Volume 102 ·  Issue 23 ·  2022

With the progress of medical imaging technology and the accumulation of experience, dual-energy CT has moved from simple scientific research to clinical application. In the imaging of abdominal tumors, dual-energy CT has obvious advantages over conventional CT in improving the diagnostic performance, reflecting the pathological characteristics of malignant tumors and evaluating the therapeutic effect. This paper briefly describes the classification of dual-energy CT, the current research status of this technology in abdominal malignant tumors, and puts forward the challenges and application traps faced by dual-energy CT technology, in order to promote the clinical generalization and application of this technology.

The incidence and mortality of lung cancer in China rank first among malignant tumors. In order to further standardize the prevention and treatment measures of lung cancer in China, improve the diagnosis and treatment level of lung cancer, improve the prognosis of patients, and provide professional evidence-based medicine suggestions for clinical medical staff at all levels, the Oncology Branch of Chinese Medical Association organized experts from respiratory medicine, medical oncology, thoracic surgery, radiotherapy, imaging and pathology departments, based on the application indications approved by the state, based on the practically applicable drugs in China, combined with the recommendations of international guidelines and the current status of clinical practice in China, and integrated the latest evidence-based medicine evidence in diagnosis and treatment of lung cancer in recent years, such as screening, diagnosis, pathology, genetic testing, immune molecular marker detection and treatment methods, and follow-up. After a consensus meeting, the Oncology Branch of Chinese Medical Association formulated the Clinical Diagnosis and Treatment Guidelines for Lung Cancer (2022 Edition), aiming to provide reasonable recommendations and suggestions for clinicians, imaging, laboratory, rehabilitation and other professionals at all levels.

To explore the application value of spectral CT multi-parameter imaging in preoperative assessment the status of lymphovascular invasion (LVI) and perineural invasion (PNI) in patients with gastric cancer.

A total of 62 patients who underwent energy spectral CT and with pathology confirmed gastric cancer in Lanzhou Uiversity Second Hospital from September 2020 to September 2021 were retrospectively collected, which including 46 males and 16 females, aged from 36 to 71 (57.5±9.1) years. According to the presence or absence of LVI/PNI in postoperative pathological results, they were divided into the positive group (42 cases) and the negative group (20 cases). The CT values of 40 keV and 70 keV (CT_{40 keV}, CT_{70 keV}), iodine concentration (IC), normalized iodine concentration (NIC) were measured in the arterial phase, the venous phase, and the delay phase, and the spectral curve slope of 40 keV to 70 keV (K_(40-70)) and the combined parameters (the arterial phase: AP~all, the venous phase: VP~all, the delay phase: DP~all) were calculated. Spectral parameters between the positive and negative groups were compared, and the receiver operating characteristic curve (ROC) with the area under the curve (AUC), sensitivity, specificity, and optimal threshold were calculated for evaluating the diagnostic performance of each parameter.

The CT_{40 keV}, CT_{70 keV}, K_(40-70), IC, and NIC in the arterial phase and the venous phase and the CT_{70 keV} and NIC in the delay phase of the LVI/PNI-positive group were all higher than those of the negative group [the representative parameters: the arterial phase NIC 0.14±0.04 vs 0.12±0.04, the venous phase NIC 0.5(0.5, 0.6) vs 0.4(0.4, 0.5), the delay phase NIC 0.6±0.1 vs 0.5±0.1, all P<0.05]. ROC curve analysis showed that the diagnostic efficacy of the parameters of the venous phase is better than that of the arterial phase and the delay phase, and the diagnostic efficiency of the combined parameters is better than that of the individual parameters. The AUC value, sensitivity, and specificity of the most optimal parameter VP~all of the venous phase were 0.931(95%CI:0.872-0.990), 80.95%, and 95.00%, respectively.

In the preoperative evaluation the status of the LVI and PNI in gastric cancer, the diagnostic efficacy in the venous phase parameters is better than that in the arterial phase and delay phase, and the diagnostic efficacy of combined parameters is better than that of individual parameters.

