[Analysis of the safety and diagnostic efficiency of CT-guided percutaneous biopsy of pancreatic space-occupying lesions using large needle:comparison of trans-organ biopsy approach and non-trans-organ biopsy approach].

Objective: To compare the safety and diagnostic efficiency of CT-guided trans-organ and non-trans-organ large needle biopsy in the diagnosis of pancreatic space-occupying lesions. Methods: The clinical data of 367 patients with pancreatic mass who underwent CT-guided percutaneous biopsy in the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2022 were retrospectively analyzed, including 211 males and 156 females, aged 18 to 87 (60.7±11.8) years old. They were divided into a trans-organ route group (n=142) and a non-trans-organ route group (n=225) according to whether traversing the organs during the procedures. The imaging data, pathological results, puncture process and complications of patients of the two groups were recorded. The successful rate for obtaining tissue,one-time successful diagnosis rate, accuracy, sensitivity, specificity, false negative rate and the incidence of complications were compared between the two groups. Results: There was no significant difference in baseline data between the two groups (all P>0.05).There were 28, 57, 24, and 33 biopsies were performed via a pathway traversing liver, stomach, small bowel and colon, respectively. The overall sampling success rates of the two groups were 100%.The one-time successful diagnosis rate did not show statistically difference between the two groups [86.6%(123/142) vs 87.1%(196/225),P=0.892]. There was no statistically difference in accuracy, sensitivity and false negative rates between trans-organ route group and non-trans-organ routegroup [92.3%(131/142) vs 92.0%(207/225), 91.8% (123/134) vs 90.0%(190/211) and 8.2% (11/134) vs 10.0%(21/211), all P>0.05]. The specificity was 100% in both groups. The common complications of the two groups were increased pancreatic amylase and hematoma, and there was no significant difference in the incidence of complications between the trans-organ route group and the non-trans-organ route group [10.6% (15/142) vs 12.4% (28/225), P=0.585]. In the trans-organ route group, 5 patients had increased pancreatic amylase and 10 patients had local hematoma, all of which were improved after conservative treatment. In the non-organ route group, 11 patients had elevated pancreatic amylase, and 17 patients had local hematoma, 1 case received surgical treatment due to bleeding, the rest were improved by conservative treatment. Conclusion: CT-guided percutaneous transabdominal organ large needle biopsy of pancreatic space-occupying lesions has the comparable diagnostic efficiency and safety as non-transabdominal organ approach.

[Comparison on the efficacy of Chinese-made novel-designed mechanical-locked and elastic self-locked transcatheter edge-to-edge repair system in the treatment of patients with functional mitral regurgitation].

Objective: To evaluate and compare the short-term efficacy of domestic mechanical-locked (Clip2Edge) and elastic self-locked (ValveClip) transcranial mitral valve edge-to-edge interventional repair (TEER) devices in the treatment of functional mitral regurgitant valves. Methods: In this retrospective non-randomized comparative study, patients underwent TEER procedure in Fuwai Yunnan Cardiovascular Disease Hospital from May 2022 to April 2023 for heart failure combined with moderate to severe or severe functional mitral valve were divided into Clip2Edge and ValveClip groups based on the TEER system used. Baseline, perioperative, and postoperative 30 d follow-up data were collected and compared between the two groups. The primary outcome was the success rate on the 30 d post operation, while secondary outcomes included immediate postoperative technical success rate and the incidence of all-cause mortality on the 30 d post operation, readmission rate of acute heart failure, cerebral infarction, severe bleeding, and other serious adverse events rates. Results: A total of 60 patients were enrolled, 34 patients were in the Clip2Edge group and 26 in the ValveClip group, mean age was (63.8±9.3) years, and 24 patients (40%) were female. There were no significant differences in baseline data of age, cardiac function, comorbidities, mitral regurgitation 4+(19(73%) vs. 29(85%)), the end-diastolic volume of left ventricle ((220.8±91.2) ml vs. (210.8±71.7) ml) between the two groups (all P>0.05). The technical success rate immediately after the procedure was 100%. There were no readmission of acute heart failure, death, cerebral infarction, severe bleeding, and other serious adverse events up to the 30 d follow-up. Device success rate was similar between the ValveClip group (24 cases (100%)) and the Clip2Edge group (27 cases (96%)) (P>0.05). Conclusion: Both types of novel domestic TEER devices are safe and feasible in treating patients with functional mitral regurgitation.

[Safety and efficacy of cryoablation versus radiofrequency ablation for stage â non-small-cell lung cancer].

