Changes in functional connectivity in patients with acute mild traumatic brain injury based on a triple-network model: a resting state functional MRI study / 中华行为医学与脑科学杂志

Objective:To investigate the resting state functional connectivity changes of the " triple network model" composed of salient network (SN), executive control network (ECN) and default mode network (DMN) in patients with acute mild traumatic brain injury (mTBI).Methods:From August 2020 to December 2021, forty-five acute mTBI patients (mTBI group) and 40 healthy controls (HC group) with matched sex, age, and education were included.The Montreal cognitive assessment (MoCA) scale was used to evaluate the cognitive status of all subjects.The resting state network (RNS) was established based on independent component analysis (ICA), and the SN, ECN and DMN were extracted, then functional network connectivity (FNC) was analyzed.Subsequently, the correlation between functional connectivity abnormalities and the performance of cognitive impairment was analyzed.SPSS 19.0 was used for statistical analysis and double sample t test was used for comparison between the tow groups. Results:Compared with HC group, mTBI group had enhanced functional connectivity between SN(L-insula) (MNI: x, y, z=-36, 15, 0, t=3.693)and ECN (left superior parietal gyrus, L-SPG) (MNI: x, y, z=-33, -69, 54, t=3.333)(FDR adjust, P<0.05), and decreased functional connectivity between DMN(left superior frontal gyrus, L-SFG) (MNI: x, y, z=-30, 30, 42, t=-4.063)and DMN(L-angular gyrus)(MNI: x, y, z=-21, -66, 33, t=-4.101)(FDR adjust, P<0.05). For FNC analysis, functional network connectivity in SN(IC26)-DMN(IC8) was enhanced in the acute mTBI group and decreased between SN(IC26)-DMN(IC12) and ECN(IC3)-DMN(IC12). The changes of left superior parietal gyrus functional connection were negatively correlated with MoCA score ( r=-0.627, P<0.01), and SN (IC26) -DMN(IC12) connection was positively correlated with MoCA score ( r=0.411, P=0.005). Conclusions:In patients with acute mTBI, the resting functional connectivity changes within and between the networks of the " triple network model" composed of SN, ECN and DMN, and is related to the decline of cognitive function.This will help to better understand the neuropathological mechanism of acute mTBI and post-traumatic cognitive impairment, and may become an effective imaging marker for identifying and predicting cognitive impairment after mTBI.

Correlation between vascular wall shear stress and stenosis degree and plaque characteristics in patients with atherosclerotic stenosis in the middle brain / 中华神经科杂志

Objective:To investigate the relationship between wall shear stress (WSS) and the degree of lumen stenosis and plaque characteristics in patients with atherosclerotic stenosis in the middle brain.Methods:Thirty-four patients with moderate to severe unilateral middle cerebral artery stenosis in Nanjing First Hospital from June 2020 to June 2021 were analyzed retrospectively. All patients underwent routine magnetic resonance imaging and vascular wall imaging to obtain plaque parameters such as plaque area, remodeling mode and remodeling index. Based on magnetic resonance angiography, a computational fluid dynamics model was established to simulate the local hemodynamics near the lesion and quantify WSS. The patients were divided into high WSS group and low WSS group according to the median WSS. The differences of clinical baseline data, degree of lumen stenosis and plaque characteristics between the two groups were compared. Pearson correlation analysis was used to calculate the correlation between WSS and lumen stenosis and plaque characteristics.Results:A total of 34 patients were included in this study, 17 in the high WSS group and 17 in the low WSS group. Compared with the low WSS group, the plasma homocysteine level in the high WSS group was lower [(11.10±4.96) μmol/L vs (16.97±6.98) μmol/L, t=-2.83, P=0.010], the degree of stenosis was lower (0.56±0.05 vs 0.66±0.08, t=-4.54, P<0.001), and the proportion of positive lumen remodeling was higher (12/17 vs 4/17, P=0.015). Pearson correlation analysis showed that the degree of lumen stenosis was negatively correlated with WSS ( r=-0.44, P=0.011), and the plaque area was not correlated with WSS. Conclusions:WSS in middle cerebral artery stenosis is related to the degree of lumen stenosis and the mode of vascular remodeling. Higher WSS has poor stability, but lower WSS is more likely to cause lumen stenosis.

