The early prediction of axillary lymph node metastasis is crucial to the treatment and prognosis of breast cancer patients. Radiomics, as a non-invasive, convenient and efficient emerging technology, can achieve deep exploration and processing of imaging images and plays an increasingly important role in the evaluation of benign and malignant breast tumors, prediction of lymph node metastasis and other aspects. This article reviews the studies on the prediction of axillary lymph node metastasis of breast cancer based on radiomics of mammography, ultrasound and magnetic resonance imaging.

The early prediction of axillary lymph node metastasis is crucial to the treatment and prognosis of breast cancer patients. Radiomics, as a non-invasive, convenient and efficient emerging technology, can achieve deep exploration and processing of imaging images and plays an increasingly important role in the evaluation of benign and malignant breast tumors, prediction of lymph node metastasis and other aspects. This article reviews the studies on the prediction of axillary lymph node metastasis of breast cancer based on radiomics of mammography, ultrasound and magnetic resonance imaging.

The early detection and qualitative diagnosis of salivary gland tumors are very important, which is helpful for clinical intervention and treatment in time to delay or stop the progression of the disease. At present, the multi-parameter quantitative analysis of dual-energy CT, such as virtual monochromatic image (VMI), base material image, spectrum curve and effective atomic number have been gradually applied to evaluate salivary gland tumors, providing many quantitative indexes for the characterization, staging and classification of salivary gland diseases. This article reviews the research progress of various post-processing parameters of dual-energy CT in the evaluation of salivary gland tumors.

Objective:To assess the value of ultrasonography in the diagnosis of fetal isomerism syndrome in the first trimester.Methods:Sonographic features of 15 fetuses with isomerism syndrome diagnosed in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2015 to March 2020 were reviewed. Ultrasonic characteristics in the first trimester were analyzed, and the ultrasonic characteristics of early mid-trimester and pathological anatomical results were combined for comparison.Results:There were 6 cases of left isomerism syndrome (LIS) and 9 cases of right isomerism syndrome (RIS) in the 15 fetues.Increased nuchal translucency(NT) (≥3.0 mm, 6 cases), reversed A wave in ductus venosus (10 cases), and atrio-ventricular valve regurgitation (14 cases) were found during the first trimester. There were 14 cases with abnormal visceral laterality. Of the 15 fetues, 14 cases with cardiac malformations, including 6 cases of functional single ventricle, 8 cases of complete atrioventricular septal defect (CAVSD), and 12 cases with great artery abnormalities. All of the 6 LIS cases had bradycardia, 3 cases had interruption of inferior vena cava (IVC). Six cases of RIS had juxtaposition of descending aorta and IVC, and 1 case of RIS had total anomalous pulmonary vein drainage. The major structural malformations were consistent with the early mid-trimester ultrasound examination or autopsy. Karyotype and chromosomal microarray were available in 12 cases and all were normal.Conclusions:Isomerism syndrome has high positive rate of fetal aneuploidies ultrasonographic marker, especially with the atrio-ventricular valve regurgitation, but the risk of chromosome abnormality is low. Ultrasound screening for fetal cardiac structural abnormalities is beneficial to the early diagnosis of isomerism syndrom in the first trimester.

Objective:To explore the feasibility and prognosis of prenatal ultrasonic diagnosis of fetal isolated vascular ring at 11-13 + 6 weeks. Methods:A total of 36 996 fetuses were selected to compare the results of ultrasound screening at 11-13 + 6 weeks and 20-24 weeks of pregnancy in Guangxi Maternity & Child Healthcare Hospital from January 2016 to January 2020, the reasons for missed diagnosis and misdiagnosis of fetal isolated vascular ring by ultrasonography in the first trimester were summarized. Results:Thirty-five cases were diagnosed as isolated vascular ring in the first trimester, including 19 cases right aortic arch combined with aberrant left subclavian artery with "U-shaped" vascular ring, 7 cases double aortic arch with "O-shaped" vascular ring, and 9 cases aberrant right subclavian artery with "C-shaped" vascular ring. While 155 cases were diagnosed as isolated vascular ring at 20-24 weeks of pregnancy, consisting of 18 cases of combined with aberrant left subclavian artery, 9 cases of double aortic arch, 126 cases of aberrant right subclavian artery and 2 cases of pulmonary artery sling, the diagnosis coincidence rates were 94.74%, 77.78%, 7.14%, 0(Kappa value were 0.97, 0.88, 0.13, 0). For the diagnosis of right aortic arch combined with aberrant left subclavian artery, double aortic arch and aberrant right subclavian artery in the first trimester, the specificities were 99.99%, 100%, 100%, the sensitivities were 100%, 77.78%, 7.14%, the false-positive rates were 0.01%, 0, 0, the false-negative rates were 0, 22.22%, 92.86%, and the Youden′s indices were 0.99, 0.78, 0.07.Conclusions:Right aortic arch combined with aberrant left subclavian artery and double aortic arch have high coincidence rate by ultrasonography in the first trimester, while the diagnostic coincidence rate of isolated aberrant right subclavian artery was low. Ultrasound screening for isolated vascular ring in the first trimester still needs ultrasound examination in the second trimester to exclude the minor cardiac malformations that are difficult to diagnose in the first trimester.

