Study on sex differences and potential clinical value of threedimensional computerized tomography pelvimetry in rectal cancer patients

BACKGROUND Laparoscopic rectal cancer radical surgery is a complex procedure affected by various factors.However,the existing literature lacks standardized parameters for the pelvic region and soft tissues,which hampers the establishment of consistent conclusions.AIM To comprehensively assess 16 pelvic and 7 soft tissue parameters through computerized tomography(CT)-based three-dimensional(3D)reconstruction,providing a strong theoretical basis to address challenges in laparoscopic rectal cancer radical surgery.METHODS We analyzed data from 218 patients who underwent radical laparoscopic surgery for rectal cancer,and utilized CT data for 3D pelvic reconstruction.Specific anatomical points were carefully marked and measured using advanced 3D modeling software.To analyze the pelvic and soft tissue parameters,we emp-loyed statistical methods including paired sample t-tests,Wilcoxon rank-sum tests,and correlation analysis.RESULTS The investigation highlighted significant sex disparities in 14 pelvic bone parameters and 3 soft tissue parameters.Males demonstrated larger measurements in pelvic depth and overall curvature,smaller measurements in pelvic width,a larger mesorectal fat area,and a larger anterior-posterior abdominal diameter.By contrast,females exhibited wider pelvises,shallower depth,smaller overall curvature,and an increased amount of subcutaneous fat tissue.However,there were no significant sex differences observed in certain parameters such as sacral curvature height,superior pubococcygeal diameter,rectal area,visceral fat area,waist circumference,and transverse abdominal diameter.CONCLUSION The reconstruction of 3D CT data enabled accurate pelvic measurements,revealing significant sex differences in both pelvic and soft tissue parameters.This study design offer potential in predicting surgical difficulties and creating personalized surgical plans for male rectal cancer patients with a potentially“difficult pelvis”,ultimately improving surgical outcomes.Further research and utilization of these parameters could lead to enhanced surgical methods and patient care in laparoscopic rectal cancer radical surgery.

Computerized tomography-guided therapeutic percutaneous puncture catheter drainage-combined with somatostatin for severe acute pancreatitis: An analysis of efficacy and safety

BACKGROUND Severe acute pancreatitis(SAP),a condition with rapid onset,critical condition and unsatisfactory prognosis,poses a certain threat to human health,warranting optimization of relevant treatment plans to improve treatment efficacy.AIM To evaluate the efficacy and safety of computerized tomography-guided the-rapeutic percutaneous puncture catheter drainage(CT-TPPCD)combined with somatostatin(SS)in the treatment of SAP.METHODS Forty-two SAP patients admitted to The Second Affiliated Hospital of Fujian Medical University from June 2020 to June 2023 were selected.On the basis of routine treatment,20 patients received SS therapy(control group)and 22 patients were given CT-TPPCD plus SS intervention(research group).The efficacy,safety(pancreatic fistula,intra-abdominal hemorrhage,sepsis,and organ dysfunction syndrome),abdominal bloating and pain relief time,bowel recovery time,hospital stay,inflammatory indicators(C-reactive protein,interleukin-6,and pro-calcitonin),and Acute Physiology and Chronic Health Evaluation(APACHE)II score of both groups were evaluated for comparison.RESULTS Compared with the control group,the research group had a markedly higher total effective rate,faster abdominal bloating and pain relief and bowel recovery,INTRODUCTION Pancreatitis,an inflammatory disease occurring in the pancreatic tissue,is classified as either acute or chronic and is associated with high morbidity and mortality,imposing a socioeconomic burden[1,2].The pathogenesis of this disease involves early protease activation,activation of nuclear factor kappa-B-related inflammatory reactions,and infiltration of immune cells[3].Severe acute pancreatitis(SAP)is a serious condition involving systemic injury and subsequent possible organ failure,accounting for 20%of all acute pancreatitis cases[4].SAP is also characterized by rapid onset,critical illness and unsatisfactory prognosis and is correlated with serious adverse events such as systemic inflammatory response syn-drome and acute lung injury,threatening the health of patients[5,6].Therefore,timely and effective therapeutic inter-ventions are of great significance for improving patient prognosis and ensuring therapeutic effects.Somatostatin(SS),a peptide hormone that can be secreted by endocrine cells and the central nervous system,is in-volved in the regulatory mechanism of glucagon and insulin synthesis in the pancreas[7].It has complex and pleiotropic effects on the gastrointestinal tract,which can inhibit the release of gastrointestinal hormones and negatively modulate the exocrine function of the stomach,pancreas and bile,while exerting a certain influence on the absorption of the di-gestive system[8,9].SS has shown certain clinical effectiveness when applied to SAP patients and can regulate the severity of SAP and immune inflammatory responses,and this regulation is related to its influence on leukocyte apoptosis and adhesion[10,11].Computerized tomography-guided therapeutic percutaneous puncture catheter drainage(CT-TPPCD)is a surgical procedure to collect lesion fluid and pus samples from necrotic lesions and perform puncture and drainage by means of CT image examination and precise positioning[12].In the research of Liu et al[13],CT-TPPCD applied to pa-tients undergoing pancreatic surgery contributes to not only good curative effects but also a low surgical risk.Baudin et al[14]also reported that CT-TPPCD has a clinical success rate of 64.6%in patients with acute infectious necrotizing pan-creatitis,with nonfatal surgery-related complications found in only two cases,suggesting that this procedure is clinically effective and safe in the treatment of the disease.In light of the limited studies on the efficacy and safety of SS plus CT-TPPCD in SAP treatment,this study performed a relevant analysis to improve clinical outcomes in SAP patients.

