Rationale and objectivesTo investigate alterations in the brain structure in patients with Crohn's disease in activity (CD-A) and in remission (CD-R) compared to healthy controls (HCs) and explore the relationship between gray matter volume (GMV) and psychological disorders.Materials and methodsA total of 127 CD patients (62 CD-A, 65 CD-R) and 92 healthy controls (HCs) were enrolled and analyzed in this study. The Crohn's disease activity index (CDAI) was used as the grouping criteria. Voxel-based morphometry (VBM) was applied to investigate gray matter volume (GMV), white matter volume (WMV) and global cerebrospinal fluid (CSF) volume alterations. Pearson correlation analysis was used to evaluate the relationships.ResultsThe CSF volume was negatively correlated with the disease duration in CD-R. Increased GMV of CD was observed in the parahippocampal gyrus, precentral gyrus, precuneous cortex, and subcallosal cortex, decreased was located in the occipital pole, precentral gyrus, inferior temporal gyrus, middle frontal gyrus, angular gyrus, frontal pole, lateral occipital cortex, and lingual gyrus. The GMV in the right temporal pole, left precuneous cortex, and left cingulate gyrus had a positive correlation with erythrocyte and hemoglobin in CD groups. The GMV in the right frontal pole, right postcentral gyrus, and left cingulate gyrus had a negative correlation with somatization in the CD groups. The GMV in the right temporal pole had a negative correlation with psychoticism and other in the CD groups. The GMV in the left cingulate gyrus was positive with bowel symptoms and systemic symptoms in the CD groups.ConclusionAlterations of GMV in CD-A and CD-R and associated correlation with psychological disorders may provide evidence for possible neuro-mechanisms of CD with psychological disorders.

Objective To assess the diagnostic value of spectral parameters in differentiating adrenal adenomas from metastases based on dual-layer detector spectral CT (DLSCT). Materials and methods Patients with adenomas or metastases who underwent enhanced DLSCT of the adrenals were enrolled. The CT values of virtual noncontrast images (CT VNC ), iodine density (ID) values, and Z-effective (Z-eff) values, the normalized iodine density (NID) values, slopes of spectral HU curves (s-SHC), and iodine-to-CT VNC ratios of the tumors were measured in each phase. Receiver operating characteristic (ROC) curves were used to compare the diagnostic values. Results Ninety-nine patients with 106 adrenal lesions (63 adenomas, 43 metastases) were included. In the venous phase, all spectral parameters were significantly different between adenomas and metastases (all p < 0.05). The combined spectral parameters showed a better diagnostic performance in the venous phase than in other phase (P < 0.05). The iodine-to-CT VNC value had a larger area under the ROC curve (AUC) than the other spectral parameters in the differential diagnosis of adenomas and metastases, with a diagnostic sensitivity and specificity of 74.4% and 91.9%, respectively. In the differential diagnosis of lipid-rich adenomas, lipid-poor adenomas and metastases, the CT VNC value and s-SHC value also had a larger AUC than the other spectral parameters, with a diagnostic sensitivity of 97.7%, 79.1% and specificity of 91.2%, 93.1%, respectively. Conclusion On DLSCT, the combined spectral parameters in the venous phase could help better distinguish adrenal adenomas from metastases. The iodine-to-CT VNC , CT VNC and s-SHC values had the highest AUC values in differentiating adenomas, lipid-rich adenomas and lipid-poor adenomas from metastases, respectively.

