Objective:To investigate the association between different types of lung nodules and the risk of lung cancer in a population at high risk of lung cancer and to provide an epidemiologic basis for the comprehensive management of lung nodules.Methods:Using the free lung cancer screening program of low-dose CT (LDCT) in Wenling, Zhejiang Province, we collected baseline and imaging information of high-risk groups for lung cancer who underwent LDCT screening from April 2019 to October 2021 and patients with previous history of lung cancer, tuberculosis, pneumoconiosis, and silicosis were excluded. A total of 28 539 study subjects were included in the analysis, and the follow-up ended on 31 December 2023. Based on the characteristics of the detected pulmonary nodules, the study subjects were classified with no nodules, with solid nodules, with pure ground glass nodules, and with part solid nodules groups. The association between different characteristics of lung nodules and the risk of lung cancer development was analyzed using the Cox proportional hazard regression model with a new diagnosis of lung cancer during the follow-up period as the outcome.Results:The overall detection rate of lung nodules with a mean diameter of ≥3 mm was 76.5%, of which 53.7%, 18.2%, and 4.6% were detected in the solid nodule, pure ground glass nodule, and partially solid nodule groups, respectively. There were statistically significant differences between the different nodule groups in terms of age, gender, BMI, history of toxic exposure education level, smoking status, history of lung disease, and family history of lung cancer (all P<0.05). The median follow-up time of the study population was 3.4 years, and 485 new lung cancer cases were diagnosed during the follow-up period. After adjusting for covariates, the results of multifactorial Cox proportional hazard regression model analysis showed that the risk of lung cancer was higher in pure ground glass nodules and part solid nodules compared with solid nodules, with HR values (95% CI) of 1.89 (1.52-2.35) and 6.49 (5.18-8.14), respectively. The results of subgroup analysis showed that patients in the group of part solid nodules had the highest risk of lung cancer in all strata of the population, followed by patients with pure ground glass nodules. Patients in the solid nodule group who were older or had previous lung disease had a higher risk of lung cancer, and the risk of lung cancer in the part solid nodule group differed between genders. Conclusions:The proportion of lung nodules detected is high in the high-risk group of lung cancer, and among them, patients with pure ground glass and part solid nodules have a higher risk of developing lung cancer. Attention should be paid to the annual follow-up management for patients with solid nodules who are older or who have had lung diseases, as well as for female patients with part solid nodules.

Objective:To investigate the application value of dual-energy computer tomo-graphy (CT) multi-parameter imaging in predicting the pathological grade of pancreatic ductal adeno-carcinoma (PDAC).Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 147 patients with PDAC who were admitted to The Fifth Affiliated Hospital of Wenzhou Medical University from January 2017 to August 2023 were collected. There were 102 males and 45 females, aged (59±10)years. All patients underwent preoperative dual-energy CT examination and postoperative histopathological examination. The 147 patients were divided into a training set of 103 cases and a test set of 44 cases by stratified random sampling at a ratio of 7∶3. The training set was used to construct the prediction model, and the test set was used to verify the effectiveness of prediction model. Observation indicators: (1) analysis of factors affecting the pathological grade of PDAC patients in the training set; (2) construction and evaluation of the fusion prediction model for pathological grade of PDAC. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. The performance of the model was evaluated by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), accuracy, sensitivity and specificity were calculated. The Delong test was used to analyze the effec-tiveness of model. The calibration curve and decision curve of Hosmer-Lemeshow test were used to evaluate the consistency and clinical application value of the nomogram, respectively. Results:(1) Analysis of factors affecting the pathological grade of PDAC patients in the training set. Results of multivariate analysis showed that tumor cystic necrosis, vascular invasion, standardized iodine concentration (NIC) in venous phase, effective atomic number (Zeff) in venous phase, and energy spectrum curve slope (λ HU) in venous phase were all independent factors affecting the pathological grade of PDAC patients in the training set ( odds ratio=4.326, 3.887, 4.155, 5.389, 3.164, 95% confidence interval as 1.167-16.033, 1.111-13.592, 1.707-10.113, 1.284-22.613, 1.247-8.028, P<0.05). (2) Construction and evaluation of the fusion prediction model for pathological grade of PDAC. Accor-ding to the results of multivariate analysis, tumor cystic necrosis, vascular invasion, NIC in venous phase, Zeff in venous phase and λ HU in venous phase were all included to construct the clinical-imaging fusion prediction nomogram model. The AUC, accuracy, sensitivity and specificity of the fusion prediction model in the training set were 0.938 (95% confidence interval as 0.896-0.981), 87.38%, 89.74% and 85.94%, respectively. The above indicators of the fusion prediction model in the test set were 0.893 (95% confidence interval as 0.802-0.985), 84.09%, 82.35% and 85.19%, respectively. Results of Delong test showed that there was no significant difference in AUC between the training set and the test set ( Z=0.343, P>0.05). Results of Hosmer-Lemeshow test showed that the fusion prediction model had a good fit in the training set and the test set ( χ2=3.042, 7.545, P>0.05). Results of calibration curve showed that the predictive ability of the fusion prediction model was good. Conclusions:Multiple parameters in venous phase of the dual-energy CT can be used as imaging markers for preoperative evaluation of the pathological grade of patients with PDAC. Establishing a clinical-imaging fusion prediction model can effectively predict the pathological grade of PDAC.