Detection of tracheal branching with computerized tomography:The relationship between the angles and age-gender

BACKGROUND The data obtained on the anatomical knowledge of the tracheobronchial system can be used for diagnosis,treatment and interventional interventions in areas such as anesthesia,thoracic surgery,pulmonary physiology.AIM To determine the tracheobronchial branching angles in pediatric and adult populations by using the multislice computed tomography(CT)and minimum intensity projection(MinIP)technique,which is a non-invasive method.METHODS Our study was carried out retrospectively.Patients who underwent contrast and non-contrast CT examination,whose anatomically and pathophysiologically good tracheobronchial system and lung parenchyma images were obtained,were included in the study.Measurements were made in the coronal plane of the lung parenchyma.In the coronal plane,right main bronchus-left main bronchus angle,right upper lobe bronchus-intermedius bronchus angle,right middle lobe bronchus-right lower lobe bronchus angle,left upper lobe bronchus-left lower lobe bronchus angle were measured.RESULTS The study population consisted of 1511 patients,753 pediatric(mean age:13.4±4.3;range:1-18 years)and 758 adults(mean age:54.3±17.3;range:19-94 years).In our study,tracheal bifurcation angle was found to be 73.3°±13.7°(59.6°-87°)in the whole population.In the pediatric group,the right-left main coronal level was found to be higher in boys compared to girls(74.6°±12.9°vs 71.2°±13.9°,P=0.001).In the adult group,the right-left main coronal level was found to be lower in males compared to females(71.9°±12.9°vs 75.8°±14.7°,P<0.001).CONCLUSIONS Our study,with the number of 1511 patients,is the first study in the literature with the largest number of patient populations including pediatric and adult demographic data,measuring the angle values of the tracheobronchial system using multislice CT and MinIP technique.Study data will not only be a guide during invasive procedures,but it can also guide studies to be done with imaging methods.

Effects of Irregular Respiratory Motion on the Positioning Accuracy of Moving Target with Free Breathing Cone-Beam Computerized Tomography

For positioning a moving target, a maximum intensity projection (MIP) or average intensity projection (AIP) image derived from 4DCT is often used as the reference image which is matched to free breathing cone-beam CT (FBCBCT) before treatment. This method can be highly accurate if the respiratory motion of the patient is stable. However, a patient’s breathing pattern is often irregular. The purpose of this study is to investigate the effects of irregular respiration on positioning accuracy for a moving target aligned with FBCBCT. Nine patients’ respiratory motion curves were selected to drive a Quasar motion phantom with one embedded cubic and two spherical targets. A 4DCT of the phantom was acquired on a CT scanner (Philips Brilliance 16) equipped with a Varian RPM system. The phase binned 4DCT images and the corresponding MIP and AIP images were transferred into Eclipse for analysis. FBCBCTs of the phantom driven by the same respiratory curves were also acquired on a Varian TrueBeam and fused such that both CBCT and MIP/AIP images share the same target zero positions. The sphere and cube volumes and centroid differences (alignment error) determined by MIP, AIP and FBCBCT images were calculated, respectively. Compared to the volume determined by MIP, the volumes of the cube, large sphere, and small sphere in AIP and FBCBCT images were smaller. The alignment errors for the cube, large sphere and small sphere with center to center matches between MIP and FBCBCT were 2.5 ± 1.8 mm, 2.4 ± 2.1 mm, and 3.8 ± 2.8 mm, and the alignment errors between AIP and FBCBCT were 0.5 ± 1.1 mm, 0.3 ± 0.8 mm, and 1.8 ± 2.0 mm, respectively. AIP images appear to be superior reference images to MIP images. However, irregular respiratory pattern could compromise the positioning accuracy, especially for smaller targets.

