Clinical application of dual-layer spectral CT multi-parameter feature to predict microvascular invasion in hepatocellular carcinoma.

OBJECTIVE: This study aimed to investigate the feasibility of using dual-layer spectral CT multi-parameter feature to predict microvascular invasion of hepatocellular carcinoma. METHODS: This retrospective study enrolled 50 HCC patients who underwent multiphase contrast-enhanced spectral CT studies preoperatively. Combined clinical data, radiological features with spectral CT quantitative parameter were constructed to predict MVI. ROC was applied to identify potential predictors of MVI. The CT values obtained by simulating the conventional CT scans with 70 keV images were compared with those obtained with 40 keV images. RESULTS: 50 hepatocellular carcinomas were detected with 30 lesions (Group A) with microvascular invasion and 20 (Group B) without. There were significant differences in AFP,tumer size, IC, NIC,slope and effective atomic number in AP and ICrr in VP between Group A ((1000(10.875,1000),4.360±0.3105, 1.7750 (1.5350,1.8825) mg/ml, 0.1785 (0.1621,0.2124), 2.0362±0.2108,8.0960±0.1043,0.2830±0.0777) and Group B (4.750(3.325,20.425),3.190±0.2979,1.4700 (1.4500,1.5775) mg/ml, 0.1441 (0.1373,0.1490),1.8601±0.1595, 7.8105±0.7830 and 0.2228±0.0612) (all p < 0.05). Using 0.1586 as the threshold for NIC, one could obtain an area-under-curve (AUC) of 0.875 in ROC to differentiate between tumours with and without microvascular invasion. AUC was 0.625 with CT value at 70 keV and improved to 0.843 at 40 keV. CONCLUSION: Dual-layer spectral CT provides additional quantitative parameters than conventional CT to enhance the differentiation between hepatocellular carcinoma with and without microvascular invasion. Especially, the normalized iodine concentration (NIC) in arterial phase has the greatest potential application value in determining whether microvascular invasion exists, and can offer an important reference for clinical treatment plan and prognosis assessment.

Diagnosis of pulmonary artery sarcoma and differential diagnosis of pulmonary embolism with double-detector spectral CT: a case report / 中国医师杂志

Objective:The differential diagnosis of pulmonary artery sarcoma (PAS) and pulmonary embolism (PE) by double-detector spectral computerized tomography (CT) provides a new way to improve the detection rate of PAS and reduce the misdiagnosis rate.Methods:In the way of retrospective study, the Philips Nebula Workstation (ISP) was used to reconstruct electron density map, iodine density map and spectral curve in the spectral CT plain scan and enhancement of the PAS patient. In the plain scan image, the low density areas of the ascending aorta and the right pulmonary trunk were selected to measure their electronic density values. In the chest enhancement image, the iodine density of PAS area and PE area were measured respectively, and the spectral curves of PSA area and PE area were compared.Results:The electron density of the ascending aorta and the right pulmonary trunk in the low density area of the PAS patient during the plain scan of spectral CT were 104.4% EDW (relative to the percentage of the electron density of water) and 102.2% EDW, respectively, which were lower than those in the normal ascending aorta area. The fusion image of mixed energy and electron density clearly reflected the scope of the lesion. The iodine density in PAS area was 1.89 mg/ml, and the iodine density in PE area was 0.03 mg/ml during the enhancement phase. The iodine uptake in PAS area was significantly higher than that in PE area. The slope of PAS region was 2.08, and the slope of PE region was -1.86. The slopes of the two spectral curves were inconsistent.Conclusions:The electronic density, iodine density and spectral curve measured by double-detector spectral CT may provide powerful imaging basis for the diagnosis of PAS and the differentiation of PAS from PE, which is helpful for the early diagnosis of the lesions, and also provide basis for the biopsy location of the mixed lesions of PAS and PE.

Cervical Cancer Prognosis and Diagnosis Using Electrical Impedance Spectroscopy.