Objective: To compare the safety and efficacy of cryoablation(CYA) and radiofrequency ablation(RFA) for stageⅠnon-small cell lung cancer(NSCLC). Methods: From January 2014 to January 2019, 90 eligible patients [48 males, 42 females, age: 39-85(63.6±10.1)years] in the First Affiliated Hospital of Zhengzhou University met the inclusion criteria were retrospectively analyzed. They were divided into 2 groups according to different treatment methods(group CYA and group RFA). The duration of operation, intraoperative pain, local tumor progression rate and the incidence of complications were compared. The progression-free survival (PFS) and overall survival (OS) of the 2 groups were estimated by Kaplan-Meier curves, and were compared by using log-rank test. Results: The clinical data and tumor situation of the patients between two groups did not show significant differences. The mean duration of operation for group CYA was longer than that for group RFA [(73.5±17.2)min vs (51.4±18.7)min, P<0.001];the mean intraoperative visual analogue score(VAS)for group CYA was lower than that for group RFA (0.53±0.89 vs 3.44±2.44, P<0.001). The median follow-up period time were 53 months and 52 months for group CYA and RFA. At the end of the study, The local tumor progression rate was 31.6%(12/38) and 25.0%(13/52) for group CYA and group RFA, the difference were not statistically(P=0.491). There was no statistical difference for progress-free survival(PFS)between group CYA and group RFA[51(95%CI:40.3-55.0)months)vs 44(95%CI:37.2-54.1) months, P=0.649]. The median OS was not reached in both groups. The most common complications observed in the two groups were pneumothorax, hemorrhage and pleural effusion. There was no statistical difference in the incidence rates [42.1%(16/38) for group CYA vs 28.8% (15/52)for group RFA, P=0.191]. The incidence rate of pleural effusion for group CYA was higher than that for group RFA [26.3%(10/38)vs 5.8%(3/52), P=0.006]. The incidence rates of pneumothorax and hemorrhage had no statistical difference between the two groups [13.3%(5/38)vs 13.5% (7/52) and 15.8%(6/38) vs 9.6% (5/52), all P>0.05]. Conclusion: Compared with RFA,CYA shows no significant differences in the same efficacy and safety for treating patients with stage Ⅰ NSCLC, with less intraoperative pain but longer operative duration.

[Diagnosis and treatment status of perioperative anemia in patients with gastrointestinal neoplasms: a multi-center study in Hubei Province].

Objective: To investigate the incidence and treatment of perioperative anemia in patients with gastrointestinal neoplasms in Hubei Province. Methods: The clinicopathological data of 7 474 patients with gastrointestinal neoplasms in 62 hospitals in 15 cities (state) of Hubei Province in 2019 were collected in the form of network database. There were 4 749 males and 2 725 females. The median age of the patients was 62 years (range: 17 to 96 years). The hemoglobin value of the first time in hospital and the first day after operation was used as the criterion of preoperative anemia and postoperative anemia. Anemia was defined as male hemoglobin <120 g/L and female hemoglobin <110.0 g/L, mild anemia as 90 to normal, moderate anemia as 60 to <90 g/L, severe anemia as <60 g/L. The t test and χ2 test were used for inter-group comparison. Results: The overall incidence of preoperative anemia was 38.60%(2 885/7 474), and the incidences of mild anemia, moderate anemia and severe anemia were 25.09%(1 875/7 474), 11.37%(850/7 474) and 2.14%(160/7 474), respectively. The overall incidence of postoperative anemia was 61.40%(4 589/7 474). The incidence of mild anemia, moderate anemia and severe anemia were 48.73%(3 642/7 474), 12.20%(912/7 474) and 0.47%(35/7 474), respectively. The proportion of preoperative anemia patients receiving treatment was 26.86% (775/2 885), and the proportion of postoperative anemia patients receiving treatment was 14.93% (685/4 589). The proportions of preoperative anemia patients in grade ⅢA, grade ⅢB, and grade ⅡA hospitals receiving treatment were 26.12% (649/2 485), 32.32% (85/263), and 29.93% (41/137), and the proportions of postoperative anemia patients receiving treatment were 14.61% (592/4 052), 22.05% (73/331), and 9.71% (20/206). The proportion of intraoperative blood transfusion (16.74% (483/2 885) vs. 3.05% (140/4 589), χ²=434.555, P<0.01) and the incidence of postoperative complications (17.78% (513/2 885) vs. 14.08% (646/4 589), χ²=18.553, P<0.01) in the preoperative anemia group were higher than those in the non-anemia group, and the postoperative hospital stay in the preoperative anemia group was longer than that in the non-anemia group ((14.1±7.3) days vs. (13.3±6.2) days, t=5.202, P<0.01). Conclusions: The incidence of perioperative anemia in patients with gastrointestinal neoplasms is high. Preoperative anemia can increase the demand for intraoperative blood transfusion and affect the short-term prognosis of patients. At present, the concept of standardized treatment of perioperative anemia among gastrointestinal surgeons in Hubei Province needs to be improved.

[Diagnostic efficacy of a combined diagnostic model based on extreme gradient boosting algorithm in differentiating the pathological grading of gastric neuroendocrine neoplasms].

