TiAVox: Time-aware Attenuation Voxels for Sparse-view 4D DSA Reconstruction

Four-dimensional Digital Subtraction Angiography (4D DSA) plays a critical role in the diagnosis of many medical diseases, such as Arteriovenous Malformations (AVM) and Arteriovenous Fistulas (AVF). Despite its significant application value, the reconstruction of 4D DSA demands numerous views to effectively model the intricate vessels and radiocontrast flow, thereby implying a significant radiation dose. To address this high radiation issue, we propose a Time-aware Attenuation Voxel (TiAVox) approach for sparse-view 4D DSA reconstruction, which paves the way for high-quality 4D imaging. Additionally, 2D and 3D DSA imaging results can be generated from the reconstructed 4D DSA images. TiAVox introduces 4D attenuation voxel grids, which reflect attenuation properties from both spatial and temporal dimensions. It is optimized by minimizing discrepancies between the rendered images and sparse 2D DSA images. Without any neural network involved, TiAVox enjoys specific physical interpretability. The parameters of each learnable voxel represent the attenuation coefficients. We validated the TiAVox approach on both clinical and simulated datasets, achieving a 31.23 Peak Signal-to-Noise Ratio (PSNR) for novel view synthesis using only 30 views on the clinically sourced dataset, whereas traditional Feldkamp-Davis-Kress methods required 133 views. Similarly, with merely 10 views from the synthetic dataset, TiAVox yielded a PSNR of 34.32 for novel view synthesis and 41.40 for 3D reconstruction. We also executed ablation studies to corroborate the essential components of TiAVox. The code will be publically available.Comment: 10 pages, 8 figure

Reintervention after Thoracic Endovascular Aortic Repair of Uncomplicated Type B Aortic Dissection

Background: Data are scarce regarding the incidence, reasons, potential risk factors, and long-term outcomes of reintervention after thoracic endovascular aortic repair (TEVAR) in patients with uncomplicated type B aortic dissection (TBAD). Methods: Between January 2010 and December 2020, 238 patients with uncomplicated TBAD who received TEVAR were analyzed retrospectively. The clinical baseline data, aorta anatomy, dissection characteristics, and details of the TEVAR procedure were evaluated and compared. A competing-risk regression model was used to estimate the cumulative incidences of reintervention. The multivariate Cox model was used to identify the independent risk factors. Results: The mean follow-up time was 68.6 months. A total of 27 (11.3%) cases of reintervention were observed. The competing-risk analyses showed that the 1-, 3-, and 5-year cumulative incidences of reintervention were 5.07%, 7.08%, and 14.0%, respectively. Reasons for reintervention included endoleak (25.9%), aneurysmal dilation (22.2%), retrograde type A aortic dissection (18.5%), distal stent-graft-induced new entry and false lumen expansion (18.5%), and dissection progression and/or malperfusion (14.8%). Multivariable Cox analysis demonstrated that a larger initial maximal aortic diameter (Hazard ratio [HR], 1.75; 95% Confidence interval [CI], 1.13–2.69, p = 0.011) and increased proximal landing zone oversizing (HR, 1.07; 95% CI, 1.01–1.47, p = 0.033) were the significant risk factors for reintervention. Long-term survival rates were comparable between patients with or without reintervention (p = 0.915). Conclusions: Reintervention after TEVAR in patients with uncomplicated TBAD is not uncommon. A larger initial maximal aortic diameter and excessive proximal landing zone oversizing are associated with the second intervention. Reintervention does not significantly affect long-term survival

Focus on the Dynamics of Neutrophil-to-Lymphocyte Ratio in Cancer Patients Treated with Immune Checkpoint Inhibitors: A Meta-Analysis and Systematic Review

Background: A number of studies have reported an association between the dynamics of neutrophil-to-lymphocyte ratio (NLR) and clinical efficacy in patients treated with immune checkpoint inhibitors (ICIs), but there is still a lack of a meta-analysis or systematic review. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched until September 2022 for studies reporting on the association between the change in NLR after ICI treatment and clinical outcomes. Outcome measures of interest included: change in NLR before and after treatment, overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Results: A total of 4154 patients in 38 studies were included. The pooled percentage of patients with increased NLR was 49.7% (95CI%: 43.7–55.8%). Six studies discussing the change in NLR in patients with different tumor responses all showed that the NLR level in patients without response to immunotherapy may increase after ICI treatment. The upward trend in NLR was associated with shorter OS (pooled HR: 2.05, 95%CI: 1.79–2.35, p p p p p p < 0.001). In addition, post-treatment high NLR was associated with more impaired survival than baseline high NLR (pooled HR of baseline high NLR: 1.82, 95%CI: 1.52–2.18; pooled HR of post-treatment high NLR: 2.93, 95%CI: 2.26–3.81), but the NLR at different time points may have a similar predictive effect on PFS (pooled HR of baseline high NLR: 1.68, 95%CI: 1.44–1.97; pooled HR of post-treatment high NLR: 2.00, 95%CI: 1.54–2.59). Conclusions: The NLR level of tumor patients after ICI treatment is stable overall, but the NLR level in patients without response to immunotherapy may increase after ICI treatment. Patients with an upward trend in NLR after ICI treatment were associated with worse clinical outcomes; meanwhile, the downward trend in NLR was associated with better clinical outcomes. Post-treatment high NLR was associated with more impaired survival than baseline high NLR