20 December 2023, Volume 42 Issue 12
    

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  • Prognostic Value of ASPECTS on Post-Treatment Diffusion Weighted Imaging for Acute Ischemic Stroke Patients after Endovascular Thrombectomy
    WU Jiang, ZHU Yan, BAI Genji, et al
    Journal of Clinical Radiology. 2023, 42(12): 1866-1870.
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    Objective To assess the value of Alberta Stroke Program Early CT Score (ASPECTS) on post-treatment diffusion weighted imaging for acute ischemic stroke of the middle cerebral artery after endovascular thrombectomy,and compare it with that of infarction volume. Methods A total of 121 patients with acute ischemic stroke of the middle cerebral artery after endovascular thrombectomy from March 2019 to February 2022 were enrolled from the Department of Neurology,Huai'an First Hospital Affiliated to Nanjing Medical University.According to the modified Rankin Scale (mRS) at 3 months,the patients were divided into 2 groups:the favorable outcome group (mRS of 0-2) and the unfavorable outcome group (mRS of 3-6).The clinical datas and imaging indicators were compared between the two groups.Logistic regression was used to analyze the above statistically significant variables and the prognostic value of post-treatment DWI-ASPECTS and infarction volume were assessed and compared using receiver-operating-characteristic curves and the DeLong method. Results Out of 121 patients,there were 67 patients in the favorable outcome group with bleeding transformation occurred in 17 cases (25.4%) and 54 patients in the unfavorable outcome group with bleeding transformation occurred in 30 cases (55.5%).The DWI-ASPECTS of the good outcome group were higher,the infarction volume was lower and the NIHSS score at admission was lower,which was statistically significant compared with the unfavorable outcome group (P<0.05).Logistic regression analysis showed that NIHSS score at admission (OR=1.111,P=0.048),DWI-ASPECTS score (OR=0.315,P=0.00) and infarction volume (OR=1.068,P=0.00) were independent predictors of unfavorable outcome after endovascular thrombectomy in both two models.ROC analysis showed that the area under the ROC curve of DWI-ASPECTS was 0.887 (95%CI:0.827-0.948),and the cutoff value of post-treatment DWI ASPECTS score for predicting unfavorable outcome was set at 5.5 with the sensitivity was 73.1% and the specificity was 87%,which was comparable with that of infarction volume with the AUC was 0.907(95%CI:0.854-0.960),the cut-off volume was 86.5 ml,the sensitivity 68.5% and the specificity 98.5%. Conclusion Post-treatment DWI-ASPECTS might be a potential surrogate of infarction volume for predicting functional outcome in patients with acute ischemic stroke of the middle cerebral artery after endovascular thrombectomy.
  • Study of Radiation Dose of Contrast-Enhanced Spectral Mammography
    XIONG Ying, RONG Xiaocui, WANG Hongguang, et al
    Journal of Clinical Radiology. 2023, 42(12): 1871-1875.
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    Objective To evaluate the radiation dose of contrast-enhanced spectral mammography (CESM). Methods 183 patients who were completed the CESM and digital breast tomosynthesis (DBT) examination in our hospital from March 2020 to July 2022.Analyzed the average glandular dose (AGD) of CESM and the correlation of AGD with compressed breast thickness in different examination positions.Compared the total-AGD of CESM with the AGD of DBT and European diagnostic reference level (including acceptable level and achievable level). Results The median total-AGD of CESM in cranio-caudal (CC) and medial lateral oblique (MLO) were 1.89 mGy(1.74 mGy,2.31 mGy),2.04 mGy(1.77 mGy,2.62 mGy).The AGD of CC was lower than that of MLO (Z=-6.02,P<0.05).The AGD of low energy (LE-AGD) of CESM accounts for 74%-83% of the total-AGD,and the AGD of high energy (HE-AGD) of CESM accounts for 17%-26% of the total-AGD.The compressed breast thickness was moderately or strongly correlated with LE-AGD,HE-AGD and total-AGD,and the correlation coefficients (CC/MLO) were 0.602/0.758,0.841/0.857,0.763/0.832,respectively.The total-AGD of CESM was higher (about 30%) than that of DBT(CC:Z=-14.61,P<0.05;MLO:Z=-14.78,P<0.05).CESM total-AGD was higher than that of the achievable level.When the compressed breast thickness was above or equal to 30mm,CESM total-AGD was always lower than that of the acceptable level;When the compressed breast thickness was less than 30 mm,CESM total-AGD was slightly higher than that of the acceptable level. Conclusion The radiation dose of CESM is higher than that of DBT,which is positively correlated with the compressed breast thickness.Within the range of each compressed breast thickness,the radiation dose of CESM is within the diagnostic reference level.
  • Differential Diagnostic Value of Diffusion Kurtosis Combined with Dynamic Enhanced Magnetic Resonance Imaging for Prognostic Factors in Breast Cancer
    YANG Zili, SHAO Kai, ZHAO Fan, et al
    Journal of Clinical Radiology. 2023, 42(12): 1876-1881.
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    Objective To investigate the predictive value of diffusion kurtosis imaging(DKI) and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) for the prognostic factors in breast cancer. Methods A total of 150 cases of breast cancer patients confirmed by pathology were collected.DKI and DCE-MRI scanning were performed in all patients.The mean diffusion rate (MD),mean kurtosis value (MK),volume transfer constant (Ktrans),extravascular extracellular space distribute volume per unit tissue volume(Ve) and rate constant(Kep) were analyzed.The diagnostic the diagnostic efficacy was analyzed by receiver operating characteristic curve. Results MD and Ktrans values in the ER negative group were higher than that of positive group (P<0.05).The HER-2 positive group had higher Ktrans value and lower Ve value than that of the negative group (P<0.05).MD,MK,Ktrans,Kep values were significantly different between the axillary lymph node metastasis and non-metastasis groups(P<0.05).MK and Ktrans and Kep in high-grade group were higher than that of the low-grade group,while MD was lower than low-grade group (P<0.05).The MK and Kep values of high-stage TNM group were higher than those of the low-stage group (P<0.05).MK and Ktrans and Kep values were higher in the Ki-67 high expression group than those of the lower expression group,while MD was smaller than that of the low expression group (P<0.05).MK and Ktrans and Kep values in high-grade Nottingham group (NPI ≥ 3.4) were higher than those of the low-grade Nottingham group (NPI <3.4) and MD was less than the low-grade Nottingham group (P<0.05).The combination of MD+MK+Ktrans+Kep showed moderate positive correlation with Nottingham index (r=0.612,P<0.01).The AUC was 0.887,which was higher than a single parameter (Z=1.986-3.403;P＜0.05),the sensitivity is 75.0%,the specificity is 89.5%,and the accuracy is 85.3%. Conclusion DKI combined with DCE-MRI can be used to predict prognostic factors in breast cancer and provide a reference for clinical treatment and prognostic evaluation.
