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Table of Content

    23 November 2023, Volume 41 Issue 6
    2023, 41(6):  0-0. 
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    Review and Articles
    Study of Low Dose and Low Concentration Contrast Agent in 320-row Coronary Computer Tomography Angiography
    BAO Zhaodi, MA Zhuangfei, SONG Dandan, WANG Chao, QI Xingliang
    2023, 41(6):  283-289.  DOI: 10.7517/issn.1674-0475.230925
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    To explore the feasibility of low dose combined with low concentration contrast agent in 320-row coronary computer tomography (CT) angiography. 153 patients who underwent coronary computer tomography angiography were prospectively collected. 49 patients were included in group A, 52 patients were included in group B, and 52 patients were included in group C. The tube voltage of three groups were 80 kV, 100 kV and 100 kV, respectively. The concentration of contrast agent of three groups were 300 mgI/mL, 300 mgI/mL and 350 mgI/mL, respectively. Statistical data are shown, there were no significant differences in the CT values of the middistal left anterior descending (LAD) and the distal left circumflex (LCX) of three groups (P>0.05), and the CT values of the other segments in group A were higher than those in group B and C (P<0.05). There were no significant differences in the noise values of the middistal LAD, LCX and right coronary artery (RCA) in the three groups (P>0.05). There were no significant differences in signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and subjective scores among the three groups (P>0.05). The radiation dose of group A was significantly lower than that of group B and group C (P<0.05). In conclusion, low dose combined with low concentration contrast agent can be used in 320-row coronary CTA, which is conducive to reducing the harm of X-ray radiation and high concentration of contrast agent to patients.
    Analysis of Accuracy and Misdiagnosis of Controlled Attenuation Parameter in Evaluating Hepatic Steatosis in Patients with Chronic Hepatitis B
    LU Jingnan, WANG Gailian, WEN Ya, SHA Wenxia
    2023, 41(6):  290-295.  DOI: 10.7517/issn.1674-0475.230711
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    To explore the accuracy of controlled attenuation parameter (CAP) in assessing liver steatosis in chronic hepatitis B, and to analyze factors affecting the diagnostic accuracy of CAP. The clinical data of 215 patients with chronic hepatitis B were retrospectively collected, the diagnostic performance of CAP was analyzed using the receiver operating characteristic (ROC) curve, and the optimal cutoff value of CAP to evaluate different degrees of hepatic steatosis was obtained to distinguish different degrees of hepatic steatosis. To analyze the inconsistency between CAP and magnetic resonance proton density fat fraction (MRI-PDFF) in assessing the stage of hepatic steatosis. Logistic regression was used to analyze risk factors for CAP misdiagnosis. The results showed that in the entire study population, CAP had good diagnostic performance in diagnosing steatosis with or without steatosis, mild steatosis, and moderate to severe steatosis. According to the inconsistency in the diagnosis of steatosis stage between CAP and MRI-PDFF, patients were divided into a diagnostic consistency group and a diagnostic inconsistency group.Logistic regression results showed that age and BMI were independent risk factors for misdiagnosis of CAP. Although CAP has a certain misdiagnosis rate in assessing hepatic steatosis in chronic hepatitis B, it still has good diagnostic accuracy.
    Analysis of the Echocardiographic Features in Patients with Kawasaki Disease Shock Syndrome
    LI Si, LIU Gang, ZHANG Tongru
    2023, 41(6):  296-299.  DOI: 10.7517/issn.1674-0475.230708
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    This study aims to improve the understanding of cardiovascular complications of KDSS by retrospectively analyzing the echocardiographic manifestations of children with Kawasaki disease shock syndrome (KDSS) in the acute phase. A total of 20 children diagnosed as KDSS and 41 children diagnosed as hemodynamically stable Kawasaki disease (KD) were collected as study subjects to compare their echocardiographic characteristics in the acute phase. There were no statistically significant differences in age and sex between the KDSS group and the control group; the incidence of coronary artery dilatation and mitral regurgitation in the acute phase of echocardiographic manifestation was significantly higher than that of the control group, and the differences were statistically significant (P<0.05). KDSS is more likely to cause cardiovascular system complications and requires closer echocardiographic monitoring; mitral regurgitation is a characteristic manifestation of KDSS in the acute phase.
