To investigate the feasibility of measuring Epicardial fat volume (EFV) on non-gated, non-contrast, and non-gated non-contrast computed tomography (CT) images. A total of 79 patients (male/female: 46/33, mean age: 57.91 ± 13.30 years old) who underwent triple-rule-out CT (TRO-CT) examinations were retrospectively enrolled, where electrocardiography (ECG)-gated contrast-enhanced coronary CT angiography (CCTA), non-gated non-contrast routine chest CT (RCCT), non-contrast coronary artery calcium scoring CT (CACS-CT), and non-gated CT pulmonary angiography (CTPA) and aortic CT angiography (ACTA) were simultaneously available. Three experienced radiologists manually measured the EFV on each image set. EFVs obtained on CACS-CT, CTPA, ACTA, or RCCT were compared with those obtained on CCTA, which were taken as the reference. Subgroup comparison was made for patients identified with (n = 36) and without coronary plaques (n = 43). Inter-observer agreements were analyzed using intraclass correlation coefficients (ICCs). Differences in EFVs were assessed using paired Wilcoxon signed-rank tests. For EFVs significantly deviating from the reference, correlation coefficients were calculated for the possibility of correction. The ICCs for all measurements were > 0.88. EFVs obtained on CACS-CT showed no significant differences from the reference (p = 0.899), while those on CTPA, ACTA or RCCT were significantly underestimated (all p < 0.05). Similar results of comparison were found for patients without plaques, even though EFVs obtained on CTPA were found comparable to the reference for patients identified with plaques (p = 0.187). Underestimated EFVs were fitted using linear functions with respect to those on CCTA, where excellent fitting results were found (all R2 > 0.97). EFVs obtained on non-contrast CT images (e.g., CACS-CT) were sufficiently accurate, while those obtained on non-gated CT images (e.g., CTPA and ACTA) or non-gated non-contrast CT images (e.g., RCCT) were significantly underestimated. Fortunately, all underestimations can be eliminated through simple correction functions.

Objective To investigate the clinical value of bedside lung ultrasound (LUS) in the non-invasive assessment of lung lesions in children with Mycoplasma pneumoniae pneumonia (MPP). Methods A total of 47 children with MPP hospitalized at our hospital from October 1, 2023 to December 31, 2023 were included. All children underwent LUS and chest CT examinations. The sonographic patterns of lung lesions were observed and scored using LUS, and the results were compared with chest CT as the “gold standard” to evaluate the comparability of LUS and chest CT in the diagnosis of pediatric MPP. Results The main LUS findings in children with MPP were interstitial edema (87.2%, 41/47) and lung consolidation (55.3%, 26/47), with bilateral involvement predominantly affecting the basal and dorsal regions of the lung. There was a moderate agreement between bedside LUS and chest CT in assessing lung lesions in children with MPP (Kappa = 0.609). The positive rate of MPP detected by LUS was 87.2% (41/47), and LUS’ accuracy in diagnosing MPP was 74.4% (35/47). In evaluating mild, moderate, and severe MPP, the sensitivity of LUS was 73.3%, 70.6%, and 72.7%; the specificity was 84.3%, 84.3%, and 100.0%; and the accuracy was 80.9%, 85.1%, and 93.6%, respectively. Conclusion LUS demonstrates a good performance in the assessment of lung lesions in children with MPP, and is worthy of further clinical promotion.

Rationale and ObjectivesThis study aimed to develop a diagnostic model based on clinical and CT features for identifying clear cell renal cell carcinoma (ccRCC) in small renal masses (SRMs).Material and methodsThis retrospective multi-centre study enroled patients with pathologically confirmed SRMs. Data from three centres were used as training set (n = 229), with data from one centre serving as an independent test set (n = 81). Univariate and multivariate logistic regression analyses were utilised to screen independent risk factors for ccRCC and build the classification and regression tree (CART) diagnostic model. The area under the curve (AUC) was used to evaluate the performance of the model. To demonstrate the clinical utility of the model, three radiologists were asked to diagnose the SRMs in the test set based on professional experience and re-evaluated with the aid of the CART model.ResultsThere were 310 SRMs in 309 patients and 71% (220/310) were ccRCC. In the testing cohort, the AUC of the CART model was 0.90 (95% CI: 0.81, 0.97). For the radiologists' assessment, the AUC of the three radiologists based on the clinical experience were 0.78 (95% CI:0.66,0.89), 0.65 (95% CI:0.53,0.76), and 0.68 (95% CI:0.57,0.79). With the CART model support, the AUC of the three radiologists were 0.93 (95% CI:0.86,0.97), 0.87 (95% CI:0.78,0.95) and 0.87 (95% CI:0.78,0.95). Interobserver agreement was improved with the CART model aids (0.323 vs 0.654, P < 0.001).ConclusionThe CART model can identify ccRCC with better diagnostic efficacy than that of experienced radiologists and improve diagnostic performance, potentially reducing the number of unnecessary biopsies.

