Objective To study the MR images of patients with Alzheimer's disease (AD) for analysis of the volume changes ofbrainstem and deep brain nuclei,hoping to provide evidence for early clinical diagnosis.Methods Selected for this study were MRI images from the ADNI database from July 2006 to November 2010 of 31 AD patients (AD group),34 patients with mild cognitive impairment (MCI group),and 34 normal aged people (NC group).The follow-up MRI data of all the above subjects 2 years later were also collected.Software Freesufer was used to calculate and compare the volume changes ofbrainstem and deep brain nuclei in all the subjects.Results An identical trend was found concerning the MRI-based volumes of brainstem,hippocampus and deep brain nuclei (caudal nucleus and putamen) before and after follow-up between the 3 groups:AD group＜MCI group＜NC group,with statistically significant differences between groups (P＜0.05).Follow-ups revealed significant decreases in all the indicators in AD and MCI groups (P＜0.05),but no such differences in NC group (P＞0.05).Pearson relative analysis showed a positive correlation between the brainstem volume and the volume of deep brain nuclei (caudal nucleus and putamen) in AD patients (r=0.653,P=0.021;r=0.596,P=0.014).Conclusions As AD progresses,the brainstem and deep brain nuclei in AD patients continue to shrink in volume and there may be a positive correlation between them.Therefore,detection of the volume changes of the brainstem and deep brain nuclei contributes to the early diagnosis of AD.

Objective To explore the clinical effect of double M-shaped cartilage used in nasal tip cosmetic plasty.Methods From December 2016 to May 2017,nasal fip plasty was performed in 39 patients in Hangzhou Huashan Luyeme Medical Cosmetology Hospital.With the Goodman's incision in the columella and nasal vestibule,a big piece of autologous nasal septal cartilage was removed and transplanted to the front of nasal septum.Ear cartilage was trimmed into two strips and sutured with nasal septum cartilage graft.Meanwhile,the sandwich cartilage graft was inserted between the lower lateral cartilages to form the first "M" shape stent when fixing part of it on the nasal septum.Then the ear cartilage was turned over and fixed with lateral crus of the lower lateral cartilages to form the second "M" shape stent.Willow-shaped prosthesis was placed into the nasal dorsum.Results A total of 39 cases of nasal tip surgery were performed,including 1 male and 38 females.Ages ranged from 21 to 48 years in this group.The follow-up period was from 1 month to 5 months.36 patients were satisfied with the efficacy while 2 patients were suffered from the deviation of nasal tip,one patient was suffered from nasal septum deviation.Conclusions The application of double M-shaped cartilage in nasal tip cosmetic plasty is one of ideal rhinoplasty approaches with less wound,simple procedure and good clinical effects.

Objective To investigate the morphological changes of the brainstem in patients with Alzheimer's disease (AD) and their relationship with hippocampal morphological changes.Methods Sixty AD patients (AD group) and sixty age-and gender-matched normal elderly (normal control group) were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database.The hippocampus and the brainstem of each subject were segmented and their normalized volumes were calculated.According to the hippocampal volume standard value (Z-score),AD patients were divided into two subgroups (hippocampal atrophy group (n=51) and hippocampal spared group (n=9)).A voxel-based morphology (VBM) study was also performed to investigate the morphological differences of the brainstem between the normal control group and the AD group,as well as between the AD subgroups.Results Compared with the normal control group,the brainstem volume in the AD group decreased significantly (16 741.31±1 739.11 vs 15 609.67±1 451.60,t=3.870,P=0.001).In AD subgroups,the volume of the brainstem in the hippocampal atrophy group was significantly smaller than that in the hippocampal spared group (16 556.30 ± 1 514.86 vs 15 442.62 ± 1 389.05,t=2.189,P=0.033).Pearson correlation analysis showed that Mini-Mental State Examination scores were positively correlated with the hippocampal and the brainstem volumes (r=0.590,P＜0.01;r=0.234,P＜0.05),and there was a positive correlation between the hippocampal and the brainstem volume changes in patients with AD (r=0.315,P=0.014).VBM results showed that both the bilateral midbrain and the bilateral pons in the AD group had significant atrophy compared with the normal control group (P＜0.05).In the AD subgroups,the bilateral midbrain and the left pons in the hippocampal atrophy group were significantly atrophied compared with the hippocampal spared group (P＜0.05).Conclusion The brainstem showed morphological changes in patients with AD,and the morphological changes of the brainstem in AD patients with different degrees of hippocampal atrophy were different,indicating the morphological changes of the hippocampus and the brainstem may have an interrelated relationship.