The relationship between anxiety- and depression-like behavior and regional homogeneity of fMRI in inferior colliculus and ventrolateral orbital cortex in rats with noise-induced hearing loss / 中华行为医学与脑科学杂志

Objective:To investigate the local consistency of inferior colliculus and ventrolateral orbital cortex by resting-state functional magnetic resonance imaging (fMRI) in rats with noise induced deafness and its relationship with anxiety- and depression-like behavior.Methods:Twenty-four clean grade male four-weeks old SD rats were randomly divided into noise group and control group with 12 rats in each group.Rats in the noise group were exposed to 122 dB broadband strong noise for 2 hours to induce severe bilateral hearing loss, while rats in the control group were placed in a quiet environment. Hearing thresholds were assessed by auditory brainstem response (ABR) test. The open field test (OFT) was conducted to examine anxiety-depression related behavior, and the local consistency in the rat brain was evaluated by fMRI.SPM12 software was used to process fMRI data, and Pearson correlation analysis was conducted by SPSS 22.0 software to calculate the correlation between fMRI data and behavior.Results:The results of ABR showed that the full band hearing threshold of rats in the noise group was higher than that of rats in the control group ((85.417±6.463) dB, (20.083±8.853) dB, t=46.168, P<0.001). And compared with control group, the rats in the noise group showed obvious anxiety-depression-like behavior in the open field test, that was, low activity level.The results of OFT showed that the total distance ((39.912±5.696) m, (47.993±10.820)m, t=-2.289, P=0.032), average moving speed ((13.306±1.900)cm/s, (15.998±3.607)cm/s, t=-2.290, P=0.032) and standing times ((13.333±5.960), (23.500±7.323), t=-3.730, P=0.001) of the rats in the noise group were all lower than those in the control group. Compared with the control group, the local consistency of hypothalamus in the noise group was significantly enhanced, while the local consistency of ventrolateral orbital cortex was significantly reduced, and the abnormal neural activity was lateralized. The correlation analysis showed that the neural activity of the inferior colliculus was negatively correlated with the total distance of rats in the noise group moving in the open field( r=-0.691, P=0.013), while the neural activity of the ventrolateral orbital cortex was not significantly correlated with the anxiety-depression-like behavior in the open field. Conclusions:The neural activity of inferior colliculus is closely related to anxious-depression behavior in rats with noise-induced deafness, while the ventrolateral orbital cortex may be related with other behaviors.

Prediction of the onset time of acute stroke by deep learning based on DWI and FLAIR / 中华放射学杂志

Objective:To evaluate the effect of deep learning based on DWI and fluid attenuated inversion recovery (FLAIR) to construct a prediction model of the onset time in acute stroke.Methods:A total of 324 cases of acute stroke with clear onset time, from January 2017 to May 2020 in Nanjing First Hospital, were retrospectively enrolled and analyzed. The patients were divided into a training set of 226 patients and a test set of 98 patients according to the complete randomization method using a 7∶3 ratio, and the patients were divided into ≤ 4.5 h and >4.5 h according to symptom onset time in each group. The acute infarction areas on DWI and the corresponding high signal area on FLAIR were manually outlined by physician. Using the InceptionV3 model as the basic model for image features extraction, the deep learning prediction model based on single sequence (DWI, FLAIR) and multi sequences (DWI+FLAIR) were established and verified. Then the area under curve (AUC), accuracy of human readings, single sequence model and multi sequence model in predicting the acute stroke onset time from imaging were compared.Results:DWI-FLAIR mismatch was found in 94 cases (94/207) of patients with symptom onset time from imaging ≤ 4.5 h, while in 28 cases (28/117) of patients with symptom onset time from imaging >4.5 h. ROC analysis showed that the AUC of DWI-FLAIR mismatch in predicting acute stroke onset time from imaging was 0.607, and the accuracy was 60.2%. The prediction model of deep learning based on single sequence showed that the AUC of FLAIR was 0.761 and the accuracy was 71.4%; the AUC of DWI was 0.836 and the accuracy was 81.6%. The AUC of predicting stroke onset time based on the multi-sequence (DWI+FLAIR) deep learning model was 0.852, which was significantly better than that of manual identification ( Z = 0.617, P = 0.002), FLAIR sequence deep learning model ( Z = 2.133, P = 0.006) and DWI sequence deep learning model ( Z = 1.846, P = 0.012). Conclusion:The deep learning model based on DWI and FLAIR is superior to human readings in predicting acute stroke onset time from imaging, which could provide guidance for intravenous thrombolytic therapy for acute stroke patients with unknown onset time.