The Differences of Interstitial Lung Diseases in High-Resolution Computerized Tomography and Pulmonary Function Test among Different Connective Tissue Diseases, and the Correlated Factors

Objective. To study the difference of interstitial lung diseases (ILDs) in high-resolution computerized tomography and pulmonary function test among different connective tissue diseases (CTDs). Methods. 209 patients with different CTDs were recruited and underwent lung HRCT and PFT. Eerythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum ferritin (SF), anti-SSA, and so on were tested. Based on HRCT, a patient was classified into ILD group (CTD+ILD) or non-ILD group (CTD-ILD). HRCT, PFT, and laboratory markers were compared according to CTDs and CTD-associated ILDs. Results. The incidences of ILD were 79.6%, 82.0%, 89.7%, and 97.1% respectively for Rheumatoid arthritis (RA), primary Sjogren’s symptom (pSS), dermatomyositis/polymyositis (DM/PM), and systemic sclerosis (SSc) groups. RA and pSS patients exhibited more nodules, patching, ground-glass opacity, and cord shadow foci in HRCT, DM/PM and SSc patients exhibited more reticular opacity and honeycombing foci. RA and pSS patients exhibited more obstructive ventilatory disorder, small airway dysfunction and emphysema in PFT, and DM/PM and SSc patients exhibited more restrictive ventilatory disorder, mixed ventilatory disorder. ESR, CRP and SF were significantly higher in total CTD+ILD group than in total CTD-ILD group (P = 0.047, 0.006, 0.004, respectively), and higher in different CTD+ ILD groups than in comparable CTD-ILD groups (P = 0.049, 0.048, and 0.023, pSS+ILD, SSc+ILD and RA+ILD compared to pSS-ILD, SSc-ILD and RA-ILD, respectively for ESR, CRP, SF). The positive rate of anti-SSA was significantly higher in DM/PM+ILD group than in DM/PM-ILD group (P = 0.025). Conclusions. The manifestations and incidences of ILDs differ among different CTDs in HRCT and PFT, and inflammation and anti-SSA are positively correlated with ILDs in different CTDs, which provide important evidences for judging disease condition and prognosis.

Pore structure of ore granular media by computerized tomography image processing

The pore structure images of ore particles located at different heights of leaching column were scanned with X-ray computerized tomography (CT) scanner, the porosity and pore size distribution were calculated and the geometrical shape and connectivity of pores were analyzed based on image process method, and the three dimensional reconstruction of pore structure images was realized. The results show that the porosity of ore particles bed in leaching column is 42.92%, 41.72%, 39.34% at top, middle and bottom zone, respectively. Obviously it has spatial variability and decreases appreciably along the height of the column. The overall average porosity obtained by image processing is 41.33% while the porosity gotten from general measurement method in laboratory is 42.77% showing the results of both methods are consistent well. The pore structure of ore granular media is characterized as a dynamical space network composed of interconnected pore bodies and pore throats. The ratio of throats with equivalent diameter less than 1.91 mm to the total pores is 29.31%, and that of the large pores with equivalent diameter more than 5.73 mm is 2.90%.

Application of Proton Magnetic Resonance Spectroscopy and Computerized Tomography in the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease

In order to investigate the application of proton magnetic resonance spectroscopy(1H-MRS) and computerized tomography(CT) in the quantitative diagnosis of nonalcoholic fatty liver disease(NAFLD) and evaluation of therapeutic effects,22 patients with NAFLD were selected according to the Chinese Medical Association's(CMA) standard of the NAFLD in comparison with 20 healthy volunteers(as control group).Blood samples for biochemistry were collected.The severity of hepatosteatosis was evaluated by 1H-MRS scan and CT scan of liver.The intrahepatic content of lipid(IHCL) and CT value ratio of liver to spleen were calculated.The patients in NAFLD group were treated with Ganzhixiao Capsule for 8 weeks.The changes in IHCL and CT value ratio of liver to spleen were observed before and after treatment.In NAFLD group serum ALT,TG,IHCL calculated by 1HMRS were increased and CT value ratio of liver to spleen decreased significantly as compared with control group.After treatment for 8 weeks serum ALT,TG,IHCL were decreased significantly,while CT value ratio of liver to spleen increased significantly in NAFLD group.It was suggested that IHCL could be measured precisely by 1HMRS.NAFLD was treated effectively by Ganzhixiao capsule.

