Objective To obtain the parameters of optimal spectral scanning mode in chest spectral CT imaging,radiation doses,image quality,CNR and subjective scores are compared in spectral and conventional scan modes with anthropomorphic chest phantom.Methods An anthropomorphic chest phantom underwent both conventional scan and spectral scan using three different protocols:GSI assist mode (protocol A);GSI mode with mean tube current (protocol B);GSI mode with maximum tube current (protocol C).All above scans were performed with the noise index (NI) as 9 and 11 respectively.The radiation dose was recorded,and the SD values of adipose tissue and muscle tissue of 5 different sections were measured in regions of interest (ROls) to evaluate the image quality.All scans were subjectively scored in 5 score system by two senior radiologists on lung markings and branches with the lung window technique.Results The effective dose (E) values of conventional CT scan and protocols A,B and C were 8.0,8.5,6.2,10.4 and 5.3,5.1,4.3,6.2 mSv.When NI =9,the difference of SD values had statistically significance between conventional scan and protocols A,C (F =4.496,P ＜ 0.05).When NI =11,there was statistically significant difference of SD value between conventional scan and protocols A,B,C (F =8.425,P ＜ 0.05).In conventional chest scan,the difference of SD values was statistically significant between NI =9 and 11 (t =-2.570,P ＜ 0.05),while other protocols had no statistically significant difference (P ＞ 0.05).The difference of CNR and subjective score had no statistically significance in either the same NI different scanning modes or the same scanning mode with different NIs.Conclusions Appropriate spectral scanning mode had no significant difference with conventional CT scanning in radiation dose,yet higher image quality can be obtained.Furthermore,appropriate NI can reduce the radiation dose obviously while the similar image quality was achieved.Considering the two factors,GSI assist mode can achieve balance between radiation dose and image quality.

Objective: To investigate the clinicopathological features of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. Methods: Five cases of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract from the Affiliated Hospital of Qingdao University from 2016 to 2019 were retrospectively reviewed. The clinical and pathological parameters were analyzed by combining clinical data and reviewing the available literature of 35 cases (34 cases abroad and 1 case in China). Results: There were 4 males and 1 female with a median age of 47 years (18-66 years). All patients had abdominal pain and constitutional symptoms including diarrhea, emaciation, intermittent mucous stool or oral and epiglottic ulcers. Endoscopic manifestations included multiple punctate congestion, erosion and ulcer at the terminal ileum and colorectum. Two cases had congestion and erosion of antrum and angle of stomach, and the lesions did not fuse and form tumors. Histologically, the lamina propria was expanded by a dense, medium to small lymphocyte infiltration, which was monomorphic, with slightly irregular nuclei without prominent nucleolus or lymphoepithelial lesions. There were admixed small amount of plasma cells and eosinophils. In 4 cases, immunohistochemistry showed the lesional cells were positive for CD3, CD8, TIA1, and negative for CD4, CD56, granzyme B and Ki-67 index was ≤10%. In situ hybridization showed that EBER was negative and clonal TCR gene rearrangement was detected. One consultation case was CD3⁺, CD5^- and Ki-67 index of 10%, although other indicators were not done. All five patients were treated with symptomatic support. In follow-up observation for 2 to 25 months, all patients were alive with the disease. Conclusions Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract is a newly classified monoclonal T-cell proliferative disease, with low incidence, clinical inertia and long-term survival. It has unique clinicopathological features but pathologically it is easily misdiagnosed as inflammatory bowel disease or T-cell lymphoma. Correct diagnosis is of great important clinical significance.

Primary hepatic cancer is one of the major problems that need to be solved urgently in the field of public health, seriously endangering the life and health of Chinese people. Its treatment mode is multidisciplinary participation and synergy of multiple therapeutic methods. Even though there are many common clinical treatments for liver cancer in China, its therapeutic outcome is still unsatisfactory. yttrium-90 has been applied for more than 20 years, and a large amount of foreign clinical data have been accumulated. Combining the latest literature and clinical practice, the authors describe the clinical application and research progress of yttrium-90 micro-sphere selective internal radiation therapy in primary liver cancer.