Hemodynamic evaluation of intracranial atherosclerotic lesions based on computational fluid dynamics / 国际脑血管病杂志

Intracranial atherosclerotic lesions are a common cause of ischemic stroke. Hemodynamics plays an important role in the formation and development of atherosclerosis and the risk assessment of clinical ischemic stroke events. As an evaluation method of cerebral hemodynamics, computational fluid dynamics can intuitively obtain hemodynamic parameters and provide valuable information for clinical diagnosis and treatment. This article reviews the application progress of computational fluid dynamics in evaluating peripheral hemodynamics of intracranial atherosclerotic lesions.

Automatic Detection and Classification of Rib Fractures on Thoracic CT Using Convolutional Neural Network: Accuracy and Feasibility

Objective@#To evaluate the performance of a convolutional neural network (CNN) model that can automatically detect and classify rib fractures, and output structured reports from computed tomography (CT) images. @*Materials and Methods@#This study included 1079 patients (median age, 55 years; men, 718) from three hospitals, between January 2011 and January 2019, who were divided into a monocentric training set (n = 876; median age, 55 years; men, 582), five multicenter/multiparameter validation sets (n = 173; median age, 59 years; men, 118) with different slice thicknesses and image pixels, and a normal control set (n = 30; median age, 53 years; men, 18). Three classifications (fresh, healing, and old fracture) combined with fracture location (corresponding CT layers) were detected automatically and delivered in a structured report. Precision, recall, and F1-score were selected as metrics to measure the optimum CNN model. Detection/diagnosis time, precision, and sensitivity were employed to compare the diagnostic efficiency of the structured report and that of experienced radiologists. @*Results@#A total of 25054 annotations (fresh fracture, 10089; healing fracture, 10922; old fracture, 4043) were labelled for training (18584) and validation (6470). The detection efficiency was higher for fresh fractures and healing fractures than for old fractures (F1-scores, 0.849, 0.856, 0.770, respectively, p = 0.023 for each), and the robustness of the model was good in the five multicenter/multiparameter validation sets (all mean F1-scores > 0.8 except validation set 5 [512 x 512 pixels; F1-score = 0.757]). The precision of the five radiologists improved from 80.3% to 91.1%, and the sensitivity increased from 62.4% to 86.3% with artificial intelligence-assisted diagnosis. On average, the diagnosis time of the radiologists was reduced by 73.9 seconds. @*Conclusion@#Our CNN model for automatic rib fracture detection could assist radiologists in improving diagnostic efficiency, reducing diagnosis time and radiologists’ workload.

Value of 68Ga-PSMA-11 PET/CT SUVmax combined with MRI ADC in the diagnosis of prostate cancer / 中华核医学与分子影像杂志

Objective To evaluate the combined application of the maximum standardized uptake value (SUVmax) of 68Ga-N,N'-bis (2-hydroxy-5-(carboxyethyl) benzyl) ethylenediamine-N,N'-diacetic acid (HBED-CC)-(Ahx) Lys-CO-Glu (PSMA-11) PET/CT imaging and the apparent diffusion coefficient (ADC) value of MRI in the differential diagnosis of prostate cancer (PCa).Methods Seventy untreated patients (age:(68.3± 12.1) years) with suspected PCa between December 2016 and April 2018 were prospectively studied.All patients underwent PET/CT and MRI examinations.The SUVmax and average ADC value were measured as diagnostic parameters,and the SUVmax/ADC ratio was calculated.The sensitivity and specificity of the 3 parameters were calculated by receiver operating characteristic (ROC) curve analysis.Results Of the 70 patients,31 were pathologically diagnosed as benign diseases and 39 were as PCa.The diagnostic sensitivity and specificity of average ADC value for PCa were 81％ and 72％,respectively,with a threshold value of 1.08× 10-3 mm2/s (b=1 000 s/mm2).The diagnostic sensitivity and specificity of SUVmax were 82％ and 71％ for PCa with a critical value of 7.69,and those were 72％ and 93％ with SUVmax/ADC ratio of 11.87.Conclusion The combination of 68Ga-PSMA-11 PET/CT and MRI can improve the diagnostic specificity for PCa,and the SUVmax/ADC ratio is a valuable differential diagnostic index.

