Application of Dual-Source CT TurboFlash Coarse Pitch Scanning in Coronary Artery Imaging

Objective: To compare and analyze the image quality and radiation dose of three scanning modes of dual-source CT coronary artery retrospectively, and to discuss the application value of TurboFlash coarse pitch scanning mode. Methods: The imaging data of 100 patients who underwent CT coronary angiography (CCTA) using Siemens force CT retrospective gated triggering spiral scan (RES-SPIRAL), adaptive prospective gated triggering sequence scan (SEQ) and prospective coarse pitch scan (TurboFlash) retrospectively was collected. The image quality was evaluated by objective and subjective methods. The effective radiation dose of patients was compared and analyzed, and the indications of the three scanning modes were analyzed. The application value of dual-source CT TurboFlash coarse pitch scanning in coronary artery imaging was evaluated. Results: The results showed that the left main coronary artery, the right coronary artery and their tertiary branches could be clearly displayed in the three groups of images: the left anterior descending branch, the left circumflex branch, and their three-level branches. There was no statistical difference in subjective image quality among the three groups of pictures (P > 0.05). There was no statistical difference in objective evaluation indexes, such as CT value, SNR, CNR and Noise among the three groups (P > 0.05). The patient radiation dose results showed that the effective radiation dose ED of RES-SPIRA scan was (9.22 ± 1.33) mSv. The dose of SEQ was (2.88 ± 2.47) mSv, and the dose of TurboFlash was (0.51 ± 0.16) mSv. There was significant difference in comparison of the three groups (P 0.05). RES-spiral scanning had the highest radiation dose and TurboFlash coarse pitch scanning (TurboFlash) had the lowest radiation dose. Conclusion: TurboFlash coarse pitch scanning is low in dosage, fast in speed and wide in adaptability. It is especially suitable for the elderly, children, coma and other patients who cannot cooperate with breath-holding examination, as well as for the screening and examination of coronary artery diseases in asymptomatic population. Undoubtedly, it is a worthy method of heart coronary artery examination.

Application of an Advanced Image-Based Virtual Monoenergetic Reconstruction of Dual Source Dual-Energy CT Data at Low keV Increases Image Quality for Esophageal Cancer Patients Imaging

Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving the imaging quality of esophageal cancer patients. Materials and methods: 68 patients with clinically suspected esophageal cancer (all confirmed by pathology) were collected. Routine plain scan was performed with SIEMENS Force dual-energy CT and then dual-phase scans were performed. The venous phase images were respectively subjected to traditional virtual monoenergetic reconstructions (Mono_E) and new generation virtual monoenergetic reconstructions (Mono+). Mono_E 55 keV and Mono+ 55 keV virtual single-energy images were obtained respectively. The signal-to-noise ratio (SNR) of normal esophageal tissue and esophageal cancer lesions, noise and contrast noise ratio (CNR tumor) of normal esophageal tissue and esophageal cancer lesions were compared among 100 kV images, Mono_E images and Mono+ images. At the same time, two imaging physicians read the films and scored the images of each group by using a 5-point scoring method. Results: Mono+ 55 keV images, SNR, SNRtumor, noise and CNRtumor were statistically different from those of 100 kV images and Mono_E images (P < 0.05). And Mono+ 55 keV images also had the highest subjective score, with statistical significance (P 55 keV images had the best quality. Conclusion: The new generation of virtual monoenergetic reconstructions post-processing (Mono+) could reduce image noise and improve the contrast between esophageal cancer lesions and normal esophageal tissues, which was of great significance to improve the imaging quality of esophageal cancer patients and improve the early detection rate of esophageal cancer.

Assessment of neovascularization within carotid plaques in patients with ischemic stroke

