Objective We aimed to evaluate the performance of the newly developed deep learning radiomics of elastography (Dlre) for assessing liver fibrosis stages. Dlre adopts the radiomic strategy for quantitative analysis of the heterogeneity in two-dimensional shear wave elastography (2D-SWe) images. Design a prospective multicentre study was conducted to assess its accuracy in patients with chronic hepatitis B, in comparison with 2D-SWe, aspartate transaminaseto-platelet ratio index and fibrosis index based on four factors, by using liver biopsy as the reference standard. its accuracy and robustness were also investigated by applying different number of acquisitions and different training cohorts, respectively. Data of 654 potentially eligible patients were prospectively enrolled from 12 hospitals, and finally 398 patients with 1990 images were included. analysis of receiver operating characteristic (rOc) curves was performed to calculate the optimal area under the rOc curve (aUc) for cirrhosis (F4), advanced fibrosis (≥F3) and significance fibrosis (≥F2). results aUcs of Dlre were 0.97 for F4 (95% ci 0.94 to 0.99), 0.98 for ≥F3 (95% ci 0.96 to 1.00) and 0.85 (95% ci 0.81 to 0.89) for ≥F2, which were significantly better than other methods except 2D-SWe in ≥F2. its diagnostic accuracy improved as more images (especially ≥3 images) were acquired from each individual. no significant variation of the performance was found if different training cohorts were applied.

Purpose To investigate the diagnostic performance of two-dimensional (2D) shear-wave elastography (SWE) in chronic hepatitis B. Materials and Methods This prospective multicenter study from January 2015 to January 2016 was conducted at 12 hospitals and included 654 participants with chronic hepatitis B who had undergone liver biopsy and 2D SWE examination. Participants were divided into chronic infection and chronic hepatitis groups. The diagnostic performance of 2D SWE was compared with the aspartate amino transferase-to-platelet ratio index (APRI), the Fibrosis-4 index (FIB-4), and transient elastography (TE) by using a DeLong test and was also compared between two subgroups. Dual cutoff values for cirrhosis were determined with multilevel likelihood ratio analysis. Results Overall, 402 participants with chronic hepatitis B were enrolled (154 with chronic infection and 248 with chronic hepatitis). The areas under the receiver operating characteristic curve of 2D SWE (0.87; 95% confidence interval [CI]: 0.83, 0.90) were higher than those of TE (0.80; 95% CI: 0.68, 0.88), APRI (0.70; 95% CI: 0.65, 0.74), and FIB-4 (0.73; 95% CI: 0.69, 0.78) in cirrhosis. The high area under the receiver operating characteristic curve (0.92; 95% CI: 0.87, 0.96) was achieved in the chronic infection group and was significantly higher than that of the chronic hepatitis group (0.84; 95% CI: 0.78, 0.88; P = .017). Dual cutoff values with the likelihood ratios below 0.1 and above 10 (8.4 kPa and 11.0 kPa to rule out and rule in a diagnosis of cirrhosis, respectively) were effectively determined in chronic infection; a total of 81.2% (125 of 154) participants with cirrhosis were definitively diagnosed. Conclusion The performance of two-dimensional (2D) shear-wave elastography (SWE) was higher than that of other noninvasive methods. 2D SWE was most effective in ruling in and ruling out cirrhosis in participants with chronic infection, which may prompt antiviral treatment. © RSNA, 2018 Online supplemental material is available for this article.

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Fluoroalkyl diazo compounds are versatile reagents for introducing fluoroalkyl groups into organic compounds. Despite their uses as carbene precursors in many reactions, asymmetric fluoroalkyl carbene insertion into C­(sp3)–H bonds remains quite rare. Herein we report the rhodium-catalyzed enantioselective intramolecular insertion of a carbene into ether α-C­(sp3)–H bonds under mild conditions using operationally safe and easily decomposable fluoroalkyl N-triftosylhydrazones as the carbene source. This method enables the efficient synthesis of a range of previously inaccessible chiral fluoroalkyl 2,3-dihydrobenzofuran derivatives in good to high yields with excellent diastereoselectivities and high enantioselectivities. The usefulness of this transformation is exemplified in the straightforward synthesis of several CF3 analogues of natural products and bioactive molecules. DFT calculations provide insights into the underlying stepwise pathway and the origin of the enantioselectivity.

Background Kawasaki disease (KD) patients who are unresponsive to intravenous immune globulin (IVIG) have a high occurrence of coronary artery lesions (CALs). The characteristics of left ventricular (LV) function alternation in IVIG‐resistant patients are not well‐described. Hypothesis Two‐dimensional speckle tracking echocardiography (STE) is a useful technique that can accurately detect myocardium subclinical dysfunction in resistant patients and may assist in differentiating patients with KD at a higher risk of IVIG resistance. Methods A consecutive sample of 50 IVIG‐resistant patients (25 males, 2.2 ± 0.9 years), 50 IVIG‐responsive patients (27 males, 2.2 ± 0.7 years) and 50 normal subjects (27 males, 2.1 ± 0.9 years) were analyzed using STE, and receiver operating characteristic curve (ROC) analysis was utilized to determine the threshold values of STE parameters associated with IVIG resistance. Results Compared with normal children, IVIG‐resistant patients had lower global longitudinal strain (GLS) (15.82 ± 3.32 vs 20.01 ± 2.98, P = 0.000) and lower global circumferential strain (GCS) (16.65 ± 3.12 vs 20.11 ± 2.86, P = 0.042). Both GLS and GCS in IVIG‐resistant patients were significantly lower than in IVIG‐responsive patients (15.82 ± 3.32 vs 19.95 ± 3.01, 16.65 ± 3.12 vs 19.01 ± 3.00, P = .000, .030, respectively). ROC analysis demonstrated that the absolute values of GLS < 16.8% and GCS < 15.9% were optimal predictors of IVIG unresponsiveness (area under the curve = 0.78, 0.75; sensitivity = 0.83, 0.79; specificity = 0.69, 0.65, respectively). Conclusion IVIG‐resistant patients presented with more severe LV systolic dysfunction compared with IVIG‐responsive patients, which may be the result of myocarditis rather than CALs. STE may be a helpful diagnostic tool that provides supportive criteria to detect KD patients at a higher risk of IVIG resistance.