Validations of new cut-offs for surgical drains management and use of computerized tomography scan after pancreatoduodenectomy:The DALCUT trial

BACKGROUND Postoperative pancreatic fistula(POPF)is the most fearful complication after pancreatic surgery and can lead to severe postoperative complications such as surgical site infections,sepsis and bleeding.A previous study which identified cut-offs of drains amylase levels(DALs)determined on postoperative day(POD)1 and POD3,was able to significantly predict POPF,abdominal collections and biliary fistulas,when related to specific findings detected at the abdominal computerized tomography(CT)scan routinely performed on POD3.AIM To validate the cut-offs of DALs in POD1 and POD3,established during the previous study,to assess the risk of clinically relevant POPF and confirm the usefulness of abdominal CT scan on POD3 in patients at increased risk of abdominal collection.METHODS The DALCUT trial is an interventional prospective study.All patients who will undergo pancreatoduodenectomy(PD)for periampullary neoplasms will be considered eligible.All patients will receive clinical staging and,if eligible for surgery,will undergo routine preoperative evaluation.After the PD,daily DALs will be evaluated from POD1.Drains removal and possible requirement of abdominal CT scans in POD3 will be managed on the basis of the outcome of DALs in the first three postoperative days.RESULTS This prospective study could validate the role of DALs in the management of surgical drains and in assessing the risk or relevant complications after PD.Drains could be removed in POD3 in case of POD1 DALs<666 U/L and POD3 DALs<207 U/L.In case of POD3 DALs≥252,abdominal CT scan will be performed in POD3 to identify abdominal collections≥5 cm.In this latter category of patients,drains could be maintained beyond POD3.CONCLUSION The results of this trial will contribute to a better knowledge of POPF and management of surgical drains.

X-Ray Industrial Computerized Tomography System for Testing Advanced Structural Ceramics

This paper presents a X-ray industrial CT system with an image intensifier for NDT of ceramics, which was developed by Tsinghua University in 1990, and another one with discrete detectors, which is under constructing, and puts forward the work plan for the near future.

Four-Dimensional Computerized Tomography (4D-CT) Reconstruction Based on the Similarity Measure of Spatial Adjacent Images

Objective:To investigate the feasibility of a 4D-CT reconstruction method based on the similarity principle of spatial adjacent images and mutual information measure. Methods:A motor driven sinusoidal motion platform made in house was used to create one-dimensional periodical motion that was along the longitudinal axis of the CT couch. The amplitude of sinusoidal motion was set to an amplitude of ±1 cm. The period of the motion was adjustable and set to 3.5 s. Phantom objects of two eggs were placed in a Styrofoam block, which in turn were placed on the motion platform. These objects were used to simulate volumes of interest undergoing ideal periodic motion. CT data of static phantom were acquired using a multi-slice general electric (GE) LightSpeed 16-slice CT scanner in an axial mode. And the CT data of periodical motion phantom were acquired in an axial and cine-mode scan. A software program was developed by using VC++ and VTK software tools to resort the CT data and reconstruct the 4D-CT. Then all of the CT data with same phase were sorted by the program into the same series based on the similarity principle of spatial adjacent images and mutual information measure among them, and 3D reconstruction of different phase CT data were completed by using the software. Results:All of the CT data were sorted accurately into different series based on the similarity principle of spatial adjacent images and mutual information measures among them. Compared with the unsorted CT data, the motion artifacts in the 3D reconstruction of sorted CT data were reduced significantly, and all of the sorted CT series result in a 4D-CT that reflected the characteristic of the periodical motion phantom. Conclusion:Time-resolved 4D-CT reconstruction can be implemented with any general multi-slice CT scanners based on the similarity principle of spatial adjacent images and mutual information measure.The process of the 4D-CT data acquisition and reconstruction were not restricted to the hardware or software of the CT scanner and has the feasibility ,which extensive applicability.

The possible value of ~18F-FDG positron emission tomography/computerized tomography imaging in detection of atherosclerotic plaque

