Objective To investigate the accuracy,image quality and effective dose (ED)of the whole-heart CT scanner in infants with congenital heart disease.Methods Totally 86 consecutive pediatric patients younger than 2 years old with congenital heart disease were enrolled.They were divided into 2 groups:whole-heart CT scanner with low dose group,43 patients(28 males,15 females,aged 12 d -19 months)underwent CT acquisition by using the whole-heart CT,and the other 43 patients(23 males,20 females,aged 19 d-16 months)examined with volume helical shuttle (VHS)of high definition CT were assigned as VHS group.With surgical results as the standard,the sensitivity, specificity,positive predictive value (PPV),negative predictive value (NPV)and the diagnostic accuracy of the 2 groups for cardiovascular abnormalities were evaluated.Attenuation and noise of 2 groups of ascending aorta,main pul-monary artery,and muscle were measured,and the signal -to -noise ratio (SNR)and contrast -to - noise ratio (CNR)were calculated.The double blind method was used to evaluate the subjective image quality of the level of intra-cardiac,extra-cardiac and coronary artery.Both the volumetric CT dose index (CTDIvol)and dose-length product(DLP)of each child were recorded,and the ED was also estimated in both groups.Results By using surgical findings as the reference standard,a total of 124 and 113 separate cardiovascular anomalies were confirmed by the whole-heart CT scanner in the low dose group and the VHS group.The diagnostic accuracy in 2 groups was 99.2%and 98.8%,respectively,without significant difference(χ2＝0.035,P＝0.852).The sensitivity,specificity,PPV and NPV in 2 groups were 97.8%,99.7%,98.4%,99.6% and 95.2%,99.3%,98.2%,98.7%,respectively.No signifi-cant difference was found in the attenuation,image noise,SNR,and CNR between 2 groups in the same anatomic regions (all P＞0. 05).No significant difference was found in subjective image quality between 2 groups on the intra-cardiac and extra-cardiac structure(all P＞0.05).But the subjective image quality of coronary artery was significantly higher in whole-heart CT scanner in the low dose group than that of the VHS group(4.02 ± 0.91 vs.2.79 ± 0.74),and the differ-ence was significant(Z＝ -5.562,P＝0.000).ED was (0.59 ± 0.31)mSv in whole-heart CT scanner in the low dose group and (2.28 ± 1.07)mSv in the VHS group,reflecting dose savings of 74% by using the whole-heart CT scanner with high temporal resolution,and the difference was significant(t＝ -11.285,P＝0.000).Conclusions The whole-heart CT scanner with low dose can improve image quality with lower ED,especially for the image quality of coronary artery,which is an effective examination method for the diagnosis of congenital heart disease of children, especially for complex congenital heart disease.

BACKGROUND: Subsolid pulmonary nodules are common computed tomography (CT) findings of primary lung adenocarcinoma. It is of clinical value to determine the clinical treatment strategies based on CT features. The aim of this study is to find the valuable CT characteristics on differential diagnosis and the degree of invasion prediction by a retrospectively analysis of three groups subsolid nodules, including benign, and invasive adenocarcinoma. METHODS: The CT findings of 106 cases of resected sub-solid nodules were retrospectively analyzed. The nodules were firstly divided into benign and malignant groups and the malignant group was further divided into non/micro-invasive group (atypical adenomatous hyperplasia/adenocarcinoma in situ/minimally invasive adenocarcinoma) and invasive adenocarcinoma group. The nodule size, proportion of solid components, tumor-lung interface, shape, margin, pleural traction, air bronchus sign, vascular abnormalities inside the nodule were evaluated. The univariate analysis (χ2 test, non-parametric test Mann-Whitney U test) was performed to screen statistically significant variables and then enrolled in further multivariate Logistic regression analysis. RESULTS: Multivariate logistic regression analysis showed that a clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormalities were important indicators of malignant nodules with hazard ratios of 38.1 (95%CI: 5.0-287.7; P<0.01), 7.9 (95%CI: 1.3-49.3; P=0.03), 7.2 (95%CI: 1.4-37.0; P=0.02), respectively. The proportion of solid components was the only significant indicator for identifying invasive adenocarcinoma from AAH/AIS/MIA , with a risk ratio of 1.04 (95%CI: 1.01-1.06, P=0.01). CONCLUSIONS SSNs with clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormality inside nodule are more likely to be malignant. A higher percentage of solid components indicates a higher likelihood to be an invasive lesion in malignant SPNs.
Adenocarcinoma ; diagnostic imaging ; pathology ; Adenocarcinoma of Lung ; Adult ; Aged ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND: To study the characteristics of ventricular function in Pulmonary Hypertension (PH) Patients with different shape of Interventricular Septum (IVS) by cardiac magnetic resonance (CMR). METHODS: 36 PH patients diagnosed by right heart catheterization accepted CMR. According to the morphology of IVS, the patients were divided into two groups: the non-deformation group (10 patients) and the deformation group (26 patients). The ventricular function parameters were as follows: RV and LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), cardiac index (CI), ejection fraction (EF), and myocardial mass index (MMI). RESULTS: ANOVA analysis showed that the differences of RVEDVI, RVESVI, RVSVI, RVCI, RVEF, RVMMI, LVEDVI, LVESVI, LVSVI and LVCI were significant among the three groups. Compared with control group, RVSVI (P=0.017), RVEF (P<0.001), LVEDVI (P=0.048) and LVSVI (P=0.015) decreased in IVS non-deformation group. Compared with IVS non-deformation group, RVEDVI (P<0.001), RVESVI (P<0.001), RVCI (P=0.002) and RVMMI (P=0.017) were increased in IVS deformation group; while RVEF (P=0.001), LVEDVI (P=0.003), LVSVI (P<0.001) and LVCI (P=0.029) were decreased. Compared with the control group, RVEDVI (P<0.001), RVESVI (P<0.001), RVCI (P=0.004) and RVMMI (P=0.003) were increased in the IVS deformation group, while RVEF (P<0.001), LVEDVI (P<0.001), LVESVI (P<0.001), LVSVI (P<0.001), LVCI (P<0.001) were decreased. CONCLUSIONS Ventricular function is different in PH Patients with different IVS shape. The IVS shape can represent the changes of ventricular function in PH patients.
Adult ; Aged ; Female ; Heart ; diagnostic imaging ; physiopathology ; Humans ; Hypertension, Pulmonary ; diagnosis ; diagnostic imaging ; physiopathology ; Lung Neoplasms ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Stroke Volume ; Ventricular Function ; Ventricular Septum ; diagnostic imaging ; physiopathology

