Nondestructive and three-dimensional visualization by identifying elements using synchrotron radiation microscale X-ray CT reveals microbial and cavity distributions in anaerobic granular sludge.

We developed a nondestructive three-dimensional microbial visualization method utilizing synchrotron radiation X-ray microscale computed tomography to better understand the relationship between microorganisms and their surrounding habitats. The method was tested and optimized using a mixture of axenic Escherichia coli and Comamonas testosteroni. The osmium-thiocarbohydrazide-osmium method was used to stain all the microbial cells, and gold in situ hybridization was used to detect specific phylogenetic microbial groups. The stained samples were embedded in epoxy resin for microtomographic analysis. Differences in X-ray absorbances were calculated by subtracting the pre-L3-edge images from the post-L3-edge images to visualize the osmium and gold signals. Although we successfully detected cells stained with osmium, those labeled with gold were not detected, probably because of the insufficient density of gold atoms in the microbial cells. We then applied the developed technique to anaerobic granules and visualized the distribution of microbial cells and extracellular polymeric substances. Empty spaces were highlighted to determine the cavity distribution in granules. Numerous independent cavities of different sizes were identified in the granules. The developed method can be applied to various environmental samples for deeper insights into microbial life in their habitats. IMPORTANCE: Microorganisms inhabit diverse environments and often form biofilms. One factor that affects their community structure is the surrounding physical environment. The arrangement of residential space within the formed biofilm plays a crucial role in the supply and transportation of substances, as well as the discharge of metabolites. Conventional approaches, such as scanning electron microscopy and confocal laser scanning microscopy combined with fluorescence in situ hybridization, have limitations as they provide information primarily from the biofilm surface and cross-sections. In this study, we developed a method for detecting microorganisms in biofilms using synchrotron radiation X-ray microscale computer tomography. The developed method allows nondestructive three-dimensional observation of biofilms at a single-cell resolution (voxel size of approximately 200 nm), facilitating an understanding of the relationship between microorganisms and their physical habitats.

Peripheral blood eosinophils: an important reference for radiologists to distinguish between pulmonary paragonimiasis and tuberculous pleurisy in children.

OBJECTIVE: In this study, we examined the value of chest CT signs combined with peripheral blood eosinophil percentage in differentiating between pulmonary paragonimiasis and tuberculous pleurisy in children. METHODS: Patients with pulmonary paragonimiasis and tuberculous pleurisy were retrospectively enrolled from January 2019 to April 2023 at the Kunming Third People's Hospital and Lincang People's Hospital. There were 69 patients with pulmonary paragonimiasis (paragonimiasis group) and 89 patients with tuberculous pleurisy (tuberculosis group). Clinical symptoms, chest CT imaging findings, and laboratory test results were analyzed. Using binary logistic regression, an imaging model of CT signs and a combined model of CT signs and eosinophils were developed to calculate and compare the differential diagnostic performance of the two models. RESULTS: CT signs were used to establish the imaging model, and the receiver operating characteristic (ROC) curve was plotted. The area under the curve (AUC) was 0.856 (95% CI: 0.799-0.913), the sensitivity was 66.7%, and the specificity was 88.9%. The combined model was established using the CT signs and eosinophil percentage, and the ROC was plotted. The AUC curve was 0.950 (95% CI: 0.919-0.980), the sensitivity was 89.9%, and the specificity was 90.1%. The differential diagnostic efficiency of the combined model was higher than that of the imaging model, and the difference in AUC was statistically significant. CONCLUSION: The combined model has a higher differential diagnosis efficiency than the imaging model in the differentiation of pulmonary paragonimiasis and tuberculous pleurisy in children. The presence of a tunnel sign on chest CT, the absence of pulmonary nodules, and an elevated percentage of peripheral blood eosinophils are indicative of pulmonary paragonimiasis in children.

Diagnostic Value of X-Map Images Reconstructed by Plain Dual-Energy Computed Tomography Scans in Acute Ischemic Stroke.

OBJECTIVE: This study aimed to evaluate the diagnostic value of X-Map reconstruction based on Dual-Energy Computed Tomography (DECT) in acute ischemic stroke (AIS). METHODS: Sixty-six cases of suspected AIS patients hospitalized from November, 2021 to April, 2022 were retrospectively selected. DECT, Computed Tomography Perfusion imaging (CTP), Computed Tomography Angiography (CTA), and MRI were all performed within 24 hours after symptom onset. As the gold standard for diagnosing AIS, a total of 53 patients were diagnosed with AIS based on the diffusion-weighted imaging positive results in MRI. The Chi-square test was used to evaluate the diagnostic efficacy of AIS among X-Map, CTP, and CTA. RESULTS: In the 53 patients with confirmed ASI, a total of 72 lesions were detected, including in the frontal lobes (n=33), parietal lobes (n=7), temporal lobes (n=12), basal ganglia regions (n=12), thalamus (n=3), and pons (n=5). The case detection rate of X-Map for AIS was similar to that of CTP (p=0.151) but was significantly higher than that of CTA (p<0.001). In terms of diagnostic efficacy, among the total 66 patients enrolled, X-Map achieved a higher diagnostic sensitivity (85%) than CTP and CTA. However, CTP achieved the best diagnostic specificity (84.6%) and diagnostic accuracy (77.4%) among the diagnostic tools used. CONCLUSION: X-Map provides a better or equal clinical value for the diagnosis of AIS as compared to CTA and CTP, respectively, highlighting its potential in clinical applications.