To investigate the value of dual-layer spectral detector CT(SDCT) in preoperative prediction of lymph node (LN) metastasis of gastric cancer.

From January 2019 to January 2021, the clinical and imaging data of 130 gastric cancer patients(93 males and 37 females, aged from 37 to 84 years)confirmed by pathology in the Zhongshan hospital of Xiamen University were retrospectively collected. According to the status of lymph node metastasis, those patients were divided into metastatic LNs group (n=104) and nonmetastatic LNs group (n=26). The maximum diameter of gastric cancer on spectral CT images, CT Values of lesions in 40, 50, 60, 70. KeV monoenergetic image of arterial and Venous phase (CT_{40 keV}, CT_{50 keV}, CT_{60 keV}, CT_{70 keV}), iodine concentration (IC) and effective atomic number (Z_eff) were measured, then the normalized IC(NIC) and spectral curve(K_(40-70)) value were calculated. The differences of each parameter derived from spectral CT between the two groups were compared, and a logistic regression model was constructed. The ROC curves and area under the curve (AUC) were conducted to evaluate the diagnostic performance of each parameter and Delong test was used to compare the difference of each AUC.

Compared to nonmetastatic LNs group, metastatic LNs group had higher maximum diameter of tumor, CT_{40 keV}, CT_{50 keV}, CT_{60 keV}, CT_{70 keV}, IC, NIC, Zeff, and K_(40-70) values on venous phase (the representative parameter is Z_eff: 8.4 (8.2, 8.5) vs 8.2 (8.1, 8.3)) (all P<0.05). The proportion of patients with lower histology differentiated degree, higher T grade and positive carcino embryonic antigen (CEA)were higher than that in nonmetastatic LNs (the representative parameter was CEA: 34.6%(36/104) vs 7.7%(2/26) (all P<0.05). The regression model constructed by CEA and Zeff had the highest predictive value in predicting metastatic LNs, with an AUC of 0.835(0.759-0.894), sensitivity and specificity of 83.65% and 73.08%, respectively.

SDCT quantitative parameters on venous phase and CEA facilitate the accurate prediction of metastatic LNs in patients with gastric cancer, and the multi-parameter regression model has the highest diagnostic performance.

To develop a model combined with dual-energy CT quantitative parameters and conventional CT features for evaluating the expression level of Ki-67 in invasive breast cancer.

A total of 191 patients with histologically confirmed invasive breast cancer in Lishui Central Hospital from March 2019 to December 2020, were retrospectively enrolled, all of them were females, aged from 25 to 77 (53.2±11.3) years. All patients underwent preoperative non-contrast chest and contrast-enhanced Dual energy CT scans, and the normalized iodine concentration (NIC) of lesions on arterial and venous phase, spectral curve slope (λ_HU), and normalized effective atomic number (nZ_eff) were measured and calculated, and their conventional CT characteristics were assessed. According to the results of immunohistochemistry (IHC), the patients were divided into Ki-67 high expression group (n=129 patients) and low expression group (n=62 patients) level. The differences in clinical data, conventional CT characteristics and dual-energy CT quantitative parameters between the two groups were analyzed. The receiver operating characteristic curve (ROC) curve was conducted to assess the efficacy of each individual model and joint model in evaluating Ki-67 expression levels, and the area under the curve (AUC), sensitivity, specificity, and accuracy were calculated, respectively.

