active thyroid-associated ophthalmopathy (TAO) patients, inactive TAO patients and healthy controls and to investigate the neuropathological relationship of TAO using magnetic resonance imaging (MRI) data.In this observational case-control study, we included 35 inactive TAO patients, 37 active TAO patients and 23 healthy controls. Voxel-based morphometry (VBM) analysis was conducted to evaluate the gray matter volume (GMV) changes among groups, and the correlations between GMV alterations and clinical parameters in active and inactive TAO groups were investigated.Active TAO patients showed significantly increased GMV in the right inferior frontal gyrus, left superior frontal gyrus (SFG), orbital superior frontal gyrus, orbital middle frontal gyrus, precuneus and postcentral gyrus compared with controls and significantly increased GMV in the right middle temporal gyrus, left SFG and precuneus compared with the inactive TAO group. No significant differences were observed between the inactive TAO group and healthy controls. Notably, the receiver operating characteristic (ROC) curve analysis demonstrated altered GMV among groups and significantly (p 0.001) differentiated active TAO from inactive TAO and healthy controls. In addition, the mean GMV in precuneus and postcentral gyrus were significantly associated with clinical parameters in active TAO.Our findings suggested the localized GMV alterations among groups were associated with the pathophysiology of TAO and served as a potential discriminative pattern to detect clinical phases of TAO at the individual level. The altered brain morphometry may suggest a corresponding process of self-repair and remodeling of the brain structure as the disease progresses in TAO.

Determination of disease activity in Takayasu arteritis (TAK) is crucial for clinical management but challenging. The value of different magnetic resonance imaging (MRI) characteristics for the assessment of disease activity remains unclear. This study investigated the imaging findings of the thoracic aortic wall and elasticity by using a comprehensive 3.0 T MRI protocol.We prospectively enrolled 52 consecutive TAK patients. TAK activity was recorded according to the ITAS2010. All the patients underwent thoracic aortic MRI. The luminal morphology of the thoracic aorta and its main branches were quantitatively evaluated using a contrast-enhanced magnetic resonance angiography (MRA) sequence. The maximum wall thickness of the thoracic aorta, postcontrast enhancement ratio, and aortic wall edema were analyzed in each patient through pre- and post-enhanced T1-weighted and T2-weighted imaging. Pulse-wave velocity (PWV) of the thoracic aorta was calculated using a four-dimensional flow technique.The majority of the 52 patients had type V disease (34.62%, 18/52). Among all the MRI indicators of the thoracic aorta, the area under the curve was the largest for the maximal wall thickness (0.804, 95% confidence interval [CI] = 0.667-0.941). The maximal wall thickness (93.33%, 95% CI = 68.1%-99.8%) exhibited the highest sensitivity with a cutoff value of 3.12 mm. Wall edema (84.00%, 95% CI = 63.9%-95.5%) presented the highest specificity. A positive correlation was noted between PWV and patients' age (r = 0.54,MRI enabled the comprehensive assessment of aortic wall morphology and functional markers for TAK disease activity. Aortic maximal wall thickness was the most accurate indicator of TAK activity. The early phase was superior to the delay phase for aortic wall enhancement analysis for assessing TAK activity.

Multi-Dynamic Multi-Echo (MDME) Sequence is a new method which can acquire various contrast-weighted images using quantitative relaxometric parameters measured from multicontrast images. The purpose of our study was to investigate the effect of scan parameters of MDME Sequence on measured T1, T2 values of phantoms at 3.0 T MRI scanner. Gray matter, white matter and cerebrospinal fluid simulation phantoms with different relaxation times (named GM, WM, CSF, respectively) were used in our study. All the phantoms were scanned 9 times on different days using MDME sequence with variations of echo train length, matrix, and acceleration factor. The T1, T2 measurements were acquired after each acquisition. The repeatability was characterized as the intragroup coefficient of variation (CV) of measured values over 9 times, and the discrepancies of measurements across different groups were characterized as intergroup CVs. The highest intragroup CVs of T1-GM, T2-GM, T1-WM, T2-WM, T1-CSF, T2-SCF were 1.36%, 1.75%, 0.74%, 1.41%, 1.70%, 7.79%, respectively. The highest intergroup CVs of T1-GM, T2-GM, T1-WM, T2-WM, T1-CSF, T2-SCF were 0.54%, 1.86%, 1.70%, 0.94%, 1.00%, 2.17%, respectively. Quantitative T1, T2 measurements of gray matter, white matter and cerebrospinal fluid simulation phantoms derived from the MDME sequence were not obviously affected by variations of scanning parameters, such as echo train length, matrix, and acceleration factor on 3T scanner.

