Deep learning model based on PET/CT and combination with Cox proportional hazard model for predicting progression of lung invasive adenocarcinoma after surgery

Objective To observe the efficacy of deep learning(DL)model based on PET/CT and its combination with Cox proportional hazard model for predicting progressive disease(PD)of lung invasive adenocarcinoma within 5 years after surgery.Methods The clinical,PET/CT and 5-year follow-up data of 250 patients with lung invasive adenocarcinoma were retrospectively analyzed.According to PD or not,the patients were divided into the PD group(n=71)and non-PD group(n=179).The basic data and PET/CT findings were compared between groups,among which the quantitative variables being significant different between groups were transformed to categorical variables using receiver operating characteristic(ROC)curve and corresponding cut-off value.Multivariant Cox proportional hazard model was used to select independent predicting factors of PD of lung invasive adenocarcinoma within 5 years after surgery.The patients were divided into training,validation and test sets at the ratio of 6∶2∶2,and PET/CT data in training set and validation set were used to train model and tuning parameters to build the PET/CT DL model,and the combination model was built in serial connection of DL model and the predictive factors.In test set,the efficacy of each model for predicting PD of lung invasive adenocarcinoma within 5 years after surgery was assessed and compared using the area under the curve(AUC).Results Patients'gender and smoking status,as well as the long diameter,SUV max and SUV mean of lesions measured on PET images,the long diameter,short diameter and type of lesions showed on CT were statistically different between groups(all P<0.05).Smoking(HR=1.787[1.053,3.031],P=0.031)and lesion SUV max>4.15(HR=5.249[1.062,25.945],P=0.042)were both predictors of PD of lung invasive adenocarcinoma within 5 years after surgery.In test set,the AUC of PET/CT DL model for predicting PD was 0.847,of the combination model was 0.890,of the latter was higher than of the former(P=0.036).Conclusion DL model based on PET/CT had high efficacy for predicting PD of lung invasive adenocarcinoma within 5 years after surgery.Combining with Cox proportional hazard model could further improve its predicting efficacy.

DR与CT检查用于脊柱爆裂型骨折诊断中的效能分析

目的对比数字X线摄影术(Digit Radiography,DR)与计算机X线断层摄影机(CT)检查对脊柱爆裂型骨折的诊断效能。方法纳入120例脊柱骨折患者,诊治时间为2018年1月至2022年3月,所用患者均行DR与CT检查,对比不同类型脊柱骨折的检出率,并对两种方式对脊柱爆裂型骨折的诊断效能进行对比。结果两种方式对压缩型骨折和chance骨折的检出率比较,无统计学差异(P>0.05),CT检查对脊柱爆裂型骨折的检出率为95.00%,总检出率为95.83%,高于DR的77.50%和80.83%;CT诊断脊柱爆裂型骨折的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为95.00%、96.25%、95.83%、92.68%和97.47%,高于DR检查的77.50%、82.50%、80.93%、62.89%和88.00%,数据对比有差异(P<0.05)。结论与DR比较,CT诊断脊柱爆裂型骨折敏感性高,特异性强,有广泛应用价值。

B超·C T·核磁共振

B超、CT、核磁共振,是目前医院用来诊查疾病较为先进的三种影像技术。虽然它们诊断疾病的原理不同,但能各显神通,为捕捉人体的“妖魔病怪”立下了汗马功劳。 B超:是根据人体各脏器组织结构密度不同的特点,通过超声的原理,在荧光屏上显示出各脏器的切面图像。医生根据对图像的观察分析进行病变诊察,具有真实性强、直观效果好、迅速方便。

Pre-operative predictive factors for gallbladder cholesterol polyps using conventional diagnostic imaging

