Objective To investigate the clinical value of gemstone spectral imaging (GSI) associated with patient-based low dose of contrast medium protocol in carotid CTA. Methods One hundred and twenty patients who were suspected with stenotic carotid artery or carotid plaque were prospectively enrolled in the study. All of them were divide into two groups by random number table. Group A (routine group): 60 were scanned with 120 kVp after the administration of moderate-concentration CM(320 mg/ml) with 5 ml/s injection velocity, Group B (low dose group):60 were scanned with GSI which was reconstructed using 50%ASiR after the administration of the same CM with 3 ml/s injection velocity. The contrast dose [(test bolus peak time +2 s – 5 s) × injection velocity] was calculated. Images of the two groups were compared in terms of arterial attenuation, signal-noise-ratio (SNR), contrast-to-noise ratio (CNR), and subjective image quality (IQ) score. The value of CT dose index volume (CTDIvol), dose length product (DLP) and effective dose (ED) was recorded, respectively. Data were analyzed by using independent samples t test or Mann-Whitney U test. Results The mean attenuation, noise, SNR, CNR, subjective image quality score, contrast dose, CTDIvol, DLP and ED of routine group was (363 ± 56)HU, (13 ± 4)HU, 30 ± 10, 38±13, 3.0 score, (69 ± 13) ml, 13.61 mGy,527 mGy · cm and 3.11 mSv, respectively. The above variables of low-dose-group was (378 ± 69) HU, (9 ± 4)HU, 48 ± 19, 62 ± 24, 2.0 score,(49 ± 7)ml, 12.72 mGy, 478 mGy · cm and 2.82 mSv, respectively. The mean attenuation and subjective IQ score of carotid artery had no significant differences statistically between two groups (P>0.05), respectively. The noise, SNR, CNR, contrast dose, CTDIvol, DLP and ED had significant differences statistically between two groups (P<0.05), respectively. Conclusion Compared with 120 kVp protocol, the use of GSI associated with patient-based low dose of contrast medium protocol in carotid CTA could provide equivalent image quality and higher SNR and CNR of carotid artery with a smaller amount of iodine and a lower radiation dose.

Objective To evaluate spectral CT imaging in characterizing the pathological type and the differentiation of gastric cancer.Methods Ninety-one patients diagnosed of gastric cancer were retrospectively analyzed.Patients were all underwent triple-phase enhanced scan using single source dualenergy CT on gemstone spectral imaging(GSI) mode.Three types of images were reconstructed for analysis:the water concentration (WC),iodine concentration (IC),and normalized iodine concentration (NIC).The patients were divided into groups of mucinous carcinoma (MUC),including mucinous adenocarcinoma and signet ring cell carcinoma,and non-mucinous gastric carcinoma (non-MUC).Independent-samples t test was used for statistical analysis.Results There were 24 patients of MUC and 67 patients of non-MUC.The IC and NIC of the non-MUC were significantly higher than the MUC in vein phase (VP) and in parenchymal phase (PP) [(21.33 ±6.31) × 100 vs (16.94 ±6.13) × 100 μg/ml,0.55 ±0.17 vs 0.42 ±0.14 in VP,and(20.65 ±5.49) × 100 vs (18.07 ±4.51) × 100 μg/ml,0.72 ±0.20 vs 0.57 ±0.12 in PP,respectively t =-2.948,-3.362,-2.261,-4.326,P ＜0.05].The IC and NIC of the signet ring cell carcinoma were statistically higher than those of the mucinous adenocarcinoma [(19.36 ± 4.75) × 100 vs (12.10 ±5.92) ×100μg/ml,0.49 ± 0.09 vs0.28±0.11 in VP,and (19.88±3.28) ×100 vs (14.45±4.62) ×100 μg/ml,0.63 ±0.08 vs 0.47 ±0.11 in PP,respectively t =3.253,5.180,3.339,3.850,P ＜0.01].For the poorly differentiated and well /moderately differentiated adenocarcinoma,the IC and NIC of the former were higher than those of the latter in VP and PP [(23.48 ±6.49) × 100 vs (18.98 ±5.26) × 100 μg/ml,0.61±0.16vs0.48±0.15 in VP,and (22.95±5.51) ×100 vs (18.28±4.47) ×100 μg/ml,0.81 ± 0.21 vs 0.63 ± 0.15 in PP,respectively t =3.098,3.249,3.766,4.117,P ＜ 0.01].The between-group differences of WC,IC and NIC in artery phase were no significant (P ＞ 0.05).Conclusions Different pathological types could determine different IC.The spectral CT imaging may be helpful for characterizing the pathological type of gastric cancer.

