Objective:To investigate the diagnostic value of MRI and CT for the liver space-occupying lesions.Methods:The clinical data of 70 cases of patients with liver space-occupying lesions in our hospital from June 2012 to May 2016 were divided into two groups and retrospectively analyzed.35 cases underwent contrast enhanced ct scans (CT group),and others underwent dynamic contrast-enhanced MR imaging(MRI group).The pathological diagnosis,number of lesions and lesions diameter were ompared between two groups.Results:No significant difference was found in the pathological diagnosis,number of lesions(71 vs 70) and lesions diameter(2.25 ± 2.01 cm vs 2.19± 1.98 cm) between two groups(P＞0.05).As the gold standard by pathological diagnosis results,correct diagnostic rate of MRIgroup were 85.71％,which was 77.14％ CT group and lower than that of the MRI group,but no significant difference was found between two groups (P＞0.05).The incidence of adverse reactions in CT group was significantly higher than that of the MRI group (P＞0.05).Conelusion:Both CT and MRI enhancement scanning have higher diagnostic value for the liver space-occupying lesions,but MRI enhancement scanning has higher safety and tolerability.

Objective To explore the value of the spectral CT iodine-based material decomposition technique in differential diagnosis of central pulmonary carcinoma from obstructive pneumonia and atelectasis.Methods 25 cases with central pulmonary carcinoma complicating with obstructive pneumonia and atelectasis underwent CT plain scan and spectral contrast scan including pulmonary-arterial-phase (PAP) and bronchial-arterial-phase(BAP).Conventional CT images and iodine base images were generated in each phase by GSI viewer.The 4 groups of images differences between the tumor and the obstructive pneumonia and atelectasis were analyzed.Results The margin of the tumor was ill-defined in plain scan.The cases that showed difference between the tumor and the obstructive pneumonia and atelectasis in 4 groups of images were respectively as follows,10 in conventional CT images of PAP,1 6 in conventional CT images of BAP,1 9 in iodine base images of PAP,and 23 in iodine base images of BAP.The difference of the 4 groups was significant (χ2 =16.54,P<0.05).There was the highest accuracy in iodine base images of BAP in defining the tumor margin (χ2 = 12.83,χ2 = 4.20,χ2 =1.34,P <0.05). The accuracy between conventional CT images of BAP and iodine base images of PAP had no significant differences (χ2 =0.86,P >0.05),but were better than that of the conventional CT images of PAP(χ2 =6.65,P <0.05).Conclusion Spectral CT iodine-based material decomposition technique is helpful to improve subjective diagnosis of central pulmonary carcinoma complicating with obstructive pneumonia and atelectasis,especially in iodine base images of BAP,it can provide accurate information for clinical stage and treatment.

PurposeSupport vector machine (SVM) is a machine learning method based on statistical learning theory of Vapnik-Chervonenkis (VC) dimension structure and risk minimization theory. We analyzed the gem spectrum CT scan data of patients with thyroid nodules and established the SVM diagnostic model. The experimental targets were then reduced and the forecast analysis was carried out based on SVM model. The diagnostic model and experimental methods were proved to provide guidance for clinical diagnosis of thyroid nodules.

Objective To demonstrate the feasibility of high-resolution computed tomography(HRCT)reconstructed with a model-based iterative reconstruction (MBIR)for evaluating early peripheral lung cancer (≤3 cm),by comparing image quality obtained from MBIR,filtered back proj ection reconstruction(FBP)and state of the art adaptive statistical iterative reconstruction(ASIR)algorithm respectively.Methods A total of 30 patients confirmed with lung cancer by postoperative pathology were enrolled in the study.A chest phantom was also used to evaluate image noise,spatial resolution and density resolution.Both patients and chest phantom were received HRCT,and the images were reconstructed using FBP,ASIR(40% ASIR and FBP mix)and MBIR.The objective CT value, standard deviation(SD)and signal noise ratio(SNR)were measured.Two radiologists used a semi-quantitative to rate subjective image quality of lung nodules.Results There was no significant difference in CT value between the three reconstruction algorithms (P>0.05).But significant improvements in objective image noise were observed in MBIR compared with FBP and ASIR (P<0.05):including the SD value in back muscle [(12.63±1.70)with MBIR vs (31.58±5.21)with FBP and (24.55±4.14)with ASIR],and in subcutaneous fat [(12.77±2.53)vs (24.39±5.08)and (19.20±4.11)].Subjective image noise of the three group were also significantly difference:FBP with lowest subjective noise score;and MBIR with highest subjective noise score.The sharpness of small vessels and bronchi and diagnostic acceptability with MBIR were significantly better than with FBP and ASIR (P< 0.05).Conclusion Lung HRCT reconstructed with MBIR provides diagnostically more acceptable images for the detailed analyses of peripheral lung cancer compared with FBP and ASIR.