Objective: To evaluate the diagnostic efficacy of combined diagnostic model based on extreme gradient boosting (XGBoost) algorithm to determine the pathological grading of gastric neuroendocrine neoplasms (NENs). Methods: A total of 81 gastric NENs patients in the First Affiliated Hospital of Zhengzhou University confirmed by definite pathological grading from August 2012 to December 2019 were enrolled. The data of clinical and CT findings were collected. The number of lesions, tumor location, shape, lymph node metastasis, thickness, longitude of tumor and CT values in arterial and venous phase were analyzed. ITK-SNAP software and Python 2.1.0 PyRadiomics software were used to perform the image preprocessing and radiomics features extraction from segmented images. XGBoost algorithm was used to build the CT findings model, radiomics model in arterial phase, radiomics model in venous phase and combined diagnostic model. The diagnostic efficacy of CT imaging model, radiomics model in arterial phase, radiomics model in venous phase and combined diagnostic model were evaluated by accuracy, mean squared error (MSE) and mean absolute error (MAE). Results: The subjects were 28.0 to 78.0 (58.6+10.7) years old, including 56 males (69.1%). The number of lesions, tumor location, shape, lymph node metastasis, thickness and longitude of tumor between G1/G2 and G3 patients showed statistic significances (all P values<0.05), while there were no differences in CT values in arterial and venous phase (both P values>0.05). Six most important features in the combined diagnostic model were A_logarithm_glcm_Imc1, P_squareroot_glcm_Maximum Probability, thickness, longitude, A_wavelet-HHL_glrlm_GrayLevelNonUniformity and P_wavelet-LLL_ngtdm_Contrast, respectively. The accuracy of CT findings model, radiomics model in arterial phase, radiomics model in venous phase and combined diagnostic model were 81.8%, 86.0%, 87.8% and 91.0%, respectively; with MSE were 539.41, 490.08, 429.99 and 371.92, respectively; and MAE were 16.72, 15.25, 14.23 and 12.33, respectively. The MAE value of the combined diagnostic model was lower than those of CT findings model and radiomics model in arterial phase (P<0.001 and 0.004, respectively), while no statistically difference was detected compared to radiomics model in venous phase (P=0.111). Conclusion: The combined diagnostic model based on XGBoost algorithm have a good diagnostic efficiency for the pathological grading of gastric NENs.

[The application value of multi-material artifact reduction technique in maxillofacial CT images of patients with metallic dental implants].

Objective: To investigate the effect of multi-material artifact reduction (MMAR) technique on the maxillofacial CT images of patients with metallic dental implants. Methods: The data of 30 patients with metal denture implants who underwent maxillofacial wide-detector CT scans in the Department of Radiology of the First Affiliated Hospital of Zhengzhou University from March 2019 to February 2020 were retrospectively collected. The images of the lesion sites of patients were all affected by the metal implants artifacts. The 120 kV-like, virtual monoenergetic images (VMI) (70, 90, 110 keV), VMI (70, 90, 110 keV)+MMAR images were reconstructed at venous phase by energy spectrum scanning. A total of 7 image sequences were obtained for each patient. The CT value and noise value of the lesion and the longus capitis muscle on the same plane were measured, and the artifact index (AI) of lesion was calculated.Friedman test and Wilcoxon test were used to evaluate image quality objectively and subjectively. Results: There were significant differences in SD and AI among the 7 groups (χ2=133.800,P<0.001;χ2=92.147,P<0.001). The SD[10 (8, 12)] and AI [6 (5, 9)]of VMI 110 keV+M images were the lowest, but there were no significant differences in AI between VMI 110 keV+M and VMI 90 keV+M image (P= 0.271). The SD and AI of VMI+M group were lower than those in VMI group (all P<0.05). There was significant difference in image score among the 7 groups (χ 2 = 151.199, P<0.001). The image scores of VMI (70, 90, 110 keV)+M group were higher than those of VMI group (Z=-4.583, P = 0.000; Z=-3.742, P = 0.000; Z =-2.449, P = 0.014). The subjective score of VMI 90 keV+M [4 (3, 4)] was the highest, higher than those of other 6 groups (all P<0.05), in 26 out of 30 cases, lesions displayed clear contrast, and the artifacts eliminated completely. Conclusion: The MMAR technique of wide-detector CT might effectively remove the metallic dental implants artifacts and improve the image quality. VMI 90 keV+MMAR images could achieve the best artifact removal effect and good tissue contrast.

[Comparative study of CT relative enhancement value and subjective visual evaluation for intestinal ischemia in patients with closed loop obstruction].

Objective: To compare and evaluate the diagnostic performance of visual evaluation and CT maximal density relative enhancement value in the diagnosis of intestinal ischemia complication in patients with closed loop obstruction and to explore the feasibility of CT maximal density relative enhancement value in quantifying the degrees of intestinal ischemia. Methods: The clinical and CT imaging data of 82 patients, 46 males and 36 females, aged from 19 to 78(52±18) years, with closed loop obstruction were retrospectively analyzed in the First Affiliated Hospital of Zhengzhou University from July 2017 to July 2019. All patients were classified into three groups: necrosis group (28 cases), ischemia group (22 cases), non-ischemia group(32 cases) using clinicopathologic results as reference standard. CT visual evaluation was performed by two experienced radiologists. The sensitivity, specificity, positive and negative predictive values and accuracy of the two observers were calculated respectively. The inter-observer agreement was analyzed by kappa analysis. Maximal density relative enhancement value was defined as the difference CT value of an ROI at dilated obstructed loops between contrast-enhanced and unenhanced CT images. The differences among groups were compared by one-way analysis of variance. Diagnostic performances were evaluated by receiver operating characteristic (ROC) curve analysis. Results: The sensitivity, specificity, positive and negative predictive values and accuracy of observer1 were 62.0%, 87.5%, 88.6%, 59.6%, 72.0%, and 58.0%, 93.8%, 93.5%, 58.8%, 72.0%for observer2, respectively. The kappa value of inter-observer agreement was 0.747. The unenhanced CT value of necrosis group, ischemia group and non-ischemia group was (53.7±9.7), (45.7±7.2) and (44.7±7.0) HU, enhanced CT value was (60.5±10.1), (65.0±11.6) and (87.0±15.8) HU, relative enhancement value was(6.8±8.4), (19.2±12.4) and(44.7±16.2)HU, respectively. All had a statistical difference among three groups (all P<0.05). The unenhanced CT value of necrosis group was higher than that of ischemia group and un-ischemia group (both P<0.05). The enhanced CT value of non-ischemia group was higher than that of ischemia group and necrosis (both P<0.05). The relative enhancement value all had a significant difference between groups (all P<0.05). Taking maximal density relative enhancement value below 19.5 HU as diagnosis threshold, the sensitivity, specificity and area under curve(AUC) were 96.9%, 74.0% and 0.947, respectively. Taking enhanced CT value below 66.5 HU as diagnosis threshold, the sensitivity, specificity and AUC were 93.8%, 60.0% and 0.903, respectively; the sensitivity was higher than that of objective visual evaluation. Conclusion: Maximal density relative enhancement value can quantize the bowel wall enhancement, and is a more reliable way in the diagnosis of intestinal ischemia than visual evaluation.