In the analysis of CT features, the longest diameter, shape and enhancement pattern of the tumor were significantly difference between the two groups (all P<0.05). The NIC, nZ_eff on the arterial phase and NIC, nZ_eff and λ_HU [M(Q₁,Q₃)] on the venous phase were higher in the high Ki-67 expression group compared to the low expression group [0.13 (0.12, 0.16) vs 0.11 (0.08, 0.14), 0.71 (0.70, 0.75) vs 0.70 (0.67, 0.72), 0.40 (0.32, 0.48) vs 0.23 (0.17, 0.32), 3.10 (2.58, 3.63) vs 2.86 (2.19, 3.48), 0.88 (0.85, 0.92) vs 0.85 (0.84, 0.86), all P<0.05]. The logistic regression model, which integrated significant conventional CT features and dual-energy CT quantitative parameters, demonstrated the highest diagnostic performance for assessing Ki-67 expression levels, with an AUC of 0.924, sensitivity of 88.37%, specificity of 83.87%, and accuracy of 86.91%; the AUC of the dual-energy CT parameter model was 0.908, sensitivity of 82.17%, specificity of 88.71%, and accuracy of 84.29%. Though the diagnostic efficacy was no significant difference (P=0.238), both models showed superior to the conventional CT feature model (all P<0.001).

A dual-energy CT quantitative parameter combined with a conventional CT feature model was successfully constructed, which has a good evaluation performance on the expression level of Ki-67 in invasive breast cancer.

To investigate the longitudinal changes of white matter microstructural based on diffusion tensor imaging in parents who lost their only child without psychiatric disorders and its relationship with symptoms of posttraumatic stress disorder (PTSD).

Parents who had who lost their only child and without psychiatric disorders in Jiangsu Province, from September 2016 to March 2017, were retrospectively collected (TENP group, 32). MRI scans were performed at baseline and at the end of 5-year follow-up, and the Clinician Administered PTSD Scales (CAPS) were used for assessing the severity of symptoms. Additionally, sex, age and education level matched healthy subjects were recruited as healthy controls (control group, 27) and underwent MRI scanning using the same protocol. The differences of fractional anisotropy (FA) values between TENP group and control group at baseline were analyzed by using Tract-based spatial statistics method, and the brain areas of lateral differences were used as the regions of interest for longitudinal follow-up analysis of TENP group. Partial correlation analysis was used to evaluate the relationship between FA values changes in longitudinal differences in brain regions and CAPS scores.

Compared with the control group, FA values of the right cingulate gyrus, Uncinate fasciculus, superior longitudinal fasciculus, corticospinal tract, Inferior fronto-occipital fasciculus, Inferior longitudinal fasciculus and forceps major in TENP group were decreased at baseline ((0.613±0.032) vs (0.631±0.034), (0.539±0.048) vs (0.563±0.045), (0.534±0.033) vs (0.558±0.039), (0.560±0.038) vs (0.580±0.030), (0.519±0.023) vs(0.549±0.024), (0.489±0.038) vs (0.518±0.027), (0.499±0.027) vs (0.533±0.032); all P<0.05). From baseline to follow-up, scores of trauma reexperience symptoms and avoidance/numbness symptoms were decreased ((5.2±2.8) vs (8.1±4.9), (4.0±3.2) vs (6.6±5.4); all P<0.05); FA values of the right corticospinal tract, Inferior fronto-occipital fasciculus, Inferior longitudinal fasciculus and forceps major were decreased ((0.523±0.049) vs (0.537±0.049), (0.568±0.052) vs (0.590±0.050), (0.540±0.063) vs (0.559±0.059), (0.520±0.059) vs (0.547±0.059); all P<0.05); The decrease of FA values of the right Inferior fronto-occipital fasciculus and right Inferior longitudinal fasciculus was negatively correlated with the decrease of avoidance/numbness symptoms scores (r=-0.458, -0.374, respectively, all P<0.05).

The trauma of parents who lost their only child can result in impaired microstructural integrity of white matter. As the post-traumatic time goes by, parents who have lost their only child do not develop to PTSD and other psychiatric disorders, and the clinical symptoms are alleviated, the damage of the white matter microstructure continued to progress.

To explore the application value of personalized three-dimensional (3D) printed protective cap in brain protection after decompressive craniectomy (DC).