  • The Value of Predicting Axillary Lymph Node Metastasis in Patients with Breast Cancer Based on Dynamic Contrast-Enhanced Magnetic Resonance Imaging and Intravoxel Incoherent Motion
    LI Meiqin, SONG Weiwei, ZHAO Fan, et al
    Journal of Clinical Radiology. 2023, 42(12): 1882-1886.
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    Objective To assess the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and Intravoxel incoherent motion(IVIM) for predicting the risk of axillary lymph node (ALN) metastasis in patients with breast cancer. Methods A total of 166 cases of breast cancer patients confirmed by pathology were collected.Seventy-seven patients had axillary lymph node metastasis (axillary lymph node,ALN),and 89 patients had no axillary lymph node metastasis.DCE-MRI and IVIM scanning were performed in all patients.The volume transfer constant(Ktrans),extravascular extracellular space distribute volume per unit tissue volume(Ve) and rate constant(Kep) and true diffusion coefficient (D),perfusion-related diffusion coefficient (D*),perfusion fraction (f)were analyzed.The diagnostic performance of these models was evaluated by Receiver Operating Characteristic Curve (ROC) analysis. Results Symptoms of vascular and nerve invasion in breast cancer with ALNmetastasis were more common than those of non-metastases,and Ki-67 was more highly expressed (P<0.001).The D value of the ALN metastasis group was lower than that of the non-ALN metastasis group (P<0.001),showing a low degree of negative correlation (r=-0.422,P<0.001).The D*,Ktrans,and Kep values of the ALN metastasis group were higher than those of the non-ALN metastasis group (P=0.016,P=0.004,P＜0.001).The Ktrans value was moderately positively correlated with ALN metastasis (r=0.516),and the Kep and D* values were low-grade positively correlated with ALN metastasis(r=0.223;r=0.187). Conclusion The features of DCE-MRI and IVIM parameters can be used to predict the ALN metastasis in patients with breast cancer.Ktrans has higher diagnostic accuracy.DCE-MRI combined with IVIM showed higher diagnostic efficiency for ALN metastasis in breast cancer than single model.
  • Quantitative-Semanticfeatures of Low-Dose CT for Predicting the Poorly Differentiated Invasive Non-Mucinous Pulmonary Adenocarcinoma
    WANG Lu, LIU Jieke, XU Fuyang, et al
    Journal of Clinical Radiology. 2023, 42(12): 1887-1894.
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    Objective Poorly differentiated invasive non-mucinous pulmonary adenocarcinoma (IPA),based on the novel grading system,was related to poor prognosis,with a high risk of lymph node metastasis and local recurrence.This study aimed to build the quantitative-semantic model of low-dose CT (LDCT) and evaluate its diagnostic performance for distinguishing the poorly differentiated invasive non-mucinous pulmonary adenocarcinoma (IPA) from well/moderately differentiated IPA manifesting as solid or part-solid pulmonary nodules. Methods A total of 259 patients,who underwent preoperative LDCT scan and were pathologically diagnosed with IPA,were included from July 2018 to December 2021.Nodules were assigned to well/moderately differentiated IPA (n=195) and poorly differentiated IPA (n=64) according to the pathological results.The quantitative features,including average diameter,volume and mean attenuation,the semantic features,including nodule type,shape,margin,interface,lobulation,spiculation,pleural indentation,air bronchogram,vacuole sign and vessel convergence sign,and clinical features,including age and gender,were included in our study.The independent risk predictors and predictive model were determined through multivariable logistic regression.The diagnostic performance was assessed by area under curve (AUC) of receiver operating characteristic (ROC) curve,accuracy,sensitivity,and specificity.Delong test was used for comparisons of the AUCs among independent risk predictors and predictive model. Results Diameter (OR=1.195,95%CI:1.072-1.332,P=0.001),mean attenuation (OR=1.009,95%CI:1.006-1.012,P<0.001),vacuole sign (OR=15.610,95%CI:1.679-145.175,P=0.016) and vessel convergence sign (OR=3.134,95%CI:1.031-9.526,P=0.001) wereindependent risk predictorsfor predicting the poorly differentiated IPA.Those features werefurther selected to build the quantitative-semantic model.The AUC of quantitative-semantic model was 0.937 (95% CI:0.900-0.963),which was significantly higher than any other independent risk factors according to Delong test (all P< 0.05).The accuracy,sensitivity and specificity of the quantitative-semantic model was 0.861 (95% CI:0.813-0.910),0.906 (95% CI:0.807-0.965),and 0.846 (95% CI:0.788-0.894),respectively. Conclusion The quantitative-semantic model of LDCT,which could preoperatively predict the poorly differentiated IPA with excellent diagnostic performance in lung cancer screening,mightoffer clinical value for optimizing therapeutic decisions.
  • Application of CT Radiomics Models in Predicting Early Efficacy of Chemotherapy in Patients with Lung Cancer
    ZHANG Chu, WU Shaohong, DUAN Shaofeng, et al
    Journal of Clinical Radiology. 2023, 42(12): 1895-1899.
