Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)-derived fractional flow reserve(CT-FFR)for long term outcomes.We examined the long-term prognostic value of CT-FFR combined with CCTA-defined atherosclerotic extent in diabetic patients with coronary artery disease(CAD). Methods A retrospective pooled analysis of individual patient data was performed.Deep-learning-based vessel-specific CT-FFR was calculated.All patients enrolled were followed-up for at least 5 years.Predictive abilities for major adverse cardiac events(MACE)were compared among three models(model 1,constructed using clinical variables;model 2,model 1+CCTA-de-rived atherosclerotic extent(Leiden risk score);and model 3,model 2+CT-FFR. Results A total of 480 diabetic patients[median age,61(55-66)years;52.9%men]were included.During a median follow-up time of 2197(2126-2355)days,55 patients(11.5%)experienced MACE.In multivariate-adjusted Cox models,Leiden risk score(HR:1.06;95%CI:1.01-1.11;P=0.013)and CT-FFR≤0.80(HR:6.54;95%CI:3.18-13.45;P<0.001)were the independent predict-ors.The discriminant ability was higher in model 2 than in model 1(C-index,0.75 vs.0.63;P<0.001)and was further promoted by adding CT-FFR to model 3(C-index,0.81 vs.0.75;P=0.002).Net reclassification improvement(NRI)was 0.19(P=0.009)for model 2 beyond model 1.Of note,adding CT-FFR to model 3 also exhibited significantly improved reclassification compared with model 2(NRI=0.14;P=0.011). Conclusion In diabetic patients with CAD,CT-FFR provides robust and incremental prognostic information for predicting long-term outcomes.The combined model exhibits improved prediction abilities,which is beneficial for risk stratification.

BACKGROUND:Prior studies provided limited data regarding natural history of initially medically treated type A intramural hematoma (IMH). OBJECTIVES:To develop predictive models for adverse aorta-related events in patients with type A IMH. METHODS:We performed a retrospective pooled analysis of individual patient data, including baseline clinical and CT characteristics. All patients enrolled were followed up for adverse aorta-related events, defined as a composite of aortic disease-related death and the presence of aortic complications that required aortic invasive treatment. RESULTS:A total of 172 patients (52.9% men) were included, with a mean age of 61.1 ± 11.2 years. During a median follow-up time of 770.5 (45.3-1695.8) days, 60 patients (34.9%) experienced adverse aorta-related events. In Cox regression model for predicting adverse aorta-related events, hypertension (HR = 3.78, p = .067), MAD (HR = 1.05, p = .018), presence of ULP (HR = 2.43, p = .002) and pericardial effusion (HR = 1.65, p = .061) were independently associated with adverse aorta-related events. A majority of the adverse aorta-related events (n = 46, 76.7%) occurred within acute and subacute phase (90 days) of IMH. In predictive model for 90 days aortic events, MAD≥50.7 mm (OR = 2.79, p = .006) and presence of ULP (OR = 3.20, p = .002) were independent predictors. C statistic of the predictive model were 0.71 (p < .001). CONCLUSIONS:Predictive models including baseline clinical and CT characteristics as predictors allow for accurate estimation of risk of adverse aorta-related events in patients with type A IMH. The proposed predictive models are helpful for risk estimates and decision making.

Background::Diabetes mellitus (DM) is considered a cardiovascular risk factor. The aim of this study was to analyze the prevalence and volume of coronary artery plaque in patients with diabetes mellitus (DM) vs. those without DM. Methods::This study recruited consecutive patients who underwent coronary computed tomography (CT) angiography (CCTA) between October 2016 and November 2017. Personal information including conventional cardiovascular risk factors was collected. Plaque phenotypes were automatically calculated for volume of different component. The volume of different plaque was compared between DM patients and those without DM.Results::Among 6381 patients, 931 (14.59%) were diagnosed with DM. The prevalence of plaque in DM subjects was higher compared with nondiabetic group significantly (48.34% vs. 33.01%, χ2 = 81.84, P < 0.001). DM was a significant risk factor for the prevalence of plaque in a multivariate model (odds ratio [OR] = 1.465, 95% CI: 1.258-1.706, P < 0.001). The volume of total plaque and any plaque subtypes in the DM subjects was greater than those in nondiabetic patients significantly ( P < 0.001). Conclusion::The coronary artery atherosclerotic plaques were significantly higher in diabetic patients than those in non-diabetic patients.