[Development and validation of three-dimensional body image stimuli for Chinese middle-aged adults].

Objective: To develop a three-dimensional body image stimuli suitable for middle-aged people in China, and verify the validity and reliability of the body image stimuli. Method: According to China and World Health Organization body mass index classification standards of adults, a set of three-dimensional body image stimuli of Chinese middle-aged males and females with different body size was developed by using 3D Studio Max and Adobe Photoshop CC based on the literature and expert consultation method. Forty-two 45- and 59-year-old middle-aged people in Zhengzhou City, Henan Province were recruited to verify the three-dimensional body image stimuli. Through questionnaire survey and physical examination, the coincidence between the selected body type and the actual body type was tested; the body composition was measured by dual-energy absorptiometry (DXA), and the structure validity of the image was tested; the body size satisfaction was investigated by the body image stimuli and the standard questionnaire, and the empirical validity of the image was tested. The repeated survey was conducted 14 days after the initial survey, and three experts were invited to score the current somatotype of the subjects to test the test-retest reliability and inter-rater reliability of the body image stimuli. Pearson, Spearman, Kendall correlation and Kappa consistency analysis were used to evaluate the validity and reliability of the body image stimuli. Results: The average age of 42 subjects was 52.7 years old, including 13 males and 29 females. A group of three-dimensional body image stimuli of middle-aged men and women were developed, and each group included 8 images. 73.8% of the subjects chose the body size consistent with the actual body type, and the weighted Kappa coefficient was 0.755 (P<0.01). The selected somatotype was positively correlated with body weight and body composition indexes such as fat content, and the Pearson correlation coefficient of construct validity was 0.623-0.717 (P<0.05). The results of the two surveys were positively correlated, and the Spearman correlation coefficient of test-retest reliability was 0.784-0.821 (P<0.05). The scores of the three experts on the current somatotype of the subjects were positively correlated, and the Kendall correlation coefficient of inter-rater reliability was 0.818-0.878 (P<0.05). Conclusion: The development of principle and reference basis of three-dimensional body image stimuli of middle-aged people is reliable, and the validity and reliability of the body image stimuli are good.

Deep learning radiomic nomogram can predict the number of lymph node metastasis in locally advanced gastric cancer: an international multicenter study.

BACKGROUND: Preoperative evaluation of the number of lymph node metastasis (LNM) is the basis of individual treatment of locally advanced gastric cancer (LAGC). However, the routinely used preoperative determination method is not accurate enough. PATIENTS AND METHODS: We enrolled 730 LAGC patients from five centers in China and one center in Italy, and divided them into one primary cohort, three external validation cohorts, and one international validation cohort. A deep learning radiomic nomogram (DLRN) was built based on the images from multiphase computed tomography (CT) for preoperatively determining the number of LNM in LAGC. We comprehensively tested the DLRN and compared it with three state-of-the-art methods. Moreover, we investigated the value of the DLRN in survival analysis. RESULTS: The DLRN showed good discrimination of the number of LNM on all cohorts [overall C-indexes (95% confidence interval): 0.821 (0.785-0.858) in the primary cohort, 0.797 (0.771-0.823) in the external validation cohorts, and 0.822 (0.756-0.887) in the international validation cohort]. The nomogram performed significantly better than the routinely used clinical N stages, tumor size, and clinical model (P < 0.05). Besides, DLRN was significantly associated with the overall survival of LAGC patients (n = 271). CONCLUSION: A deep learning-based radiomic nomogram had good predictive value for LNM in LAGC. In staging-oriented treatment of gastric cancer, this preoperative nomogram could provide baseline information for individual treatment of LAGC.

[The value of spectral CT-based radiomics in preoperative prediction of lymph node metastasis of advanced gastric cancer].