Fourty-five patients who underwent DC from January 2021 to October 2021 were selected, including 26 males and 19 females, aged 5-73 (50±13) years old. The brain CT data were imported into 3D Slicer software to rebuild the protective cap through 3D printing. The cap was worn on the head of the patient, thereby preventing secondary braindamage. The follow-up results were compared with 53 patients without protective capduring the same period.

There were no statistically significant differences in age, skull defect location and follow-up time between the two groups (all P>0.05).Among 45 patients, 47 brain protective caps (2 cases with bilateral skull defects) were successfully designed. The time for image post-processingand 3D printing was (21.2±6.0) min and (62.4±8.3) min, respectively. There were 6 cases of low compliance, 9 cases of moderate compliance, 32 cases of high compliance, respectively. Six cases with low conformity were redesigned and printed, 2 of 9 cases with moderate conformity were redesigned and printed, and the remaining 7 cases reached high compliance after grinding and packaging. In the current study, 45 patients with brain protective caps were followed up for 3 months, and no secondary brain injury occurred. However, among 53 patients without brain protective caps during the same period, 4 patients had secondary accidental brain compression. The incidence of injury was 7.5 %, and the difference was statistically significant (P<0.001).

Brain protective cap designed based on cranial CT and 3D printing can be used in patients with skull defects to protect the brain tissue from secondary crush damage and has certain clinical value.

To summarize the clinical experience of sandwich-shaped resection and cheiloplasty in the treatment of macrocheilia secondary to arteriovenous malformation, and to observe its clinical efficacy and complications. The clinical data of 27 patients with macrocheilia secondary to arteriovenous malformation who received surgical treatment from January 2018 to October 2020 in Linyi Cancer Hospital were retrospectively analyzed. There were 14 males and 13 females. The median age was 4.5 years (ranged from 2 to 57 years). There were 18 cases of upper lip and 9 cases of lower lip. All patients had received interventional embolization sclerotherapy for 5 to 10 times before surgery with unsatisfied effect. There was no obvious improvement in the appearance,whereas 3 cases progressed presenting as abnormal enlargement. Sandwich-shaped resection and cheiloplasty was performed in all the patients. Histopathological examinations confirmed arteriovenous malformations in all 27 cases. Twenty-six patients received one course of operation and one received two courses. Partial mucosal necrosis occurred in 1 case and healed after dressing change, while the rest healed by first intention. Local recurrence occurred in 2 cases within 6 months after operation. A four-level standard was used for long-term evaluation, and 24 cases got grade Ⅲ (good), three cases got grade Ⅱ (moderate) after 1 to 3 years of follow-up. Sandwich-shaped resection and cheiloplasty can achieve good long-term efficacy with excellent appearance and function. Due to its advantages of hidden incision and three-dimensional resection and reservation, it is worthy of further clinical promotion.

The novel coronavirus pneumonia (COVID-19) pandemic caused by the novel coronavirus (SARS-CoV-2) has posed a serious threat to the health of people all over the world and has become an international public health emergency. In most cases, COVID-19 mainly manifests as respiratory symptoms, such as fever, cough and dyspnea, but some patients can have the first onset of abdominal symptoms and often mask their own respiratory symptoms, resulting in delayed illness. Therefore, COVID-19 abdominal organ involvement is gradually attracting people's attention. Common abdominal organs involved are gastrointestinal tract, liver, gallbladder, pancreas, spleen and kidney. Digestive tract symptoms are the most common abdominal symptoms, which are closely related to the prognosis of patients. The symptoms of COVID-19 abdominal involvement and their imaging signs are reviewed to deepen the understanding of abdominal organ damage caused by SARS-CoV-2 infection by clinical and radiologists, so as to achieve rapid and effective diagnosis and treatment.

