Objective To investigate the relevant risk factors for endoscopic electrocoagulation hemostasis in elderly patients with acute epistaxis,and establish and validate a nomogram prediction model to facilitate early selection of appropriate hemostasis methods in clinical practice.Methods Clinical data of 228 elderly patients with unilateral acute epistaxis from January 2018 to December 2022 were collected.There were two groups,the electrocoagulation group(n = 112)and the conservative packing group(n = 116),based on whether they received endoscopic electrocoagulation hemostasis.Analysis was performed to explore the independent risk factors for requiring endoscopic electrocoagulation hemostasis.A nomogram prediction model was established based on the multivariate results,and receiver operator characteristic curve(ROC curve),calibration curve and clinical decision curve analysis(DCA)were used to evaluate the predictive performance and consistency of the model.Results According to the research results,the univariate analysis showed that age,hypertension,cardiovascular disease,anticoagulant use,and bleeding site were associated with endoscopic electrocoagulation hemostasis(P<0.05).The multivariate binary Logistic regression analysis revealed that older age,the presence of hypertension,long-term use of anticoagulants,and bleeding sites located in the posterior nasal region or unknown location were associated with a higher likelihood of undergoing endoscopic electrocoagulation hemostasis(P<0.05).Based on these independent risk factors,a nomogram model for predicting endoscopic electrocoagulation hemostasis for acute epistaxis in elderly patients was established,the area under the curve(AUC)was 0.856(95%CI:0.805～0.907).The calibration curve and DCA showed that the use of the nomogram model could benefit patients over a wide range of diagnostic threshold probabilities.Conclusion A nomogram model based on age,hypertension,anticoagulant use,and bleeding site to predict the risk of endoscopic electrocoagulation hemostasis in elderly patients with acute epistaxis has a good predicted performance.

Microvascular invasion (MVI) is an independent predictor of early recurrence and poor prognosis following hepatocellular carcinoma (HCC) resection and transplantation. As a novel non-invasive diagnostic tool, radiomics can extract the quantitative imaging features of tumors and peritumoral tissues with high throughput, providing more information on tumor heterogeneity than conventional and functional imaging of visual analysis and having a good application prospect in predicting the presence of MVI in HCC patients, thereby improving the accuracy of HCC diagnosis and prognosis. The value of the multimodal radiomics method based on various imaging methods in evaluating the possibility of MVI in HCC patients is elucidated here in combination with the latest research progress.

Objective To investigate the value of quantitative evaluation in white matter damage caused by delayed neuropsychiatric sequelae (DNS) after carbon monoxide poisoning (CO) with diffuse kurtosis imaging (DKI).Methods A prospective study was conducted from November 2016 to February 2019 in 28 patients diagnosed as having DNS after CO poisoning and 30 healthy controls in our hospital.DKI scans were performed within 7 d of onset and DKI-derived parameters (9 regions of interest),including mean kurtosis (MK),axial kurtosis (AK),and radial kurtosis (RK),were obtained.Mini Mental State Examination Scale (MMSE),Barthel Index,Verbal Fluency Test (VFT),and Digital Breadth Test (DST) were performed on both subjects to conduct neurocognitive assessment;multivariate regression analysis was performed to determine the statistical relations of scores of above neurocognitive scales with AK values of ROIs.Results As compared with those in the control group,the MK,AK and RK values in all ROIs showed an increased trend in DNS group;among which,the anterior semioval center,posterior semioval center and frontal lobe enjoyed the most obvious increase,with significant differences (P＜0.05).In the genu of corpus callosum,body of corpus callosum and parietal lobe,the AK value of DNS group was significantly higher than that in the controls (P＜0.05).Except for temporal lobe and occipital lobe,area under the curve (AUC) of AK value of other ROIs in diagnosing DNS was larger than that of RK and MK values of other ROIs;AK value of anterior semioval center (AUC=0.802,P=0.000),posterior semioval center (AUC=0.785,P=0.000),frontal lobe (AUC=0.749,P=0.001),genu of corpus callosum,(AUC=0.730,P=0.003),parietal lobe (AUC=0.699,P=0.009) and body of corpus callosum (AUC=0.654,P=0.045) had better performance than RK and MK in diagnosing DNS,with statistically significant differences (P＜0.05).Multivariate regression analysis results show that the DST value (reverse) is the independent influencing factors of AK values of anterior semioval center,genu of corpus callosum,and frontal lobe;VET (vegetable) is the independent influencing factors of AK values of body of corpus callosum,age is the independent influencing factors of AK values of posterior semioval center,splenium of corpus callosum,and frontal,temporal and occipital lobes;and education is the independent influencing factors of AK values of temporal lobe.Conclusion DKI can quantitatively evaluate the microstructural damage of white matter caused by DNS,and the increase of AK is related to the decrease of neurological function in patients with DNS.

