Objective To evaluate the feasibility and the safety of the direct coronary stent implantation Methods Retrospectively reviewed the clinical and angiographic data of 139 patients received direct coronary stent implantation, follow up was performed in 95 of these patients Results The direct coronary stenting procedure was successful in 133 (95 7%) of 139 cases In residual 6 (4 3%) failure cases, the stent could not cross the lesion and was successful retrieved in 2 cases, balloon predilation was added In 4 cases the stent did not completely cover the lesion or dissection appeared after direct stenting, the second stent was deployed Angiographic success was achieved in all the 139 cases without major adverse coronary events during in hospital In 7 (7 4%) of 95 cases the target lesion needed repeat PTCA because of significant restenosis during 1～23 months (median 4 7 months) of clinical follow up Conclusion Direct coronary stent implantation is feasible and safe in selective patients It can save the cost of one balloon catheter

Objective To explore the characters of the aged patients with coronary disease undergoing percutaneous transluminal coronary angioplasty in clinical presentation, procedural success, and in-hospital outcomes. Methods Data were collected as a part of a prospective registry of all percutaneous coronary interventions performed by authors between January 2001 and October 2002. Comparisons between 2 age groups (≥70 years and

Objective To investigate the incidence and risk factors of renal artery stenosis (RAS) in patients with coronary artery disease (CAD). Methods Retrospective analysis was made based on the clinical and angiographic data of patients with CAD and RAS proved by angiography during May 2003 and August 2004. Results Forty-eight (13.7%) out of 350 CAD patients were identified with significant RAS. Multi-variance logistic analysis showed that age over 70 years old, serum creatinine greater than 120 ?mol/L, history of hypertension and multi-vessel coronary disease were the independent predictive factors. Conclusion The incidence of RAS in CAD patients was 13.7%. Routine renal angiography was recommended for CAD patients.

Objective To evaluate the clinical features of in-stent restenosis after drug eluting stent (DES) implantation and investigate the relationship between different patterns of DES restenostic lesions and long-term prognosis.Methods All scoronary heart disease patients who underwent repeated pereutaneous coronary intervention (PCI) for DES in-stent restenosis from September 2006 to December 2009 were enrolled.All patients were divided into focal group and non-focal group according to the pattern of restenosis.All patients were prospectively followed up for major adverse cardiovascular event (MACE) including death,repeat PCI and myocardial infarction.Results Totally 88 patients (40 with focal restenosis,48 with non-focal restenosis) were enrolled.There were no significant differences between two groups in age,gender,risk factors,clinical presentation and medical therapy (P ＞ 0.05).Compared with that in focal group,the patients in non-focal group had a higher portion of in-segment restenosis [58.3％ (28/48) vs.12.5％(5/40),P＜ 0.01],higher stenosis rate [(78.1 ± 10.0)％ vs.(70.0 ± 9.7)％,P ＜ 0.01],more need for another DES[81.2％(39/48) vs.17.5％(7/40),P＜ 0.01],and longer stent implanted [(25.0 ± 7.0) mm vs.(17.4 ±3.4) mm,P ＜0.01].After following up for (2.2 ± 1.0) years,there were no significant differences between two groups in MACE and each component (P ＞ 0.05),however,compared with that in focal group,there was a trend of increase in MACE in non-focal group[22.9％(11/48) vs.10.0％(4/40),P=0.092].Conclusion It suggests that patients with non-focal restenosis have a more severe lesion angiographically,which usually results in another DES implanted,and has a worse long-term prognosis.

Objective To compare the safety and efficacy of direct and remedial rotational atherectomy in the treatment of heavily calcified coronary artery lesions.Methods We retrospectively reviewed 58 patients admitted in the Shanghai Chest Hospital and Liaocheng People Hospital from May 2012 to July 2015 who had received stent implantation and rotational atherectomy.The 58 patients were divided into two groups which were the direct atherectomy group (n =27) and the remedial atherectomy group (n =31).General clinical date,lesion and procedural characteristics,intraoperative complications,in-hospital and follow-up MACCE were compared between the two groups.Results There were no differences between the two groups in general clinical date intraoperative complications,amount of contrast agent used,proceduraltime,rates of in-hospital and follow-up MACCE.Nevertheless,compared with the direct artherectomy group,the remedial group had more number of balloon dilations during procedure [3 (1,5) vs.2 (1,2),P ＜ 0.001] and higher peak cardiac troponin levels [1.1 (0.3,3.0) μg/L vs.0.5 (0.1,2.3) μg/L,P =0.032].Conclusions Remedial rotational atherectomy with drug-eluting stent had the same safety and efficacy as direct atheretomy with drug-eluting stent in treating patients with heavily calcified coronary lesions.It is reasonable and safe to transform routine PCI to remedial rotational atherectomy when the 2.0 mm semi compliant balloon or/and 2.5 mm non-compliant balloon cannot pass through or dilate the lesions.

