BackgroundTo compare the application value of conventional single-shot echo planar imaging (SS-EPI), simultaneous multi-slice single-shot echo planar imaging (SMS + SS-EPI), and simultaneous multi-slice segmented readout isotropic acquisition in diffusion weighted imaging (SMS + RESOLVE-ISO DWI) for subacute early small artery occlusive cerebral infarction.MethodsA retrospective analysis was conducted on 60 patients with subacute early small artery occlusive cerebral infarction, who were treated with SS-EPI-ISO DWI, SMS + SS-EPI-ISO DWI, and SMS + RESOLVE-ISO DWI sequence was used for 1.5 mm isovoxel acquisition. Two radiologists independently assessed the image quality, combining multi-planar reconstruction (MPR), 3-Dimensional fluid attenuated inversion recovery (3D-FLAIR), and apparent diffusion coefficient (ADC) images to evaluate the number of infarct lesions. And subjective and objective evaluations of the image quality were conducted. Objective evaluations include contrast, signal-to-noise ratio (SNR), time SNR (tSNR), contrast-to-noise ratio (CNR) and ADC. Friedman’s test was used to analyze image indicators, Weighted Kappa test was employed to assess the consistency of subjective score, and intraclass correlation coefficient (ICC) was used to analyze the consistency of measurement results.ResultsThe scanning times for SS-EPI-ISO DWI, SMS + SS-EPI-ISO DWI, and SMS + RESOLVE-ISO DWI were 3:06, 1:38, and 4:51 min, respectively. The number of infarcted lesions showed that both SS-EPI-ISO DWI and SMS + SS-EPI-ISO DWI detected 129 lesions, while SMS + RESOLVE-ISO DWI detected 123 lesions. Subjective evaluation showed that SMS + RESOLVE-ISO DWI was superior to the other sequences in terms of overall image quality, artifacts, and geometric distortions (p < 0.001). Objective evaluation revealed significant differences in contrast, SNR, and tSNR among the three sequences (p < 0.001), but no significant differences in CNR and ADC values (p > 0.05).ConclusionSMS + SS-EPI-ISO DWI achieves image quality comparable to that of SS-EPI-ISO DWI while shortening the scanning time. Although its suppression effect on artifacts and geometric distortion is not as good as that of the SMS + RESOLVE-ISO DWI sequence, the clarity of lesion display is similar to that of the SS-EPI-ISO DWI sequence. Therefore, it is suitable for the diagnosis of subacute early small artery occlusive cerebral infarction.

Lung cancer has the highest mortality rate among cancers. The commonly used clinical method for diagnosing lung cancer is the CT-guided percutaneous transthoracic lung biopsy (CT-PTLB), but this method requires a high level of clinical experience from doctors. In this work, an automatic path planning method for CT-PTLB is proposed to provide doctors with auxiliary advice on puncture paths. The proposed method comprises three steps: preprocessing, initial path selection, and path evaluation. During preprocessing, the chest organs required for subsequent path planning are segmented. During the initial path selection, a target point selection method for selecting biopsy samples according to biopsy sampling requirements is proposed, which includes a down-sampling algorithm suitable for different nodule shapes. Entry points are selected according to the selected target points and clinical constraints. During the path evaluation, the clinical needs of lung biopsy surgery are first quantified as path evaluation indicators and then divided according to their evaluation perspective into risk and execution indicators. Then, considering the impact of the correlation between indicators, a path scoring system based on the double spherical constraint Pareto and the importance-correlation degree of the indicators is proposed to evaluate the comprehensive performance of the planned paths. The proposed method is retrospectively tested on 6 CT images and prospectively tested on 25 CT images. The experimental results indicate that the method proposed in this work can be used to plan feasible puncture paths for different cases and can serve as an auxiliary tool for lung biopsy surgery.

Lung cancer has is highly prevalent worldwide and is the leading cause of cancer-related deaths. In the clinic, a biopsy sample of the lesion is taken to determine whether a lung mass is benign or malignant. CT-guided percutaneous lung biopsy is a minimally invasive intervention and is commonly used to diagnose lung cancer. Path planning before surgery plays a crucial role in percutaneous lung biopsy. Traditionally, path planning for lung biopsy is performed manually by physicians based on CT images of the patient, which demands knowledge and extensive clinical experience of the operating physicians. In this work, a computer-assisted path planning system for percutaneous lung biopsy is proposed based on clinical objectives. Five constraints are presented to remove unqualified skin entry points and determine a feasible entry region based on clinical criteria. Inspired by the Pareto principle and the concept of geometric weighting, the loose-Pareto and adaptive heptagonal optimization (LPHO) method is introduced to plan the optimal puncture path. CT images of 29 patients were collected from Zigong First People's Hospital. Retrospective experiments and test experiments were conducted to evaluate the effectiveness of the algorithm. The planning paths obtained using the proposed method were clinically feasible for 89.7% of patients, demonstrating the applicability and robustness of the system in surgical path planning for lung biopsy.