Objective:To explore the CT imaging and clinical features of gastritis cystica profunda (GCP) and improve the level of diagnosis.Methods:From June 2015 to August 2019, the clinical and CT imaging data of 9 GCP patients confirmed by pathology in the First Affiliated Hospital of Zhengzhou University were retrospectively collected. These 9 GCP patients included 3 male and 6 female, aged from 44 to 66 years, with an avereage age of (59±7) years. All the 9 patients underwent plain and enhanced abdominal CT scan. The location, shape, size, margin, density, enhancement pattern and enhancement degree of the lesions were analyzed and summarized.Results:The lesions are more common in gastric antrum (3 cases) and gastric fundus (3 cases). CT imaging showed thickening gastric wall thickening in 3 cases, circular ovoid or circular mass shadow protruding into the gastric cavity in 6 cases. Solid components were dominant in 2 cases and cystic components were dominant in 7 cases. In arterial phase, solid components showed significantly enhancement in 6 cases and moderate enhancement in 3 cases, while muscle layer of lesions were characterized by mild enhancement in 5 cases and moderate enhancement in 4 cases. In venous phase, solid components illustrated as significantly enhancement in 6 cases with progressive pattern and moderate enhancement in 3 cases, while the muscle layer of lesions were featured as progressive moderate enhancement in 4 cases and there is no significant enhancement in the rest 5 cases whose enhancement degree were similar to that of normal gastric wall. Additionally, the surface of the cyst covered with intact mucosa in 7 cases and in other 2 cases without complete mucosa.Conclusion:On the basis of accurate localization, CT scan could provide rich information including size, shape, internal structure and state around the lesion, which is of great value for the diagnosis of GCP.

Objective:To investigate the clinicopathological features and computed tomography (CT) findings of tracheal glomus tumor (GT) in order to improve the understanding and diagnosis of tracheal GT.Methods:The clinical and CT imaging data of 2 patients with tracheal GT diagnosed in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively. The image characteristics based on previous reports were analyzed.Results:The clinical manifestations of trachea GT were dyspnea, chest tightness, hemoptysis, etc., which were easy to be misdiagnosed. The CT manifestations were spherical or nodular protrusions in the trachea cavity, with uneven edges, which can be lobulated. Cystic changes can be seen in the focus. After enhancement, it showed progressive filling and obvious enhancement, without deep infiltration and distant metastasis.Conclusions:Chest CT can accurately localize tracheal GT, provide its morphological size, blood supply, growth characteristics and other characteristics, accurately display the overall morphology of the lesion, and provide some help for the development of the surgical plan, and its definitive diagnosis still relies on pathological examination.

