Surgical management of neonatal coarctation of the aorta with aortic arch hypoplasia: A retrospective study in a single center / 中国胸心血管外科临床杂志

@#Objective     To summarize the surgical treatment experience in neonates with coarctation of the aorta (CoA) and aortic arch hypoplasia (AAH). Methods     The neonates with CoA and AAH who underwent surgical treatment in the Department of Pediatric Cardiac Surgery of Guangdong Provincial People's Hospital from 2013 to 2020 were retrospectively enrolled. The postoperative complications, long-term survival rate, and freedom from aortic reobstruction were analyzed. Patients undergoing extended end-to-end anastomosis were allocated into an extended end-to-end group, those undergoing extended end-to-side anastomosis into an extended end-to-side group, and those undergoing pulmonary autograft patch aortoplasty into a patch aortoplasty group. Results     Finally 44 patients were  enrolled, including 37 males and 7 females, aged 5.00-30.00 (19.34±7.61) days and weighted 2.00-4.50 (3.30±0.60) kg. There were 19 patients of extended end-to-end anastomosis, 19 patients of extended end-to-side anastomosis, and 6 patients of pulmonary autograft patch aortoplasty. The mean values of the Z scores of the proximal, distal, and isthmus of the aortic arch were –2.91±1.52, –3.40±1.30, and –4.04±1.98, respectively. The mean follow-up time was 45.6±3.7 months. There were 2 early deaths and no late deaths. Aortic reobstruction occurred in 8 patients, and 3 patients underwent reoperation intervention. The 5-year rate of freedom from reobstruction was 78.8%. The Cox multivariable regression analysis showed that the related factors for postoperative reobstruction were the Z score of the preoperative proximal aortic arch (HR=0.152, 95%CI 0.038-0.601, P=0.007) and the postoperative left main bronchus compression (HR=15.261, 95%CI 1.104-210.978, P=0.042). Conclusion     Three surgical procedures for neonates with CoA and AAH are safe and effective, but the aortic reobstruction rate in long term is not low. The smaller Z score of the preoperative proximal aortic arch and the postoperative left main bronchus compression are risk factors for long-term aortic reobstruction.

Application of virtual reality technology in surgical treatment of congenital heart disease complicated with ventricular outflow tract stenosis / 中华胸心血管外科杂志

Objective:To explore the application value of virtual reality(VR) technology in the surgical diagnosis and treatment of congenital heart disease complicated with ventricular outflow tract stenosis.Methods:From November 2017 to October 2018, a total of 11 cases of congenital heart disease complicated with ventricular outflow tract stenosis were diagnosed and treated by VR technology assisted surgery in our center, including 9 cases of tetralogy of Fallot, 1 case of right ventricular double outlet stenosis and 1 case of right ventricular double outlet complicated with right ventricular outflow tract and pulmonary valve stenosis. The matching degree and value score of VR model by surgeons after operation. The data of these cases, including postoperative severe complications, maximum flow velocity and peak pressure difference and left ventricular ejection fraction(LVEF) 3 months after surgery, were retrospectively analyzed to evaluate the application value of VR technology and summarize the application experience of our center.Results:The operations were successful in all the 11 cases with no death in hospital. No serious complications related to the ventricular outflow tract occurred after the operation. The peak systolic velocity of the ventricular outflow tract in all the patients decreased to less than 2 m/s, and LVEF was in the normal range three months after the operation. In terms of VR model scores, the matching degree of all cases was 8/10 or above and 8 patients received a 3/3 of value score.Conclusion:For patients with congenital heart disease complicated with ventricular outflow tract stenosis, VR technology based on CT three-dimensional reconstruction can help surgeons more intuitively understand the spatial location information of each intra- and extra-cardiac structure and evaluate the feasibility of key surgical procedures, which is conducive to individual surgery and guarantees a good surgical outcome.

Application of artificial intelligence in cardiovascular medicine / 中国胸心血管外科临床杂志

@#Cardiovascular diseases are the leading cause of death and their diagnosis and treatment rely heavily on the variety of clinical data. With the advent of the era of medical big data, artificial intelligence (AI) has been widely applied in many aspects such as imaging, diagnosis and prognosis prediction in cardiovascular medicine, providing a new method for accurate diagnosis and treatment. This paper reviews the application of AI in cardiovascular medicine.