Evaluating the consistency in different methods for measuring left atrium diameters.

BACKGROUND: The morphological information of the pulmonary vein (PV) and left atrium (LA) is of immense clinical importance for effective atrial fibrillation ablation. The aim of this study is to examine the consistency in different LA diameter measurement techniques. METHODS: Retrospective imaging data from 87 patients diagnosed with PV computed tomography angiography were included. The patients consisted of 50 males and 37 females, with an average age of (60.74 ± 8.70) years. Two physicians independently measured the anteroposterior diameter, long diameter, and transverse diameter of the LA using six different methods. Additionally, we recorded the post-processing time of the images. Physician 1 conducted measurements twice with a one-month interval between the measurements to assess intra-rater reliability. Using the intraclass correlation coefficient (ICC), the consistency of each LA diameter measurement by the two physicians was evaluated. We compared the differences in the LA diameter and the time consumed for measurements using different methods. This was done by employing the rank sum test of a randomized block design (Friedman M test) and the q test for pairwise comparisons among multiple relevant samples. RESULTS: (1) The consistency of the measured LA diameter by the two physicians was strong or very strong. (2) There were statistical differences in the anteroposterior diameter, long diameter, and transverse diameter of LA assessed using different methods (χ2 = 222.28, 32.74, 293.83, P < 0.001). (3) Different methods for measuring the diameters of LA required different amounts of time (χ2 = 333.10, P < 0.001). CONCLUSION: The results of left atrium (LA) diameter measurements conducted by different physicians were found to be reliable. However, the LA diameters obtained through various techniques exhibited variations. It was observed that measuring LA long diameters using only the VR (volume rendering) picture was the most clinically applicable method.

Dual-energy computed tomography in the early evaluation of acute radiation pneumonia.

OBJECTIVE: To investigate the value of dual-energy dual-source computed tomography (DSCT) in evaluating pulmonary perfusion changes before and after radiotherapy for esophageal cancer, and its clinical use in the early diagnosis of acute radiation pneumonia (ARP). METHODS: We selected 45 patients with pathologically confirmed esophageal cancer who received radiotherapy (total irradiation dose of 60 Gy). Dual-energy DSCT scans were performed before and after radiotherapy and the normalized iodine concentrations (NIC) in the lung fields of the areas irradiated with doses of > 20 Gy, 10-20 Gy, 5-10 Gy, and < 5 Gy were measured. We also checked for the occurrence of ARP in the patients, and the differences in NIC values and NIC reduction rates before and after radiotherapy were calculated and statistically analyzed. RESULTS: A total of 16 of the 45 patients developed ARP. The NIC values in the lung fields of all patients decreased at different degrees after radiotherapy, and the NIC values in the area where ARP developed, decreased significantly. The rate of NIC reduction and incidence rate of ARP increased gradually with the increasing irradiation dose, and the inter-group difference in NIC reduction rate was statistically significant (P < 0.05). Based on the receiver operating characteristic (ROC) curve analysis, the areas under the curves of NIC reduction rate versus ARP occurrence in the V5-10 Gy, V10-20 Gy, and V> 20 Gy groups were 0.780, 0.808, and 0.772, respectively. Sensitivity of diagnosis was 81.3%, 75.0%, and 68.8% and the specificity was 65.5%, 82.8%, and 79.3%, when taking 12.50%, 16.50%, and 26.0% as the diagnostic thresholds, respectively. The difference in NIC values in the lung fields of V<5 Gy before and after radiotherapy was not statistically significant (P > 0.05). CONCLUSION: The dual-energy DSCT could effectively evaluate pulmonary perfusion changes after radiotherapy for esophageal cancer, and the NIC reduction rate was useful as a reference index to predict ARP and provide further reference for decisions in clinical practice.

Chinese expert consensus on imaging diagnosis of drug-resistant pulmonary tuberculosis.

Tuberculosis (TB) remains one of the major infectious diseases in the world with a high incidence rate. Drug-resistant tuberculosis (DR-TB) is a key and difficult challenge in the prevention and treatment of TB. Early, rapid, and accurate diagnosis of DR-TB is essential for selecting appropriate and personalized treatment and is an important means of reducing disease transmission and mortality. In recent years, imaging diagnosis of DR-TB has developed rapidly, but there is a lack of consistent understanding. To this end, the Infectious Disease Imaging Group, Infectious Disease Branch, Chinese Research Hospital Association; Infectious Diseases Group of Chinese Medical Association of Radiology; Digital Health Committee of China Association for the Promotion of Science and Technology Industrialization, and other organizations, formed a group of TB experts across China. The conglomerate then considered the Chinese and international diagnosis and treatment status of DR-TB, China's clinical practice, and evidence-based medicine on the methodological requirements of guidelines and standards. After repeated discussion, the expert consensus of imaging diagnosis of DR-PB was proposed. This consensus includes clinical diagnosis and classification of DR-TB, selection of etiology and imaging examination [mainly X-ray and computed tomography (CT)], imaging manifestations, diagnosis, and differential diagnosis. This expert consensus is expected to improve the understanding of the imaging changes of DR-TB, as a starting point for timely detection of suspected DR-TB patients, and can effectively improve the efficiency of clinical diagnosis and achieve the purpose of early diagnosis and treatment of DR-TB.