    Investigation the Factors of Brain Injury in Children with Patent Ductus Arteriosus Based on Ultrasound Cerebral Blood Flow Parameters
    LV Xia, DUAN Yanni, ZHANG Mengmeng, MA Liqiong
    2023, 41(6):  300-306.  DOI: 10.7517/issn.1674-0475.230607
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    This article explores the factors leading to brain injury in children with patent ductus arteriosus (PDA) based on ultrasound cerebral blood flow parameters. 207 premature infants with PDA were divided into a non brain injury group (148 cases) and a brain injury group (59 cases) as the study subjects. Compare the clinical data and cerebral blood flow parameters of two groups of research subjects, and analyze the risk factors that may cause brain injury. The efficacy of combining clinical indicators and cerebral blood flow parameters in predicting the occurrence of brain injury. Build a column chart model and validate it. The results showed that birth weight, chorioamnionitis, 5-minute Apgar score, middle cerebral artery resistance index (RI), and anterior cerebral artery RI were all influencing factors for the occurrence of brain injury in premature infants with PDA (OR>1, P<0.05). The column chart prediction model has good discrimination, accuracy, and effectiveness. The combination of cerebral blood flow parameters and clinical indicators has higher diagnostic efficacy in predicting brain injury.
    Correlation Analysis of Intracranial Vascular Plaque Parameters Based on HR-MRI and Prognosis of Patients with Early-onset and Re-onset Cerebral Infarction
    ZHU Tong, WU Yanyun, CHEN Yuxian
    2023, 41(6):  307-313.  DOI: 10.7517/issn.1674-0475.230701
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    The differences of intracranial vascular plaque parameters between high-resolution magnetic resonance imaging (HR-MRI) in elderly patients with primary and recurrent cerebral infarction were compared, and the relationship between the characteristic parameters of intracranial vascular plaque and the prognosis of patients was discussed. A total of 179 elderly patients with cerebral infarction were retrospectively selected. All patients underwent HR-MRI examination before treatment. According to the cause of hospitalization, the patients were divided into primary group and recurrent group. The differences of HR-MRI intracranial vascular plaque parameters between the two groups were compared. According to the clinical outcomes, the patients were divided into good prognosis group and poor prognosis group. Univariate and multivariate Logistic regression analysis were used to analyze the relationship between HR-MRI intracranial vascular plaque parameters and other factors and the prognosis of patients with cerebral infarction. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of HR-MRI intracranial vascular plaque parameters in predicting the poor prognosis of patients with cerebral infarction. The results indicate there was no significant difference in plaque remodeling and eccentricity index between the initial and recurrent cerebral infarction groups (P>0.05). There were significant differences in intracranial vascular plaque area, plaque load, plaque hemorrhage ratio and plaque enhancement degree between the two groups (P<0.05). Univariate and multivariate results showed that recurrent cerebral infarction, infarct size, increased NIHSS score, increased plaque load, and intraplaque hemorrhage were independent influencing factors for poor prognosis in patients with cerebral infarction. The AUC of plaque burden, intraplaque hemorrhage, plaque enhancement and predictive probability based on HR-MRI in predicting the risk of poor prognosis in patients with cerebral infarction were 0.658, 0.604 and 0.616, respectively, and the specificities were 77.8%, 76.9% and 82.9%, respectively. The combined prediction AUC was 0.727, the sensitivity was 79.0%, and the specificity was 53.8%. The above findings the characteristics of intracranial vascular plaques in patients with primary and recurrent acute cerebral infarction are different. The characteristics of intracranial vascular plaques are closely related to the prognosis of patients with cerebral infarction. The characteristics of intracranial vascular plaques in cerebral infarction by HR-MRI are helpful to predict the prognosis of patients with cerebral infarction.