Objective:To investigate the association between different types of lung nodules and the risk of lung cancer in a population at high risk of lung cancer and to provide an epidemiologic basis for the comprehensive management of lung nodules.Methods:Using the free lung cancer screening program of low-dose CT (LDCT) in Wenling, Zhejiang Province, we collected baseline and imaging information of high-risk groups for lung cancer who underwent LDCT screening from April 2019 to October 2021 and patients with previous history of lung cancer, tuberculosis, pneumoconiosis, and silicosis were excluded. A total of 28 539 study subjects were included in the analysis, and the follow-up ended on 31 December 2023. Based on the characteristics of the detected pulmonary nodules, the study subjects were classified with no nodules, with solid nodules, with pure ground glass nodules, and with part solid nodules groups. The association between different characteristics of lung nodules and the risk of lung cancer development was analyzed using the Cox proportional hazard regression model with a new diagnosis of lung cancer during the follow-up period as the outcome.Results:The overall detection rate of lung nodules with a mean diameter of ≥3 mm was 76.5%, of which 53.7%, 18.2%, and 4.6% were detected in the solid nodule, pure ground glass nodule, and partially solid nodule groups, respectively. There were statistically significant differences between the different nodule groups in terms of age, gender, BMI, history of toxic exposure education level, smoking status, history of lung disease, and family history of lung cancer (all P<0.05). The median follow-up time of the study population was 3.4 years, and 485 new lung cancer cases were diagnosed during the follow-up period. After adjusting for covariates, the results of multifactorial Cox proportional hazard regression model analysis showed that the risk of lung cancer was higher in pure ground glass nodules and part solid nodules compared with solid nodules, with HR values (95% CI) of 1.89 (1.52-2.35) and 6.49 (5.18-8.14), respectively. The results of subgroup analysis showed that patients in the group of part solid nodules had the highest risk of lung cancer in all strata of the population, followed by patients with pure ground glass nodules. Patients in the solid nodule group who were older or had previous lung disease had a higher risk of lung cancer, and the risk of lung cancer in the part solid nodule group differed between genders. Conclusions:The proportion of lung nodules detected is high in the high-risk group of lung cancer, and among them, patients with pure ground glass and part solid nodules have a higher risk of developing lung cancer. Attention should be paid to the annual follow-up management for patients with solid nodules who are older or who have had lung diseases, as well as for female patients with part solid nodules.