Objective:To explore the optimal monochromatic level for the observation of coronary in-stent lumen by dual-layer spectral CT (DLCT).Methods:Forty-nine patients with 74 stents after percutaneous coronary intervention (PCI) who underwent coronary CTA (CCTA) examinations by a DLCT between January 2016 and September 2017 were retrospectively enrolled. A total of 12 groups of images including 60-120 keV (kilo electron voltage) images with 10 keV interval, 140-200 keV images with 20 keV interval and conventional images. In-stent lumen diameter of proximal, mid and distal portion was measured. Difference of CT values between in-stent lumen and ascending aorta was used to describe as blooming artifact, and noise of in-stent lumen as image noise. Then Likert 5-point scale was performed to evaluate images noise, enhancement of in-stent lumen, blooming artifact and diagnostic confidence. Differences of objective and subjective parameters among conventional and various monochromatic images were compared by Friedman test.Results:In the diameter measurement of the proximal, middle and distal segments of the stent, the difference between the images of each group was statistically significant (χ 2 = 427.270, 426.375, 400.981, P< 0.001). The diameter of the lumen measured by 120-200 keV single-level image was larger than that measured by 60-100 keV single-level image, and the difference was statistically significant ( P< 0.05). In the comparison of CT difference between the stent lumen and ascending aorta, the difference between the images of each group was statistically significant (χ 2 = 242.193, P< 0.001), and 100-200 keV single-level images were lower than the conventional images, the difference was statistically significant ( P< 0.05). In the comparison of noise values, the difference between the images of each group was statistically significant (χ 2 = 420.161, P< 0.001), and the difference was statistically significant ( P< 0.05). In the subjective scores of noise, enhancement, halo artifact and diagnostic confidence, there were statistically significant differences among the groups (χ2= 333.827, 455.989, 276.824, 399.497, P< 0.001). The noise score of 100-200 keV single-level image was higher than that of conventional image, the difference was statistically significant ( P< 0.05). The enhancement score of 60 keV was significantly higher than that of other images ( P< 0.05). The halo artifact score of 100-200 keV single level image was higher than that of 60-90 keV image, the difference was statistically significant ( P<0.05). The scores of 90-120 keV single-level images were higher than those of other single-level images, and the difference was statistically significant ( P< 0.05). Conclusions:CCTA examinations can be effectively performed by DLCT in patients after PCI in clinical settings, and 120 keV is recommended as the optimal monochromatic image for the observation of in-stent lumen.

Objective:To investigate the clinical value of virtual monoenergetic images (VMI) and electron density map (EDM) derived from the dual-layer spectral detector CT (DLCT) in the differential diagnosis of benign and malignant pulmonary ground glass nodules (GGN).Methods:From July 2019 to August 2020, a total of 65 patients with lung GGN (27 benign GGNs and 38 malignant GGNs) confirmed by pathology were retrospectively enrolled in Gulou Clinical Medical College of Nanjing Medical University. All the patients underwent DLCT plain scanning within two weeks before the surgery. The conventional 120 kVp polyenergetic image (PI), EDM and 40-80 keV VMI were reconstructed. The differences of CT and electron density (ED) values between benign and malignant lesions on different images were compared by Mann-Whitney U test. Independent t-test was used to compare the lesion size and χ 2 test was used to analyze the CT features (including lesion location, shape, edge, internal structure, adjacent structure, nodule type) between benign and malignant lesions. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of different energy spectrum quantitative parameters in the differential diagnosis of benign and malignant GGN. The statistically significant CT signs and energy spectrum quantitative parameters were analyzed by logistic regression analysis to find out the independent risk factors of malignant GGN, and then ROC curve analysis was performed for each independent risk factor alone or in combination. Results:There were significant differences in lesion shape, spiculation, lobulation, location and size between benign and malignant groups ( P<0.05). The CT value of pulmonary GGN in PI, 40-80 keV VMI and the ED value in EDM were statistically different between benign and malignant lesions ( P<0.05). The area under ROC curve (AUC) were 0.680, 0.682, 0.683, 0.686, 0.694, 0.676 and 0.722, respectively, among which the ED value had the highest AUC. Binary logistic regression analysis was carried out with GGN shape, spiculation, lobulation, location, size, ED value and CT value in PI, 40-80 keV VMI as independent variables, and malignant GGN as dependent variables. The results showed that ED value (OR=1.045, 95%CI 1.001-1.090, P=0.044), lesion size (OR=1.582, 95%CI 1.159-2.158, P=0.004), spiculation sign (OR=11.352, 95%CI 2.379-54.172, P=0.002) were independent risk factors for malignant GGN. ROC curve analysis showed the AUC of ED value, lesion size, spiculation sign and combination of the three for differential diagnosis of benign and malignant GGN were 0.722, 0.772, 0.698 and 0.885. The AUC for the combined parameters was the largest, with sensitivity of 92.1% and specificity of 74.1%. Conclusion:The diagnostic efficacy of EDM is higher than that of other VMI in the differential diagnosis of pulmonary GGN by DLCT images; The efficacy is further improved when EDM is combined with lesion size and spiculation sign for comprehensive diagnosis.