    Diagnostic Sensitivity Analysis of Abdominal Ultrasound Combined with DCE-MRI in Ovarian Tumor-like Lesions
    YUAN Yan, HU Pingxiang, LIN Yanqiu, QIU Yuanchan, ZENG Weishan, WU Shan
    2023, 41(6):  314-319.  DOI: 10.7517/issn.1674-0475.230714
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    Studying the diagnostic sensitivity of abdominal ultrasound combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in ovarian tumor-like lesions. In patients with clinically suspected ovarian tumor-like lesions. All patients underwent abdominal ultrasound DOS combined with DCE-MRI, with the postoperative pathological results as the "gold standard". To explore the positive and negative findings of abdominal ultrasound combined with DCE-MRI. Compare the diagnostic efficacy of abdominal ultrasound combined with DCE-MRI (specificity, sensitivity). Also compare the resistance index (RI) of abdominal ultrasound combined with DCE-MRI examination. Automatic calculation of volume transfer constant (Ktrans), rate constant (Kep) and the vascular extracellular space volume ratio (Ve) using matching software. Receiver operator characteristic (ROC) curve analysis model diagnostic value. The results found that the sensitivity of abdominal ultrasound combined with DCE-MRI (96.77%) and specificity (98.55%) were higher than those of single abdominal ultrasound and DCE-MRI (P<0.05). The RI index of ovarian tumor group was higher than that of ovarian tumor group, and Ktrans, Kep and Ve levels were lower than that of ovarian tumor group (P<0.05). The optimal cut-off value of drawing ROC curve prediction model was 0.088, suggesting that the diagnostic value of abdominal ultrasound combined with DCE-MRI in ovarian tumor lesions was high.
    Preoperative Imaging Score Combined with Tumor Marker to Evaluate the Prognosis of Hepatocellular Carcinoma after TACE
    XIA Zhiying, DU Fuchuan
    2023, 41(6):  320-325.  DOI: 10.7517/issn.1674-0475.230712
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    To evaluate the value of imaging tumor burden score (TBS) combined with serum alpha-fetoprotein (AFP) in the prognosis of hepatocellular carcinoma (HCC) after transarterial chemo-embolization (TACE). Clinical and imaging data of 87 HCC patients who underwent TACE were collected. The TBS scores were calculated from CT-enhanced images. OS was compared between groups using Kaplan-Meier survival curves and log-rank test. The median survival of HCC patients after TACE was 20.5 months, and the mean TBS score was 9.52±3.26. The results showed that the 3-year OS decreased progressively with increasing TBS (P<0.001); the difference in OS between patients with TBS ≤ 9.9 and TBS>9.9 was statistically significant (P<0.001). Patients' pre-TACE AFP levels were moderately negatively correlated with OS (r=-0.519; P<0.001), and OS was worse in patients with AFP ≥ 400 ng/mL compared with those with AFP < 400 ng/mL (P=0.001). Multifactorial analysis showed that patients with TBS ≤ 9.9 and AFP ≥ 400 ng/mL (HR:5.449; 95%CI:1.951-15.217; P=0.01), TBS>9.9 and AFP<400 ng/mL (HR:13.576; 95%CI:5.873-31.382; P<0.001) and TBS>9.9 and AFP ≥ 400 ng/mL (HR:27.854; 95%CI:8.950-86.683; P<0.001) were both independent predictors of OS after TACE in patients with hepatocellular carcinoma, and the OS of patients with TBS ≤ 9.9 and AFP<400 ng/mL was better than the other three groups (P<0.05). Therefore, the image-based TBS score combined with AFP level has a high value in the prognosis assessment of HCC patients with TACE.
    CT Signs of Acute Appendicitis Perforation in the Elderly
    GAO Zhiyou, GAO Yuan, FANG Tongman
    2023, 41(6):  326-331.  DOI: 10.7517/issn.1674-0475.230713
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    The purpose of this study was to investigate the role of CT signs in the perforation of acute appendicitis in the elderly, so as to improve the diagnosis level of the disease. The CT imaging data of 36 cases of acute appendicitis perforated by laparoscopic appendectomy and pathologically confirmed were retrospectively analyzed and compared with 102 cases of acute appendicitis without perforation. Appendiceal diameter, appendiceal fecalith, air accumulation in appendiceal cavity, air accumulation outside appendiceal cavity, peritoneal thickening and abdominal and pelvic effusion were clearly shown, with statistical differences (P<0.05). There was no significant difference in fat density around the appendix (P>0.05). The most direct sign in the qualitative diagnosis of perforation of appendicitis was extravehicular gas (100%). Binary Logistic regression analysis showed that appendix diameter, peritoneal thickening and abdominal and pelvic effusion were the risk factors for appendix perforation (P<0.05). The ROC curve showed that the diameter of the appendix increased (AUC=0.769), the peritoneum thickened (AUC=0.696) and the abdominal pelvic effusion (AUC=0.601). When appendectomy diameter thickened ≥ 12.35 mm, peritoneal thickening combined with abdominal and pelvic effusion combined diagnosis, the area under ROC curve was up to 0.840. It can be seen that CT image features can provide reliable imaging indicators for the perforation of acute appendicitis in the elderly, and have guiding significance for clinical treatment.