Objective To compare the spatial resolution and density resolution balance algorithm(MBIRSTND)and spatial resolution preference algorithm (MBIRRP20)from new version of model-based iterative reconstruction(MBIRn),and adaptive statistical iterative reconstruction(ASIR) with lung kernel in routine dose about the performance of computer-aided detection (CAD)for quantitative analysis of airway.Methods 30 patients were involved who were scanned for pulmonary disease with spectrum CT.Data with a slice thinkness 0.625 mm were reconstructed with ASIR,MBIRSTNDand MBIRRP20.Airway dimensions from three reconstruction algorithm images were measured using an automated and quantitative software(Dexin-FACT)that was designed to segment and quantify the bronchial tree,and a skeletonization algorithm to extract the center-line of airway trees automatically.For each patient,reconstruction algorithm chose the right middle lobe bronchus,and the bronchial length of the matched airways was measured by this scheme.Two radiologists used a semiquantitative 5 scale (Score 0 stands for its image quality is similar to that with ASIR;Score±1 stand for a little better or a little worse;Score±2 stand for obviously better or obviously worse)to rate subjective image quality of airway trees about images reconstructed with MBIRSTNDand MBIRRP20.Paired t test and Wilcoxon signed-rank test were used.Results Algorithm impacts the measurement variability of bronchus length in chest CT.The bronchial length with MBIRRP20was longer than with MBIRSTND, while the length with ASIR were the shortest(P<0.05).In addition, the optimal reconstruction algorithm was found to affect the subjective noise,the continuity and completeness of bronchial wall,and the show of bronchial end.The subjective noise of MBIRSTNDwas better than that of MBIRRP20.The show of bronchial end of MBIRRP20was better than that of MBIRSTND(P<0.05).There was no significant difference in the continuity and completeness of bronchial wall compared with MBIRRP20and MBIRSTND(P>0.05),which was much better than with ASIR(P<0.05).Conclusion MBIRn can inmprove the analyzing ability of CAD airway.The MBIRSTNDcan significantly reduce the image noise,the MBIRRP20significantly improve the branching of the bronchial arteries,both of which can allow the desired airway quantification accuracy of CAD for chest CT of the bronchial wall.

Objective To assess image quality of adaptive statistical iterative reconstruction (ASIR),conventional modelbased iterative reconstruction (MBIRc) and a new lung-specific setting (MBIRRP20 and MBIRNR40) from the new version of model-based iterative reconstruction (MBIRn) in submillisievert chest CT comparing with ASIR in standard-dose.Methods Two chest CT examinations were performed with standard-dose and low-dose in 30 patients.Low-dose CT images were reconstructed with ASIR,MBIRc and MBIRn,while standard-dose CT images were reconstructed with ASIR only.Objective image noise and SNR were measured on the same part from the back muscle and subcutaneous fat which located at the level of thoracic entry,trachea carina and hepatic portal.Image quality of lung,mediastinum and upper abdomen structures were evaluated on a 5-point scale.The results were compared with one-way ANOVA and Wilcoxon signed-rank tests.Results The effective dose equivalent for standard-dose CT was (3.01 ± 1.89) mSv,compared with (0.88 ± 0.83) mSv for low dose CT,which decreased by 70.76％.The mean image noise for low-dose MBIRNR40 was significantly lower than that of conventional-dose ASIR,low-dose ASIR and MBIRc (P＜0.05).The mean SNR for low-dose MRIRNR40 was significant ly higher than that of conventional dose ASIR,low-dose ASIR and MBIRc (P＜0.05).The subjective image noise score was significantly lower than that of ASIR and MBIRc,and the score of sharpness of details of the structures score for low dose MBIRn was significantly better than that of the ASIR and MBIRc (P＜0.05).Conclusion MBIRNR40 can significantly reduce image noise and improve SNR compared to ASIR and MBIRc in low-dose,even better than ASIR in standard dose,which reduce radiation dose by about 70％.In low-dose,MBIRPP20 can well display lung structures,and MBIRNR40 can display mediastinal and the upper abdominal structures.