Imaging findings of 14 cases of intestinal schwannoma / 复旦学报（医学版）

Objective To investigate the imaging features of intestinal schwannoma(IS)in order to improve the diagnostic ability of the disease.Methods The clinical and imaging data of 14 patients with surgically and pathologically confirmed IS were retrospectively analyzed,including the location,size,morphology,nature,growth pattern,CT density,MRI signal,PET/CT metabolism and other characteristics of the tumors.Results Of the 14 IS cases,the lesions of 3 cases were located in the duodenum,2 cases in the cecum,8 cases in the colon and 1 case in the rectum.The lesions were all round or oval,with an average maximum diameter of(2.4±1.1)cm.The lesions were solid in 13 cases,extraluminal growth in 10 cases,cystic degeneration in 1 case and myxoid degeneration in 1 case.Chronic inflammatory lymph nodes were seen around the diseased intestines in 9 cases,and the short diameter of lymph nodes was greater than 5 mm in 6 cases.All 14 cases of IS showed low attenuation on plain CT scan,and progressive enhancement after contrast injection,including 1 case of mild enhancement,2 cases of moderate enhancement,and 11 cases of obvious enhancement.Two cases of IS showed low signal intensity on T1WI,slightly high signal intensity on T2WI,significantly high signal intensity on DWI,and obvious progressive enhancement after contrast injection on MRI.Two cases of IS showed high metabolism on 18F-FDG-PET/CT,and the SUVmax was 9.4 and 8.8,respectively.Conclusion The imaging findings of IS were characteristic to a certain extent.They mainly manifested as solid nodules or masses derived from the intestinal submucosa,with uniform attenuation or signal intensity,obvious progressive enhancement after contrast injection,obvious hypermetabolism on 18F-FDG-PET/CT,and slightly larger homogeneous lymph nodes were common around the lesions.

The value of 18 F ⁃FDG PET/CT dynamic imaging in the diagnosis of primary hepatocellular carcinoma with liver metastases / 安徽医科大学学报

Objective @#To explore the value of 18 F ⁃FDG PET/CT dynamic imaging in the diagnosis of primary liver cancer and liver metastases.@*Methods @#In this study , the data of 94 patients with hepatic malignant lesions [hepatocellular carcinoma group (25 cases) , cholangiocellular carcinoma group (27 cases) , and liver metastases group (42 cases)] imaged by whole⁃body dynamic 18 F ⁃FDG PET/CT were used as the research subjects , and the methods of (ANOVA) and subjects ′ working characteristic curves (ROC) were applied to examine the patients with liver malignant tumours of different pathological types SUV max , MRFDG , TBR and d max were statistically analysed as imaging features. @*Results @#Among 94 patients , the differences in SUV max , MRFDG , TBRSUV max and TBRMRFDG were statistically significant in the hepatocellular carcinoma , cholangiocellular carcinoma and hepatic metastasis groups (SUV max : F = 48. 773 , P < 0. 001 ; MRFDG : F = 26. 334 , P < 0. 001 ; TBRSUV : F = 41. 314 , P < 0. 001 ; TBRMRFDG : F = 20. 821 , P < 0. 001) . The AUCs for the differential diagnosis of primary hepatocellular carcinoma and hepatic metastases for SUV max , MRFDG , TBRSUV max , and TBRMRFDG were 0. 836 , 0. 851 , 0. 827 , and 0. 847 , respectively. There was a positive correlation between SUV max , MRFDG , and the hepatic malignant lesions ′ There was a positive correlation between SUV max , MRFDG and the maximum diameter d max (SUV max : r = 0. 4 , P < 0. 05 ; MRFDG :r = 0. 2 , P < 0. 05) , and the difference was statistically significant. @*Conclusion @#18 F ⁃FDG PET/CT dynamic imaging has good differential diagnostic efficacy in different pathological types of liver malignant tumors. There is a positive correlation between SUV max , MRFDG and d max in different pathological types of liver malignant tumors.

Diagnostic value of computed tomography and magnetic resonance imaging in ovarian malignant mesothelioma.