Objective:To evaluate the clinical value with positron emission tomography/computerized tomography(PET/CT)imaging for the detection of vulnerable plaque in atherosclerotic lesions.Methods:Sixty people with a age of over 60[mean age(69.2±7.1)years] underwent three dimension(3D)whole-body fluorine-18-2-fluoro-2-deoxy-D-glucose(18F-FDG)PET/CT imaging and were evaluated retrospectively,including 6 cases assessed as normal and 54 cases with active atherosclerotic plaque.Fifty-four cases with SUVs and CT values in the aortic wall of high-FDG-uptake were measured retrospectively.These high-FDG-uptake cases in the aortic wall were divided into three groups according their CT value.Cases in group 1 had high uptake in atherosclerotic lesions of the aortic wall with CT value of less than 60 Hu(soft plaque).Cases in group 2 had high uptake with CT value between 60-100 Hu(intermediate plaque).Cases in group 3 had high uptake with CT value more than 100 Hu(calcified plaque).Group 4 was normal.Results:In group 1,there were 42 high-FDG-uptake sites(average SUV 1.553±0.486).In group 2,there were 30 high-FDG-uptake sites(average SUV 1.393± 0.296).In group 3,there were 36 high-FDG-uptake sites(average SUV 1.354±0.189).In group 4,there were 33 normal-FDG-uptake sites(average SUV was 1.102±0.141).The SUVs showed significant difference among the four groups(F = 678.909,P = 0.000).There were also significant difference found between the normal-FDG-uptake group and the high-FDG-uptake groups(P = 0.000,0.000,0.001,respectively).Conclusion:Different degrees of 18F-FDG uptake in active large atherosclerotic plaque were shown in different stages of atherosclerotic plaque formation.The soft plaque had the highest FDG uptake in this study.This suggested that 18F-FDG PET/CT imaging may be of great potential value in early diagnosis and monitoring of vulnerable soft plaque in atherosclerotic lesions.

优化双下肢动脉能谱CT血管造影成像方案

目的优化双下肢动脉能谱CT血管造影(CTA)成像方案。方法回顾性分析30例疑诊双下肢动脉硬化性闭塞症(ASO)患者双下肢动脉能谱CTA资料,经重建获得40~80 keV(间隔5 keV)单能量(共9种)及100 kVp混合能量图像,对比双下肢动脉在不同图像中的CT值、噪声(SD)值、信噪比(SNR)及对比度噪声比(CNR);针对50、60 keV单能量和100 kVp混合能量图像质量及血管节段的可诊断性进行主观评估,观察40、45、50、60 keV单能量和100 kVp混合能量图像的自动去骨能力。结果40~80 keV范围内,随keV升高,各动脉在图像中的CT值、SD值、SNR及CNR均逐渐降低。相比100 kVp,腘动脉(PA)及其近端动脉的CT值、CNR及SNR均在40~55 keV图像中升高(P均<0.05);50~55 keV图像中SD值升高(P均<0.05),而60 keV图像中差异无统计学意义(P>0.05)。50及60 keV图像质量主观评分及可诊断动脉节段数与100 kVp差异均无统计学意义(P均>0.05)。PA以远节段的SNR及CNR在各单能量图像及100 kVp图像中差异均无统计学意义,其CT值在40~45 keV图像中、SD在40 keV图像中均高于100 kVp(P均<0.05),但SD在45 keV与100 kVp图像中差异无统计学意义(P>0.05);50 keV图像中,PA以远节段图像质量主观评分及可诊断节段数均高于60 keV及100 kVp(P均<0.05)。40 keV图像对9例(9/30,30.00%)、45 keV图像对6例(6/30,20.00%)不能自动去骨,50及60 keV、100 kVp对30例(30/30,100%)均可自动去骨。结论行双下肢动脉能谱CTA时,对PA及其近端节段以60 keV单能量成像较佳,对其以远或双下肢全程则以50 keV单能量成像较佳。

基于增强CT影像组学预测食管鳞癌淋巴血管侵犯状态的价值

目的:探讨基于增强CT影像组学预测食管鳞癌(ESCC)淋巴血管侵犯(LVI)的价值。方法:回顾性搜集行根治性切除术并经术后病理证实的224例食管鳞癌患者,其中包括66例LVI阳性和158例LVI阴性患者。所有患者均在术前2周内进行胸部增强CT扫描。将入组的患者按照7:3的比例随机分为训练集和测试集。使用3D Slicer软件逐层勾画全肿瘤感兴趣区(ROI),采用Python软件的Pyradiomics包提取肿瘤组织的影像组学特征,建立影像组学模型用于预测食管鳞癌的LVI状态并进行验证。采用受试者工作特征(ROC)曲线的曲线下面积(AUC)、敏感度、特异度、准确度、阳性预测值和阴性预测值来评价影像组学模型的诊断效能,使用校准曲线评价影像组学模型在训练集和测试集中的拟合程度。使用决策曲线分析(DCA)评价影像组学模型的临床应用价值。结果:从全肿瘤ROI中提取了1130个组学特征,经过筛选最终保留了7个影像组学特征,并使用多因素logistic回归建立影像组学预测模型。在训练集中,影像组学模型预测LVI的AUC值为0.930,敏感度为0.851,特异度为0.919,准确度为0.899,阳性预测值为0.816,阴性预测值为0.936;在测试集中,AUC值为0.897,敏感度为0.789,特异度为0.787,准确度为0.788,阳性预测值为0.600,阴性预测值为0.902。校准曲线显示影像组学模型在训练集及测试集中的预测概率与实际概率的一致性良好。DCA曲线显示影像组学模型具有良好的临床应用价值。结论:基于增强CT构建的影像组学模型,能够在术前有效预测食管鳞癌的LVI状态。

