Objective To explore the feasibility,effectiveness,and safety of balloon catheter-assisted total hepatic vascular exclusion.Methods We designed and manufactured an endovascular catheter with three lumens and double balloons,which can be inserted into the retrahepatic inferior vena cava through the femoral vein.The superior and inferior vena cava of the liver can be blocked by filling balloon,and the total hepatic vascular exclusion was achieved by combining with pringle method.In animal experiments,total hepatic vascular exclusion was performed by balloon catheter-assist method(experimental group)or traditional methods(control group),and the complete time was compared between the two groups.Blood flow blocking effect was observed by angiography and incision of retrahepatic inferior vena cava under direct vision.The complications were recorded.Results Total hepatic vascular exclusion was successfully completed in both groups.The completion time in the experimental group was significantly shorter than that in the control group([12.5±1.2]min vs.[35.8±4.9]min,P<0.05).CT angiography,DSA,and direct vision of blood vessels all confirmed the effectiveness of balloon catheter-assisted hepatic blood flow exclusion.No catheter displacement,balloon rupture,or air embolism occurred.Conclusion The balloon catheter-assisted hepatic total vascular exclusion is simpler and more feasible than traditional method.

Objective:To explore the diagnostic value of preoperative diffusion weighted imaging (DWI) histogram parameters in the depth of invasion of early rectal cancer.Methods:A total of 180 patients with early rectal cancer admitted to 904th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from August 2020 to August 2024 were selected as the study objects. Patients were divided into intramucosal cancer group ( n=102) and submucosal cancer group ( n=78) according to the depth of tumor invasion. The general data of the two groups were compared. The intraclass correlation coefficient (ICC) was used to analyze the consistency of DWI histogram parameters extracted by the two radiologists, and the differences between the two groups were compared. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of each parameter to the depth of tumor invasion. Multivariate logistic regression was used to analyze the independent influencing factors of invasion depth, and a predictive model was constructed. The ROC curve was drawn to analyze the predictive value of the model for tumor invasion depth, and the Hosmer-Lemeshow test was used to analyze the goodness of fit of the model. Results:There were statistically significant differences in age ( t=8.15, P<0.001), maximum tumor diameter ( χ2=29.29, P<0.001), endoscopic type ( χ2=20.96, P<0.001), histological type ( χ2=24.93, P<0.001) and differentiation degree ( χ2=73.35, P<0.001) between intramucosal cancer group and submucosal cancer group. The mean, variance, skewness, kurtosis, the 1 st, 10 th, 50 th, 90 th, and 99 th percentiles of the histogram parameters of DWI had good consistency (all ICC>0.75). There were statistically significant differences in the mean ( t=5.69, P<0.001), variance ( t=9.75, P<0.001), skewness ( t=10.88, P<0.001), kurtosis ( t=10.06, P<0.001), the 1 st percentile ( t=3.43, P<0.001), 10 th percentile ( t=3.59, P<0.001), 50 th percentile ( t=9.97, P<0.001), 90 th percentile ( t=4.63, P<0.001), and 99 th percentile ( t=2.44, P=0.016) of the DWI histogram parameters between the intramucosal cancer group and the submucosal cancer group. ROC curve analysis results showed that mean [area under the curve (AUC) =0.77], variance (AUC=0.88), skewness (AUC=0.88), kurtosis (AUC=0.78), 50 th percentile (AUC=0.86) and 90 th percentile (AUC=0.82) had certain diagnostic value for submucous cancer. Multivariate analysis showed that age ( OR=9.98, 95% CI: 1.10-90.70, P=0.041), maximum tumor diameter ( OR=7.36, 95% CI: 1.08-50.23, P=0.042), and differentiation degree ( OR=19.88, 95% CI: 1.21-327.92, P=0.037), variance ( OR=16.24, 95% CI: 2.26-116.68, P=0.006), skewness ( OR=21.13, 95% CI: 2.80-59.61, P=0.003), 1 st percentile ( OR=9.78, 95% CI: 1.17-81.76, P=0.035) were independent factors in predicting tumor invasion depth in patients with early rectal cancer. The predictive model based on the above indicators was logit ( P) =1.51+2.30×age+2.00×maximum tumor diameter+2.99×differentiation degree+2.79×variance+3.05×skewness+ 2.28×the 1 st percentile. ROC curve analysis showed that the predictive model had an AUC of 0.97 (95% CI: 0.95-0.99) for judging the occurrence of submucosal cancer in patients with early rectal cancer, the sensitivity was 0.95, and the specificity was 0.88. The Hosmer-Lemeshow test results showed that the goodness of fit of the model was ideal ( P=0.823) . Conclusions:Age, maximum tumor diameter, differentiation degree, variance, skewness, and the 1 st percentile are independent factors in predicting tumor invasion depth in patients with early rectal cancer. The predictive model constructed based on these factors can effectively predict the risk of submucosal cancer in patients with early rectal cancer.