OBJECTIVE: To investigate the diagnostic value of computed tomography (CT) and magnetic resonance imaging (MRI) in ovarian malignant mesothelioma (OMM). METHODS: The clinical and imaging data of 10 pathologically-confirmed OMM patients were analyzed retrospectively. RESULT: (1) The patients were 27 years to 70 years old, with an average age of 57.2 ± 15.4 years. Seven patients reported abdominal distension and pain, 1 reported lower abdominal discomfort and decreased appetite, and 2 patients had no symptoms. (2) Two cases of localized OMM with incomplete semi-annular "capsule" observed around the localized OMM tumors were reported while 8 cases had diffuse OMM in which the tumor parenchyma showed isointense or slightly hypointense on T1WI, inhomogeneous hyperintense on T2WI, and obviously hyperintense on DWI, with obvious inhomogeneous enhancement after enhancement. Diffuse OMM was not mainly composed of ovarian masses and was mainly characterized by mild ovarian enlargement, nodular and irregular thickening of the peritoneum, cloudy omentum, unclear fat gap, and reticular or irregular thickening, which can fuse into a "cake-shape". (3) All 10 patients underwent surgery, while 9 patients underwent systemic chemotherapy or immunotherapy after surgery. All patients with localized OMM survived. Out of the 8 diffuse-type patients, 5 died, 1 was lost to follow-up, and 2 survived. CONCLUSION: OMM has certain clinical and imaging characteristics. There is no liquefaction, calcification, or partition in the tumor. The ovarian enlargement in the diffuse lesion is not significant. The diffuse thickening of the peritoneum and omentum with early appearance of mural nodules and ascites in the upper abdomen, help the diagnosis of OMM.

Construction of pathological classification prediction model for malignant pulmonary pure ground-glass nodule patients based on CT imaging / 国际肿瘤学杂志

Objective:To construct the pathological classification prediction model for malignant pulmonary pure ground-glass nodule (pGGN) patients based on CT imaging and to analyze the predictive efficacy.Methods:A total of 193 pulmonary pGGN patients with histopathological findings who underwent surgical treatment in 3201 Hospital from January 2018 to December 2022 were retrospectively included, with 217 lesions. All patiens were divided into invasive adenocarcinoma group (68 patients, 73 lesions) and non-invasive adenocarcinoma group (125 patients, 144 lesions) based on whether they were invasive adenocarcinoma; The clinical feature data and CT imaging parameters were compared between the two groups; Multivariate logistic regression analysis was used to analyze the risk factors of malignant lung pGGN diagnosed as invasive adenocarcinoma; A logistic prediction model for pathological classification of malignant lung pGGN was constructed to analyze its predictive efficacy using receiver operator characteristic (ROC) curves.Results:The percentages of burr signs in invasive adenocarcinoma group and non-invasive adenocarcinoma group were 34.25% (25/73) and 5.56% (8/144), respectively; The proportion of internal vascular signs was 93.15% (68/73) and 18.75% (27/144), respectively; The air bronchial signs were 67.12% (49/73) and 12.50% (18/144), respectively, with statistically significant differences ( χ2=30.93, P<0.001; χ2=108.95, P<0.001; χ2=67.72, P<0.001). The maximum CT value of nodular plain scan in invasive adenocarcinoma group (-527.82±72.95) HU, was significantly higher than that in non-invasive adenocarcinoma group (-592.79±86.47) HU, with a statistically significant difference ( t=-5.50, P<0.001). The results of multivariate analysis showed that spicule sign ( OR=8.93, 95% CI: 1.99-39.97, P=0.004), air bronchial sign ( OR=8.16, 95% CI: 2.91-22.86, P<0.001), internal vascular sign ( OR=48.39, 95% CI: 14.81-158.07, P<0.001) and the maximum CT value of plain scan ( OR=1.01, 95% CI: 1.00-1.02, P=0.001) were independent factors for the diagnosis of malignant pulmonary pGGN as invasive adenocarcinoma. Using burr sign, air bronchogram sign, internal vascular sign, maximum CT value of plain scan, and logistic regression model P-value to predict the pathological classification of malignant lung pGGN, the optimal cutoff values were 0.50, 0.50, 0.50, -547.23 HU, 0.46, and the area under the curve was 0.64, 0.77, 0.87, 0.69 and 0.96, respectively. The sensitivity was 34.25%, 67.12%, 93.15%, 82.19% and 89.04%, and the specificity was 94.44%, 87.50%, 81.25%, 46.53% and 92.36%, respectively, with the Jordan index being 28.69%, 54.62%, 74.40%, 28.72% and 81.40%. Conclusion:Patients with malignant pulmonary pGGN who have concomitant spicule sign, air bronchial sign, internal vascular sign, and maximum CT value on plain scan have a higher risk of being diagnosed with invasive adenocarcinoma; The predictive model constructed based on spicule sign, air bronchial sign, internal vascular sign, and maximum CT value on plain scan has shown good predictive performance in assisting the differential diagnosis of malignant pulmonary pGGN pathological classification.

18F-FDG PET/CT manifestations of primary systemic anaplastic large cell lymphoma / 中国医学影像技术