Objective To compare the effect on image quality of low-dose upper abdominal CT reconstructed with the new version of model-based iterative reconstruction (MBIRn) focused on low-contrast resolution (MBIRNR40),conventional model-based iterative reconstruction (MBIRc),adaptive statistical iterative reconstruction (ASIR) and routine-dose CT reconstructed with filtered back projection (FBP).Methods Water plantom at rest was scanned with CT,and spatial resolution and density resolution were compared among FBP,ASIR,MBIRc,and MBIRNR40.Sixty patients with 2 times CT in the upper abdomen within a year were enrolled.The initial examination was acquired at a standard radiation dose (noise index [NI] of 10 HU) and reconstructed with the conventional FBP algorithm.The follow-up scan was acquired at a lowdose (NI=20 HU) and reconstructed with the standard ASIR,MBIRc and MBIRNR40.All images were obtained with 0.625 mm slice thickness.CT values and noise of fat,muscle as well as the liver and kidney parenchyma were measured and CNR of liver and kidney parenchyma using the fat SD as background image noise were calculated.Two radiologists independently graded images for noise,sharpness of details of structures and lesion.The quantitative image quality scores of different reconstructions were analyzed with one-way ANOVA using FBP reconstruction as reference of standard.The degree of interobserver consistency was evaluated using Kappa test.Results The phantom study revealed the highest spatial resolution with MBIRc and highest density resolution with MBIRNR40 among all reconstructions.The dose-length product and radiation dose for the first inspection was (93.18 ± 41.21) mGy · cm,(1.40 ± 0.62) mSv,respectively,and were (368.03 ± 146.25)mGy · cm,(5.52 ± 2.19)mSv for the second inspection,representing an approximate overall dose reduction of 74.68％ and 74.64％.The mean image noise of muscle and fat for MBIRNR40 was significantly lower than that of MBIR,ASIR and FBP(P＜0.05).The mean CNR values of liver and spleen for MBIRNR40 were significantly higher than that of ASIR,MBIRc and FBP (P＜0.05).Two radiologists had a good subjective score consistency.Low-dose MBIRNR40 subjective image noise was the lowest,showing the most detailed on the upper abdominal detail structure and lesion edge,better than MBIRc,MBIRc was superior to routine-dose FBP,low dose ASIR was worst,the difference was statistically significant (P＜0.05).Conclusion With 75％ dose reduction in upper abdominal CT,the MBIRNR40 can provide well objective and subjective image quality than MBIRc and ASIR40,and the routine-dose FBP.

[Abstraet] Purpose To explore the application of noise reduction settings among modelbased iterative reconstruction (MBIRn) on decreasing radiation dose in CTA through experimental study.Materials and Methods Spectral CT was used to scan vessel model which could accommodate 8 tubes under static condition under 120 kVp fixed tube voltage at 10 mA,50 mA,150 mA and 600 mA.The tubes were filled with purified water,1,2,5,10,20 and 30 mgI/ml solutions and 30 mgCa/ml solution.Algorithms of FBP (standard),ASIR40 (combined by 40％ ASIR and FBP),MBIRc and MBIRn with optimized spatial resolution setting as MBIRRP20,MBIRstnd (standard setting),and MBIRNR40 (noise reduction setting) were adopted for original scanning data to reconstruct images of 0.625 mm slice thickness for contrastive analysis.Three fixed layers were chosen and regions of interest were placed on central tube and surrounding ester matrix,and CT value and standard variation (SD) were measured to represent noise.Noise reduction setting MBIRNR40 and solution noise of other reconstruction algorithm images were calculated and compared and average value of contrast noise ratio (CNR) was compared.Results Compared to FBP under different tube currents,ASIR40,MBIRc,MBIRRP20,MBIRstnd and MBIRNR40 reduce noise and increase CNR at different levels.Average noise of MBIRNR40 was the lowest (reduced by 78.33％) and CNR the highest (increased by 241.74％),making it superior to other reconstruction algorithm images (P＜0.05).Meanwhile,the lower the radiation dose was,the more obvious its advantage was.Reconstruction image noise of MBIRNR40 at 10 mA was close to that of FBP and ASIR40 at 600 mA.CNR was obvious greater than that of FBP and ASIR40 at other tube voltage.Conclusion Reconstruction algorithms of MBIRc,MBIRn and ASIR can help enhance CTA image quality and reduce radiation dose.Noise reduction setting MBIRNR40 from MBIRn has the lowest noise and greatest CNR.The lower the radiation dose is,the more obvious its advantage is.