    Application of MAC Technique in CT Removal of Metal Artifacts after Total Ankle Arthroplasty
    ZOU Meng, LI Zhenlin, PAN Xuelin, FAN Min
    2023, 41(6):  332-337.  DOI: 10.7517/issn.1674-0475.230809
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    To investigate the clinical application value of metal artifact correction (MAC) to reduce metal artifact in CT after total ankle arthroplasty. 40 patients who underwent CT reexamination after total ankle arthroplasty were retrospectively collected. The original data were reconstructed by MAC technique and KARL-3D iterative reconstruction and divided into two groups, group A was reconstructed by MAC technique and group B was reconstructed by KARL-3D iterative reconstruction. In group A and group B, the same two layers (tibial prosthesis and talus prosthesis) were selected to characterize the region of interest (ROI), measured the CT value and image noise, calculated the mean value, and calculated the signal-to-noise ratio (SNR) and contrastive noise ratio (CNR) using muscle as reference. Group A and group B were scored subjectively by two radiologists through blind method. The results show that, compared with group B, the CT values of the metal high density area, joint space beside prosthesis and bone tissue in group A were reduced, while the CT values of the metal low density area were increased. The image noise values in group A were all lower than those in group B, with statistical significance (P<0.05). SNR, CNR and image score of group A were higher than those of group B, with statistical significance (P<0.05). MAC reconstruction technique can reduce metal artifacts in CT examination after total ankle joint replacement, improve image quality, and has good clinical application value.
    Study on the Predictive Diagnostic Value of Benign and Malignant Breast Nodules Based on the MRI Nomogram Model
    YANG Qiaofei, YANG Pu, BI Xiaoyang, LI Zhengliang, YANG Lufan, TANG Yanlong
    2023, 41(6):  338-344.  DOI: 10.7517/issn.1674-0475.230814
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    Multivariate Logistic regression analysis was used to construct an MRI multiparametric diagnostic prediction model of breast nodules and to verify the diagnostic efficacy of this model. A total of 205 lesions were retrospective analysis in patients with breast lesions, including 113 malignant lesions and 92 benign lesions. The morphological and kinetic characteristics of the benign and malignant lesions were observed. Using the malignant group as the experimental group and the benign group as the control group, 205 lesions were randomly divided into 174 samples in the training set and 31 samples in the external validation test set. Through statistical analysis, build the prediction model with the training set data and draw its nomogram; use the external verification test set sample to verify the consistency of model diagnosis; draw the receiver operator characteristic (ROC) curve and verify the differentiation of the model by calculating the area under the curve (AUC) to evaluate the sensitivity, specificity and accuracy of the model in the differential diagnosis of benign and malignant breast nodules. After screening, the independent risk factors included in the prediction model were patient age and lesion ADC value, TIC curve, lesion size, and enhancement characteristics. After the study, the prediction accuracy of the prediction model for benign and malignant breast nodules reached 92.2% in this sample. Therefore, the nomogram based on Logistic regression analysis has a high reference value for the prediction of benign and malignant breast nodules.
