Objective To observe the value of mitral annular calcification(MAC)score based on cardiac plain CT for predicting intraoperative surgical procedure change of mitral regurgitation(MR).Methods Totally 182 MR patients were retrospectively enrolled and divided into MAC group(n=57)and non MAC group(n=125)based on the presence or not of MAC,and clinical and imaging data were compared between groups.Logistic regression analysis was used to observe the impact factors of surgical procedure change.The receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to explore the efficacy of MAC score for predicting surgical procedure change.Results Significant differences of the proportions of hypertension,atrial fibrillation(AF),mitral valve repair,mitral valve replacement,aortic valve replacement,tricuspid valve repair and surgical procedure change,as well as of admission left atrial diameter(LAD),admission left ventricular end-diastolic volume(LVEDV),admission left ventricular ejection fraction(LVEF),aortic valve stenosis,aortic regurgitation,the proportion of mitral stenosis(MS)and follow-up LAD were found between MAC group and non MAC group(all P＜0.05).Then the patients were divided into surgical procedure change group(n=50)and non-change group(n=132),and significant differences of patients'gender,AF,MAC,MAC score,admission LAD,aortic valve stenosis,MS and MR degree were found between surgical procedure change group and non-change group(all P＜0.05).MAC score was an independent impact factor of intraoperative surgical procedure change of MR(P＜0.001),with AUC of 0.757.Conclusion MAC score based on cardiac plain CT could be used to predict intraoperative surgical procedure change of MR.

Objective To observe the value of mitral annular calcification(MAC)score based on cardiac plain CT for predicting intraoperative surgical procedure change of mitral regurgitation(MR).Methods Totally 182 MR patients were retrospectively enrolled and divided into MAC group(n=57)and non MAC group(n=125)based on the presence or not of MAC,and clinical and imaging data were compared between groups.Logistic regression analysis was used to observe the impact factors of surgical procedure change.The receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to explore the efficacy of MAC score for predicting surgical procedure change.Results Significant differences of the proportions of hypertension,atrial fibrillation(AF),mitral valve repair,mitral valve replacement,aortic valve replacement,tricuspid valve repair and surgical procedure change,as well as of admission left atrial diameter(LAD),admission left ventricular end-diastolic volume(LVEDV),admission left ventricular ejection fraction(LVEF),aortic valve stenosis,aortic regurgitation,the proportion of mitral stenosis(MS)and follow-up LAD were found between MAC group and non MAC group(all P＜0.05).Then the patients were divided into surgical procedure change group(n=50)and non-change group(n=132),and significant differences of patients'gender,AF,MAC,MAC score,admission LAD,aortic valve stenosis,MS and MR degree were found between surgical procedure change group and non-change group(all P＜0.05).MAC score was an independent impact factor of intraoperative surgical procedure change of MR(P＜0.001),with AUC of 0.757.Conclusion MAC score based on cardiac plain CT could be used to predict intraoperative surgical procedure change of MR.

Objective:To construct a standardized training course system for new nurses in radiology department based on their post competency.Methods:The first draft of standardized training course for new nurses in radiology department was drawn up by referring to domestic and foreign literature, expert interview and group discussion. 20 experts in radiology department from 12 third grade hospitals were consulted for two rounds by Delphi method, and the index weight at all levels was determined by AHP.Results:The standardized training course system of new nurses in radiology department based on post competency includes four first level indicators (knowledge, skills, situational decision-making, humanistic quality), 10 second level indicators and 55 third level indicators. In the second round of expert consultation, the positive coefficient of experts was 85%, 100% and the authoritative coefficient was 0.75 and 0.80 respectively; In the second round expert consultation, the harmony coefficient of the first, second and third level indexes was 0.401 and 0.493 respectively, P < 0.01. Conclusion:the standardized training course system of new nurses in radiology department based on post competency is scientific and reasonable, which can provide reference for standardized training of new nurses in radiology department.

