Objective To investigate the effect factors and the relationship of diagnostic system efficiency as soft copy reading with medical LCD.MethodsThirty chest images were selected from PACS on-line.Three of high,mid and low-experienced radiologists interpreted the images on different types of displays independently.Design four display levels based on five factors influencing diagnostic system efficiency,including view distance (0.3 m,0.6 m,0.9 m,1.2 m),monitor resolution ( 1 MP,2 MP,3 MP,5 MP),illuminant level (50 Ix,100 Ix,200 lx,400 lx),view angle (0°,15°,30°,45°) and angle of negative effect light (0°,30°,60°,90°).Three indices of misdiagnosis frequency,diagnosis time and frequency of unable to recognize were analyzed.Orthogonal experimental design and software SPSS 13.0 were used to analyze the results.Results The indices were much different for different factors at different levels.According to the index of average misdiagnosis frequency,extreme difference value of view angle was the lowest (1.4) and angle of negative effect light was the highest (5.0).Extreme difference value of view distance,monitor resolution and illuminant level were 2.9,2.8 and 2.5,respectively.ConclusionsThe order of different factors influencing diagnostic system efficiency is as follows: angle of negative effect light,view distance,monitor resolution,illuminant level and view angle.

Objective To discuss and to compare the curative effects of interventional embolization with different embolic agents in treating giant hepatic cavernous hemangiomas. Methods From 2008 to 2010, a total of 30 cases with clinically proved hepatic cavernous hemangioma were treated with interventional embolization. According to the embolic agents used , the patients were divided into pingyangmycin-lipiodol emulsion mixed with sodium alginate microspheres group(PLE+KMG, group A, n=15) and pingyangmycin-lipiodol emulsion group (PLE, group B, n=15). CT scanning was performed one, 3, 6, 12 months after the treatment to evaluate the curative effect. Results The technical success rate was 100%in both groups. The mean PLE dose used in group A and B was (10.9 ± 5.2) ml and (11.4 ± 4.9) ml respectively, the difference between the two groups was not significant (P > 0.05). CT reexamination performed one, 3, 6 months after the treatment showed that a reduction in tumor volume over 50%in group A was seen in 9, 11 and 14 cases respectively, while in group B it was 0, 3 and 5 cases respectively (P <0.05). One week after the procedure, the degree of pain in patients of group A was more severe than that in patients of group B, the difference between the two groups was statistically significant (P < 0.05). Slight abnormal hepatic function was seen in some patients of both groups, which presented mainly as an elevation of aminotransferase, which returned to normal after symptomatic medication. Follow-up with questionnaire indicted that patients of group A were more satisfied with the treatment than the patients of group B. Conclusion Transhepatic infusion of pingyangmycin-lipiodol emulsion is a safe and effective treatment for giant cavernous hemangioma of the liver. Combination use of pingyangmycin-lipiodol emulsion and sodium alginate microspheres can obviously reduce the tumor size mainly in the first and the third month after the treatment, besides it produces instant clinical effect although the pain is more severe than in patients treated with pure pingyangmycin-lipiodol emulsion.

Objective To evaluate spiral CT features and differential diagnosis of cystadenocarcinoma in the hepatic biliary duct.Methods CT findings of cystadenocarcinoma in the hepatic biliary duct proved by pathology in 4 cases were retrospectively analysed with review literatures.Results Biliary cystadenocarcinoma appeared as unilocular or multilocular cystic tumor,the cystic wall was irregular with mural nodules and satellite leisons,and the distal biliary duct was dilated.Conclusion Spiral CT is efficient method in diagnosis of cystadenocarcinoma in the hepatic biliary duct.