AIM： To determine the clinical data that might be useful for differentiating benign from malignant gallbladder （GB） polyps by comparing radiological methods, including abdominal ultrasonography （US） and computed tomography （CT） scanning, with postoperative pathology findings. METHODS： Fifty-nine patients underwent laparoscopic cholecystectomy for a GB polyp of around 10 ram. They were divided into two groups, one with cholesterol polyps and the other with non-cholesterol polyps. Clinical features such as gender, age, symptoms, size and number of polyps, the presence of a GB stone, the radiologically measured maximum diameter of the polyp by US and CT scanning, and the measurements of diameter from postoperative pathology were recorded for comparative analysis. RESULTS： Fifteen of the 41 cases with cholesterol polyps （36.6%） were detected with US but not CT scanning, whereas all 18 non-cholesterol polyps were observed using both methods. In the cholesterol polyp group, the maximum measured diameter of the polyp was smaller by CT scan than by US.Consequently, the discrepancy between those two scanning measurements was greater than for the non- cholesterol polyp group. CONCLUSION： The clinical signs indicative of a cholesterol polyp include： （1） a polyp observed by US but not observable by CT scanning, （2） a smaller diameter on the CT scan compared to US, and （3） a discrepancy in its maximum diameter between US and CT measurements. In addition, US and the CT scan had low accuracy in predicting the polyp diameter compared to that determined by postoperative pathology.

Is there correlation between pancreatic enzyme and radiological severity in acute pancreatitis?

AIM: To investigate the correlation between the changes of pancreatic enzyme, the biochemical markers and the clinical results according to the Balthazar computer tomography (CT) grade. METHODS: Between July 2004 and July 2005, we reviewed the charts of 119 patients who were admitted to our hospital with acute pancreatitis. RESULTS: Eighty-three patients (69.7%) were male, and the mean age of the patients was 57 ± 15.7 years. The biliary pancreatitis patients had an older mean age. Forty-nine patients (41.1%) had biliary pancreatitis and forty-six (38.6%) had alcoholic pancreatitis. Group 3 patients had a longer duration of pain (2.51 ± 1.16 vs 3.17 ± 1.30 vs 6.56 ± 6.13, P < 0.001), a longer period of fasting (7.49 ± 4.65 vs 10.65 ± 5.54 vs 21.88 ± 13.81, P < 0.001) and a longer hospital stay (9.17 ± 5.34 vs 14.63 ± 8.65 vs 24.47 ± 15.52, P < 0.001) than the other groups. On the univariate analysis, the factors that affected the radiological grade were the leukocyte count at admission (P = 0.048), the hemoglobin (P = 0.016) and total bilirubin concentrations (P = 0.023), serum lipase (P = 0.009), the APACH Ⅱ scores at admission (P = 0.017), the APACH Ⅱ scores after 24 h (P = 0.031), the C-reactive protein (CRP) titer (P = 0.0001) and the follow up CRP titer (P = 0.003). But the CRP level (P = 0.001) and follow up CRP titer (P = 0.004) were only correlated with the radiological grade on multivariate analysis. According to the ROC curve, when we set the CRP cut off value at 83 mg/L, the likelihoodratio for a positive test was 3.84 and the likelihood ratio for a negative test was 0.26 in group 3. CONCLUSION: In conclusion, our study suggests that the CRP with the radiological severity may be used to estimate the severity of acute pancreatitis.

Computed tomography perfusion in evaluating the therapeutic effect of transarterial chemoembolization for hepatocellular carcinoma