Objective: To investigate the spectral CT-based radiomics in predicting preoperatively the lymph node metastasis (LNM) of advanced gastric cancer. Methods: From January 2014 to October 2018, the spectral CT imaging and clinical data of 196 gastric adenocarcinoma patients confirmed by pathology in the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled (training set and test set were randomly divided according to the ratio of 1∶1). These 196 patients include143 males and 53 females, aged from 28 to 81 years, with an average age of (59±11) years, and were divided into nodular metastasis group and non-metastasis group according to clinicopathological data. The spectral parameters were measured and calculated, and the CT-reported lymph node (LN) status from CT images were obtained. 273 radiomics features were extracted from the dual-phases CT images in different energy level (40, 65 and 100 keV) to build the radiomics signature respectively. Univariate analysis was used to compare the differences of spectral parameters and radiomics features between two groups, and then the significant indicators were put into multivariable logistic regression analysis to construct combined prediction model and radiomics nomogram. In addition, the performance of prediction model in training and test set were measured using the receiver operating characteristics (ROC) curves and were compared using DeLong test. Results: Both in training set and in test set, the iodine concentration (IC) of tumor in venous phase (VP) in nodular metastasis group were higher than that in non-metastasis group [training set: 22.98 (100 mg/L)>20.31 (100 mg/L), P=0.086; test set: 25.14 (100 mg/L)>21.07 (100 mg/L), P=0.009]. The CT-reported LN status showed significant differences between the two group (P<0.001, P=0.001). The radiomics signatures 40 keV-arterial phase, 65 keV-venous phase, IC-VP of tumor and CT-reported LN status were independent indicators for prediction of preoperative LNM of advanced gastric cancer in combined prediction model (P<0.05). The radiomics nomogram predicated LNM with an area under curve (AUC) and 95% confidence interval (CI) of 0.822 (0.739-0.906) in training set and 0.819(0.732-0.906) in test set, and there were no significant differences in AUC between two sets (P>0.05). Conclusions: The spectral CT-based radiomics can be used to quantitatively predict the LNM of advanced gastric cancer preoperatively.

[Evaluation on the effect of clinic standardized blood pressure measurement model applying to first blood pressure measurement among community population aged 35 years old and above].

Objective: To evaluate the effect of clinic standardized blood pressure measurement model (SBPM) applying to first blood pressure measurement among community population aged 35 years old and above. Methods: SBPM was implemented in the community health service center of Dapuqiao street, Huangpu district of Shanghai from June 1, 2018, and the data between June 1 and December 31, 2018 was used as the SBPM data. The first-diagnosis blood pressure measurement data in this center between June 1 and December 31, 2017 was used as the conventional measurement (CM) model data. The detection rate of elevated blood pressure under SBPM was standardized according to the gender and age distribution of subjects in CM. The equilibrium of the value distribution of the end digit of blood pressure value in different pressure-measuring models and difference of elevated blood pressure rate of subjects with different characteristics and seasons were analyzed by using the χ(2) test, and the difference of standardized elevated blood pressure rate in different pressure-measuring models was analyzed by using the U test. Results: The SBPM included 1 548 subjects and 639 (41.28%) of them were males. The CM included 2 952 inpatients and 1 196 (40.51%) of them were males. The frequency of the end digit of blood pressure in SBPM ranged from 9.04% to 10.72%, and both systolic and diastolic blood pressure showed a balanced distribution of end digit (P values were 0.996 and 0.981 respectively). The frequency of blood pressure end digital in the CM ranged from 0.37% to 67.92%, and both systolic and diastolic blood pressure showed an unbalanced distribution (both P values <0.001). The crude rate and standardized elevated blood pressure rate in SBPM were 23.19% (359/1 548) and 23.05%, which were higher than that in CM, about 7.22% (213/2 952) (both P values <0.001). The elevated blood pressure rate in SBPM in summer, autumn and winter was 18.85% (141/748), 26.72% (152/591) and 31.58% (66/209), respectively, which was higher than that in CM, about 6.28% (91/1 450), 7.20% (82/1 139) and 11.02% (40/363), respectively (all P values <0.001). Conclusion: The quality of blood pressure data and the efficiency of hypertension screening of SBPM are better than those of CM when applying to first blood pressure measurement among community population aged 35 years old and above.

Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer.

BACKGROUND: Occult peritoneal metastasis (PM) in advanced gastric cancer (AGC) patients is highly possible to be missed on computed tomography (CT) images. Patients with occult PMs are subject to late detection or even improper surgical treatment. We therefore aimed to develop a radiomic nomogram to preoperatively identify occult PMs in AGC patients. PATIENTS AND METHODS: A total of 554 AGC patients from 4 centers were divided into 1 training, 1 internal validation, and 2 external validation cohorts. All patients' PM status was firstly diagnosed as negative by CT, but later confirmed by laparoscopy (PM-positive n = 122, PM-negative n = 432). Radiomic signatures reflecting phenotypes of the primary tumor (RS1) and peritoneum region (RS2) were built as predictors of PM from 266 quantitative image features. Individualized nomograms of PM status incorporating RS1, RS2, or clinical factors were developed and evaluated regarding prediction ability. RESULTS: RS1, RS2, and Lauren type were significant predictors of occult PM (all P < 0.05). A nomogram of these three factors demonstrated better diagnostic accuracy than the model with RS1, RS2, or clinical factors alone (all net reclassification improvement P < 0.05). The area under curve yielded was 0.958 [95% confidence interval (CI) 0.923-0.993], 0.941 (95% CI 0.904-0.977), 0.928 (95% CI 0.886-0.971), and 0.920 (95% CI 0.862-0.978) for the training, internal, and two external validation cohorts, respectively. Stratification analysis showed that this nomogram had potential generalization ability. CONCLUSION: CT phenotypes of both primary tumor and nearby peritoneum are significantly associated with occult PM status. A nomogram of these CT phenotypes and Lauren type has an excellent prediction ability of occult PM, and may have significant clinical implications on early detection of occult PM for AGC.