Objective:To explore risk factors of death in type A intramural hematoma (IMH) patients with conservative therapy and provide important information for clinical risks stratification and decisions-making.Methods:This retrospectively study enrolled 130 patients diagnosed with type A IMH in the first CT examination at Fuwai Hospital of Chinese Academy of Medical Sciences and only received conservative therapy between September 2009 and June 2018. Baseline clinical and CT characteristics were recorded. All patients enrolled were followed up. The endpoint was aortic disease-related death, patients were divided into endpoint group and non-endpoint group according to whether or not an endpoint event occurs. Difference between two groups of normally distributed continuous variables, non-normally distributed continuous variables and categorical variables were tested by independent sample t test, Mann-Whitney U test and chi-square test or Fisher′s exact test, respectively. Independent risk factors related to outcomes were assessed with Cox regression analysis and survival analysis. Results:In baseline CT data, the mean value of the maximum aortic diameter (MAD) was (49.2±6.9) mm, and the median value of the maximum hematoma thickness (MTH) was 11.0 (8.5, 13.2) mm. There were 56 and 30 patients with ulcer-like projection (ULP) and intramural blood pool (IBP), respectively, which including 36 patients with ULP of ascending aorta, 51 patients with pericardial effusion and 50 patients with pleural effusion. During a median follow-up time of 1 050 (242, 1 949) days, 26 patients experienced aortic disease-related death. Compared with non-endpoint group patients, patients who experienced aortic disease-related death showed older age and larger MAD( t=2.363, 3.640, P=0.020,<0.001), higher proportion of aortic atherosclerosis, ULP and pericardial effusion (χ 2=5.275, 6.596, 9.325, P=0.022, 0.010, 0.002).In Cox regression multivariate analysis shows that aortic atherosclerosis [hazard ratio (HR)=3.48, P=0.043], ULP (HR=2.66, P=0.019) and pericardial effusion (HR=2.49, P=0.030) were independent risk factors for aortic disease-related death. Conclusions:Aortic atherosclerosis, ULP and pericardial effusion are independent predictors of subsequent aortic disease-related death for type A IMH patients with conservative therapy, identifying these risk factors is helpful for further risk stratification and decisions-making.

目的 回顾初次和复查CT表现,探究其对初始接受保守治疗的A型主动脉壁内血肿(IMH)患者的预后价值.方法 连续入选2009年9月～2018年6月于本院确诊为A型IMH并至少进行过一次CT复查的患者103例,收集患者的临床和影像资料并进行随访,随访终点为主动脉相关不良事件,建立主动脉相关不良事件的预测模型并对随访结果作生存分析.结果 中位复查时间为14 d(8～37 d),中位随访时间为482 d(28～1600 d),随访期间有52例(50.5％)患者发生终点事件.初次检查资料中的高脂血症(OR=3.85,P=0.004)、最大管径(MAD)≥50 mm(OR=3.14,P=0.020)和内膜破裂(OR=3.08,P=0.015)以及复查资料中的最大血肿厚度(MTH)增加(OR=1.32,P<0.001)是主动脉相关不良事件的独立危险因素,联合预测模型(AUC=0.85)的诊断效能优于简单预测模型(AUC=0.72).此外,有高脂血症、内膜破裂和MTH增加的患者无事件生存率更低.结论 对于初始进行药物治疗的A型IMH患者,初次CT联合复查CT对预测主动脉相关不良事件有极为重要的价值,定期影像复查能为临床治疗决策提供更多的帮助.