Objective:To investigate the predictive value of visceral adipose tissue (VAT) in occult peritoneal metastasis (OPM) of gastric cancer.Methods:A total of 93 patients with gastric cancer admitted to the First Affiliated Hospital of Zhengzhou University from October 2018 to October 2021 were retrospectively collected. None of the patients had typical peritoneal metastasis on CT. Patients were divided into OPM group (31 cases) and non-OPM group (62 cases) according to laparoscopic exploration. The clinical, pathological and CT features were recorded. The parameters related to adipose tissue (VAT and subcutaneous adipose tissue) within the range of 15 mm and 25 mm below the largest layer of gastric cancer lesions in preoperative CT images were measured, including the volume, average CT attenuation and standard deviation. The independent-sample t test, Wilcoxon rank-sum test, χ 2 test or Fisher′s exact probability were used to compare the clinical, pathological and CT imaging parameters between OPM and non-OPM groups. Multivariate logistic regression analysis was used to explore the independent risk factors for OPM of gastric cancer and establish a combined model. The receiver operating characteristic curve was used to evaluate the efficacy of each indicator and the combined model in predicting OPM of gastric cancer. Results:There were statistically significant differences in age, pathological type, CA125, ascites, cT stage, the thickest diameter of lesion, average CT attenuation of 15 mm VAT and 25 mm VAT between the OPM group and the non-OPM group ( P<0.05). Multivariate analysis showed that ascites, cT stage and average CT attenuation of 25 mm VAT were independent risk factors for OPM of gastric cancer, with the OR (95%CI) of 4.940 (1.287-18.967), 4.284 (1.270-14.455), and 1.149 (1.013-1.303), respectively. A combined model was established. The area under the curve (AUC) of ascites, cT stage, average CT attenuation of 25 mm VAT, average CT attenuation of 15 mm VAT and combined model were 0.685, 0.718, 0.703, 0.674 and 0.813, respectively. There were statistically significant differences in AUC between the combined model and each four single indicators above ( Z=2.98, 2.63, 2.09, 2.54, P=0.003, 0.009, 0.037, 0.011). Conclusions:The ascites, cT stage and average CT attenuation of 25 mm VAT are independent risk factors for OPM in gastric cancer. The combined model based on the above three indicators has the best performance in predicting OPM in gastric cancer.

Objective:To understand the clinical features and computed tomography (CT) imaging performance of mediastinal giant malignant synovial sarcoma (SS) and to improve the clinicians′ diagnosis and treatment of this disease.Methods:We report the clinical data of 2 cases of primary mediastinal giant malignant SS, and reviews the literature for CT presentation and differential diagnosis.Results:Primary giant malignant SS of mediastinum is rare in clinic. CT showed irregular cystic and solid mass with mural nodules, adjacent osteolytic destruction, unclear boundary with adjacent tissues. The enhancement showed that the solid components of the tumor and mural nodules were enhanced, while the cystic necrosis area had no enhanced uneven enhancement. The two cases in this paper showed " borehole-like" growth above the clavicle and growth into the left thoracic cavity, with pulmonary metastasis and lymphatic metastasis respectively.Conclusions:Mediastinal malignant SS is a rare disease with high malignancy and easy to metastasize, which emphasizes " early detection, early diagnosis and early treatment" . It should be taken into account in the differential diagnosis of mediastinal tumors, but the confirmation of diagnosis needs to be combined with pathological and immunohistochemical findings. Clinicians need to take advantage of imaging examinations to provide auxiliary guidance on the diagnosis, metastasis assessment and surgical treatment options of SS.

Imaging omics can predict disease evolution, progression, and treatment response by extracting high-dimensional quantitative features from medical imaging. Positron emission tomography (PET) related imaging omics has been a research hotspot in recent years, and its application in urogenital system tumors is rapidly increasing. This article provides a review of the research progress on the application of PET related imaging omics in urogenital system tumors, and discusses the existing challenges and future prospects, in order to provide reference for further clinical application research.