AIM： To prospectively assess the changes in parameters of computed tomography （CT） perfusion pre- and post-transarterial chemoembolization （TACE） of hepatocellular carcinoma （HCC） in different treatment response groups, and to correlate the changes with various responses of HCC to TACE. METHODS： Thirty-nine HCC patients underwent CT perfusion examinations pre-（1 d before TACE） and post-treatment （4 wk after TACE）. The response evaluation criteria for solid tumors （RECIST） were referred to when treatment responses were distributed. Wilcoxon-signed ranks test was used to compare the differences in CT perfusion parameters pre- and post- TACE for different response groups. RESULTS： Only one case had treatment response to CR and the CT perfusion maps of post-treatment lesion displayed complete absence of signals. In the PR treatment response group, hepatic artery perfusion （HAP）, hepatic arterial fracture （HAF） and hepatic blood volume （HBV） of viable tumors post-TACE were reduced compared with pre-TACE （P = 0.001, 0.030 and 0.001, respectively）. In the SD group, all CT perfusion parameters were not significantly different pre- and post-TACE. In the PD group, HAP, HAl=, portal vein perfusion （PVP） and hepatic blood flow （HBF） of viable tumors post-TACE were significantly increased compared with pre-TACE （P = 0.005, 0.012, 0.035 and 0.005, respectively）. CONCLUSION： Changes in CT perfusion parameters of viable tumors are correlated with different responses of HCC to TACE. Therefore, CT perfusion imaging is a feasible technique for monitoring response of HCC to TACE.

Imaging of the gastrointestinal tract-novel technologies

Imaging of the gastrointestinal tract is very useful for research and clinical studies of patients with symptoms arising from the gastrointestinal tract and in visualising anatomy and pathology. Traditional radiological techniques played a leading role in such studies for a long time. However, advances in non-invasive modalities including ultrasound (US), computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI), etc, have in the last decades revolutionised the way in which the gastrointestinal tract is studied. The resolution of imaging data is constantly being improved and 3D acquisition, tools for fi ltering, enhancement, segmentation and tissue classif ication are continually being developed. Additional co-registration techniques allow multimodal data acquisition with improved classif ication of tissue pathology. Furthermore, new functional imaging techniques have become available. Altogether, the future of gastrointestinal imaging looks very promising which will be of great benef it in clinical and research studies of gastrointestinal diseases. The purpose of this review is to highlight the capabilities of the newest techniques to explore the detailed morphology, biomechanical properties, function and pathology of the gastrointestinal tract.

A case of multiple intra-abdominal splenosis with computed tomography and magnetic resonance imaging correlative findings

Hepatic splenosis refers to heterotopic auto- transplantation and implantation of splenic tissue resulting from the spillage of cells from the spleen after splenic trauma or splenectomy. The true incidence of splenosis is unknown, because this entity is usually an incidental finding at surgery. Splenic implants are usually multiple, and can be localized anywhere in the peritoneal cavity. Splenic implants in the peritoneal cavity may be confused with renal tumors, abdominal lymphomas and endometriosis. We describe computed tomography (CT) and magnetic resonance imaging (MRI) findings in a rare case of multiple intra-abdominal splenosis located along the hepatic surface and adjacent to the upper pole of the right kidney, mimicking a renal neoplasm.

Highly metabolic thrombus of the portal vein:^(18)F fluorodeoxyglucose positron emission tomography/computer tomography demonstration and clinical significance in hepatocellular carcinoma

AIM： To assess the ability of ^18F-fluorodeoxyglucose positron emission tomography/computer tomography （^18F-FDG PET/CT） to differentiate between benign and malignant portal vein thrombosis in hepatocellular carcinoma （HCC） patients.METHODS： Five consecutive patients who had HBV cirrhosis, biopsy-proven HCC, and thrombosis of the main portal vein and/or left/right portal vein on ultrasound （US）, computer tomography （CT） or magnetic resonance imaging （MRI） were studied with ^18F-FDG PET/CT. The presence or absence of a highly metabolic thrombus on ^18F-FDG PET/CT was considered diagnostic for malignant or benign portal vein thrombosis, respectively. All patients were followed-up monthly with US, CT or MRI. Shrinkage of the thrombus or recanalization of the vessels on US, CT or MRI during follow-up was considered to be definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered to be consistent with malignancy. ^18SF-FDG PET/CT, and US, CT or MRI results were compared.RESULTS： Follow-up （1 to 10 mo） showed signs of malignant thrombosis in 4 of the 5 patients. US, CT or MRI produced a true-positive result for malignancy in 4 of the patients, and a false-positive result in 1. ^18F-FDG PET/CT showed a highly metabolic thrombus in 4 of the 5 patients. ^18F-FDG PET/CT achieved a true-positive result in all 4 of these patients, and a true-negative result in the other patient. No false-positive result was observed using ^18F-FDG PET/CT.CONCLUSION： ^18F-FDG PET/CT may be helpful in discriminating between benign and malignant portal vein thrombi. Patients may benefit from ^18F-FDG PET/CT when portal vein thrombi can not be diagnosed exactly by US, CT or MRI.