To develop a nomogram based on contrast-enhanced CT (CECT) image features and clinical factors for preoperatively predicting the expression level of Ki67 in patients with hepatocellular carcinoma (HCC). One hundred eighty-three patients diagnosed with HCC were included in this study. All patients underwent CECT scans before surgeries or biopsies. The Ki67 expression was assessed by immunohistochemistry. The nomogram was constructed based on a combination of CECT image features and clinical factors which showed an independent association with Ki67 expression. The area under the receiver operating characteristic curve (AUC), calibration curve and decision curve analysis (DCA) were used to verify the performance of the nomogram. In multivariate logistic regression, bumpy margin, blurred margin, intra-tumoral vessels and α-fetoprotein (AFP) were identified as independent predictors of Ki67 expression (p < 0.05). Three CECT image features and one clinical factor were selected to construct the nomogram, which showed great discrimination ability in the training and validation cohort with AUCs of 0.932 and 0.870 respectively. The calibration curve and DCA indicated that the nomogram had positive clinical application. The nomogram, developed based on CECT image features and clinical factors in this study, provide a non-invasive method for accurately predicting the expression level of Ki67, and has the potential to support clinicians in making pretreatment decisions.

针对放射专业住院医师规范化培训消化道造影检查教学中病例资源不足、临床实践难度大等问题,利用教师标准化病人联合Mini-CEX的方法,初步研究证实该方法能够解决上述问题,并有效提升住院医师的沟通能力、减少患者的辐射损害,但在教师标准化病人模拟病种的多样性及Mini-CEX评分量表的专科化改良等方面仍需要进一步的改进.

Objectives To retrospectively analyze the CT imaging features and patterns at baseline and as they evolve with time as the disease progresses or resolves in a cohort of pediatric patients affected with 2019 corona virus disease (COVID-19) pneumonia from three different cities in China.Methods We evaluated 29 pediatric patients with COVID-19 in the authors’ institution from Jan 1 to Feb 20, 2020. Cases were confirmed by laboratory test and were analyzed for epidemiological, demographic, clinical, radiological features and patterns.Results 29 initial scans and 23 follow-up scans were obtained from 29 patients. 15(52%) patients had been to Hubei Province and 26 (90%) of them had close contact with the COVID-19 positive patients in 14 days prior to the illness onset. The peak severity time was 5-8 days after symptom onset. A significant difference between the number of involved segments at different time points was indicated (p=0.019). Half (52%) of the laboratory confirmed patients had no CT positive findings. Nine (31%) of the laboratory confirmed patients had no symptoms. Six (21%) had no CT positive findings nor symptoms. All the patients of one center(n=6) whose fecal samples remained positive after the respiratory samples became negative.Conclusion The common positive CT findings included ground-glass opacities (50%), ground-glass opacities mixed with consolidation (36%), peribronchial thickening (21%), and consolidations (14%). We recommend for pediatric patients CT should not be used as a first-line test to diagnose COVID-19.

