The latest research progress on early diagnosis of lung cancer according to CT-based computer intelligent analysis / 中国胸心血管外科临床杂志

@#Lung cancer has brought tough challenges to human health due to its high incidence and mortality rate in the current practice. Nowadays, computed tomography (CT) imaging is still the most preferred diagnostic tool for early screening of lung cancer. However, a great challenge brought from accumulative CT imaging data can not meet the demand of the current clinical practice. As a novel kind of artificial intelligence technique aimed to deal with medical images, a computer-aided diagnosis has been found to provide useful auxiliary information, attenuate the workload of doctors, and significantly improve the efficiency and accuracy for clinical diagnosis of lung cancer. Therefore, an effective combination of computer-aided techniques and CT imaging has increasingly become an active area of investigation in early diagnosis of lung cancer. This review aims to summarize the latest progress on the diagnostic value of computer-aided technology with regard to early stage lung cancer from the perspectives of machine learning and deep learning.

Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer

Objective@#To objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer. @*Materials and Methods@#This retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40–80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Z eff) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis. @*Results@#Low keV MEI (+) at 40–50 keV showed increased CNR and SNR breast lesion compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNR breast lesion: 40 keV, 21.01; 50 keV, 16.28; vs.PEI, 10.77; p< 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images (p < 0.001). MEI (+) at 40 keV, ID, and Z eff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI (p = 0.022, p = 0.033, respectively). @*Conclusion@#Compared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.

Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer

Objective@#To objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer. @*Materials and Methods@#This retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40–80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Z eff) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis. @*Results@#Low keV MEI (+) at 40–50 keV showed increased CNR and SNR breast lesion compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNR breast lesion: 40 keV, 21.01; 50 keV, 16.28; vs.PEI, 10.77; p< 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images (p < 0.001). MEI (+) at 40 keV, ID, and Z eff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI (p = 0.022, p = 0.033, respectively). @*Conclusion@#Compared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.

CT characteristics of primary pulmonary lymphoma and misdiagnosis analysis / 实用放射学杂志

Objective To explore CT performance of primary pulmonary lymphoma(PPL)and analyze the cause of misdiagnosis. Methods CT data of 42 cases with PPL which confirmed by pathology and clinical were analyzed.All cases met the diagnostic criteria of Kim et al[1] and CT analysis of lesions included the location,shape,border,enhanced degree and internal characteristic,etc.CT images of 29 preoperative misdiagnosis cases were also analyzed and summarized.Results 34 cases underwent both pre-contrast and post-contrast scan and 8 cases only had plain CT scan.The cases included mass or nodular type(21 cases),pneumonic-alveolar type(11 cases), bronchovascular-lymphatic type(4 cases),and mixed pattern(6 cases).Meanwhile,CT features contained air-bronchus sign (32 cases),angiogram sign(20 cases),airway dilatation(4 cases)and cross lobe growing(4 cases).29 cases were misdiagnosed as other lung diseases,thus misdiagnosis rate accounted for 69%.Conclusion PPLs mainly present with intrapulmonary nodules, masses and patches.In the lesions,air-bronchus sign or angiogram sign can be seen,and the density of solid portion is homogeneous with mildly to moderately homogeneous enhancement.The coexistence of multiple-type lesions and trans-lobes distribution have certain characteristics.

Assessment of renal cortex blood flow with arterial spin labeling MRI in patients with type 2 diabetes / 中国医学影像技术

Objective To investigate the value of arterial spin labeling (ASL) MRI in evaluation of renal cortex perfusion in patients with type 2 diabetes.Methods Fifty patients with type 2 diabetes were enrolled and divided into simple diabetes (SD) group (n=25) and diabetes kidney disease (DKD) group (n=25) according to suffering from DKD or not.Based on estimated glomerular filtration rate (eGFR),DKD group were further divided into mild disease subgroup (n=11,eGFR≥ 60 ml/[min · 1.73m2]) and moderate-severe disease subgroup (n=14,eGFR＜60 ml/[min · 1.73m2]).Twenty-five healthy volunteers were recruited as control group at the same time.ASL MRI were performed on all participants.The cortical renal blood flow (RBF) of bilateral kidneys were measured by 2 radiologists.The consistency between 2 radiologists was analyzed.Statistical analysis were conducted to analysis the differences in cortical RBF among different groups.Correlation analysis were performed to evaluate the relationship between RBF and eGFR in type 2 diabetes patients.Results Cortical RBF values measured by two radiologists showed high consistency (all ICC＞0.90).There was significant difference in cortical RBF among control group ([269.71±33.28]ml/[100 g · min]),SD group ([258.52±42.30]ml/[100 g · min]),mild disease group ([242.86±56.86]ml/[100 g · min]) and moderate-severe disease group ([173.39±27.16]ml/ [100 g· min];F=20.66,P＜0.01).Moreover,the RBF in moderate-severe disease group was significantly lower than those in other groups (all P＜0.01).And no significant differences of RBF was found among the remainder groups (P=0.064,0.320).RBF in type 2 diabetes patients was positively correlated to eGFR (r=0.646,P＜0.001).Conclusion ASL MRI is a valuable tool to quantitatively assess the renal perfusion in patients with type 2 diabetes mellitus,which can provide potential imaging indicator as RBF for the functional evaluation of kidney.

