Objective To evaluate the value of low-dose computed tomographic colonography (CTC) performed with 64-slice CT in the diagnosis of incidental extracolonic lesions and its clinical significance .Methods The image data in 158 CTC examinations with two positions were retrospectively analyzed .All abdominal extracolonic lesions were recorded .According to the age ,the pa-tients were divided into two groups :elderly and non-elderly groups .The extracolonic lesions were divided into 4 groups(E1- E4) according to the clinical importance .The incidence rates in two groups were calculated respectively .Results The incidence rate of the E2-E4 level extracolonic lesions in the elderly group was higher than that in the non -elderly group ,the difference between them had statistical signficance (P< 0 .05) .Conclusion Low-dose CTC has the high diagnostic value in finding extracolonic le-sions ,and the incidence rate of extracolonic lesions with important clinical significance is increased with the age increase ,especially for the elder patients over the age of 60 years .

Objective To evaluate the diagnostic value of intra-arterial thrombi under went susceptibility weighted imaging(SWI) in patients with acute ischemic stroke(AIS).Methods The MRI images of 133 patients with AIS was analyzed,included time of flight MR angiography(TOF-MRA )and SWI.The patients were divided into two groups according to the time between onset of symptoms and MR imaging (group A,interval time<24 h;group B,interval time 24-72 h).Two neuroradiologists who were blin-ded to the patients clinical information,documented the number and location of susceptibility vessel sign (SVS)in SWI and embolic occlusion or stenosis on TOF-MRA in AIS patients.Results The thrombus detection rate in group A was higher than that in group B.There was no significant difference in the overall detection rate of thrombi between SWI and TOF-MRA in all AIS patients,but the thrombi detection rate in M3 segement of middle cerebral artery(MCA)with SWI was higher than that with TOF-MRA in group A(P <0.05).Conclusion SWI performs a high diagnostic value for thrombus detection in AIS patients,especially for the thrombus detection of M3 segement in early period of AIS.

Objective To evaluate the diagnostic ability of fusion images of SWI and DWI in ischemic penumbra(IP)of patients with acute ischemic stroke(AIS).Methods 47 AIS patients were retrospective analyzed.Two neuroradiologists analyzed the fusion images of SWI and DWI respectively.SDM was defined as that the hypo-intensity signals of intramedullary or sulcal veins were dilated or increased on fusion images compared with contralateral areas.The results compared with the PDM,which was considered as the“gold standard”.Areas under the receiver operating characteristic curve(AUC)were used to assess the efficacy of SDM which determined by fusion images and compared to PDM.Chi-square test was used to analyze the consistency between the two neuroradiologists and also the consistency between SDM and PDM in IP assessment Results The fusion images of SWI and DWI had a high diagnostic efficacy compared to PDM, AUC of the two radiologists were 0.885,0.877,the diagnostic sensitivity were 84.2%,78.9% and specificity were 92.9%,96.4%respectively.There was also a high consistency in SDM assessment through fusion images between the two neuroradiologists (Kappa=0.908,P >0.05). Conclusion Fusion images of SWI and DWI have a high diagnostic efficacy in IP assessment,which may be considered as a simple approach for IP assessment in patients with AIS.

The high recurrence rate of hepatocellular carcinoma (HCC) after surgery cannot be ignored, but there are still no consensus statements and guideline recommendations for adjuvant therapies after HCC surgery. Current studies have shown that microvascular invasion is one of the high-risk factors for postoperative recurrence of HCC, and for HCC patients with microvascular invasion, timely postoperative adjuvant therapy may delay the time to recurrence and bring benefits to patients. At this stage, the prevention of postoperative recurrence of HCC and the prolongation of survival time through adjuvant therapy have attracted more and more attention. This article reviews the research advances in adjuvant therapy after surgery for HCC with microvascular invasion in recent years, in order to provide reference and help for postoperative adjuvant therapies for HCC patients with microvascular invasion.

Objective: To assess the collateral grade based on 4-dimensional magnetic resonance angiography (4D-MRA) in predicting short-term outcome in patients with acute ischemic stroke (AIS) . Methods: Forty-seven patients with unilateral MCA stroke were enrolled in this study. All patients underwent multi-modality MRI within 4.5 to 24.0 hours onset of stroke. The collateral grade was assessed through the dynamic MRI angiograms derived from perfusion raw data. The AIS patients were divided into favorable and unfavorable outcome group according to the improvement of national institutes of health stroke scale (NIHSS) score. The differences in baseline data, infarct volume, the ratio of volume of ischemic tissue on perfusion to infarct core on diffusion (rVPD) and collateral grade between the two groups were analyzed. Logistic regression analysis was used to identify variable influencing the short-term clinical outcomes. The Kappa coefficient was used to analyze the consistency of the collateral grade assessed between the two observers. Spearman rank-order correlation test was used to analyze the relationship between the collateral grade, infarct volume, hypoperfusion volume and rVPD. Results: The collateral grade used ASITN/SIR based on 4D-MRA was performed in 47 patients. Grade 1 in 4 patients, grade 2 in 21paitients, grade 3 in 16 patients and grade 4 in 6 patients, respectively. The collateral grade had a high consistency among the observers (Kappa=0.806, P<0.01). Of the patients who enrolled the study, the median of infarct volume was 29.63 (4.92, 69.17) ml, the hypoperfusion volume was 73.76 (29.75, 178.42) ml, and the rVPD was 3.1 (1.5, 5.8). It was negatively correlated with initial infarct volume (r=-0.627, P<0.01) and hypoperfusion volume (r=-0.354, P<0.01) . There was a significant positive correlation between the collateral grade and rVPD (r=0.575, P<0.001). There was also significant differences in infarct volume, rVPD, and collateral grade between favorable and unfavorable outcome group (P<0.05). The collateral grade based on 4D-MRA was an independent predictor of favorable clinical outcome (OR=4.419, P<0.05) . Conclusions The collateral circulation classification based on 4D-MRA proved to be a significant predictor of clinical outcome, it can be considered as a reliable method for analyzing the cerebral hemodynamic changes and collateral grade in AIS patients.

