目的 分析颈内动脉颅内闭塞(IICAO)患者CTA图像,判断经Willis环的初级侧支循环,评估血管内机械取栓术(EVMT)预后良好的相关因素.方法 对162例行EVMT治疗的IICAO患者进行分析.搜集基线资料包括人口统计学特征、血管危险因素、ASPECTS评分、NIHSS初始评分、术后再出血例数.根据CTA图像将Willis环的形态分为4种,并结合颈动脉闭塞位置及Willis环变异情况,将初级侧支循环分为4组.通过90天后改良Rankin量表(mRS)评分来衡量术后临床结局,判断取栓术预后良好的相关因素.结果 在162例IICAO患者中,出院38.3％(62例)取栓治疗后mRS 0～2分;预后良好29.0％(47例)mRS 3～5分;死亡32.7％(53例)mRS 6分.三组间基线资料中年龄、入院NIHSS评分及房颤有统计学差异(P＜0.05),Willis发育变异比例无统计学差异(P＞0.05),有无初级侧支循环有统计学差异(P＜0.05),其中无初级侧支循环的患者死亡率57.1％.在多变量Logistic回归中,房颤及血流循环分组为预后良好的相关因素.结论 基于颈动脉闭塞位置,结合Willis环变异联合判断是否存在初级侧支循环可能是IICAO患者EVMT后疗效的预测因子.

目的:探讨CT灌注成像(CTPI)对急性缺血性脑卒中(acute ischemic stroke,AIS)患者出血转化的预测价值.方法:选取2018年12月—2023年5月无锡市锡山人民医院收治的82例AIS患者作为AIS组,另选取同期60名健康体检的志愿者为对照组,均行CTPI检查,测量并比较CTPI定量参数脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)、平均通过时间(mean transit time,MTT)、达峰时间(time to peak,TTP)及灌注延迟时间(delay time,DT),并根据AIS患者是否发生出血转化(hemorrhagic transformation,HT),分为HT组(n=28)和非HT组(n=54),采用受试者工作特征(ROC)曲线分析CTPI定量参数对AIS患者发生HT的预测价值.结果:AIS组CTPI定量参数CBF、CBV水平均低于对照组,MTT、TTP、DT长于对照组,差异有统计学意义(P＜0.05).HT组CTPI定量参数CBF、CBV水平均低于非HT组,MTT、TTP、DT长于非HT组,差异有统计学意义(P＜0.05).ROC曲线分析显示,CTPI定量参数CBF、CBV、MTT、TTP、DT预测AIS患者发生HT的曲线下面积(AUC)分别为0.883(95%CI:0.800～0.967)、0.819(95%CI:0.696～0.943)、0.876(95%CI:0.784～0.967)、0.869(95%CI:0.786～0.951)、0.828(95%CI:0.732～0.925),对应灵敏度为78.6%、78.6%、78.6%、68.2%、67.9%,特异度为88.9%、87.2%、83.3%、87.0%、81.5%;联合预测的AUC为0.969(95%CI:0.935～0.998),灵敏度、特异度为92.9%、92.6%.结论:CTPI定量参数可作为预测AIS患者发生HT的重要指标,联合预测价值更高,能为临床制定防治措施提供参考.

RATIONALE AND OBJECTIVES:The measurement of the time since stroke onset (TSS) is crucial for decision-making in the treatment of acute ischemic stroke (AIS). This study assessed the utility of computed tomography angiography (CTA) radiomics features (RFs) to estimate TSS. MATERIALS AND METHODS:A total of 221 patients with AIS were enrolled in this retrospective study and were divided into a training group (n = 154) and a test group (n = 67). Thrombi in CTA images were manually outlined using ITK-SNAP. Images were aligned, normalized, and pre-processed to extract RFs. The TSS was calculated as the time from stroke onset to CTA completion. The patients were classified into two groups according to estimated TSS: ≤4.5 and >4.5 hours. A total of 944 RFs were extracted from CTA images. Clinical factors associated with TSS were identified using multivariate logistic regression, and a combined model (clinical data and RFs) was constructed. The predictive value of the models was assessed by the area under the receiver operating characteristic curve (AUC). The performance of the models was compared using the DeLong test, and clinical utility was evaluated by decision curve analysis. RESULTS:The AUC of the radiomics model was 0.803 (95% confidence interval [CI]: 0.733-0.873) and 0.803 (95% CI: 0.698-0.908) in the training and test cohorts, respectively. The AUC of the combined model (containing data on age, diabetes, and atrial fibrillation) in the training and test sets was 0.813 (95% CI: 0.750-0.889) and 0.803 (95% CI: 0.699-0.907), respectively. The DeLong test showed no significant difference between the radiomics and combined models. Decision curve analysis showed that both models had clinical utility. CONCLUSION:CTA-based thrombus radiomics can estimate TSS in patients with AIS. The addition of clinical data to the model does not improve predictive performance.