目的:探讨基于冠状动脉CT血管成像(CCTA)的人工智能(AI)软件在检出冠状动脉病变及评估其CAD-RADS分级中的价值.方法:回顾性分析2018年11月-2020年12月本院临床疑诊为冠心病且行CCTA和冠状动脉血管造影(ICA)检查的175例患者的病例资料.由AI软件及3位不同年资影像诊断医师基于CCTA图像分别进行CAD-RADS分级,以ICA为金标准,计算AI软件和不同年资医师对阻塞性冠脉病变(冠脉狭窄程度≥50％)的诊断效能.采用Kappa检验分别评价AI软件与高、中、低年资医师基于CCTA对冠脉病变CAD-RADS分级评估的一致性.结果:(1)AI及高、中、低年资诊断医师评估冠脉狭窄≥50％ 的A U C值分别为0.764、0.858、0.747和0.731.其中,在钙化积分≥400组,相应的A U C值分别为0.608、0.750、0.625和0.625;在钙化积分<400组,相应的A U C值分别为0.801、0.884、0.776和0.756.A I软件及各年资医师A U C值的差异无统计学意义(P>0.05).(2)AI软件与高年资医师基于CCTA的CAD-RADS分级一致性良好(Kappa值为0.677,P<0.001),与中、低年资医师的分级一致性中等(Kappa值分别为0.466和0.428;P值均<0.001).结论:AI系统对冠脉狭窄≥50％ 具有良好的诊断效能,兼具时间效率.AI软件基于CCTA的CAD-RADS分级与诊断医师之间具有良好的一致性,可在临床影像诊断工作中推广使用.

原发性小肠淋巴瘤(PSIL)是指原发于十二指肠、空肠和回肠黏膜下淋巴组织的恶性肿瘤,较少见,绝大多数为非霍奇金淋巴瘤.CT肠道成像对显示小肠淋巴瘤具有重要价值.充分认识该病的临床和影像学表现是正确诊断与鉴别诊断的基础.就PSIL的临床表现、CT肠道成像检查及其影像表现进行介绍,旨在提高对该病的诊断水平.

目的 定量评估体素内不相干运动-扩散加权成像(IVIM-DWI)参数在不同严重程度的早期急性胰腺炎(AP)中的改变及其应用价值.方法 连续性搜集2019年11月至2020年11月在本院诊疗、符合纳入和排除标准的早期AP患者共28例,所有患者均行IVIM-DWI序列扫描.根据MR严重指数(MRSI)将患者分为轻度急性胰腺炎(MAP)组(14例)、中度急性胰腺炎(MSAP)组(13例)和重度急性胰腺炎(SAP)(1例),分别测量MAP组和MSAP组患者的灌注分数(f)值、纯扩散系数(D)值和伪扩散系数(D*)值,比较上述参数在两组间的差异,采用受试者工作特征曲线(ROC)分析上述参数对两组AP的鉴别诊断效能,并采用Delong检验比较上述参数在轻、中度AP鉴别诊断效能之间的差异.采用Spearman等级相关性分析评价IVIM-DWI参数与AP的MRSI的相关性.结果 MAP 组的 f 值 18.73％(15.08％,27.86％)明显高于 MSAP 组 13.17％(11.99％,15.47％)(P=0.003),两组间D值、D*值无明显差异(P均＞0.05).ROC曲线和Delong检验显示,f值对鉴别MAP与MSAP的效能较好,曲线下面积(AUC)为0.841;D值和D*值对鉴别两组AP的效能较低,AUC分别为0.588和0.536.f值与AP MRSI呈负相关(r=-0.684,P＜0.001).结论 IVIM-DWI定量参数中,灌注分数f值能较好地鉴别MAP与MSAP,且与AP的严重程度呈负相关,在定量评估早期AP方面有一定的应用价值.

目的 评价CT增强扫描及血管后处理技术对肺隔离症的诊断价值.方法 回顾分析40例经影像学检查诊断为肺隔离症患者的资料,对异常供血血管进行后处理重建.结果 40例患者中26例行CT增强扫描,14例行CT血管成像检查,其中18例经外科手术证实(17例为叶内型肺隔离症,1例为叶外型肺隔离症).40例中,39例病灶位于肺下叶,1例位于左肺上叶舌段;27例异常供血动脉起自胸主动脉,6例起自腹主动脉,6例起自腹腔干动脉,1例由主动脉及肺动脉双重供血;异常供血动脉血管管径＜2 mm组1例(2.5％),2～5 mm组24例(60.0％),5～10 mm组9例(22.5％),＞10 mm组6例(15.0％);MIP后处理技术可清晰显示肺隔离症的供血动脉,异常供血动脉血管管径＜5 mm组以MIP技术显示更佳,＞10 mm组VR技术显示效果较好,5～10 mm组二者差异不大.结论 CT增强扫描及血管成像后处理技术的多元运用能清晰显示病灶与肺组织的关系及其内异常供血动脉,对肺隔离症的诊断及相关治疗方式的制定具有重要的临床提示价值.

