3D characterization and analysis of pore structure of packed ore particle beds based on computed tomography images

Methods and procedures of three-dimensional （3D） characterization of the pore structure features in the packed ore particle bed are focused. X-ray computed tomography was applied to deriving the cross-sectional images of specimens with single particle size of 1-2, 2-3, 3-4, 4-5, 5-6, 6-7, 7-8, 8-9, 9-10 ram. Based on the in-house developed 3D image analysis programs using Matlab, the volume porosity, pore size distribution and degree of connectivity were calculated and analyzed in detail. The results indicate that the volume porosity, the mean diameter of pores and the effective pore size （d50） increase with the increasing of particle size. Lognormal distribution or Gauss distribution is mostly suitable to model the pore size distribution. The degree of connectivity investigated on the basis of cluster-labeling algorithm also increases with increasing the particle size approximately.

Impact of computed tomography/magnetic resonance imaging registration on rehabilitation after percutaneous endoscopic decompression for lumbar stenosis: Retrospective study

BACKGROUND Percutaneous endoscopic lumbar decompression(PELD)shows promise for lumbar spinal stenosis(LSS)treatment,but its use is limited by the disease's complexity and procedural challenges.AIM In this study,the effects of preoperative planning and intraoperative guidance with computed tomography(CT)/magnetic resonance imaging(MRI)registration techniques on PELD for LSS and postoperative rehabilitation outcomes were evaluated.METHODS This retrospective study was conducted with data from patients who underwent PELD for LSS between January 2021 and December 2023.Patients were assigned to preoperative CT/MRI registration and control groups.Data collected included the operative time,length of hospital stay,visual analog scale(VAS)scores for low back and leg pain,and the Japanese Orthopaedic Association(JOA)lumbar spine score.Differences between groups were assessed using Student’s t test.RESULTS Data from 135 patients(71 in the CT/MRI registration group,64 in the control group)were analyzed.The operative time was significantly shorter in the CT/MRI registration group(P=0.007).At 2 months postoperatively,both groups showed significant reductions in VAS leg and low back pain scores(all P<0.001)and improvements in the JOA score(both P<0.001).No complication or death occurred.Preoperatively,pain and JOA scores were similar between groups(P=0.830,P=0.470,and P=0.287,respectively).At 2 months postoperatively,patients in the CT/MRI registration group reported lower leg and low back pain levels(P<0.001 and P=0.001,respectively)and had higher JOA scores(P=0.004)than did patients in the control group.CONCLUSION Preoperative CT/MRI registration for PELD for LSS reduced the operative time and VAS pain scores at 2 months and improved JOA scores,demonstrating enhanced effectiveness and safety.

Effectiveness of magnetic resonance imaging and spiral computed tomography in the staging and treatment prognosis of colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a prevalent cancer type in clinical settings;its early signs can be difficult to detect,which often results in late-stage diagnoses in many patients.The early detection and diagnosis of CRC are crucial for improving treatment success and patient survival rates.Recently,imaging techniques have been hypothesized to be essential in managing CRC,with magnetic resonance imaging(MRI)and spiral computed tomography(SCT)playing a significant role in enhancing diagnostic and treatment approaches.AIM To explore the effectiveness of MRI and SCT in the preoperative staging of CRC and the prognosis of laparoscopic treatment.METHODS Ninety-five individuals admitted to Zhongshan Hospital Xiamen University underwent MRI and SCT and were diagnosed with CRC.The precision of MRI and SCT for the presurgical classification of CRC was assessed,and pathological staging was used as a reference.Receiver operating characteristic curves were used to evaluate the diagnostic efficacy of blood volume,blood flow,time to peak,permeability surface,blood reflux constant,volume transfer constant,and extracellular extravascular space volume fraction on the prognosis of patients with CRC.RESULTS Pathological biopsies confirmed the following CRC stages:23,23,32,and 17 at T1,T2,T3,and T4,respectively.There were 39 cases at the N0 stage,22 at N1,34 at N2,44 at M0 stage,and 51 at M1.Using pathological findings as the benchmark,the combined use of MRI and SCT for preoperative TNM staging in patients with CRC demonstrated superior sensitivity,specificity,and accuracy compared with either modality alone,with a statistically significant difference in accuracy(P<0.05).Receiver operating characteristic curve analysis revealed the predictive values for laparoscopic treatment prognosis,as indicated by the areas under the curve for blood volume,blood flow,time to peak,and permeability surface,blood reflux constant,volume transfer constant,and extracellular extravascular space volume fraction were 0.750,0.683,0.772,0.761,0.709,0.719,and 0.910,respectively.The corresponding sensitivity and specificity values were also obtained(P<0.05).CONCLUSION MRI with SCT is effective in the clinical diagnosis of patients with CRC and is worthy of clinical promotion.