Objective:To evaluate the application values of classifications of acute distal occlusion of internal carotid artery and variation of Willis' circle in predicting prognoses of acute ischemic stroke patients after mechanical thrombectomy (MT).Methods:One hundred and fifty-eight patients with acute ischemic stroke, admitted to our hospital from January 2016 to November 2020, were chosen in our study; these patients had conformed imaging diagnosis of acute distal occlusion of internal carotid artery and accepted endovascular MT; the clinical and imaging data of these patients were retrospectively analyzed. The distal occlusion of internal carotid artery was divided into Ia, Ib, L, and T types according to the occlusion positions. Prognoses were evaluated by modified Rankin Scale (mRS) 90 d after treatment. Multivariate Logistic regression was used to determine the independent factors for prognoses.Results:Among these 158 patients, 58 patients achieved good prognosis and 100 had poor prognosis. As compared with patients in the poor prognosis group, patients in the good prognosis group had significantly younger age, significantly lower NIHSS scores at admission, and statistically lower atrial fibrillation ratio ( P<0.05). There were statistical differences in the classifications of acute distal occlusion of internal carotid artery between the two groups ( P<0.05): the proportion of Ia type in patients of good prognosis group was the highest (75.9%), while that of T type was the lowest (3.4%). There was no significant difference in variation of Willis' circle between the two groups ( P>0.05). Multivariate Logistic regression analysis showed that T type of acute distal occlusion of internal carotid artery and atrial fibrillation were independent factors for prognoses of these patients ( OR=0.342, 95%CI: 0.127-0.919, P=0.033; OR=0.066, 95%CI: 0.005-0.803, P=0.033). Conclusion:Patients with T type of acute distal occlusion of internal carotid artery and atrial fibrillation are trend to have poor prognosis.

目的 探讨非酒精性脂肪性肝病(NAFLD)合并冠状动脉斑块患者CT检测的肝脏脂肪分数(HFF)的临床意义.方法 2015年1月～2021年1月我院诊治的NAFLD患者168例,均接受冠状动脉CT血管成像检查,在Syngo.via工作站基于双能CT基物质分解算法自动计算HFF.结果 168例NAFLD患者中,无冠状动脉斑块76例,存在冠状动脉斑块但不符合高危冠状动脉斑块(HRP)者48例,HRP 44例;无斑块组、HRP阴性组和HRP组心外膜脂肪组织体积(EATV)分别为91.8(82.4,98.3)cm3、102.6(87.6,120.4)cm3和136.2(82.4,98.3)cm3,差异具有统计学意义(P<0.05),EAT CT值分别为-79.3(-81.2,-76.4)HU、-74.2(-77.3,-70.4)HU和-66.8(-70.5,-63.4)HU,差异具有统计学意义(P<0.05),冠状动脉周围脂肪组织(PAT)CT值分别为-79.0(-80.6,-76.3)HU、-73.1(-75.2,-70.2)HU和-66.2(-70.1,-63.0)HU,差异具有统计学意义(P<0.05);无斑块组、HRP阴性组和HRP组冠状动脉周围脂肪组织体积(PATV)分别为[17.5(15.5,18.6)cm3]、[17.4(15.7,21.8)cm3]和[18.9(17.5,23.1)cm3],差异具有统计学意义(P<0.05);HFF分别为[6.8(5.3,9.2)％]、[8.8(7.0,12.6)％]和[15.4(12.3,17.8)％],差异具有统计学意义(P<0.05);肝脏CT值分别为[(44.4±4.7)HU]、[(43.2±4.6)HU]和[(39.7±4.4)HU]比差异具有统计学意义(P<0.05);无斑块组、HRP阴性组和HRP组吸烟史、高血压、糖尿病、中性粒细胞/淋巴细胞比率(NLR)、HDL、TG、TC和Framingham危险评分等差异具有统计学意义(P<0.05);HRP阴性组与HRP组冠状动脉狭窄程度、低密度斑块、点状钙化斑块、重构指数和餐巾环征等差异具有统计学意义(P<0.05).结论 作为测定肝脏脂肪含量的新型非侵入性成像方法,CT检测HFF具有测量简便、可重复性好等优点,有助于优化对NAFLD患者合并心血管疾病的危险分层.