Objective To evaluate the value of MRI in qualitative and quantitative diagnosis of bone marrow involvement in patients with lymphoma. Methods 28 diagnosed lymphoma with bone marrow infiltration and 31 healthy spines as controls were included.MRI performance and the signal intensity ratio on T1WI (SIR1) of the spine bone marrow and cerebrospinal fluid were analyzed and statistical analyses were performed.Results Qualitative diagnosis among these patients,was shown than MRI results indicated that 27 cases had abnormal signal. The sensitivity of MRI was 96.4 ％. There were four main patterns of marrow infiltration in MRI,containing nodular pattern 21.4 ％ (6/28),scattered pattern 53.6 ％ (15/28),mottled pattern 14.3 ％ (4/28) and uniform pattern 7.1％ (2/28) respectively.By quantitative diagnosis the SIR1 of study group (1.251±0.253) was apparently lower than that in the control group (2.625±0.434) with statistical significance (t =15.022,P ＜ 0.001).The results of multiple comparisons showed that the SIR1 of mild degree (1.390±0.172),moderate degree (0.982±0.790) and severe degree (0.908±0.122) patients with lymphoma compared with the normal controls had significant differences (all P =0.000),and difference between mild and moderate degree had statistical significance (LSD,P =0.012),so did the difference between mild and severe degree (LSD,P =0.025).However,no significant difference could be seen between moderate and severe degree (LSD, P =0.757). Positive linear correlation was existed between the persentages of SIR1 and tumor cells in bone marrow (r =-0.765, P ＜ 0.001). Conclusion As a noninvasive and direct-viewing technique, MRI presents a global view of bone marrow with high sensitivity in detecting bone marrow involvement in lymphoma. To a certain extent, it could be possible to estimate the infiltration degree and evaluation of the tumor burden in bone marrow by quantitative measurement of MRI.

Objective To investigate the value of wide-detector Revolution CTA with 70 kV tube voltage and prospective ECG-gated technique in diagnosis of congenital heart disease (CHD) in infants and children.Methods Forty-five infants and children with complicated CHD underwent echocardiography and wide-detector Revolution CTA.According to the sur gical findings,the diagnostic efficiency of Revolution CTA and echocardiography were calculated and compared.The radiation effective dose (ED) and iodine dose were calculated.The quality of CT images was also evaluated.Results There were 25 separate cardiovascular anomalies including 6 congenital cardiac structure anomalies and 19 congenital extracardiac vascular anomalies.For congenital extracardiac vascular anomalies,there was significant difference of diagnostic accuracy and the detectable rate between CTA (99.77％ [853/855],97.73％ [86/88]) and echocardiography (98.71％ [844/855],88.64％ [78/88];x2 =6.28,5.72,both P＜0.05).The average of ED was (0.20±0.05)mSv and the mean iodine dose was (2.06± 1.09)g.All CT images were qualified for diagnosis.Conclusion The wide-detector Revolution CTA,with the prospective ECG-gated technique and 70 kV tube voltage,can provide high accuracy for assessment of CHD in infants and children,which can keep good image quality,with the low radiation dose.