Objective:To explore the risk factors of spontaneous rupture of hepatocellular carcinoma (HCC), and to analyze the prognosis of transcatheter arterial embolization (TAE) in the treatment of spontaneous rupture of HCC.Methods:From January 2008 to December 2018, at Tianjin Third Central Hospital, 126 patients diagnosed with spontaneous rupture of HCC (spontaneous rupture group) and in the same period 252 patients diagnosed as HCC without rupture (non-spontaneous rupture group) were retrospectively selected. Independent sample t test, Mann-Whitney U test and chi-square test were used to compare the general data, laboratory test results and imaging results between spontaneous rupture group and non-spontaneous rupture group. Multivariate logistic regression was used to analyze the independent risk factors of spontaneous rupture of HCC. Kaplan-Meier method and log-rank test were used for survival analysis of 92 patients treated with TAE and 31 patients treated with conservative treatment in patients with spontaneous rupture of HCC, and multivariate Cox proportional hazard regression was used to analyze the independent prognostic factors of patients treated with TAE. Results:The proportions of tumor maximum diameter ≥5 cm, tumors mainly located in segment Ⅱ, Ⅲ, Ⅳ and Ⅵ of the liver, tumors protruding height from the surface of liver ≥1 cm, liver cirrhosis and portal vein thrombosis (PVT) in spontaneous rupture group were all higher than those in non-spontaneous rupture group (46.8%, 59/126 vs. 35.7%, 90/252; 61.1%, 77/126 vs. 46.0%, 116/252; 73.0%, 92/126 vs. 18.7%, 47/252; 81.7%, 103/126 vs. 69.0%, 174/252; 20.6%, 26/126 vs. 11.5%, 29/252), and the level of fibrinogen is lower than that in non-spontaneous rupture group ((3.07 ±1.38) g/L vs. (3.92±1.13) g/L), and the differences were statistically significant ( χ2=4.343, 7.644, 106.780, 6.918 and 5.628, t=-3.276, all P<0.05). The results of multivariate logistic regression analysis showed that the location of tumors in segment Ⅱ, Ⅲ, Ⅳ, Ⅵ of the liver, the height of tumors protruding from the surface of liver ≥1 cm, liver cirrhosis and the fibrinogen was lower than the lower limit of the reference value were independent risk factors of spontaneous rupture of HCC (odds ratio ( OR)=1.354, 5.726, 1.152, 1.892; 95% confidence interval ( CI) 1.062 to 2.008, 1.049 to 19.575, 1.016 to 1.895, 1.267 to 3.346; all P<0.05). Among 92 patients with spontaneous rupture of HCC treated with TAE, the TAE technical success rate and clinical success rate were 100.0% (92/92) and 93.5% (86/92), respectively. Thirty-one patients received conservative treatment. The median survival time of the patients treated with TAE was 243 d (38 d, 377 d), which was about 10 times that of the patients who accepted conservative treatment (23 d (9 d, 51 d)). The 1-month, 3-month, 6-month, 1-year and 3-year survival rates of the patients treated with TAE were 72.8%, 50.8%, 46.0%, 31.1% and 13.6%, respectively, and those of patients who accepted conservative treatment were 25.8%, 17.2%, 11.5%, 5.7% and 0, respectively; and the differences in survival rates between the two groups were statistically significant ( χ2=34.606, P<0.01). Log-rank test analysis showed that initial hemoglobin <60 g/L, C grade of liver function, total bilirubin (TBil)≥50 μmol/L, complicated with portal vein tumor thrombus, hepatic lobe embolism during TAE, and tumor maximum diameter ≥10 cm were all correlated with poor survival rates of patients with spontaneous rupture of HCC after TAE ( χ2=3.752, 4.146, 22.318, 4.087, 5.685 and 7.893, all P<0.05). The results of multivariate Cox proportional hazard regression analysis showed that TBil ≥ 50 μmol/L, hepatic lobe embolism during TAE, and tumor maximum diameter ≥10 cm were independent factors of poor prognosis of spontaneous rupture of HCC treated with TAE ( OR=25.873, 8.415, 18.620; 95% CI 4.916 to 126.005, 1.136 to 27.319, 2.754 to 84.368; all P<0.05). Conclusions:In HCC patients with tumors located in segments Ⅱ, Ⅲ, Ⅳ and Ⅵ of the liver, the height of tumors protruding from the surface of liver ≥1 cm, liver cirrhosis or the fibrinogen is lower than the lower limit of the reference value, close attention should be paid to the risk of spontaneous tumor rupture. TAE is an effective treatment for acute spontaneous rupture of HCC, and the prognosis of patients treated with TAE is better than that of patients receiving conservative treatment. However, patients with TBil ≥50 μmol/L, hepatic lobe embolism during TAE and tumor maximum diameter ≥10 cm have a poor prognosis after TAE treatment.