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    Objective To investigate the application value of radiomics in predicting early efficacy of chemotherapy in patients with lung cancer. Methods A total of 202 patients with lung cancer were selected which were pathologically confirmed from January 2017 to January 2022,the patients were divided into two groups:partial response (PR) (n=100) and progressive disease (PD) (n= 102) according to RECIST 1.1 criteria.The chest CT DICOM files of the enrolled patients were imported into the open source image segmentation software ITK-SNAP for ROI delineation,and then the radiomics features were extracted.According to the ratio of 7∶3,they were randomly assigned to the training group and the test group and establish radiomics models,and finally evaluate the diagnostic and predictive efficacy of model according to the area under the receiver operating characteristic curve (AUC),sensitivity,and specificity. Results The AUC value,specificity and sensitivity of the training group were 0.737 (95%CI:0.656-0.819),0.71 and 0.67;The AUC value,specificity and sensitivity of the validation group were 0.722 (95%CI:0.594-0.851),0.77 and 0.53.The model achieved good clinical efficacy. Conclusion CT-based radiomics has a high diagnostic value for predicting early efficacy of chemotherapy in patients with lung cancer.
  • Study of Relationship between Cardiac Magnetic Resonance Late Gadolinium Enhancement and Histological Myocardial Fibrosis based on the Transplanted Heart Specimen
    YANG Jianchang, REN Guanmin, HUANG Huimin, et al
    Journal of Clinical Radiology. 2023, 42(12): 1900-1906.
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    Objective We evaluated the relationship of fibrosis assessment by Cardiac magnetic resonance(CMR) late gadolinium enhancement (LGE) techniques with human histology based on the ex-vivo whole heart specimen. Methods Preoperative CMR-LGE examination was performed on 22 patients with heart disease who were to undergo heart transplantation.After transplantation,16 segments of the whole heart were collected and stained with Sirius red,and the collagen volume fraction (CVF) was quantified.The relationships were observed between CVF and LGE measuredby“n”-standard deviations (SD) approach and full width half maximum (FWHM). Results For patients with LGE on CMR images (13 cases),significant correlations were observed between LGE and CVF,withstrongest correlation measured at 6 SD(r=0.783,P=0.02).Bland-Altman analysis revealed optimum agreementbetween CVF and LGE measured at 6 SD (bias:-0.95).In ischemic cardiomyopathy (ICM) group,strong correlation was observed between CVF and LGE measured by FWHM(pre patient,r=0.932,P=0.002).In non-ischemic cardiomyopathy (NICM) group,moderate correlation was observed between CVF and LGE measured at 8 SD(pre LGE + segment,r=0.674,P<0.001). Conclusion As a non-invasive examination to evaluate myocardial fibrosis,CMR-LGE measured by FWHM and 8 SD yields the closest approximation to the extent of patients with ICM and NICM fibrosis measured by the histopathological standard of reference.
  • Prediction of Risk Factors for the Growth of Subsolid Pulmonary Nodules on Thin-Section CT During Long-Term Follow-Up
    HE Yifan, XIONG Ziqi, ZHANG Jingyu, et al
    Journal of Clinical Radiology. 2023, 42(12): 1907-1912.
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    Objective To explore the natural course of growth,growth rate,and risk factors for the appearance of subsequent growth in subsolid nodules (SSN) with long-term follow-up,in order to help clinical formulation of a reasonable follow-up management strategy. Methods This study retrospectively enrolled 149 SSNs from 132 patients.The diameter,overall mean-CT attenuation (m-CTA),and volume of each SSN were obtained by manual segmentation,followed by calculation of mass,volume doubling time (VDT),and mass doubling time (MDT).SSNs were divided into growth and non-growth groups,and the differences in baseline clinical and radiological features between the two groups were compared.Independent risk factors affecting SSN growth were analyzed using Kaplan-Meier curves and multivariate Cox proportional risk regression. Results The median follow-up time for 149 SSNs was 1313.0 (range:376.0-4703.0) days.Eighty-eight (59.1%) SSNs showed growth with median VDT and MDT of 1093.7 (range:156.3-6799.0) and 1003.9 (range:142.3-7264.5) days,respectively.Multivariate Cox risk regression analysis showed that age ≥68 years (HR=2.965,P<0.001),initial m-CTA ≥ -487 HU (HR=2.313,P=0.017) and vacuole sign (HR=1.870,P=0.008) were independent risk factors for SSN growth. Conclusion SSNs show an indolent growth course.In older adults,SSNs with vacuole signs and larger initial m-CTAs may be of greater concern,as these factors are significantly associated with SSNs growth.
  • Application of 3D CT Radiomics Characteristics in Prediction of Chemotherapy Efficacy for Advanced Lung Squamous Cell Carcinoma
    WU Mingming, CHEN Aiqi, TANG Congcong, et al
    Journal of Clinical Radiology. 2023, 42(12): 1913-1917.
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    Objective A 3D CT imaging omics model was established to evaluate the chemotherapy efficacy of platinum-containing two-drug combination regimen in the treatment of advanced lung squamous cell carcinoma,in order to help the selection and adjustment of later treatment regimen. Methods The imaging data of 127 patients with advanced lung squamous cell carcinoma confirmed by pathology in the First Affiliated Hospital of Bengbu Medical College,Anhui Province from January 2019 to December 2021 were retrospectively analyzed.Chest CT images of mediastinal window before chemotherapy and chest CT images of two cycles after chemotherapy were selected.According to the efficacy evaluation criteria for solid tumors (RECIST 1.1),the patients were divided into effective group (78 cases) and ineffective group (49 cases).The data were randomly divided into training group and test group according to 4∶1 by using Hui Ying big data artificial intelligence scientific research platform.The images of patients before chemotherapy were selected to delineate the region of interest (ROI),extract the imaging omics features of lesions,establish and verify the prediction model.The model was evaluated by receiver operating characteristic (ROC) curve. Results In the training group,the AUC of the effective group was 0.82(0.74,0.91),the accuracy was 0.65,the specificity was 0.74 and the sensitivity was 0.74.In the invalid group,AUC was 0.82(0.74,0.91),accuracy was 0.84,specificity was 0.77,sensitivity was 0.77.In the test group,the AUC of the effective group was 0.76(0.77-0.96),the accuracy was 0.70,the specificity was 0.81 and the sensitivity was 0.81.The AUC of the invalid group was 0.76(0.77-0.96),the accuracy was 0.81,the specificity was 0.70,and the sensitivity was 0.70. Conclusion The mediastinal window 3D imaging omics model based on pre-treatment enhanced CT can accurately evaluate the efficacy of advanced lung squamous cell carcinoma before chemotherapy,which has certain guiding value for the individualized treatment of patients.