Objective To investigate the limitation of quantitative measurement of cerebral blood flow (CBF) of normal white matter by using a single subtraction with thin-slice TI1 periodic saturation (Q2TIPS Ⅱ ) pulsed arterial spin labeling (PASL)technique. Methods Thirty-one patients with brain tumors were examined at 3.0 T MRI system . A second version of quantitative imaging of perfusion using a single subtraction with additional thin-section periodic saturation after inversion and a time delay (Q2TIPS) technique of pulsed arterial spin labeling in the multisection mode and T2* dynamic susceptibility-weighted contrast-enhanced (T2* DSC)MR imaging were both implemented. Cerebral blood flow map obtained from PASL and DSC were reviewed. The regions of interest( ROI )were placed in the region of normal white matter contralateral to the lesion in the proximal and distal slices. In regions of interest, the signal intensity (SI)was measured from the maps of cerebral blood flow map obtained from PASL and DSC. Pair-t test was performed to determine if there were significant signal differences between proximal and distal slices. Pearson linear correlation analysis of signal intensity was performed for values from the same slices of PASL-CBF and DSC-CBF maps. Results In the deep white matter of distal slice, PASL-CBF map showed perfusion deficit while DSC-CBF map showed low CBF in the corresponding brain area. With the increased inversion time,the PASL-CBF map showed obviously improved perfusion signal in deep white matter (but still some perfusion deficit)and slightly decreased perfusion signal in grey matter. The mean signal of normal white matter measured from distal slices of PASL-CBF maps was( -22.1 ±55.5) ml· 100 g-1 · min-1 while it was (89.5 ±45.5) ml. 100 g-1 · min-1 in proximal slices. There was a significant difference of signal intensity from PASL-CBF maps between distal and proximal slices ( t = - 9. 512, P ＜ 0. 01 ＝, while no difference of signal intensity between distal[ (62. 8 ± 29.9) ml · 100 g-1 · min-1] and proximal slices [(57. 1 ±29.6) ml · 100 g-1 · min-1 ]was obtained from DSC-CBF maps(t= -1.607,P＞0.05). There was no significant correlation between PASL-CBF and DSC-CBF in both distal ( r = 0. 093, P ＞ 0. 05 ) and proximal slices ( r = - 0. 234, P ＞ 0. 05). ConclusionsPASL has limitation in the accurate quantification of cerebral blood flow of normal white matter. The quantification of CBF was affected by the limitations of the technique itself and the different parameters chosen..

Objective: To investigate the differences of gemstone spectral curve and CT value of gastric cancer with different pathological types and differentiation degrees. Methods: 91 cases of preoperative gemstone CT images with gastric cancer were collected, including 24 cases of mucinous carcinoma, 67 cases of non-mucinous carcinoma, 16 cases of signet ring cell carcinoma, 8 cases of mucinous adenocarcinoma, 32 cases of moderately differentiated adenocarcinoma and 35 cases of poorly differentiated adenocarcinoma. Gemstone CT spectral imaging was performed preoperatively, and the spectral curve of the lesion in venous phase was obtained by using GSI Viewer software, the slope of the curve was calculated, and 11 monoenergetic CT values of 40~140 keV (10 keV interval) were measured. The gemstone spectral curves and CT values of gastric cancer with different pathological types and differentiation degrees are compared. Results: The curve slopes of non-mucinous carcinoma, signet ring cell carcinoma and poorly differentiated adenocarcinoma were -1.92±0.53, -1.73±0.37 and -2.14±0.54, respectively. The absolute values were higher than those of mucinous carcinoma (-1.45±0.54), mucinous adenocarcinoma (-0.90±0.34) and moderately differentiated adenocarcinoma (-1.67±0.41), and the differences were all statistically significant (P<0.05). There were significant differences in monoenergetic CT values between mucinous and non-mucinous carcinomas at 40-140 keV (all P<0.05). The former was lower than the latter in different degrees, and the lower the energy, the greater the difference was. There were significant differences in monoenergetic CT values between signet ring cell carcinoma and mucinous adenocarcinoma at 40-100 keV (all P<0.05); monoenergetic CT values between poorly differentiated adenocarcinoma and moderately differentiated adenocarcinoma at 40-90 keV showed statistically significant differences (P<0.05). Conclusions Gastric cancer with different pathological types and differentiation degrees have their characteristic spectral curves in venous phase, and the monoenergetic CT values are significantly different at low energy. The spectral curve of gemstone CT may be helpful to evaluate the pathological type and differentiation degree of gastric cancer before operation.