[Application of a multi-material artifact reduction algorithm in a wide-detector CT in the evaluation of the portal venous angiography of postoperative TIPS and embolization].

Objective: To assess the effect of monochromatic images and metal artifact reduction (MAR) on the image quality of spectral CT portal venous angiography in patients with operation of after the performing transjugular intrahepatic portosystemic stent shunt(TIPS) and embolization. Methods: From December 2017 to April 2018, the examination data of 28 patients with portal hypertension due to cirrhosis who underwent portal vein angiography 1 month after TIPS and embolization were prospectively collected. After spectral CT scanning in revolution CT, the monochromatic energy levels(60 keV, 120 keV), 60 keV + 120 keV, 120kV-like + 120 keV fused images combined with MAR algorithm were reconstructed. Quantitative parameters such as image artifact index (AI) and qualitative visual evaluation scores were recorded and compared. Results: The 120 keV monochromatic images showed the lowest AI value(30.8±8.5, 18.2±4.3) and highest metal artifacts reduction effect. The 60 keV monochromatic images showed the highest AI value (57.3±15.7, 32.1±7.9) and the lowest metal artifacts reduction effect. The AI value of 60 keV + 120 keV fused images was lower than that of 60 keV images(26.2%, 24.7%). The difference of AI value between each group was statistically significant(all P<0.05). The interobserver agreement in the subjective image scores was moderate with kappa value of 0.824. The overall image quality score of 60 keV + 120 keV fused image and the noise score of 120 kV-like+120 keV were higher than the remaining groups. The differences of the subjective scores among each group were statistically significant(all P<0.05). Conclusion: The spectral CT with MAR algorithm can effectively improve the image quality of portal vein angiography after the TIPS and embolization therapy and the 60 keV + 120 keV fused images can eliminate artifacts and ensure a clear display of blood vessels.

[Relationship between one-stop CT spectral perfusion imaging parameters and expression of lymphatic microvessel density and vascular endothelial growth factor-C in axillary lymph nodes of rabbit VX2 breast cancer].

Objective: To analyze the correlation between quantitative parameters of one-stop spectral perfusion computed tomography imaging and the expression level of vascular endothelial growth factor-C(VEGF-C) and MLVD in metastatic lymph nodes of rabbit VX2 breast cancer. Methods: Thirty New Zealand purebred female rabbits were used to establish the lymph node metastasis model of rabbit VX2 breast cancer, one-stop spectral and perfusion CT imaging protocol was performed.The axillary lymph nodes were selected for corresponding image markers. The observed morphology of conventional HE staining and the EnVision method were used to quantitatively analyze VEGF-C expression and calculate MLVD.Pearson linear correlation was used to analyze the perfusion parameters of metastatic lymph node energy spectrum and the correlation of MLVD and VEGF-C expression. Results: Twenty-four experimental rabbits were successfully modeled and performed a one-stop CT scan on the 28th day. A total of 39 metastatic lymph nodes were included. The VEGF-C of metastatic lymph node was 20.0%±2.8%,and the MLVD was 12.5±3.5. There was a positive correlation between BF, AP(λHU), IC(VP), NIC(VP), VP(λHU) of metastatic lymph node and VEGF-C and MLVD (P<0.05). There was a positive correlation between lymph node IC(AP) and MLVD (P=0.027) and no correlation with VEGF-C expression (P=0.386).There was no correlation between BV, NIC(A)P and VEGF-C, MLVD(P>0.05). The correlation between VP(λHU) and MLVD was higher (r=0.448, P=0.001). Conclusions: One-stop CT spectral perfusion imaging quantitative parameters and pathological indicators have a good correlation, and it can reflect lymphatic vessel metastasis in lymph nodes.

[Application of adaptive statistical iterative reconstruction V (ASIR-V) in contrast-enhanced abdominal scanning with low-dose for liver cirrhosis].

Objective: To investigate the application of adaptive statistical iterative reconstruction-V (ASIR-V) in contrast-enhanced abdominal CT scanning with low-dose for liver cirrhosis. Methods: From June 2017 to May 2018, a total of 112 liver cirrhosis patients who underwent contrast-enhanced abdominal CT scanning were collected prospectively as the study group. According to Child-Pugh grading of liver function, the study group was divided into A, B and C groups. Thirty examiners with normal liver function who underwent contrast-enhanced abdominal CT scanning no abdominal diseases were collected as the control group. The control group applied 0 pre-ASIR-V. The study group applied 30%, 40% and 50% pre-ASIR-V in plain scanning, arterial and portal vein phase, respectively. The control and study group both combined with 60% post-ASIR-V. The difference of qualitative parameters (contrast to noise ratio of the liver, pancreas, spleen, abdominal aorta and portal vein), image noise and radiation dose were compared by One-way ANOVA. Subjective score of images were compared by Kruskal-Wallis H test. Results: The volume computed tomography dose index (CTDI(vol)), dose length product (DLP) and the effective dose (ED) of study group were lower than the control group in the same phase (F=13.354-28.192, P<0.01). And the ED were decreased by 1.12 (23.9%), 1.54 (33.5%), 2.14 mSv (46.7%). The CNR values of liver and portal vein in Child C group was 0.34-0.42 and 0.43-0.49 lower than that of Child A and control group, respectively (q=2.851-4.658, P<0.05). Image noise had no difference in study and control group. There were no statistical differences between each group of subjective score in arterial and portal vein phase. The mean score of Child C in portal phase was lower than 3, which affected the diagnosis. And there were significant difference among the control, Child A and Child C group(Z=26.734-29.218, P<0.05). Conclusions: According to the classification of liver function, liver cirrhosis combined with ASIR-V can ensure the image quality while reduce the radiation dose. When liver function is Child-Pugh A or B, preset 50%ASIR-V is recommended; 40%ASIR-V is recommended for Child-Pugh C.