Objective To investigate the image quality and radiation dose of the wider detector array CT scanner with low dose scanning mode in young children with congenital heart disease.Methods Totally 100 consecutive pediatric patients younger than 3 years with congenital heart disease were enrolled.They were divided into two groups.The low dose group with fifty patients underwent axial CT scanning with ECG gating,and the control group with fifty patients were scanned with volume helical shuttle (VHS) technique.CT number and noise of two groups images at the level of ascending aorta,main pulmonary artery,left ventricle,descending aorta and adjacent muscle were measured,and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated.The double blind method was used to evaluate subjective image quality of the level of intra-cardiac,extra-cardiac and coronary artery.Effective dose was also calculated for both groups.Results No significant difference was found in the CT number,image noise,SNR,and CNR between the two groups in the same anatomic regions (P ＞ 0.05).No significant difference was found in subjective image quality between the two groups for the intra-cardiac and extra-cardiac structure(P ＞0.05).The subjective image quality of coronary artery was significant higher in low dose group than the control group(4.10 ± 0.90 vs.2.88 ± 0.82,Z =-5.818,P ＜ 0.05).Effective dose was (0.57 ± 0.30)mSv in group A and (2.39 ± 1.15)mSv in group B with dose savings of 76％ (t =-11.642,P ＜ 0.05).Conclusions The wider detector array CT scanner with low dose scanning mode can improve image quality with lower radiation dose.

Background and objective Pulmonary hypertension (PH) often leads to dilatation of main pulmonary artery (MPA). MPA measurements can be used to predict PH. This aim of this study is to investigate power of MPA vessel indi-ces, which are acquired from cardiovascular magnetic resonance, to evaluate PH. Methods Cardiovascular-magnetic-resonance-determined parameters of MPA were acquired and calculated in 83 PH patients, whose diagnosis were confirmed with right heart catheterization and 49 healthy volunteers; these parameters included MPA diameter (DPA), ratio of DPA and ascending aorta diameter (DPA/DAo), max mean diameter (MDmax), min mean diameter (MDmin), fraction transverse diameter (fTD), fraction longitudinal diameter (fLD), and distensibility.Results Compared with control group, DPA, DPA/DAo, MDmax, and MDmin were significantly higher in patients with PH (P<0.001); fTD, fLD, and distensibility significantly decreased (P<0.001). fTD was lesser than fLD in control group (P<0.001), whereas difference was not observed in PH (P=0.305). MPA indices were significantly correlated with mean pulmonary arterial pressure (mPAP) (P<0.05), and strongest correlation was observed for DPA/DAo (r=0.534, P<0.001). By receiver operating characteristic analysis, MDmin>28.4 mm, and MDmax>32.4 mm (area under the curve, AUC=0.979, 0.981) showed best performance in predicting PH, yielding highest specificity at 100%.Conclu-sion Noninvasive cardiovascular-magnetic-resonance-derived MPA measurements provide excellent and practical reference in clinical settings for detecting PH.