  • Study on Predictive Value of Refractory Mycoplasma Pneumonia Based on Quantitative CT
    HU Tian, LEI Yu, YIN Weiling, et al
    Journal of Clinical Radiology. 2023, 42(12): 1918-1921.
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    Objective To explore the value of quantitative CT index in the prediction of refractory mycoplasma pneumonia by laboratory index model. Methods A total of 197 children with mycoplasma pneumoniae pneumonia (MPP) diagnosed in the affiliated Hospital of Yan'an University from January 2019 to May 2021 were enrolled retrospectively,including 60 children with refractory type and 137 children with common type.All children underwent CT scan and laboratory examination after admission.The chest CT was quantitatively analyzed by computer aided diagnosis and analysis software of pulmonary infection.The laboratory index and quantitative CT index were analyzed by Mann-Whitney U test or χ2 test,and the reclassification improvement index (NRI),comprehensive discriminant improvement index (IDI) and ROC were used to evaluate the value of quantitative CT index in predicting the ability of children with refractory mycoplasma pneumonia. Results The difference analysis of clinical symptoms between the two groups showed that RMPP group was older,had longer hospital stay and had more severe clinical symptoms than GMPP group (P<0.05).The difference analysis of laboratory indexes showed that the ratio of CRP,LDH and neutrophils in peripheral serum of RMPP group was higher than that of GMPP group,while the lymphocyte ratio was lower than that of GMPP group.The IgM of RMPP was higher than that of GMPP,while IgG was lower than that of GMPP.The quantitative parameters of LeV,LeV%,MLeD,LM and GGO in CT group were higher than those in GMPP group.The GGO(-300) was lower than GMPP group.With the addition of quantitative CT index,the predictive efficiency of the clinical model of refractory children was improved.The NRI of the LeV% model was 0.9515,the NRI of the GGO model was 0.7886,and the IDI of the model with all quantitative CT indexes was 0.1199.the NRI of the model with all quantitative IDI indexes was 1.1004 and 0.2583 (P<0.01). Conclusion Quantitative CT can significantly improve the predictive efficiency and differential ability of clinical models in children with RMPP.
  • Development and Validation a Combined Model Based on Radiomics Extracted from Enhanced-CT and Clinical Parameters to Evaluate Microvascular Invasion of Hepatocellular Carcinoma
    XIANG Shouhong, FU Langzhou, ZHOU Daiquan, et al
    Journal of Clinical Radiology. 2023, 42(12): 1924-1932.
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    Objective Based on preoperative enhanced CT images of arterial phase and venous phase to extract imaging omics parameters combined with clinical parameters to construct a combined clinical imaging model to evaluate whether microvascular invasion in patients with hepatocellular carcinoma. Methods The Third Affiliated Hospital of Chongqing Medical University and the University Town Hospital of Chongqing Medical University were retrospectively included.From March 2016 to March 2021,there were pathologically confirmed hepatocellular carcinoma (microvascular invasion,MVI) hepatocellular carcinoma (MVI) after surgery HCC patients.With HCC patients from the Third Affiliated Hospital of Chongqing Medical University as the first center,the MVI-positive and MVI-negative patients were divided into training group and internal test group according to the 7∶3 ratio based on the principle of stratified randomization.The Affiliated University of Chongqing Medical University The patients in the city hospital belonged to the external verification group.After the primary lesions were segmented for all patients,the imaging omics features were extracted according to the arterial phase and the venous phase.Take the MVI positive of the patients in the training group as the research label,and use Max-Relevance and Min-Redundancy (Max-Relevance and Min-Redundancy,mRMR and the Least absolute shrinkage and selection operator,LASSO) to reduce the imaging features,and Construct radioomics signature (Radiomics signature,Radscore);then perform feature reduction of clinical parameters,use whether the patients in the training group are MVI positive as the research label,and use multiple logistic regression to construct clinical model clinics.At the same time,the clinical parameters in the combined clinical model are included Build a multiple logistic regression model with Radscore to evaluate whether patients in the training group are MVI positive,use receiver operating characteristic curve (ROC) to evaluate the efficacy of Radscore,Clinics and the combined model in diagnosing MVI positive,and use Hosmer-Lemeshow test to evaluate the model Differences with actual observations,and use the clinical decision curve analysis (decision curve analysis,DCA) to evaluate the clinical benefits of Radscore,Clinics and the combined model. Results Finally,9 venous stage features were retained to construct Radscore.Radscore evaluated the AUVs of MVI-positive patients in the training group,internal test group,and external verification group to be 0.906,0.873,and 0.793,respectively.The variance inflation factoer (VIF) was screened out.After clinical parameters ≥5,a total of four clinical parameters (Age,Clinical stage,AFP,Diameter CT) are retained based on the minimum AIC principle to construct a clinical model Clinics,Radscore and four clinical parameters are combined to construct a joint model,and the joint model in the training group the diagnostic power (AUC=0.989) was significantly higher than the clinical model (AUC=0.953,P=0.023) and Radscore (AUC=0.905,P=0.0002);the diagnostic power of the combined model in the test group (AUC=0.984) was significantly higher than Radscore (AUC=0.872,P=0.018),higher than the clinical model (AUC=0.957),the difference was not statistically significant (P=0.2444);the clinical model and Radscore had no significant difference between the training group and the test group (P= 0.121,P=0.119),using Hosmer-Lemeshow test to show that the joint model and actual There was no statistical difference between the observed values (P=0.995,P=0.662).The clinical decision curve analysis showed that the clinical benefit of the combined model was always higher than that of the clinical model and Radscore. Conclusion The construction of a combined model based on enhanced CT arterial phase combined with venous phase extraction of imaging features combined with clinical parameters can help clinically evaluate whether HCC patients are positive for MVI before surgery.
  • CT Measurement and Evaluation of Liver Cirrhosis Complicated with Spontaneous Portosystemic Shunt and Analysis on Risk Factors of Complications
    ZHANG Huan, XING Tenglong, HUO Xiankai, et al
    Journal of Clinical Radiology. 2023, 42(12): 1933-1938.
