Background: To explore the diagnostic performance of triggered angiography non-contrast-enhanced magnetic resonance imaging (TRANCE-MRI) for the evaluation of venous pathology of the lower extremity. Methods: This was a single-centre prospective cohort study of 25 patients with suspected venous disease in the lower extremities. Each patient received Doppler ultrasonography (for venous evaluation) before the scheduled TRANCE-MRI (for venous and arterial evaluations) on a 1.5 T MR scanner (Philips Ingenia, Philips Healthcare, Best, the Netherlands), followed by lymphography and computed tomography angiography that were arranged according to the diagnostic indications. Results: The sensitivity, specificity and accuracy of TRANCE-MRI were 85.7%, 88/9 and 88%, respectively. The inter-rater agreement for deep vein thrombosis (DVT) of the thigh between the ultrasonography and TRANCE-MRI results was substantial agreement (Cohen’s kappa κ, 0.72). In ultrasonography-negative cases, TRANCE-MRI detected four additional cases (16%, 4/25) of DVT; three cases (12%, 3/25) of venous compression caused by pelvic lymphadenopathy, hip prosthesis or knee joint effusion; one case (4%, 1/25) of vena cava anomaly; two cases (8%, 2/25) of occult peripheral artery disease (PAD); and one case (4%, 1/25) of an occluded bypass graft. Conclusion: TRANCE-MRI can be used as an alternative and objective tool for assessing lower extremity diseases, especially suspected venous pathology. Compared with ultrasonography, TRANCE-MRI plays a better role in assessing varicose veins of the lower extremities and deep veins of the pelvis and abdomen. However, false-positive results may occur in the left common iliac vein of elderly patients. Finally, occult PAD rarely occurs in patients with suspected lower extremity venous disease. Therefore, we recommend performing the TRANCE-MRV protocol instead of the full protocol (MRV + MRA) in the clinical setting in patients with venous scenarios.

Background: This study proposes a prediction model for the automatic assessment of lung cancer risk based on an artificial neural network (ANN) with a data-driven approach to the low-dose computed tomography (LDCT) standardized structure report.Methods: This comparative validation study analysed a prospective cohort from Chiayi Chang Gung Memorial Hospital, Taiwan. In total, 836 asymptomatic patients who had undergone LDCT scans between February 2017 and August 2018 were included, comprising 27 lung cancer cases and 809 controls. A derivation cohort of 602 participants (19 lung cancer cases and 583 controls) was collected to construct the ANN prediction model. A comparative validation of the ANN and Lung-RADS was conducted with a prospective cohort of 234 participants (8 lung cancer cases and 226 controls). The areas under the curves (AUCs) of the receiver operating characteristic (ROC) curves were used to compare the prediction models.Results: At the cut-off of category 3, the Lung-RADS had a sensitivity of 12.5%, specificity of 96.0%, positive predictive value of 10.0%, and negative predictive value of 96.9%. At its optimal cut-off value, the ANN had a sensitivity of 75.0%, specificity of 85.0%, positive predictive value of 15.0%, and negative predictive value of 99.0%. The area under the ROC curve was 0.764 for the Lung-RADS and 0.873 for the ANN (P = 0.01). The two most important predictors used by the ANN for predicting lung cancer were the documented sizes of partially solid nodules and ground-glass nodules.Conclusions: Compared to the Lung-RADS, the ANN provided better sensitivity for the detection of lung cancer in an Asian population. In addition, the ANN provided a more refined discriminative ability than the Lung-RADS for lung cancer risk stratification with population-specific demographic characteristics. When lung nodules are detected and documented in a standardized structured report, ANNs may better provide important insights for lung cancer prediction than conventional rule-based criteria.

The oxidative stress biomarker of urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG) was reported to be changed in patients with allergic diseases. Measurement of urinary oxidative products is noninvasive. However, correlations between the severity levels of atopic diseases and oxidative stress remain unclear. This study aimed to investigate the association among urinary 8-OHdG, atopic dermatitis (AD), and the phenotypes of atopic diseases in children. In a nested case-control study, participants of kindergarten children were enrolled from the Childhood Environment and Allergic Diseases Study (CEAS). Urinary analyses and urinary 8-OHdG were performed on samples from 200 children with AD as cases and 200 age- and sex-matched controls. Our study presents the following main findings: (1) The urinary 8-OHdG levels were significantly higher in cases than controls. Higher urinary 8-OHdG levels were associated with the risk of AD in a dose-response-manner; (2) Children’s AD history was associated with higher risks of asthma, allergic rhinitis, and night pruritus; (3) For children with AD, urinary 8-OHdG levels of >75th percentile were associated with higher risk of asthma, compared with the reference group of 0–25th percentiles. In summary, this study provides better understanding of the underlying mechanisms of AD and urinary 8-OHdG by analyzing a large-scale sample survey in Taiwan.

