Objective To evaluate MR findings and clinical features in patients with spontaneous spinal epidural hematoma (SSEH). Methods Eight patients (5 men, 3 women; aged 16-50 years ) with SSEH underwent MR imaging during 1994-2001, including 7 cases without history of trauma or coagulation disorders and 1 case with history of hypertension. MR imaging was performed from 4 hours to 3 days after the onset of symptoms in all 8 patients with surgical and pathologic diagnosis. Results The hematomas were in lateral posterior or posterior epidural space, including 3 cases in cervical vertebra, 2 cases in thoracic vertebra, 2 cases in cervical and thoracic junction region, and 1 case in thoracic and lumbar part. The MRI confirmed an encapsulated hematoma caused by arteriovenous malformation in 1 case and two hematomas associated with disc herniation. The signal intensity of the hematoma varied with the hematoma age, but T 1-weighted images reflected its typical signal changes. Sagittal and coronal T 1- weighted images revealed isointense (7 cases) and slight high-intense (1 case) signal; Sagittal and axial T 2-weighted images revealed mixed-intensity (6 cases) and mixed high-intensity (2 cases). Conclusion MR imaging has an important value on localization, identification, and differential diagnosis of the lesion, therefore, it is the most helpful diagnostic tool for this condition.

Objective To investigate the application of MRI in evaluation of the traumatic temporomandibular joint (TMJ) injury induced by type Ⅵ condylar fracture. MethodsMRI was performed in TMJs in 18 patients with type Ⅵ condylar fractures at days 3-14 post-injury and the MRI findings were analyzed. ResultsMRI findings of 18 patients with traumatic TMJ injury with 19 sides of type Ⅵ condylar fractures showed 15 sides of TMJ disk displacement,nine sides of capsule tear,16 sides of retrodiscal tissue tear (double-plate area) and 19 sides of joint effusion change. Conclusions MRI is very important in the diagnosis and evaluation of traumatic TMJ injury,since it can clearly display the TMJ injuries in type Ⅵ condylar fractures.Therefore,the clinical application of MRI is beneficial for selection of the therapeutic schedules.

Objective To investigate the radiation dose delivered to the patients with dense breasts and the influence of photographic conditions on image quality in full field digital mammography (FFDM).Methods (1) Clinical test:we analyzed the compression thickness of breasts,Target-filter(T-F),voltage current (kV),tube current (mAs),average glandular dose (AGD) and entrance surface dose (ESE) of 100 patients (a total of 370 images,277 images of Molybdenum-Rhodium(Mo-Rh)and 93 images of Wolfram-Rhodium (W-Rh)) who underwent examinations in mode of automatic exposure by FFDM with dense breasts.(2) Phantom experiments:placed the Aluminium plate on different thickness of polymethyl methacrylate (PMMA) plates to simulate the dense breasts.68 mm phantom was used to simulate photographic condition of W-Rh and 58 mm to Mo-Rh.The two groups of dense phantom were exposed automatically and manually.The parameters were recorded for each exposure including the compression thickness of breasts,T-F,kV,mAs,AGD,ESE,the calculation of the ratio between ESE and AGD (ESE/AGD).The image quality figure inverse (IQFInv) was obtained by software.To the clinical test,used multiple factors of variance to analyze the influence of compression thickness and mAs on AGD and ESE,Pearson correlation and regression to analyze the influence of compression thickness on ESE/AGD.To the phantom experiments,used Pearson correlation to analyze the influence of kV and mAs on AGD,ESE and ESE/AGD,single factor of variance to analyze the influence of kV and mAs on IQFInv.Results (1) Clinical test:to Mo-Rh and W-Rh,with the increase of compression thickness,ESE/AGD was increased significantly.Compression thickness had linear relationship with ESE/AGD.Pearson correlation coefficients of W-Rh and Mo-Rh were 0.956 and 0.980,respectively(P＜0.01).The effects of compression thickness and mAs on AGD and ESE were statistically significant (P＜0.05) in the two groups.(2)Phantom experiments:adjusted exposure parameters to the two dense phantoms of W-Rh and Mo-Rh.With the increase of mAs and kV,IQFInv was increased in W-Rh and Mo-Rh.Different mAs and kV were statistically significant (P＜0.05) on IQFInv,mAs and kV had positive correlation with ESE and AGD (P＜0.05),mAs and kV had different correlation with ESE/AGD in the two dense phantoms.Conclusions In mode of automatic exposure by FFDM,choosing W-Rh can achieve relatively high image quality and lower radiation dose.According to the results of phantom experiments,adjusting kV and mAs properly in manual exposure can reduce AGD and ESE effectively and ensure the quality of the image.