定量CT评价胸椎骨密度及与年龄相关的骨丢失

目的探讨胸椎定量CT(QCT)测量骨密度及骨丢失率的可行性。方法选取因健康体检及急腹症行全腹部CT扫描的患者708例,使用QCT软件测量T10-L3椎体骨密度。将受检者按每10岁为一个年龄段分组。计算每个年龄组的胸椎及腰椎骨密度,并计算各组别的峰值骨密度及骨丢失率。胸椎与腰椎骨密度及其与年龄的相关性采用Pearson相关分析。结果男性、女性骨密度峰值均在20~29岁年龄组,30岁以后胸腰椎骨密度开始不同程度减低,80~89岁女性胸椎及腰椎累计骨丢失率分别为60.61%及61.34%,而男性分别为44.45%及49.35%。男性与女性胸腰椎骨密度均与年龄呈负相关(P<0.01)。胸椎与腰椎骨密度呈正相关(男性r=0.96、女性r=0.98,P<0.01)。结论胸椎及腰椎QCT均能准确地显示不同年龄组的骨密度及骨丢失情况,胸椎QCT可以作为评价和监测骨丢失的一种方法。

基于不同管电压的人工智能重建算法对胸部体模CT扫描图像质量和辐射剂量的影响研究

目的:基于成年男性仿真胸部体模(PH-N1)CT扫描,探究不同管电压结合人工智能(AI)重建(CI)算法对胸部体模CT扫描图像质量和辐射剂量的影响。方法:采用512层超高端CT分为4种管电压对体模进行扫描,分别为70 kV、80 kV、100 kV和120 kV,对不同管电压的CT扫描图像采用10%、30%、50%、70%和90%CI算法重建1 mm薄层图像,比较4组扫描的容积剂量指数(CTDIvol)和剂量-长度乘积(DLP)。测量图像主动脉、腹壁脂肪及竖棘肌的CT值、标准偏差(SD)值,由两名5年以上工作经验的高年资诊断医师独立双盲的对图像质量进行5分制评估,并行Kappa一致性检验。采用单因素方差分析比较图像目标组织的CT值、SD值差异。采用Friedman秩和检验比较组间主观图像质量的差异。结果:4种不同管电压的CTDIvol和DLP比较,差异有统计学意义(F=1855.617、3996.118,P<0.05)。在70 kV管电压下,10%、30%、50%、70%和90%CI算法重建的主动脉、腹壁脂肪及竖棘肌的CT值比较,差异均无统计学意义(P>0.05),而SD值差异均有统计学意义(F=32.267、53.327、14.873,P<0.05)。在90%权重的CI算法重建4种不同管电压下,主动脉、腹壁脂肪及竖棘肌的CT值随着管电压的降低,CT值逐渐降低,差异有统计学意义(F=139.899、2563.93、219.231,P<0.05)。两名诊断医师对各组图像的主观评分一致性较好(Kappa=0.712~0.869)。结论:CI算法在70 kV管电压下90%权重的CI算法重建图像与80 kV、90 kV、120 kV图像相比,可以明显降低辐射剂量,同时图像具有良好信噪比。