Chronic pancreatitis:Pain and computed tomography/magnetic resonance imaging findings

Chronic pancreatitis(CP)is a fibroinflammatory disease characterized by irreversible destruction of pancreatic tissue.With the development of the disease,it may lead to exocrine and/or endocrine insufficiency.CP is one of the common diseases that cause abdominal pain,which will not get permanent spontaneous relief as the disease evolves.The American College of Gastroenterology clinical guidelines recommend computed tomography or magnetic resonance imaging as the first-line examination for the diagnosis of CP.CP common imaging findings include pancreatic atrophy,irregular dilatation of the pancreatic duct,calcification of pancreatic parenchyma,pancreatic duct stones,etc.In clinical practice,whether any correlations between CP-induced abdominal pain patterns(no pain/constant/intermittent pain)and corresponding imaging findings present are not well known.Therefore,this review aims to comprehensively sort out and analyze the relevant information by collecting lots of literature on this field,so as to construct a cross-bridge between the clinical manifestations and imaging manifestations of CP patients.Also,it provides an imaging basis and foundation for the classification and diagnosis of abdominal pain types in clinical CP patients.

Use of high-resolution X-ray computed tomography and 3D image analysis to quantify mineral dissemination and pore space in oxide copper ore particles

Mineral dissemination and pore space distribution in ore particles are important features that influence heap leaching performance. To quantify the mineral dissemination and pore space distribution of an ore particle, a cylindrical copper oxide ore sample (I center dot 4.6 mm x 5.6 mm) was scanned using high-resolution X-ray computed tomography (HRXCT), a nondestructive imaging technology, at a spatial resolution of 4.85 mu m. Combined with three-dimensional (3D) image analysis techniques, the main mineral phases and pore space were segmented and the volume fraction of each phase was calculated. In addition, the mass fraction of each mineral phase was estimated and the result was validated with that obtained using traditional techniques. Furthermore, the pore phase features, including the pore size distribution, pore surface area, pore fractal dimension, pore centerline, and the pore connectivity, were investigated quantitatively. The pore space analysis results indicate that the pore size distribution closely fits a log-normal distribution and that the pore space morphology is complicated, with a large surface area and low connectivity. This study demonstrates that the combination of HRXCT and 3D image analysis is an effective tool for acquiring 3D mineralogical and pore structural data.

An algorithm for computed tomography image reconstruction from limited-view projections

With the development of the compressive sensing theory, the image reconstruction from the projections viewed in limited angles is one of the hot problems in the research of computed tomography technology. This paper develops an iterative algorithm for image reconstruction, which can fit the most cases. This method gives an image reconstruction flow with the difference image vector, which is based on the concept that the difference image vector between the reconstructed and the reference image is sparse enough. Then the l1-norm minimization method is used to reconstruct the difference vector to recover the image for flat subjects in limited angles. The algorithm has been tested with a thin planar phantom and a real object in limited-view projection data. Moreover, all the studies showed the satisfactory results in accuracy at a rather high reconstruction speed.

Monochromatic energy computed tomography image for active intestinal hemorrhage:A model investigation