Rationale: Contrast-enhanced computed tomographic venography (CTV) or magnetic resonance venography (MRV) are usually used to detect May-Thurner syndrome (MTS). However, both are associated with contrast-induced nephrotoxicity. For patients who cannot receive contrast media, non-contrast-enhanced MRV using three-dimensional (3D) turbo spin-echo (TSE) is considered an alternative. We report a case of MTS to describe its clinical utility and advantages. Patient concerns: A 49-year-old male experienced isolated left leg swelling and pain for half a month. He had a history of chronic renal insufficiency that made contrast-enhanced imaging studies inadequate. Diagnoses: A lower extremity venous Duplex scan showed a thrombus extending from the left distal femoral vein to the popliteal vein with valvular reflux, consistent with infrainguinal deep vein thrombosis (DVT). The suprainguinal DVT was evaluated by non-contrast-enhanced MRV. The results showed sandwich external compression of the left common iliac vein between the right common iliac artery and lumbar vertebrae, consistent with DVT of the left common iliac vein caused by MTS. Interventions: The patient received angioplasty with the implantation of a balloon-expandable stent over the left common iliac vein. Outcomes: Excellent recanalization of the left iliac vein was noted postoperatively. Lessons: In the evaluation of suprainguinal venous lesions, non-contrast-enhanced MRV presents the venous structure alone at high resolution without the accompanying arterial structure, which makes it an excellent diagnostic imaging tool for MTS. These findings indicate that non-contrast-enhanced MRV could be useful for detecting systemic venous pathologies in patients with renal insufficiency.

Objectives: Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. Methods: An observational study with retrospective data analysis. Materials: Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV). The clinical appliance of TRANCE-MRI was analysed by groups. Results: In total, 63 patients completed the study. TRANCE-MRI could identify venous thrombosis, including that of the abdominal and pelvic vessels, and it enabled the timely treatment of underlying diseases in patients with OV disease. TRANCE-MRI was statistically compared with the duplex scan, the gold standard to exclude deep vein thrombosis (DVT) in the legs, with regard to their abilities to detect venous thrombosis by using Cohen’s kappa coefficient at a compatible value of 0.711. It could provide the occlusion degree of the peripheral artery for treating an SU. Finally, TRANCE-MRI can be used to outline all collateral veins and occult thrombi before treating symptomatic or recurrent VV to ensure a perfect surgical plan and to avoid complications. Conclusions: TRANCE-MRI is an innovative tool in the treatment of versatile venous pathology in the lower extremities and is widely used for vascular diseases in our institution.

Cerebral Small Vessel Disease (CSVD) frequently affects the elderly, with inflammation playing a crucial role in related health complications, including dementia, stroke, and SVD. Studies, including animal experiments, indicate a strong link between inflammation and SVD progression. The Neutrophil-Lymphocyte Ratio (NLR) serves as a possible biomarker for ongoing inflammatory risks. A total of 720 adults aged 50 years or older from the community-based I-Lan Longitudinal Aging Study were included in this study. General linear regression and ordinally logistic regression analyses were performed to evaluate the association between NLR and CSVD. We further examined the presence of lacune, microbleed, and white matter hyperintensity (WMH) on brain MRI, which were used to construct a combined CSVD score. The NLR was positively associated with WMH (adjusted r = 0.109, p = 0.003), microbleed (adjusted r = 0.102, p = 0.006), and lacune (adjusted r = 0.100, p = 0.008). After adjustments for smoking, drinking, and physical activity in the ordinal logistic regression analysis, age, gender, brachial Systolic Blood Pressure (SBP), fasting glucose, LDL-cholesterol, and Hs-CRP were compared among subjects with low tertile (T1), medium tertile (T2) and high tertile (T3) NLR. The results showed that T2 vs. T1 had an odds ratio of 1.23 (0.86–1.77); and T3 vs. T1 had an odds ratio of 1.87 (1.29–2.71) of CSVD scores in four groups (zero (reference group), one, two, and three or more). NLR could be used to assess the state of inflammation in cerebral vessels. A significant and positive correlation between NLR and CSVD was verified in this study. However, the practical clinical application of NLR in CSVD patients and prognosis prediction should be validated through more scientific attempts.