Purpose: This study compares the results of Artificial Intelligence (AI) diagnosis of rib fractures using initial CT and follow-up CT as the final diagnostic criteria, and studies AI-assisted diagnosis in improving the detection rate of rib fractures.Methods: A retrospective study was conducted on 113 patients who underwent initial and follow-up CT scans due to trauma. The initial and follow-up CT were used as diagnostic criteria, respectively. All images were transmitted to the AI software (V2.1.0, Huiying Medical Technology Co., Beijing, China) for rib fracture detection. The radiol-ogist group (Group 1), AI group (Group 2), and Radiologist with AI group (Group 3) reviewed CT images at an interval of one month, recorded and compared the differences in the sensitivity and specificity for diagnosing rib fractures.Results: 589 and 712 rib fractures were diagnosed by the initial and follow-up CT, respectively. The initial CT di-agnosis failed to detect 127 rib fractures, resulting in a missed rate of 17.84%. In addition, four normal ribs were mistakenly identified as being fractured. The follow-up CT was regarded as the diagnostic standard for rib frac-tures. The sensitivity and specificity were 82.16% and 99.80% for Group 1, 79.35% and 84.90% for Group 2, and 91.57% and 99.70% for Group 3. The sensitivity of Group 3 was higher than that of Group 1 and Group 2 (p < 0.05). The specificity was lower for Group 2 compared with Group 1 and Group 3 (p < 0.05).Conclusion: AI-assisted diagnosis improved the detection rate of rib fractures, the follow-up CT should be used for the diagnosis standard of rib fractures, and AI misdiagnoses can be greatly reduced when a radiologist reviews the diagnosis.& COPY; 2023 Elsevier Inc. All rights reserved.

Coronary heart disease (CHD) is the leading cause of mortality in the world. Early detection and treatment of CHD are crucial. Currently, coronary CT angiography (CCTA) has been the prior choice for CHD screening and diagnosis, but it cannot meet the clinical needs in terms of examination quality, the accuracy of reporting, and the accuracy of prognosis analysis. In recent years, artificial intelligence (AI) has developed rapidly in the field of medicine; it played a key role in auxiliary diagnosis, disease mechanism analysis, and prognosis assessment, including a series of studies related to CHD. In this article, the application and research status of AI in CCTA were summarized and the prospects of this field were also described.

Coronary heart disease (CHD) is the leading cause of mortality in the world. Early detection and treatment of CHD are crucial. Currently, coronary CT angiography (CCTA) has been the prior choice for CHD screening and diagnosis, but it cannot meet the clinical needs in terms of examination quality, the accuracy of reporting, and the accuracy of prognosis analysis. In recent years, artificial intelligence (AI) has developed rapidly in the field of medicine; it played a key role in auxiliary diagnosis, disease mechanism analysis, and prognosis assessment, including a series of studies related to CHD. In this article, the application and research status of AI in CCTA were summarized and the prospects of this field were also described.

Breast cancer is one of the diseases with the highest incidence and mortality among women in the world, which has posed a serious threat to women's health. The appearance of clustered calcifications is one of the important signs of breast cancer, and thus how to classify clustered calcifications comes to be a key breakthrough in controlling breast cancer. In this study, the discriminant model based on image convolution is used to learn the image features related to the classification of clustered microcalcifications, and the graph convolutional network (GCN) based on topological graph is used to learn the spatial distribution characteristics of clustered microcalcifications. These two models are fused to obtain a complementary model of image information and spatial information. The results show that the performance of the fusion model proposed in this paper is obviously superior to that of the two classification models in the classification of clustered microcalcification.

Super-resolution (SR) in medical imaging is an emerging application in medical imaging due to the needs of high quality images acquired with limited radiation dose, such as low dose Computer Tomography (CT), low field magnetic resonance imaging (MRI). However, because of its complexity and higher visual requirements of medical images, SR is still a challenging task in medical imaging. In this study, we developed a deep learning based method called Medical Images SR using Generative Adversarial Networks (MedSRGAN) for SR in medical imaging. A novel convolutional neural network, Residual Whole Map Attention Network (RWMAN) was developed as the generator network for our MedSRGAN in extracting the useful information through different channels, as well as paying more attention on meaningful regions. In addition, a weighted sum of content loss, adversarial loss, and adversarial feature loss were fused to form a multi-task loss function during the MedSRGAN training. 242 thoracic CT scans and 110 brain MRI scans were collected for training and evaluation of MedSRGAN. The results showed that MedSRGAN not only preserves more texture details but also generates more realistic patterns on reconstructed SR images. A mean opinion score (MOS) test on CT slices scored by five experienced radiologists demonstrates the efficiency of our methods.