Benign and malignant classification of renal occupancy lesions CT images using convolutional neural networks / 国际生物医学工程杂志

Objective To investigate the feasibility and application value of the benign and malignant classificational methods of renal occupying CT images based on convolutional neural networks (CNN). Methods An image omics method that can automatically learn the image features and classify CT images was used. Firstly, the CNN model obtained by large-scale natural image training was used to migrate the characteristics of the renal occupancy lesions CT images, and then the fine-tuning of the full connection layer was used to realize the benign and malignant classification of the images. Results The evaluation indexes of the VGG19 model were lower than ResNet50 and Inception V3, and the training result showed obvious overfitting. The accuracy, sensitivity and negative prediction values of the Inception V3 model was 93.8％, 99.5％ and 99.1％, respectively, which were higher than that of the ResNet50 model. Conclusions The benign and malignant classification of renal occupancy lesions CT images using CNN is a reasonable and feasible method, and the fine-tuned Inception V3 model has a better classification performance.

Relationship between remodeling patterns and plaque enhancement in patients with symptomatic atherosclerotic middle cerebral artery stenosis / 国际脑血管病杂志

Objective To investigate the relationship between vascular remodeling patterns of atherosclerotic middle cerebral artery (MCA) stenosis and plaque enhancement.Methods From August 2015 to June 2016,patients with unilateral symptomatic atherosclerotic MCA stenosis underwent routine MRI and black blood magnetic resonance inaging examinations.The vessel area and lumen area of MCA at the site of atherosclerotic MCA stenosis were measured,and the degree of MCA stenosis and the remodeling index were calculated.Results A total of 33 patients were included.Eleven had obvious plaque enhancement,including 9 positive remodeling and 2 negative remodeling;22 did not have plaque enhancement,including 5 positive remodeling,5 no remodeling,and 12 negative remodeling.The obvious plaque enhancement group was mainly positive remodeling (81.8％ vs.22.7％),and the no obvious enhancement group was mainly negative remodeling (54.5％ vs.18.2％).The difference was statistically significant (P=0.018).Conclusion Plaque enhancement at the site of atherosclerotic MCA stenosis is mainly positive remodeling,which reflects plaque instability.

Effects of iASSIST navigation system and personal specific instrument assisted total knee arthroplasty in the treatment of osteoarthritis / 中华外科杂志