AIM:To assess neovascularization within human ca-rotid atherosclerotic soft plaques in patients with isch-emic stroke.METHODS:Eighty-one patients with ischemic stroke and 95 patients without stroke who had soft athero-sclerotic plaques in the internal carotid artery were studied.The thickest soft plaque in each patient was examined using contrast-enhanced ultrasound.Time-intensity curves were collected from 5 s to 3 min after contrast injection.The neovascularization within the plaques in the internal carotid artery was evaluated using the ACQ software built into the scanner by 2 of the experienced investigators who were blinded to the clinical history of the patients.RESULTS:Ischemic stroke was present in 7 of 33 patients(21%) with grade Ⅰ plaque,in 14 of 51 pa-tients(28%) with grade Ⅱ plaque,in 26 of 43 patients(61%) with grade Ⅲ plaque,and in 34 of 49 patients(69%) with grade Ⅳ plaque(P < 0.001 comparing grade Ⅳ plaque with grade I plaque and with grade Ⅱ plaque and P = 0.001 comparing grade Ⅲ plaque with grade Ⅰ plaque and with grade Ⅱ plaque).Analysis of the time intensity curves revealed that patients with ischemic stroke had a significantly higher intensity of enhancement(IE) than those without ischemic stroke(P < 0.01).The wash-in time(WT) of plaque was signifi-cantly shorter in stroke patients(P < 0.05).The sensi-tivity and specificity for IE in the plaque were 82% and 80%,respectively,and for WT were 68% and 74%,respectively.There was no significant difference in the peak intensity or time to peak between the 2 groups.CONCLUSION:This study shows that the higher the grade of plaque enhancement,the higher the risk of ischemic stroke.The data suggest that the presence of neovascularization is a marker for unstable plaque.

Role of microbubble ultrasound contrast agents in the non-invasive assessment of chronic hepatitis C-related liver disease

长期地感染丙肝病毒的病人经常得长期的肝疾病，对肝损伤的严厉的评价在认为病毒的根除是治疗以前被要求。这篇文章检验从标准答案肝活体检视当前可得到的各种各样的评价方法到血清学的标记和成像。超声是在临床的实践的最广泛地使用的成像形式之一并且已经是为肝疾病的一个首要的诊断工具。Microbubble 超声对比代理人允许更高的分辨率要获得的图象和对要执行的微脉管的变化的功能的评价。在确定的这些代理人的角色肝的损害的状态作为与丙肝在病人决定肝疾病的阶段和等级的一个可行方法被讨论。尽管当前限制了到专家中心，提高对比的超声将不可避免地在临床的背景增加的微水泡的可获得性。

3D Gray Level Co-Occurrence Matrix Based Classification of Favor Benign and Borderline Types in Follicular Neoplasm Images

Since the efficiency of treatment of thyroid disorder depends on the risk of malignancy, indeterminate follicular neoplasm (FN) images should be classified. The diagnosis process has been done by visual interpretation of experienced pathologists. However, it is difficult to separate the favor benign from borderline types. Thus, this paper presents a classification approach based on 3D nuclei model to classify favor benign and borderline types of follicular thyroid adenoma (FTA) in cytological specimens. The proposed method utilized 3D gray level co-occurrence matrix (GLCM) and random forest classifier. It was applied to 22 data sets of FN images. Furthermore, the use of 3D GLCM was compared with 2D GLCM to evaluate the classification results. From experimental results, the proposed system achieved 95.45% of the classification. The use of 3D GLCM was better than 2D GLCM according to the accuracy of classification. Consequently, the proposed method probably helps a pathologist as a prescreening tool.

Application of Dual-Energy CT Non-Linear Fusion Technology in Improving CTA Image Quality of Renal Cancer

Objective: To explore the significance of dual-energy CT non-linear fusion technique in improving the quality of CTA image of renal cancer. Methods: The CTA images of 100 patients who had been confirmed by pathology as renal cancer were collected and were randomly divided into experimental group and control group with 50 cases respectively. The two groups of patients were treated with iodine concentration of 300 mg/ml and 350 mg/ml non-ionic contrast agent, with a dosage of 1.5 ml/kg and an injection rate of 4 ml/s. The contrast agent intelligently tracking method was adopted bolus. The control group used the conventional CTA scanning, with a reference tube voltage/tube current of 100 kv/ref150 mas. The experimental group adopted the double energy scanning, with ball tube A and ball tube B. The reference tube voltage/tube current was 100 kv/ref250 mas and sn150 kv/ref125 mas respectively. The images of the experimental group were non-linear fused to obtain the Mono+ 55 kev single-energy images. The CT value, SNR contrast ratio of the abdominal aorta, renal artery and tumor tissue of the experimental group images and the 100 KV images and the Mono+ 55 kev images of the control group were compared. The objective evaluation and subjective evaluation of the image quality of the three groups of images was performed. Results: The results showed that the 100 kV images of the experimental group were statistically different from those of the control group (P05) in CT value, SNR and CNR (P 0.05). And there was no statistically significant difference between the non-linear fusion single-energy Mono+ 55 kev images and the control group images in CT value, SNR and CNR (P > 0.05). The subjective evaluation of image quality showed that there was no significant difference between Mono+ 55 kev images and control group images, and the quality of Mono+ 55 kev images was higher than that of experimental group 100 kV images. Conclusion: The dual-energy CT non-linear fusion technique can improve the quality of CTA image in patients with renal cancer, and it is possible to obtain high quality CTA images with low iodine concentration contrast agent.