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignant tumor with rapid progression and poor prognosis. In the present study, 11 high‑quality microarray datasets, comprising 334 tumor samples and 151 non‑tumor samples from the Gene Expression Omnibus, were screened, and integrative meta‑analysis of expression data was used to identify gene signatures that differentiate between PDAC and normal pancreatic tissues. Following the identification of differentially expressed genes (DEGs), two‑way hierarchical clustering analysis was performed for all DEGs using the gplots package in R software. Hub genes were then determined through protein‑protein interaction network analysis using NetworkAnalyst. In addition, functional annotation and pathway enrichment analyses of all DEGs were conducted in the Database for Annotation, Visualization, and Integrated Discovery. The expression levels and Kaplan‑Meier analysis of the top 10 upregulated and downregulated genes were verified in The Cancer Genome Atlas. A total of 1,587 DEGs, including 1,004 upregulated and 583 downregulated genes, were obtained by comparing PDAC with normal tissues. Of these, hematological and neurological expressed 1, integrin subunit α2 (ITGA2) and S100 calcium‑binding protein A6 (S100A6) were the top upregulated genes, and kinesin family member 1A, Dymeclin and β‑secretase 1 were the top downregulated genes. Reverse transcription‑quantitative PCR was performed to examine the expression levels of S100A6, KRT19 and GNG7, and the results suggested that S100A6 was significantly upregulated in PDAC compared with normal pancreatic tissues. ITGA2 overexpression was significantly associated with shorter overall survival times, whereas family with sequence similarity 46 member C overexpression was strongly associated with longer overall survival times. In addition, network‑based meta‑analysis confirmed growth factor receptor‑bound protein 2 and histone deacetylase 5 as pivotal hub genes in PDAC compared with normal tissue. In conclusion, the results of the present meta‑analysis identified PDAC‑related gene signatures, providing new perspectives and potential targets for PDAC diagnosis and treatment.

Objective ToevaluateimagequalityoflowerextremityCTAoflowradiationdoseandlowcontrastmediumprotocol withsinogram-affirmediterativereconstruction(SAFIRE).Methods Thisstudyincluded116patientswhoreferredtolowerextremityCT angiographyusinga128-sliceCTscanner.Accordingtovoltageandcontrastmediumconcentration,patientsweredividedintofour groups:100kV+350mgI/mL,100kV+320mgI/mL,100kV+300mgI/mL,80kV+CarekV+300mgI/mL.Imagereconstructionunderwent conventionalfilteredback-projection (FBP)andSAFIREtechniqueineachprotocoltocompareSNR,CNRofarterialimages.Results Comparisonoftwosubgroupsinthesamegroup,SAFIREhadsignificantlyhigherimagequalitythanFBP.Comparisonamong groupsshowed:imagequalityinlowcontrastmediumandlowradiationdoseSAFIREgroupcouldreachsimilarorbetterthanthatin higherdoseFBPgroup.SAFIREcouldreduceimagenoiseandimproveimageSNRandCNR.Conclusion InlowerextremityCTA, 80kV+CarekV,300mgI/mLcontrastmediumwithSAFIREexamineprotocolcouldreducecontrastmediumconcentrationandradiationdose withnocompromiseddiagnosticdemand.