Objective:To evaluate the reliability of cardiac late iodine enhancement dual-energy CT (LIE-DECT) multiparameter post-processing technique for evaluating the presence, location, and extent of cardiac scars in patients with heart failure (HF), using cardiac MR (CMR) late gadolinium enhancement (LGE) as a reference standard.Methods:Thirty-nine HF patients who underwent cardiac LIE-DECT and LGE-CMR examinations in the Second Affiliated Hospital of Nantong University from November 2019 to November 2021 were prospectively collected, all enrolled HF patients underwent LIE-DECT post-processing to reconstruct monoenergetic plus (Mono+) map (40 keV), iodine map and Rho/Z map, to evaluate the enhancement degree, location and extent of left ventricular myocardial LIE on the left ventricular short-axis map, respectively, and compared with LGE-CMR. Cohen′s Kappa test was used to assess the intra-and inter-observer consistency of LIE by DECT multiparameter technique and the consistency of LIE presence and location by DECT multiparameter technique and by CMR. The diagnostic efficacy of DECT multiparameter technique in diagnosing myocardial scar was calculated.Results:Of the 39 patients included, 32 patients were detected by CMR with LGE in 147 segments, including 37 subendocardial patterns, 19 transmural patterns, 74 mid-wall patterns, and 17 epicardial patterns. The intra-observer consistency Kappa values of 40 keV Mono+map, iodine map and Rho/Z map were 0.878, 0.930 and 0.835 ( P all<0.001), respectively. The inter-observer consistency Kappa values were 0.838, 0.892 and 0.808 ( P all<0.001), respectively. The LIE of 40 keV Mono+map, iodine map and Rho/Z map were in good agreement with CMR, Kappa values were 0.903, 0.883 and 0.810 ( P all<0.001), respectively. For the per-patient analysis, the accuracies of 40 keV Mono+map, iodine map and Rho/Z map were 92.3% (36/39), 92.3% (36/39) and 82.1% (32/39), respectively. For the segment-based analysis, the accuracies of 40 keV Mono+map, iodine map and Rho/Z map accuracy were 96.1% (492/512), 95.3% (488/512) and 92.6% (474/512), respectively. In Bland-Altman analysis, the consistency bias between scar extent measured by 40 keV Mono+map, iodine map, Rho/Z map and that measured by LGE-CMR were -2.03%, -2.21%, -2.65%, and the 95% limit of agreement were -12.20%-8.14%, -12.69%-8.28% and -14.85%-9.58%, respectively. Conclusion:LIE-DECT multiparameter technique can detect myocardial scar in HF patients well, which is consistent with LGE-CMR.

Objective:To investigate the predictive value for major adverse cardiovascular events (MACE) occurring within 1 year in patients with old myocardial infarction(OMI) using characteristics of myocardial scar derive from dual-energy CT (DECT) post-processing technique.Methods:OMI patients who received coronary CT angiography following dual-energy CT with late iodine enhancement (LIE-DECT) in the Second Affiliated Hospital of Nantong University from November 2019 to October 2022 were continuously included, and the images of all enrolled patients were reconstructed using 40 keV monoenergetic plus (Mono+) map, LIE (representing myocardial scar) was quantified on left ventricular short-axis images, including the LIE segments, the LIE score, and the LIE degree. All enrolled patients were followed up for MACE, defined as hospitalization for heart failure, malignant arrhythmia, and cardiac death. Regression analysis was used to investigate the relationship between the quantified value of myocardial scar and the occurrence of MACE, and receiver operating characteristic curve (ROC) was used to evaluate the efficacy of quantified value of myocardial scar in predicting MACE. The area under the curve (AUC) was compared using the DeLong test.Results:Finally, 231 patients with OMI were included, and MACE occurred in 37 cases (16.0%) within 1 year after LIE-DECT examination. The LIE segments 5 (4, 7), the LIE score 27 (13, 49) and the LIE degree 9.4%(7.5%, 15.5%) in the MACE group were higher than those in the non-MACE group 3 (2, 5), 9 (6, 15) and 6.7%(6.3%, 7.9%) (all P<0.001). Multivariable logistic regression analysis showed that after adjusting for confounders, the LIE segments ( OR=2.118, P<0.001), the LIE score ( OR=3.168, P<0.001), and the LIE degree ( OR=3.092, P<0.001) remained risk factors for the development of MACE. On ROC analysis, AUC of LIE segments, LIE score and LIE degree were 0.715, 0.822 and 0.806 (all P<0.001), with sensitivities of 81.1%, 86.5%, and 91.9%, and specificities of 53.6%, 69.6%, and 60.8%, respectively. DeLong′s test showed that the predictive efficacy of LIE score and LIE degree was higher than that of LIE segments ( Z=2.63, P=0.008; Z=1.96, P=0.049), and there were no significant differences in the predictive efficacy of LIE score and LIE degree ( Z=0.60, P=0.551). Conclusion:The LIE segments, the LIE score and the LIE degree detected by LIE-DECT 40 keV Mono+maps are risk factors for the occurrence of MACE in patients with OMI and have good efficacy in predicting the occurrence of MACE, which can be used as important indicators for assessing the clinical prognosis of OMI.