AIM: To investigate the value of computed tomography(CT) spectral imaging in the evaluation of intestinal hemorrhage.METHODS: Seven blood flow rates were simulated in vitro.Energy spectral CT and mixed-energy CT scanswere performed for each rate(0.5,0.4,0.3,0.2,0.1,0.05 and 0.025 m L/min).The detection rates and the contrast-to-noise ratios(CNRs) of the contrast agent extravasation regions were compared between the two scanning methods in the arterial phase(AP) and the portal venous phase(PVP).Comparisons of the CNR values between the PVP and the AP were made for each energy level and carried out using a completely random t test.A χ2 test was used to compare the detection rates obtained from the two scanning methods.RESULTS: The total detection rates for energy spectral CT and mixed-energy CT in the AP were 88.57%(31/35) and 65.71%(23/35),respectively,and the difference was significant(χ2 = 5.185,P = 0.023); the total detection rates in the PVP were 100.00%(35/35) and 91.4%(32/35),respectively,and the difference was not significant(χ2 = 1.393,P = 0.238).In the AP,the CNR of the contrast agent extravasation regions was 3.58 ± 2.09 on the mixed-energy CT images,but the CNRs were 8.78 ± 7.21 and 8.83 ± 6.75 at 50 and 60 keV,respectively,on the single-energy CT images,which were significantly different(3.58 ± 2.09 vs 8.78 ± 7.21,P = 0.031; 3.58 ± 2.09 vs 8.83 ± 6.75,P = 0.029).In the PVP,the differences between the CNRs at 40,50 and 60 keV different monochromatic energy levels and the polychromatic energy images were significant(19.35 ± 10.89 vs 11.68 ± 6.38,P = 0.010; 20.82 ± 11.26 vs 11.68 ± 6.38,P = 0.001; 20.63 ± 10.07 vs 11.68 ± 6.38,P = 0.001).The CNRs at the different energy levels in the AP and the PVP were significantly different(t =-2.415,-2.380,-2.575,-2.762,-2.945,-3.157,-3.996 and-3.189).CONCLUSION: Monochromatic energy imaging spectral CT is superior to polychromatic energy images for the detection of intestinal hemorrhage,and the detection was easier in the PVP compared with the AP.

Optimization-based image reconstruction in x-ray computed tomography by sparsity exploitation of local continuity and nonlocal spatial self-similarity

The additional sparse prior of images has been the subject of much research in problems of sparse-view computed tomography（CT） reconstruction. A method employing the image gradient sparsity is often used to reduce the sampling rate and is shown to remove the unwanted artifacts while preserve sharp edges, but may cause blocky or patchy artifacts.To eliminate this drawback, we propose a novel sparsity exploitation-based model for CT image reconstruction. In the presented model, the sparse representation and sparsity exploitation of both gradient and nonlocal gradient are investigated.The new model is shown to offer the potential for better results by introducing a similarity prior information of the image structure. Then, an effective alternating direction minimization algorithm is developed to optimize the objective function with a robust convergence result. Qualitative and quantitative evaluations have been carried out both on the simulation and real data in terms of accuracy and resolution properties. The results indicate that the proposed method can be applied for achieving better image-quality potential with the theoretically expected detailed feature preservation.

Low-radiation and high image quality coronary computed tomography angiography in “real-world” unselected patients

AIM To determine the radiation dose and image quality in coronary computed tomography angiography(CCTA)using state-of-the-art dose reduction methods in unselected"real world"patients.METHODS In this single-centre study,consecutive patients in sinus rhythm underwent CCTA for suspected coronary artery disease(CAD)using a 320-row detector CT scanner.All patients underwent the standard CT acquisition protocol at our institute(Morriston Hospital)a combination of dose saving advances including prospective electrocardiogram-gating,automated tube current modulation,tube voltage reduction,heart rate reduction,and the most recent novel adaptive iterative dose reconstruction 3D(AIDR3D)algorithm.The cohort comprised real-world patients for routine CCTA who were not selected on age,body mass index,or heart rate.Subjective image quality was graded on a 4-point scale(4=excellent,1=non-diagnostic).RESULTS A total of 543 patients were included in the study with a mean body weight of 81±18 kg and a pre-scan mean heart rate of 70±11 beats per minute(bpm).When indicated,patients received rate-limiting medication with an oral beta-blocker followed by additional intravenous beta-blocker to achieve a heart rate below 65 bpm.The median effective radiation dose was 0.88 mSv(IQR,0.6-1.4 mSv)derived from a Dose Length Product of61.45 mGy.cm(IQR,42.86-100.00 mGy.cm).This also includes what we believe to be the lowest ever-reported radiation dose for a routine clinical CCTA(0.18 mSv).The mean image quality(SD)was 3.65±0.61,with a subjective image quality score of 3("good")or above for 93%of patient CCTAs.CONCLUSION Combining a low-dose scan protocol and AIDR3D with a 320-detector row CT scanner can provide high quality images at exceptionally low radiation dose in unselected patients being investigated for CAD.