Objective To compare the effectiveness of patient-controlled intravenous analgesia with or without background infusion of dezocine plus flurbiprofen axetil injection in patients undergoing laparoscopic colorectal cancer operation. Methods Sixty patients scheduled for laparoscopic colorectal cancer surgery,35 males and 25 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups:common-dose background infusion group(Group CB,n = 30),and no background infusion group(Group NB, n = 30). All patients were intravenously administered a PCA pump containing dezocine 0.6 mg/kg,flurbiprofen axetil 3 mg/kg and normal saline in a volume of 120 mL.Patients in Group CB were given background infusion rate of 2 mL/h with PCA bolus dose 2 mL,patients in Group NB were given PCA bolus dose 4 mL only.NRS scores, Ramsay sedation scores,pressing times,consumption of analgesic,supplementary analgesics,incidence of ad-verse reactions,time of first exhaust,time of first leaving bed and patients'satisfaction scores were recorded after surgery. The influence factors of time of first exhaust and time of first leaving bed were also analyzed. Results Compared with group CB,the NRS scores in group NB were higher both at rest and during movement(P<0.05), the Ramsay sedation scores in group NB were lower at 24 and 48 h after surgery(P<0.05),the pressing times in group NB were higher(P < 0.05),the consumption of analgesic in group NB were lower after surgery,and the incidence of using supplementary analgesics was higher(P < 0.05). No statistical difference was found on the in-cidence of adverse reactions between the two groups(P > 0.05). Moreover,the time of first leaving bed in group NB was longer than that in group CB(P<0.05).The satisfaction scores in group NB was lower than that in group CB(P<0.05).The main influence factors of the time of first leaving bed were gender and NRS score during move-ment at 24 h after the operation(P<0.05).The main influence factors of the time of first exhaust were age,BMI and fluid infusion volume(P < 0.05). Conclusion Postoperative patient-controlled intravenous analgesia with background infusion of dezocine and flurbiprofen axetil injection was more efficacious and satisfactory,and more suitable in postoperative pain management.

Objective To investigate the feasibility of energy spectrum CT material separation technology for quantitative evaluation of nonalcoholic fatty liver patients,to compare the accuracy of this method with the conventional liver/spleen CT ratio for grading liver fat content.Methods Sixty patients diagnosed with nonalcoholic fatty liver and 20 healthy volunteers were chosen to undergo liver MR multi-echo(ME)Dixon and energy spectrum CT scans.The proton density fat fraction(PDFF),fat concentration(FC),and liver/spleen CT ratio were then measured for each participant.According to PDFF,nonalcoholic fatty liver patients were divided into mild fatty liver group,moderate fatty liver group,and severe fatty liver group.Results With the increase in PDFF,FC increased and the liver/spleen CT ratio decreased.The difference between FC groups in normal,mild,moderate and severe fatty liver groups was statistically significant(P<0.05),while the difference between the liver/spleen CT ratio of normal group and mild fatty liver group was not statistically significant(P>0.05).The receiver operating characteristic(ROC)curve analysis showed that when the critical value of FC was 351.19 mg/mL,the sensitivity,specificity and area under the curve for normal group and fatty liver group were 0.95,0.1 and 0.99,respectively.Conclusion The energy spectrum CT material separation technology has a good correlation between the fat content measured by the MR ME Dixon,which is superior to the fat content measured by the liver/spleen CT ratio.For patients with nonalcoholic fatty liver,FC in energy spectrum CT has high accuracy in differentiating normal and mild fatty liver.