Objective To investigate the differences of gemstone spectral curve and CT value of gastric cancer with different pathological types and differentiation degrees. Methods 91 cases of preoperative gemstone CT images with gastric cancer were collected, including 24 cases of mucinous carcinoma, 67 cases of non?mucinous carcinoma, 16 cases of signet ring cell carcinoma, 8 cases of mucinous adenocarcinoma, 32 cases of moderately differentiated adenocarcinoma and 35 cases of poorly differentiated adenocarcinoma. Gemstone CT spectral imaging was performed preoperatively, and the spectral curve of the lesion in venous phase was obtained by using GSI Viewer software, the slope of the curve was calculated, and 11 monoenergetic CT values of 40～140 keV (10 keV interval) were measured. The gemstone spectral curves and CT values of gastric cancer with different pathological types and differentiation degrees are compared. Results The curve slopes of non?mucinous carcinoma, signet ring cell carcinoma and poorly differentiated adenocarcinoma were －1.92±0.53,－1.73±0.37 and －2.14±0.54, respectively. The absolute values were higher than those of mucinous carcinoma (－1.45±0.54), mucinous adenocarcinoma (－0.90± 0.34) and moderately differentiated adenocarcinoma (－1.67±0.41), and the differences were all statistically significant (P＜0.05). There were significant differences in monoenergetic CT values between mucinous and non?mucinous carcinomas at 40?140 keV ( all P＜0.05). The former was lower than the latter in different degrees, and the lower the energy, the greater the difference was. There were significant differences in monoenergetic CT values between signet ring cell carcinoma and mucinous adenocarcinoma at 40?100 keV (all P＜0.05); monoenergetic CT values between poorly differentiated adenocarcinoma and moderately differentiated adenocarcinoma at 40?90 keV showed statistically significant differences ( P ＜ 0. 05 ). Conclusions Gastric cancer with different pathological types and differentiation degrees have their characteristic spectral curves in venous phase, and the monoenergetic CT values are significantly different at low energy. The spectral curve of gemstone CT may be helpful to evaluate the pathological type and differentiation degree of gastric cancer before operation.

Objective To explore the application effect of modified installing method of high flexion rotating platform prosthesis trial model in double compartment knee arthroplasty.Methods A total of 20 patients(26 knees)with severe knee osteoarthritis admitted to Hebi People's Hospital from January 2021 to April 2022 and required double compartment knee arthroplasty were selected as the research subjects.Patients were divided into the control group(10 knees)and the observation group(16 knees)based on the installing method of high flexion rotating platform prosthesis trial model.The patients in the control group used the conventional installing method of high flexion rotating platform prosthesis test model(placing the tibial side test model,the femoral side test model and finally the pad test model),while patients in the observation group used the modified installing method of high flexion rotating platform prosthesis test model(matching the femoral test model,pad and tibial test model when the patient flexed 60° to 90°,and placing them together into the knee joint osteotomy groove).The intraoperative bleeding volume and surgical time of patients in the two groups were recorded.Before surgery,2 weeks after surgery and 18 months after surgery,the knee joint function of patients was evaluated by the American hospital for special surgery(HSS)scoring system,and the range of motion(ROM)of knee joint of patients was measured by protractor.Results The intraopera-tive bleeding volume of patients in the observation group was significantly less than that in the control group,and the surgical time was significantly shorter than that in the control group(P＜0.05).There was no statistically significant difference in preoperative HSS score and ROM of knee joint of patients between the two groups(P＞0.05).At 2 weeks and 18 months after surgery,the HSS score and ROM of knee joint of patients in the observation group were significantly higher than those in the control group(P＜0.05).Conclusion Compared with the conventional installing method of high flexion rotating platform prosthesis trial method,the modified installing method of high flexion rotating platform prosthesis trial model in double compart-ment knee arthroplasty for patients with severe knee osteoarthritis can effectively improve surgical efficiency,reduce intraopera-tive bleeding,improve knee function and increase ROM of knee joint.