Objective@#To compare the application of iASSIST assisted total knee arthroplasty (TKA) and three-dimentional(3D) printing personal specific instrument (PSI) assist TKA in the treatment of osteoarthritis (OA).@*Methods@#Clinical data of 47 patients with OA admitted at Department of Orthopaedic Surgery in Nanjing Medical University Nanjing Hospital between April and September 2016 were retrospectively reviewed, including 20 males and 27 females, aging from 57 to 77 years with mean age of (63.8±8.2) years. They were randomly divided into iASSIST-TKA group (23 patients) and PSI-TKA group (24 patients). The data such as hip knee ankle (HKA) angle, frontal femoral component (FFC) angle, frontal tibial component (FTC) angle, lateral femoral component (LFC) angle, lateral tibial component (LTC) angle, time of operation, post-operative wound drainage, period of hospitalization, visual analog scale (VAS) and Knee Society Score (KSS) at 1 day, 7 days, 14 days, 1 month and 3 months were recorded and compared between the two groups. T test was used to compare measurement data, Fisher exact test and χ2 test were applied to enumeration data in comparison among groups, and Kruskal-Wallis test was applied to ranked data.@*Results@#The deviation values of HKA, FFC, LFC, FTC and LTC angles were all below 3°(-2° to 2°), and there were no significant difference between iASSIST-TKA group and PSI-TKA group (Z=-0.610 to 0.000, P=0.542 to 1.000). Compared to PSI-TKA group, the time of operation was long((80.7±8.8) minutes vs.(60.2±7.8) minutes), the amount of post-operative wound drainage was increased((210.7±32.1) ml vs.(185.5±30.2)ml) and the period of hospitalization decreased((5.4±2.4) d vs.(6.7±1.6) d) in iASSIST-TKA group, there were significant difference(t=-2.190 to 8.460, P=0.000 to 0.033). There were no significant difference in intra-operative blood drainage((18.4±5.4) ml vs.(17.3±6.2) ml) between the two groups(t=0.650, P=0.521). PSI-TKA group had a superior VAS score(4.8±0.6 vs. 5.5±0.9, 3.6±0.8 vs. 4.3±0.9), KSS clinical score(49.3±5.5 vs. 44.2±6.4, 54.9±4.0 vs. 50.8±4.2) and KSS function score(44.1±2.9 vs. 41.2±3.5, 49.6±3.8 vs. 46.6±3.2) in 1 day and 7 days post-operation(t=-3.420 to 3.150, P=0.001 to 0.007). There were no significant difference in VAS and KSS score in 14 days, 1 month and 3 months post-operation(t=-1.390 to 0.530, P=0.170 to 1.000) between the two groups.@*Conclusions@#The iASSIST-TKA and PSI-TKA can help to make TKA procedure more accurately. iASSIST-TKA may take longer time of operation and have slower recovery, PSI-TKA may need more X-ray input and longer period of hospitalization. The long-term research of both techniques may be valuable for the further clinical usage.

Clinical value of dual-energy CT Volume software in quantitative analysis of urate crystals / 实用放射学杂志

Objective To assess the clinical value of dual-energy CT (DECT) Volume software in quantitative analysis of urate crystals.Methods The DECT data of 60 gout patients based on the American College of Rheumatology diagnostic criteria were analyzed retrospectively.The volumes of urate crystals were quantitatively analyzed by using Volume software with two senior radiologists.The results were statistically analyzed.Results Seventy-two joints of 60 gout patients were scanned by DECT.40 of 43 joints had urate crystals in foot and ankle with the average volume of (0.621±0.742) cm3;18 of 19 joints had urate crystals in knee with the average volume of (0.842±1.086) cm3;10 of 10 joints had urate crystals in hand and wrist with the average volume of (0.796±0.583) cm3.There was no statistical difference for volume measurement between two doctors (P>0.05).The volumes of urate crystals in 4 patients with regular medication were reduced.Conclusion Volume software of DECT can quantitatively analyze urate crystals with a good repeatability, which has high application value in clinical diagnosis and treatment monitoring of gout.

Clinical value of magnetic resonance venography in diagnosing Cockett syndrome / 介入放射学杂志

Objective To evaluate non-enhancement magnetic resonance venography (MRV) of iliac vein in diagnosing Cockett syndrome.Methods Magnetic resonance iliac venography was performed with Ingenia 3.0 T superconducting type MRI system.Abdominal surface coil was employed.The scanning sequences included M2DIPEAR (TR/TE=45/5.8 ms,flip angle=60°),THRIVE (TR/TE=6.8/3.5 ms,flip angle=10°),BTFESPAIR (TR/TE=3.4/1.7 ms,flip angle=80°) and FLAIR (TR/TE=9 000/120 ms,flip angle 90°).The layer thickness of 3 mm was used in all scanning,and the average number of acquisition was 3 times.Results On MRV imaging,Cockett syndrome was characterized by narrowed anteroposterior diameter and broadened transverse diameter of the compressed iliac vein,and curved impression could be seen on its anterior border,and collateral vessel formation could be observed.The mean diameters of the left iliac veins in the light,mnedium and severe patients with Cockett syndrome were 7.52,4.83 and 2.76 mm respectively,with the average compression ratios being 37％,69％ and 83％ respectively.Conclusion Non-enhanced MRV is a feasible method for the diagnosis of iliac vein stenosis,this examination is especially suitable for the checking needs of specific population.