Electrical impedance spectroscopy (EIS) has been used as an adjunct to colposcopy for cervical cancer diagnosis for many years, Currently, the template match method is employed for EIS measurements analysis, where the measured EIS spectra are compared with the templates generated from three-dimensional finite element (FE) models of cancerous and non-cancerous cervical tissue, and the matches between the measured EIS spectra and the templates are then used to derive a score that indicates the association strength of the measured EIS to the High-Grade Cervical Intraepithelial Neoplasia (HG CIN). These FE models can be viewed as the computational versions of the associated physical tissue models. In this paper, the problem is revisited with an objective to develop a new method for EIS data analysis that might reveal the relationship between the change in the tissue structure due to disease and the change in the measured spectrum. This could provide us with important information to understand the histopathological mechanism that underpins the EIS-based HG CIN diagnostic decision making and the prognostic value of EIS for cervical cancer diagnosis. A further objective is to develop an alternative EIS data processing method for HG CIN detection that does not rely on physical models of tissues so as to facilitate extending the EIS technique to new medical diagnostic applications where the template spectra are not available. An EIS data-driven method was developed in this paper to achieve the above objectives, where the EIS data analysis for cervical cancer diagnosis and prognosis were formulated as the classification problems and a Cole model-based spectrum curve fitting approach was proposed to extract features from EIS readings for classification. Machine learning techniques were then used to build classification models with the selected features for cervical cancer diagnosis and evaluation of the prognostic value of the measured EIS. The interpretable classification models were developed with real EIS data sets, which enable us to associate the changes in the observed EIS and the risk of being HG CIN or developing HG CIN with the changes in tissue structure due to disease. The developed classification models were used for HG CIN detection and evaluation of the prognostic value of EIS and the results demonstrated the effectiveness of the developed method. The method developed is of long-term benefit for EIS-based cervical cancer diagnosis and, in conjunction with standard colposcopy, there is the potential for the developed method to provide a more effective and efficient patient management strategy for clinic practice.

Clinical value of energy spectrum curves of dual-energy computer tomography may help to predict pathological grading of gastric adenocarcinoma.

BACKGROUND: To explore the clinical value of energy spectrum curves of dual-energy computer tomography (CT) in quantitative evaluation of different pathological grades of gastric adenocarcinoma. METHODS: A total of 62 patients with 36 poorly, 25 moderately and 1 well differentiated gastric adenocarcinomas confirmed pathologically were collected. Dual-energy CT plain and enhanced scanning were undergone before operation. Dual-Energy software was used to measure the slope of the energy spectrum curves (λ) in arterial and venous phases (VPs) after image reconstruction. Patients were divided into two groups according to the pathological results, including well and moderately differentiated gastric adenocarcinoma group and poorly differentiated gastric adenocarcinoma group. Data of each group were analyzed by independent sample t-test. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficiency of the corresponding parameters. RESULTS: There were significant differences in λ values of 40-50, 40-60, 40-80, 40-90, 40-100, 40-120, 40-130, 40-140 and 40-150 keV energy ranges in VP between the well and moderately differentiated group and poorly differentiated group (P<0.05), but no significant differences in λ values of different energy ranges in arterial phase (AP) between the two groups (P>0.05). And the area under curve in 40-120 keV energy range was the largest in VP. λ40-120keV=2.69 was selected as the diagnostic threshold with the maximum Youden index, the sensitivity and specificity were 61.1% and 76%, respectively. CONCLUSIONS: The energy spectrum curve of dual-energy CT had certain diagnostic value in the quantitative evaluation of pathological grading of gastric adenocarcinoma.

Application value of dual-energy computed tomography spectrum curve combined with clinical risk factors in predicting adherent perinephric fat.

BACKGROUND: Adherent perinephric fat (APF) is evaluated preoperatively with the Mayo adhesive probability (MAP) scoring system using conventional single form computed tomography (CT) images. An objective or quantitative indicator for predicting APF is urgently needed for clinical application. METHODS: Data obtained from 150 renal tumor patients with partial nephrectomy (PN) were used in the present study. Patients were divided into two groups based on the surgical results: an APF group (n=100) and a non-APF group (n=50). All patients had renal contrast-enhanced dual-energy CT (DECT) scan, and the data were brought into a post-processing workstation. Monoenergetic plus mode was adopted to analyze the spectrum curve of the region of interest (ROI). Logistic stepwise relapse investigation was utilized to analyze the related risk factors. The maximum Youden index was taken as the cut-off value. The sensitivity, specificity, accuracy, and 95% CI of the model were calculated. RESULTS: APF is related to patients' clinical characteristics of age, gender, BMI, smoking, tumor diameter, exophytic, and benign or malignant nature of the renal masses (P<0.05). The shape of the curve of ROI1 in the APF group was different from that of the ROI4 in the non-APF group, and the curve slope of K1 (-0.21±0.47) was different from that of K4 (-1.30±0.14) (P<0.001). Statistical analysis showed that the slope K was solely retained in the model index. The best cut-off point for the K value was -0.95. The AUC of the cut-off point was 0.97 (95% CI: 0.96-0.99). CONCLUSIONS: The DECT spectrum curve performed well in predicting APF, and the curve slope K can be used as an objective quantitative indicator.