The accurate vestibule segmentation from CT images is essential to the quantitative analysis of the anatomical structure of the ear. However, it is a challenging task due to the tiny size, blur boundary, and drastic variations in shape and size. In this paper, according to the specific characteristics and segmentation requirements of the vestibule, a vestibule segmentation network with a hybrid deep feature fusion of 2D CNN and 3D CNN is proposed. First, a 2D CNN is designed to extract the intraslice features through multiple deep feature fusion strategies, including a convolutional feature fusion strategy for different receptive fields, a feature channel fusion strategy based on channel attention mechanism, and an encoder-decoder feature fusion strategy. Next, a 3D DenseUNet is designed to extract the interslice features. Finally, a hybrid feature fusion module is proposed to fuse the intraslice and interslice features to effectively exploit the context information, thus achieving the accurate segmentation of the vestibule structure. At present, there is no publicly available dataset for vestibule segmentation. Therefore, the proposed segmentation method is validated on two self-established datasets, namely, VestibuleDataSet and IEBL-DataSet. It has been compared with several state-of-the-art methods on the datasets, including the general DeeplabV3+ method and specific 3D DSD vestibule segmentation method. The experimental results show that our proposed method can achieve superior segmentation accuracy.

To investigate the relevant factors of unilateral pulsatile tinnitus (PT) in patients with idiopathic intracranial hypertension (IIH) using CT. CT angiography images of IIH patients with unilateral PT (n = 19), without PT (n = 13), and controls (n = 32) were reviewed. The characteristics including transverse sinus stenosis (TSS), venous outflow laterality (VOL), sigmoid sinus wall dehiscence (SSWD), and sigmoid sinus diverticulum (SSD) were quantitatively or/and qualitatively detected. VOL was compared between the symptomatic side of IIH patients with PT and the larger side of IIH patients without PT and the controls. TSS, SSWD, and SSD were compared between the symptomatic side of IIH patients with PT, and both sides of the latter two groups. There was no statistical difference in body mass index or cerebrospinal fluid pressure between IIH patients with and without PT. The prevalence of TSS was significantly higher in IIH patients than that in the controls (p = 0.000), but TSS had no correlation with PT within IIH patients. The prevalence of SSWD successively decreased in IIH patients with PT, without PT, and the controls, with significant differences between each two of three groups (p = 0.000, p′ = 0.000, p″ = 0.031). The proportion of VOL and the prevalence of SSD were significantly larger in IIH patients with PT than in the latter groups respectively (pVOL = 0.005, p′VOL = 0.000; pSSD = 0.040, p′SSD = 0.000). All SSDs in IIH patients with PT were accompanied with SSWD. The dominant VOL and ipsilateral SSWD with/without SSD may be correlated with the occurrence of unilateral PT in IIH patients.

To analyze the mechanical properties in different regions of the brain in healthy adults in a wide age range: 26 to 76 years old. We used a multifrequency magnetic resonance elastography (MRE) protocol to analyze the effect of age on frequency-dependent (storage and loss moduli, G′ and G″, respectively) and frequency-independent parameters (μ1, μ2, and η, as determined by a standard linear solid model) of the cerebral parenchyma, cortical gray matter (GM), white matter (WM), and subcortical GM structures of 46 healthy male and female subjects. The multifrequency behavior of the brain and frequency-independent parameters were analyzed across different age groups. The annual change rate ranged from − 0.32 to − 0.36% for G′ and − 0.43 to − 0.55% for G″ for the cerebral parenchyma, cortical GM, and WM. For the subcortical GM, changes in G′ ranged from − 0.18 to − 0.23%, and G″ changed − 0.43%. Interestingly, males exhibited decreased elasticity, while females exhibited decreased viscosity with respect to age in some regions of subcortical GM. Significantly decreased values were also found in subjects over 60 years old. Values of G′ and G″ at 60 Hz and the frequency-independent μ2 of the caudate, putamen, and thalamus may serve as parameters that characterize the aging effect on the brain. The decrease in brain stiffness accelerates in elderly subjects. • We used a multifrequency MRE protocol to assess changes in the mechanical properties of the brain with age. • Frequency-dependent (storage moduli G′ and loss moduli G″) and frequency-independent (μ1, μ2, and η) parameters can bequantitatively measured by our protocol. • The decreased value of viscoelastic properties due to aging varies in different regions of subcortical GM in males and females, and the decrease in brain stiffness is accelerated in elderly subjects over 60 years old.