The application of combined venography in the diagnosis of iliac vein compression syndrome with dual-source CT / 实用放射学杂志

Objective To explore the clinical value of the combined dual-source CT venography(CTV)for the diagnosis of iliac vein compression syndrome(IVCS).Methods 43 patients with clinically suspected IVCS underwent CTV examination.Among them,22 cases were assessed with combined CTV while 21 cases were given conventionally indirect CTV.The lower extremity deep vein was scanned from foot to head.The dual-energy technology was applied for data acquisition.Results Two kinds of CTV methods could be used directly for diagnosing IVCS and checking the asymptomatic mild iliac vein compression.32 IVCS patients were diagnosed by CTV.In 27 cases with deep venous thrombosis(DVT),the average diameter of the left iliac vein was(3.23 ± 1.45)mm and the average compression rate was 67%.The differences were statistically significant in comparisons of the average diameter of left iliac vein between IVCS patients with or without DVT and patients without IVCS.The image quality scores of bidirectional CTV were higher than indirect CTV with statistically significant difference.Conclusion Combined CTV is a feasible technique for lower extremity venography.The image quality of combined CTV is better than conventional indirect CTV with greater clinical value.

Study on constancy of CT numbers of SIEMENS Sensation Open CT-simulator / 中华放射肿瘤学杂志

Objective To evaluate the constancy of CT numbers of SIEMENS Sensation Open CT-simulator by analyzing the CT numbers of seven materials obtained from quality assurance(QA)tests. Methods QA tests for SIEMENS Sensation Open CT-simulator were performed with the Catphan504 phantom monthly. The CT images were obtained using three scan protocols(HeadSeq,RT_Head,and RT_Abdomen)for the CTP404 module in the phantom. The DoseLab software was used to analyze the 72 CT images acquired from January 2014 to December 2015,and the CT numbers(Y)of seven materials were obtained. Statistical analysis was performed on the Y data. The mean,standard deviation,maximum, minimum,and range values of Y for seven materials were calculated in three scan protocols. Results The standard deviation values of air,polymethylpentene,low-density polyethylene,polystyrene,acrylic acid, polyoxymethylene resin(Delrin),and polytetrafluoroethylene(Teflon)were as follows:(1)HeadSeq:0.54, 0.60,0.82,0.58,0.75,0.66,and 1.83 HU;(2)RT_Head:0.08,0.69,0.86,0.66,0.80,0.89,and 2.49 HU;(3)RT_Abdomen:0.11,0.61,0.76,0.72,0.78,0.96,and 2.56 HU.According to the statistical data, the constancy of CT numbers of the SIEMENS Sensation Open CT-simulator was in good condition in two years. Conclusions The variation of CT numbers of Teflon is the biggest among the seven materials. The relative values of CT numbers between different scan protocols vary with the relative electron density of materials.

Application of Diffusion Tensor Imaging Quantitative Parameters in Grading of Cerebral Glioma on a 3.0T Scanner / 中国医学影像学杂志

Purpose To study the application of MR diffusion tensor imaging (DTI) quantitative parameters in grading of cerebral glioma on a 3.0T scanner. Materials and Methods DTI mapping of 51 cases of cerebral glioma confirmed by pathology were retrospective analyzed. All the cases were divided into two groups: low-grade gliomas (grade I-II, 18 cases) and high-grade gliomas (grade III-IV, 33 cases). Value of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD),λ1, λ2, and λ3 of the tumor, peritumoral edema and contralateral tissue area were recorded and compared. Results rMDt, rADt, rRDt, λ1t, λ2t and λ3t of tumor in the low-grade glioma group were higher than those in the high-grade glioma group, and the difference was statistically significant (t=-3.235- -2.458, P0.05). rFAe of peritumoral edema in the low-grade glioma group was higher than those in the high-grade group, while rMDe, rADe, rRDe, λ1e, λ2e and λ3e were lower in the low-grade group. All differences were not statistically significant except λ1e (t=2.052, P<0.05). ROC analysis showed the area under the curve (Az) of rMDt, rADt, rRDt, λ1t, λ2t, λ3t and λ1e were 0.746, 0.710, 0.762, 0.735, 0.722, 0.705 and 0.374, respectively. Az value of rMDt, rADt, rRDt,λ1t, λ2t, λ3t were statistically different between the low- and high-grade gliomas (Z=3.287-4.605, P<0.001). Conclusion Among DTI quantitative parameters on glioma grading, rMD, rAD, rRD, λ1, λ2, and λ3 of tumor area are helpful in grading gliomas.