Objective To observe the 18F-FDG PET/CT manifestations of primary systemic anaplastic large cell lymphoma(ALCL).Methods A total of 21 patients with primary systemic ALCL were enrolled,and PET/CT manifestations were observed.Results Among 21 cases of ALCL,there were 15 cases of ALK+and 6 cases of ALK-.Affected lymph nodes in multiple site were observed in 19 cases,mainly located in the neck(n=13),mediastinum(n=12 cases)or retroperitoneum(n=12),while single site affected lymph node was notice in 2 cases.Extranodal organs/site involvements were found in 12 cases,including 6 cases of soft tissue(such as skin,muscles,etc.),4 cases of bone,14 cases of organs,including 4 cases of lung,3 cases of liver,2 cases of pancreas,2 cases of kidney,2 cases of gastrointestinal tract and 1 case of thyroid.Among 21 cases of ALCL,19 with irregular lymph node morphology and fused into clusters,17 with uniform density,3 with necrosis and 1 with calcification.All ALCL lesions in 21 cases showed hypermetabolism,the maximum standard uptake value(SUVmax)and the mean standard uptake value(SUVmean)of the affected lymph node was 17.04±9.94 and 9.96±6.15,respectively,while the metabolic tumor volume(MTV)and total lesion glycolysis(TLG)of all lesions was 92.54(67.61,249.21)cm3 and 723.46(419.78,1 461.17)g,respectively.The maximum diameter of the affected lymph node was not significantly correlated with SUVmax nor SUVmean(both P＞0.05),but positively correlated with MTV and TLG of all lesions(r=0.696,0.767,both P＜0.001).Ann Arbor staging was positively correlated with the maximum diameter,SUVmax and SUVmean of the affected lymph node,also MTV and TLG of all lesions(r=0.467,0.458,0.702,0.780,0.664,all P＜0.05).Conclusion 18F-FDG PET/CT manifestations of primary systemic ALCL were characteristic,with significant changed metabolic parameters,including SUVmax,SUVmean,MTV and TLG.

Application value of deep learning reconstruction algorithm in CT imaging of abdominal phantoms / 中华放射医学与防护杂志

Objective:To explore the value of the deep learning image reconstruction (DLIR) algorithm in improving the CT image quality of abdominal phantoms under different radiation doses by comparing the DLIR algorithm with the conventional Adaptive Statistical Iterative Reconstruction-V (ASIR-V) technique.Methods:Two groups with tube voltages of 100 kV and 120 kV (also referred to as the 100 kV and 120 kV groups, respectively) were involved. Each group was further divided into six subgroups based on different volumetric CT dose indices (CTDI vol: 2, 4, 6, 8, 10 and 15 mGy). Subsequently, CT images based on the filtered back projection (FBP) algorithm were obtained and were then reconstructed using the ASIR-V algorithm with different weights (ASIR-V 50%, 80%, and 100%) and the DLIR algorithm with different levels (DLIR-L, M, and -H). As a result, 84 groups of images were obtained in total. Afterward, this study compared and analyzed the variations in CT values, noise, signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), and subjective scores of various parts in various CTDI vol subgroups under different reconstruction conditions. In addition, the subjective scores of the image quality were compared using the Kruskal-Wallis H test, while objective indices and radiation doses were compared through the univariate analysis of variance (ANOVA) and the paired t test. Results:Under the same tube voltage, there were statistically significant differences in the noise, SNRs, and CNRs of various parts in various CTDI vol subgroups under different reconstruction conditions ( F = 415.39, 315.30, P < 0.001), while there was no statistically significant difference in the noise, SNRs, and CNRs of images constructed using ASIR-V 50% and DLIR-L ( P > 0.05). Under different tube voltages, the subjective scores of both groups show statistically significant differences (100 kV group: H = 13.47, P = 0.036; 120 kV group: H = 12.99, P = 0.043). Moreover, two physicians offered consistent subjective scores, with Kappa values > 0.70. Among these images, DLIR-H images showed the highest subjective scores, followed by DLIR-M and ASIR-V 50% images, which had roughly consistent subjective scores. Moreover, the subjective scores of the 100 kV group were slightly higher than those of the 120 kV group. With the ASIR-V 50% images of the subgroup with a CTDI vol of 15 mGy as references, the DLIR-L, -M, and -H reduced radiation doses by more than 30%, 70% and 85%, respectively on the premise that diagnostic requirements were met. Conclusions:The DLIR algorithm can not only significantly reduce the image noise and improve the image quality, but also effectively decrease the radiation doses on the premise of meeting the diagnostic requirements. It is recommended that 100 kV tube voltage combined with a medium- or high-level DLIR algorithm should be applied to low-dose abdominal CT scans in clinical applications.

Clinical Features and CT Imaging Findings of Melioidosis Pneumonia / 中山大学学报(医学科学版)

ObjectiveTo summarize and analyze the clinical features and CT imaging findings of melioidosis pneumonia in order to increase awareness of this disease. MethodsA retrospective study was done on clinical and CT imaging data of 68 cases with melioidosis pneumonia diagnosed from January 1， 2012 to April 1， 2023. ResultsOf the 68 cases， 62 presented with acute infection and 6 chronic infection， 88.2% were male， 85.3% were native residents of Hainan， 85.3% were farmers， 77.9% had onset in summer and autumn， 66.2% had diabetes， 100% had fever as the first clinical symptom， and 88.2% were confirmed positive by blood culture. In most patients， white blood cell count， neutrophil ratio， C-reactive protein and calcitonin levels increased， while lymphocyte ratio decreased， but no statistical difference was found between acute and chronic infection groups （P > 0.05）. Of the patients， 36.8% recovered， 42.6% got better， 11.8% patients became therapy-resistant and 8.8% died. CT image showed pathomorphological changes including nodules/masses， patchy ground-glass attenuation or large patchy consolidation or all of these at the same time. Acute and chronic infection groups had significant difference in pathomorphological changes （P = 0.01）， but no statistical difference in other imaging findings. Moreover， 36.8% of the patients developed extrapulmonary infections， 8.8% of which multi-site abscess formation. ConclusionsMelioidosis Pneumonia should be considered if the patient is the sojourner from epidemic area， or has diabetes， high fever and rapid-developing disease， with additional presence of multiple inflammatory lesions in lung CT.