Assessment of monochromatic CT value and spectrum energy curve in the differential diagnosis of splenomegaly / 实用放射学杂志

Objective To determine the utility of single energy CT value and spectrum energy curve in identifying different cause of diffuse spleen enlargement.Methods 43 patients confirmed by either surgical pathology,aspiration biopsy or clinical comprehensive diagnosis and follow-up were assessed,including lymphoma with spleen infiltration(lymphoma group,n=18) and cirrhotic splenomegaly(liver cirrhosis group,n=25).All patients underwent upper abdomen CT scans in GSI mode and the GSI data were transferred to the Workstation AW 4.6 to acquire single energy CT value(40-140 keV,10 keV's interval) and spectrum energy curve of the spleen on the venous phase.All single energy CT values and the slope of curves were comparatively analyzed through independent-samples t test.The diagnostic efficiency were evaluated by ROC analysis.Results Under 40-140 keV energy range,single energy CT values were significantly lower in the lymphoma group than in the liver cirrhosis group(all P＜0.05).The spectrum energy curve were both types of decreasing.Under 40-90 keV,100-140 keV energy range,the slop of curves in the lymphoma group(2.42 ± 0.70,0.27± 0.08) were also significantly lower than in the liver cirrhosis group (3.11 ± 0.62,0.34± 0.07),respectively(all P ＜0.05).When the slope of curve under 40-90 keV energy range was selected as a diagnostic indicator,the area under the curve(AUC) would reach 0.77.If threshold value of 1.39 was taken,the sensitivity and specificity would be equal to 86 ％ and 64 ％,respectively.Conclusion Single energy CT value and spectrum energy curve are helpful for differentiation of lymphoma with spleen infiltration from cirrhotic splenomegaly.

Application of dual-source CT dual-energy scanning fusion 3D reconstruction in gastric cancer and lymph nodes / 实用肿瘤学杂志

Objective The objective of this study was to determine the lesion range between gastric cancer lesions and normal gastric wall,improve the early diagnosis of gastric cancer rate,distinguish between me-tastatic lymph nodes and non-metastatic lymph nodes,and accurate N staging by dual-source CT double-en-ergy enhanced scan parameters.Methods The dual energy enhanced scan of patients with preoperative gastric cancer was performed by Siemens Somatom Definition Flash dual-source CT.The collected data were analyzed by Syngo.Via software and reconstructed three-dimensionally to obtain the absolute iodine of gastric cancer,nor-mal gastric wall,metastatic lymph node and non-metastatic lymph node value,standardized iodine value and vir-tual single energy spectrum curve of the slope to combine with postoperative pathological results.The use of statis-tical methods was to determine the difference between the post-and preoperation.Results The absolute iodine values(IC)were(3.329±0.812)g/L in the gastric cancer lesion and(64.006±17.450)% for the standard io-dine values(NIC).The slope of the virtual single energy spectrum curve was-2.916±1.3227,IC(1.563±0.708)g/L in the normal gastric wall.The NIC were(37.122±16.267)%and-1.621±1.4028 for the slope of the virtual single energy spectrum curve.They were significantly statistical difference(P<0.05).The IC of meta-static lymph nodes were(2.968±0.547)g/L,(63.597±14.633)% for the NIC and(-2.532±0.753)for the slope of the virtual single energy spectrum curve.The IC of non-metastatic lymph nodes were(1.465±0.408)g/L,(35.240±14.357)%for the NIC and(-1.378±0.726)for the slope of the virtual single energy spectrum curve.They also had significantly statistical difference(P<0.05).Conclusion Dual-source CT dual-energy scan combined with three-dimensional reconstruction technique can help to determine the lesion range,improve the diagnostic rate of early gastric cancer,distinguish between metastatic and non-metastatic lymph nodes,and improve the accuracy of N staging.