Objective:To investigate clinical significance and related factors of magnetic resonance hyperintense vessel sign (HVS).Methods:The clinical data and related imaging parameters of 109 patients with acute anterior circulation occlusion cerebral infarction, who admitted to Northern Theater Command General Hospital of People′s Liberation Army from April 2017 to August 2019, were analyzed retrospectively. Brain magnetic resonance imaging (MRI) examinations including fluid attenuated inversion recovery (FLAIR), diffusion weighted imaging (DWI) and three dimensional time of flight magnetic resonance angiography (3D TOF MRA) sequences within 24 hours of onset were performed. According to the distribution range of HVS in FLAIR sequence, the patients were divided into four grades (0, 1, 2 and 3), grades 0 and 1 belonging to HVS low grade group, and grades 2 and 3 HVS high grade group. Univariate and multivariate analyses were made to explore related factors of HVS. Fifty-two patients who completed baseline CT within six hours of onset before MRI examination were performed CT-Alberta Stroke Program Early CT Score (CT-ASPECTS) and DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS).The difference between CT-ASPECTS and DWI-ASPECTS was calculated. When the difference of ASPECTS ≤1, they were categorized as ASPECTS unchanged group (AN group); when the difference of ASPECTS>1, they were categorized as ASPECTS changed group (AY group). These two groups were compared to explore whether there was any difference in HVS grade, and Spearman correlation analysis was performed to investigate the relationship between HVS grade and the difference of ASPECTS.Results:The difference of hyperlipidemia, TOAST classification (large artery atherosclerosis (LAA), other etiology (SOE) or undetermined etiology (SUE)) and Willis circle classification (types Ⅰ, Ⅱ, Ⅲ and Ⅳ) between HVS groups were remarkable (58.6% (34/58) vs 37.3% (19/51), χ2=4.959, P=0.026; 23/5/23 vs 43/1/14, P=0.004; 3/14/12/22 vs 7/29/14/8, χ2=13.124, P=0.004). Other clinical factors and the locations of vessel occlusion did not show significant difference ( P>0.05). Multivariate Logistic regression analysis indicated that LAA in TOAST classification (LAA vs SOE or SUE, OR=3.054, 95% CI1.257-7.422, P=0.014), Willis circle type Ⅰ (type Ⅰ vs type Ⅳ, OR=5.494, 95% CI1.074-28.091, P=0.041), and type Ⅱ (type Ⅱ vs type Ⅳ, OR=5.571, 95% CI1.895-16.372, P=0.002) were independent related factors to stimulate wide distribution of HVS. The grades of HVS were significantly different between the AN group and the AY group (1/15 vs18/18, χ2=9.114, P=0.002). Spearman correlation analysis showed that HVS grade was negatively correlated with the difference of ASPECTS ( r=-0.573, P<0.001). Conclusions:Both TOAST and Willis circle classifications are crucial factors affecting HVS distribution. HVS distribution range reflects the status of collateral compensatory. Recognizing HVS may help to evaluate the progress of early cerebral infarction volume.

Objective To investigate the abnormal cerebral perfusion of unilateral ICA and VBA sclerotic stenosis by CT perfusion and DSA image.Methods Among 219 patients with ICS,the imaging (CTP,DSA) and clinical data from 120 patients with unilateral ICA sclerotic stenos(67 patients)and VBA sclerotic stenosis 53 patients were analyzed retrospectively.The degree of ICA sclerotic stenosis and collateral circulation were determined according to DSA results.Univariate analysis was used to explore the effects of stenosis degree of ICA and VBA sclerosis,establishment of collateral circulation and stroke risk factors on cerebral perfusion.Results The degree of unilateral ICA and VBA sclerosis stenosis has a low-degree positive correlation with cerebral perfusion (r=0.249,P=0.042,P=0.025;r=0.381,P=0.005,P=0.007),which is statistically significant.The collateral circulation of unilateral ICA stenosis (13 cases of normal perfusion and 12 cases of hypoperfusion) was significantly different from cerebral perfusion (P=0.041).There was no statistical significance between abnormal CTP perfusion and stroke factors (P>0.05).Fifty three cases of VBA sclerosis stenosis (19 cases of low perfusion include VBA severe stenosis 5 and occlusion 14;34 cases of normal perfusion group include 22 cases of severe stenosis and 12 cases of occlusion).There was no statistical significance between the establishment of collateral circulation (23 cases in the normal perfusion group and 8 cases in the low perfusion group) and the influencing factors of stroke (P>0.05).Conclusion There was a low positive correlation between the degree of sclerotic stenosis of ICA and VBA and cerebral perfusion.The establishment of collateral circulation can improve the state of cerebral blood flow to a certain extent.