[Laparoscopic versus open surgery for gastric gastrointestinal stromal tumors in unfavorable location: a propensity score-matching analysis].

Objective: To investigate the efficacy and feasibility of laparoscopic resection for gastric gastrointestinal stromal tumor (GIST) in unfavorable location by comparing with open surgery. Methods: Clinicopathological and follow-up data of 176 patients with gastric GIST in unfavorable location admitted at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to December 2017 were analyzed retrospectively. There were 94 males and 82 females, aging of (57.4±12.7) years (range: 20-90 years). Of the 176 patients, 64 underwent laparoscopic surgery (laparoscopic group) and 112 underwent open surgery (open group). One-to-one propensity score matching (PSM) was performed to balance the covariance between laparoscopic group and open surgery group. Before PSM, the differences between the two group in tumor size and modified National Institutes of Health risk classification were significant. After PSM, there were 63 pairs (63 cases in laparoscopic group and 63 cases in open group) and the baseline characteristics were comparable between the two groups(P>0.05). The difference of short-term outcome between the two groups were compared using t test, χ(2) test or Wilcoxon rank-sum test. The survival curve was established by Kaplan-Meier method and the Log-rank test was used to compare the survival of the two groups. Results: The operation time of laparoscopic group was shorter ((141.6±100.6) minutes vs. (100.4±67.7) minutes, t=2.681, P=0.008), the hospitalization cost was higher ((5.2±0.7) ten thousand yuan vs. (4.2±0.8) ten thousand yuan, t=7.357, P=0.000) than open group. The time to first flatus ((49.1±8.2) hours vs. (71.0±4.6) hours, t=-18.482, P=0.000) and preoperative hospital stay ((10.3±6.0) days vs. (14.8±7.6) days, t=-3.717, P=0.000) was shorter in laparoscopic group. With a median follow-up time of 44 months (range: 10 to 154 months), the 1-, 3-, 5-year relapse-free survival rates in the laparoscopic group and open group were 98.3%, 92.1%, 92.1% and 100%, 86.3%, 83.2%, respectively (χ(2)=0.696, P=0.404). The 1-, 3-, 5-year overall survival rates in the laparoscopic group and open group were 96.6%, 94.7%, 94.7% and 100%, 91.1%, 81.4%, respectively (χ(2)=0.366, P=0.545). Conclusions: In experienced medical centers, laparoscopic resection is safe and feasible for GIST in unfavorable location. Compared to open surgery, laparoscopic resection achieves a faster postoperative recovery and a similar long-term prognosis.

[Comparative study on image quality of third-generation dual-source CT pulmonary angiography combined with advanced modeled iterative reconstruction].

Objective: To quantitatively evaluate the quality of advanced modeled iterative reconstruction (ADMIRE) combined with 70 kVp and linear blending images in low dose dual energy (70 kVp/sn150 kVp) pulmonary angiography. Methods: A total of 74 cases with normal BMI underwent dual-source CT dual-energy pulmonary angiography with small amount of contrast medium (30 ml) from 2015 to 2017 from the First Affiliated Hospital of Zhengzhou University were randomly assigned to protocol Ⅰ(100 kVp/sn140 kVp) or protocol Ⅱ(70 kVp/sn150 kVp). 70 kVp+ ADMIRE (group 1), linear blending+ ADMIRE (group 2), 100 kVp+ SAFIRE (group 3) images were obtained. CT value and noise standard deviation (SD) of pulmonary arteries were measured in pulmonary trunk artery, left pulmonary artery and left superior pulmonary artery, then SNR and CNR were calculated. Radiation dose parameters (CTDIvol, DLP) were recorded. Results: CT values of pulmonary artery of group 1 were significantly higher than those in group 2 and 3 (both P<0.05). In group 2, SD value of pulmonary artery was lower than that of group 1 and 3(both P<0.05). SD value of pulmonary trunk and left pulmonary artery in group 1 was higher than that in group 3 (P<0.05), SD value of left superior pulmonary artery had no significant difference between group 1 and group 3 (P>0.05). SNR and CNR value in group 1 and group 2 had no statistical difference, but they were both higher than that in group 3 (both P<0.05). The effective dose of protocolⅠwas 46% lower than protocol Ⅱ. Conclusion: ADMIRE combined with 70 kVp and linear blending images are better than SAFIRE combined with 100 kVp images, and radiation dose is reduced.70 kVp/sn150 kVp with small amount of contrast medium (30 ml) is a feasible dual energy pulmonary artery scanning protocol.

[Application of preset adaptive statistical iterative reconstruction-V in dual-enhanced abdominal CT].