Mild traumatic brain injury (mTBI) is the most common type of traumatic brain injuries (TBI). Currently, the diagnosis and assessment of mTBI in clinical practice mainly relies on the Glasgow Coma Scale (GCS) and imaging examinations. However, GCS scoring is less accurate and efficient due to its high subjectivity; while the imaging techniques including conventional CT and MRI are unable to provide detailed information for diagnosis of mTBI. Therefore, more sensitive and precise imaging techniques are required for diagnosis and assessment of mTBI. This article reviews the recent advances of the application of novel magnetic resonance techniques in diagnosis and assessment of mTBI, including diffusion tensor imaging, neurite orientation dispersion and density imaging, resting-state functional MRI, magnetic resonance spectroscopy, as well as multimode imaging techniques. The article also discusses the application of newly emerging artificial intelligence and relevant automated processing software in mTBI.

Objective:To explore the value of Alberta stroke program early CT Score (ASPECTS) regional net water intake (NWU) based on plain CT in evaluating the neurological outcome of patients with acute large vessel occlusive stroke (ALVOS) after mechanical thrombectomy.Methods:The study was a prospective cross-sectional study. The clinical and imaging data of patients with ALVOS who underwent mechanical thrombectomy in the 904 Hospital of the PLA Joint Service Support Force from June 2022 to June 2024 were prospectively collected. Clinical data analysis included age, gender distribution, National Institutes of Health Stroke Scale (NIHSS) score and Glasgow Coma Scale (GCS) score at admission. All patients underwent plain CT and CT angiography (CTA). Automated processing software quantified ischemic brain edema by calculating ASPECTS and measuring the ASPECTS regional NWU rate (CT-ASPECTS-NWU) based on plain CT. Cerebral collateral circulation was assessed using CTA images. According to the modified Rankin Scale score of patients with mechanical thrombectomy 90 days after the telephone follow-up, 0-2 points were defined as good neurological outcome, and 3-6 points were defined as poor neurological outcome. Independent samples t test, Mann-Whitney U test and χ2 test were used to analyze the differences of clinical and imaging indicators between patients with good and poor neurological outcome, indicators with statistically significant differences were included in multivariate logistic regression analysis to screen out the independent influencing factors that predicted the neurological outcome of patients with ALVOS after mechanical thrombectomys. The efficacy of related indicators to predict neurological outcomes after mechanical thrombectomy in patients with ALVOS was evaluated using receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) calculated. Results:A total of 122 patients with ALVOS were included, including 101 patients with good neurological outcome and 21 patients with poor neurological outcome after mechanical thrombectomy. There were statistically significant differences in preoperative GCS score, collateral circulation status, NIHSS score at admission, preoperative ASPECTS and CT-ASPECTS-NWU between patients with good neurological outcome and patients with poor neurological outcome ( P<0.05). Multivariate logistic regression analysis showed that the status of collateral circulation ( OR=3.450, 95% CI 1.158-10.277, P=0.026), preoperative ASPECTS ( OR=0.510, 95% CI 0.274-0.952, P=0.034) and CT-ASPECTS-NWU ( OR=2.131, 95% CI 1.301-3.493, P=0.003) were independent predictors of neurological outcome in patients with ALVOS after mechanical thrombectomy. ROC curve analysis showed that CT-ASPECTS-NWU had the highest predictive value, with an AUC of 0.881, a sensitivity of 85.7%, a specificity of 85.1%, and an optimal cutoff value of 7.55. Conclusion:CT-ASPECTS-NWU demonstrates high diagnostic value in evaluating the neurological outcome of patients with ALVOS after mechanical thrombectomy, and can provide an objective imaging biomarker to guide clinical decision-making.