Being overweight and obese are strongly associated with cardiovascular disease. 1 Snijder M.B. van Dam R.M. Visser M. Seidell J.C. What aspects of body fat are particularly hazardous and how do we measure them?. Int J Epidemiol. 2006; 35: 83-92 Crossref PubMed Scopus (398) Google Scholar Several different anthropometrical measurements are used in the clinical setting to predict disease risk in relation to overweight and obesity. Body mass index (BMI) is well known and frequently used, both in clinical practice and in the health and fitness industry. 2 WHO Expert Consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363: 157-163 Abstract Full Text Full Text PDF PubMed Scopus (7948) Google Scholar However, BMI is a measure of general adiposity which does not distinguish between central and general obesity. Prospective epidemiological studies have revealed that central obesity was more relevant to CAD risk compared to general obesity. 3 Pischon T. Boeing H. Hoffmann K. et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008; 359: 2105-2120 Crossref PubMed Scopus (1526) Google Scholar Waist-to-height ratio (WHR) was suggested in the mid-1990s as an anthropometric measurement that may improve on BMI because it was used commonly to evaluate central obesity. 4 Browning L.M. Hsieh S.D. Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev. 2010; 23: 247-269 Crossref PubMed Scopus (842) Google Scholar However, there was little data available about whether WHR was better than BMI as a predictive indicator of coronary artery disease (CAD) in large cohort.

Rationale and Objectives: We sought to compare the prevalence and volume of lipid plaque, fibrous plaque, and calcified plaque in patients with smokers versus nonsmokers. Materials and Methods: We studied consecutive patients suspected of coronary artery disease and who underwent coronary computed tomography angiography. A structured interview and review of existing clinical data was conducted before computed tomography angiography to collect information on demographic characteristics, the presence of cardiovascular risk factors. The volume of lipid, fibrous, and calcified plaque were automatically calculated and marked in different colors according to predefined Hounsfield unit thresholds. The prevalence and volume of plaques were compared between smokers and nonsmokers. Results: Overall 6380 patients (3351 men and 3029 women, mean age 55.35 years) were finally analyzed, of whom 2075 (32.5%) were smokers, and 4305 (67.5%) were never smokers. The prevalence of any plaque in smokers was significantly higher compared to never smokers (47.7% vs. 32.3%, p < 0.001). Smoking was an independent risk factor of the presence of any plaque after correcting for age, gender, body mass index, hypertension, dyslipidemia, diabetes, and family history in a multivariate model (odds ratio = 1.250 (1.088-1.437), p = 0.002). The volume of lipid plaque, fibrous plaque, calcified plaque, and total plaque in smokers was significantly greater than nonsmokers (p < 0.001). Conclusion: The prevalence and volume of lipid plaque, fibrous plaque, and calcified plaque were significantly higher in smokers versus never smokers.

BackgroundIdentifying disease activity in Takayasu arteritis (TAK) is challenging. This study aimed to investigate the value of quantitative characterization with computed tomography angiography in the assessment of disease activity in patients with TAK.MethodsWe retrospectively analysed the data on 162 aortic CT angiography from 140 TAK patients. Patients were categorized based on disease activity according to the National Institutes of Health criteria into two groups: active disease group (n = 65) and inactive disease group (n = 97).ResultsPatients with active TAK had a thicker wall compared with patients with inactive TAK (5.2 ± 2.4 mm vs. 2.5 ± 0.8 mm, p < 0.001). The relative post-contrast enhancement ratio of the thickened wall was higher in active TAK than in inactive TAK (1.5 ± 0.3 vs. 1.1 ± 0.2, p < 0.001). Given a thickness cutoff of 3.3 mm, sensitivity for active-phase TAK was 83.1%, specificity 89.7%, positive predictive value 84.4%, and negative predictive value 88.8%. With a relative post-contrast enhancement ratio cutoff of 1.2, sensitivity for active-phase TAK was 89.2%, specificity 76.3%, positive predictive value 71.6%, and negative predictive value 91.3%. In receiver-operating characteristic curves comparison, maximal wall thickness and relative post-contrast enhancement ratio were superior to C-reactive protein and erythrocyte sedimentation rate for determining active phase disease (p < 0.05).ConclusionsQuantitative characterization with CT angiography was a useful tool to assess disease activity in TAK patients. Maximal wall thickness and relative post-contrast enhancement ratio have a high sensitivity and specificity for detecting TAK activity.