Objective:To investigate the application value of dual-energy computer tomo-graphy (CT) multi-parameter imaging in predicting the pathological grade of pancreatic ductal adeno-carcinoma (PDAC).Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 147 patients with PDAC who were admitted to The Fifth Affiliated Hospital of Wenzhou Medical University from January 2017 to August 2023 were collected. There were 102 males and 45 females, aged (59±10)years. All patients underwent preoperative dual-energy CT examination and postoperative histopathological examination. The 147 patients were divided into a training set of 103 cases and a test set of 44 cases by stratified random sampling at a ratio of 7∶3. The training set was used to construct the prediction model, and the test set was used to verify the effectiveness of prediction model. Observation indicators: (1) analysis of factors affecting the pathological grade of PDAC patients in the training set; (2) construction and evaluation of the fusion prediction model for pathological grade of PDAC. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Univariate and multivariate analyses were conducted using the Logistic regression model. The performance of the model was evaluated by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), accuracy, sensitivity and specificity were calculated. The Delong test was used to analyze the effec-tiveness of model. The calibration curve and decision curve of Hosmer-Lemeshow test were used to evaluate the consistency and clinical application value of the nomogram, respectively. Results:(1) Analysis of factors affecting the pathological grade of PDAC patients in the training set. Results of multivariate analysis showed that tumor cystic necrosis, vascular invasion, standardized iodine concentration (NIC) in venous phase, effective atomic number (Zeff) in venous phase, and energy spectrum curve slope (λ HU) in venous phase were all independent factors affecting the pathological grade of PDAC patients in the training set ( odds ratio=4.326, 3.887, 4.155, 5.389, 3.164, 95% confidence interval as 1.167-16.033, 1.111-13.592, 1.707-10.113, 1.284-22.613, 1.247-8.028, P<0.05). (2) Construction and evaluation of the fusion prediction model for pathological grade of PDAC. Accor-ding to the results of multivariate analysis, tumor cystic necrosis, vascular invasion, NIC in venous phase, Zeff in venous phase and λ HU in venous phase were all included to construct the clinical-imaging fusion prediction nomogram model. The AUC, accuracy, sensitivity and specificity of the fusion prediction model in the training set were 0.938 (95% confidence interval as 0.896-0.981), 87.38%, 89.74% and 85.94%, respectively. The above indicators of the fusion prediction model in the test set were 0.893 (95% confidence interval as 0.802-0.985), 84.09%, 82.35% and 85.19%, respectively. Results of Delong test showed that there was no significant difference in AUC between the training set and the test set ( Z=0.343, P>0.05). Results of Hosmer-Lemeshow test showed that the fusion prediction model had a good fit in the training set and the test set ( χ2=3.042, 7.545, P>0.05). Results of calibration curve showed that the predictive ability of the fusion prediction model was good. Conclusions:Multiple parameters in venous phase of the dual-energy CT can be used as imaging markers for preoperative evaluation of the pathological grade of patients with PDAC. Establishing a clinical-imaging fusion prediction model can effectively predict the pathological grade of PDAC.

Objective To analyze the influencing of vascular endothelial growth factor (VEGF) gene polymorphism on success rate of embryo implantation in patients with thin endometrium. Methods A total of 100 patients with thin endometrium from the gynecological outpatient and inpatient departments of the hospital from June 2022 to December 2023 were selected as study group, and another 100 healthy adult women from the physical examination department in the same period were selected as control group. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the single nucleotide polymorphism at four different loci of the VEGF gene. Allele-specific PCR (AS-PCR) was used to analyze the distribution of VEGF genotypes and allele frequencies at the corresponding loci in both groups. The study group underwent frozen-thawed embryo transfer (FET), and their pregnancy conditions were confirmed by ultrasound 30 to 35 days later. Based on pregnancy outcomes, the study group was divided into successful pregnancy group and failed pregnancy group, and VEGF gene polymorphism between the two groups was compared. Logistic regression analysis was conducted to investigate the influence of VEGF gene polymorphism on pregnancy outcomes in patients with thin endometrium. Receiver operating characteristic (ROC) curve was plotted to assess the predictive value of VEGF gene polymorphism for pregnancy failure in patients with thin endometrium. Results Compared with the AA+CA genotype at the -2578C/A locus, patients carrying the CC genotype had increased risk of developing thin endometrium by 1.412 times (95%CI, 1.004 to 1.985), and the allelic mutation C showed increased risk by 1.526 times (95%CI, 1.066 to 2.186). Similarly, compared with the GA+AA genotype at the -1154G/A locus, patients carrying the GG genotype had increased risk of developing thin endometrium by 1.467 times (95%CI, 1.011 to 2.128), and the allelic mutation G showed increased risk by 1.531 times (95%CI, 1.026 to 2.284). There were no significant differences in VEGF gene genotypes and allele distributions at the -460C/T and +936C/T loci between the two groups (P>0.05). Among the 100 patients with thin endometrium in the study group, 40 cases had successful pregnancies after FET. There were significant differences in the distribution of VEGF gene genotypes at the -2578C/A and -1154G/A loci between the successful pregnancy group and the failed pregnancy group (P < 0.05). Logistic regression analysis revealed that carrying the CC genotype at the -2578C/A locus and the GG genotype at the -1154G/A locus were risk factors for pregnancy outcomes in patients with thin endometrium (OR>1, P < 0.05). The ROC curve showed that the area under the curve (AUC) for predicting pregnancy failure in patients with thin endometrium based on VEGF gene polymorphisms at the -2578C/A and -1154G/A loci was 0.801(95%CI, 0.552 to 0.838). Conclusion Carrying the CC genotype at the -2578C/A locus and the GG genotype at the -1154G/A locus can increase the risk of developing thin endometrium and reduce the success rate of pregnancy in patients with thin endometrium. Moreover, VEGF gene polymorphisms at the -2578C/A and -1154G/A loci can effectively predict the risk of pregnancy failure in patients with thin endometrium.