Quantitative evaluation of deep convolutional neural network-based image denoising for low-dose computed tomography

To minimize radiation risk,dose reduction is important in the diagnostic and therapeutic applications of computed tomography(CT).However,image noise degrades image quality owing to the reduced X-ray dose and a possible unacceptably reduced diagnostic performance.Deep learning approaches with convolutional neural networks(CNNs)have been proposed for natural image denoising;however,these approaches might introduce image blurring or loss of original gradients.The aim of this study was to compare the dose-dependent properties of a CNN-based denoising method for low-dose CT with those of other noise-reduction methods on unique CT noise-simulation images.To simulate a low-dose CT image,a Poisson noise distribution was introduced to normal-dose images while convoluting the CT unit-specific modulation transfer function.An abdominal CT of 100 images obtained from a public database was adopted,and simulated dose-reduction images were created from the original dose at equal 10-step dose-reduction intervals with a final dose of 1/100.These images were denoised using the denoising network structure of CNN(DnCNN)as the general CNN model and for transfer learning.To evaluate the image quality,image similarities determined by the structural similarity index(SSIM)and peak signal-to-noise ratio(PSNR)were calculated for the denoised images.Significantly better denoising,in terms of SSIM and PSNR,was achieved by the DnCNN than by other image denoising methods,especially at the ultra-low-dose levels used to generate the 10%and 5%dose-equivalent images.Moreover,the developed CNN model can eliminate noise and maintain image sharpness at these dose levels and improve SSIM by approximately 10%from that of the original method.In contrast,under small dose-reduction conditions,this model also led to excessive smoothing of the images.In quantitative evaluations,the CNN denoising method improved the low-dose CT and prevented over-smoothing by tailoring the CNN model.

Artificial Intelligence-Based Image Reconstruction for Computed Tomography: A Survey

Computed tomography has made significant advances since its intro-duction in the early 1970s,where researchers have mainly focused on the quality of image reconstruction in the early stage.However,radiation exposure poses a health risk,prompting the demand of the lowest possible dose when carrying out CT examinations.To acquire high-quality reconstruction images with low dose radiation,CT reconstruction techniques have evolved from conventional reconstruction such as analytical and iterative reconstruction,to reconstruction methods based on artificial intelligence(AI).All these efforts are devoted to con-structing high-quality images using only low doses with fast reconstruction speed.In particular,conventional reconstruction methods usually optimize one aspect,while AI-based reconstruction has finally managed to attain all goals in one shot.However,there are limitations such as the requirements on large datasets,unstable performance,and weak generalizability in AI-based reconstruction methods.This work presents the review and discussion on the classification,the commercial use,the advantages,and the limitations of AI-based image reconstruction methods in CT.

Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding:A useful predictor of positive angiographic findings

BACKGROUND Gastrointestinal bleeding(GIB)is a severe and potentially life-threatening condition,especially in cases of delayed treatment.Computed tomography angiography(CTA)plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage.AIM To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings.METHODS In this retrospective single-centre study,35 patients(22 men;median age 69 years;range 16-92 years)admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled.Twenty-three(65.7%)patients underwent endoscopy before CTA.Bleeding volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated software.Bleeding rate was obtained from volume change between the two phases and standardised for unit time.Patients were divided into two groups,according to the angiographic signs and their concordance with CTA.RESULTS Upper bleeding accounted for 42.9%and lower GIB for 57.1%.Mean haemoglobin value at the admission was 7.7 g/dL.A concordance between positive CTA and direct angiographic bleeding signs was found in 19(54.3%)cases.Despite no significant differences in terms of bleeding volume in the arterial phase(0.55 mL vs 0.33 mL,P=0.35),a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography(2.06 mL vs 0.9 mL,P=0.02).In the latter patient group,a significant increase in bleeding rate was also detected(2.18 mL/min vs 0.19 mL/min,P=0.02).CONCLUSION In GIB of any origin,extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.