Deep learning is a growing trend in medical image analysis. There are limited data of deep learning techniques applied in Chest X-rays. This paper proposed a deep learning algorithm for cardiothoracic ratio (CTR) calculation in chest X-rays. A fully convolutional neural network was employed to segment chest X-ray images and calculate CTR. CTR values derived from the deep learning model were compared with the reference standard using Bland-Altman analysis and linear correlation graphs, and intra-class correlation (ICC) analyses. Diagnostic performance of the model for the detection of heart enlargement was assessed and compared with other deep learning methods and radiologists. CTR values derived from the deep learning method showed excellent agreement with the reference standard, with mean difference 0.0004 ± 0.0133, 95% limits of agreement -0.0256 to 0.0264. Correlation coefficient between deep learning and reference standard was 0.965 (P <; 0.001), and ICC coefficient was 0.982 (95% CI 0.978-0.985) (P <; 0.001). Measurement time by deep learning was significantly less than that of the manual method [0.69 (0.69-0.70) VS 25.26 (23.49-27.44) seconds, P <; 0.001]. Diagnostic accuracy, specificity, and positive predictive value were comparable between the two methods. However, deep learning showed relatively higher sensitivity and negative predictive value (97.2% vs 91.4%, P = 0.004; and 96.0% vs 89.0%, P = 0.006; respectively) compared with the manual method. Performance of this computer-aided technique was demonstrated to be more reliable, time and labor saving than that of the manual method in CTR calculation.

To investigate prognostic significance of follow-up CT findings for initially medically treated type B aortic intramural hematoma (IMH). We performed a retrospective pooled analysis of individual patient data, including baseline and follow-up CT characteristics. All enrolled patients were followed up for adverse aorta-related events, defined as a composite of aortic disease–related death and surgical or endovascular aortic repair. A total of 238 patients (73.9% men) were included, with a mean age of 58.1 ± 9.8 years. During follow-up, 83 patients (34.9%) experienced adverse aorta-related events, most of the events (83.1%) occurred within 1 month after follow-up CT imaging (n = 69). In the Cox regression model for predicting adverse aorta-related events, baseline maximal aortic diameter (MAD) (HR = 1.05, p = 0.008), ulcer-like projection (ULP) (HR = 2.47, p < 0.001), changes of maximal hematoma thickness (MHT) (HR = 1.22, p < 0.001), newly developed ULP (HR = 4.44, p < 0.001), and newly developed pleural effusion (HR = 2.46, p = 0.002) were powerful independent predictors. In combined predictive model for 1-month aortic events, baseline MHT ≥ 11.8 mm (OR = 4.39, p = 0.001), ULP (OR = 3.98, p < 0.001), changes of MHT (OR = 1.46, p < 0.001), newly developed ULP (OR = 9.27, p = 0.002), and newly developed pleural effusion (OR = 3.45, p = 0.015) were independent predictors. Besides, in patients with pleural effusion at baseline, resorption of pleural effusion was associated with adverse aorta-related events (HR = 0.36, p = 0.027) and 1-month aortic events (OR = 0.23, p = 0.026). Follow-up CT findings provide strong and incremental prognostic information for initially medically treated type B IMH, which are helpful for risk estimates and decisions-making. • Follow-up CT provides strong and incremental prognostic information for initially medically treated type B aortic intramural hematoma. • Follow-up CT is highly recommended for type B intramural hematoma in patients who did not receive urgent invasive therapy. • Follow-up CT is helpful for risk estimates and decisions-making.