宽体探测器CT血管造影与超声心动图对小儿先天性心脏病的诊断效能

目的探讨宽体探测器CT血管造影(computer tomography angiography,CTA)与超声心动图(ultrasound cardiogram,UCG)在小儿先天性心脏病(congenital heart disease,CHD)的诊断效能。方法回顾性分析2019-08/2023-09月作者医院收治的65例疑似CHD患儿的影像学资料,所有患儿均行心脏CTA及UCG检查。对两种检查方式的图像质量进行主观评价并比较其差异;以手术或数字减影血管造影(digital subtraction angiography,DSA)为“金标准”,对比两种检查方式在诊断CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率的差异,并应用Kappa检验比较与“金标准”结果的一致性;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析两种检查方式对小儿CHD的诊断效能。结果CTA诊断小儿CHD心外畸形图像质量主观评分明显高于UCG,二者比较差异具有统计学意义(P<0.05),心内畸形图像质量主观评分二者比较差异无统计学意义(P>0.05)。两名医师对图像质量主观评分的一致性较好(κ=0.802)。CTA、UCG诊断小儿CHD心内畸形准确率比较差异无统计学意义(P>0.05);CTA诊断小儿CHD心外畸形准确率为96.43%,显著高于UCG 50.00%,组间比较差异具有统计学意义(P<0.05)。CTA诊断小儿CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为90.00%、60.00%、96.43%、33.33%及87.69%,与手术或DSA结果一致性较好(κ=0.766);UCG诊断CHD的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为83.33%、20.00%、92.59%、9.09%及79.81%,与手术或DSA结果一致性一般(κ=0.522)。CTA、UCG两种检查方式诊断小儿CHD的灵敏度、特异度、阴性预测值及准确率差异比较均有统计学意义(P均<0.05)。ROC曲线分析结果显示,CTA与UCG诊断小儿CHD的曲线下面积(area under the cure,AUC)分别为0.853和0.773,二者比较差异有统计学意义(P<0.05)。结论宽体探测器CTA在小儿CHD心外畸形方面的诊断效能优于UCG,而在心内畸形方面稍差,因此建议二者联合检查,诊断价值更高。

胸部定量CT对COPD患者治疗反应预测因素分析

目的分析胸部定量CT扫描对慢性阻塞性疾病(COPD)患者治疗反应的预测因素。方法回顾性分析2018年8月至2021年2月接受治疗COPD患者120例的临床资料,对其随访1年,根据肺功能检测结果将其分为有治疗反应组[n=24,第1秒用力呼气容积(FEV_(1))增加≥0.225 L]和非无治疗反应组(n=96,FEV_(1)增加<0.225 L)。对2组一般资料进行单因素分析,对其中差异有统计学意义的变量进行多因素Logistic回归分析,从而筛选出预测COPD患者治疗反应的因素。结果单因素分析结果显示,有治疗反应组和无治疗反应组在EI、ATI、Pi10、WA%、T方面的差异有统计学意义(P<0.05),而2组间性别比、年龄、体重指数、GOLD分期、入院肺功能检测的差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,Pi10为预测COPD患者治疗反应的因素(OR=2.321,P<0.05)。ROC曲线显示,Pi10在预测COPD患者治疗反应中具有极高的临床价值,ROC曲线显示,Pi10预测COPD患者治疗反应的曲线下面积为0.701,95%CI为0.610~0.781,约登指数为0.354,最佳截断值为4.65 mm,灵敏度为85.40%,特异度为50.00%。结论胸部定量CT扫描参数Pi10能够帮助预测COPD患者治疗反应。

基于定量CT身体组分、^(18)F-FDG PET/CT显像预测手术联合新辅助化疗治疗早期乳腺癌预后的价值

目的 分析定量CT (QCT)身体组分、^(18)F-氟脱氧葡萄糖正电子发射型计算机断层显像(^(18)F-FDG PET-CT)对手术联合新辅助化疗(NAC)治疗早期乳腺癌患者预后的预测效能,为临床治疗提供参考。方法 选取2020年3月至2022年10月于南阳市第二人民医院接受手术联合NAC治疗的82例早期乳腺癌患者纳入研究,在NAC前和化疗1、3个周期后检测记录QCT参数[L_(1)、L_(2)水平的皮下脂肪面积(SFA)、内脏脂肪面积(VFA)、骨密度(BMD)、L_(3)水平的椎旁肌肉面积(TMA)]、^(18)F-FDG PET/CT显像的最大标准摄取值(SUV_(max))、肿瘤代谢体积(MTV)。NAC结束后进行手术,随访12个月(失访2例),依据有无复发转移分为预后良好组43例和预后不良组37例,比较不同预后患者的QCT参数、^(18)F-FDG PET/CT显像指标,采用受试者工作特征(ROC)曲线获取曲线下面积(AUC)分析其对早期乳腺癌患者预后的预测效能。结果化疗1个周期后,预后良好组患者的SFA、BMD、VFA、MA水平分别为(45.23±4.07) cm^(2)、(128.97±26.53) mg/m^(2)、(78.07±6.69) cm^(2)、(37.36±5.74) cm^(2),明显高于预后不良组的(42.52±3.32) cm^(2)、(112.54±25.82) mg/m^(2)、(73.73±7.25) cm^(2)、(32.94±5.31) cm^(2),差异均有统计学意义(P<0.05);化疗3个周期后,预后良好组患者的SFA、BMD、VFA、MA水平分别为(40.95±3.92) cm^(2)、(113.55±15.87) mg/m^(2)、(73.59±6.17) cm^(2)、(32.67±4.98) cm^(2),明显高于预后不良组的(37.51±3.56) cm^(2)、(95.18±17.45) mg/m^(2)、(70.30±5.14) cm^(2)、(28.52±4.42) cm^(2),差异均有统计学意义(P<0.05);化疗1个周期后,预后良好组患者的SUV_(max)、MTV分别为5.43±1.25、(3.86±0.87)×10^(4)mm,明显低于预后不良组的6.04±1.07、(4.27±0.85)×10^(4)mm,差异均有统计学意义(P<0.05);化疗3个周期后,预后良好组患者的SUV_(max)、MTV分别为3.94±1.06、(2.61±0.70)×10^(4)mm,明显低于预后不良组的4.73±1.21、(3.05±0.93)×10^(4)mm,差异均有统计学意义(P<0.05);经ROC曲线分析结果显示,SFA、BMD、VFA、MA、SUV_(max)、MTV联合预测手术联合NAC治疗早期乳腺癌患者预后的AUC分别为0.898 (95%CI:0.809~0.954)、0.919 (95%CI:0.836~0.968)。结论 NAC过程中检测QCT参数、^(18)F-FDG PET/CT显像指标可预测手术联合NAC治疗早期乳腺癌患者的预后,联合预测的价值较高。