Accuracy evaluation of cardiac models of cases with complex congenital heart disease printed by domestic 3D printers / 中华胸心血管外科杂志

Objective To evaluate the accuracy of 3D models of patients with complex congenital heart disease(CHD) printed by domestic 3D priuters based on cardiac CT data.Methods From April 2018 to June 2018,our hospital used domestic 3D printers to print the hearts of 50 patients with complex CHD.The median age of the patients was 24 months(1 month to 61 years),and the diseases included pulmonary atresia,right ventricular double outlet and transposition of aorta.3 measurement sites(150 in total) were selected for each patient.Pearson correlation coefficient calculation,paired t test and Bland-Altman analysis were performed.Results Pearson correlation coefficient is 0.997.The difference of the measured value of CT-model was tested for normality.P was 0.2 of the D test.The Q-Q graph showed that the data point and the theoretical line were highly overlapped.The mean difference was (-0.07 ± 0.67) mm,P =0.196.In Bland-Altman analysis,the consistency boundary value interval of the difference was(-1.29 mm,1.16 mm) between which there were 143/150(95.33％) points.Conclusion 3D models of patients with complex CHD printed by domestic 3D printers based on cardiac CT data have good accuracy.

A preliminary discussion on the application experience of virtual reality technology and mixed reality technology in complex congenital heart disease surgery / 中华胸心血管外科杂志

Objective To analyze the application of virtual reality technology and mixed reality techniques in our hospital before and during intraoperative evaluation of complicated congenital heart diseases .Methods Methods Retrospectively ana-lyze the clinical treatment, surgical decision-making, intraoperative and early prognosis of 11 children with complicated congen-ital heart disease assessed by virtual reality technology and mixed reality techniques.The time of operation was 34-121 min, CPB time was 26-101 min, the clamping time of aorta was 18-56 min.There was no operative death.Results All 11cases were assessed by virtual reality technology and mixed reality technology before surgery .Personalized surgical strategies were made based on the evaluation results.All patients had undergone operations successfully.Compared with traditional surgical methods, fewer surgical incisions and shorter operation time were required.And it improved the surgical results.Conclusion Virtual reality technology and mixed reality technology have a great advantage in preoperative and intraoperative evaluation of complex congenital heart diseases.They can optimize surgical strategies, shorten operation time, and reduce surgical trauma. They are worthy of further promotion and application in clinical practice.

Effects of bimodal intervention on the development of auditory and speech ability in infants with unilateral cochlear implantation / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the effects of bimodal intervention on the development of auditory and speech ability in the infants with unilateral cochlear implantation(CI).@*Methods@#Total 35 bilateral profound sensorineural hearing loss infants with unilateral CI, aged 0.7 to 2.8 years old, were selected. The subjects were divided into two groups: the group with unilateral CI(cochlear implant alone, n= 15), and the bimodal group with CI and contralateral fitting hearing aid(n= 20). Their auditory and speech abilities were estimated at the different time points after switch-on(the 0th, 0.5th, 1st, 3rd, 6th, 12th, 18th, and 24th month, respectively) using Infant Toddler-Meaningful Auditory Integration Scale(IT-MAIS), Meaningful Use of Speech Scale(MUSS), Categories of Auditory Performance(CAP), and Speech Intelligibility Rating(SIR) scores.@*Results@#The IT-MAIS scores of bimodal group after switch-on were higher than unilateral CI group(the 0.5th, 1st, 3rd, 6th, 12th, and 18th month), the statistical significances were identified at the 0.5th, 1st, 3rd, 6th, and 12th month, respectively(P<0.05). The CAP scores of bimodal group before CI operation and after switch-on(the 0.5th, 1st, 3rd, 6th, 12th, 18th and 24th month)were higher than unilateral CI group, the statistical significances were seen at the 3rd, 6th, 12th, 18th and 24th month after switch-on(P<0.05). The MUSS scores of bimodal group after switch-on were higher than unilateral CI group(the 1st, 3rd, 6th, 12th, 18th and 24th month), the statistical significances were found at the 12th, 18th and 24th month, respectively(P<0.05). The SIR scores of bimodal group after switch-on were higher than unilateral CI group(the 3rd, 6th, 12th, 18th and 24th month), and significant differences appeared at the 12th, 18th and 24th month after switch-on(P<0.05).@*Conclusion@#Bimodal intervention could be helpful to the development of auditory and speech ability of infants.