Cerebrospinal fluid (CSF) is a colorless and transparent fluid in the central nervous system, which plays a protective and supportive role in the central nervous system. It is mainly produced by the choroid plexus tissue of the middle ventricle of the human cerebral hemisphere, and a small part is produced in the third and fourth ventricles. It is absorbed by arachnoid granulosa cells near the sagittal sinus at the apex of the brain, and thus flows back into the venous blood. The daily secretion of cerebrospinal fluid is relatively constant, ranging from 400 to 500 ml. When CSF absorption is impaired, it will lead to an increase in the total amount of CSF in the central nervous system, which is clinically called hydrocephalus. At present, the main surgical treatment for hydrocephalus is ventriculoperitoneal shunt (V-P shunt) and third ventriculostomy. In most cases, the choice of treatment is ventriculoperitoneal shunt. The main complications of this procedure include intracranial infection, excessive shunt, subdural hematoma, induced epilepsy and tube blockage. It is widely accepted in the industry that early detection of such complications can lead to a better prognosis for patients. The purpose of this study was to evaluate and compare the effects of CSF MRI flow imaging scans, CSF component analysis, and X-ray films in the detection of postoperative complications in hospitalized children with V-P shunt. The study conducted a retrospective analysis of hospitalized cases of school-age children in a 10-year period from 2006 to 2016 at Rasul Akram Hospital in Tehran. The recorded data covered age, sex, postoperative complications, MRI flow imaging scans and routine and biochemical indexes of cerebrospinal fluid. A total of 95 children were included, 56 males (58.9%) and 39 females (41.1%), and the mean age of onset of postoperative complications was (2.8 ± 2.2) years. Postoperative tubular obstruction (60%) was the most common complication, followed by intracranial infection (25.3%). MRI CSF flow imaging could detect 36.5% of postoperative complications. The specificity and sensitivity of MRI CSF flow imaging for finding postoperative tubular obstruction were 87% and 50%, respectively. On the other hand, MRI CSF flow imaging is also valuable in detecting postoperative intracranial infection, with its specificity and sensitivity reaching 60% and 20%, respectively. When children had postoperative intracranial infection, the results of routine and biochemical examination of cerebrospinal fluid in all samples were comprehensively analyzed. 92% of children had decreased glucose level, 87.5% had increased protein and cell count, and 62.5% had positive cultures of cerebrospinal fluid pathogens. The sensitivity, specificity, positive predictive value and negative predictive value of CSF components were 92%, 82%, 63% and 97%, respectively. Combining the symptoms and signs of the child with the diagnosis helps to obtain a higher accuracy.

Long-term cardiac complications following COVID-2019 infection are poorly understood. This study was mainly to follow up the changes in left and right ventricular function after acute COVID-2019 infection based on echocardiographic parameters. The study mainly selected patients with acute COVID-19 infection registered with the World Echocardiography-COVID Federation, and all enrolled patients completed transthoracic echocardiography and were followed up. A total of 198 patients were enrolled with a mean follow-up day of 129 d, of which 153 patients had both analysable initial images (at the time of acute COVID-2019 infection) and follow-up images, including echocardiographic parameters of the left and right ventricles. Differences in echocardiographic parameters were compared at the time of acute COVID-2019 infection and at follow-up, respectively. Throughout the study cohort, echocardiographic parameters of left and right ventricles at follow-up did not differ significantly from those at acute COVID-2019 infection (bothP>0.05）。 Patients with hyperdynamic left ventricular ejection fraction (>70%) at acute COVID-2019 infection were reduced at follow-up (74.3% ± 3.1% vs. 64.4% ± 8.1%,P<0.001), while left ventricular ejection fraction decreased (<50%) were elevated at follow-up (42.5%±5.9% vs 49.3%±13.4%,P=0.02), there was no significant change in patients with normal left ventricular ejection fraction. Left ventricular longitudinal strain normal (<-18%) were reduced at follow-up (-21.6%±2.6% vs-20.3%±4.0%,P=0.006), whereas patients with impaired left ventricular longitudinal strain improved at follow-up (-14.5%±2.9% vs-16.7%±5.2%,P<0.001）。 Patients with abnormal right ventricular global longitudinal strain (>-20%) and abnormal right ventricular basal transverse diameter (>4.5 cm) improved at follow-up (bothP<0.05）。