Objective: To investigate the echocardiographic characteristics, pathological anatomy and genetic abnormality of congenital absent semilunar valves in first trimester. Methods: Eleven cases of congenital absent semilunar valve fetus diagnosed at 11-13^{+ 6} weeks of gestation in Guangxi Magernity & Child Healthcare Hospital from December 2014 to December 2018 were analyzed. The characteristics of echocardiography and the abnormal microanatomy of cardiac tissue after labor induction was compared. Results: The crown-lump length of the 11 fetus was 46-74(62.0±9.2)mm, and nuchal translucency thickness(NT) was 2.4-10.4 (6.4±2.6)mm. The NT of 10 cases were greater than 3.0 mm. Color Doppler flow imaging revealed that biphasic bidirectional flow in the aortic arch and/or pulmonary artery at the 3VT view( "to-and-fro" ) in those 11 cases, and pansystolic turbulence and pandiastolic reflux spectrum were showed on spectral Doppler. Among them, there were 10 cases of " stealing type" , including 2 cases of isolate absent aortic valves, 3 cases of absent pulmonary valves and 5 cases of absent both aortic and pulmonary valves; and all the 10 cases had secondary ultrasonic manifestations of fetal heart failure. Chromosome analysis and detection of genes showed that 4 cases with Trisomy 13 syndrome, 3 cases with Trisomy 18 syndrome, 1 case with 22q11.2 deletion, 1 case with 12q24.32q24.33 deletion and 1 case was normal. Pathological anatomy revealed enlarged heart in 8 cases, isolate absent aortic valves in 2 cases (1 case complicated with pulmonary atresia, absence of ductus arteriosus and thymus), absent pulmonary valves in 3 cases, absent both aortic and pulmonary valves in 3 cases, relics of semilunar valves in 3 cases. And 2 cases of absent pulmonary valves and 3 cases of absent both aortic and pulmonary valves with short and thick ductus arteriosus. Only 1 case was congenital absent semilunar valve in " non-stealing type" without secondary ultrasonic manifestations of fetal heart failure. Chromosome analysis and detection of genes showed 22q11.2 deletion, and there were relics of semilunar valves in the pathological anatomy. It also combined with tetralogy of Fallot and absence of ductus arteriosus. Conclusions In first trimester, congenital absent semilunar valves are more common as " stealing type" . The echocardiographic features of congenital absent semilunar valves are the " in-out sign" of aorta arch and/or pulmonary artery and biphasic spectrum in spectral Doppler. Trisomy 13 syndrome and trisomy 18 syndrome significantly increased the risk of congenital absent semilunar valves in " stealing type" in first trimester.

Objective To investigate the correlation between the angle and distribution of non-calcified plaque of left main coronary bifurcation and its hydrodynamic theory. Methods Retrospective analysis of 55 patients suspected of coronary heart disease who had undergone coronary computed tomographic angiography from January 2014 to June 2016.Angle,quadrant distribution,distance from bifurcation reference plane,minimal lumen area and extravascular elastic membrane cross section area of left main coronary bifurcation were measured. Then we calculated the plaque burden. The left main coronary bifurcation lesions were divided into plaque group and non-plaque group.Student's t test was used to compare the two groups.The left main coronary bifurcation lesions were divided into≥70°group and<70° group, Chi-square test and Fisher exact test were used to compared the two groups. Pearson correlation analysis was used to analyse the bifurcation angle and plaque distance. The data of non-plaque group was imported into the MIMICS,3-MATIC and abaqus CFD software to establish the hydrodynamic model,which was used to analyze the changes of pressure and velocity at different angles.Results Plaque group has 25 patients whose average value of the bifurcation angle was(55.95±14.77)°;non-plaque group has 30 patients whose average value of the bifurcation angle was(55.95±14.77)°.Angle difference was statistically significant between plaque and non-plaque group(t=2.893,P=0.006);Plaque difference was statistically significant between≥70°and<70°groups.The distance was negatively correlated with bifurcation angle(r=-0.773,P<0.001). Following the increase of bifurcation angle, the vascular wall area of high pressure and low speed region growed The green region of low-wall pressure with irregular distribution appeared in the lateral wall of the vessel that opposite to the red region of the bifurcation,and this region had lager gradient variability of wall pressure. Conclusion With the increase of coronary bifurcation angle, the possibility of plaque formation increases, the distance from plaque to bifurcation increases,the plaques tend to appear in the lateral wall of the blood vessels.