Assessment of tumor vascularization with functional computed tomography perfusion imaging in patients with cirrhotic liver disease

BACKGROUND:Hepatocellular carcinoma(HCC)is a common malignant tumor in China,and early diagnosis is critical for patient outcome.In patients with HCC,it is mostly based on liver cirrhosis,developing from benign regenerative nodules and dysplastic nodules to HCC lesions,and a better understanding of its vascular supply and the hemodynamic changes may lead to early tumor detection.Angiogenesis is essential for the growth of primary and metastatic tumors due to changes in vascular perfusion,blood volume and permeability.These hemodynamic and physiological properties can be measured serially using functional computed tomography perfusion(CTP)imaging and can be used to assess the growth of HCC.This study aimed to clarify the physiological characteristics of tumor angiogenesis in cirrhotic liver disease by this fast imaging method. METHODS:CTP was performed in 30 volunteers without liver disease(control subjects)and 49 patients with liver disease (experimental subjects:27 with HCC and 22 with cirrhosis). All subjects were also evaluated by physical examination, laboratory screening and Doppler ultrasonography of the liver. The diagnosis of HCC was made according to the EASL criteria. All patients underwent contrast-enhanced ultrasonography, pre-and post-contrast triple-phase CT and CTP study.A mathematical deconvolution model was applied to provide hepatic blood flow(HBF),hepatic blood volume(HBV), mean transit time(MTT),permeability of capillary vessel surface(PS),hepatic arterial index(HAI),hepatic arterial perfusion(HAP)and hepatic portal perfusion(HPP)data. The Mann-Whitney U test was used to determine differences in perfusion parameters between the background cirrhotic liver parenchyma and HCC and between the cirrhotic liver parenchyma with HCC and that without HCC.RESULTS:In normal liver,the HAP/HVP ratio was about 1/4. HCC had significantly higher HAP and HAI and lower HPP than background liver parenchyma adjacent to the HCC.The value of HBF at the tumor rim was significantly higher than that in the controls.HBF,HBV,HAI,HAP and HPP,but not MTT and PS,were significantly higher in the cirrhotic liver parenchyma involved with HCC than those of the controls. Perfusion parameters were not significantly different between the controls and the cirrhotic liver parenchyma not involved with HCC. CONCLUSIONS:CTP can clearly distinguish tumor from cirrhotic liver parenchyma and controls and can provide quantitative information about tumor-related angiogenesis, which can be used to assess tumor vascularization in cirrhotic liver disease.

Reactive lymphoid hyperplasia of the liver:Perinodular enhancement on contrast-enhanced computed tomography and magnetic resonance imaging

We report the case of a 69-year-old woman with reactive lymphoid hyperplasia(RLH) of the liver.She underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma; however,histopathological analysis revealed RLH.The liver nodule showed the imaging feature of perinodular enhancement in the arterial dominant phase on contrast-enhanced computed tomography and magnetic resonance imaging,which could be a useful clue for identifying RLH in the liver.Histologically,the perinodular enhancement was compatible with prominent sinusoidal dilatation surrounding the liver nodule.

Gd-EOB-DTPA-enhanced magnetic resonance imaging features of hepatic hemangioma compared with enhanced computed tomography