Objective:To explore the value of multiphasic CT-based radiomics signature in predicting the invasive behavior of pancreatic solid pseudopapillary neoplasm (pSPN).Methods:The multiphasic CT images of patients with pSPN confirmed by postoperative pathology in the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2021 were analyzed retrospectively. There were 23 cases of invasiveness and 59 cases of non-invasiveness. The region of interest(ROI) was artificially delineated layer by layer in the plain scan, arterial-phase and venous-phase images, respectively. The 1 316 image features were extracted from each ROI. The data set was divided into training and validation sets with a ratio of 7∶3 by stratified random sampling, and synthetic minority oversampling technique (SMOTE) algorithm was used for oversampling in the training set to generate invasive and non-invasive balanced data for building the training model. The constructed model was validated in the validation set. The receiver operating characteristic(ROC) analysis was used to evaluate model performance and the Delong′s test was applied to compare the area under the ROC curve (AUC) of different predict models. The improvement for classification efficiency of each independent model or their combinations were also assessed by net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices.Results:After feature extraction, 2, 6 and 3 features were retained to construct plain-scanned model, arterial-phase and venous-phase models, respectively. Seven independent-phase and combined-phase models were established. Except the plain-scanned model, the AUC values of other models were greater than 0.800. The arterial-phase model had the best efficiency for classification among all independent-phase models. The AUC values of arterial-phase model in the SMOTE training and validation sets were 0.913 and 0.873, respectively. By combining the radiomics signature of the arterial-phase and venous-phase models, the AUC values of training and validation sets increased to 0.934 and 0.913 respectively. There were no significant differences of the AUC values between the scan-arterial venous-phase model and arterial venous-phase model in both training and validation sets (both P>0.05). The NRI and IDI indexes showed that the combined form of plain-scan model and arterial-venous-phase model could not significantly improve the classification efficiency in the validation set (both NRI and IDI<0). Conclusions:The arterial-phase CT-based radiomics model has a good predictive performance in the invasive behavior of pSPN, and the combination with a venous-phase radiomics model can further improve the model performance.

Objective:To analyze clinical features, short-term efficacy and side effects of salvage re-irradiation therapy for patients with locally recurrent esophageal cancer after definitive chemoradiotherapy, to investigate the prognostic factors of re-irradiation with precise radiotherapy techniques.Methods:A retrospective analysis was performed on patients with locally recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy treated in the Fourth Hospital of Hebei Medical University from January 2008 to December 2016. The patients underwent re-irradiation therapy (re-RT) or re-irradiation therapy concurrent chemotherapy (re-CCRT). The main observation index was after-recurrence survival (ARS), which was calculated by Kaplan-Meier method for survival analysis. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox regression model.Results:A total of 109 patients were included, with a median age of 66 years (43-89 years), and a median follow-up time of 120.8 months (79.0-176.5 months). The objective response rates (ORR) and dysphagia improvement rates (DIR) in all patients were 64.2% and 63.0%, respectively. The median ARS and 1-, 3-, 5-, 8-year survival rates in all patients were 7.8 months and 32.1%, 9.2%, 7.3% and 2.3%, respectively. The median ARS and 1-, 3-, 5-years survival rates were 10.8 months and 45.9%, 13.5%, 10.8% for patients with time to recurrence (TTR) ≥24 months, significantly longer than those of 5.7 months and 25.0%, 6.9%, 5.6% for patients with TTR<24 months ( χ2=7.99, P=0.005). The median ARS in groups with re-irradiation dose of ≤50 Gy,>50-54 Gy, and>54 Gy groups were 5.7, 10.0 and 8.1 months, respectively ( χ2=6.94, P=0.031). The 1-, 3- and 5-year survival rates were 30.4%, 5.1%, and 3.8% for re-RT versus 36.7%, 20.0%, and 16.7% for re-CCRT ( χ2=2.12, P=0.145). Multivariate analysis showed that TTR ( HR=0.607, 95% CI=0.372-0.991, P=0.046) and lesion length ( HR=0.603, 95% CI=0.371-0.982, P=0.042) were the independent factors for ARS. There was no significant difference in ≥2 grade pneumonitis and 2-3 grade radiation esophagitis between the re-RT and re-CCRT groups ( χ2=0.25, P=0.619; χ2=0.51, P=0.808). The morbidity of ≥2 grade myelosuppression in the re-RT group was significantly lower than that in the re-CCRT group (3.7% vs. 36.7%, χ2=18.15, P<0.001). Conclusions:Precise re-irradiation therapy for patients with locally recurrent esophageal cancer after definitive chemoradiotherapy can alleviate dysphagia, but ARS remains poor. Re-irradiation dose range from>50-54 Gy may be suitable for locally relapse patients as salvage treatment. Patients with TTR≥24 months and lesion length ≤5 cm obtain favorable prognosis.