Background and objective Background and objective Follow up by computed tomography (CT) and growth evaluation are routine methods for the differential diagnosis of indeterminate pulmonary nodules in clinical practice. Pulmonary nodules with diverse biological behaviors may show different growth patterns and velocities. The aim of this study is to identify the volume growth curve of both benign and malignant pulmonary nodules. This work also intends to determine these nodules' growth patterns and provide evidence for the establishment of a follow-up strategy. Methods The CT data of 111 pulmonary nodules (54 solid, 57 subsolid) were retrospectively evaluated using 3D volumetric software. All of these nod-ules have been followed up at least twice. Of these nodules, 35 were confirmed as lung cancers, whereas 5 were confirmed as benign by pathology or histology. Moreover, 71 nodules showed no growth in more than 2 years. Stable nodules were defined as low-risk nodules, as confirmed by reevaluation from experts. On the basis of their densities and diameters, the nodules were classified into four types: benign/low-risk solid nodules, malignant solid nodules (diameter ≤1 cm and >1 cm), benign/low-risk subsolid nodules, and malignant subsolid nodules (diameter ≤1 cm and >1 cm). The follow-up interval time (d) were plot-ted on the x-axis, and the nodules' volume (mm3) and logarithmic volume were plotted on the y-axis. Two radiologists subjec-tively determined the type of growth curve. Chi-square test was performed to compare the growth curves of benign/low-risk and malignant nodules. Results Of 18 solid cancers, 12 cases (66%) were found with steep ascendant growth curves. Those of 3 cases (16.7%) were flat ascendant, 2 cases (11.1%) slowly ascendant, and 1 (5.56%) case flat. Of 17 subsolid cancers, 8 cases (47.1%) manifested steep ascendant growth curves. Those of 4 cases (23.5%) were slowly ascendant, 3 (17.6%) flat, and 2 (11.8%) descendant–ascendant. Of 36 benign/low-risk solid nodules, 5 cases (13.9%) manifested descendant growth curves, 17 cases (47.2%) flat, 8 cases (21.6%) slowly ascendant, and 6 cases (16.7%) undulate. Of 40 benign/low-risk subsolid nod-ules, 4 cases (10%) manifested descendant growth curves, 21 cases (52.5%) flat, 9 cases (22.5%) slowly ascendant, and 6 cases (15%) undulate. The distribution of growth curve types significantly differed between benign/low-risk and malignant nodules (χ2=42.4, P<0.01). Conclusion The growth curves of lung cancers are heterogeneous. A steep ascendant curve is the main type for lung cancer, with the exception of flat, slowly ascendant, or even descendant curve. A slowly ascendant curve cannot exclude the diagnosis of lung cancer, especially for subsolid nodules.

Background and objective The detection and quantification of solid components in pulmonary sub-solid nodules (SSN) are of vital importance on differential diagnosis, pathological speculation and prognosis prediction. How-ever, no objective and wide-accepted criterion has been built up to now. The purpose of this study is to explore the optimal threshold that can be used for the detection and quantification of solid components in SSNs by using threshold segmentation method on computed tomography (CT) images. Methods CT images of 102 SSNs were retrospectively analyzed. To estab-lish a reference standard, the observers made judgments on whether the solid component existed in every SSN and did manual measurements of the volume of solid component with the help of software. Threshold segmentations of every nodule were then performed using different threshold settings and all of the measured volumes were assumed to be solid volumes, then solid-to-total volume ratios were calculated. The results were compared with the reference standards using the receiver operating char-acteristic curve and Wilcoxon test. Results The application of thresholds as -250 HU or -300 HU resulted in high diagnostic value on the detection of solid component, with area under curve values as 0.982 and 0.977, respectively; the cut-off values of solid-to-total volume ratio were 1.10% and 6.14%, respectively; the median volumes of solid components were 202.7 mm3 (598.2 mm3), 247.1 mm3(696.0 mm3), which were not significantly different from the reference standard[199.5 mm3 (743.1 mm3)](P=0.125,1, 0.061,3). Conclusion Threshold segmentation on chest CT images is valuable to detect and quantify the solid component on SSNs, the thresholds as -250 HU and -300 HU are recommended.