An advanced preoperative rehearsal system for lung puncture biopsy surgery is designed to address the issue of the high operator requirements and high risk of postoperative complications. The system enables the creation of three-dimensional model of both the lung and the puncture needle. It mechanically models the skin, fat and muscle of the chest wall to establish a virtual surgical rehearsal environment combined with force feedback technology. The realism and ease of operation of the system were validated based on analyzing various parameters from simulated lung puncture surgery performed by 20 volunteers. The results indicate that the system has high degree of effectiveness and clinical value that can serve as an auxiliary tool in lung puncture surgery.

The quality of the clinician-planned puncture path significantly affects the success rate of percutaneous lung biopsy procedures. Therefore, a preoperative path planning algorithm for lung puncture biopsy is proposed to assist clinicians in planning the needle path of lung biopsy. First, lung tissues and organs are segmented based on CT images. Then, a multiple puncture target point approach is proposed to screen the target locations of sus-pected tumors. And the puncture needle path is determined after selecting the entry points on the skin. According to lung biopsy clinical requirements, three hard constraints are proposed to remove paths that do not meet clinical requirements. Additionally, six soft constraints and the Pareto optimization based on multidimensional space distance are proposed to obtain the optimal puncture paths. The experimental data were collected from 33 patients with suspected pulmonary nodules in the Zigong First People's Hospital. In the experiments, physicians labeled 98.46 % of the paths planned by the algorithm as clinically feasible, indicating that the proposed al-gorithm can be applied to nodule cases of different sizes and that it follows the clinical constraints of lung puncture. The average distance between the optimal algorithmic path and the surgical path was (5.77 & PLUSMN; 3.85) mm, which indicates that the proposed algorithm could simulate the surgical path according to the clinical guidelines of the physicians. The experimental results demonstrated that the proposed algorithm could provide an objective and effective path planning method for lung puncture biopsy of different nodule sizes.

1 临床资料 患者,男, 68 岁,因"吞咽困难伴上腹部不适1 +月"入院,查体:患者体型消瘦,双侧锁骨上淋巴结未扪及肿大,胸廓无畸形,右侧锁骨中线第五肋间可触及心尖搏动,叩出心界,闻及心音.左侧未触及心尖搏动,无法叩出心界,未闻及心音.胃镜示:距门齿30 ～35 cm可见不规则菜花状新生物,累及管壁3/5 周,新生物表面糜烂,轻触易出血,胃黏膜呈镜像改变;病理检查示:鳞状细胞癌.

目的 探讨1.5T磁共振常规序列对胎儿后颅窝池畸形的诊断价值.方法 回顾性分析自贡市第一人民医院及四川大学华西第二医院2017年1月至2020年12月期间产前超声检查异常并行胎儿颅脑MRI平扫检查,经临床综合诊断为后颅窝池畸形的17例胎儿的临床影像资料.采用快速稳态进动序列(Balance-FFE)和三维快速扰相梯度回波序列(FFE)进行胎儿颅脑横断、矢状和冠状面快速扫描,选择T2WI冠状位测量小脑横径(TCD),选择胎儿小脑蚓部的正中矢状面观察后颅窝结构及相邻结构间的毗邻关系,测量小脑蚓部上下径、小脑蚓部前后径、BV角、BT角.结果 17例胎儿后颅窝畸形中Dandy-Walker综合征2例,小脑蚓部发育不良3例,后颅窝蛛网膜囊肿8例,胎儿后颅窝池增宽3例,小脑发育异常1例;所有患者小脑蚓部上下径、小脑蚓部前后径、BV角、BT角及小脑横径均小于正常值,且符合超声测值标准.结论 1.5T磁共振对胎儿后颅窝池畸形的产前诊断具有重要临床价值.