-OBJECTIVE: Endovascular mechanical thrombectomy (EVMT) has shown significant efficacy in improving neurological functions in patients with intracranial internal carotid artery occlusion (IICAO), but its clinical outcomes are variable. We examined the relationship between favorable clinical outcomes after EVMT in IICAO and a set of predictors. -METHODS: In this retrospective study, 189 patients with IICAO treated by EVMT at 3 centers from November 2015 to December 2020 were included and analyzed. Non -contrast computed tomography and computed tomography angiography were evaluated on admission. The morphology of IICAO was categorized into Ia, Ib, L, or T types, depending on the involvement of the posterior communicating artery origin, proximal anterior cerebral artery, and middle cerebral artery. The Willis' circle was categorized as integrated or compromised Willis' circle. In combination with the involvement of the IICAO and the integrity of Willis' circle, we used the primary collateral grade (PCG) to describe the presence of functional Wil-lisian collaterals. Baseline data including demographics, characteristics, vascular risk factors, and initial National Institutes of Health Stroke Scale scores were collected. Hemorrhagic transformation was evaluated using the 24 -hour non-contrast computed tomography after EVMT. Favorable outcomes based on modified Rankin scale, were defined as 0-2 at 90 days. -RESULTS: A total of 189 patients were included (median age, 69 years; 126 male [66.7%]). 104 patients [55.0%] showed reperfusion after EVMT, but 72 patients [38.1%] achieved favorable outcomes at 90 days. The mortality rate of type Ib was significantly higher than that with type Ia (c2 = 14.21, P = 0.001). The outcome with different structure of Willis' circle was not statistically different between the 2 groups. A multivariate logistic regression analysis showed that IICAO T -type (odds ratio, 0.028 [95% confidence interval: 0.323-3.829], P = 0.042) and PCG 2 (odds ratio 9.427[95% confidence interval:1.863-47.698], P = 0.007) were predictors of favor-able outcomes. -CONCLUSIONS: Evaluation of PCG by determining the type of IICAO and the integrity of Willis' circle may serve as a valuable indicator for the prognosis and as an essential reference for screening patients before EVMT.

目的:探讨乳腺MRI对X线上"不对称致密影"的诊断价值.方法:回顾性分析38例X线"不对称致密影"相应MRI征象及病理对照.结果:38例在钼靶片上显示"不对称致密影"征象患者,在MRI图像上均有阳性发现,病理结果良性30例(78%),恶性8例(22%),MRI诊断准确度(accuracy,ACC)为86.84%.TIC类型为I型25例,均为良性,Ⅱ型8例,其中5例为良性,3例为恶性,Ⅲ型5例,均为恶性.结论:M R I能够正确判断"不对称致密影"中是否存在潜伏病灶,并进一步判断其良恶性.

目的:分析并探讨超声和钼靶X线在早期乳腺癌中的临床诊断方法.方法:本次研究我们抽取了90例早期乳腺癌患者进行比对分析,并用随机分配的方式分成两组,观察组和对照组各45例.对照组采用钼靶X线进行筛查,而观察组则在对照组的基础上在结合超声进行筛查,并对两组患者的筛查结果进行比对和分析.结果:根据两组的筛查结果进行比较,观察组的诊断率相对对照组的诊断率比较显著,差异(P<0.05)有统计学意义.结论:根据结论得出,钼靶x线结合超声对早期乳腺癌进行检查,可以很明显的提高患者的检查率,可以及时对患者病情做出判定,在临床上有很高的运用价值.

目的比较CT尿路成像(CTU)与静脉肾盂造影(IVP)对泌尿系病变的显示差异。方法收集2010年—2011年56例同时行CTU与IVP检查的泌尿系病变病例,统计两者对病变数目、病变范围的显示差异,进行对比性研究。结果泌尿系结石21例,CTU显示21例,IVP显示16例。肾脏肿瘤8例,CTU显示8例,IVP显示3例。输尿管肿瘤3例,CTU显示3例,IVP显示0例。膀胱肿瘤12例,CTU显示12例,IVP显示8例。单纯性输尿管炎性狭窄6例,CTU显示5例,IVP显示0例。尿路先天畸形6例,CTU及IVP均能显示。两种方法比较有显著差异。结论 CTU较IVP对泌尿系疾病诊断阳性率明显提高,对病变定位、定性均有显著帮助,具有明显的优势。