Objective To explore the feasibility of the virtual non-contrast images derived from dual-layer spectral detector CT (SDCT) substitute for true non-contrast images.Methods From July 2017 to September 2017,40 patients under-went pre-and arterial-venous dual-phase post-contrast abdominal imagining on a SDCT in Shanghai Jiaotong University School of Medicine Affiliated Ruijin Hospital.The images were retrospectively analyzed.The arterial VNC images (VNC-a) and venous VNC images (VNC-v)were derived from spectral based image (SBI) datasets of arterial and portal venous phase using a dedicated software respectively.Then mean CT attenuation,mean image noise,signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared with one-way ANOVA analysis among TNC,VNC-a,VNC-v images in liver,spleen,pancreas,abdominal aorta,inferior vena cava,psoas muscle,L4 vertebra and perirenal fat.And Bland-Altman plots was used to analyze the CT attenuation equivalence between TNC and VNC.Subjective image quality was assessed with a 5-point scale and compared with Friedman H test.The dose length product (DLP) of pre-and post-contrast scans were recorded.Results The CT attenuation of abdominal aorta,perirenal fat,L4.vertebra among three kinds of images had significant differences (P＜0.05)which overestimated the CT attenuation of perirenal fat and underestimated CT attenuation of abdominal aorta and vertebra compared to TNC,VNC.Except for pancreas,the image noise of all other tissues among three kinds of images had significant differences,images noise of VNC images were lower than TNC images (P＜0.05).The SNR of liver,spleen,psoas muscle and inferior vena cava and CNR of pancreas,abdominal aorta,inferior vena cava,L4 vertebra and perirenal fat were statistically significant among the three images (P＜0.05).Except for vertebra and perirenal fat,good equivalence between VNC and TNC images were observed in all relevant tissues with Bland-Altman analysis.Image quality subjective scoring of TNC,VNC-a,and VNC-v were 5.00(1.00),5.00(0.75),5.00(1.00) respectively which had no significant differences (P=0.20).The DLP of TNC,arterial and venous phase scan were (255.2±62.0),(258.9±62.9),(252.0±61.2)mGy·cm,and the total DLP of dual-phase contrast enhanced scan was (766.2± 185.3) mGy· cm.The DLP of TNC accounted for 33.3％(255.2/766.2) of the total DLP,and effective dose of TNC was (3.83±0.90)mSv.Conclusions CT attenuation in VNC image which exhibited lower image noise was identical to TNC images in the majority of abdomen tissues except for vertebra and perirenal fat.and the VNC image.The VNC image which reduces radiation dosage derives from SDCT enhanced image might be used as a substitute for the TNC image.