Objective: To explore the diagnosis value of late gadolinium enhancement(LGE) detected by magnetic resonance imaging(MRI) in acute myocardial infarction(AMI) patients. Methods: The clinical and MRI data of 52 AMI patients hospitalized from January 2016 to July 2017 in our hospital were retrospectively analyzed. All patients received medication and revascularization therapies after admission and cardiac magnetic resonance examination was performed within 1 week after admission. According to whether there was LGE, AMI patients were divided into LGE(+) group(33 cases) and LGE(-) group(19 cases). According to the existence of microvascular obstruction(MVO) and/or intramyocardial hemorrhage(IMH),LGE(+) patients were divided into MVO/IMH(+) group(18 cases) and MVO/IMH(-) group(15 cases). Results: (1)There were no statistical significance between the LGE(+)group and LGE(-)group in the age, gender,smoking history, hypertension, diabetes mellitus, dyslipidemia, ventricular arrhythmia, culprit vessel, left ventricular end-diastolic volume(LVEDV), and left ventricular end-systolic volume(LVESV) (all P>0.05). The left ventricular ejection fraction was significantly lower in LGE(+) group than in LGE(-) group( (38.7±17.6) % vs. (51.2±7.9)%, P=0.001). (2)The infarct size was positively correlated with LVEDV and LVESV(r=0.436,P=0.011;r=0.479,P=0.005,respectively), and negatively correlated with left ventricular ejection fraction (r=-0.641, P<0.001) in LGE(+) group. (3) The infarct size, LVEDV, and LVESV were significantly higher in MVO/IMH(+) group thanin MVO/IMH(-) group ((26.5±7.3)%vs. (16.2±8.3)%, P=0.001; (145.7±40.9)ml vs. (112.2±23.8)ml,P=0.009; (90.0±30.8)ml vs. (61.4±19.0)ml,P=0.004, respectively), and the left ventricular ejection fraction was significantly lower in MVO/IMH(+) group than in MVO/IMH(-) group ((29.8±15.0)% vs. (49.3±14.5)%, P=0.001). Conclusions LGE detected bycardiac magnetic resonance can provide useful information on the myocardial necrosis extent of AMI patients. Presence of MVO/IMH in LGE(+) patients is linked with larger infarct size and worse cardiac dysfunction in AMI patients.

Objective To evaluate the opening level and optimal time window of the blood-brain barrier induced by adenosine A2 receptor agonist ( Lexiscan) via dynamic enhanced MRI. Methods Twen-ty New Zealand white rabbits were divided into experiment group ( group A, n=10) and control group ( group B, n=10) . Rabbits in group A were injected with Lexiscan and rabbits in group B were injected with physiological salt via ear vein, then the coronary scanning was performed. Contrast enhanced MRI was performed at different time points ( 5, 10, 15, 20 min, and then every 10 min, until 2 h) following the in-fusion of Gd-diethylene triamine pentaacetic acid (DTPA). The signal intensity (SI) of region of interest ( ROI) was measured and the percent enhancement of SI was calculated. Evens blue staining results in brain tissues were observed. Pair t test was used to analyze the data. Results The percent enhancement of SI in group A significantly increased to (40. 93±3.70)％ at 5 min, reached the maximum of (43.03±3.62)％ at 30 min, slowly decreased until 50 min, and got to a stable level at almost 80 min. At each time point, the per-cent enhancement of SI in group A was significantly higher than that in group B ( t values:6.88-20.28, all P<0. 05) . The staining was evident in group A. Conclusions Lexiscan can open blood-brain barrier tem-porarily and reversibly, and the optimal opening time window is 10-50 min post-injection.