Subbands analysis of amplitude of low-frequency fluctuations in type 2 diabetes mellitus patients: a resting-state functional MRI study / 中华放射学杂志

Objective To investigate changes of spontaneous brain activity in patients with type 2 diabetes mellitus (T2DM) by fractional amplitude of low-frequency fluctuations (fALFF) on subbands, and the possible relationship between these changes and cognitive impairment caused by T2DM.Methods Twenty-two T2DM patients and twenty-three healthy control subjects were involved in this study between December 2013 and June 2014 and the demographic and clinical data (fasting plasma glucose and HbA1c level) were obtained in all subjects.General cognition was assessed by MMSE in all subjects, and memory performance was assessed by Auditory Verbal Learning Test (AVLT) in T2DM group.3D-T1 structural and resting-state functional MRI data were collected by MR scanner.Then fALFF value on slow-5 (0.010-0.027 Hz) and slow-4 (0.027-0.073 Hz) were calculated respectively using DPARSF V2.3.Intra-group and inter-group t-tests were conducted by REST V1.8.Partial correlation among fALFF values extracted from significantly different brain regions, clinical data and AVLT score of T2DM patients were calculated , using age as covariate.Results Compared to the healthy controls, T2DM patients showed increased fALFF values in bilateral anterior cingulate gyrus (cluster=130, t=4.4487, P＜0.05) and partial left cerebelum areas (cluster=89, t=3.8409, P＜0.05) in frequency band slow-5.Moreover, the T2DM patients showed decreased fALFF values in bilateral middle occipital gyrus and precuneus (Left: cluster=102, t=-3.4806.Right: cluster=151, t=-5.1355.All P＜0.05) in frequency band slow-5.While in frequency band slow-4, the T2DM patients showed increased fALFF values in left inferior temporal gyrus (cluster=104, t=4.8631, P＜0.05), and decreased fALFF values in right lingual gyrus (cluster=91, t=-3.7146, P＜0.05).There was positive correlation between fALFF values of middle occipital gyrus and precuneus and AVLT immediate memory score (r=0.456, P=0.038).Conclusions T2DM patients exhibit abnormal spontaneous activity among brain regions associated with cognition, including brain regions related to default mode network on slow-5, and brain regions related to semantic cognition and visual information processing on slow-4.The abnormal regions exhibit different spatial patterns depending on the subbands of low-frequency fluctuations.

Evaluation and development of preoperative liver reserve function evaluation methods / 中华消化外科杂志

Liver resection is one of the important treatments of liver diseases,especially hepatocellular carcinoma.In China,the vast majority of liver cancer patients suffer from generalized damage of the liver parenchyma such as cirrhosis,lead to liver reserve function reducing in various degrees.Liver dysfunction or even liver failure after liver resection becomes an important reason of perioperative death and influences the patients' long-term survival.Therefore,accurate preoperative evaluation of liver reserve function is very important.Though there are seveal kinds of assessment of liver reserve function in recent years,it still lack of a clinically recognized,comprehensive assessment method.This paper reviewed the clinical commonly used preoperative liver reserve function evaluation methods,summarizes and analyzes the value and the insufficiency of several important methods,and prospects the development of evaluation methods about preoperative liver reserve function.