Application of deep learning image reconstruction algorithm in low-dose abdominal CT / 西安交通大学学报(医学版)

【Objective】 To investigate the value of deep learning image reconstruction (DLIR) in improving image quality and reducing beam-hardening artifacts of low-dose abdominal CT. 【Methods】 For this study we prospectively enrolled 26 patients (14 males and 12 females, mean age of 60.35±10.89 years old) who underwent CT urography between October 2019 and June 2020. All the patients underwent conventional-dose unenhanced CT and contrast-enhanced CT in the portal venous phase (noise index of 10; volume computed tomographic dose index: 9.61 mGy) and low-dose CT in the excretory phase(noise index of 23; volume computed tomographic dose index: 2.95 mGy). CT images in the excretory phase were reconstructed using four algorithms: ASiR-V 50%, DLIR-L, DLIR-M, and DLIR-H. Repeated measures ANOVA and Kruskal-Wallis H test were used to compare the quantitative (skewness, noise, SNR, CNR) and qualitative (image quality, noise, beam-hardening artifacts) values among the four image groups. Post hoc comparisons were performed using Bonferroni test. 【Results】 In either quantitative or qualitative evaluation, the SNR, CNR, overall image quality score, and noise of DLIR images were similar or better than ASiR-V 50%. In addition, the SNR, CNR, and overall image quality scores increased as the DLIR weight increased, while the noise decreased. There was no statistically significant difference in the distortion artifacts (P=0.776) and contrast-induced beam-hardening artifacts (P=0.881) scores among these groups. 【Conclusion】 Compared with the ASiR-V 50% algorithm, DLIR algorithm, especially DLIR-M and DLIR-H, can significantly improve the image quality of low-dose abdominal CT, but has limitations in reducing contrast-induced beam-hardening artifacts.

Imaging Characteristics of Renal Cell Carcinoma Associated with Xp11.2 Translocation/TFE3 Gene Fusions in Children / 肿瘤防治研究

Objective To investigate the imaging characteristics of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion. Methods We retrospectively analyzed the clinical and imaging data of five children with Xp11.2 tRCC confirmed by surgery and pathology in our hospital from January 2015 to December 2020. Four cases underwent CT plain scan and contrast-enhanced examination, and one case underwent MRI plain scan, contrast-enhanced examination and DWI examination. We observed and analyzed the location, size, shape, boundary, composition, enhancement pattern and degree, the relation with the renal hilum and adjacent large vessels, and the metastasis of the tumor. Results All cases were cortical-medullary type. Four cases were solid/cystic-solid lesions, iso- or slightly hyper-density on CT scans with calcification and necrosis, in which a few with bleeding or cystic lesions. Enhanced scanning primarily showed mild to moderate enhancement, and enhancement of pseudocapsule was seen during the delayed phase. One case was cystic lesion, the cystic fluid presented as hypo-density on CT, and T1 hypo-intensity and T2 hyper-intensity, as well as restricted diffusion on DWI. No enhancement was found in the cystic part after enhancement. There were irregular and thickened cystic wall and septum, and mural nodules on enhanced MRI. Conclusion Several characteristics of Xp11.2 tRCC in children could be drawn. Punctate and patchy calcifications in or around the solid/cystic-solid lesions and delayed "pseudocapsule sign" are typical. The possibility of Xp11.2 tRCC should be considered when there are irregular and thickened cystic wall and septum and the enhancement of mural nodules.

The effects of 80 kVp combined with ASiR-V on image quality of iliac artery in preoperative evaluation of kidney transplantation / 西安交通大学学报(医学版)

【Objective】 To investigate the effects of 80 kVp combined with multi-model adaptive statistical iterative reconstruction algorithm （ASiR-V） on the image quality of CT angiography （CTA） of iliac artery in kidney transplantation candidates before operation. 【Methods】 Totally 50 kidney transplantation candidates underwent “one-stop” scanning combined CTA for coronary and iliac arteries were recruited consecutively. After the scanning， images were reconstructed with different ASiR-V levels on the iliac artery from 50% to 100% at a 10% interval， and 6 groups of images were obtained. We evaluated and compared all image qualities， DLP and CTDI in the patients’ examination were recorded， and the effective dose （ED） was calculated. 【Results】 All of the image quality objective scores of different ASiR-V levels on the iliac artery were above 3 points （3.32±0.24）， and the average CT value was （344.30±74.53）HU. The ED received by the patient throughout the examination was （2.71±0.42)mSv. The image noise decreased while SNR and CNR increased monotonically as the ASiR-V levels increased， among which 80% ASiR-V image quality score was the highest with 3.41±0.26. 【Conclusion】 For patients who need to have both coronary and iliac arteries evaluated before kidney transplantation operation， low tube voltage （80 kVp） combined with 80% ASiR-V can obtain high-quality iliac artery images under the premise of reducing the ED dose， which can provide practical basis for further reducing the dose in personalized scanning scheme for such patients. It has good feasibility and clinical application value.