Objective To investigate the differences of gemstone spectral curve and CT value of gastric cancer with different pathological types and differentiation degrees. Methods 91 cases of preoperative gemstone CT images with gastric cancer were collected, including 24 cases of mucinous carcinoma, 67 cases of non?mucinous carcinoma, 16 cases of signet ring cell carcinoma, 8 cases of mucinous adenocarcinoma, 32 cases of moderately differentiated adenocarcinoma and 35 cases of poorly differentiated adenocarcinoma. Gemstone CT spectral imaging was performed preoperatively, and the spectral curve of the lesion in venous phase was obtained by using GSI Viewer software, the slope of the curve was calculated, and 11 monoenergetic CT values of 40～140 keV (10 keV interval) were measured. The gemstone spectral curves and CT values of gastric cancer with different pathological types and differentiation degrees are compared. Results The curve slopes of non?mucinous carcinoma, signet ring cell carcinoma and poorly differentiated adenocarcinoma were －1.92±0.53,－1.73±0.37 and －2.14±0.54, respectively. The absolute values were higher than those of mucinous carcinoma (－1.45±0.54), mucinous adenocarcinoma (－0.90± 0.34) and moderately differentiated adenocarcinoma (－1.67±0.41), and the differences were all statistically significant (P＜0.05). There were significant differences in monoenergetic CT values between mucinous and non?mucinous carcinomas at 40?140 keV ( all P＜0.05). The former was lower than the latter in different degrees, and the lower the energy, the greater the difference was. There were significant differences in monoenergetic CT values between signet ring cell carcinoma and mucinous adenocarcinoma at 40?100 keV (all P＜0.05); monoenergetic CT values between poorly differentiated adenocarcinoma and moderately differentiated adenocarcinoma at 40?90 keV showed statistically significant differences ( P ＜ 0. 05 ). Conclusions Gastric cancer with different pathological types and differentiation degrees have their characteristic spectral curves in venous phase, and the monoenergetic CT values are significantly different at low energy. The spectral curve of gemstone CT may be helpful to evaluate the pathological type and differentiation degree of gastric cancer before operation.

Objective:To explore the technical advantages of MR cholangiopancreatography (MRCP) with single breath holding high parallel acquisition factor 3-D variable flip angle fast spin echo (3D-SPACE) sequence.Methods:From November 2018 to March 2019, 75 patients who underwent MRCP examination in our hospital were prospectively enrolled, with single breath holding high parallel acquisition factor 3D-SPACE sequence and free breathing navigation gated 3D-SPACE sequence. Three experienced radiologists scored the overall image quality, artifacts, CBD visibility, left and right hepatic ducts, right anterior and posterior branches, second and third branches, main pancreatic duct and gallbladder duct with four scales. Paired t test was used for statistical analysis. Results:The scanning time of single breath holding method (18 s) was significantly shorter than that of free breathing diaphragm navigation method［264（226，313）s］, and the difference between the two methods was statistically significant ( Z=-7.520， P<0.001). The SNR, CR and CNR (8.31±4.23, 0.92±0.30, 11.46±5.77) of single breath holding method were lower than those of free breathing diaphragm navigation method (11.23±5.70, 0.93±0.38, 15.06±7.37), and the differences between the two methods were also statistically significant ( t=4.378, 3.429, 4.063, P<0.05). The overall image quality, artifact, the CBD, left and right hepatic duct, right anterior and posterior branchs, the second and third branches, main pancreatic duct and cystic duct of single breath holding method were higher than those of free breathing diaphragm navigation method, and the differences between the two methods were statistically significant ( P<0.001). Conclusions:Compared with the free breathing diaphragm navigation gated 3D-SPACE MRCP imaging method, the single breath holding high parallel acquisition factor 3D-SPACE MRCP imaging method has less artifacts and examination time, but higher visibility to pancreaticobiliary tree and work efficiency, which is worthy of further promotion.