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    Objective To measure the imaging data of patients with liver cirrhosis complicated with spontaneous portosystemic shunt (SPSS),and analyze the correlation and influence on complications of liver cirrhosis. Methods The clinical and imaging data of 49 patients with SPSS were collected,and the linear relationship between the maximum diameter of the portosystemic shunt vein and the diameter of liver,spleen and portal vein branches was analyzed,as well as the influence on hepatic encephalopathy,upper gastrointestinal hemorrhage,portal vein thrombosis and ascites. Results Grouping was carried out according to the shunt diameter of 1 cm,and there were 29 cases with shunt diameter over 1 cm (59.18%,high shunt group) and 20 cases with shunt diameter less than 1 cm (40.82%,low shunt group).There were statistical differences in Child-Pugh score and grade,liver to abdominal area ratio (LAAR),spleen length,portal vein and multiple branch diameters between the two groups (P＜0.05).In the high shunt group,the shunt diameter was linearly correlated with LAAR,the diameter of the left branch of portal vein and the diameter of splenic vein (B=-1.222、1.306、0.726,P＜0.05);in the low shunt group,theshunt diameter was correlated with wireless factors.Theshunt diameter >1 cm was a risk factor for hepatic encephalopathy and portal vein thrombosis(OR=1.318、1.236,P＜0.05).SPSS was not clearly associated with upper gastrointestinal bleeding and ascites. Conclusion The shunt diameter＞1 cm can be used as the critical value to judge the compensatory state of SPSS;The shunt diameter>1 cm is a risk factor for hepatic encephalopathy and portal vein thrombosis;Imaging measurement has certain predictive value for complications of liver cirrhosis.
  • Prediction of T-Stage of Rectal Cancer after Neoadjuvant Therapy Based on Multi-Parameter Model of Magnetic Resonance Radiomics
    GUO Xiaofang, YUAN Zilong, WANG Boquan, et al
    Journal of Clinical Radiology. 2023, 42(12): 1939-1945.
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    Objective Accurate T staging is helpful for individualized treatment of rectal cancer.The purpose of this study was to investigate the value of MRI multiparameter radiomics model in predicting posttreatment T (pT) stage of rectal cancer after neoadjuvant therapy. Methods This study retrospectively analyzed the pretreatment clinical featuresn and pT stage of 171 rectal cancerpatients,which confirmed by pathological who underwent 3 T MRI examination before neoadjuvant therapy and radical resection after neoadjuvant therapy.According to the pathological T stage,the patients were divided into lower stage group (pT 0-2)(n=71) and higher stage group(pT 3-4)(n=100).ITK-SNAP software was used to manually draw the rectal cancer tumor as the region of interest (ROI) layer by layer on the images of T2WI and enhanced T1WI,respectively.Pyradiomics software was used to extract all radiomics features in ROI.The characteristics with good retention stability (ICC≥0.75) were analyzed by intraclass correlation coefficient (ICC).The minimum absolute constriction and selection operator (LASSO) method was used to screen the most relevant features of pT from T1WI,T2WI and fusion features including T1WI,T2WI and clinical features).Clinical features associated with pT were screened out by statistical analysis.The selected T1WI radiomics features,T2WI radiomics features,clinical features and fusion features were used to construct the pT prediction models by logistic regression (LR) method,including clinical model,T1WI radiomics model,T1WI radiomics model and fusion model.The fusion model was constructed by nine T1WI,twelve T2WI radiomics features and four clinical features [including maximum lymph node short diameter (Lnmax),extra-intestinal vascular invasion (EMVI),baselineT stage (rT) and N stage (rN)].The performance of the models were evaluated by receiver operating characteristic (ROC) curve and calibration curve.Delong test was used to compare the differences between the models.The decision curve was used to evaluate the clinical application value of the models. Results In the training set,the area under the curve (AUC) of T1WI,T2WI,clinical model and fusion model were 0.868,0.921,0.713 and 0.967,respectively,and the corresponding AUC were 0.761,0.842,0.689 and 0.932 in the test set.The efficacy of T1WI and T2WI models were comparable and higher than that of clinical model,and the fusion model achieved the best predictive efficacy. Conclusion The clinical imaging findings,T1WI and T2WI radiomics features of rectal cancer can predict pTstage after neoadjuvant therapy,and the accuracy of predicting pTstage can be improved by multi-parameter MRI radiomics model incorporating clinical features.
  • The Value of Quantitative CT Body Composition Analysis in Predict the Recurrence and Metastasis of Gastric Cancer Treated by Surgery and Adjuvant Chemotherapy
    WEI Longyu, FU Baoyue, WANG Peipei, et al
    Journal of Clinical Radiology. 2023, 42(12): 1946-1950.
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    Objective To explore the value of quantitative CT (QCT) body composition parameters before and after surgery combined with chemotherapy in evaluating recurrence and metastasis of gastric cancer patients. Methods Retrospective analysis was performed on 78 patients with gastric cancer confirmed by pathology.The data of gender,age,carcinoembryonic antigen,carbohydrate antigen 199,maximum tumor diameter,tumor stage and pathological type were recorded.All patients received QCT scanning before and after treatment,and QCT parameters were measured twice before and after treatment,including bone mineral density (BMD) of L1 and L2 vertebrae,subcutaneous fat area (SFA),visceral fat area (VFA),total fat area (TFA) and paravertebral muscle area (MA) at L3 vertebral level.The change rate of QCT parameters were calculated after the QCT scan interval was standardized as 120 days.The best cut-off values of QCT parameters for predicting recurrence and metastasis of gastric cancer patients after treatment was obtained by drawing ROC curve.The independent sample t-test,Mann-Whitney U test and Fisher’s exact test were used for univariate analysis.For the factors with significant differences,multivariate logistics regression was conducted to determine the independent factors in predicting the recurrence and metastasis of gastric cancer patients after operation. Results ΔBMD,ΔSFA,ΔVFA,ΔTFA,ΔMA were -3.78%,-3.35%,-4.65%,-9.62% and -5.62%,respectively.Univariate analysis showed that ΔBMD,ΔSFA,ΔVFA,ΔTFA and ΔMA were the influencing factors for the recurrence and metastasis of gastric cancer (P<0.05).Multivariate logistics regression analysis showed that ΔBMD and ΔMA were independent risk factors for the recurrence and metastasis of gastric cancer (P<0.05). Conclusion ΔBMD and ΔMA are related to the recurrence and metastasis of gastric cancer patients receiving surgery combined with adjuvant chemotherapy.QCT body composition analysis has certain reference value in evaluating the recurrence and metastasis of gastric cancer patients aftertreatment.
