Objective To evaluate the clinical value of CT-guided interstitial implantation of ~(125)I seeds for the treatment of pulmonary carcinoma. Methods A total of 18 patients with pulmonary carcinoma underwent CT-guided interstitial implantation of ~(125)I seeds. According to the size of tumor,effective dose, and optimal quantity of ~(125)I seeds to the patient that were computed by a developed algorithm in Treatment Planning System (TPS), the ~(125)I seeds were implanted into the tumor tissues under the guidance of spiral CT. The patients were reexamined by CT 2 months after the operation and were followed up for 6 months. Results A total of 812 seeds were implanted into the 18 lesions in the 18 cases (45.1 seeds per case in average). The CT scan performed 2 months after the operation showed CR in 7 cases, PR in 10, and NC in 1. The total effectiveness (CR+PR) rate was 94% (17/18). Conclusions CT-guided interstitial implantation of ~(125)I seeds is a effective, minimally invasive, and low toxic method for valid and minimally traumatic treatment for middle- and late-stage lung cancer. Further application and long-term observation are necessary.

Objective To analyze the clinical application of monoenergetic technique of dual-energy CT in removing metal artifacts for patients with fractures fixed with metal fixer.Methods Fofly-five patients with fractures fixed with metal fixer underwent dual-energy CT scanning for the fractures.Two different data were collected in one-time scanning using dual-energy scanning sequence.With monoenergetic technique,two different data at 100 and 140 kilovolts were used for subtraction to removing metal artifacts based on different densities.Raw data were reconstructed with monoenergetic technique(group A)and conventional simulation method(group B),respectively.And,all data were reconstructed with multiplanar reconstruction (MPR),volume rendering(VR)and maximum intensity projection(MIP),respectively.Wilcoxon signed rank test was applied for the comparison of imaging quality and artifacts between the two groups.Results There were fewer artifacts on the images due to the application of monoenergetic technique in dual-energy CT scanning.In group A,the rate of high-quality images reached to 91.9%(124/135);and,in group B,it was 59.3%(80/135).There were statistical diference between the two groups(Z=-12.541.P<0.01).The images without artifact reached to 89.6%(121/135)in group A;whereas,it was 45.2%(61/135)in group B.There was statistical difference between the two groups(Z=-11.910,P<0.01).Conclusion Using monoenergetic technique,metal artifacts were removed effectively and the fine structure of fracture was clearly displayed.

Objective To evaluate the diagnostic value of multi-slice spiral CT(MSCT)perfusion imaging in chronic obstructive pulmonary disease(COPD).Methods Twenty COPD patients and20 volunteers underwent 8-row detector spiral CT(MSCT)perfusion imaging using cine scan mode with5 mm slice thickness.0.5 s rotation time and a total scan time of 45 s with 5 s intervals.60 ml contrast agent(300 mg I/ml)were administered at a rate of 4 ml/s from the forearm superficial vein.The imaging data were transferred to a workstation.A time-density curve and pseudo-color map were generated automatically with GE CT perfusion 3 software,the blood flow(BF),blood volume(BV),mean transit time(MTr)and permeability surface(PS)were measured.Results Time-density curve was flatter and the peak of the curve was obviously lower in COPD patients than the volunteers.The BF.BV.PS in COPD volunteers was(10.58 ±4.85)s and(4.50 ±1.71)s respectively.The BF,BV and PS in COPD patients Was lower than the volunteers,the MTY was higher(P＜0.01).Conclusion MSCT perfusion imaging is helpful for the diagnosis of COPD.

Objective To observe the CT features of ovary Brenner tumor. Methods CT manifestations of 5 patients with ovary Brenner tumor confirmed with pathology and clinical follow-up were retrospectively analyzed, and the masses were described for location, size, configuration, enhancement pattern, presence of calcification and metastatic spread. Results There were 7 tumors in 5 patients, 3 patients had unilateral tumors and 2 had bilateral Brenner tumors (left side 3 and right side 4), with tumor size ranging from 1.52 to 16.25 cm (mean 7.36 cm). Five masses in 4 patients were benign, 2 (bilateral tumors in 1 patient) were malignant. All tumors had well-defined margin. One patient with bilateral benign tumors had large pleural effusion and seroperitoneum. Five tumors in 4 patients (5/7, 71.43%) were solid and had calcification, 2 tumors in 1 patients (2/7, 28.57%) were mainly cystic, with septa in the tumors. The solid part of all tumors were inhomogeneous and had mild enhancement. Conclusion CT findings of ovary Brenner tumor have some characteristics. Combining with clinical manifestations, CT is helpful for the diagnosis of ovary Brenner tumor.