Objective:To investigate the clinical value of iodine density map and low keV virtual monoenergetic images (VMI) derived from dual-layer spectral detector CT (DLCT) for the pancreatic neuroendocrine tumors (pNETs) detection.Methods:From January to June 2019, data of 23 pathologically confirmed patients of pNETs were retrospectively analyzed. All of the patients underwent pancreas enhanced DLCT scanning within 1 week before surgery. The conventional polyenergetic images (PI), iodine density map and 40, 50, 60, 70 keV VMI were generated. One resident radiologist with 3 years’ experience and one senior radiologist with over 10 years’ experience interpreted the images for the lesion detection independently using the following image series: PI, VMI (40-70 keV), PI combined with iodine density map. Lesion detection rates were recorded and compared among different image series. The CT value and noise of lesion, normal pancreatic parenchyma, and abdominal subcutaneous fat were measured in PI and VMI in both arterial and portal vein phases. The contrast-to-noise ratio (CNR) of lesion was calculated. The CT value of lesion and normal pancreatic parenchyma, CNR of lesion, and image noise were compared using repeated one-way ANOVA test. Subjective image quality was assessed with a 5-point scale and compared with Friedman test.Results:A total of 26 lesions were confirmed from 23 patients. For resident radiologist and senior radiologist, the detection rates of pNETs lesion using PI were 76.9% (20/26) and 84.6% (22/26) respectively, and both improved to 92.3% (24/26) using image series of 40 and 50 keV VMI. For senior radiologist, the pNETs lesion detection rate was further improved to 96.2% (25/26) using image series of PI with iodine map. The CT value of lesion and normal pancreatic parenchyma, CNR, and image noise had statistical differences among PI and VMI (40-70 keV) in both arterial and portal vein phase ( P<0.001). The mean CT attenuation and CNR of lesion in VMI increased significantly as the energy level decreased.The CNR of lesion in all VMI (40-70 keV) was significantly higher than that in PI. The median of subjective scores of image quality in PI and VMI (40-70 keV) were 3, 3, 4, 4, and 5 respectively, and the difference was statistically significant (χ2=66.393, P<0.001). Conclusions:The low keV VMI derived from DLCT can increase the CT value and CNR of pNETs, and the lesion detection rate can be improved combined with iodine density map. The CNR of pNETs is the highest in 40 keV VMI, and image noise is still lower than that of PI, so 40 keV VMI is recommended for clinical application.

Objective:To explore the image quality of 40 keV virtual monoenergetic images (VMI) derived from dual-layer spectral detector CT （DLCT） pancreas dynamic enhanced scanning and its optimal window setting.Methods:From January to July 2019, 28 patients who underwent pancreas enhanced DLCT scan within one week before surgery and pathologically confirmed of pancreatic neuroendocrine tumors (pNETs) were retrospectively enrolled. Conventional polyenergetic images (PI) and 40 keV virtual monoenergetic images （VMI 40 keV） were generated after scanning.CT value of normal pancreatic parenchyma, lesion, abdominal subcutaneous fat, abdominal aorta and portal vein were measured in PI and VMI 40 keV. The contrast-to-noise ratio (CNR) of the pNETs lesion was calculated. All these objective results were compared between VMI 40 keV and PI using paired ttest. Individual window settings （W-Ind, including window width and window level） of VMI 40 keVwere recorded. Calculated window settings （W-Calc） were mathematically calculated via regression analysis and optimized window settings （W-Opt） were obtained.Subjective image quality was assessed with a 5-point scale and compared among VMI 40 keV with different window settings (W-Std, W-Ind, W-Calc and W-Opt) using Friedman test, and compared PI with standard abdominal window setting (W-Std) and VMI 40keV with W-Opt settings using Wilcoxon test.The maximum diameter of lesion was measured and compared with one-way ANOVA analysis among PI and VMI 40 keV with different windows settings. Results:For VMI 40 keV in both arterial phase and portal vein phase, the CT attenuation [(464.0±136.7), (375.4±79.2) HU] of pNETs lesion were statistically significantly higher than those in PI [（168.8±38.0), (140.5±23.5) HU] （ t=-16.107,-22.225, P<0.001）, CNR （16.5±11.1, 10.9±6.1） were also statistically significantly higher than those in PI （4.5±2.9, 3.0±1.9） （ t=-7.838, -9.781， P<0.001）,while with lower image noise in VMI 40 keV[（11.8±1.5),(11.8±1.4) HU] than PI （13.1±1.5,12.9±1.3 HU）（ t=6.356,3.891， P<0.001）. The subjective score for PI with W-Std and VMI 40 keV with W-Std, W-Ind, W-Calc, W-Opt in arterial phase were 4（1）, 1（0）, 5（0）, 5（0.75）, 5（1）, and which in portal vein phase were 3.5（1）, 1（0）, 5（0）, 5（0）, 5（1）.The subjective score of VMI 40 keV with different window settings had statistical differences （χ 2=76.143,76.000， P<0.001）. Compared to the image quality of PI with W-Std settings, VMI 40 keV with W-Opt settings have higher objective score （ Z=4.685, 4.235， P<0.001）. The maximum diameter of lesion has no statistical difference among PI and VMI 40 keV with different window settings （ F=0.008, 0.004， P>0.999） in both arterial phase and portal vein phase. Conclusions:The VMI 40 keV in pancreas dynamic enhancement scanning derived from dual-layer spectral detector CT have higher image quality than PI. Due to changes of CT value of tissue in VMI 40 keV, it is recommended to optimize window settings （window width/window level， 880/230 HU for arterial phase and 840/260 HU for portal vein phase） to obtain the best image quality.