Mild traumatic brain injury (mTBI) is the most common type of traumatic brain injuries (TBI). Currently, the diagnosis and assessment of mTBI in clinical practice mainly relies on the Glasgow Coma Scale (GCS) and imaging examinations. However, GCS scoring is less accurate and efficient due to its high subjectivity; while the imaging techniques including conventional CT and MRI are unable to provide detailed information for diagnosis of mTBI. Therefore, more sensitive and precise imaging techniques are required for diagnosis and assessment of mTBI. This article reviews the recent advances of the application of novel magnetic resonance techniques in diagnosis and assessment of mTBI, including diffusion tensor imaging, neurite orientation dispersion and density imaging, resting-state functional MRI, magnetic resonance spectroscopy, as well as multimode imaging techniques. The article also discusses the application of newly emerging artificial intelligence and relevant automated processing software in mTBI.

Objective:To explore the value of Alberta stroke program early CT Score (ASPECTS) regional net water intake (NWU) based on plain CT in evaluating the neurological outcome of patients with acute large vessel occlusive stroke (ALVOS) after mechanical thrombectomy.Methods:The study was a prospective cross-sectional study. The clinical and imaging data of patients with ALVOS who underwent mechanical thrombectomy in the 904 Hospital of the PLA Joint Service Support Force from June 2022 to June 2024 were prospectively collected. Clinical data analysis included age, gender distribution, National Institutes of Health Stroke Scale (NIHSS) score and Glasgow Coma Scale (GCS) score at admission. All patients underwent plain CT and CT angiography (CTA). Automated processing software quantified ischemic brain edema by calculating ASPECTS and measuring the ASPECTS regional NWU rate (CT-ASPECTS-NWU) based on plain CT. Cerebral collateral circulation was assessed using CTA images. According to the modified Rankin Scale score of patients with mechanical thrombectomy 90 days after the telephone follow-up, 0-2 points were defined as good neurological outcome, and 3-6 points were defined as poor neurological outcome. Independent samples t test, Mann-Whitney U test and χ2 test were used to analyze the differences of clinical and imaging indicators between patients with good and poor neurological outcome, indicators with statistically significant differences were included in multivariate logistic regression analysis to screen out the independent influencing factors that predicted the neurological outcome of patients with ALVOS after mechanical thrombectomys. The efficacy of related indicators to predict neurological outcomes after mechanical thrombectomy in patients with ALVOS was evaluated using receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) calculated. Results:A total of 122 patients with ALVOS were included, including 101 patients with good neurological outcome and 21 patients with poor neurological outcome after mechanical thrombectomy. There were statistically significant differences in preoperative GCS score, collateral circulation status, NIHSS score at admission, preoperative ASPECTS and CT-ASPECTS-NWU between patients with good neurological outcome and patients with poor neurological outcome ( P<0.05). Multivariate logistic regression analysis showed that the status of collateral circulation ( OR=3.450, 95% CI 1.158-10.277, P=0.026), preoperative ASPECTS ( OR=0.510, 95% CI 0.274-0.952, P=0.034) and CT-ASPECTS-NWU ( OR=2.131, 95% CI 1.301-3.493, P=0.003) were independent predictors of neurological outcome in patients with ALVOS after mechanical thrombectomy. ROC curve analysis showed that CT-ASPECTS-NWU had the highest predictive value, with an AUC of 0.881, a sensitivity of 85.7%, a specificity of 85.1%, and an optimal cutoff value of 7.55. Conclusion:CT-ASPECTS-NWU demonstrates high diagnostic value in evaluating the neurological outcome of patients with ALVOS after mechanical thrombectomy, and can provide an objective imaging biomarker to guide clinical decision-making.