  • Study on the Relationship between the Characteristics of Peritumoralvein and WHO/ISUP Grade of Renal Clear Cell Carcinoma Based on Preoperative Enhanced CT
    SHI Yuting, NI Liangping, ZHANG Dai, et al
    Journal of Clinical Radiology. 2023, 42(12): 1951-1955.
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    Objective To explore the relationship between the characteristics of peritumoral veins and WHO/ISUP grade in clear cell renal cell carcinoma(ccRCC) based on preoperative enhanced CT. Methods The data of 250 patients with postoperative pathologically confirmed ccRCC with clear pathological grades from May 2018 to December 2021 at the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed.The peritumoral veins of ccRCC were defined as asymmetrically increased and irregularly shaped vessels adjacent to the affected kidney within Gerota's fascia in the parenchymal stage.The 250 cases were divided into two groups according to the presence or absence of peritumoral veins.The imaging features of the two groups were observed and the relationship between the presence or absence of peritumoral veins and WHO/ISUP classification was analyzed.For cases with peritumoral veins,the relationship between the number of branches,maximum diameter,spatial configuration (with and without crossings) of peritumoral veins and WHO/ISUP grade was further analyzed.Spearman correlation was used to analyze the correlation between the number of peritumoral veins and WHO/ISUP grade. Results There were 146 (58.4%) patients with peritumoral veins and 104 (41.6%) patients without peritumoral veins in 250 patients with ccRCC.Compared with patients without peritumoral veins,patients with peritumoral veins have larger tumor diameter and are more prone to cystic necrosis (P< 0.05).There was no statistically significant difference in age,gender,BMI,tumor location,and presence of cancerous emboli between the two groups (P> 0.05).There were significant differences in the presence,absence,number and spatial configuration of peritumoral veins between ccRCC patients and WHO/ISUP classification (P< 0.05).There was a positive correlation between the number of peritumoral veins and WHO/ISUP grade (r was 0.310,P< 0.001).There was no significant difference between the maximum diameter of peritumoral vein and WHO/ISUP grade (P> 0.05). Conclusion The characteristics of peritumoral veins in ccRCC are related to WHO/ISUP grade,and preoperative evaluation of peritumoral veins is of guiding significance for clinical treatment decision of patients.
  • Diagnostic Value of IVIM-DWI Combined with DCE-MRI Quantitative Parameters in Predicting Type Ⅰ and Type Ⅱ Endometrial Carcinoma Preoperative
    JIANG Xueyan, FU Baoyue, ZHANG Yu, et al
    Journal of Clinical Radiology. 2023, 42(12): 1956-1961.
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    Objective To evaluate the diagnostic value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) combined with dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) in predicting type Ⅰ and type Ⅱ endometrial carcinoma(EC) preoperative. Methods Fifty patients with type Ⅰ(n=31) and type Ⅱ (n=19) EC confirmed by operation and pathology were analyzed retrospectively.IVIM-DWI and DCE-MRI were scanned,and the value of quantitative including ADC,D,D* and f of IVIM-DWI and Ktrans,Kep,Ve,Vp of DCE-MRI was measured for all patients and analyzed for their value in differentiating type Ⅰ and type Ⅱ EC.The diagnostic efficacy of each parameters was evaluated by drawing the receiver operating characteristic (ROC) curve,and the area under the curve (AUC) was compared by Delong Test. Results The ADC value and D value of type Ⅰ EC were significantly higher than those of type Ⅱ EC,and the D* value,Ktransvalue and Ve value were significantly lower than those of type Ⅱ EC,and the differences were statistically significant (P< 0.05 ).The AUC of ADC,D,D*,Ktrans and Ve values in predicting type Ⅰ and type Ⅱ EC were 0.855,0.735,0.705,0.694 and 0.722,respectively.The combined parameters (ADC,D,D*,Ktrans and Ve) had the highest efficacy in predicting type Ⅰ and type Ⅱ EC,with AUC of 0.924,which was better than D,D*,Ktrans and Ve alone (P< 0.05),and the sensitivity and specificity were 87.10 % and 94.74 %,respectively. Conclusion IVIM-DWI and DCE-MRI quantitative parameters has good diagnostic value in preoperative prediction of type Ⅰ and type Ⅱ EC,and the combined application can further improve the predictive efficiency.
  • BOLD-MRI in Evaluation of Renal Function and Pathological Injury in Chronic Glomerular Nephritis
    WANG Xinquan, GU Hongmei, YAN Jiaxin, et al
    Journal of Clinical Radiology. 2023, 42(12): 1962-1967.
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    Objective To explore the value of blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) in quantitative assessment of renal function and pathological damage degree in patients with chronic glomerular nephritis(CGN). Methods Blood oxygen level dependent magnetic resonance imaging was used on 19 healthy volunteers and 53 CGN patients.The R2* value of renal cortex and medulla was measured.The clinical data and renal pathological scores were recorded,and the relationship between renal R2* value and renal function and pathological injury in CGN patients was analyzed. Results The R2* values of renal cortex and medulla in the control group,mild injury CGN group and moderate-severe injury CGN group were statistically significant(F=10.171,P<0.001;F=19.666,P<0.001).The R2* values of renal cortex and medulla were negatively and positively correlated with eGFR(r=-0.570,P＜ 0.001;r=0.357,P＜0.009).The R2* values of renal cortex and medulla were correlated with all pathological scores and Cystatin C.The areas under the ROC curve(AUC) of cortical and medullary R2* values were 0.634 and 0.667 respectively when differentiating the control group from the mild injury CGN group.The AUC of cortical and medullary R2* values were 0.719 and 0.729 respectively when differentiating the control group from the moderate-severe injury group. Conclusion BOLD-MRI has the important predictive value for renal function and pathological damage degree in patients with CGN.