Objective To evaluate multi-slice three-dimensional CT angiography (MS 3D-CTA) for the follow-up of intracranial aneurysm clipping.Methods MS 3D-CTA of 16 patients with intracranial aneurysm clipping were retrospectively analyzed.The patients were scanned on a 16-slice spiral CT(GE Lightspeed pro).Volume rendering(VR),thin maximum intensity projection(thin MIP) and multi-planar reconstruction (MPR) were employed in image postprocessing in all cases.Results There were 17 clips in the 16 patients with aneurysm clipping.Six clips were located at the posterior communicating artery,5 at the anterior communicating artery,4 at the middle cerebral artery,and the remaining 2 clips were located at the pericallosal artery in 1 patient.There were no abnormalities found in the aneurysm clipping region in 7 cases by MS 3D-CTA.There were residual aneurysm in 2 cases,parent artery stenosis in 4 cases,and artery spasm in 3 cases.There was no parent artery occlusion and clip displacement in all cases.VR showed excellent 3D spacial relations between the clip and parent artery in 12 cases,and showed good relations in 3 cases.The 1 case with 2 clips in the pericallosal artery showed heavy beam-hardening artifacts.The size and shape of aneurysm clips were clearly depicted by MPR and thin MIP,while 3D spacial relation of aneurysm clip and parent artery were poorly showed.Conclusion MS 3D-CTA is a safe and efficient method for the follow-up of intracranialaneurysm clipping.Combined VR with MPR or thin MIP can well reveal postoperative changes after aneurysm clipping.

Objective To investigate the radiation dose to phantoms of thick dense breasts (compression thickness ＞ 65 mm) and the influence of Molybdenum-Rhodium (Mo-Rh) and Wolfram Rhodium (W-Rh)) target-filter combination on image quality in full field digital mammography (FFDM).Methods An aluminium plate was placed on polymethyl methacrylate (PMMA) plates to simulate dense breasts.Two of 68 mm in-depth phantoms were used to simulate photography condition of thick dense breasts with 0.1 and 0.2 mm aluminium plates respectively.The two phantoms were exposed automatically,half-automatically and manually.The parameters were recorded for each exposure including the target-filter(T-F),tube voltage (kV),tube current (mAs),average glandular dose (AGD),entrance surface dose (ESD) and the image quality figure inverse (IQFInv).Pearson correlation and regression was used to analyze the influence of AGD on IQFInv.Paired sample t-test was used to analyze the influence of different target-filters on IQFInv and AGD.Results AGD had a positive correlation with IQFInv (r =0.806-0.953,P ＜ 0.05).For the phantom of 0.1 mm aluminium,when the tube current was fixed at 100 mAs or the tube voltage was fixed at 28 kVp,AGD and IQFInv had statistically significant difference for two target-filters(t =3.162-8.028,P ＜0.05).For the phantom with 0.2 mm aluminium,when the tube current was fixed at 100 mAs under different tube voltage,AGD and IQFInv had statistically significant difference for two target-filters(t =4.768-8.028,P ＜ 0.05);when tube voltage was fixed at 28 kVp under different tube current,AGD had statistically significant difference for two target-filters(t =7.730,P ＜ 0.05),while there was no statistical difference in IQFInv(P ＞ 0.05).In addition,when tube current was 100 mAs,IQFInv had statistically significant difference for two phantoms in W-Rh(t =2.345,P ＜ 0.05).Conclusions W-Rh target-filter combination can achieve lower radiation dose under the guarantee of the image quality compared with Mo-Rh target-filter combination.At the same tube current,W-Rh target-filter combination can provide a better image quality under a relatively high tube voltage.