Background Previous evidence have shown that long non-coding RNA (lncRNA) TMPO antisense RNA 1 (TMPO-AS1) is involved in the aggressiveness of several cancers. Nevertheless, the precise functions of TMOP-AS1 in hepatocellular carcinoma (HCC) are still unresolved. Materials and methods The expressions of TMPO-AS1 and miR-320a were detected in HCC tissues and cells by qRT-RCR. The cell growth, migration and invasion were detected by colony formation, wound healing assay and Transwell assay, respectively. The targeting relation between miR-320a and TMPO-AS1 was predicted by bioinformatics analysis and identified by luciferase reporter gene as well as FISH assay. The expression of SERPINE1 MRNA Binding Protein 1 (SERBP1) was detected by Western blot. The growth of HCC cell was analyzed using transplanted tumor model. Results Currently, we revealed that TMPO-AS1 was overexpressed in clinical HCC samples and a panel of HCC cell lines. Clinically, a higher level of TMPO-AS1 was connected to the advanced stage of HCC and worse prognosis of patients. Depletion of TMPO-AS1 repressed HCC cell viability, migration ability and invasiveness. Nevertheless, upregulation of TMPO-AS1 caused opposite results. Further studies revealed that lncRNA TMPO-AS1 was largely located in the cytoplasm of HCC cell and sponge miR-320a, resulting in increasing the level of SERBP1 in HCC cell. Finally, TMPO-AS1 silencing suppressed tumor growth of HCC cell in vivo. Conclusion Collectively, our results suggested that TMPO-AS1 was a promoting factor for the aggressive behaviors of HCC cell.

Brain iron deposition in hemodialysis (HD) patients increases over time. Iron deficiency in gray matter nuclei has been reported to lead to idiopathic restless legs syndrome (RLS) symptoms. Regardless of unpleasant RLS sensations, the patterns of iron deposition between hemodialysis patients with RLS (HD-RLS) and hemodialysis patients without RLS (HD-nRLS) are still unclear. To evaluate the differences in iron deposition patterns between HD-RLS and HD-nRLS patients, we utilized quantitative susceptibility mapping (QSM).In sum, 24 HD-RLS patients, 25 HD-nRLS patients and 30 age- and sex-matched healthy controls (HCs) were enrolled. The QSM was used to assess susceptibility values of the regions of interest (ROIs), including the caudate nucleus (CN), putamen (PUT), globus pallidus (GP), thalamus (THA), substantia nigra (SN), red nucleus (RN) and dentate nucleus (DN).HD duration was significantly longer in HD-RLS patients than in HD-nRLS patients (P 0.05). The susceptibility of HD-RLS and HD-nRLS patients in PUT was higher than that in HCs (P 0.05), illustrating elevated iron content in the nucleus. Compared with HD-nRLS patients, HD-RLS patients demonstrated reduced susceptibility in CN and PUT (both P 0.05). Compared with HCs, HD-RLS patients displayed decreased susceptibility in DN (P 0.05).Different iron deposition patterns between HD-RLS and HD-nRLS patients in PUT and DN, which further support disturbed sensory processing in RLS, may be involved in RLS pathogenesis in HD patients.

Computed Tomography (CT) has become an important way for examining the critical anatomical organs of the human temporal bone in the diagnosis and treatment of ear diseases. Segmentation of the critical anatomical organs is an important fundamental step for the computer assistant analysis of human temporal bone CT images. However, it is challenging to segment sophisticated and small organs. To deal with this issue, a novel 3D Deep Supervised Densely Network (3D-DSD Net) is proposed in this paper. The network adopts a dense connection design and a 3D multi-pooling feature fusion strategy in the encoding stage of the 3D-Unet, and a 3D deep supervised mechanism is employed in the decoding stage. The experimental results show that our method achieved competitive performance in the CT data segmentation task of the small organs in the temporal bone.