Objective To explore the application of CARE kV technique in the adult chest CT and the value of reducing radiation dose.Methods Sixty-nine patients were divided into two groups by random number generators:group A(39 cases) and group B(30 cases).Group A was examined by using CARE kV technique and group B was examined at routine 120 kV.CT dose index(CTDIvol),dose length product (DLP) and effective dose (E) were compared between the two groups,and analyzed the correlation between tube voltage selection and patient body mass index (BMI) of group A was analyzed.Results The average CTDIvol [(11.00 ± 3.89) mGy],DLP[(294.05 ± 91.17) mGy·cm] and E[(4.12 ± 1.28) mSv] of group A were lower than those of group B (16.64 ± 1.20) mGy,[(475.99 ± 41.16) mGy · cm],[(6.66 ±0.58) mSv].With statistically significant difference (t =-7.653,-10.151,-10.150,P ＜ 0.05).Compared with routine 120 kV technique (group B),the CARE kV technique (group A) could reduce the total radiation dose about 38.14％.Compared obese patients(BMI≥28 kg/m2) with non-obese patients in group A and B,the mean E of non-obese patients was lower than that of obese patients in group A,which reduced the total E about 31.74％ (t =4.322,P ＜0.05),while E in group B was no significant different between non-obese patients and obese patients.Conclusions In adult chest CT,CARE kV technique can select optimum scanning voltage automatically according to the patients with different BMI and anatomical regions,which can reduce the overall radiation dose while maintaining image quality.

Objective To compare the quality and radiation doses of coronary artery angiography under the natural heart rate condition between Flash spiral heart mode and prospective electrocardiogramtriggering sequence mode using dual-source,in order to choose personalized low doses of coronary artery scanning mode.Methods Sixty patients who underwent coronary angiography(CTA)on a 128-slice,dualsource CT scanner were divided into 2 group i.e,group A(27cases)and group B(33 cases).Flash spiral heart scan mode was employed for group A.Inclusion criteria included:heart rate<65 bpm.regular sinus rhythm,heart rate fluctuation less than ±5 bpm.Date acquisition was set at 60% of the R-R interval.Prospective electrocardiogram-triggering sequence scan mode(SAS)was performod for group B.Inclusion criteria included:(1)heart rate≥65 bpm,(2)arrhythmias,premature beat,fibrillation atrial.Exclusion criteria included:bad holding breath.Date acquisition(1)At low heart rate(≤75 bpm),date acquisition was set at 60%-80%of the R-R interval.(2)At high heart rate(>75 bpm),date acquisition was set at 30%-50%of the R-R interval. (3)At the arrhythmias,premature beat,fibrillation atrial,date acquisition was set at 20%-90%of the R-R interval.In both gronps,patients with a BMI≥25.0kg/m2 were examined with a tube voltage of 120 kV.while the other patients with a BMI<25.0 kg/m2 were examined with a tube voltage of 100 kV.The BMl was(24.6±1.0)kg/m2 in group A,while that was (24.6±0.9)kg/m2 in group B.In both groups,all images were transferred to the workstation for further processing and analysis.The imaging quality of coronary artery segments and the radiation dose were compared with t test.Results A total of 336 coronary artery segments were evaluated in group A and 412 segments were evaluated in group B.The imaging quality of coronary artery segments were scored.Excellent or good was achieved in 98.2%(330 of 336)artery segments in group A,and that was 98.1%(404 of 412)in group B.There was no statistical difference in imaging quality between the two groups(t=0.513,P=0.608).The average effective dose was(0.74±0.29)mSv in group A,whereas that was(3.67±1.37)mSv in group B.There was a significant difference between the two groups(t=-10.858,P=0.000).Conclusions The personalized low doses coronary artery scanning mode can substantially reduce radiation damage while preserving good imaging quality.