Objective To investigate the feasibility of reducing bolus?tracking monitor frequency in coronary CT angiography (CTA). Methods This prospective study including 120 patients with suspected coronary artery disease (CAD). According to the examination registration order, the patients were divided into groups A, B and C (n=40 for each group). All patients underwent coronary CTA with bolus?tracking technology, and were monitored at 10 s after the injection of contrast. The monitoring frequency of bolus?tracking for Group A was every 1.14 s, that for Group B was every 1.47 s , and for Group C was every 2.00 s, while the trigger threshold was set as 100 HU. To evaluate the image quality, the objective evaluation included signal noise ratio (SNR) and contrast noise ratio (CNR) of aorta (AO), CNR of left main coronary artery (LM) and right coronary artery (RCA), and the subjective score was recorded for each coronary artery segment. The monitoring times when CT density of the region of interest (ROI) reached the threshold, the CT value and the effective dose (ED) in the 3 groups were recorded. Objective image quality, monitoring parameters and radiation dose were compared using analysis of variance method, subjective image quality was compared withχ2 tests. Results There was no significant difference in AO (SNR and CNR), LM (CNR) and RCA (CNR) among the 3 groups, respectively (P>0.05). Subjective image quality scores of groups A, B, C were (1.879±0.042), (1.876±0.042), (1.881±0.042 ), with no significant difference (χ2=0.003,P>0.05). The monitoring times of to reach the threshold in groups A, B, C were (4.78±2.37), (3.76±1.39), (2.77±0.99), and ED were (0.058±0.031),(0.031±0.011), (0.021±0.007) mSv, with the significant difference (F=9.009, 31.998, respectively, P<0.01). Peak CT values during monitoring among three groups were (133 ± 24), (142 ± 39), (137±26) HU, respectively, with no significant difference (F=0.575,P=0.565). Conclusions It is feasible to reduce monitoring times when performing coronary CTA in dual?source CT scanner. The bolus?tracking monitor frequency in every 2 seconds can not only obtain satisfactory image quality, but also significantly reduce radiation dose.

Objective To investigate the accuracy and availability of three‐dimensional ultrasonography ( 3DUS ) in the Bismuth‐Corlette classification of hilar cholangiocarcinoma ( HCCA ) . Methods Forty‐eight patients who underwent surgery and obtained pathologic diagnosis of HCCA were retrospectively analyzed . All patients underwent 3DUS and magnetic resonance cholangiopancreatography (MRCP) before surgery . With surgical outcomes as the gold standard ,the diagnostic efficacy of two examinations in classification of HCCA were compared . Results Forty‐eight cases of HCCA were divided into 5 types according to surgical results ,including type Ⅰ (8 cases) ,type Ⅱ(13 cases) ,Ⅲa(8 cases) ,Ⅲb (11 cases) and type Ⅳ(8 cases) respectively . Among them ,39 cases accepted radical resection and the rest of 9 cases received palliative resection . The accuracy of the Bismuth classification confirmed by 3DUS was 85 .4% (41/48) . The percentage of underestimated and overestimated classification confirmed by 3DUS were 10 .4% (5/48) and 4 .2% (2/48) respectively . The accuracy of the classification confirmed by MRCP was 87 .4% (42/48) .Both of the percentage of underestimated and overestimated classification confirmed by MRCP were samely 6 .3% (3/48) .The difference between the 3DUS and MRCP was not statistically significant(χ2 =0 .597 ,P=0 .440) . Both the percentage of underestimated and overestimated classification between 3DUS and MRCP were samely not statistically significant ( P =0 .714 , P =1 .000 ,respectively) . Conclusions As a new diagnostic technique ,3DUS was feasible and had significant value in evaluating HCCA classification comparable to MRCP .