  • The Application Values of Cine Magnetic Resonance Imaging in the Accessing the Grading of Pelvic Organ Prolapse
    LI Shuang, LIU Ying, LV Weifu, et al
    Journal of Clinical Radiology. 2023, 42(12): 1968-1971.
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    Objective To compare the values of cine magnetic resonance imaging (cine-MRI) and pelvic organ prolapse quantification (POP-Q) examination in the evaluating and diagnosing the degree of pelvic organ prolapse(POP). Methods 80 POP cases diagnosed by POP-Q examination at Anhui provincial hospita from January 2021 to June 2022 were viewed as research targets,all patients were performed the cine-MRI to extracted the sagittal MRI images at rest and maximal Valsalva,the degree of POP was evaluated by measuring the vertical distance from the lowest edge of the organ to the pubococcygeal line (PCL) respectively and compared with the result of POP-Q examination. Results The distances from each anatomical landmarks on the vaginal wall to the marginal hymen are positively correlated with the vertical distance from each reference point of cine MRI to the PCL(P＜0.05),and compared with the posterior pelvic organ,cine-MRI possessed a better consistency in the accessing the grading of anterior and middle pelvic organ(χ2=24.686,P＜0.001),furthermore,the consistency of grading POP between POP-Q and cine-MRI were great in the anterior(Kappa=0.804,P＜0.001) and middle(Kappa=0.724,P＜0.001) pelvic organ but poor in the posterior pelvic organ(Kappa=0.325,P＜0.001). Conclusion cine-MRI scan can evaluate the degree of the anterior and middle pelvic organ,which can be established as effective supplements to the clinical examination.
  • MRI and Clinical Features of Soft Masses:Correlation with Pathologic Findings
    HUANG Wenxiao, GONG Liya, LUO Zhendong, et al
    Journal of Clinical Radiology. 2023, 42(12): 1972-1977.
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    Objective To evaluate the conventional clinical and MRI features of invasive and non-invasive soft tissue masses,and to improve the MRI diagnostic accuracy of soft tissue tumors as well as develop the individualized treatment protocols earlier. Methods The conventional MRI and Enhanced MRI of 160 patients with soft tissue lesions confirmed by operation and pathology were analyzed retrospectively.A total of eight indicators were analyzed,including the location of occurence,age,boundary(sharpness/not clear),peritumoral edema,heterogeneity(cystic/myxoid degeneration/necrosis,T2 signal characteristics,contrast characteristics and maximum diameter. Results A total of 160 patients,of which 51 cases were malignant,30 cases were intermediate with locally invasive,and 79 were benign.Univariate analysis showed:The 4 indexes in the 8 indexes were statistically significant differences between invasive and non-invasive lesions(P＜0.05),including the maximum diameter,age,boudary,peritumoral edema.Mutiple-factors analysis showed:The area under the curve(AUC) of 4 indexes in decreasing order was maximum diameter(0.788)＞peritumoral edema(0.718)＞boundary(0.648)＞age(0.629).The findings showed that the value of maximum diameter was greater.When the value of maximum diameter was more than the boundary value(5.2 centimeters),it indicated the possibility of malignancy. Conclusion The maximum tumor diameter,peritumor edema,boundary,and age have reference value in the differentiation of invasive and non-invasive soft tissue tumorsin a certain.Larger lesions (maximum tumor diameter >5.2 cm),ill-defined margins,peritumor edema,and older age (>48 years),combined with other serial information such as DWI(diffusion weighted imaging) and ADC(apparent diffusion coefficient),clinical history,and mass mobility,provide a reliable basis for differentiating invasive from non-invasive tumors.
  • The Analysis of MR Manifestations and Etiologies of Complications after Anterior Cruciate Ligament Reconstruction
    LI Xiaohai, XIE Guangyou, LIANG Lisong, et al
    Journal of Clinical Radiology. 2023, 42(12): 1978-1982.
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    Objective The analysis of MR manifestations and etiologies of complications after anterior cruciate ligament reconstruction. Methods A total of 76 patients with complications after ACLR due to anterior cruciate ligament (ACL) rupture in our hospital from January 2014 to December 2021 were collected as the research objects.All patients were treated with single bundle autogenous hamstring tendon ACLR.To analyze the effect of injury-operation interval,bone tunnel location and graft diameter on the occurrence of complications after ACLR. Results There were 90 graft complications,including tear (41.11%),bone tract cyst (21.11%),impingment (14.44%),joint fibrosis (14.44%),infection (6.67%) and myxoid degeneration (2.22%).There were more chronic complications (55.56%) than acute complications (44.44%) in 90 grafts,and the difference was statistically significant (χ2 = 20.297,P< 0.001).Among the 90 graft complications,35 (38.89%) of bone tract deviation were found,among which 21 (23.33%) of tears combined with bone tract deviation were found.Among the complications,18 (20.00%),62 (68.89%) and 10 (11.11%) graft diameters were 6 mm,7 mm and 8 mm,respectively. Conclusion MRI is an important method for the diagnosis of complications in the clinical follow-up after ACLR.Bone tunnel location and graft diameter are risk factors for predicting ACLR failure,and the incidence of postoperative complications of ACLR may be reduced in the acute phase.
  • CT and MRI Diagnosis of Pediatric Adrenal on Cocytomas
    LI Tingting, XIAO Hanfang, YANG Xiujun
    Journal of Clinical Radiology. 2023, 42(12): 1983-1986.
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    Objective To investigate the clinical CT and MRI features and diagnostic criteria of adrenal oncoctyoma (AOC) in children. Methods The clinical, CT and MRI data of 3 cases with AOC confirmed by surgery and pathology were collected and analyzed retrospectively,and the CT and MRI appearances were emphatically summarized in combination with the literature. Results The 3 patients were all female, aged from 4 years 2 months to 11 years 8 months, with an average of 7.9 years. The clinical manifestations were virilisation in 2 cases and precocious puberty in 1 case, with different degrees of endocrine abnormalities. All tumors were singlewith well-circumscribedlarge solid mass,and 2 on the leftas well asthe other one on the right adrenal glands.Characteristicfibrous encapsulation with delayed enhancement was intactin every mass.The average length of the tumor was 4.87 cm, with more homogeneous density/signal and homogeneously continuous enhancement.One case showed a nodulewithinrich lipid composition in the tumor mass. Conclusion A AOC has some characteristics on CT and MR imaging,which can prompt the diagnosis combined with hormone secreting behavior.