Objective To explore the clinical value of multimodal MRI in the early diagnosis of premature brain injury. Methods The characteristics of multimodal MRI images of 58 premature infants with brain injury in our hospital were retrospectively analyzed, including The conventional sequence image, DWI and SWI, and compared with clinical diagnosis. Results There were 18 cases of hemorrhagic brain injury, including 7 cases of subarachnoid hemorrhage, 8 cases of white matter hemorrhage, 1 case of lateral periventricular hemorrhage with intraventricular hemorrhage, 1 case of subdural hematoma, and 1 case of subarachnoid hemorrhage with subdural hematoma. There were 40 cases of ischemic brain injury, including 22 cases of localized ischemic brain injury, 13 cases of diffuse ischemic brain injury and 5 cases of periventricular leukomalacia. MRI diagnosis of 58 premature infants with brain injury was basically consistent with clinical diagnosis. Conclusion Multi-modal MRI has important clinical value in early diagnosis of premature brain injury.

患者 女,51 岁.主诉:胸痛 1+年,加重 2 周入院.患者于1+年前无明显诱因出现左下侧胸痛,性质呈间断性锐痛,不随体位改变,无放射性疼痛,无咳嗽、咳痰、咯血.2 周前患者胸痛症状无明显诱因加重,间断性锐痛,疼痛频率较前增多,伴背部放射痛,偶出现恶心、胸闷不适等症状.患者 2 年前行胆囊切除术,无高血压、糖尿病等病史,无遗传病及传染病家族史.查体:胸廓双侧对称,无畸形,无局部隆起或凹陷,无压痛.患者入院后行胸部CT平扫+增强扫描:纵隔窗示左侧下胸壁胸膜局部增厚,呈结节状改变,最大截面径约 2.1 cm×1.1 cm,平扫密度稍低,CT值平均约 1 HU,密度均匀,边界尚清楚,相邻骨质未见骨质破坏(图 1);增强扫描病灶明显均匀强化,平均 CT约 36 HU (图2 ).CT诊断:左侧胸壁结节,考虑肿瘤性病变可能性大.患者完善术前准备后行全麻下胸腔镜左侧胸壁肿瘤切除术+胸膜粘连烙断术,手术顺利.术中见:胸腔内无积液,左侧胸壁6～7 肋间腋后线见一大小约2.5 cm×1.5 cm×1.2 cm肿物,质硬,表面光滑,与周围组织致密粘连.

1 一般资料 患者,男,62岁,发现颈部包块20+年入院.21年前因颈部包块曾行"甲状腺包块切除术"(具体不详).术后患者无特殊不适.手术1年后患者颈部右侧再次出现包块并进行性长大,仍不伴特殊不适.1月前,患者出现呼吸不畅、活动后气促、进食梗阻感.主要体征:颈软,颈前见最大径约3cm陈旧性手术疤痕;右侧颈根部见大小约9cm×6cm×6cm巨大肿块,质硬、不活动.

目的 探讨冠状动脉CT造影(CCTA)的管腔内衰减梯度(TAG)在诊断不同类型斑块所致冠状动脉狭窄中的应用价值.方法 前瞻性收集2017年1月至2018年1月四川省自贡市第一人民医院收治的158例冠心病患者为研究对象,按照是否发生冠状动脉狭窄分为狭窄组(101例)与非狭窄组(57例),所有患者均行CCTA检查,比较两组的TAG值以及不同狭窄程度与不同斑块性质患者的TAG值.结果 狭窄组冠状动脉TAG值低于非狭窄组,差异有统计学意义(P<0.05);非狭窄组与狭窄组左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)的TAG值比较,差异均有统计学意义(P<0.05);非狭窄组、轻度狭窄组、中度狭窄组、重度狭窄组的TAG值比较,差异有统计学意义(P<0.05);轻度狭窄组、中度狭窄组、重度狭窄组的TAG值比较,差异有统计学意义(P<0.05);轻度狭窄组与中度狭窄组的TAG值比较,差异无统计学意义(P>0.05);轻度狭窄组、中度狭窄组分别与重度狭窄组的TAG值比较,差异均有统计学意义(P<0.05);不同斑块性质所致冠状动脉轻度狭窄患者的TAG值比较,差异无统计学意义(P>0.05).结论 CCTA的TAG值在冠状动脉狭窄诊断中的应用价值较高,且可用于诊断不同类型斑块导致的冠状动脉狭窄.