Objectives To retrospectively analyze the most common imaging features on CT at baseline and as they evolve with time as the disease progresses or resolves in a cohort of patients affected with 2019 coronal virus disease (COVID-19) pneumonia in Zhuhai, China.Methods We evaluated 38 patients with COVID-19 in the authors’ institution from Jan 1 to Jan 31, 2020. Cases were confirmed by real-time RT-PCR and were analyzed for epidemiological, demographic, clinical, and radiological features. Outcomes were followed up until Feb 18, 2020. Results 38 initial scans and 62 follow-up scans were obtained. 28 (74%) patients had the history of travel to or residence in Hubei Province of China in 14 days prior to the illness onset. Common findings included ground-glass opacification (GGO), sometimes mixed with consolidation, and interlobular septal and intralobular interstitial thickening. Follow-up imaging often demonstrated peripheral GGO and consolidations spreading to the remainder of the lungs and the increasing consolidative component reflecting the progression of the disease. 8 patients (21%) whose swabs or serum were positive for COVID-19 had no imaging findings on CT throughout the disease course. After treatment the serum and sputum tests became negative for COVID-19 in 32(84%) cases. 28(74%) patients were discharged and three (8%) of them were transferred to the Observation Ward, while seven (18%) patients were kept in Isolation Ward. Conclusion The commonest pattern observed was GGO alone or GGO mixed with consolidation predominantly in lower and peripheral lungs. The follow-up CT scan is crucial for the diagnosis and evaluation of the disease process.

The article by W. Lu et al. [W Lu et al. Ultraschall in Med 2020; 41: 300–307] is a timely, retrospective report on the early experience using lung ultrasound (US) in Zhuhai, China.

OBJECTIVE The microcirculatory hemodynamic changes of small-for-size syndrome (SFSS) are still unclear. In this study, they were investigated by four-dimensional CT perfusion (4D-CTP) technique. METHODS The sham group, 50, 60, 70 and 80 % partial hepatectomy (PH) rat groups were established. At 1 hour (1 h), 1 day (1 d), 3 days (3 d) and 7 days (7 d) post-operation, serological examination, 4D-CTP scan and histopathological examination were performed. One-way analysis of variance and the Kruskal-Wallis test were used for the comparison. RESULTS Based on the diagnostic criteria of SFSS, the 80 % group was considered to be a successful model. In all the PH groups, portal vein perfusion and total liver perfusion peaked at 1 h and declined at 1d and 3d. Both portal vein perfusion and total liver perfusion were significantly higher in the 80 % group than the sham group, 50 and 60% groups at 1 h (p < 0.05), and 80 % group at 3d and 7d (p < 0.05). In the 50 and 60 % groups, hepatic artery perfusion decreased at 1 h and maintained at a lower level until at 7 d; whereas, in the 70 and 80% groups, it increased at 1 h, then decreased and reached the lowest level at 7 d. No significant difference appeared in hepatic artery perfusion between any two groups at any time points. At all time points, hepatic perfusion index was lower in all the PH groups than the sham group. Significant differences in hepatic perfusion index appeared between the 80% group and the sham group at 1 h and 1 d (p < 0.05). CONCLUSIONS The CTP parameters quantitatively revealed the microcirculatory hemodynamic changes in SFSS, which were further confirmed to be associated with histopathological injury. It is suggested that the hemodynamic changes in SFSS remnant liver can provide useful information for further revealing the mechanism of SFSS and may help for guiding the treatments. ADVANCES IN KNOWLEDGE By using the 4D-CTP technique, the hepatic microcirculatory hemodynamic changes could be quantitatively measured in vivo for small animal research.

AIM To identify clinical biomarkers that could early predict improved survival in patients with advanced-stage hepatocellular carcinoma (HCC) treated with transarterial chemoembolization combined with sorafenib (TACE-S). METHODS We retrospectively evaluated the medical records of consecutive patients with advanced-stage HCC who underwent TACE-S from January 2012 to December 2015. At the first follow-up 4-6 wk after TACE-S (median, 38 d; range, 33-45 d), patients exhibiting the mo-dified Response Evaluation Criteria in Solid Tumors (mRECIST)-evaluated complete response, partial response, and stable disease were categorized as early disease control. At this time point, multiple variables were analyzed to identify the related factors affecting survival. RESULTS Ninety-five patients were included in this study, and 60 of these patients achieved early disease control, with an overall disease control rate (DCR) of 63.2%. Patients who got sorafenib at the first TACE (no previous TACE) and patients without portal vein tumor thrombus (PVTT) had a higher DCR than those who underwent previous TACE before TACE-S (72.4% vs 48.6%, P = 0.019) and those with PVTT (75.5% vs 50.0%, P = 0.010). Early disease control after TACE-S, no previous TACE, and no PVTT were the independent prognostic factors for survival in the uni- and multivariate analyses. CONCLUSION The first follow-up 4-6 wk after TACE-S can be used as the earliest time point to assess the response to TACE-S, and patients with mRECIST-evaluated early disease control, no previous TACE, and no PVTT had better survival.