Automatic Robotic Puncture System for Accurate Liver Cancer Ablation Based on Optical Surgical Navigation / 中国医疗器械杂志

This paper designed an automatic robotic puncture system for accurate liver cancer ablation based on optical surgical navigation. The near-infrared optical surgical navigation system we constructed for liver ablation was applied to carry out surgical planning and simulation, the near-infrared cameras dynamically tracked the current position of puncture needle relative to the location of the patient's anatomy, then guided the surgery robot to position precisely in three-dimensional space and performed the surgery.

3D printing technology-based diagnosis and therapeutic pattern in complex congenital heart disease: single center experience in 40 patients / 中华胸心血管外科杂志

Objective To evaluate the value of three-dimensional(3 D) printing technique in the diagnosis and treatment of complex congenital heart disease(CHD).Methods From March 2016 to February 2018,40 patients with complex CHD underwent heart CT scanning.The CT images were imported to Standard Template Library(STL) files after 3D reconstruction and then exported for 3D printing.The 3D printed models were then used for decision making and navigation during surgery.Results Thirty patients were indicated for surgical operation.Three patients underwent single ventricular repair,and biventricular repair were operated on 27 patients.The 3D printed models were quite in accordance with the actual anatomical findings in all the patients.And all the procedures carried on were exactly same as planned based on 3D printed model.Conclusion The 3D printing may help improve the diagnosis and treatment level in complex CHD.

The value of cardiac MRI in diagnosis of Ebstein anomaly / 中华放射学杂志

Objective To evaluate the value of cardiac MRI in the diagnosis of Ebstein anomaly (EA). Methods Twenty patients from February 2014 to April 2017 with EA confirmed by surgery were enrolled into this study. The analysis in all patients was made according to preoperative cardiac MRI, 2D TTE and surgical data, including the changes of tricuspid valve leaflets, Carpentier classification, the size and function of atrioventricle, late Gadolinium enhancement, the total right/left-volume index and cardiopulmonary bypass time,etc.The numbers of apicaldisplaced leaflets and development condition of all the leaflets were compared using the R×C χ2among the three groups.With surgical results as the reference standard, the diagnostic accuracy of the two groups for the development condition of all the leaflets were evaluated. One-way ANOVA was performed to compare the differences of the apicaldisplaced distance of septal leaflet, using these three methods. Comparisons of the total right/left-volume index, surgery-related data between patients with or without late gadolinium enhancement were performed by independent t test.Results (1) The results in anatomicalstructures, such as distance of apicaldisplacedseptal leaflet,displacement of each leaflet and the Carpentier classification, showed nostatistical difference among MRI,2D TTE and operational findings. The leaflet dysplasia defined by MRI and 2D TTE areequivalent to surgically defined severe dysplasia, and surgically defined mild to moderate dysplasia can't be identified by the former two methods. The overall diagnostic accuracy of MRI and 2D TTE to identify leaflet dysplasia were 41.3%(19/46) and 34.7%(16/46), respectively.(2) Functional right ventricular volume index decreased in 1 case, normal in 8 cases, increased in 11 cases;functional right ventricula rejection fraction decreased in 15 cases. Six patients' left ventricular volume index decreased, 13 remained in normal range, 1 showed increased;left ventricula rejection fraction decreased in 14 cases. (3)LGE was identified in 8 patients and non-LGE in 12. Difference of the total right/left-volume index [(7.12 ± 4.06) vs. (3.84 ± 2.10), P=0.029] between two groups was statistically significant. However, there was no statistical difference in extracorporeal circulation time, aorticcross-clamping time, intubation time, ICU residence time and postoperative hospital staybetween the LGE and non-LGE groups.Conclusions Cardiac MRI can relatively accurately evaluate the apicaldisplacement of leaflets and the morphological changes of the atria and ventricles, as well as quantitatively evaluate the ventricular function, which can rovide references for clinical diagnosis and severity evaluation of EA.