Diagnosis of Dual-source CT in Acute Aortic Dissection / 中国医学影像学杂志

Purpose To explore the value of 128-slice dual source CT (DSCT) three-dimensional post-processing techniques in the diagnosis of acute aortic dissection (AAD). Materials and Methods All image data of 116 patients with AAD who underwent conventional and enhanced DSCT scan by dual-energy scanning technology were retrospectively analyzed, and the multi-planar reconstruction (MPR), volume rendering (VR) and maximum intensity projection (MIP) were conducted in the workstation. Taking digital subtraction angiography (DSA) as the diagnostic gold standard, we analyzed the imaging manifestation of the original and 3D-reconstruction images and evaluated the specificity and the sensitivity of diagnostic accuracy and the image quality. Results The diagnostic accuracy of conventional scan was 37.1%(43/116). The display rates of MPR for initial break, intimal flap and true and false lumen were 93.1%, 100.0%and 100.0%, respectively. The display rates of VR and MIP for the initial break were 33.62%and 6.90%, respectively, which was both lower than that of MPR. The display rate of MIP for the true and false lumen was 23.28%. The overall display capability of MPR was significantly better than that of VR and MIP (P<0.01), and the display capability of VR was better than that of MIP (P<0.01). The sensitivity and specificity of enhanced DSCT in the diagnosis of AAD were both 100.0%. Conclusion DSCT has a fast and reliable diagnostic value on AAD. Conventional CT signs should be highly valued in the evaluation of chest or abdominal pain; and a thin layer of MPR and VR should be chosen in the three-dimensional reconstruction;whilst MIP reconstruction may be unnecessary for AAD.

Effect of intensive blood pressure reduction on peri-hematomal secondary neuronal injury and prognosis in patients with intracerebral hemorrhage / 中国神经精神疾病杂志

Objective To study the influence of early intensive blood pressure (BP) lowering treatment on peri-he?matomal secondary neuronal injury and prognosis after acute intracerebral hemorrhage. Methods A randomised con?trolled trial consisting of 36 consecutive patients within 6 h of intracerebral hemorrhage onset were randomly assigned to intensive BP lowering group and guideline BP lowering group. All patients underwent MR spectroscopy at 72 h and were followed up 90 days. N Acetyl Aspartate/Creatine (NAA/Cr) and lactic acid wave around peri-hematomal at 72 h, neuro?logic function at early stage, and death and/or disability at 90d were compared between these two group. Results Spec?trum lines were obtained from thirty-one patients:14 from intensive BP lowing group and 17 from guideline BP lowering group. There was no significant difference in the percentage declines of NAA/Cr at 72 h between the two groups (13.3%± 4.2% vs. 11.9%± 2.8%, P = 0.308). There was no statistical differences either in neurologic function at 7 d or in death and/or disability at 90 d (P>0.05). Conclusions Early intensive BP-lowering treatment had no role on peri-hematomal secondary neuronal injury and prognosis after acute intracerebral hemorrhage. Further high-quality and large-scale ran?domised controlled trial are necessary to verify this result.

Role of CT angiography in the detection of mechanical obstructive cause of deep vein thrombosis of lower extremity / 中华放射学杂志