Purpose To explore the application value of diffusion kurtosis imaging (DKI) in assessing brain injury in different clinical stages caused by carbon monoxide (CO) poisoning. Materials and Methods MR plain scan, diffusion weighted imaging (DWI) and DKI scans were performed in 26 patients with acute CO poisoning, 17 patients with delayed neuropsychologic sequelae (DNS), 15 patients with chronic phase, and 21 healthy volunteers (control group). The DKI parameter values in regions of interest among the four groups were compared, and the correlation between the values of each parameter and DWI apparent diffusion coefficient (ADC) value was analyzed. Results ①The mean kurtosis (MK) values in the area of pallidum in acute phase, DNS phase, and chronic phase were 1.51±0.15, 1.07±0.11 and 0.59±0.11, respectively; among which the MK value in acute phase was significantly higher than that in the control group (1.06±0.06, P<0.05), and the chronic phase was significantly lower than the DNS phase and the control group (P<0.05); compared with the control group, the MK in centrum semiovale and subcallosal zone was relatively higher in acute phase and DNS phase, lower in chronic phase, both showing the most significant increase in DNS phase (P<0.05). ②In each region of interest, the MK value and mean diffusivity (MD) all showed an increase after decrease. Among them, MD values in the area of pallidum in acute phase were significantly lower than those in DNS and control group (0.74±0.11 vs. 0.85±0.07 and 0.98±0.12, P<0.05), and the centrum semiovale and callosum were the smallest in DNS phase (0.67±0.09 and 0.80±0.05, respectively), significantly lower than that in the control group (P<0.05). ③The fractional anisotropy (FA) values of all regions of interest showed a progressive decrease in different clinical stages, in which pallidum and centrum semiovale were the lowest in chronic phase (0.19±0.04 and 0.22±0.03, respectively), significantly lower than those in DNS phase and the control group (P<0.05). ④There was a positive correlation between MD values and ADC values in different clinical stages of CO poisoning in each region of interest (P<0.01). Conclusion DKI can quantitatively evaluate the changes of brain gray matter microarchitecture after CO poisoning, which is helpful to understand the characteristics of brain injury in different clinical stages caused by CO poisoning from the microscopic level.

Early small hepatocellular carcinoma (SHCC) can be cured by surgery and interventional operation to improve the survival rate of paitents,so the accurate diagnosis of SHCC is of great significance.Presently,the dynamic contrast-enhanced MR scan could only obtain single arterial phase imaging by single breath hold,and it had breathing motion artifact because of the long scanning time.The early arterial transient enhancement of SHCC was easy to be misdiagnosed.The CAIPIRINHA-Dixon-TWIST-VIBE (CDT-VIBE) sequence couldobtain high-quality multiple arterial phases images and hepatic arterial dominant (HAD) images in short-time scanning.And it could not only detect small focal lesions which were difficult to find by other imaging examination,but also find the start enhanced difference between lesions which were relevant to lesions property and blood supplement.The CDT-VIBE has a high clinical value in diagnosis and treatment of SHCC.The research progresses of CDT-VIBE in diagnosis of SHCC was reviewed in this article.

Objective To explore the application value of CT perfusion imaging for predicting the tiny lymph nodes metastasis and micrometastasis of squamous cell carcinoma in cervix after neoadjuvant chemotherapy.Methods The clinical data and CT perfusion parameters of 46 patients with cervical squamous cell carcinoma who underwent neoadjuvant chemotherapy followed by surgery were enrolled in the study.Based on the surgical pathology findings and short-term follow up,the cases were divided into without tiny lymph nodes metastasis (short axle diameter of lymph nodes＜10 mm) group (n=32) and with tiny lymph nodes metastasis group (n=14).All perfusion data were analyzed retrospectively and the diagnostic value were investigated.Results Blood flow (BF),blood volume (BV) and the maximum diameter of tumor per-chemotherapy in with tiny lymph nodes metastasis group were higher than those in without tiny lymph nodes metastasis group (all P＜0.05).The differences of the maximum diameter of tumor after chemotherapy,permeability,time to peak (TTP) between two groups were not statistically significant (all P＞0.05).Multivariate Logistic regression analysis showed BF and the maximum diameter of tumor per-chemotherapy were independent predictors of the tiny lymph nodes metastasis in cervix after neoadjuvant chemotherapy.ROC showed BF (AUC=0.86,P＜0.001,95％CI [0.75,0.96]) had higher predictive value than maximum diameter of tumor per-chemotherapy (AUC=0.70,P=0.02,95 ％ CI [0.54,0.88]).Conclusion CT perfusion imaging shows the significant predictive value for the tiny lymph nodes metastasis of squamous cell carcinoma in cervix after neoadjuvant chemotherapy.