Objective To evaluate the diagnosis accuracy for coronary stenosis from diameter measurements of differ?ent severities of stenosis by using gemstone spectral imaging (GSI). Methods Totally 3 different coronary artery models(in?ternal diameter:3.00 mm) that with different severities of stenosis (residual lumen diameter ratio:75%, 50%and 25%) were placed in a pulsating cardiac phantom (ALPHA 1-VT PC, Fuyo Corporation, Japan). The coronary phantom was scanned in two models:gemstone spectral imaging (GSI) and axial scan model(AXIAL). All the spectral imaging data were analyzed by using GSI viewer to reconstruct the VMS images (40-140 keV by 10 keV interval) and AXIAL. CT values (HU) of the re?mained lumen from all different stenosis lumens were measured. The residual rate (%) was calculated by dividing the diame?ters of the remained lumen to normal lumen on the reformatted short axial images. One-way ANOVA was used to compare the measurement difference of residual rates between VMS images. Student t-test was used to compare the measurement dif?ference of residual rate between VMS and AXIAL. Bland-Altman test was used to compare the measured residual rates and the gold standard. Results There were no significant differences in measured residual rate betweeb VMS images (P>0.05). From student t-test, only significant difference was found on 50%stenosis between 70 keV VMS and AXIAL(t=4.617,P<0.042). From the Bland-Altman test, measurement of residual rate was more accurate from 70 keV VMS than that of AXIAL by taking the stenosis rate of real model as gold standard(t=14.560,P<0.001). Conclusion VMS image (70 keV) shows more accurate rate than AXIAL images on both diameter measurement and evaluation of the coronary stenosis.

Background and objective hTe management of pulmonary nodules relies on cancer risk assessment, in which the only widely accepted criterion is diameter. hTe development of volumetric computed tomography (CT) and three-dimensional (3D) sotfware enhances the clarity in displaying the nodules’ characteristics. hTis study evaluated the values of the nodules’ volume and 3D morphological characteristics (edge, shape and location) in cancer risk assessment.Methods hTe CT data of 200 pulmonary nodules were retrospectively evaluated using 3D volumetric sotfware. hTe malignancy or benignity of all the nodules was conifrmed by pathology, histology or follow up (>2 years).Logistic regression analysis was performed to calculate the odds ratios (ORs) of the 3D margin (smooth, lobulated or spiculated/irregular), shape (spherical or non-spherical), location (purely intraparenchymal, juxtavascular or pleural-attached), and nodule volume in cancer risk assessment for total and sub-centimeter nodules. hTe receiver operating characteristic (ROC) curve was employed to determine the opti-mal threshold for the nodule volume.Results Out of 200 pulmonary nodules, 78 were malignant, whereas 122 were benign. hTeLogistic regression analysis showed that the volume (OR=3.3;P<0.001) and the 3D margin (OR=13.4, 9.8; bothP=0.001) were independent predictive factors of malignancy, whereas the location and 3D shape exhibited no total predictive value (P>0.05). ROC analysis showed that the optimal threshold for malignancy was 666 mm3. For sub-centimeter nodules, the 3D margin was the only valuable predictive factor of malignancy (OR=60.5, 75.0;P=0.003, 0.007).Conclusion hTe volume and 3D margin are important factors considered to assess the cancer risk of pulmonary nodules. Volumes larger than 666 mm3 can be determined as high risk for pulmonary nodules; by contrast, nodules with lobulated, spiculated, or irregular margin present a high malignancy probability.

Background and objectivehTe clinical course of pulmonary hypertension (PH) is one of progressive deterioration interspersed with episodes of acute decompensation. It is diffcult to predict when patients will die because death may come either suddenly or slowly due to progressive heart failure. hTe aim of this study is to investigate morphology, func-tion and hemodynamics in PH, compared with healthy people, and to investigate the clinical value of detection of PH by use of cardiac magnetic resonance (CMR) parameters.MethodsCMR was performed in 56 PH patients collected from Tianjin Medical University General Hospital from January 2012 to December 2014 and 22 healthy controls. hTe following parameters were calculated: right ventricle (RV) end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), myocar-dial mass (MM), RV fractional area change (RVFAC), interventricular septal curvature (CIVS), letf ventricular free wall curva-ture (CFW), and CIVS/CFW, main pulmonary artery (MPA) positive peak velocity, maximal area, minimal area and distensibility. Comparisons of CMR measurements between PH patients and controls were analyzed by using the studentt-tests. Receiver operating characteristic (ROC) curve analysis was used to compare the PH diagnostic abilities for four parameters (MPA posi-tive peak velocity, distensibility, curvature ratio, and RVFAC) and combined CMR parameter.P<0.05 was considered signiif-cant.Results Compared with healthy controls, RV morphology, function and hemodynamics of PH group declined and dete-riorate obviously. hTe ROC curve analysis showed that among the four parameters distensibility of MPA had the highest AUC value (AUC=0.95). Additionally, combined CMR parameter (positive peak velocity+distensibility+curvature ratio+RVFAC) had even higher AUC (AUC=0.988).ConclusionComprehensive CMR parameters is conducive to accurately relfect the overall state RV-pulmonary circulation in patients with PH.