CT features of primary liver leiomyosarcoma / 中华消化外科杂志

Objective:To investigate the computed tomography (CT) features of primary liver leiomyosarcoma (PHLMS).Methods:The retrospective and descriptive study was conducted. The clinical and imaging data of 10 patients with PHLMS who were admitted to 4 medical centers including 3 cases in Wenzhou Central Hospital, 3 cases in the Second Affiliated Hospital of Wenzhou Medical University, 2 cases in Wenzhou People's Hospital and 2 cases in Yueqing People's Hospital from January 2011 to December 2020 were collected. There were 5 males and 5 females, aged from 41 to 83 years, with a median age of 55 years. All 10 patients underwent abdominal CT examination. Observation indicators: (1) CT features; (2) treatment and pathological examination; (3) follow-up and survival. Follow-up using postoperative outpatient or inpatient examination to detect patient survival was conducted. Patients underwent imaging examination to detect tumor recurrence. Follow-up was up to December 2020. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) CT features: results of CT examination showed that each of the 10 patients had only one single tumor, including 3 cases with tumor on the left lobe of liver and 7 cases with tumor on the right lobe of liver. The tumor diameter of the 10 patients was 8.0 cm(range, 4.5-13.5 cm). Results of plain CT scan of 10 patients showed that 7 cases had tumor in expansive growth as round or oval, with clear boundaries and the tumor parenchyma showing low-density signals and patchy lower density area can be seen in the center, and 3 cases had tumor in infiltrative growth as patchy, with unclear boundaries and the tumor parenchyma showing iso-density signals. The CT scan value of 10 patients was 40 HU(range, 23-47 HU). Results of enhanced CT scan at arterial phase of the 7 cases with tumor in expansive growth showed that 3 cases undergoing tumor parenchyma with uneven mild enhancement signals, 3 cases undergoing tumor parenchyma with uneven moderate enhancement signals and 1 case undergoing tumor parenchyma with uneven significant enhancement signal. The CT scan value of 7 cases was 68 HU(range, 62-88 HU). Results of enhanced CT scan at arterial phase of the 3 cases with tumor in infiltrative growth showed that the peripheral region had high signal than the central region. The CT scan value of 3 cases was 73 HU(range, 67-90 HU). Results of enhanced CT scan at portal vein phase in the 7 cases with tumor in expansive growth showed that the tumor parenchyma showing continuous and progressive mild and moderate enhancement with uneven density, and the CT scan value was 63 HU(range, 55-78 HU). Of the 7 cases, 3 cases showed the enhancement range of tumor parenchyma with the trend of fusion and filling, and 4 cases showed small patchy or nodular enhancement and grid like enhancement in the center and periphery of the tumor. Results of enhanced CT scan at portal vein phase in the 3 cases with tumor in infiltrative growth showed that the enhancement withdrew, the density was uneven, and the CT scan value was 58 HU(range, 50-62 HU). Results of enhanced CT scan at delayed phase in 10 patients showed that the enhancement in the tumor withdrew slowly, and the CT scan value was 53 HU(range, 50-60 HU). Of the 10 patients, 4 cases showed decreased density of enhanced nodules around the tumor and 6 cases showed partially fused and filled to the center of tumor with no enhancement in the necrotic part. (2) Treatment and pathological examination: all 10 patients underwent completed tumor resection successfully, and no metastasis was found in liver or the hilar region. Results of postoperative pathological examination showed that each of the 10 patients had only one single visible tumor with tumor diameter of 8.0 cm(range, 4.5?13.5 cm). Of the 10 patients, 7 cases had tumor with complete or incomplete pseudocapsule with clear boundary and 3 cases had tumor without pseudocapsule and the boundary was unclear. All 10 patients had tumor with hard parenchyma and the section was mostly gray and fish like. Among them, patchy or punctate necrosis was seen in 7 cases, small patchy or punctate hemorrhage was seen in 3 cases, and small patchy calcification was seen in 2 cases. Microscopically, the tumor tissue was crisscross, the tumor cells were in spindle shaped, the nuclei were in round, oval, blunt at both ends or in thin rod like, with obvious heteromorphism, large and deeply staining, and obviously division. Immunohistochemical staining showed positive staining of smooth muscle actin, desmin and vimentin. (3) Follow-up and survival: all 10 patients were followed up postoperatively for 6 to 130 months, with a median follow-up time of 55 months. The overall survival time of 10 patients were 10 to 120 months, with a median overall survival time of 46 months. Of the 10 patients, 2 cases died of tumor recurrence and distant metastasis 10 and 11 months after operation, respectively and 8 cases survived >12 months.Conclusions:Results of plain CT scan of PHLMS show clear or unclear cysts and solid masses with uneven density. Results of enhancement CT scan of PHLMS show persistent uneven enhancement in tumor parenchyma and the surrounding area.