Subclinical hypothyroidism is associated with lipid-rich plaques in patients with coronary artery disease as assessed by optical coherence tomography

Background Subclinical hypothyroidism （SCH） has recently been acknowledged as an unconventional risk factor for coronary artery disease （CAD） and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH. Methods Patients with coronary artery disease were enrolled in the study and divided into an SCH group （patients, n = 26; plaques, n = 35） and a non-SCH group （patients, n = 52; plaques, n = 66）. They were divided 1：2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography （OCT） imaging was performed on all patients, and images were analyzed by two inde- pendent investigators. Lipid-rich plaques （LRP）, the precursor of vulnerable plaques, were defined as having more than one quadrant occu- pied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The pres- ence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted. Results The ratio of LRP in SCH group was significantly higher than that in non-SCH group （54% vs. 30.3%, P = 0.037）. That was the case as well for the maximum lipid arcs value （181.5°± 61.6° vs. 142.1° 4± 35.9°, p = 0.046）. While thin-cap fibroatheroma （TCFA） was detected, no difference was identified between the two groups in either TCFA ratio （20% vs. 16.7%, P = 0.579） or fibrous cap thickness （57.5 4± 14.0 vs. 63.5 4±10.7 gin, P = 0.319）. Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar. ConcLusion Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.

Application of ultrasonic CT method in nondestructive detection of interior defects in large scale concrete structural member of bridge

The ultrasonic computed tomography （USCT） method is derived from the basic principles of X-ray section scanning. This method records the arriving times of ultrasonic wave between the probes and the sources to ealculate the elastic wave velocity values in the section using the arrival times. Through analyzed the distribution Of elastic wave velocity in aim area, the information of the strength and the homogeneity of the investigated zone could be got indirectly. The authors introduced the operational principle of USCT and a practical case of using this method to detect the interior defects in large scale concrete structural member. Compared with other exploration methods, this method is more efficient and accurate.

CT机的发明

X光透视的缺陷 1895年,德国物理学家伦琴在做阴极射线管实验时,偶然发现了X射线。从此,人们患病到医院诊断,医生往往要叫你先拍一张X光片作检查,然后再进行对症治疗。可是,平时透视或拍片,X射线是从人体的前后方向上照射,透视出来的图像是这个方向的平面图,只能看到上下与左右的位置关系,而不能分辨病变的深浅,特别是有些深部的病变,由于受到前面脏器的阻隔,无法作出正确的诊断。

Contour changes in human alveolar bone following tooth extraction of the maxillary central incisor