AIM:To clarify features of hepatic hemangiomas on gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) compared with enhanced computed tomography (CT). METHODS:Twenty-six patients with 61 hepatic hem- angiomas who underwent both Gd-EOB-DTPA-enhanced MRI and enhanced CT were retrospectively reviewed. Hemangioma appearances (presence of peripheral nodular enhancement, central nodular enhancement, diffuse homogenous enhancement, and arterioportal shunt during the arterial phase, fill-in enhancement during the portal venous phase, and prolonged enhancement during the equilibrium phase) on Gd-EOB-DTPA-enhanced MRI and enhanced CT were evaluated.The degree of contrast enhancement at the enhancing portion within the hemangioma was visually assessed using a five-point scale during each phase. For quantitative analysis, the tumor-muscle signal intensity ratio (SIR), the liver-muscle SIR, and the attenuation value of the tumor and liver parenchyma were calculated. The McNemar test and the Wilcoxon's signed rank test were used to assess the significance of differences in the appearances of hemangiomas and in the visual grade of tumor contrast enhancement between Gd-EOB-DTPA-enhanced MRI and enhanced CT. RESULTS:There was no significant difference between Gd-EOB-DTPA-enhanced MRI and enhanced CT in the presence of peripheral nodular enhancement (85% vs 82%), central nodular enhancement (3% vs 3%), diffuse enhancement (11% vs 16%), or arterioportal shunt (23% vs 34%) during arterial phase, or fill-in enhancement (79% vs 80%) during portal venous phase. Prolonged enhancement during equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than on enhanced CT (52% vs 100%, P < 0.001). On visual inspection, there was significantly less contrast enhancement of the enhancing portion on Gd-EOB-DTPA-enhanced MRI than on enhanced CT during the arterial (3.94 ± 0.98 vs 4.57 ± 0.64, respectively, P < 0.001), portal venous (3.72 ± 0.82 vs 4.36 ± 0.53, respectively, P < 0.001), and equilibrium phases (2.01 ± 0.95 vs 4.04 ± 0.51, respectively, P < 0.001). In the quantitative analysis, the tumor-muscle SIR and the liver-muscle SIR observed with Gd-EOB-DTPA-enhanced MRI were 0.80 ± 0.24 and 1.28 ± 0.33 precontrast, 1.92 ± 0.58 and 1.57 ± 0.55 during the arterial phase, 1.87 ± 0.44 and 1.73 ± 0.39 during the portal venous phase, 1.63 ± 0.41 and 1.78 ± 0.39 during the equilibrium phase, and 1.10 ± 0.43 and 1.92 ± 0.50 during the hepatobiliary phase, respectively. The attenuation values in the tumor and liver parenchyma observed with enhanced CT were 40.60 ± 8.78 and 53.78 ± 7.37 precontrast, 172.66 ± 73.89 and 92.76 ± 17.92 during the arterial phase, 152.76 ± 35.73 and 120.12 ± 18.02 during the portal venous phase, and 108.74 ± 18.70 and 89.04 ± 7.25 during the equilibrium phase, respectively. Hemangiomas demonstrated peak enhancement during the arterial phase, and both the SIR with Gd-EOB-DTPA-enhanced MRI and the attenuation value with enhanced CT decreased with time. The SIR of hemangiomas was lower than that of liver parenchyma during the equilibrium and hepatobiliary phases on Gd-EOB-DTPA-enhanced MRI. However, the attenuation of hemangiomas after contrast injection was higher than that of liver parenchyma during all phases of enhanced CT. CONCLUSION:Prolonged enhancement during the equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than enhanced CT, which may exacerbate differentiating between hemangiomas and malignant tumors.

Computed tomography scan imaging in diagnosing acute uncomplicated pancreatitis: Usefulness vs cost

BACKGROUND Literature has suggested that imaging is over-utilized in the diagnosis of pancreatitis. If the diagnosis of acute pancreatitis(AP) is established with abdominal pain and increased serum amylase or lipase activity without systemic signs of severe disease, computed tomography(CT) imaging may not be necessary. We hypothesize that among patients with uncomplicated acute pancreatitis(AUP), there is a significant number of unwarranted CT imaging studies. This imposes increased expenditure and cost in our healthcare system and does not improve hospital stay or management of AUP.AIM To assess the overutilization and associated cost of CT imaging among patients meeting diagnostic criteria for AUP.METHODS In this Institutional Review Board-approved retrospective, single-center study,we identified all adult patients admitted with AP from January 1, 2012 through October 1, 2017. Patients were identified via International Classification of Diseases(ICD-9) code for AP(577.0) and ICD-10 codes for different etiological AP(K85.9 unspecified, K85.0 idiopathic, K85.1 biliary, K85.2 alcohol-induced, K85.3 drug-induced, and K85.8 other). Diagnosis was confirmed by chart review using established non-imaging diagnostic criteria(presence of typical abdominal pain and elevated lipase or amylase greater than 3 times upper limit of normal).Ranson criteria and BISAP scores on presentation were calculated and patients that met scores less than or equal to 2 for both were included to suggest AUP.The utilization and cost of imaging in these patients were recorded.RESULTS Between January 2012 and October 2017, 1305 patients presented to the emergency department with AP, and 405 patients(31%) met our inclusion criteria for AUP(201 males, 204 females; mean age 49 years, range 18-98). Of those, 210 patients(51.85%) underwent CT imaging. One patient(0.47%) had evidence of pancreatic necrosis, one patient had cyst formation(0.47%), and the remaining208 patients(99.05%) had either normal CT scan imaging or findings consistent with mild AP without necrosis. The average cost of CT scan imaging was $4510 with a total cost of $947056. Median length of hospitalization stay was 3 d among both groups. Combining Ranson's Criteria and BISAP score identified AUP in our patient population with an accuracy of 99.5%.CONCLUSION CT imaging is unnecessary when AUP is diagnosed clinically and biochemically.Reducing overuse of diagnostic CT scans will decrease healthcare expenditure and radiation exposure to patients.