Significance of an Advanced Image-Based Virtual Monoenergetic Reconstruction of Dual Source Dual-Energy CT Data at Low keV Increases Image Quality for Portal Vein System of Pancreatic Cancer Patients

Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving image quality for portal vein system of pancreatic cancer patients. Materials and methods: 47 patients with clinically suspected pancreatic cancer (all confirmed by pathology) were collected. Routine plain scan was performed with Siemens Force dual-source dual-energy CT followed by 3 scans respectively carried out in arterial phase, portal phase and delayed phase. Traditional virtual monoenergetic reconstructions (Mono_E) and new generation of virtual monoenergetic reconstructions (Mono+) were respectively performed on portal vein images to obtain virtual single energy images including Mono_ E70 keV, Mono_E 55 keV and Mono+ 70 keV and Mono+ 55 keV. The signal-to-noise ratio (SNR) and noise of portal vein, normal pancreatic tissues and pancreatic lesions of 100 kV, Mono_E and Mono+ images were compared. In addition, the contrast noise ratio of portal vein and lesions as well as pancreatic tissues and lesions (CNR PV, CNRtumor) were also compared. At the same time, two imaging physicians with rich clinical experiences read the films and scored the images of each group by using the 5-point scoring method. Results: Mono+ 55 keV images including SNRpv, SNRpanc, SNRtumor, Noise, CNRpv, CNRtumor were statistically different from 100 KV images and Mono_E images (P < 0.05). As for the subjective score, Mono+ 55 keV image score also had the highest score, which had statistical significance (P < 0.05). The results showed that Mono+ 55 keV images had the best quality. Conclusion: The new generation of virtual Mono+ post-treatment can reduce image noise. Low energy Mono+ images can improve the contrast between pancreatic cancer lesions and portal of pancreatic cancer patients.

Virtual-Reality-Based Training System for the Improvement of the Driver’s Ability to Predict Dangers in Driving Situations

Improving the danger prediction during driving can significantly reduce the risk of accidents.However,previous danger prediction training systems had not been sufficiently effective owing to the lack of realism.In this study,we propose an immersive training system for danger prediction training using virtual reality(VR)technology.This system provides drivers with a highly realistic training environment with 360°videos viewed with VR goggles.Users can practice various dangerous scenarios in an environment that simulates a real-driving situation.In addition,we introduced a system to select dangerous spots with a controller and implement training schemes on a voluntary basis.This setup enables them to train in a highly interactive state.In addition,we proposed a method to express multiple indices numerically so that users can understand the training effect.We tested the effect of the system on the danger prediction abilities of various users with two experiments by using this approach.These results show that our system was more effective in improving the driver’s danger prediction ability than previous systems.

染料增感过氧化酯体系引发的可见激光感光性高分子

由过氧化物3,3′,4,4′-四叔丁基过氧碳酰二苯甲酮和香豆素酮染料所组成的光引发体系对可见光敏感,致使感光树脂可以用氩离子激光曝光。感光树脂的敏度有赖于基体树脂,当用聚N-乙烯基-2-吡咯烷酮为基体树脂时,对波长488nm的氩离子激光可获得0-01mJ/cm^2的高敏度。染料对过氧化物的敏化是由于电子从染料激发态转移到过氧化物而引起的。

黑血MRA评价颅内动脉瘤是否有价值?