Objective:To analyse the morphology and resilience of upper airway in patients with OSAHS using 128-slice MSCT. Method:CT imaging of the upper airway in 49 patients with OSAHS was acquired in two respiratory status (quiet respiration and Müller maneuver). The two-dimensional measurements of retropalatal and retroglossal regions, airway volume, and airway resilience were measured in patients with severe OSAHS and non-severe OSAHS. And the results were compared between those two groups. Result:① The following measurements during Müller maneuver were smaller than those during quiet respiration: the smallest cross section area of retropalatal and retroglossal region, the anteroposterior diameters(AP) and lateral diameters(L) of retropalatal region, L of retroglossal region, volume and average volume of upper airway and retropalatal area（P<0.01）.②The pharyngeal wall resilience of retropalata region was larger than those of retroglossal region in patients with severe OSAHS. The total resilience of retropalatal was larger than that of retroglossal region in patients with non-severe OSAHS. The pharyngeal wall resilience between severe and non-severe OSAHS had no significant difference. ③ L of retropalatal and retroglossal region, and average area of retropalatal region, were smaller in patients with severe OSAHS than those with non-severe OSAHS during Müller maneuver（P<0.05）.④ The cross-section of upper airway tend to be horizontal oval in retropalatal regions, and vertical oval in retroglossal regions. Conclusion:128-slice MSCT scan can achieve both positioning and quantitative analysis of the morphology and resilience changes of the upper airway in patients with OSAHS.

Purpose To evaluate the diagnostic performance of left coronary bifurcation angles and plaque characteristics for prediction of coronary stenosis by dual-source CT. Methods 106 patients suspected of coronary artery disease undergoing both coronary computed tomography angiography (CCTA) and invasive coronary angiography (CAG) within three months were included. Left coronary bifurcation angles including the angles between the left anterior descending artery and left circumflex artery (LAD-LCx), left main coronary artery and left anterior descending artery (LM-LAD), left main coronary artery and left circumflex artery (LM-LCx) were measured on CT images. CCTA plaque parameters were calculated by plaque analysis software. Coronary stenosis ≥ 50% by CAG was defined as significant. Results 106 patients with 318 left coronary bifurcation angles and 126 vessels were analyzed. The bifurcation angle of LAD-LCx was significantly larger in left coronary stenosis ≥ 50% than stenosis < 50%, and significantly wider in the non-calcified plaque group than calcified. Multivariable analyses showed the bifurcation angle of LAD-LCx was an independent predictor for significant left coronary stenosis (OR = 1.423, P = 0.002). In ROC curve analysis, LAD-LCx predicted significant left coronary stenosis with a sensitivity of 66.7%, specificity of 78.4%, positive predictive value of 85.2% and negative predictive value of 55.8%. The lipid plaque volume improved the diagnostic performance of CCTA diameter stenosis (AUC: 0.854 vs. 0.900, P = 0.045) in significant coronary stenosis. Conclusions The bifurcation angle of LAD-LCx could predict significant left coronary stenosis. Wider LAD-LCx is related to non-calcified lesions. Lipid plaque volume could improve the diagnostic performance of CCTA for coronary stenosis prediction.

目的 初步评估不同狭窄程度左前降支腔内强化梯度与相应冠状动脉供血区心肌首过灌注表现及其相关性.方法 搜集CT冠状动脉成像诊断前降支狭窄病例52例(狭窄＜50％组及狭窄≥50％组)与无狭窄病例20例(对照组),分别测量并计算前降支供血区心肌首过灌注值及其校正值、前降支腔内强化梯度及其校正值,进行统计学分析.结果 (1)狭窄组和对照组在收缩期、舒张期前降支腔内强化梯度校正值及供血区心肌首过灌注值差异均无统计学意义(均P ＞0.05);而首过灌注校正值差异均有统计学意义(均P＜0.05).(2)狭窄＜50％组、狭窄≥50％组和对照组三组间在收缩期、舒张期前降支腔内强化梯度校正值及供血区心肌首过灌注值差异均无统计学意义(均P＞0.05).(3)狭窄＜50％组和对照组在收缩期心肌首过灌注校正值差异无统计学意义(P＞0.05),在舒张期差异有统计学意义(P＜0.05);狭窄≥50％组与狭窄＜50％组、狭窄≥50％组与对照组在收缩期、舒张期心肌首过灌注校正值差异分别具有统计学意义(均P＜0.05).结论 心肌首过灌注校正值更能客观反映相应冠状动脉供血区的心肌血流灌注情况;腔内强化梯度校正值不能有效预测心肌缺血.