The management of stable coronary artery disease guideline recommends clinical risk assessment for estimating pretest probability of disease using Bayesian reasoning as a key initial step in the evaluation of patients with suspected coronary artery disease (CAD) ([1][1]). However, the diagnostic

BACKGROUND:To compare the difference of coronary diameter stenosis by quantitative analysis of CT angiography (QCT) in the systolic (QCT-S) and diastolic phase (QCT-D) of the cardiac cycle, with invasive catheter angiography (QCA) as reference standard. METHODS:A total of 109 patients (57.5 ± 10.6 years, 78.9% male) with suspected coronary artery disease (CAD) who underwent both CT angiography and invasive catheter angiography were retrospectively included in this study. Coronary diameter stenoses in systolic and diastolic coronary CTA reconstructions were compared with QCA. RESULTS:Mean time interval between CT angiography and invasive angiography was 17.4 ± 4.4 days. QCT-D overestimated coronary diameter stenosis by 5.7%-8.5% while QCT-S overestimated coronary diameter stenosis by 9.4%-11.9% (p < 0.05). In calcified lesions, QCT-D overestimated coronary diameter stenosis by 13.2 ± 4.3%, while QCT-S overestimated by stenosis by 16.6 ± 4.3% (p < 0.05). CONCLUSIONS:Coronary diameter stenosis was overestimated by QCT-D as well as QCT-S, respectively, when compared with QCA. Overestimation was more pronounced in calcified lesions.

Objective To assess effects of stress dynamic CT myocardial perfusion imaging (CT-MPI) combined with coronary CT angiography (CCTA) on the diagnosis of myocardial perfusion defects in coronary artery disease (CAD). Methods Patients with CAD diagnosed by CCTA underwent ATP stress CT-MPI examination. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (SPECT-MPI) was performed within one week and set as the reference standard. CT-MPI results were qualitatively analyzed, and myocardial blood flow (MBF), myocardial blood volume (MBV) as well as time to peak (TTP) were quantified according to CT-MPI. Effects of CCTA, CT-MPI, and CT-MPI combined with CCTA on predicting myocardial perfusion defects were assessed in comparison with NMPI. Results Thirty patients [(54.8±8.4)years] were enrolled in our study, 20 were men (68%). MBF [(79.3±18.0) versus (135.1± 35.2) ml·100 ml-1·min-1] and MBV [(8.9±2.9) versus (13.8±8.9) ml/100 ml] were significantly decreased in hypoperfused segments compared with normal segments, while TTP was increased in hypoperfused segments [(13.9 ± 2.5)s] compared with normal segments [(9.1 ± 2.1)s] (t=0.302, 0.866 and 0.024 respectively, all P values<0.01). The sensitivity, specificity of CT-MPI for identifying segments with perfusion defects were 91.3%(147/161), 84.6%(281/332), respectively. On a per-vessel basis, the area under the receiver operating characteristic curve for predicting myocardial perfusion defects were 0.635(95%CI:0.517—0.753) for CCTA, 0.709(95%CI:0.599—0.819)for CT-MPI, and 0.837(95%CI:0.749—0.925)for CT-MPI combined with CCTA, respectively. Conclusions The performance of stress dynamic CT-MPI in the diagnosis of myocardial perfusion defects in CAD was good. One-stop examination of CT-MPI combined with CCTA improves the diagnostic accuracy for identifying flow-obstructing stenosis.