Anatomic classification of coronary arteries in complete transposition of great arteries：diagnosis and analysis with multi-slice CT / 中华放射学杂志

Objective To evaluate the diagnostic value of multi-slice spiral CT (MSCT) in classifying coronary arteries of complete transposition of great arteries (D-TGA). Methods The clinical and imaging data of 367 patients with D-TGA who had undergone MSCT examination from March 2005 to June 2015 were retrospectively analyzed. The origin and course of the coronary arteries of the patients were classified according to the Marie Lannelongue classification. There were four patterns of courses: normal, looping, intramural and miscellaneous. And the four patterns were subdivided into eleven subgroups. The anatomic classification of coronary arteries in D?TGA were recorded, and the ratio of descriptive statistics was used according to categorical variable data. Results All the origin and course of the coronary arteries could be clearly displayed on MSCT. Of 367 patients with D-TGA, 209 cases (56.95%) were normal course (typeⅠ), 138 cases (37.60%) were looping course (typeⅡ), 16 cases (4.36%) were intramural course (typeⅢ), and 4 cases (1.09%) were miscellaneous course (typeⅣ). In looping course, the posterior looping (typeⅡA), anterior looping (typeⅡB) and double looping (typeⅡC) were found in 63 cases (17.17%), 30 cases (8.17%) and 45 cases (12.26%), respectively. The ratios of the anatomic classification of looping courses wereⅡA-1 44(11.99%),ⅡA-2 19(5.18%),ⅡB-1 12(3.27%),ⅡB-2 8(2.18%),ⅡB-3 10(2.72%),ⅡC-1 25 (6.81%),ⅡC-2 17(4.63%),ⅡC-3 3(0.82%). Conclusions MSCT is an effective technique to visualize and classify the coronary arteries in patients with D-TGA. And it is helpful for successful transfer of the coronary arteries and reducing the rate of coronary events after operation.

Analysis of CT features of nodular or mass-like type of pulmonary cryptococcosis / 中华放射学杂志

Objective To investigate the CT features of nodular or mass-like type pulmonary cryptococcosis(PC). Methods A total of 52 cases with nodular or mass-like type PC confirmed by pathological examinations at Fuzhou Pulmonary Hospital of Fujian from January 2008 to December 2012 were studied. Each patient underwent a breath-hold MSCT scan and contrast enhanced CT was performed in 19 patients. The data including lesion size, number, distribution, density, performance of enhanced CT scan and accompanying signs were analyzed. Each CT accompanying sign was compared between nodular lesions and mass-like lesions using χ2 test,continuous correction χ2 test or Fisher exact test. Results Of all the 52 patients, pulmonary cryptococcosis was consisted single nodules/masses (21 cases) and multiple of nodules/masses (31 cases). There were total 206 lesions with 172 nodules and 34 masses. The lesions were mainly found in lower lobe(73.3%, 151/206)and outer zone or subpleura(87.4%, 180/206)of lung. Plain CT scan showed the densities of most lesions were solid and uniform(74.7%, 154/206). A total of 95 lesions were detected in the 19 patients with contrast enhanced CT, in which 61 lesions (64.2%) showed homogeneous enhancement and 86 lesions (90.5%) showed moderate enhancement. Nodular or mass-like lesions accompanied by many CT signs including halo sign (59.2%, 122/206), air bronchogram (32.0%, 66/206), pulmonary cavity or vocule sign (15.0%, 31/206), lobulation sign (25.2%, 52/206), spicule sign (13.1%, 27/206), pleural indentation(7.8%, 16/206) and vascular cluster (1.9%, 4/206). Compared with mass-like lesions, lobulation sign was more frequently observed in nodular lesions(χ2=13.750, P=0.001), whereas air bronchogram and pulmonary cavity orvocule sign were less frequently observed(χ2=19.957, P=0.001; χ2=5.295, P=0.021, respectively). No significant statistically differences were detected in other CT signs between them (P>0.05). Conclusions PC lesions usually occur in right lung, lower lobe and close to the pleura. Halo sign and air bronchogram are the characteristic findings of CT manifestations in nodular or mass-like type PC.