OBJECTIVE This study is to investigate the hemodynamic changes of pulsatile tinnitus (PT) patients induced by sigmoid sinus wall anomalies (SSWA). STUDY DESIGN Prospective study. SETTING Tertiary referral university hospital. PATIENTS Fifteen unilateral PT patients with SSWA identified on computed tomography images and surgery and 15 age-, sex-, and body mass index-matched healthy volunteers underwent velocity-encoded, cine magnetic resonance imaging. INTERVENTION Hemodynamic data in sigmoid sinus were obtained from velocity-encoded, cine magnetic resonance imaging, and compared between PT patients and controls. MAIN OUTCOME MEASURES Heart rate was recorded. Cross-sectional area (CSA), peak positive velocity (PPV), average positive flow volume per beat (APFV/beat), average flow volume per beat (AFV/beat), peak negative velocity (PNV), and average negative flow volume per beat (ANFV/beat) were measured. Average flow volume per minute (AFV/min), average positive flow volume per minute (APFV/min), average negative flow volume per minute (ANFV/min), average positive velocity (APV), average negative velocity (ANV), and regurgitation fraction (RF) were calculated. RESULTS APV at PT side of patients was 13.4 ± 3.3 cm/s, which was significantly slower than that at corresponding side of controls (15.8 ± 2.6 cm/s). PNV and RF at PT side of patients were 21.0 ± 15.4 cm/s and 2.4% respectively, which were significantly higher than those values at corresponding side of controls (both of them were 0). HR, CSA, PPV, APFV/beat, APFV/min, AFV/beat, AFV/min, ANV, ANFV/beat, and ANFV/min were 69.8 ± 9.4 beat/min, 48.4 ± 17 mm, 31.4 ± 5.9 cm/s, 5.4 ± 1.8 ml/beat, 373.9 ± 117.7 ml/min, 5.1 ± 2.0 ml/beat, 352.0 ± 134.6 ml/min, 2 (0-4.9) cm/s, 1 (0-2.7) ml/beat, and 4.1 (0-141.3) ml/min at PT side of patients, and 67.4 ± 7.8 beat/min, 38.2 ± 18 mm, 29.9 ± 3.9 cm/s, 5.3 ± 2.0 ml/beat, 350.3 ± 125.3 ml/min, 5.1 ± 1.9 ml/beat, 340.5 ± 117.9 ml/min, 0 (0-2.1) cm/s, 0 (0-0.8) ml/beat, and 0 (0-55.4) ml/min at corresponding side of controls. These hemodynamics were not significantly different between groups. CONCLUSION APV, PNV, and RF changes take place in SSWA patients, which may be associated with the occurrence of PT and have the potential value to improve accurate etiological diagnosis and predict treatment success.

Objective. The aim of this study was to explore cerebral blood flow (CBF) alterations in subjects with high myopia (HM) using three-dimensional pseudocontinuous arterial spin labeling (3D-pcASL). Methods. A total of sixteen patients with bilateral HM and sixteen age- and sex-matched healthy controls (HCs) were recruited. All subjects were right-handed. Image data preprocessing was performed using SPM8 and the DPABI toolbox. Clinical parameters were acquired in the HM group. Two-sample t-tests and Pearson correlation analysis were applied in this study. Results. Compared to HCs, patients with HM exhibited significantly increased CBF in the bilateral cerebellum, and no decreases in CBF were detected in the brain. However, no relationship was found between the mean CBF values in the different brain areas and the disease duration (P>0.05). Conclusions. Using ASL analysis, we detected aberrant blood perfusion in the cerebellum in HM patients, contributing to a better understanding of brain abnormalities and brain plasticity through a different perspective.

Altered functional connectivity (FC) of the thalamus has been proven to be an important finding in tinnitus patients. Tinnitus can be effectively desensitized by sound therapy. However, it is still unclear whether and how sound therapy affects the FC of the thalamus. Resting-state functional magnetic resonance imaging data and anatomical data were longitudinally collected from 25 idiopathic tinnitus patients before and after 12 weeks of sound therapy by using adjusted narrow band noise and from 25 matched healthy controls at the same time interval without any intervention. The FC of bilateral thalami were analyzed by setting the left and right thalamus as the regions of interest. Significant main effect of group on the FC of the thalamus were found mainly in the key components of the default mode network, limbic network, salience network, cognitive control network, auditory network and occipital region. FC values between the thalamus, inferior frontal gyrus (IFG), and anterior cingulate cortex (ACC) featured higher values in the tinnitus group at baseline compared to the healthy controls and restoration in tinnitus patients after treatment. Decreased Tinnitus Handicap Inventory (THI) scores and decreased FC values between the right thalamus and right IFG were positively correlated (r = 0.476, P = 0.016). Abnormal FC of the thalamus is associated with multiple brain networks. Sound therapy has a normalizing effect on the enhanced FC of the thalamus-IFG and thalamus-ACC, representing decreased tinnitus attention control and less involvement of the noise-canceling system.