Objective To explore the value of 3D digital subtraction angiography(DSA)in neurointerventional surgery for ruptured intracranial aneurysm.Methods Clinical data of 176 patients with ruptured intracranial aneurysms who underwent neurointerventional surgery at No.904 Hospital of Joint Logistics Support Force from January 2020 to March 2023 were retrospectively analyzed.All patients were diagnosed with intracranial aneurysms through CT angiography and underwent 2D and 3D DSA examinations.The display of distal blood vessels and branches,detection rates of aneurysms,display of the relationship between the aneurysm neck and parent artery,and display of the vessels penetrated by aneurysms were recorded.Results There was no significant difference between the 2D-DSA and 3D-DSA technologies in displaying distal blood vessels and branches(P>0.05).The detection rate of aneurysms by 3D-DSA was 99.43%(175/176),which was significantly higher than that by 2D-DSA(89.20%,157/176),with statistical difference(P<0.05).The detection rate of common cystic aneurysm by 3D-DSA was significantly higher than that by 2D-DSA(66.86%vs 47.16%,P<0.05).Unclear relationship between the aneurysm neck and parent artery was found in 108 patients(61.36%)by 2D-DSA and in 68 patients(38.64%)by 3D-DSA(13.64%),and there was significant difference in the detection rate of the unclear relationship between 2D-DSA and 3D-DSA(P<0.05).No penetrating blood vessels were detected by 2D-DSA,while 20(11.36%)penetrating blood vessels were detected by 3D-DSA(P<0.05).Conclusion 3D-DSA technique can improve the detection rate of aneurysms,and has high diagnostic value for the morphology of aneurysms and their relationship with the parent artery.

Objective To explore the diagnostic value of multi-slice spiral CT combined with vimentin in dedifferentiated liposarcoma(DDL).Methods A total of 88 patients with suspected DDL admitted to No.904 Hospital of Joint Logistics Support Force of PLA from June 2017 to June 2022 were enrolled.Multi-slice spiral CT examination and vimentin detection were performed in all the patients.Pathological results were taken as the golden standard of diagnosis.The consistency of multi-slice spiral CT examination and pathological results was investigated.The expression of vimentin was compared between DDL patients and non-DDL patients.The diagnostic value of multi-slice spiral CT combined with vimentin in dedifferentiated liposarcoma was analyzed.Results Pathological diagnosis showed that 64 patients were diagnosed as DDL and 24 patients were not DDL.The results of multi-slice spiral CT showed that 63 patients were diagnosed as DDL.CT results of 59 patients with DDL and 20 patients with non-DDL were consistent with pathological diagnosis.The multi-slice spiral CT examination and pathological results were generally consistent(Kappa=0.746,P<0.01).The expression of vimentin was positive in 59 DDL patients and negative in 5 DDL patients.The expression of vimentin was positive in 6 non-DDL patients and negative in 18 non-DDL patients.Kappa consistency test showed that and the 2 diagnostic methods were generally consistent(Kappa=0.681,P<0.01).Sixty-three patients were diagnosed as DDL by multi-slice spiral CT combined with vimentin detection.The combined detection of 61 patients with DDL and 22 patients with non-DDL were consistent with pathological diagnosis.Kappa consistency test showed that,the 2 diagnostic methods were well consistent(Kappa=0.866,P<0.01).The sensitivities of multi-slice spiral CT,vimentin detection and their combination were 92.18% ,92.18% and 95.31% ,respectively;the specificities were 83.34% ,75.00% and 91.67% ,respectively;the Youden indexes were 0.755,0.671 and 0.870,respectively.The combined use of multi-slice spiral CT and vimentin detection had higher diagnostic value for DDL.Conclusion The result of multi-slice spiral CT combined with vimentin detection is consistent with pathological diagnosis and this method can be widely used in clinic.