Analysis of radiation dose to operators involved in coronary angiography with radiation protection shields: a phantom study / 中华放射医学与防护杂志

Objective To measure the dose to the primary operator and assistant operators by employing eight beam projections commonly used in coronary angiography with and without radiation protection shields in order to supply helpful guidance on radiation protection in cardiac intervention.Methods From 20 to 180 cm above the ground at the primary and assistant operators' locations,a DoseAware personal dose meter was placed in terms of an increment of 20 cm to measure radiation dose.Eight commonly used beam projections were performed,including LAO (left anterior oblique) 45°,RAO (right anterior oblique) 30°,CRAN (cranial)25°,cranial LAO (LAO45°/25°),caudal LAO(LAO45°/ 25°),CAUD (caudal) 25°,cranial RAO (RAO30°/25°),caudal RAO (caudal RAO30°/25°).Under the two different conditions,with or without radiation protection shields,the doses to the operators in the selected beam projections were respectively recorded at nine measuring positions and the shielding factor were calculated.Results The primary operator was effectively protected with radiation protection shields.In the standing area of the primary operator,except for the position at the height of 120 cm (radiation dose rate:0.35-4.78 mSv/h;shielding factor:27.67％-89.33％),the shielding factor for each measuring position was above 91％.Higher radiation doses were found at caudal LAO,LAO,and cranial LAO.The shielding factor for the assisting operator was lower than for the primary operator.In the standing area of the assisting operator (radiation dose rate:0.27-1.86 mSv/h;shielding factor:30.34％-92.13％),the peak levels were found at the height of 80,100,140 cm.And caudal RAO,caudal LAO,CRAN,LAO were found to have received higher radiation doses.Conclusions Emphasis should be attached to the use of radiation shields in coronary angiography.With radiation protection shields,higher dose is still recorded in caudal LAO,LAO,cranial LAO,caudal RAO.Furthermore,it should be paid more attention to radiation protection at 80-140 cm height,and less prolonged exposure should be employed in those beam projections mentioned above.

The optimal radiation protective protocol of ceiling-suspended lead shield for interventional radiolo-gists：a phantom study / 介入放射学杂志

Objective To evaluate the radiation protective efficacy of different types and the positions of ceiling-suspended lead shield to the principal and assistant interventional operators in order to provide a scientific basis for the selection of optimal scheme in using ceiling-suspended lead shield. Methods At the principal and assistant interventional operators’ standing places the personal dose-measuring instruments were set up, which were placed at the height of 20 cm to 180 cm above the ground with an interval distance of 20 cm between each other. The postero-anterior (PA) projection and left lateral projection were used. The ceiling-suspended protection lead shields included lead glass (glass type) and lead glass with connected lead flexible stripe below (mixed type). The placed sites of the protection lead-shields were close to the principal operator, away from the principal operator, on the left side of the principal operator and close to the X-ray tube respectively. The radiation doses of PA projection and left lateral projection were determined. The real-time radiation dose rate and dose shielding rate at the nine measuring positions for the principal operator and assistant operator were separately calculated. The results were analyzed. Results The radiation protection of the glass type was slightly superior to that of the mixed type , but the difference was not significant. The principal operator was best protected when the shield was positioned close to him in the PA projection , and for left lateral projection the principal operator was best protected when the shield was positioned on his left side. For the assistant operator, the optimal protection was obtained when the shield was positioned close to him in both PA and left lateral projection . In the optimal position of ceiling-suspended lead shield , the highest radiation dose rate (0.71 mSv/h in glass group and 1.07 mSv/h in mixed group) was recorded on the principal operator at the height of 120 cm at PA projection, and higher radiation dose rate (≥0.47 mSv/h) was recorded on every point of both operators at the left lateral projection. Meanwhile , the overall received radiation doses of the two groups were very close. At the principal operator standing area , except for the position of 120 cm height (attenuation ratio 60.11% in glass group and 39.89% in mixed group), the attenuation ratio of each measuring point was above 93%. And the assistant operator standing area the attenuation ratio was 57%-97%. The lateral shielding ratio was generally slightly higher than PA shielding ratio. Conclusion The radiation protection effect of the two type shields is quite similar, both shields can obtain excellent protection efficacy. But the radiation dose at the height of 120 cm above the ground at PA projection is higher for the principal operator, while at lateral projection the radiation dose at all height levels is still relatively higher for both operators. Therefore, the radiation protection at the level of 120 cm height needs to be strengthened and the lateral projection exposure should be used as less as possible.