Objective To analyze the value of dual-source computed tomography (DSCT)in the diagnosis of complex congenital heart disease(CCHD).Methods DSCT angiography and transthoracic echocardiography (TTE)were retrospectively assessed in 46 patients who were confirmed by surgery with 107 deformities.Results There were 49 intracardiac deformities and 58 extracardiac deformities.The diagnostic accuracies in detection of intracardiac malformation were 81.63%(40/49)on DSCT and 93.88%(46/49) on TTE,those in detection of extracardiac malformation were 94.83%(55/58)on DSCT and 58.62%(34/58)on TTE,and the overall accuracies of cardiovascular malformations were 88.79%(95/107)on DSCT and 74.77%(80/107)on TTE,respectively,exhibting statistical differences.The diagnostic accuracy of DSCT in combination with TTE in detection of intracardiac and extracardiac malformation was 94.39%(101/107),which was higher than DSCT or TTE with statistical differences.Conclusion The combination of TTE and DSCT is helpful to improve the diagnostic accuracy of CCHD.

Objective To evaluate the value of volume measured by multi-slice spiral CT in preoperative N staging of gastric canc-er.Methods CT data of 1 93 cases of gastric cancer proven pathologically were collected and analyzed.Volume of the tumor was cal-culated in the portal phase,and the correlation between the results and N staging was evaluated.ROC curve was used to get diagnos-tic value to differentiate N stages.Results Intra-observer Kappa value was 0.77 (P < 0.05 ),0.72 (P < 0.05 ),Inter-observer Kappa value was 0.69 (P <0.05).The tumor volume data was positively correlated with different N stages (r=0.568,P <0.05). ROC curve showed that the volume could help differentiate between stage N0 and stage N1 - N3 (cutoff 12.06 cm3 ,sensitivity 55%,specificity 95%),stage N0-N1 and stage N2-N3 (cutoff 22.35 cm3 ,sensitivity 66%,specificity 86%),stage N0-N2 and stage N3 (cutoff 25.95 cm3 ,sensitivity 62%,specificity 89%)respectively.Conclusion The volume of gastric cancer measured by CT plays an important part in predicting lymph node metastasis staging and optimizing individualized clinical strategy for patients.

Objective To observe the appearances of decussation of superior cerebellar peduncle (SCP) on MR diffusion tensor imaging (DTI) with different parameters of scanning and reconstruction. Methods Twenty healthy volunteers were examined on Siemens 3.0T MR DTI (b=0, 1000 s/mm~2), post processing were made in Siemens Leonardo workstation using Siemens Standar 6 dirs software to reconstruct the white matter fibers with different fractional anisotropy (FA) threshold value (0.04-0.20), angle threshold value (20°-89°) and voxel size (1.2 mm×1.2 mm×3.0 mm-1.6 mm×1.6 mm×5.0 mm). Results Crossing fiber was presented each voxel group on diffusion tensor tractography (DTT). The types of crossing fiber in the small voxel were more than those of big voxel image obviously. Reduced along with the FA threshold value, the number of crossing fiber increased gradually. After the peak value (FA=0.08), the number of crossing fiber reduced along with the FA threshold value reduced gradually. Increased along with the angle threshold value, the number of crossing fiber increased gradually. The number of crossing fiber reduced along with the angle threshold value increased gradually after the peak value (the angle threshold value＝80°). There were 5 kinds of MR fiber tracking appearances at the level of decussation of SCP on DTT. The fiber crossed to the opposited red nucleus in anterior-posterior style, superior-inferior style and single main bundle fiber. Kissing fiber and missing fiber sign was shouw in all subjects, which mainly located in the center of the decussation. Conclusion DTT FACT can show the descussation of SCP in most health subjects with five typical appearance. The descussation of SCP has the obvious appearances, may be causing by individual difference. For the crossing fiber of SCP, voxel size 1.2 mm×1.2 mm×3.0 mm, FA 0.08 and the angle 80° are recommended.

Objective To observe the CT and MR features of hepatic hydatid cyst, and to evaluate the diagnostic value of CT and MR. Methods CT and MR images were retrospectively analyzed in 42 patients with pathologically proved hepatic hydatid diseases, and the relative articles were reviewed. Results Hepatic echinococcosis granulosus occured in 85.71% patients, among which ring like pattern calcification, the ribbon calcification, multiple daughter vesicles and detached membranes within cyst were the main findings. Hepatic echinococcosis alveolaris occured in 14.29% patients, whereas the main finding included calcification, small vacuoles, peninsula sign, geographic sign and colliquative necrosis. For the diagnosis of hepatic hydatidosis, MR was better than CT in the judgement of the cyst wall, detached membranes and fibrous septum, but was inferior to CT in displaying calcification sign. Conclusion Hepatic hydatidosis can be diagnosed either with CT or MR, CT is superior to MR in integrated diagnosis of this disease.