Brain metastases are one of the most common distant metastases in patients with non-small cell lung cancer (NSCLC), and the prognosis will be extremely poor. The effect of chemotherapy and operation is limited. As a standard treatment, radiotherapy is widely used in clinical practice. Radiotherapy alone includes whole brain radiotherapy, stereotactic radiotherapy and whole brain radiotherapy combined with stereotactic radiotherapy. With the continuous development of radiotherapy and the progress of gene sequencing, radiotherapy has been combined with targeted drugs, anti-angiogenic drugs and immunodrugs in the treatment of NSCLC brain metastasis, which can improve the survival of patients with NSCLC brain metastasis.

Objective: To evaluate image quality and radiation dosage of CT cerebral perfusion (CTP) imaging of 70 kV with different tube current and scanning passes and its diagnostic value for hyperacute cerebral infarction. Methods: A total of 190 patients with suspected hyperacute cerebral infarction in Lishui Central Hospital of Zhejiang Province from December 2017 to February 2019 were selected prospectively, and all patients were divided into 4 groups according to random number table and received non-contrast CT examination and dual-source CT cerebral perfusion imaging with 70 kV protocol simultaneously within 6 hours after the onset of symptoms: group A, 120 mA, 21 scanning time points; group B, 100 mA, 21 scanning time points; group C, 100 mA, 17 scanning time points; group D, 80 mA, 21 scanning time points. The values of perfusion parameters such as cerebral blood flow (CBF), crerbral blood volume (CBV), mean transit time (MTT), time to peak (TTP) were acquired. Image quality was evaluated and effective dose (ED) was recorded. The quantitative variables of image quality and radiation dosage were compared between four groups using one-way analysis of variance test. Results: There was no differences between groups on the CBF, CBV, MTT, TTP maps for all CTP values (P>0.05), and all images could meet the diagnostic requirements. The subjective image quality score of vessel sharpness and overall image quality of both internal carotid artery and middle cerebral artery and the degree of noise of internal carotid in artery in group A was higher than that in group D (P<0.05). The score of vessel sharpness of internal carotid in artery ingroup A was higher than those in both groups B and C (P<0.05). The scores of vessel sharpness of both internal carotid artery and middle cerebral artery internal carotid in artery ingroups B and C were higher than that in group A (P<0.05). The mean EDs of non-contrast CT in group A, B, C, D were 1.10, 2.11, 1.76, 1.42, 1.40 mSv; compared to group A, ED was reduced approximately 16.6% (0.35/2.11), 32.7% (0.69/2.11) and 33.6% (0.71/2.11), respectively (P<0.05). The diagnostic accuracy of low dose dual source CTP for detecting hyperacute cerebral infarction was 93.5% (172/184), while that of non-contrast CT was 52.2% (96/184);for detecting hyperacutelacunar cerebral infarction, it was 72.1% (31/43) and 16.3% (7/43) respectively (P<0.05). Conclusion Appropriate reduction of tube current (100 mA) and scanning passes (17 scanning time points) can reduce the radiation dosage and acquire comparable image quality for 70 kV protocol CTP. Compared with non-contrast CT, low dose dual-source CTP is more sensitive to hyperacute cerebral infarction, especially hyperacute lacunar cerebral infarction.

Objective:To investigate the correlation between the enhancement characteristics in arterial phase and the prognosis of patients with massive intrahepatic cholangiocarcinoma (IMCC).Methods:The imaging and clinical data of 92 patients with IMCC who were pathologically confirmed and underwent enhanced MRI or CT in Central Hospital of Lishui from June 2004 to February 2019 were retrospectively analyzed. According to the enhancement pattern of the primary lesion in the arterial phase, patients were divided into rich arterial blood supply group （17 cases） and deficient arterial blood supply group （75 cases）. The clinical data and imaging features of these patients were studied. Differences between measurement data and count data between the two groups were compared using t test and Fisher test. Kaplan-Meier analysis and log-rank test were used to analyze overall survival. The Cox regression multivariate analysis was used to study the relationship between the variables and the risk of death. Result:The enlargement of lymph nodes, long diameter of the primary lesion, CA19-9, treatment and HPD around the primary lesion in arterial phase were statistically different in the two groups ( P<0.05), others were no statistical difference. CA19-9>200 U/ml, lymph node enlargement, HPD around the primary lesion in arterial phase and deficient arterial blood supply were independent factors for the prediction of prognosis in IMCC patients with surgery ( P values were 0.008, 0.002, 0.049 and 0.005, respectively). Lymph node enlargement and deficient arterial blood supply were independent risk factors for the prediction of prognosis in IMCC patients with surgery ( P values are 0.049 and 0.045, respectively). Conclusion:The blood supply characteristics of arterial phase are independent factors for the prognosis of patients with IMCC.