According to previous studies, many neuroanatomical alterations have been detected in patients with tinnitus. However, the results of these studies have been inconsistent. The objective of this study was to explore the cortical/subcortical morphological neuroimaging biomarkers that may characterize idiopathic tinnitus using machine learning methods. Forty-six patients with idiopathic tinnitus and fifty-six healthy subjects were included in this study. For each subject, the gray matter volume of 61 brain regions was extracted as an original feature pool. From this feature pool, a hybrid feature selection algorithm combining the F-score and sequential forward floating selection (SFFS) methods was performed to select features. Then, the selected features were used to train a support vector machine (SVM) model. The area under the curve (AUC) and accuracy were used to assess the performance of the classification model. As a result, a combination of 13 cortical/subcortical brain regions was found to have the highest classification accuracy for effectively differentiating patients with tinnitus from healthy subjects. These brain regions include the bilateral hypothalamus, right insula, bilateral superior temporal gyrus, left rostral middle frontal gyrus, bilateral inferior temporal gyrus, right inferior parietal lobule, right transverse temporal gyrus, right middle temporal gyrus, right cingulate gyrus, and left superior frontal gyrus. The accuracy in the training and test datasets was 80.49% and 80.00%, respectively, and the AUC was 0.8586. To the best of our knowledge, this is the first study to elucidate brain morphological changes in patients with tinnitus by applying an SVM classifier. This study provides validated cortical/subcortical morphological neuroimaging biomarkers to differentiate patients with tinnitus from healthy subjects and contributes to the understanding of neuroanatomical alterations in patients with tinnitus.

AIM A nomogram model was developed to predict the histological subtypes of lung invasive adenocarcinomas (IAs) and minimally invasive adenocarcinomas (MIAs) that manifest as part-solid ground-glass nodules (GGNs). MATERIALS AND METHODS This retrospective study enrolled 119 patients with histopathologically confirmed part-solid GGNs assigned to the training (n=83) or testing cohorts (n=36). Radiomic features were extracted based on the unenhanced computed tomography (CT) images. R software was applied to process the qualitative and quantitative data. The CT features model, radiomic signature model, and combined prediction model were constructed and compared. RESULTS A total of 396 radiomic features were extracted from the preoperative CT images, four features including MaxIntensity, RMS, ZonePercentage, and LongRunEmphasis_angle0_offset7 were indicated to be the best discriminators to establish the radiomic signature model. The performance of the model was satisfactory in both the training and testing set with areas under the curve (AUCs) of 0.854 (95% confidence interval [CI]: 0.774 to 0.934) and 0.813 (95% CI: 0.670 to 0.955), respectively. The CT morphology of the lesion shape and diameter of the solid component were confirmed to be a significant feature for building the CT features model, which had an AUC of 0.755 (95% CI: 0.648 to 0.843). A nomogram that integrated lesion shape and radiomic signature was constructed, which contributed an AUC of 0.888 (95% CI: 0.82 to 0.955). CONCLUSIONS The radiomic signature could provide an important reference for differentiating IAs from MIAs, and could be significantly enhanced by the addition of CT morphology. The nomogram may be highly informative for making clinical decisions.

To assess the risk of cancer induced by diagnostic X-ray exposure in multiple radiological examinations and to explore the relevant influences to provide a reference for rational usage of X-ray examinations.Data for all adult patients who underwent X-ray examinations from August 2004 to April 2020 in a general hospital was collected, including sex, age, primary diagnosis, and X-ray examination. Based on the Biological Effects of Ionizing Radiations report, age and sex and effective dose for a single X-ray examination were used to calculate the lifetime attributable risk (LAR). Patients whose cancer LAR values were in the top 5% were considered to have a high cancer risk; the factors influencing this status were explored by using multivariate logistic regression analyses.In total, 1,143,413 patients with 3,301,286 X-ray examinations were included. LARs of cancer incidence and death were0.2% and0.13% among 95% of patients and they were1% among 0.21% and 0.07% of patients. High risks of incidence and death were significantly associated with corrected exposure frequency (odds ratio [OR], 1.080 and 1.080), sex (OR, male vs. female, 0.421 and 0.372), and year of birth (OR, 1.088 and 1.054), with all p values0.001. Among 20 disease categories, congenital disease (OR, 3.792 and 4.024), genitourinary disease (OR, 3.608 and 3.202), digestive disease (OR, 3.247 and 3.272), and tumor disease (OR, 2.706 and 2.767) had the strongest associations with high risks of incidence and death (all p values0.001).Cancer risk induced by diagnostic X-ray examinations can be considered acceptable clinically. Patients having certain diseases are potentially at a relative higher risk due to recurrent examinations.• It was the first large-scale investigation of cumulative X-ray exposure in China, involving more than 3.3 million X-ray scans of all types of diagnostic X-ray examinations for about 1.1 million patients during the past 16 years. • The study revealed that the incidence risk of cancer induced by X-ray-related examinations was 0.01% on average, which was substantially lower than that of cancer induced by non-X-ray radiation. The risk could be considered acceptable clinically. • Patients having certain diseases were potentially at a relatively higher cancer risk due to recurrent X-ray examinations. The cumulative effect of X-ray exposure could not be ignored and was worthy of attention.