  • Imaging Features and Clinicopathological Correlation of Peripheral Primordium Neuroectodermal Tumors of the Chest and Abdomen
    PEI Jiangshan, REN Gang, CAI Rong, et al
    Journal of Clinical Radiology. 2023, 42(12): 1987-1991.
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    Objective To investigate the imaging features and clinicopathological correlation of peripheral primordium-neuroectodermal tumors (pPNET) in the chest and abdomen, and to improve the understanding and diagnosis of pPNET. Methods The CT/MRI images and clinicopathological data of 13 patients with thoracic and abdominal pPNET confirmed by surgical pathology admitted to Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from November 2012 to July 2018 were retrospectively analyzed. Results Among the 13 patients, there were 8 males and 5 females, and the median age was 9 years. Eight cases occurred in chest, including mediastinum in 6 cases and chest wall in 2 cases. Five cases occurred in the abdomen, including 4 cases in the retroperitoneum and 1 case in the abdominal wall. At CT and MRI, pPNET was mostly presented as a large soft tissue mass, and necrotic cystic changes of varying sizes were seen in all 13 lesions, calcification in 5 lesions and hemorrhage in 2 lesions, and heterogeneous enhancement after administration of intravenous contrast material. The characteristic Homer-Wright chrysanthemum-shaped masses could be seen under the microscope. Immunohistochemistry showed that tumor cell membranes mainly expressed CD99 and vim, Syn, NSE in varying degrees. Conclusion pPNET occurred in the chest and abdomen is mostly found in children and adolescents. The imaging findings and immunohistochemistry shows certain characteristics, combined with clinical information has important reference value for the diagnosis of pPNET.
  • Risk Factors of Option and Denali Inferior Vena Cava Filters Tilt During Placement
    QIN Lihao, XU Qiang, MAO Youjun, et al
    Journal of Clinical Radiology. 2023, 42(12): 1992-1996.
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    Objective To investigate the risk factors of tilt during Option and Denali inferior vena cava filter placement. Methods Retrospectively collect the clinical and imaging data of patients with Option and Denali inferior vana cava filter placed from January 2019 to September 2021, and the data of two groups were compared. Results A total of 65 patients were included, including 34 cases in Option group and 31 cases in Denali group. The tilt rate of Option filter is significantly higher than that of Denali group (88.2% vs. 19.4%, P<0.001), but there was no statistically significant difference in the mean tilt angle between the two groups(7.65°±3.22° vs. 7.50°±3.38°,P=0.920). Option group: the number of left tilt in right side iliac tract (24 cases) was significantly higher than right (20 cases vs. 1 case), the tilt direction of left side iliac tract (7 cases) was all right (6 cases), the difference was statistically significant (P< 0.001), the tilt angle of the filter was positively correlated with the common iliac veno-IVC angle (r=0.663, P < 0.001), and for each degree of increase in the common iliac vein-IVC angle, the probability of a tilt angle of 10.1-15.0° was 1.141 times higher than that of 5.1°-10.0° (P=0.002, OR=1.141, 95%CI:1.049-1.242). Denali group: there was no correlation between tilt direction and tract vessels (P>0.05), tilt angle and tract vessels (P>0.05), there was no correlation between the tilt angle of the filter and the angle between the common iliac vein-IVC (r=-0.112, P=0.587). Conclusion Although the tilt angle of Option and Denali filters are similar, the tilt rate of Option was higher than that of Denali during placement, the tilt direction of the Option filter is affected by the tract vessels, and the tilt degree is affected by the common iliac veno-IVC angle, while the tilt direction and degree of the Denali filter are not affected by the tract vessels and the common iliac veno-IVC angle.
  • Reduction of Artifacts from Head and Neck Metal Implants by Spectral CT: A Study Based on Human Simulation Phantom
    CUI Yongbin, HUANG Yong, LI Ruoying, et al
    Journal of Clinical Radiology. 2023, 42(12): 1997-2005.
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    Objective To explore the effect of Virtual Monoenergetic Images (VMI) and Orthopedic Metal Artifact Reduction (OMAR) based on spectral CT on removing artifacts of different metal implants in different parts of the head and neck. Methods The models of spinal fixation,metal dental filling and cerebral aneurysm embolism were constructed with adult human phantom. Metal stainless steel and titanium are used to replace the equivalent structure. Philips spectral CT was used to scan the three site models under the conditions of metal-free implants,metallic stainless steel implants and metallic titanium implants. The non-OMAR images and OMAR images under 60 keV,80 keV,100 keV,120 keV,140 keV,160 keV,180 keV and 120 kVp were reconstructed respectively. The CT value and SD value in the ROI near the metal implant were measured,and the Artifacts Index (AI) and Signal-to-Noise Ratio (SNR) were calculated. Results In the spine metal implant phantom,the metal artifacts caused by metal titanium were the most serious,especially in VMI60,the AI value was 160.103,and the SNR value was 1.851; When the VMI energy level was 100 keV,the AI value after combining with OMAR was 4.689,and the SNR value was 6.471. In the metal denture filling model,the minimum AI value of metal artifacts caused by titanium was 12.831 in the VMI180 image,and the AI value of the image after OMAR treatment did not change significantly (P=0.121),but the maximum SNR value was 2.262 in the VMI180+OMAR,which was significantly better than VMI180 (P=0.002). In the model after cerebral aneurysm embolization,the AI value was equivalent in the VMI120 and above energy levels,and after OMAR treatment,The artifact value was slightly reduced,but the SNR value was significantly increased. Conclusion VMI image and OMAR algorithm based on spectral CT can effectively reduce metal artifacts caused by metal implants,but the higher VMI level combined with OMAR algorithm might not obtain the best effects,the effectiveness of removing artifacts depends on the material and site of metal implants.
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