Application of dual-source CT dual-energy scanning fusion 3D reconstruction in gastric cancer and lymph nodes / 实用肿瘤学杂志

Objective The objective of this study was to determine the lesion range between gastric cancer lesions and normal gastric wall,improve the early diagnosis of gastric cancer rate,distinguish between me-tastatic lymph nodes and non-metastatic lymph nodes,and accurate N staging by dual-source CT double-en-ergy enhanced scan parameters.Methods The dual energy enhanced scan of patients with preoperative gastric cancer was performed by Siemens Somatom Definition Flash dual-source CT.The collected data were analyzed by Syngo.Via software and reconstructed three-dimensionally to obtain the absolute iodine of gastric cancer,nor-mal gastric wall,metastatic lymph node and non-metastatic lymph node value,standardized iodine value and vir-tual single energy spectrum curve of the slope to combine with postoperative pathological results.The use of statis-tical methods was to determine the difference between the post-and preoperation.Results The absolute iodine values(IC)were(3.329±0.812)g/L in the gastric cancer lesion and(64.006±17.450)% for the standard io-dine values(NIC).The slope of the virtual single energy spectrum curve was-2.916±1.3227,IC(1.563±0.708)g/L in the normal gastric wall.The NIC were(37.122±16.267)%and-1.621±1.4028 for the slope of the virtual single energy spectrum curve.They were significantly statistical difference(P<0.05).The IC of meta-static lymph nodes were(2.968±0.547)g/L,(63.597±14.633)% for the NIC and(-2.532±0.753)for the slope of the virtual single energy spectrum curve.The IC of non-metastatic lymph nodes were(1.465±0.408)g/L,(35.240±14.357)%for the NIC and(-1.378±0.726)for the slope of the virtual single energy spectrum curve.They also had significantly statistical difference(P<0.05).Conclusion Dual-source CT dual-energy scan combined with three-dimensional reconstruction technique can help to determine the lesion range,improve the diagnostic rate of early gastric cancer,distinguish between metastatic and non-metastatic lymph nodes,and improve the accuracy of N staging.

Spectral imaging technique diagnosis the metastatic lymph nodes in thyroid carcinoma, squamous cell carcinoma metastatic lymph nodes and lymphoma / 实用放射学杂志

Objective To explore the value of spectral imaging technique in dual-energy CT in differential diagnosis of the metastatic lymph nodes in thyroid carcinoma,squamous cell carcinoma metastatic lymph nodes and lymphoma in the neck.Methods In 30 patients with pathologically confirmed with a total of 79 cervical lymph nodes enlargement which were using dual energy scan .Then observed the change trend of the spectrum curve and comparison the three kinds of lymph node energy spectrum curve’s slope.Results In the 79 lymph nodes,the metastatic lymph nodes in thyroid carcinoma were twenty-three,squamous cell carcinoma metastatic lymph nodes were twenty-four and lymphoma were thirty-two.From 60 to 180 keV,with the increase of keV values,the three kinds of malignant lymph nodes of the corresponding CT value decreasing and the higher the keV value,the CT value decrease magnitude was small,and the spectrum curve was〞drop type〞.The slope spectrum curve of the metastatic lymph nodes of thyroid carcinoma in arterial phase and parenchymal phase were maximum,which were 1.23±0.41 and 0.85±0.33,respectively.The slope spectrum curve of lymphoma in arterial phase and parenchymal phase were least,whcih were 0.40±0.16 and 0.47 ±0.09.The slope spectrum curve of the squamous cell carcinoma metastatic lymph nodes in arterial phase and parenchymal phase were 0.88±0.10 and 0.62±0.28.The energy spectrum curve slope of the three kinds of malignant lymph nodes have statistical significance.Conclusion The energy spectrum curve slope of arterial phase and parenchymal phase has some significance lymph node metastasis of in thyroid carcinoma,the metastatic lymph nodes and lymphoma in the neck.