Objective: To analyze the effect of preset adaptive statistical iterative reconstruction-V (ASIR-V) on image quality and radiation dose in dual-enhanced abdominal CT and to investigate the optimal ASIR-V in clinic use. Methods: From February 13 to April 30 in 2017, one hundred and eighty patients who received up abdominal CT scan in the First Affiliated Hospital of Zhengzhou University were collected prospectively. All patients underwent arterial phase (AP) and portal venous phase (PVP) enhanced abdominal CT(120 kVp, noise index 10) and were randomly divided into 6 groups according to random number table (A-F, 30 cases in each group). In group A-F, 0-50% preset ASIR-V (an interval of 10%) was applied, respectively. Qualitative parameters (subjective image quality, diagnosis confidence and radiation dose) and quantitative parameters[image noise, CT number and contrast to noise ratio (CNR)]were measured and compared among the groups by using one-way analysis of variance or Kruskal-Wallis H test. Results: The CT dose index volume (CTDIvol) decreased with the increasing of preset ASIR-V. The effective radiation dose (ED) was significant different among groups (F=27.598, P<0.05), and the ED of group B-F dropped by 10.8%, 21.7%, 31.2%, 44.9% and 61.9% respectively when compared with that in group A. Group E showed the optimal image quality (Z=18.675, 27.548, 19.761, all P<0.05) and diagnosis confidence(Z=21.387, 17.693, 22.459, all P<0.05) in plain scan, AP and PVP phases. There was no significant differences in image noise and CT value of liver, pancreas and muscle among groups (F=1.468, 0.337, 0.592, 0.284, all P>0.05). There were significant differences in CNRs in liver and portal vein in PVP phase among the groups (F=3.980, 4.681, both P<0.05). Conclusion: In abdominal CT, 40% preset ASIR-V can provides the best image quality and it can reduce radiation dose for 44.9%.

Screening and comparison of polychromatic and monochromatic image reconstruction of abdominal arterial energy spectrum CT.

We screened the suitable image reconstruction to observe the abdominal artery and compare the quality between the polychromatic and the monochromatic reconstruction images of the abdominal artery spectrum CT. Eighty patients underwent Gemstone CT energy spectrum imaging to obtain an abdominal artery polychromatic image (140 kVp) and a monochromatic image from 40 ~ 140 keV. The CT value of region of interest (ROI) was measured on the polychromatic image and the single energy image. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the abdominal aorta and hepatic artery were determined. The images in each group underwent image quality subjective scoring by three experienced radiologists using a blinded method. Finally, comprehensive comparisons and image quality subjective scorings were performed on the CT, SNR, and CNR values of the abdominal aorta. The obtained data were statistically analyzed by SPSS 19.0 software. When the keV value was reduced, the CT value of the abdominal artery gradually increased, and the image noise also changed. The comprehensive comparisons and subjective scorings were finalized for each single energy image based on the abdominal artery image quality objective indicators (CT value, SNR, and CNR). Results revealed that the abdominal artery image quality in the 50 ~ 60 keV monochromatic group was better compared to the polychromatic group. Furthermore, onochromatic imaging had different impacts on the abdominal aorta and hepatic artery image qualities. In different types of abdominal arterial reconstruction images obtained using abdominal energy spectrum CT conventional enhanced scanning, the image quality of the 50 ~ 60keV monochromatic reconstruction was higher when compared with the polychromatic reconstruction. Thus, it is recommended to apply the conventional reconstruction for abdominal artery energy spectrum CT scanning.

[Application value on localization and evaluation of sentinel lymph nodes in early-stage breast cancer with CT lymphography].

Objective: To explore the clinical value of CT lymphography (CT-LG) on the localization and evaluation of sentinel lymph node (SLN) in patients with early-stage breast cancer. Methods: Thirty-six patients with early-stage breast cancer were enrolled in this study from September 2014 to June 2016 in the First Hospital of Zhengzhou University.The diagnoses were confirmed by puncture or local surgical pathology with negative clinical palpation of axillary lymph nodes, and sentinel lymph node biopsy (SLNB) was planned.The patients received CT-LG examination.The first one or several lymph nodes along the lymph duct draining from the injection site to axilla was/were defined as SLN(s), and the results were compared with the SLNB.Wilcoxon signed ranks test was used to compare the number of SLN detected by CT-LG and SLNB; according to the pathologic results, Student t test or chi-square test was used to compare the differences of the positive SLNs with negative ones. Results: SLNs were successfully identified in all 36 patients, 32 cases (88.9%) had high-quality images (with both SLN and lymphatic vessel visible); 36 SLNs were located by CT-guided wire with a success rate of 100%.A total of 88 SLNs were identified by CT-LG in 36 patients, and 102 SLNs were obtained by SLNB (Z=-2.646, P=0.008). The long-short diameter ratio (L/S) of SLN obtained by SLNB was significantly smaller than that of CT-LG (1.7±0.3 vs 1.9±0.4, t=2.880, P=0.004). Compared with pathology, CT-LG showed 21 positive SLNs and 67 negative SLNs, and the short diameter of positive SLNs was bigger than that of negative ones[(5.9±2.1) vs (4.8±1.8) mm, t=2.235, P=0.028]. Of 67 negative SLNs, 61(91.04%) appeared homogenously contrast agent filling, and 13(61.90%) of the 21 positive SLNs were found filling defect changes, and the differences in filling defect changes between positive and negative SLNs were statistically significant (χ(2)=26.479, P<0.001). Conclusion: CT-LG can accurately locate the SLN for early-stage breast cancer, and both the short diameter and filling defect changes can help evaluate the status of SLN.