Computed tomography vs liver stiffness measurement and magnetic resonance imaging in evaluating esophageal varices in cirrhotic patients:A systematic review and meta-analysis

BACKGROUND Computed tomography(CT),liver stiffness measurement(LSM),and magnetic resonance imaging(MRI)are non-invasive diagnostic methods for esophageal varices(EV)and for the prediction of high-bleeding-risk EV(HREV)in cirrhotic patients.However,the clinical use of these methods is controversial.AIM To evaluate the accuracy of LSM,CT,and MRI in diagnosing EV and predicting HREV in cirrhotic patients.METHODS We performed literature searches in multiple databases,including Pub Med,Embase,Cochrane,CNKI,and Wanfang databases,for articles that evaluated the accuracy of LSM,CT,and MRI as candidates for the diagnosis of EV and prediction of HREV in cirrhotic patients.Summary sensitivity and specificity,positive likelihood ratio and negative likelihood ratio,diagnostic odds ratio,and the areas under the summary receiver operating characteristic curves were analyzed.The quality of the articles was assessed using the quality assessment of diagnostic accuracy studies-2 tool.Heterogeneity was examined by Q-statistic test and I2 index,and sources of heterogeneity were explored using metaregression and subgroup analysis.Publication bias was evaluated using Deek’s funnel plot.All statistical analyses were conducted using Stata12.0,Meta Disc1.4,and Rev Man5.3.RESULTS Overall,18,17,and 7 relevant articles on the accuracy of LSM,CT,and MRI in evaluating EV and HREV were retrieved.A significant heterogeneity was observed in all analyses(P<0.05).The areas under the summary receiver operating characteristic curves of LSM,CT,and MRI in diagnosing EV and predicting HREV were 0.86(95%confidence interval[CI]:0.83-0.89),0.91(95%CI:0.88-0.93),and 0.86(95%CI:0.83-0.89),and 0.85(95%CI:0.81-0.88),0.94(95%CI:0.91-0.96),and 0.83(95%CI:0.79-0.86),respectively,with sensitivities of 0.84(95%CI:0.78-0.89),0.91(95%CI:0.87-0.94),and 0.81(95%CI:0.76-0.86),and 0.81(95%CI:0.75-0.86),0.88(95%CI:0.82-0.92),and 0.80(95%CI:0.72-0.86),and specificities of 0.71(95%CI:0.60-0.80),0.75(95%CI:0.68-0.82),and 0.82(95%CI:0.70-0.89),and 0.73(95%CI:0.66-0.80),0.87(95%CI:0.81-0.92),and 0.72(95%CI:0.62-0.80),respectively.The corresponding positive likelihood ratios were 2.91,3.67,and 4.44,and 3.04,6.90,and2.83;the negative likelihood ratios were 0.22,0.12,and 0.23,and 0.26,0.14,and 0.28;the diagnostic odds ratios were 13.01,30.98,and 19.58,and 11.93,49.99,and 10.00.CT scanner is the source of heterogeneity.There was no significant difference in diagnostic threshold effects(P>0.05)or publication bias(P>0.05).CONCLUSION Based on the meta-analysis of observational studies,it is suggested that CT imaging,a non-invasive diagnostic method,is the best choice for the diagnosis of EV and prediction of HREV in cirrhotic patients compared with LSM and MRI.

Comparison of endoscopic ultrasound, computed tomography and magnetic resonance imaging in assessment of detailed structures of pancreatic cystic neoplasms