Objective We performed a diffusion tensor imaging (DTI) study to explore the value of mode of anisotropy (MO) and other DTI-derived indices in assessing white matter fiber damage with mild to moderate Alzheimer disease (AD) patients. Methods This study was a prospective study. From February 2015 to February 2018, 33 patients with mild to moderate AD according to criteria were prospectively recruited as AD group at the First Affiliated Hospital of Wenzhou Medical University. Twenty healthy age-, sex-matched volunteers were recruited as normoal conctrast (NC) group. All subjects were performed by conventional brain MRI and DTI scans. The MO, anisotropic fraction (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AxD) of white matter fibers were obtained from DTI images after TBSS post-processing. The statistical analyses of DTI indices between AD group and NC group were carried out in Functional MRI Software Library software. Results As compared with NC group, we found 1 cluster with significant decrease FA and increase RD in AD group, the affected fibers involving bilateral anterior thalamic radiation, corticospinal tract, cingulate gyrus, hippocampus, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, uncinated fasciculus, superior longitudinal fasciculus (P<0.05). The MD value increase(P<0.1) was found to coincide with the decrease of FA and the increase of RD, while no significant increase or decrease in P<0.05. Three clusters of MO increases (P<0.05) accompanying with increases of AxD were found in left anterior limb of internal capsule, bilateral posterior limb of internal capsule, posterior forceps, left centrum semiovale and parietal lobe. Two clusters of MO decreases (P<0.05) accompanying with decreases of FA and increases of RD were found in fornix, forceps, external capsule, centrum semiovale and left frontal lobe. Conclusions The combination of MO with DTI routine tensor indices (FA, RD, MD, AxD) can further reveal the microstructural damage of white matter fibers in AD, especially to crossing-fibers. The abnormalities of MO combined with FA, RD and MD reveal the degeneration of both bundles of crossing-fibers,and the abnormalities of MO combined with AxD reveal that the white matter damage was mainly caused by axon damage of one bundle of cross fibers.

Objective To evaluate the clinical value of enhanced 3D-SPACE-STIR sequence MR in brachial plexus injury post-ganglionic nerve.Methods Eighteen patients with suspected brachial plexus injury were examined by routine MRI,3D-SPACE-STIR sequence and enhanced scan.The position,morphology,signal intensity of the brachial plexus injury and its relation with the proximal and distal portions of the brachial plexus were evaluated by senior radiologists.The image quality of plain and enhanced 3D-SPACE-STIR was evaluated respectively.Results The CNR of plain scan and enhanced 3D-SPACE-STIR sequence images were 32.31+2.98 and 43.66+2.78 respectively and the difference was statistically significant.Plain and enhanced 3D-SPACE-STIR sequences of supraclavicular nerves display rate were 95.0% and 96.1% respectively without having statistically significant difference.However,the subclavicular segment of the brachial plexus showed the displaying rates of 66.7% and 94.4% and the difference was statistically significant.Moreover, the background suppression effect of enhanced scan was better than that of the plain scan.Conclusion Enhanced 3D-SPACE-STIR sequence can clearly show brachial plexus injury,and its image quality is better than that of the plain scan,which can provide important imaging basis for accurate diagnosis of brachial plexus injury.

Objective:To investigate the CT features of primary hepatic lymphoma in order to improve the accuracy of diagnosis.Methods:The clinical data, CT and pathological findings of 11 patients with primary hepatic lymphoma confirmed by surgery and pathology in Wenzhou Medical University Affiliated Yueqing Hospital, Wenzhou People′s Hospital of Zhejiang Province and the First Affiliated Hospital of Wenzhou Medical College from September 2008 to September 2018 were retrospectively analyzed.Results:Among the 11 patients, the tumors were located in the right liver in 7 cases, in the left liver in 2 cases, and in the left and right lobe of the liver in 2 cases; there were 27 tumors with the largest diameter of 1.7 to 12.6 cm; the tumors were round in 3 cases, oval in 5 cases and irregular in 3 cases; the tumor boundary was clear in 8 cases and unclear in 3 cases. CT scan showed low density in 6 cases, slightly low density in 3 cases and equal density in 2 cases; the density was uniform in 7 cases and inhomogeneous in 4 cases; CT value was 26 to 47 (38 ± 5) HU; there were 2 cases of splenic metastasis, 1 case of rib metastasis and 1 case of abdominal and retroperitoneal lymph node enlargement. CT enhanced scan showed no obvious enhancement in 1 case; in arterial phase, mild to moderate enhancement was seen in 10 cases, including 8 cases of continuous circular enhancement at the edge of the lesions in portal venous phase and delayed phase, and 2 cases with nodular enhancement; the CT value of arterial phase was 30 to 68 (53.8 ± 11.6) HU, that of portal venous phase was 52 to 69 (64.3 ± 9.3) HU, and that of delayed phase was 43 to 64 (56.4 ± 6.0) HU. Eight cases were completely resected, and 6 cases recurred after operation. Five cases survived for 3 years and 2 cases survived for 5 years; 3 cases were not completely resected, and all of them recurred after operation. One case survived for 3 years and no patient survived for 5 years. Among them,. Pathological diagnosis was diffuse large B-cell lymphoma in 10 cases and T-cell lymphoma in 1 case.Conclusions:CT examination of primary hepatic lymphoma has important value in the localization, qualitative and auxiliary clinical diagnosis of the tumor.