Objective To compare the clinical efficacy and postoperative liver function in patients with primary hepatic carcinoma treated by transcatheter arterial chemoembolization(TACE) or TACE combined with portal vein chemoembolization.Methods 48 patients with primary hepatic carcinoma, randomly divided into 2 groups (hepatic artery group in 25 cases and dual interventional group in 23 cases),underwent interventional treatment.The hepatic artery group underwent conventional hepatic artery interventional therapy, while the dual interventional group underwent hepatic artery and portal vein interventional treatment.The postoperative clinical efficiency, liver volume and liver function between the two groups'' patients were compared.Results To the endpoint of observation,the clinical efficacy and tumor reduction degree of dual interventional group were better than that of hepatic artery group.Compared with hepatic artery group, the postoperative ALT, AST and TBIL of dual interventional group were higher on the first and third days.On the seventh and fourteenth days, the statistical difference was not significant.The volume of non-embolization part in dual interventional group was larger than that in preoperative volume to different degrees.The most obvious change of liver volume happened in the 4th weeks after treatment.There was no treatment-related death or severe adverse reaction in two groups.Conclusion The treatment of TACE combined with portal vein chemoembolization is a safe and effective method, which may effectively inhibit the growth and reduce the volume of tumor, and result in compensatory hypertrophy of non-embolization part.

Objective To investigate the impact of tube current and tube voltage on CT attenuation,the correlation between CT attenuation and iodine concentration,as well as the percentage of reducing dosage for contrast agent while reducing the tube voltage.Methods A total of 100 saline solutions with decreasing dilution of contrast medium,in which concentration was between 0.5 to 50.0 mg/ml with the interval of 0.5 mg/ml,was produced.Each of the 25 syringes with a 4 ml sample was fixed on a cylindrical CT calibrated water phantom with an equal distance used the tape.CT scans were performed with a total of 15 scanning methods of the combination of the different tube voltages (70,80,100,140 kV) and tube current (100,200,280 mA).All of the CT attenuations were measured and recorded.The differences of CT attenuations under different scanning tube currents and tube voltages were compared with one-way ANOVA.The Pearson correlation analysis was used to analyze the relationship between CT attenuation and iodine concentration,and linear correlation equations were calculated and shown by regression analysis.According to the equations,the changes of contrast medium dosage were calculated with the changes of tube voltage.Results There was no significant difference in CT attenuations on different tube currents when the tube voltage was fixed (all P＞0.05),while when the tube current was fixed,the difference of CT attenuations on different tube voltages was statistically significant (all P＜0.05).Under different scanning conditions,the CT attenuations was linearly related to the iodine concentration (r2 was 0.953 to 0.997,all P＜0.01).While the tube voltage was reduced from 140 kV to 120 kV,100 kV,80 kV,70 kV,respectively,the iodine concentration of the samples were reduced by 15.4％,33.7％,53.4％,64.7％ respectively.While the voltage was reduced from 120 kV to 100 kV,80 kV,70 kV,respectively,the iodine concentration were rednced by 21.6％,44.9％,58.2％,respectively.While the voltage was reduced from 100 kV to 80 kV and 70 kV,the iodine concentration was reduced by 29.7％ and 46.7％,respectively.While the voltage was reduced from 80 kV to 70 kV,the iodine concentration was reduced by 24.1％.Conclusion CT attenuation can keep constant in low tube voltage setting by reducing the dosage of contrast agent,which can achieve a low radiation dose and low contrast agent dosage.