    Research Progress of Deep Learning Algorithm in the Field of Imaging Diagnosis and Treatment of Hepatocellular Carcinoma
    ZHU Yongyue, ZHOU Zhou, LI Yanruo, GUO Wei, WANG Mohan, WANG Daoqing
    2023, 41(6):  345-349.  DOI: 10.7517/issn.1674-0475.230801
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    Deep learning algorithm is an important branch in the field of artificial intelligence, and intelligent technologies represented by deep learning algorithms have gradually applied to the medical field. Hepatocellular carcinoma is a common malignant tumor of the digestive system in China, and its incidence and mortality remain high, which seriously endangers people's life and health. Timely diagnosis, precise treatment and prognosis evaluation of patients with hepatocellular carcinoma to improve their survival quality and survival rate have always been the key and difficulties in clinical research. Deep learning provides an intelligent method for the diagnosis and treatment of hepatocellular carcinoma. This study summarizes the relevant research on the application of deep learning algorithm to the imaging diagnosis and treatment of hepatocellular carcinoma at home and abroad.
    Study on the Biological Distribution of ENO1 mAb in Cervical Cancer Bearing Mice Monitored by Near Infrared Fluorescence Imaging
    ZHAO Tiaohong, ZHANG Tingting, CHEN Yuanyuan, LU Ruxia, ZHAO Yuanxu, PEI Yaping, LIU Huiling, ZHU Bingdong
    2023, 41(6):  350-357.  DOI: 10.7517/issn.1674-0475.230808
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    In this study, the distribution, metabolism and tumor targeting efficiency of Enolase 1 (ENO1) monoclonal antibody (mAb) in cervical cancer bearing mice were investigated by near infrared fluorescence imaging. The relationship between ENO1 expression and tumor stage, prognosis and tumor immune invasion was analyzed by cancer genome atlas. Cy7-NHS and FITC were coupled with ENO1 mAb to form Cy7-ENO1 mAb and FITC-ENO1 mAb, and the localization of ENO1 mAb in cervical cancer cell TC-1 was verified by laser confocal microscopy, and the subcutaneous tumor model of cervical cancer was established. Near infrared fluorescence (NIRF) imaging was performed at 1, 6, 24, 48, 72, and 120 h after caudal intravenous injection of Cy7-ENO1 mAb. After 24 h of imaging, major organs were rapidly dissected for in vitro imaging. Bioinformatics results showed significant differences in the expression of ENO1 between normal cervical tissue and cervical cancer tissue while immunohistochemistry (IHC) indicated higher ENO1 protein expression in cervical cancer tissues. In addition, the expression of ENO1 was significantly correlated with tumor stage and lymph node stage, and the high expression of ENO1 was correlated with multiple glycolytic enzymes. Confocal laser microscopy showed that FITC-ENO1 mAb could specifically bind to the surface of TC-1 cell membrane, and no cell internalization was observed. Near infrared fluorescence imaging showed that Cy7-ENO1 mAb was mainly enriched in liver, kidney and tumor tissues, and had high tumor targeting efficiency. NIRF imaging allows real-time and dynamic monitoring of ENO1 mAb distribution in cervical cancer bearing mice, whose metabolic organs are mainly liver and kidney, and confirms ENO1 mAb's targeting of cervical cancer.
    The Predictive Value of Clinical and Ultrasound Indicators for Intraoperative Bleeding Volume in Cesarean Scar Pregnancy
    ZHANG Jieying, WAN Hui, LIU Yingying, LU Yue, DU Jianwen
    2023, 41(6):  358-363.  DOI: 10.7517/issn.1674-0475.230926
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    To explore the risk factors affecting intraoperative bleeding volume in cesarean scar pregnancy (CSP) after cesarean section, and to search for clinical and ultrasound indicators that can predict intraoperative bleeding volume in CSP. A retrospective study was conducted to analyze the clinical and ultrasound data of 133 patients with CSP, and the patients were divided into group A (bleeding volume<100 mL) and group B (bleeding volume ≥ 100 mL) based on whether the intraoperative bleeding volume was more than 100 mL. Logistic regression model was used to analyze the risk factors related to intraoperative bleeding volume in patients. Logistic regression model screened the maximum diameter of gestational sac and the residual myometrial thickness as independent risk factors for predicting intraoperative bleeding volume, with cutoff values of 32.5 mm and 2.45 mm, respectively. In this study, we concluded that residual myometrial thickness and the maximum diameter of gestational sac are independent risk factors for predicting intraoperative bleeding volume during CSP.