Application of iterative model reconstruction iterative reconstruction in cardiac CT imaging--an animal experimental study / 中华放射学杂志

Objective To evaluate the value of iterative modal reconstruction (IMR) for reducing radiation dose and controlling image quality in cardiac CT. Methods Ten pigs were included. All pigs were scanned on a 256?slice prospectively ECG?gated cardiac CT utilizing routine dose (group A) and tube current reduced by 30%(group B), 50%(group C) and 70%(group D), respectively. Filtered back projection (FBP), hybrid iterative reconstruction (iDose4) and IMR were used for all data, respectively. Image noise and contrast?to?noise ratio (CNR) of ascending aortic root were measured, while overall image quality and coronary artery image quality was rated (five point scale). All results reconstructed by FBP, iDose 4 and IMR were compared. Objective measurements were compared with one?way analysis of variance, and subjective assessments were compared with Kruskal?Wallis H test andχ2 test. Results Compared with that of FBP and iDose4, image noise of IMR was(15.1 ± 6.1),(18.8 ± 5.5),(22.1 ± 4.8)and(33.0 ± 4.0)HU, respectively in group A, B, C and D with significant reduction (F=82.77, 90.71, 96.59, 95.51 respectively, all P0.05) in the diagnosis rates of proximal coronary arteries compared with that using FBP and iDose4, while group C (100%, 40/40) and group D(92%, 37/40) had significantly increased diagnosis rates (χ2=20.05, 45.72, both P<0.01). The diagnosis rates of distal coronary arteries of IMR reconstruction which were 100%(50/50), 98%(49/50), 90%(45/50), 78%(39/50), respectively in groups A, B, C, D had significant increase compared with that of FBP and iDose4 reconstruction (χ2=7.39, 16.75, 34.62, 81.33, all P<0.05). Conclusions IMR can significantly reduce image noise, improve CNR and image quality compared with iDose4. Application of IMR can reduce radiation dose but without compromising image quality.

The optimal radiation protective protocol of ceiling-suspended lead shield for interventional radiolo-gists:a phantom study / 介入放射学杂志

Objective To evaluate the radiation protective efficacy of different types and the positions of ceiling-suspended lead shield to the principal and assistant interventional operators in order to provide a scientific basis for the selection of optimal scheme in using ceiling-suspended lead shield.Methods At the principal and assistant interventional operators’ standing places the personal dose-measuring instruments were set up, which were placed at the height of 20 cm to 180 cm above the ground with an interval distance of 20 cm between each other.The postero-anterior (PA) projection and left lateral projection were used.The ceiling-suspended protection lead shields included lead glass (glass type) and lead glass with connected lead flexible stripe below (mixed type).The placed sites of the protection lead-shields were close to the principal operator, away from the principal operator, on the left side of the principal operator and close to the X-ray tube respectively.The radiation doses of PA projection and left lateral projection were determined.The real-time radiation dose rate and dose shielding rate at the nine measuring positions for the principal operator and assistant operator were separately calculated.The results were analyzed.Results The radiation protection of the glass type was slightly superior to that of the mixed type, but the difference was not significant.The principal operator was best protected when the shield was positioned close to him in the PA projection, and for left lateral projection the principal operator was best protected when the shield was positioned on his left side.For the assistant operator, the optimal protection was obtained when the shield was positioned close to him in both PA and left lateral projection.In the optimal position of ceiling-suspended lead shield, the highest radiation dose rate (0.71 mSv/h in glass group and 1.07 mSv/h in mixed group) was recorded on the principal operator at the height of 120 cm at PA projection, and higher radiation dose rate (≥0.47 mSv/h) was recorded on every point of both operators at the left lateral projection.Meanwhile, the overall received radiation doses of the two groups were very close.At the principal operator standing area, except for the position of 120 cm height (attenuation ratio 60.11% in glass group and 39.89% in mixed group), the attenuation ratio of each measuring point was above 93%.And the assistant operator standing area the attenuation ratio was 57%-97%.The lateral shielding ratio was generally slightly higher than PA shielding ratio.Conclusion The radiation protection effect of the two type shields is quite similar, both shields can obtain excellent protection efficacy.But the radiation dose at the height of 120 cm above the ground at PA projection is higher for the principal operator, while at lateral projection the radiation dose at all height levels is still relatively higher for both operators.Therefore, the radiation protection at the level of 120 cm height needs to be strengthened and the lateral projection exposure should be used as less as possible.