Evaluation of liver function reserve with gadoxetate disodium-enhanced MR / 中华放射学杂志

Objective To determine the values of gadoxetate disodium-enhanced MRI for quantitatively evaluating the liver function reserve.Methods Forty consecutive liver cirrhosis patients were enrolled in this retrospective study.All the patients underwent complete routine laboratory tests and the gadoxetate disodium-enhanced MR imaging with the same parameters.Liver volume and the relative enhancement index of the whole liver in hepatocellular phase were used to calculate liver relative uptake value,which is supposed to represent the total liver function reserve.And the function reserve of all liver segments was evaluated respectively by the relative enhancement index of each liver segment.One-way ANOVA was used for statistical analyses.Results The patient number in Child-Pugh A,B and C group was 23,10 and 7,respectively.Significant differences was observed in liver relative uptake value among patients in different Child-Pugh classes (F =122.05,P ＜ 0.01).Mean liver relative uptake value was highest in Child-Pugh A group(1212 ± 168),followed by B group and C group (695 ± 161,234 ±55).In Child-Pugh A group,the relative enhancement index of S1 to S8 was 1.13 ± 0.22,1.12 ± 0.50,0.81 ± 0.24,1.08 ± 0.32,1.41 ± 0.25,1.10 ± 0.30,1.16 ± 0.41 and 1.17 ± 0.23,respectively (F =5.93,P ＜ 0.01).There was no significant difference in B and C group (F =1.95,1.83 ; P ＞ 0.05).Conclusion Gadoxetate disodiumenhanced MRI can be used for evaluating whole liver function reserve quantitatively.This technique also has a potential value for evaluating of the segmental liver function reserve before partial hepatectomy.

Computed tomography features of small bowel wall thickening and its clinical significance / 中华消化外科杂志

Small bowel wall thickening is one of the presentations of small bowel diseases.Conventional diagnostic methods,such as enteroscopy, barium-contrast radiography,X-ray,capsule endoscopy,and ultrasonograhy have disadvantages of low positive rate and high misdiagnosis rate.From December 2009 to December 2011,2672 patients with small bowel wall thickening were admitted to the Southwest Hospital.The location,range,degree,attenuation,enhancement feature and associated perienteric abnormalities of thickened bowel wall were studied. Differential diagnosis of tumorous and non-tumorous small bowel wall thickening,malignant and benign tumorous small bowel wall thickening,and different diseases caused nontumorous small bowel wall thickening were carried out in the study.Etiopathogenesis of small bowel wall thickening can be inferred by computed tomography,and multi-slice computed tomography plays an important role in the differential diagnosis.

The Application of fMRI in brain surgery for the lesions in or around the Broca's area of brain / 中国神经精神疾病杂志

Objective To evaluate the value of fMRI guided brain surgery for the lesions in or around Broca's area.Methods Forty-three patients with lesions in or adjacent to the Broca's area were studied.fMRI imaging was obtained by BOLD technique with the tasks of reciting.Fiber tract imaging of white matter was obtained by DTI technique.All functional imaging and anatomic imaging were transferred to neuronavigation system.The technique of direct cortical stimulation was used to validate the language cortex in fMRI.The lesions were resected in microscope.Results Broca's area activation was detected in 38 cases..The distance between the fMRI peak and direct cortical stimulation was rated as overlapping (<1 cm diatance) in 25 cases and neighbouring (<2 cm diatance) in 11 cases.Total lesion resection was achieved in 17 cases, subtotal resection in 14 cases, and partial resection in 12 cases.Postoperative neurological functions were improved in 8 cases, unchanged in 31 cases, and temporary worsen in 4 cases.Conclusions The identification of the Broca's area by reciting task in fMRI is sensitive and precise.The fMRI is helpful to decrease the side effect injury in the brain surgery for the lesions in or around the Broca's area.

MRI study on the cortical thickness of occipital lobe in children with ametropic amblyopia / 中华放射学杂志

Objective To study cortical thickness of the occipital lobe in children with ametropic amblyopia by using MRI technique and the FreeSurfer software.MethOds Nine children with ametropic amblyopia were included in the amblyopic group and 8 normal children were included in the control group.All the children underwent brain MRI on the Siemens Avanto 1.5 T scanner.For the cortical thickness analysis,3-demensional MPRAGE images were collected and analyzed with FreeSurfer software package.Cortical thickness of related regions in the occipital lobe (including the cuneus,later occipital,lingual,and pericalcarine gyri) were recorded and compared. Results The cortical thickness of the lingual,pericalcarine gyri on the left hemisphere and the cuneus,lateraloccipital,lingual gyri on the right hemisphere in amblyopic group were lower than the control group (P＜0.05). Conclusion Morphological changes existed in the occipital lobe in ametropic amblyopic children.The analysis technique with the FreeSurfer package has a potential value in the clinical application.