Objective To study the relationship between the occurrence of clinical symptoms and the type of intramural coronary artery in patients with myocardial bridges(MB).Methods A total of 185 patients with myocardial bridges,who had no coronary atherosclerosis or any abnormalities of heart,lung,mediastinum and pleura,were enrolled in this study.The patients were divided into symptomatic group and asymptomatic group.Their dual source CT coronary angiography data and the clinical materials were retrospectively analyzed.The length,depth and stenosis rate of the intramural coronary arteries were recorded,and the results were compared between the symptomatic and asymptomatic patients by using t test.The occurrence of the clinical symptoms was calculated,and the results were compared between the patients with complete MB and the patients with incomplete MB by using χ2test.Results Of the total 185 patients,92 had symptoms and 93 had no symptoms.Incomplete myocardial bridges were found in 118 patients,while complete myocardial bridges were seen in 67 patients.The average length and depth of intramural coronary arteries in the symptomatic group and asymptomatic group were(2.19 ± 1.11) cm vs(1.93 ± 0.90) cm,(0.20 ± 0.08) cm vs(0.24 ± 0.19) cm,and no significant differences in length and depth of intramural coronary artery existed between the two groups(t = 1.709,P = 0.089 and t =-1.048,P = 0.298,respectively).The stenosis rate of intramural coronary arteries in the symptomatic group and asymptomatic group were(23.8 ± 15.5) % and(13.1 ± 11.0) % respectively,and the difference between the two groups was statistically significant(t = 5.447,P = 0.000).The occurrence of the clinical symptoms in the symptomatic group and asymptomatic group was 61.2%(41 /67) and 43.2%(51 /118) respectively,the difference was significant(χ2= 5.522,P = 0.019).The occurrence of symptoms was highest when the stenosis existed in both systolic phase and diastolic phase.Conclusion In patients who have complete myocardial bridges and /or have narrowed intramural coronary artery in diastolic phase,the clinical symptoms are more liable to occur.

Objective To investigate first-pass myocardial perfusion in normal coronary segments during the cardiac cycle using contrast-enhanced dual-source CT (DSCT) scanning.Methods A total of 45 health screening individuals were enrolled in this study.The patients included 25 males and 20 females with a mean age of 62 ± 10.5 years old and had no coronary artery disease.Dual-source CT coronary angiography was performed in all patients.Images of left ventricle in optimal diastole and systole phase were reconstructed.According to 17-segment method,CT values of each segment in sub-endocardial area were automatically measured,which were used as estimation of myocardial perfusion.The variation among segments and during cardiac cycle was analyzed by using t test.Results A total of 744 segments in 45 cases were measured.Systolic perfusion score was significantly lower than diastolic perfusion score for each segment (P≤0.001) except several basal segments and cardiac apex.The sub-endocardial perfusion score in anterior,inferior and apex was lower than that in septal and lateral segments either in diastole phase or systole phase (P≤0.01).Conclusion DSCT can be used to qualitatively evaluate the sub-endocardial perfusion pattern at both systolic and diastolic phases,which is very helpful in detecting cardiac ischemia.

Objective To assess the value of CT coronary angiography(CTCA) in diagnosing myocardial bridges,and compared with invasive coronary angiography(CAG).Methods A total of 83 cases(male 58,female 25;mean age 63 years) who received both dual-source CT coronary angiography and CAG exam were reviewed retrospectively for myocardial bridges.CTCA and CAG images were analyzed by two cardiovascular and interventional radiologists who did not know the results of CTCA and CAG.Calculate the detection rate of myocardial bridges diagnosed in CTCA and CAG and compared the difference using χ2 test.Results CTCA detected 41 cases and a total of 48 myocardial bridges,the rate were 49.4%(41/83).CAG revealed 19 patients and a total of 19 myocardial bridges which were the same as that detected in CTCA examination,the detection rate was 22.9%(19/83).Compared the difference of detection rate between CTCA and CAG,there were significant difference(χ2=12.633,P 0.001).Conclusion CT coronary angiography can display the anatomy relationship between coronary artery and myocardium directly and non-invasive,which is better than CAG.