Objective To investigate the clinical correlative factors and CT pulmonary angiography (CTPA) characteristics of secondary changes of chest in different types of acute pulmonary embolism. Methods One hundred and fifty-two cases with acute pulmonary embolism diagnosed by CTPA between January 2015 and October 2016 were retrospectively analyzed.They were divided into central(70 cases)and peripheral (82 cases) groups according to the embolization site. The clinical characteristics (including gender, age, risk stratification, etc.), laboratory findings (including D-dimer, etc.) and secondary imaging findings(including enlargement of the main pulmonary artery and enlargement of right heart,etc.)of the two groups were recorded. The parameters including patient age, body mass index, length of hospital stay and laboratory findings between the two groups were compared using independent sample t test or Mann-Whitney U test. The other variables including the clinical characteristics such as gender, smoking history, etc. and secondary imaging findings between the two groups were analyzed by χ2 test and Fisher exact test.Results The high,moderate and low-risk patients were 7,33,30 cases,respectively in the central group,and 2,16, 64 cases, respectively in the peripheral group. The percentages of moderate and high-risk patients in the central group were higher than peripheral group,the difference of risk stratification between the two groups was statistically significant(P<0.001).In the choice of clinical treatment,there were 5 cases of thrombolytic therapy in the central group and 0 cases in the peripheral group, and the difference was statistically significant (P= 0.019). The other differences of clinical characteristics such as gender and age were not statistically significant(P>0.05).The cardiac troponin I was 0.03(0.01,0.11)μg/L in the central group and 0.01 (0,0.04) μg/L in the peripheral group, and the difference was statistically significant (Z=-2.799, P=0.005).The other laboratory findings such as D-dimer were not statistically significant between the two groups (P>0.05). Among the various secondary changes of the chest on CTPA, the cases of enlargement of the main pulmonary artery,enlargement of right heart,pulmonary infarction,mosaic perfusion were 47,41, 23, 24 cases, respectively in the central group, and 20, 11, 11, 15 cases, respectively in the peripheral group.The percentages of these signs were higher in the central group than peripheral group,the differences were statistically significant (χ2= 28.002,34.214,8.221,5.064, P<0.05). Conclusions Central acute pulmonary embolism is more dangerous and more likely to cause a series of secondary changes.Determining the type of embolism has certain value for clinical doctors to judge the prognosis and choose the treatment.

Objective To analyze the CT manifestations of gastrointestinal stromal tumors(GIST),and compared with the pathological results,in order to improve the value of CT in clinical diagnosis of GIST.Methods 256 slice spiral CT manifestations of 35 cases with GIST confirmed by surgery and pathology were analyzed retrospectively.Results 30 cases with GIST tumors were located in the stomach,duodenum in 2 cases,ileum in 2 cases,1 case with multiple tumors (located in mesentery,retinal).The tumor size ranged from 1.0 to 11.2 cm.11 cases of lumps showed soft tissue mass,24 cases showed uneven density with cystic and necrosis,including 10 cases with ulceration in surface.There were 5 cases with hemorrhage,2 cases with scattered calcification.After enhancement scan,11 cases of tumors were homogeneous enhancement and 24 cases showed uneven enhancement.The solid composition was shown more rich blood supply,especially in the venous phase.There were 9 cases out of the digestive tract,22 cases in the digestive tract,4 cases were mixed growth.There were 35 cases with CD117 positive expression by immunohistochemistry,34 cases with CD34 positive expression.After postoperative pathological risk assessment,there were 21 cases with low risk malignant tumor,moderate malignant tumor in 7 cases,highly malignant tumor in 7 cases.Conclusion 256 layers spiral CT scan can accurately offer the morphology of gastrointestinal stromal tumor,location,size and internal structure,and evaluate the risk level of tumor,it is helpful for clinical preoperative treatment,and determination of the prognosis.

Objective To investigate the diagnostic significance of basophil activation test (B A T) in ana-phylaxis to non-ionic contrast media through testing the content of CD 63, m ast cell-carboxypeptidase A 3 (M C-CPA 3), and term inal com plem ent com plex SC5b-9 of the individuals by testing their levels in the norm al im m une group and the anaphylaxis groups to β-lactam drugs and non-ionic contrast media. Methods The CD 63 expression of basophilic granulocyte in blood w as detected by flow cytom etry. The levels of M C-CPA 3 in blood serum and SC5b-9 in blood plasm a w ere detected by ELISA . Results The CD 63 expression of basophilic granulocyte in blood, the levels of M C-CPA 3 and SC5b-9 of anaphylaxis to non-ionic contrast media and β-lactam drugs w ere significantly higher than that in norm al im m une group (P<0.05). Conclusion There is activation of basophilic granulocytes, m ast cells and com plem ent system in anaphylaxis to non-ionic contrast media. B A Tcan be used to diagnose the anaphylaxis to non-ionic contrast media.