Objective To explore the diagnostic value of the CT angiography (CTA) in the detection of mechanical obstructive cause of deep venous thrombosis of lower extremity. Methods Forty-seven cases of CTA and DSA image data of DVT in lower extremity with mechanical obstruction were retrospectively analyzed. The CTA three-dimensional reconstruction images were compared with DSA results, and the position and size of thrombus, collateral circulation of blood vessels, vascular compression area and the corresponding outside vascular lesions were evaluated. The causes of venous occlusion were analyzed. Diagnostic agreement of CTA and DSA was assessed by Kappa statistics. The difference of the accuracy between CTA and DSA in the diagnosis of the left and right iliac femoral vein, inferior vena cava, internal iliac vein thrombosis were analyzed with χ2 test. Results There were 47 patients with lower extremity DVT. Of them, DVT was detected in the left leg in 28 patients, in the right leg in 14 patients and in both lower extremities in 5 patients. Mechanical obstruction caused DVT in all of them. There were 27 patients of iliac vein compression syndrome(IVCS)complicated with lower limb DVT. The left iliac vein was oppressed by the right common iliac artery with compression degree from 55.41%to 100.00%,and mean of(77.1 ± 16.8)%. There was congenital stenosis or occlusion of inferior vena cava in 3 patients. There was Budd-Chiari syndrome in 2 patients. There was pelvic mass pressing the common iliac vein in 4 patients. Enlarged right inguinal lymph nodes oppressed the right femoral vein in 3 patients and enlarged left inguinal lymph nodes oppressed the left femoral vein in 2 patients. Other mechanical obstruction factors caused DVT in 6 patients, including right iliac artery aneurysms,spontaneous hematoma, etc. The agreement of CTA and DSA on the diagnosis of the iliac femoral thrombosis was good (Kappa=0.978), the diagnosis agreement on the inferior vena cava thrombus was good (Kappa = 0.737), while the diagnosis agreement on the internal iliac vein thrombosis was poor (Kappa=0.189). The difference of CTA and DSA in the diagnosis of left and right iliac femoral venous thrombosis was not statistically significant (52,51 case;χ2=0.00, P>0.05), neither was the diagnostic difference of inferior vena cava thrombus (21,17 cases;χ2=1.50, P>1.50). However, the difference of the diagnosis of the iliac vein thrombosis was statistically significant (14,2 cases;χ2=8.33, P<0.05) . Conclusions CTA can clearly show the location and scope of the thrombus. Compared with conventional DSA, CTA shows higher diagnostic coincidence rate, and can accurately determine the mechanical obstruction causes of lower extremity DVT.

Multi-slice spiral CT venography and digital subtraction venography for the diagnosis of iliac vein ;compression syndrome：a comparison study / 介入放射学杂志

Objective To evaluate multi-slice spiral CT venography (MSCTV) and digital subtraction venography (DSV) in diagnosing iliac vein compression syndrome (IVCS) and secondary thrombosis. Methods The imaging materials, including MSCTV and DSV performed before and after the thrombolysis therapy, of 38 patients with clinically-suspected IVCS were collected. The inner diameters of the compressed iliac veins were measured on MSCTV images and the compression ratio was calculated. Usingχ2 test, the detection rates of IVCS by MSCTV and DSV were compared. Results Of 38 patients, IVCS was detected by MSCTV in 29, by pretreatment DSV in 20 and by post-treatment DSV in 29. The difference in the detection rate of IVCS between MSCTV and pre-treatment DSV was statistically significant (χ2=4.65, 0.010.05). Conclusion For the diagnosis of IVCS, MSCTV is superior to pre-treatment DSV in the diagnostic accuracy of iliac vein compression syndrome. Therefore, MSCTV should be used as the preferred method of examination.(J Intervent Radiol, 2015, 24:301-305)

Application and radiation dose research of dual-source CT in aortic dissection after endovascular exclusion / 中南大学学报(医学版)

OBJECTIVE@#To evaluate dual-source CT in the Standford B aortic dissection in the postoperative follow-up and to compare radiation dose of dual-energy mode with single-energy scanning.@*METHODS@#A total of 40 patients with aortic dissection after endovascular exclusion underwent dualsource CT. Tweny patients took the dual-energy scanning mode (100 kV and 140 kV, pitch 1.0); the other 20 patients had single-energy mode (120 kV, pitch 2.0). In both groups CareDose4D technology was used to track the current method. All images were analyzed to observe the stent shape, with or without endoleaks and the rate of thrombosis absorption. Radiation dose, scan length, and scan time were recorded for all patients, and then compared between dual-energy mode and single-energy scanning.@*RESULTS@#The difference in scan length and image quality was not significant between the dualenergy group and the single-energy group. The acquisition time of the dual-energy group was longer than that of the single-energy group, with significant difference. Radiation dose of the single-energy group was lower than that of the dual-energy group, with significant difference.@*CONCLUSION@#Dual-source CT can objectively evaluate the conditions after the endovascular exclusion of aortic dissection. The operative effect and complications may be analyzed comprehensively. The radiation dose of the single-energy scan mode with medium pitch is lower than that of the dual-energy mode.