Objective To explore the value of linear blending and non-linear blending images of dual-energy CT in improving the image quality of portal venography.Methods 60 patients clinically confirmed as liver cirrhosis with portal hypertension and gastric fundus esophageal varices were enrolled in the study.The patients underwent dual-energy (Sn140/80 kVp) scans in the portal phase, and four groups with 80 kVp and 140 kVp were defined as group A (linear blending images with M=0.3), B (linear ones with M=1.0), C (non-linear ones with c=150 and w=200) and D [non-linear ones with c=(CThepatic portal+CThepatic parenchymal)/2 and w=(CThepatic portal-CThepatic parenchymal)/2, and the CThepatic portal and CThepatic parenchymal were measured on M=0.3 image].The in portal vein enhancements, image noise, signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR) and CT value difference between portal vein and liver parenchyma among four groups were compared by one-way ANOVA analysis of variance test.VRT imaging quality among four groups were assessed by Kruskal-Wallis test and Mann-Whitney U test.Results In four groups, the SNR and CNR of portal vein,and the CT value difference between portal vein and liver parenchyma(14.36 HU±3.23 HU,9.78 HU±2.39 HU,107.66 HU±21.28 HU) of group D were the highest (F=34.94,68.10 and 162.43,all P<0.01),and VRT image quality score of group D(4.78±0.42) was the best when compared to others (all P<0.01).Conclusion Non-linear blending technique of group D can improve the image quality of CT portography, which may be used in clinical practice.

Objective To investigate the diagnostic value of sharp kernel reconstructed images for calcified plaque coronary artery stenosis with a dual-source CT.Methods 42 patients with suspected coronary disease underwent dual-source coronary computed tomography angiography (CCTA) and coronary angiography (CAG).The CCTA images were respectively reconstructed by smooth kernel (I26f) and sharp kernel (I46f) reconstruction.The image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured,and then the calcified plaque noise of two groups reconstructed image was scored subjectively.A total of 56 vascular stenoses that caused by calcification were taken as the research object,according to the results of CAG as a golden standard.The ROC curves of two groups were drawn with moderate stenosis (more than or equal to 50%) and severe stenosis (more than or equal to 75%), and the corresponding sensitivity, specificity, and optimal threshold were obtained.Results The images of I46f group had higher noise [I46f:(45.43±9.00) HU;I26f:(31.43±5.55) HU;t=-8.58,P=0.000],lower SNR [I46f:(10.26±2.09) HU;I26f:(14.86±3.53) HU;t=7.28,P=0.000] and lower CNR[I46f:(14.04±4.51) HU;I26f:(20.80±7.18) HU;t=5.17,P=0.000],but the subjective scoring of calcified plaque of I46f group was better than that of I26f group(I46f:2.33±0.75;I26f:1.64±0.70,Z=-4.61,P=0.000).The ROC curves of two groups: with moderate stenosis(≥50%),area under the I46f curve(0.946) was larger than that of I26f group (0.935);to diagnose with the reconstructed image of group I46f,the optimal threshold was 55%,the specificity was 95.0%,and sensitivity was 88.9%;and for I26f group,the optimal threshold was 65%, the specificity was 90%, and sensitivity was 88.9%.With severe stenosis(≥75%), area under the I46f curve (0.927) was slightly larger than that of I26f group (0.924);to diagnose with the reconstructed image of group I46f,the optimal threshold was 77.5%,the specificity was 79.1%,and sensitivity was 92.3%;for I26f group, the optimal threshold was 85%, the specificity was 74.4%,and the sensitivity was 100%.Conclusion The I46f reconstruction image of dual-source CT has more advantageous than the I26f reconstruction image,and it is a better way to diagnosethe calcified coronary stenosis.