Objective:To study the dynamic contrast-enhanced CT findings of hepatic veno-occlusive disease(HVOD) and evaluate its usefullness in diagnosis of this disorder by using multi-slice spiral CT.Methods:Twelve patients with pathologically and clinically confirmed HVOD were recruited.All CT images were reviewed and the imaging features of the disease were summarized.Results:On plain CT scan,the liver volume increased and the parenchyma appeared localized or diffuse hypodense in 12 patients.On hepatic arteral phase scans,the widening of the common hepatic artery and its main branches in association with disordered reticular intrahepatic vessels were found in 10 patients,and in 2 of the 10 cases,the hypodense parenchyma showed no abnormal enhancement compared with the unenhanced phase.On portal venous phase,hepatic parenchyma demonstrated pathy or map-like heterogeneous enhancement in 9 patients,no intrahepatic venule was noted,while the hepatic inferior vena cava of 5 in the 9 cases manifested comma-shaped,and the other 4 presented narrowed lumen like short strip.No visible distal dilatation or collateral formation was observed.The major hepatic veins,with obviously small diameter,were slightly opacified in only 3 patients.On hepatic parenchymal phase,the imaging findings of liver were similar to those on portal venous phase.Conclusion:HVOD has characteristic features on multi-slice spiral CT scans.Combined with clinical manifestations and history,CT can improve the diagnosis rate of the disease.

目的：通过双源CT（dual-source computed tomography，DSCT）心肌灌注扫描观察心肌缺血再灌注及无复流动物模型的CT表现，初步探讨其与心肌活性的关系。方法：通过介入手段堵塞犬前降支中远段，建立犬心肌缺血再灌注及无复流模型（n=6），采用DSCT进行首过加多期延迟心肌灌注扫描，观察梗塞区CT表现，完成检查后取犬心脏标本行氯化三苯基四氮唑(TTC)染色及HE染色，与DSCT检查结果进行对照。结果：4只犬完成模型建立，DSCT扫描均可见心肌梗塞区CT值较对侧正常心肌减低，且首过及多期延迟扫描呈固定灌注减低表现，TTC染色显示梗塞区与之相符，HE染色可见梗塞区心肌广泛溶解坏死。结论：DSCT可以较好的在快心率状态下显示心肌，心肌灌注扫描显示固定灌注减低可能与心肌广泛坏死有关。

目的 采用球囊导管阻断犬冠状动脉左前降支血流，并在恢复灌注后采用明胶海绵微粒制作冠脉再灌注无复流模型，为进一步的影像学研究奠定基础。 方法 18只实验杂种犬，体重10~15kg，随机分为3组，全麻后采用Seldinger技术穿刺右股动脉，将导管插至左冠状动脉，其中2组动物均在球囊阻断90min再灌注15min后分别注入丝线段和明胶海绵微粒，对照组仅进行球囊阻断90min，恢复灌注。行血管造影和心肌酶检查评价冠状动脉栓塞情况，3～4小时后行组织学检查验证心肌梗死。 结果 血管造影检查提示，明胶海绵微粒栓塞组实验动物可见左前降支前向血流显著减慢，或造影剂滞留；丝线段栓塞组所有实验动物左前降支远端无前向血流，其中丝线段组有2只实验动物旋支受累。明胶海绵栓塞组3只动物死亡。组织学检查提示，明胶海绵微粒栓塞组及丝线段栓塞组所有实验动物于心尖区观察到心肌梗死表现，对照组无一例观察到心肌梗死。 结论 明胶海绵微粒栓塞相对于普通丝线段栓塞，制作的心肌梗死动物模型可能发生在微循环水平，可部分模拟冠脉无复流现象，且可控性及重复性好，是用于制备心肌梗死动物模型的较好栓塞材料。