Background There are limited data assessing statin therapy in patients with nonobstructive coronary plaque on coronary computed tomography angiography (CCTA).Methods Two hundred six consecutive patients with mild noncalcified plaque on CCTA were enrolled in this multicenter prospective observational study. Subjects were divided into 3 groups according to subsequent statin therapy: intensive statin therapy (n = 55), moderate statins (n = 85), and no statin (n = 66). Serial scans were performed after a median interval of 18 months. Low-attenuation plaque (LAP) volume, total plaque volume, and percent plaque volume were measured.Results The LAP volume, total plaque volume, and percent plaque volume showed significant regression among intensive-statin compared with no-statin group (annualized changes: -7.1 +/- 13.1 vs 0.9 +/- 12.7 mm(3), P<.001; -16.4 +/- 35.0 vs 12.3 +/- 32.4 mm3, P<.001; and -6.2% +/- 11.8% vs 3.5% +/- 12.1%, P<.001, respectively). Progression of LAP volume, total plaque volume, and percent plaque volume was retarded among moderate-statin compared with no-statin group (annualized changes: -2.8 +/- 7.6 vs 0.9 +/- 12.7 mm(3), P=.041; -0.1 +/- 25.6 vs 12.3 +/- 32.4 mm(3), P=.014; and -1.8% +/- 11.2% vs 3.5% +/- 12.1%, P=.006, respectively). On multivariable model predicting change in total plaque volume, higher baseline LAP volume, moderate statin therapy, and intensive statin therapy were each independent predictors of plaque regression (standardized coefficients: baseline LAP volume -0.36, P<.001; moderate statin -0.21, P=.004; intensive statin -0.36, P<.001, respectively).Conclusions This study suggests that statin treatment can retard progression and even induce regression of mild noncalcified coronary plaque. Patients with greater baseline LAP volume are more likely to benefit from statin therapy.

目的：探讨CT冠状动脉成像（CCTA）半自动化测量软件检测非钙化斑块的可重复性。方法连续入选初次CCTA结果为单支局限性非钙化为主斑块病变的患者。由两名医师分别测量斑块，其中一名医师于不同时间再次测量斑块。配对样本 t 检验用于读者内和读者间斑块测量数据的比较。用Pearson相关分析和Bland-Altman检验探讨读者内及读者间测量结果的相关性和一致性。结果研究共纳入62例患者。读者内两次测量斑块体积的均数为（78.1±46.7）mm3，差值的均数为（0.1±3.2）mm3，95%一致性界限为－6.2～6.4 mm3，两次测量结果的相关系数为0.998（P＜0.001）。读者间测量斑块体积的均数为（78.0±47.2）mm3，差值的均数为（0.9±4.8）mm3，95%一致性界限为－8.5～10.3 mm3，两者测量结果的相关系数为0.995（P＜0.001）。读者内两次测量斑块体积百分比的均数为（45.1±12.1）%，差值的均数为－（0.3±2.2）%，95%一致性界限为－4.6%～4.0%，两次测量结果的相关系数为0.984（ P＜0.001）。读者间测量斑块体积百分比的均数为（45.4±12.1）%，差值的均数为－（0.4±2.3）%，95%一致性界限为－4.9%～4.1%，两者测量结果的相关系数为0.982（P＜0.001）。结论 CCTA半自动化测量软件检测非钙化斑块的可重复性好，可用于检测斑块负荷和评价药物干预斑块进展等研究。

Several studies had demonstrated that there is an association between neutrophil to lymphocyte ratio (NLR) and the severity, non-calcified plaque burden and coronary artery calcium score of coronary atherosclerosis. Patients with non-calcified or mix plaques had a higher risk of adverse outcomes.

Bicuspid aortic valve (BAV) is a common congenital heart disease. Our study was to analyze clinical features of BAV and evaluate whether aortic valve calcium score (AVCS) was a reliable marker for aortic stenosis (AS) in patients with BAV. 101 patients with BAV who both underwent echocardiology and cardiac computed tomography (CT) scan in our institution were included. Basic clinical data, haemodynamic feature, aortic valve and coronary calcium score were collected and compared among patients with different valve function and different degree of AS. Risk factors related to severe AS were evaluated by logistic regression, and a receiver operative characteristic curve was used to determine the cutoff calcium score greater than which the diagnosis of severe AS was optimized. Patients with aortic regurgitation (AR) were younger and demonstrated larger aortic annulus and sinus compared with patients with other valve dysfunction. Aortic valve calcium score was higher in patients with AS than with AR. For patients with different degree of AS, there were statistical significances in the value of age, aortic valve calcium score and coronary calcium score. AVCS was positively related to severe AS with an odd ratio of 1.286 (95% CI 1.099-1.504) by every 300 points increase. AVCS was also a strong predictor for severe AS with area under the curve 0.855 with a cutoff value of 897 (sensitivity 86.7%, specificity 72.2%). Conclusively, aortic calcium score calculated by quantitative CT is a reliable marker in evaluating severity of AS.