An automatic CT image-based path planning method for lung puncture surgery is proposed due to high failure rate, time consumption, and the high radiation dose of the existing percutaneous lung puncture surgery. The method described in this paper implements automatic organ segmentation of chest CT images. It defines six constraining conditions combined with clinical a priori knowledge to find the optimal puncture path using a multi-objective Pareto optimization method. The rationality and validity of the method were validated based on 25 sets of clinical lung mass data. Experimental results show that the optimal paths found by this system all meet the clinician's surgical requirements.

为了解决传统肺穿刺手术路径规划方法手术并发症风险大、受医师熟练度影响大、无法量化分析手术路径风险等特有的临床问题,设计了一套肺穿刺术最优路径规划方案.首先,基于胸部CT图像对胸部重要器官进行图像分割.然后,将手术风险量化为3个约束性条件和6个目标性条件,用于衡量手术路径的优劣与风险.3个约束性条件为穿刺深度、重要器官避障、入刺角度,6个目标性条件为胸壁厚度、肺内穿刺长度、重要器官之间的距离、路径延长线与重要器官之间的距离、皮肤入刺角、胸膜入刺角.最后,设计自适应凝聚层次聚类算法将路径聚类为"簇",并利用多目标优化方案对聚类中心点进行量化分析,确定肺穿刺最优路径.实验结果表明,自动规划得到的最优路径经医生确认均符合手术要求,且计算得到的最优路径在医生排序中排名均为前3,证明了本文路径规划方法的合理性与有效性,满足肺穿刺手术路径规划临床需求,可以为医生提供有效的3维可视化穿刺路径指导.

目的 分析自贡地区不同年龄段常住居民(20岁及以上)腰椎、股骨颈、全髋骨密度(BMD)变化特点,为该地区骨质疏松症的诊断及防治提供科学依据.方法 将2017年1月至2020年12月在四川省自贡市第一人民医院健康体检中心测量BMD的1200名健康成人纳入调查,按10岁一个年龄组将其分为6组,即20～29岁组、30～39岁组、40～49岁组、50～59岁组、60～69岁组、70～79岁组,每组200名(男女各100名),利用双能X线吸收测量仪测量研究对象的腰椎正位(L1-4)、股骨颈、全髋BMD,并经SPSS 17.0统计软件分析BMD与年龄、性别、部位的关系.结果 该研究中,男性股骨颈、全髋的骨峰值出现在30～39岁,腰椎正位(L1-4)的骨峰值出现在20～29岁;女性股骨颈、全髋的骨峰值出现在20～29岁,腰椎正位(L1-4)的骨峰值出现在30～39岁.男性的腰椎正位(L1-4)BMD在50岁以后高于女性,差异均有统计学意义(P<0.05).50～59岁人群的股骨颈、腰椎正位(L1-4)BMD与除20～29岁之外的所有年龄段人群比较,差异均有统计学意义(P<0.05);60～69岁人群的股骨颈、全髋BMD与其余年龄段人群比较,差异均有统计学意义(P<0.05);70～79岁人群的股骨颈、全髋BMD与其余年龄段人群比较,差异均有统计学意义(P<0.05).腰椎正位(L1-4)BMD在所有年龄段与股骨颈、全髋比较,差异均有统计学意义(P<0.05);股骨颈BMD在40岁以后与全髋比较,差异均有统计学意义(P<0.05).结论 随着年龄的增长,BMD逐渐下降;50岁以后的女性腰椎骨量下降速度高于男性;不同部位的BMD下降速度及开始时间不一致,临床需测量多部位的BMD,且在40岁以后推荐测量股骨颈BMD来诊断骨质疏松症.

目的 分析新型冠状病毒肺炎(COVID-19)患者的高分辨率CT(HRCT)影像学特征.方法 回顾性分析2020年1—4月于自贡市第一人民医院行COVID-19核酸检测阳性的9例患者的临床资料,所有患者均行HRCT检查,分析影像学特征.结果 9例患者共接受了40次HRCT扫描,平均间隔时间4.3 d.分析患者每次HRCT扫描的影像学表现,发现病情最严重时期为入院后第8天,表现为病灶呈大小不等磨玻璃影9例,实变影7例,实变病灶跨肺段但不累及整个肺段,其周围及病灶内可见增粗肺动脉及肺静脉、局部小叶间隔增厚呈铺路石征改变6例,部分血管穿行于病灶内,部分血管呈集束征改变;实变影内见厚壁小支气管穿行6例,但通畅;病灶位于肺外周或胸膜下8例;病灶呈多发6例;病灶内均未见空洞、钙化、淋巴结肿大,少见胸腔积液征象,相邻胸膜轻度增厚.入院9 d后病灶逐步吸收,影像学表现为实变影较前密度减低、变淡,边界出现,磨玻璃影随住院时间延长逐步吸收,部分残留纤维索条影,部分完全吸收,增粗血管恢复至正常状态;对于伴有基础疾病的患者,肺部病灶范围更广,实变影更多,吸收过程变慢.结论 COVID-19患者的HRCT影像学表现具有一定的特征,且其特征在疾病诊断、治疗中起着至关重要的作用.