Objective To analyze the CT findings and clinical significance of severe non-neoplastic arterioportal shunts(APS)in the liver graft after liver transplantation.Methods From January2004 to March 2014, two receptors suffered severe liver non-neoplastic APS and were detected by follow-up CT scans in third affiliated hospital. Combined with the clinical features, Doppler ultrasound and clinical outcomes,the CT findings and clinical effects of APS on the grafts were retrospectively analysed.Results The first branches and their distal branches of the portal vein were significantly enhanced in the contrast-enhanced hepatic arterial phase in both of the two patients, and the enhancement was higher than that of the superior mesenteric vein and splenic vein. In both of the cases, significant transient enhancement of hepatic parenchyma was also detected around APS in hepatic arterial phase. In Case1, a doppler ultrasound showed the hepatofugal flow in the left portal vein. Chronic rejection was confirmed by the liver biopsy. Reduced blood supply of the hilar bile ducts was detected by a contrast-enhanced ultrasound. After received anti-inflammatory, anti-rejection and liver protection therapy, APS in the liver was disappeared in the followed CT scans. The hepatopetal flow in the left portal vein and recovered biliary blood supply were showed in the followed ultrasound. Case2 was a patient with iatrogenic APS occurred during the interventional procedure of severe hepatic artery stenosis. One years later, APS still existed in the follow-up CT scan, with obvious ischemic cholangitis.Conclusion After liver transplantation, graft rejection may also be a reason for severe APS. And when amounts of hepatic arterial blood flow to the portal vein system, the receptor may suffer not only severe portal hypertension, but also may suffer ischemic bile duct injuries.

Objective To investigate the imaging findings of rare tumors or tumor-like lesions in liver grafts after liver transplantation.Methods Imaging data of 4 patients with rare tumors or tumor-like lesions in the liver grafts of patients after liver transplantation from December 2006 to August 2013 in the Third Affiliated Hospital of Sun Yat-sen University were reviewed.Findings of computerized tomography ( CT ) and ( or ) magnetic resonance imaging ( MRI) plain scan and dynamic enhanced MRI of liver lesions in these patients were analyzed specially.Results In the 4 patients, 3 cases were misdiagnosed , including undifferentiated liver sarcoma , secondary lymphoma and eosinophilic granuloma.One case was diagnosed correctly with hepatic metastases of gallbladder carcinoma.The undifferentiated liver sarcomas appeared as cystic and solid space occupying masses with significant and persistent enhancement in the surrounding solid and separating parts .No enhancement was observed in the cystic parts , which increased rapidly in a short term.No edema area around the lesions was observed , but many calcifications were detected.The secondary hepatic lymphoma appeared as intrahepatic multiple nodules , most of which presented uniform signal intensity with moderate enhancement in every phase.No intrahepatic vascular invasion was observed but extrahepatic lymphadenectasis was detected .Bleeding was observed in a few lesions.The liver eosinophilic granuloma appeared as multiple liver lesions with variable signal intensity and enhancement modes , which suggested that the lesions were consisted of variety of&nbsp;elements and in the different disease stages.Most of the lesions were observed with progressive circled enhancement.The recurrence of gallbladder carcinoma and hepatic metastasis after liver transplantation appeared as a intrahepatic hypodensity lesion with slight enhancement in arterial phase and slight hypodensity in portal phase.Retroperitoneal lymph nodes were observed swelled and fused.Conclusions Rare tumors or tumor-like lesions in liver grafts have distinctive imaging features.Imaging examinations are useful for the early detection of these rare tumors or tumor-like lesions in liver grafts.Imaging findings combining with disease history and clinical manifestations can help to make correct diagnosis.