本研究的目的是评估在标准3D时间飞跃法（3D TOF）成像中增加黑血（BB）序列是否可提高对颅内动脉瘤的定量评价。37例病人共42个经证实的颅内动脉瘤．行动脉DSA、3D TOF和BB MRI检查，用这种多方法成像形成动脉瘤的复合参考标准。3D TOF和BB成像在主观设定的7个等级上进行分级，用来确定增加BB成像是否可提高对动脉瘤的评价。

Pitfalls in Diagnosing a Tension Pneumopericardium—A Case Report

A 65-year-old female patient was brought to our emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and hence she was immediately intubated and ventilated. Blood pressure and peripheral pulses were not measurable;however the central pulses were present. Aggressive fluid resuscitation was started. Primary assessment revealed distended neck veins, bony crepitus over right chest. Bedside plain chest radiograph and focused assessment with sonograph in trauma (FAST) were done which did not establish an immediate diagnosis. Computed tomography (CT) of the thorax revealed a tension pneumopericardium and moderate right hemopneumothorax, with multiple ribs fracture. An intercostal drainage tube (ICD) was inserted on right chest. The patient suffered a cardiac arrest and resuscitation measures were unsuccessful. The diagnostic pitfalls, the CT findings, possible clues to the diagnosis and the discussion of this rare case are presented in this case report.

重度卒中的预后与临床决策

背景：重度卒中患者最后拔管死亡人数越来越多。终止治疗时机的差别提示存在延长患者不必要痛苦或造成不必要死亡的可能性。 目的：回顾机械通气卒中患者预后的现有证据，为临床医生、患者及家属优化临床决策提供一总体框架。 资料来源：于MEDLINE搜索1980年到2005年3月有关机械通气卒中患者预后的英文文章。我们从搜集的689篇文章中选出17篇进行综述。我们还确定了维持生命治疗应用过度或应用不足的影响因素以及可能造成的决策偏差，重点放在机械通气因素。 证据综合：实施机械通气的卒中患者总死亡率很高，30天死亡率接近58％（文献报道范围，46％～75％）。尽管资料有限，但是高达1／3的存活者没有或仅有轻度残疾，然而其余患者则有重度残疾。我们可以根据对卒中综合征的认识、患者早期特征、临床预测规则以及持续干预的必要性进一步判断患者的转归。影响选择生命支持治疗的因素包括：将来临床缺陷的严重程度和类型，临床缺陷发生的可能性，以及治疗的负担。可能影响终止治疗决策制定的偏差包括：预后评估错误，沟通方式不当，错误理解患者的价值观和期望，以及未能正确评价患者的生理和心理适应程度。 结论：虽然实施机械通气的卒中患者预后一般很差，但是确实有少数患者存活而且没有严重残疾。可以根据临床表现和患者特征评估预后。急需更好地了解这些患者治疗上的标志性差异，急需可靠地权衡并改善这种以患者为中心的决策。

Fournier’s gangrene complicating severe acute pancreatitis: a case report and literature review

Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis(EPN).Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported.However,extension of retroperitoneal necrosis to the scrotum causing Fournier’s gangrene is uncommon.We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation.He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay.During the 3rd month of hospital stay,the patient started developing pain and ulceration over the scrotum.He was diagnosed with Fournier’s gangrene based on clinical examination and was planned for debridement.During surgery,the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination.The case highlights a rare but potentially fatal complication of Fournier’s gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement.Concomitant management of two potentially fatal conditions poses numerous challenges.

A clinically isolated syndrome:butterfly glioma mimic

The report explores a unique and treatable“butterfly”-glioma mimic and the neuroimaging characteristics that help to diagnose this entity.A 35-year-old patient presented with subacute-onset,progressive frontal lobe dysfunction followed by features of raised intracranial pressure.Neuroimaging features were consistent with a“butterfly”lesion that favored the possibility of a gliomatosis cerebri with significant edema and marked corpus callosum and fornix thickening.Contrast-enhanced and perfusion images revealed a confluent tumefactive lesion with a characteristic“broken-ring”pattern of enhancement,mass-effect and low perfusion;features favoring an alternative inflammatory pathology.This was peculiar as calloso-forniceal involvement of this nature has not been previously reported in inflammatory demyelinating mass lesions.This was confirmed as a tumefactive demyelination on histopathology.Following treatment,on clinical and imaging follow-up,significant resolution was evident suggesting a monophasic illness.This case highlights the stringent clinico-radiological-pathological approach required in the evaluation and management of butterfly lesions despite the striking imaging appearances.Tumefactive demyelination in this patient represents a clinically isolated syndromic presentation of an inflammatory pathology that can resemble gliomatosis cerebri.These“butterfly”-glioma mimics are scarcely reported in the literature,are eminently treatable with variable prognosis and prone for relapse.