Objective To investigate the construction and application in practice of information process management system in the treatment of acute ischemic stroke (AIS).Methods From August 2017 to November 2017,the clinical data of the 597 patients with suspected stroke received green channel treatment for stroke and incorporated into the information process management system at the Cerebrovascular Disease Center,Changhai Hospital,the Second Military Mcdical University were analyzed retrospectively.The operation status and operational efficiency of each link in the AIS treatment process were evaluated.The performance assessment indicators for stroke nurses and visiting doctors were developed.The accuracy and missed diagnosis of stroke determined by the stroke nurses were calculated.The operation ability of stroke nurses was evaluated by the doctor's arrival at triage desk to establishment of intravenous access time and signing of informed consent to rt-PA bolus time,with less than 10 min as the standard.The emergency response capability of consultation physicians was evaluated by calling consultation physician to arriving at the triage desk and establishing venous channel to transport to the CT room time,with less than 5 min as the standard.The standard-reaching rate was calculated.Results A total of 597 patients were prechecked as suspected stroke.Among them,549 patients with stroke were judged by doctors,430 established venous access,443 were transported to CT room,441 completed CT scan,and 52 were treated with venous thrombolysis.In the process,the median time of patients to hospital to doctor to triage desk,doctor to triage desk to establishment of venous channel,establishment of venous channel to transportion to CT room to completion of CT scan,completion of CT scan to rt-PA bolus,patients to hospital to completion of CT scan and patients to hospital to rt-PA bolus was 3 (1,5),8 (3,16),3 (2,5),3 (2,9),9 (3,22),20(10,30) and 27 (19,55) min,respectively.The stroke nurses determined the accuracy and misdiagnosis rate of stroke were 92.0％ (549/597) and 8.4％ (50/597) respectively.The standard-reaching rate of doctor to triage desk to establishment of venous channel,signing informed consent to rt-PA bolus time were 82.1％ (353/430) and 80.8％ (42/52) respectively.The standard-reaching rates of calling consultation doctor to doctor to triage desk,establishment of venous channel to transportion to CT room time were 94.5％ (564/597) and 91.4％ (405/443) respectively.Conclusion A process management system centered on "time management" may help analyze the efficiency of various links and personnel in the AIS treatment process,and optimize the process continuously.

Objective To explore the value of MSCT in diagnosis of pulmonary atresia complicated with ventricular septal defect (PA/VSD).Methods Clinical and imaging data of 81 patients with PA/VSD were retrospectively analyzed.All patients underwent transthoracic echocardiography (TTE) and MSCT before surgical operation,and the imaging data were compared with surgical findings.Results There were 23 patients of type A1,17 of type A2,34 of type B and 7 of type C PA/VSD.The accuracy rate of MSCT classification of PA/VSD (93.82％ [76/81]) was higher than that of TTE (59.26％ [48/81];x2=26.95,P＜0.01).The accuracy rate of MSCT diagnosis of origin of major aortopulmonary collateral arteries (MAPCAs,100％ [93/93]) was higher than that of TTE (51.84％ [51/93];x2 =54.25,P＜0.01).Fifty cardiac malformations (50/53,94.34％) were detected with MSCT,53 with TTE ([53/53,100％];x2 =1.37,P=0.24),while 66 heart-vessel conjunction abnormalities (66/66,100％) were detected with MSCT,and 65 with TTE ([65/66,98.48％],P＞0.05).Meanwhile,106 extracardiac great vessel abnormalities (106/106,100％) were detected with MSCT and 87 with TTE ([87/106,82.08％],x2 =20.87,P＜0.05).McGoon index,pulmonary artery index and total neo-pulmonary arterial indexes (TNPAI) measured with MSCT were not statistical different with findings of surgical operation (all P＞ 0.05).Conclusion MSCT can accurately diagnose type of PA/VSD and display pulmonary artery developmental state,therefore providing guidance for clinical treatment of PA/VSD.