胸部CT对系统性红斑狼疮淋巴结肿大的评估及其与疾病进程关系的研究

目的:探讨胸部CT对系统性红斑狼疮淋巴结肿大的评估价值及其与疾病进程的关系。方法:选择2020年7月至2023年7月亳州市人民医院收治的70例系统性红斑狼疮患者,按照胸部CT检查显示是否存在淋巴结肿大将其分为淋巴结肿大组(35例,短径>10 mm)和非淋巴结肿大组(35例,短径<8 mm)。采集两组患者基线资料,检测实验室指标并进行对比,将上述指标中差异有统计学意义的因素纳入多因素logistic回归分析,筛选系统性红斑狼疮患者发生淋巴结肿大的危险因素,分析典型病例的影像学图像。结果:淋巴结肿大组患者关节炎的发生率高于非淋巴结肿大组,肾损害的发生率低于非淋巴结肿大组,差异有统计学意义(x^(2)=4.769、4.884,P<0.05);淋巴结肿大组患者抗核抗体(ANA)、抗ds-DNA抗体及抗Sm抗体阳性率均高于非淋巴结肿大组,差异有统计学意义(x^(2)=4.590、5.040、5.833,P<0.05),白细胞计数(WBC),补体C3和C4水平均低于非淋巴结肿大组,红细胞沉降率(ESR)、免疫球蛋白G(IgG)及系统性红斑狼疮疾病活动指数(SLEDAI)评分均高于非淋巴结肿大组,差异有统计学意义(t=28.179、20.791、26.192、16.173、41.142、10.057,P<0.05);logistic回归分析结果显示,补体C3、IgG及SLEDAI评分是系统性红斑狼疮患者发生淋巴结肿大的危险因素(OR=3.034、2.721、1.127,P<0.05),而年龄大、肾损害为保护因素(OR=0.259、0.254,P<0.05)。结论:淋巴结肿大的出现预示着患者的疾病进展的过程中发生多系统损害的风险较大,且病情活动度较为严重。

探讨定量CT及生物电阻抗测定内脏脂肪面积和骨密度的关系

目的:探讨采用定量CT(Quantitative computer tomography,QCT)及生物电阻抗(Bioelectrical impedance analysis,BIA)测定内脏脂肪面积(Visceral fat area,VFA)与骨密度(Bone density,BMD)的关系。方法:回顾性选取郑州大学第一附属医院健康管理中心1131例体检者行QCT和BIA测定的VFA及BMD,采用Pearson相关系数、多因素线性回归、单因素和多因素Logistic回归分析二者的相关性;并采用Bland-Altman评估两者测定VFA的一致性。结果:Pearson相关分析显示QCT和BIA测定的VFA与BMD呈负相关(r=-0.197和r=-0.288)。多因素Logistic回归分析显示VFA(BIA)是骨量下降的危险因素(OR=1.010,95%CI:1.005~1.015);VFA(QCT)是骨量下降的危险因素(OR=1.003,95%CI:1.001~1.005);Bland-Altman分析显示,QCT和BIA测量VFA具有较高的一致性。结论:VFA是骨量下降的危险因素,测定VFA的QCT和BIA两者具有较高的一致性,可以采用BIA测定的VFA评估骨量下降。