Objective:To investigate the relationship between monocyte/high-density lipoprotein ratio (MHR) and clinical parameters and the prognosis of patients with chronic kidney disease (CKD).Methods:Clinical data were collected of CKD patients who were diagnosed and followed up regularly in Henan Provincial People's Hospital from January 1, 2017 to June 30, 2020. According to the median baseline MHR of the selected patients, they were divided into two groups: low-level MHR group (MHR≤0.347 8) and high-level MHR group (MHR>0.347 8). The patients were regularly followed up for 3-42 months, the renal adverse prognostic events were defined as serum creatinine doubled, estimated glomerular filtration rate (eGFR) reduced to at least 50% of the original, new entry into end-stage renal disease (ESRD), starting renal replacement therapy, death due to renal or cardiovascular events. The Kaplan-Meier method was used to compare the differences in survival rates between the two groups, and Cox regression analysis method was used to explore the influencing factors of renal adverse prognosis in CKD patients. Stratified analysis was used to find special factors that might affect the relationship between MHR and renal adverse prognosis in CKD patients.Results:A total of 405 patients were included in this study. Their age was (49.77±14.82) years old. Body mass index was (25.18±4.22) kg/m 2. Women accounted for 30.62%(124/405). The proportion of patients with smoking, drinking, hypertension and diabetes was 39.51%(160/405), 35.06%(142/405), 73.33%(297/405) and 38.27%(155/405), respectively. Compared with the low-level MHR group ( n=202), the high-level MHR group ( n=203) had more people in late CKD, males, and hypertension (all P<0.01), and body mass index, white blood cells, monocytes, serum creatinine, serum uric acid, serum urea nitrogen, retinol binding protein, cystatin C, blood phosphorus were higher (all P<0.05), while hemoglobin, high density lipoprotein and eGFR were lower (all P<0.05). Spearman rank correlation results show that MHR level was positively correlated with white blood cells, serum creatinine, serum uric acid, serum urea nitrogen, retinol-binding protein, cystatin C, serum phosphorus (all P<0.01), and negatively correlated with hemoglobin and eGFR (both P<0.01). The median follow-up time was 8(4, 16) months. To the end of the follow-up, 113 patients (27.90%) had renal adverse prognostic events. Kaplan-Meier survival analysis results showed that the renal cumulative survival rate of the high-level MHR group was lower than that of the low-level MHR group ( χ2=8.277, P=0.004). Multivariate Cox regression analysis showed that high MHR level was an independent influencing factor for poor renal prognosis in CKD patients ( HR=1.628, 95% CI 1.050-2.523, P=0.029). Stratified analysis showed that, without hypertension, MHR had a more significant effect on the prognosis of the kidneys ( HR=3.414, 95% CI 1.091-10.686, P for interaction=0.001). Conclusions:The level of MHR is related to the severity and poor renal prognosis of CKD, and the high MHR level is an independent predictor for poor renal prognosis in CKD patients.

Purpose/Significance The paper analyzes the application of remote consultation in Henan province and the factors affect-ing service efficiency,optimizes service mode,and provides suggestions for the sound development of telemedicine.Method/Process The volume of remote consultation business,patient and doctor data,and consultation process data carried out through the regional tele-medicine integrated service platform in Henan province in 2022 are collected and sorted out.IBM SPSS 23.0 software is used to analyze the distribution of patients and business development of remote consultation,and factors affecting the efficiency of consultation are ana-lyzed through multiple logistic regression.Result/Conclusion The level of the hospital applying for remote consultation and the consulta-tion department affect the duration of the consultation process.The consultation department,expert titles,and referral suggestions are the main factors affecting the response time of consultation.It is suggested to optimize the service process of remote consultation,enhance the enthusiasm of doctors to participate in consultation,reduce the response time of consultation,and improve the efficiency of consultation.