Value of ultrasonography, radionuclide imaging and CT in preoperative location diagnosis of primary hyperparathyroidism / 中华普通外科杂志

Objectiv:To evaluate ultrasound, radionuclide imaging and CT in preoperative localization diagnosis of primary hyperparathyroidism (PHPT).Method:A total of 170 PHPT patients admitted to the hospital between Jan 1992 and Dec 2020 were analyzed retrospectively. The preoperative localization diagnostic efficacy of ultrasonography, radionuclide and CT alone and in combination was compared in groups.Results:The overall sensitivity of ultrasound, radionuclide and CT were 82.13%,80.43% and 75.74%. For normal positioned parathyroid adenoma: as for sensitivity of location diagnosis, ultrasound (86.67%) was higher than radionuclide (81.82%, P<0.05) and CT (80.59%, P<0.05), ultrasound/CT parallel test (94.70%, P<0.05) was higher than ultrasound alone. For specificity of location diagnosis, radionuclide (97.78%) was higher than ultrasound (91.62%) and CT (93.39%), both ultrasound/radionuclide series tests (99.00%, P<0.001)and ultrasound/CT series tests (96.94%, P<0.001) were higher than ultrasound alone. In case of ectopic parathyroid adenoma and parathyroid hyperplasia: the sensitivity and specificity of radionuclide seemed higher than ultrasound and CT. Conclusions:Ultrasound is the first choice for preoperative location diagnosis of PHPT. Ultrasound combined with radionuclide or CT can significantly improve the diagnostic efficiency of parathyroid lesions.

Analysis of the components of carotid plaque and relationship with cerebral infarction with spectral CTA / 中国医学影像技术

Objective: To investigate the feasibility of energy spectrum CT angiography (CTA) in distinguishing the components of atherosclerosis plaque in carotid artery, and to analyze the relationship of different type atherosclerosis plaque with cerebral infarction. Methods: Energy spectrum CTA and head MRI were performed on 60 patients with carotid artery stenosis detected with ultrasound. CT value and effective atomic number of plaque, fat, muscle and bone tissue were measured, respectively. The characteristic energy spectrum curve of average CT value in 40-140 keV single energy image were obtained, and slope of energy spectrum curve was calculated. Cerebral infarction was evaluated based on MRI results. According to the results of energy spectrum CTA, the plaques were divided into lipid plaque, lipid core-dominated mixed plaque, fibrous composites-dominated mixed plaque, fibrous plaque and calcified plaque. The lipid plaque and lipid/fiber mixed plaque were classified as unstable plaque, and the fibrous plaque and calcified plaque were classified as stable plaque. The differences of the slope of energy spectrum curve and effective atomic number in patients of each type plaques were compared. The incidences of cerebral infarction in patients with various types of plaques were correlated. Results: A total of 109 carotid plaques were enrolled, including 21 lipid plaque, 11 lipid core-dominated mixed plaque, 30 fibrous composites-dominated mixed plaque, 15 fibrous plaque and 32 calcified plaque. Statistical differences of the corresponding energy curve slope and effective atomic number wer found among different type plaques (F=1 494. 83, 2 108. 74, both P<0.01). Totally 19, 11, 19, 10 and 20 patients were found with lipid plaque, lipid core-dominated mixed plaque, fibrous composites-dominated mixed plaque, fibrous plaque and calcified plaque, among them MRI detected cerebral infarction in 13, 6, 7, 2 and 1 patient, and the incidence of cerebral infarction was 68.42% (13/19), 54.55% (6/11), 36.84% (7/19), 11.11% (1/9), and 0 (0/20), respectively. The incidence of cerebral infarction in all 60 patients was 45.00%(27/60, in those with unstable plaque or stable plaque was 53.06% (26/49) and 3.33% (1/30), respectively. Conclusion: Energy spectrum CTA could be used for detailed analysis on the components and types of carotid plaques. The more the lipid components of plaque, the worse its stability, and the higher the risk of cerebral infarction.

Observation on vulnerable coronary plaques in HIV-infected patients based on coronary CTA / 中国医学影像技术

Objective: To explore whether vulnerable coronary plaques in HIV-infected patients are different with those in non-HIV-infected ones, and to analyze the relative risk factors. Methods: A total of 167 HIV-infected patients (HIV-infected group) and 185 non-HIV-infected patients(non-HIV-infected group) who underwent coronary CTA (CCTA) were collected. Vulnerable plaques were defined as those with two or more high-risk morphological features. The type, location and incidence of vulnerable coronary plaques were analyzed and compared between 2 groups, and the risk factors of vulnerable coronary plaques in HIV-infected patients were analyzed. Results: There was no significant difference of baseline clinical data between the two groups. The most common types of vulnerable coronary plaques in 2 groups were both low attenuation plaques+positive remodeling, most located in the proximal segment of left anterior descending artery (segment 6). The incidence of vulnerable coronary plaques ≥1 coronary segments in HIV-infected patients was higher than that in non-HIV-infected patients (34.73% vs 24.32%,P<0.05). Vulnerable coronary plaques in HIV-infected patients were independently correlated with the duration of antiretroviral therapy (ART) drug (OR=1.29, 95%CI [1.04,1.59], P=0.02). Conclusion: The incidence of vulnerable coronary plaques in HIV-infected patients was higher than that in non-HIV-infected patients. ART drug may be an independent risk factor for coronary plaque vulnerability in HIV-infected patients.