Objective To investigate the clinical and laboratory features of acute promyelocytic leukemia (APL).Methotis 513 APL patients in the last two decades were retrospectively analyzed in this research.We investigated the clinical features including age,sex,abnormality of peripheral hemogram before treatment.therapeutic effect and follow-up and laboratory data such as morphology,immunology,cytogenetics and molecular biology(MICM).Results The median age of the APL patients was 33 years old and the ratio of male and female was 1.21:1.Before treatment,the median level of WBC was 4.3×109/L and the deteetion rate of abnormal promyelocyte on blood film was 85.8%;with immunophenotypie detection,the expression levels of CD117、CD34、HLA-DR、CD7、CD14 and CD19 in APL were found to be lower and the expression 1evels of CD2、CD33 and MPO higher than those in other subtypes of acute myelocytie leukemia(AML)(beth P<0.01).Specific abnormal chromosome t(15;17)was detected in 91.7%of the patients,of whom 75.9%had standard translocation of t(15;17),being the most common one and 15.8% of the patients had t(15;17)with additional abnormal chromosome.There was only 7.5%of the patients with nolnlal karyotype.However,the presence of both simple translocation and complex translocation was seldom seen.With molecular biological detection.PML/RARα fusion gene positive rate was 99.6%.In a relativelv long clinical follow-up,we found that the complete remission(CR)rate in APL patients was 84.7%.incidence of DIC was 13.4%and five-year survival rate was 30.7%.111e median count of WBC in CR group was lower than that non-remission group(P<0.01).There were no significant differences on expressions of CD34 and CD2 and changes of cytogenetics between the two groups(P>0.05).Conclusions Comprehensive evaluation of MICM could be of important significance in the diagnosis and prognosis iudgrnent for APL patients.The CR rate in these patients with high WBC eount was considerable low.

Objective To study the image quality and radiation dose in dual-source CT cerebral angiography with prospective ECG-triggered sequence mode (step-and-shoot,SAS).Methods A total of forty-three patients with clinically suspected cerebral vascular disease underwent cerebral CT angiography with prospective ECG-triggering (step-and-shoot,SAS).Data acquisition was at 60％ R-R interval of the ECG presentation mode.The post-processing included maximum intensity projection (MIP),multiplanar reformation (MPR) and volume rendering (VR).The CTA image quality,radiation dose and rates of excellent images were evaluated.Results The CTA image quality score was 4.72 ± 0.50 and 97.7％ (42/43) patients had excellent CTA images.The average effective dose of SAS-CTA was (0.22 ± 0.01 )mSv,which was lower by 76.31％ than that of DE-CTA.Conclusions Prospective ECG-triggering sequence could be used in cerebral angiography with a significant reduction in radiation dose and diagnostic image quality.

Objective: To summarize the clinical features, treatment and prognosis of patients with Epstein Barr virus (EBV) encephalitis after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: The clinical data of 7 patients with EBV encephalitis who had undergone allo-HSCT in the First Affiliated Hospital of Soochow University from January 2012 to December 2015 were reviewed. Results: The incidence of EBV encephalitis was 0.70% (7/998) , and the median time was 63 (10-136) d after allo-HSCT. Seven patients had fever and mental disorder, of whom 4 cases of brain MRI were positive. Two patients received HLA-matched unrelated transplantation, while other 5 ones received haploidentical allo-HSCT. In conditioning regimen process, 7 patients were combined with anti-thymocyte globulin (ATG) to prevent graft versus host disease (GVHD) , of whom 6 patients had grade Ⅱ-Ⅳ acute GVHD. All patients of EBV-DNA were negative in CSF after taking anti-virus agent Rituximab. Until the last follow-up, a total of 3 patients died, 2 died of leukemia recurrence, 1 EBV encephalitis progression. Conclusion Once suspected EBV encephalitis after allo-HSCT, brain MRI and EBV-DNA in CSF should be detected, which could improve early diagnosis of EBV encephalitis. The usage of Rituximab was effective and well tolerated.