目的 探讨不同密度结节状周围型的以附壁生长方式为主的浸润性肺腺癌(LPA) CT征象及T分期.方法 回顾性分析经手术病理证实的73例LPA共75例肺结节的术前CT图像及术后病理标本,对不同CT密度类型的LPA结节组间CT征象及T分期进行对比分析.结果 75例结节有纯磨玻璃结节(pGGN) 32例和混合磨玻璃结节(mGGN)43例,结节最大径、结节形态、毛刺征、血管集束征及异常支气管征在pGGN型和mGGN型LPA 2组间有统计学差异(P＜0.05),mGGN型最大径大于pGGN型,mGGN型以不规则形为主,pGGN型多为圆形或类圆形,毛刺征、血管集束征及异常支气管征更多见于mGGN型LPA;结节脏层胸膜侵犯及T分期在2组间有统计学差异(P＜0.05),脏层胸膜侵犯多见于mGGN型LPA,mGGN型LPA结节T分期晚于pGGN型;胸膜凹陷征及含气腔征在2组间无统计学差异(P＞0.05).结论 不同CT密度的LPA结节影像特征存在差异;mGGN型LPA结节更容易侵犯脏层胸膜,T分期晚于pGGN型.

目的:探讨表现为局灶磨玻璃密度(fGGO)的浸润性肺腺癌(IPA)CT征象与Ki-67表达水平的关系.方法:回顾性分析106例fGGO型IPA的CT图像和Ki-67免疫组化结果,分别对纯磨玻璃(pGGO)型和混合磨玻璃(mGGO)型IPA Ki-67高(≥20％)、低(<20％)增殖指数组间CT征象进行对比研究.结果:31例pGGO型IPA中,Ki-67高增殖指数组结节密度高于低增殖指数组(P<0.05),两组间大小及形态无统计学意义(P>0.05);绘制结节密度ROC曲线,曲线下面积(AUC)为0.711,鉴别pGGO型IPA Ki-67高、低增殖指数敏感度为74.2％,特异度为64.1％.75例mGGO型IPA中,Ki-67高增殖指数组结节密度高于低增殖指数组(P<0.05),不规则形、分叶征及毛刺征在Ki-67高增殖指数组多于低增殖指数组(P<0.05),两组间结节大小、空泡征、异常支气管征、血管集束征及胸膜凹陷征无统计学意义(P>0.05);绘制结节密度ROC曲线,AUC为0.812,鉴别mGGO型IPA Ki-67高、低增殖指数敏感度为84.3％,特异度为66.4％.结论:fGGO型IPA的部分CT征象与Ki-67的高、低不同表达有关.

小肠具有长度长、活动度大的特点,小肠疾病目前仍是各种临床相关检查检出率减少的部位;小肠肿瘤以间质瘤、脂肪瘤多见,恶性肿瘤以腺癌常见且好发于十二指肠,而原发于小肠的肉瘤样癌临床上极罕见;多层螺旋CT扫描是目前首选检查方法,对于小肠肿瘤的诊断具有较大的帮助.

患者男,67岁,无明显诱因右上腹持续性钝痛3天,不伴恶心、呕吐等;9个月前因胆囊结石伴慢性胆囊炎接受腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC),术中夹闭胆囊管残端及胆囊动脉,并各留置钛合金夹1枚.查体:右上腹压痛(+),无反跳痛及肌紧张.实验室检查未见明显异常.腹部增强CT:十二指肠球部见长约1.4 cm高密度异物,一端紧贴肝脏,一端突人肠腔(图1A、1B),考虑异物致十二指肠穿孔.急诊胃镜:十二指肠球部前壁金属异物嵌顿,邻近肠黏膜水肿、出血(图1C),结合患者既往LC史,考虑为LC后钛合金夹游走致十二指肠穿孔.于胃镜下钳出钛合金夹,留院观察3天,患者无不适后出院.