Feasibility of tube current modulation based on the chest circumference in coronary CT angiography / 中华放射医学与防护杂志

Objective To establish a function model to modulate the tube current according to the chest circumference at Coronary CTA scan,and to evaluate the feasibility of using the function model individually.Methods Sixty-eight consecutive patients who underwent thoracic scan with automatic current modulation were studied to establish a function model of tube current and chest circumference.The other 64 consecutive patients underwent coronary CTA scan using the new function model.The image quality was scored,and the noise,tube current and radiation dose were recorded and statistically evaluated.Results The POW function model was the best one to adjust tuber current to the chest circumference (R2 =0.691,P ＜ 0.05).The mean image quality score,noise,tube current,radiation dose (CTDIvol) and dose-length product (DLP) were (3.38±0.72) scores,(31.02 ±3.97) HU,(390.63± 89.30) mA,(34.83±10.72) mGy,(751.67 ±175.16) mGy·cm,respectively.Conclusions Tube current modulation based on the chest circumference would be feasible to reduce the radiation dose individually in coronary CT angiography.

Value of MRI in the diagnosis of complex congenital heart disease / 中国综合临床

Objective To evaluate the value of MRI in the diagnosis of complex congenital heart disease.Methods Twenty-one patients with complex congenital heart disease,who had undergone MRI examination were enrolled in this research.The MRI data of every patient was analyzed and abnormalities of anatomy was counted by two experienced cardiovascular radiologist.Surgical diagnosis (17 cases) or consistent diagnosis (4 cases) of ultrasonic,cardiac catheter and cardiac CT was regarded as reference standards.Accuracy and misdiagnosis rate were obtained.Results Twenty-one patients had 63 main abnormalities,61 malformations was found by MRI examination,the diagnostic accuracy was 96.8％,and the misdiagnosis rate was 4.8％ (1 atrial septal defect (ASD) and 1 major aorta pulmonary collateral arteries (MAPCAS) were missed,1 arterialduct stump was misdiagnosed as patent ductus arteriosus (PDA).Conclusion MRI has excellent diagnosticaccuracy on complex congenital heart disease,it is another good noninvasive cardiac examination method beside ultrasonic.

A comparative study of MRI and ultrasonic cardiography in morphology and blood flow of cavopulmonary anastomosis for patients with bidirectional Glenn shunt / 中华放射学杂志

Objective To investigate the difference of morphology and blood flow of cavopulmonary anastomosis by MRI and that by ultrasonic cardiography (UCG) in patients with bidirectional Glenn shunt (BGS).Methods Phase-contrast MRI (PC-MRI) and contrast enhanced MRI (CE-MRI) were performed for superior vena cava ( SVC ) and inferior vena cava (IVC) in 22 patients with BGS on 3.0 T MR scanner.PC-MRI was used for measuring blood flow and CE-MRI for illustrating morphology.The width,peak flow velocity and gradient pressure of cavopulmonary anastomosis were calculated by using Report Card software.The similar data of UCG was collected.The parameters by MRI and that by UCG were compared statistically by t test and Pearson correlation.Results Based on the MRI data,the blood flow of SVC [ ( 1.002 ±0.208) L/min ] was significantly lower than that of IVC [ ( 1.794 ± 0.392 ) L/min ] ( t =- 15.148,P ＜0.01 ),while the regurgitation fraction of SVC [ (26.54 ± 12.82)％ ] was significantly higher than that ofIVC [ ( 17.44 ± 10.17)％ ] (t =11.060,P ＜0.01 ).The morphology displayed with MRI angiography couldnot be detected with UCG.The width of cavopulmonary anastomosis measured by MRI [ (12.46 ±3.43 ) mm ] was significantly higher than that of UCG[ ( 11.04 ± 2.63 ) mm] ( t =4.048,P ＜ 0.01 ),while the peak flow velocity of cavopulmonary anastomosis measured by MRI [ (47.77 ± 10.44) cm/s] was significantly lower than that of UCG [ (52.19 + 9.63) cm/s] ( t =- 2.237,P ＜ 0.05 ).No significant difference was found in gradient pressure of cavopulmonary anastomosis between the values by MRI [(0.95+0.42) mm Hg(1 mm Hg =0.133 kPa)] and that by UCG [(1.12+0.38)mm Hg] (t=2.010,P ＞ 0.05).The width,peak flow velocity and gradient pressure of cavopulmonary anastomosis by MRI were closely correlated with those by UCG (r =0.858,0.489,0.427,all P＜ 0.05 ).Conclusions A good correlation is found in the width,peak flow velocity,and gradient pressure of the cavopulmonary anastomosis obtained by 3.0 T MRI and UCG.MRI is more useful tool to display the width and abnormal morphology of cavopulmonary anastomosis than UCG.