Objective To analyze the effects of quality supervision and continuous improvement system on optimizing in-hospital diagnosis and treatment process in patients with acute ischemic stroke (AIS).Methods From September 2013 to May 2016,424 consecutive patients with AIS treated with intravenous thrombolysis and/or endovascular therapy in Changhai Hospital,the Second Military Medical University were enrolled retrospectively.They were analyzed according to the annual running process (the first year[from September 2013 to August 2014],the second year[from September 2014 to August 2015],and the third year[from September 2015 to May 2016]).The spend time and delay (DTN>60 min,DTP>90 min) rate of each treatment process in the first,second,and third year (time from door-to-imaging[DTI],door-to-needle[DTN],imaging-to-needle (ITN),door-to-groin puncture (DTP) and imaging-to-groin puncture (ITP) were compared.Taking the time periods (>median) of having significant differences of the spend time of the treatment processes as the dependent variables in the first,second,and third year,the influence of the years and treatment modalities on delay was observed.The difference of constituent ratio of the reasons for delay in intravenous thrombolysis and endovascular therapy (objective reasons/other reasons) in different years were analyzed.Results (1) DTIs were 23.0 (11.0,42.0) min,22.0 (10.1,39.0) min,and 13.0 (6.0,27.0) min,respectively,and DTNs were 50.0 (30.0,77.1) min,45.0 (30.0,70.2) min,and 36.0 (24.0,57.0) min,respectively in the first,second,and third year.The spending time was shortened year by year.There were significant differences among the different years (all P<0.01).The spending time of DTP had a tendency to be shortened,but there were significant differences among different years (P=0.06).There were no significant differences between the spending time of ITN and ITP (all P>0.05).(2) The DTN delay rates were 33.3% (40/120),20.7% (29/140),and 8.1% (9/111),respectively in the first,second,and third year.There were significant differences among the 3 years (x2=22.111,P<0.01).There were no significant differences among the DTP delay rates (P=0.08).(3) Multivariate Logistic regression analysis showed that taking the first years as a reference,the risk of DTI delay was reduced in the third year (OR,0.174,95%CI 0.101-0.298,P<0.01),the risks of DTN delay were reduced in the second and third year (OR,0.564,95%CI 0.338-0.941;OR,0.180,95%CI 0.101-0.320,all P<0.05).For simple intravenous thrombolysis,bridging therapy was a protective factor for the improvement of treatment efficiency in the DTI process (OR,0.530,95%CI 0.297-0.943,P=0.031).Compared with the bridging therapy,the direct endovascular therapy was a protective factor for DTP treatment (OR,0.427,95%CI 0.202-0.901,P=0.025).The remaining independent variables were not associated with the occurrence of DTN and DTP delay (all P>0.05).(4) During the three years,the delay of intravenous thrombolysis was mainly due to objective reasons.The constituent ratio of other reasons caused delay of intravenous thrombolysis was decreased year by year.There was no other reasons for delay in the third year).There was no significant difference in the constituent ratio of the delay reasons in endovascular treatment (x2=3.622,P=0.164).Conclusion Under the existing process and resource allocation,setting the DTN target time and implementing continuous quality improvement are conducive to the effective implementation of brain CT scan and continuous optimization of intravenous thrombolysis in the processes in AIS patients with the first diagnosis.