AIM To evaluate the advantages of endoscopic ultrasound(EUS) in the assessment of detailed structures of pancreatic cystic neoplasms(PCNs) compared to computed tomography(CT) and magnetic resonance imaging(MRI).METHODS All patients with indeterminate PCNs underwent CT, MRI, and EUS. The detailed information, including size, number, the presence of a papilla/nodule, the presence of a septum, and the morphology of the pancreatic duct of PCNs were compared among the three imaging modalities. The size of each PCN was determined using the largest diameter measured. A cyst consisting of several small cysts was referred to as a motherdaughter cyst. Disagreement among the three imaging modalities regarding the total number of mother cysts resulted in the assumption that the correct number was the one in which the majority of imaging modalities indicated.RESULTS A total of 52 females and 16 males were evaluated. The median size of the cysts was 42.5 mm by EUS, 42.0 mm by CT and 38.0 mm by MRI; there was no significant difference in size as assessed among the three imaging techniques. The diagnostic sensitivity and ability of EUS to classify PCNs were 98.5%(67/68) and 92.6%(63/68), respectively. These percentages were higher than those of CT(73.1%, P < 0.001; 17.1%, P < 0.001) and MRI(81.3%, P = 0.001; 20.3%, P < 0.001). EUS was also able to better assess the number of daughter cysts in mother cysts than CT(P = 0.003); however, there was no significant difference between EUS and MRI in assessing mother-daughter cysts(P = 0.254). The papilla/nodule detection rate by EUS was 35.3%(24/68), much higher than those by CT(5.8%, 3/52) and MRI(6.3%, 4/64). The detection rate of the septum by EUS was 60.3%(41/68), which was higher than those by CT(34.6%, 18/52) and by MRI(46.9%, 30/64); the difference between EUS and CT was significant(P = 0.02). The rate of visualizing the pancreatic duct using EUS was 100%, whereas using CT and MRI it was less than 10%.CONCLUSION EUS helps visualize the detailed structures of PCNs and has many advantages over CT and MRI. EUS is valuable in the diagnosis and assessment of PCNs.

Evaluation of a rabbit rectal VX2 carcinoma model using computed tomography and magnetic resonance imaging

AIM： To establish a rabbit rectal VX2 carcinoma model for the study of rectal carcinoma.METHODS： A suspension of VX2 cells was injected into the rectum wall under the guidance of X-ray fluoroscopy. Computed tomography （CT） and magnetic resonance imaging （MRI） were used to observe tumorgrowth and metastasis at different phases. Pathological changes and spontaneous survival time of the rabbits were recorded.RESULTS： Two weeks after VX2 cell implantation, the tumor diameter ranged 4.1-5.8 mm and the success implantation rate was 81.8%. CT scanning showed low-density loci of the tumor in the rectum wail, while enhanced CT scanning demonstrated a symmetrical intensification in tumor loci. MRI scanning showed alow signal of the tumor on T1-weighted imaging anda high signal of the tumor on T2-weighted imaging.Both types of signals were intensified with enhanced MRI. Metastases to the liver and lung could beobserved 6 wk after VX2 cell implantation, and a largearea of necrosis appeared in the primary tumor. The spontaneous survival time of rabbits with cachexia and multiple organ failure was about 7 wk after VX2 cell implantation.CONCLUSION： The rabbit rectal VX2 carcinoma model we established has a high stability, and can be used in the study of rectal carcinoma.

Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

AIM:To retrospectively evaluate the imaging features of pancreatic intraductal papillary mucinous neoplasms (IPMNs) in multi-detector row computed tomography (MDCT).METHODS: A total of 20 patients with pathologically-confirmed intraductal papillary mucinous neoplasms (IPMNs) were included in this study. Axial MDCT images combined with CT angiography (CTA) and multiplanar volume reformations (MPVR) or curved reformations (CR) were preoperatively acquired. Two radiologists (Tan L and Wang DB) reviewed all the images in consensus using an interactive picture archiving and communication system. The disputes in readings were resolved through consultation with a third experienced radiologist (Chen KM). Finally, the findings and diagnoses were compared with the pathologic results.RESULTS: The pathological study revealed 12 malignant IPMNs and eight benign IPMNs. The diameters of the cystic lesions and main pancreatic ducts (MPDs) were significantly larger in malignant IPMNs compared with those of the benign IPMNs (P<0.05). The combined-type IPMNs had a higher rate of malignancy than the other two types of IPMNs (P<0.05). Tumors with mural nodules and thick septa had a significantly higher incidence of malignancy than tumors without these features (P<0.05). Communication of side-branch IPMNs with the MPD was present in nine cases at pathologic examination. Seven of them were identified from CTA and MPVR or CR images. From comparison with the pathological diagnosis, the sensitivity, specificity, and accuracy of MDCT in characterizing the malignancy of IPMN of the pancreas were determined to be 100%, 87.5% and 95%, respectively.CONCLUSION: MDCT with CTA and MPVR or CR techniques can elucidate the imaging features of IPMNs and help predict the malignancy of these tumors.