Multi-slice spiral CT in the diagnosis of congenital heart diseases associated with tracheobronchial stenosis in children / 中华放射学杂志

Objective To explore the diagnostic value of post processing techniques of MSCT for diagnosing congenital heart disease associated with tracheobronchial stenosis in children. Methods Thirty four patients with congenital heart disease complicated by tracheobronchial stenosis were evaluated with MSCT. MPR, CPR, MinIP and VR were performed to show the tracheobronchial morphology. Findings in 43 segments of 32 cases were compared with the findings of surgical operation. Mann-Whitney test was employed to assess the significance of measurement between the post processing techniques and the operation. Results The lenghth of stenotic segments were variable seen at operation, with values between 4-39 mm in trachea, 4-33 mm in main bronchi and 3-12 mm in lobe bronchi, respectively. The biggest difference between the measurement of operation and MSCT was 4 mm (3 segments). Other differences ofstenotic segments were within 3 mm. Six segments exhibitee mild, 16 moderate and 21 severe stenosis at surgery. By contrast, five segments exhibited mild, 17 moderate and 21 severe stenosis by MPR or CPR,2 mild,9 moderate and 32 severe stenosis by MinIP and 4 mild, 11 moderate and 28 sever stenosis by VR,respectively. There was no significant difference in measuring the degree of tracheobronchial stenosis between MPR or CPR, VR and the surgery (Z =-0. 105,- 1. 479;P ＞0.05), while MinIP frequently overrated the degree of stenosis compared with the measurement at surgery (Z=-2.484,P =0. 013). Conclusion The integrated three dimensional reformations of MSCT scan can accurately evaluate the degree and extent of congenital heart disease associated with tracheobronchial stenosis in children and provide valuable information for clinical management.

MRI combined with PET in diagnosis of primary lymphoma of bone / 中国医学影像技术

Objective To observe the imaging features of primary lymphoma of bone (PLB) on MRI and PET, and to assess the value of MRI combined with PET for PLB. Methods Sixteen patients with pathologically confirmed PLB were collected, and the MRI and PET appearances were analyzed retrospectively. Results Single bone infiltration was detected in 15 patients (5 in femurs, 3 in vertebro, 3 in right iliums, 2 in tibias, 1 in radius and 1 in maxillae), while multiple bones infiltration were noticed in 1 patient (lesion located in manubrium sterni and the 7th right rib). MRI demonstrated heterogeneous focal-lamellar or diffuse signal intensity within marrow, isointense or hypointense on T1WI and slightly hyperintense on T2WI with homogeneous or heterogeneous enhancement. Severe soft tissue mass was seen in all 16 patients, the range of soft tissue mass was larger than osseous lesion in 15 patients and equal to osseous lesion in 1. Most PLB were homogeneous isointense or slightly hypointense on T1WI and homogeneous or heterogeneous slight-hyperintense on T2WI with slightly or moderately homogeneous or heterogeneous enhancement, while in 3 patients showed single vertebral compression fracture with local epidural- and/or paravertebral-soft tissue, and the range of soft tissue larger than the pathologic vertebrae. PET was performed before operation in 13 patients, showing local increasement of glycometabolism and uptake of radioactive nuclide without abnormality for other sites. For three patients of primary lymphoma of vertebrae underwent PET after operation, and recurrence was detected in 1 patient after 2 months. Conclusion Large soft mass with small osseous destruction and relatively hypointensity on T2WI is somehow characteristic for PLB. PET features of PLB are not specific, but has some advantages in determining the nature of lesion, differentiating lesions and follow-up after operation. MRI combined with PET is an appropriate imaging method for PLB.