OBJECTIVE:To assess the effects of statin treatment on mild coronary plaque progression by serial coronary CT angiography.METHODS:A total of 120 consecutive patients (74 men, ages(58.9±8.1)years) with mild (≤50%luminal narrowing and lesion length<20 mm) non-calcified plaque detected by coronary CT angiography during September 2012 and December 2013 were prospectively enrolled in this study.Subjects were divided into three groups: no statin (n=36), statin lowering LDL-C <50% (n=43), and statin lowering LDL-C ≥50%(n=41). Serial scans were performed after a median interval of 705 (interquartile range: 467, 803) days.Total plaque volume, percent plaque volume for both baseline and follow-up were measured.Baseline and follow-up data were compared.RESULTS:Compared with baseline, total plaque volume in no statin group showed increasing trend by the end of follow-up ((97.3±57.8) mm(3) vs. (82.2±57.7) mm(3,) P=0.075). However, no significant change was observed as for total plaque volume ((78.5±45.2) mm(3) vs.(77.6±50.5) mm(3), P=0.910) in the statin lowering LDL-C <50% group.Total plaque volume was significantly reduced by the end of follow-up ((61.5 ± 46.1) mm(3) vs.(77.7±48.1) mm(3), P=0.024) in the statin lowering LDL-C ≥50% group.Percent plaque volume in no statin group was significantly increased by the end of follow-up ((51.9±16.5)% vs.(45.9±12.8)%, P=0.036). However, no significant change was observed as for percent plaque volume ((49.1±13.7)% vs.(47.5±14.9)%, P=0.554) in the statin lowering LDL-C <50% group. Percent plaque volume was significantly reduced by the end of follow-up ((39.1±17.1)% vs.(48.2±15.0)%, P=0.003) in the statin lowering LDL-C ≥50% group. Multivariable linear regression analysis showed that both higher baseline total plaque volume(β=-0.50, P<0.001) and statin lowering LDL-C ≥50%(β=-0.32, P=0.001) were independent determinants of plaque regression.CONCLUSION:This study suggests that LDL-C reduction ≥50% post statin treatment can retard plaque progression, and even induce regression of mild non-calcified coronary plaque, patients with greater baseline coronary plaque volume are more likely to benefit from statin therapy.

We have witnessed major advances in cardiac CT technology with updated equipments and improved scan protocols over the last decade, and cardiac CT has been widely used in the diagnosis of pediatric complex congenital heart diseases. As a non-invasive tool, cardiac CT has high image spatial resolution and powerful 3-dimensional post-processing image reconstruction, with improvement of the image quality and reduction of radiation dose. It has been considered as a complementary modality to echocardiography in evaluation of extra-cardiac anatomy, coronary arteries and vascular structures. Role of cardiac CT in preoperative examinations of pediatric complex congenital heart diseases has been emphasized. This review focused on recent results of using cardiac CT in the evaluation of pediatric complex congenital heart diseases, aim at providing guidance for clinical application and pointing out direction for further investigation.

2014年11月30日至12月5日，第100届北美放射学会（RSNA）年会于美国芝加哥召开，本届会议的主题是“医疗变革的百年（A century of transforming medicine）”。其内涵是RSNA的百年历史，见证了医学影像学技术的进步，并推动了临床医疗的变革与发展。来自130多个国家的超过5.6万名医学放射从业者参加了此次盛会。本届会议共有225个知识更新课程、81个多学科合作课程、2703个学术发言以及2151个教育展览。关于心血管影像的学术发言共301个（11%），排在神经系统、消化系统和骨骼肌肉系统之后列第4位。本次会议心血管CT和MR影像领域的科研亮点有以下几个方面。