The purpose of this study was to apply cone-beam computed tomography （CBCT） to observe contour changes in human alveolar bone after tooth extraction of the maxillary central incisor and to provide original mor- phological evidence for aesthetic implant treatment in the maxillary anterior area. Forty patients were recruited into the study. Each patient had two CBCT scans （CBCT I and CBCT II）, one taken before and one taken three months after tooth extraction of maxillary central incisor （test tooth T）. A fixed anatomic reference point was used to orient the starting axial slice of the two scans. On three CBCT I axial slices, which represented the deep, middle, and shallow layers of the socket, labial and palatal alveolar bone widths of T were measured. The number of sagittal slices from the start point to the pulp centre of T was recorded. On three CBCT II axial slices, the pulp centres of extracted T were oriented according to the number of moved sagittal slices recorded in CBCT I. Labial and palatal alveolar bone widths at the oriented sites were measured. On the CBCT I axial slice which represented the middle layer of the socket, sagittal slices were reconstructed. Relevant distances of T on the sagittal slice were measured, as were the alveolar bone width and tooth length of the opposite central incisor. On the CBCT II axial slice, which represented the middle layer of the socket, relevant distances recorded in CBCT I were transferred on the sagittal slice. The height reduction of alveolar bone on labial and palatal sides was measured, as were the alveolar bone width and tooth length of the opposite central incisor at the oriented site. Intraobserver reliability assessed by intraclass correlation coefficients （ICCs） was high. Paired sample t-tests were performed. The alveolar bone width and tooth length of the opposite central incisor showed no statistical differences （P〈0.05）. The labial alveolar bone widths of T at the deep, middle, and shallow layers all showed statistical differences. However, no palatal alveolar bone widths showed any statistical differences. The width reduction of alveolar bone was 1.2, 1.6, and 2.7 mm at the deep, middle, and shallow layers, respectively. The height reduction of alveolar bone on labial and palatal sides of T both showed statistical differences, which was 1.9 and 1.1 mm, respectively.

Effect of Zhu-yuan decoction in patients with chronic rhinosinusitis after functional endoscopic sinus surgery

OBJECTIVE: To investigate the effectiveness and safety of Zhu-yuan decoction(ZYD) in patients after functional endoscopic sinus surgery(FESS).METHODS: A total of 85 patients were randomized into two groups: 44 were treated with intranasal corticosteroids(INC), and 41 were given Chinese herbal medicine(CHM). Patients with chronic rhinosinusitis(CRS) who underwent FESS were prospectively enrolled in the study. Before surgery, they were evaluated by visual analog scale(VAS), nasal endoscopy, computed tomography(CT), and routine blood test. After surgery, they were randomized to take ZYD or INC for 12 weeks and revaluated by VAS; nasal endoscopy at 4, 8, and 12 weeks;and CT at 12 weeks after surgery.RESULTS: In the both groups, VAS and endoscopyscores decreased significantly at 4, 8, and 12 weeks,and CT scores after treatment declined at 12 weeks compared with baseline scores. No significant differences were observed with regard to postoperative VAS, endoscopy, or CT scores between groups.ZYD, combined with surgery, can reduce VAS, nasal endoscopy, and CT scores and has the same efficacy and safety profile as INC in post-FESS management.No fatalities or major adverse events occurred in either group.CONCLUSION: Our findings suggest that ZYD has similar effects and safety profiles in patients after FESS compared with INC.

A feasibility study of applying cone-beam computed tomography to observe dimensional changes in human alveolar bone

The purpose of this study was to demonstrate the feasibility of applying cone-beam computed tomography（CBCT） to observe dimensional changes in human alveolar bone continuously after tooth extraction.Sixty patients were selected from a CBCT database.Each patient had two CBCT scans（CBCT I and CBCT II）,one taken before and one taken after implant surgery.A fixed anatomic reference point was used to orient the horizontal slice of the two scans.The alveolar ridge width was measured on the horizontal slice.In each series of CBCT I sagittal slices,the number of slices from the start point to the pulp center of the test tooth was recorded.The tooth length was measured on the sagittal slice.In each series of CBCT II slices,tooth length was measured on a sagittal slice selected based on the number of slices from the start point to the pulp center recorded in CBCT I.Intraobserver reliability,assessed by the intraclass correlation coefficient（ICC）,was high.Paired sample t-tests of repeated measurements of both tooth length and alveolar bone width showed no statistically significant differences（P0.05）.This study has proved that projection differences among CBCT scans taken at different time points from one patient can be neglected without affecting the accuracy of millimeter scale measurements.CBCT is a reliable imaging tool for continuously observing dimensional changes in human alveolar bone.