Objective To explore the clinical value of the dual-low-dose with low tube voltage for head and neck CTA. Methods One hundred and sixty patients who were clinically suspected head and neck vascular disease underwent CTA procedure were propective selected, and whose body mass index (BMI) was also lower than 25 kg/m2. Forty cases were randomly selected as conventional group(120 kV,150 mAs, iodine 320 mg/ml), the other 120 cases were as the low dose group. The low dose group divided into three subgroups according to the random number table method, which were low iodine group (37 cases;120 kV,150 mAs, iodine 270 mg/ml), low tube voltage group (42 cases;100 kV,150 mAs, iodine 320 mg/ml) and low iodine and tube voltage group (41 cases;100 kV,150 mAs, iodine 270 mg/ml). The carotid bifurcated CT value, standard deviation (SD), signal-to-noise ratio (SNR), iodine intake and effective radiation dose (ED) of the four groups were recorded,all data undertook statistical analysis useing one-way ANOVA. Meanwhile, the subjective image quality score was applied to evaluate the image quality, and the differences among groups were compared by Wilcoxon signed ranks test. Results The image quality score were (2.85±0.19),(2.33 ± 0.34),(2.26 ± 0.32),(2.87 ± 0.22) in the four groups, and there was no statistical difference between groups(P>0.05).The carotid bifurcated CT value were respectively (380±30),(314±27),(514±52) and (425±28) HU in conventional, low iodine, low tube voltage and dual-low-dose groups, and the iodine intake were (18.85±2.10), (15.75±1.78), (18.53±1.98), (15.62±1.92) g, the ED of the four groups were (1.74±0.14), (1.73± 0.11), (1.32 ± 0.08) and (1.35 ± 0.09) mSv, the difference were all statistically significant (P<0.01). Furthermore, the iodine intake and the effective radiation dose in dual-low-dose group were significantly lower than the conventational group. Conclusions Head-and-neck CTA with dual-low-dose scan can provide same quality images as using 100 kV and high dose iodine contrast agent, and which also significantly reduced the ED and iodine intake greatly. Thus, this scanning program has great clinical value.

Objective To explore the effect of chest circumference index adjusting tube voltage techniquey on image quality and radiation dose at coronary CTA. Methods One hundred and twenty consecutive patients [body mass index(BMI)<25 kg/m2] with suspected coronary heart disease (CHD) undergoing coronary CT angiography were prospectively selected and divided into 2 groups at random:conventional group and low dose group. Low dose group was divided into the following three subgroups according to different chest circumferences:A group(<80 cm, n=16), B group(80 to 90 cm, n=44) and C group (>90 cm, n=20). All patients were examined by coronary CTA. The patients in conventional group were performed using retrospective ECG-gating technology and reconstructed by filtered back projection algorithm. The tube voltage/tube current was 120 kV/1 000 mAs. Prospective ECG?gating technology and iterative algorithm reconstruction were used in low dose group. The tube voltages/currents were 80 kV/150 mAs, 100 kV/150 mAs, 120 kV/150 mAs in A, B, C group, respectively. Image quality was assessed by subjective evaluation (image quality score) and objective evaluation (signal?to?noise ratio).The effective radiation dose was calculated. Analyses of the differences between groups were compared with image quality, radiation dose by single factor variance and Wilcoxon signed ranks test.Results The image quality scores and signal?to?noise ratio of aorta were respectively (3.47 ± 0.38), (3.48 ± 0.27), (3.45 ± 0.32), (3.46±0.29) and (15.5±3.6), (15.8±3.6), (15.8±4.1), (16.2±3.9) in conventional, A, B and C groups, there was no statistical difference between the four groups (P=0.24, 0.43). The effective radiation dose of four groups were respectively (17.15 ± 3.25), (0.88 ± 0.02), (1.38 ± 0.05), (2.32 ± 0.04) mSv, the difference was statistically significant (P=0.02). The effective radiation dose of A, B, C group was significantly lower than that in the conventional group. Conclusion Chest circumference index adjusting tube voltages technology at coronary CT angiography can effectively reduce the effective radiation without compromise of image quality.