Objective:To evaluate the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) after surgical resection.Methods:A retrospective study was conducted on the clinical data of 156 patients who underwent surgery for ICC in Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University from November 2010 to December 2017, including 94 males and 62 females, aged (60.0±9.5) years. Curative surgery was performed in 114 cases. Of 64 cases were in stage Ⅰ according to American Joint Committee on Cancer (AJCC), including 38 cases of non-lymph node dissection (NLND) and 26 cases of LND; 21 cases were in AJCC stage Ⅱ, including 11 cases of NLND and 10 cases of LND; 22 cases were in AJCC stage Ⅲb, including 14 cases of LND and 8 cases of lymph node resection (LNR); 5 cases were in AJCC stage Ⅲa, 2 cases were in AJCC stage Ⅳ. Univariate and multivariate Cox regression analysis were used for the risk factors of ICC prognosis. The log-rank test compared the survival rates of the two groups.Results:Cox multivariate analysis indicated that lymph node metastasis was independent risk factors for prognosis in patients with ICC ( HR=1.96, 95% CI: 1.09-3.55, P=0.026). A total of 114 patients were included in the curative surgery group. The 1-, 3-, and 5-year overall survival (OS) rates of the negative lymph node group ( n=91) were 65.9%, 47.3% and 35.6%, respectively, which were significantly better than those of the positive lymph node group ( n=23) who had 1-, 3-, 5-year OS rates of 56.5%, 17.7% and 0, respectively (χ 2=8.11, P=0.004 ). In stage Ⅰ and Ⅱ patients, there were no significant differences in 1-, 3-, 5-year OS rates between the NLND group and the LND group (both P>0.05 ). In stage Ⅲb patients, the LND group had 1-, 3-, 5-year OS rates of 71.4%, 29.8% and 0, respectively, significantly better than those of the LNR group who had 1-, 3-, 5-year OS rates of 37.5%, 0 and 0, respectively (χ 2=6.45, P=0.011). Conclusions:Lymph node metastasis is an independent risk factor affecting the prognosis of ICC. Lymph node dissection should be performed cautiously in ICC with AJCC stage Ⅰ and Ⅱ, while routine lymph node dissection is recommended in ICC with AJCC stage Ⅲb.

Objective:To investigate the application effect of intensity-modulated radiotherapy guided by computed tomography/magnetic resonance imaging (CT/MRI) fusion technology in patients with nasopharyngeal carcinoma.Methods:The case data of 112 patients with nasopharyngeal carcinoma in 904 Hospital from June 2013 to January 2018 were retrospectively analyzed. They were divided into control group (three-dimensional conformal radiotherapy guided by CT/MRI image fusion technology) and observation group (intensity-modulated radiotherapy guided by CT/MRI image fusion technology), with 56 cases in each group. The average target volume, short-term efficacy, incidence of toxic and side effects of radiotherapy, 1, 2 and 3-year survival rate and recurrence rate were compared between the two groups.Results:The target volume in the observation group was larger than that in the control group ( P<0.05), and the total effective rate (78.57%) was higher than that in the control group (60.71%, P<0.05); There was no significant difference in the incidence of dry mouth, temporomandibular joint injury, hearing loss and skin injury between the two groups ( P>0.05), but there was significant difference in the total incidence of toxic and side effects ( P<0.05); There was no significant difference in 1-year and 2-year survival rate and recurrence rate between the two groups ( P>0.05); The 3-year survival rate (82.14%) in the observation group was higher than that in the control group (64.29%), and the recurrence rate (8.93%) was lower than that in the control group (23.21%, P<0.05). Conclusions:CT/MRI image fusion technology can guide the intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma, which can improve the accuracy of radiotherapy target volume delineation and the total effective rate of treatment and 3-year survival rate, and reduce the 3-year recurrence rate. It is worthy of clinical promotion and application.