Objective:To investigate the value of dual-layer detector spectral CT in preoperative evaluation of immunohistochemical expression levels in breast cancer patients.Methods:The clinical, pathological and imaging data of breast cancer patients who received preoperative spectral CT chest scan in Affiliated Hospital of Southwest Medical University from October 2020 to January 2021 were retrospectively analyzed. A total of 70 patients were divided into positive or negative estrogen receptor (ER) group, positive or negative progesterone receptor (PR) group, positive or negative human epithelial growth factor receptor 2 (HER2) group, and positive or negative Ki-67 group according to the immunohistochemistry. Philips workstation and Special Diagnostic Suite software were used for processing and analysis. The CT value and iodine concentration value (IC) of the lesion and the effective atomic number (Z eff) of the lesion in the arterial and venous phases were measured, and the standardized CT value (NCT), standardized iodine concentration value (NIC), slope (K) of the keV-CT value curve in the arterial and venous phases as well as the CT difference and the IC difference in the arteriovenous phase were calculated. Independent sample t test was used to compare the differences in spectral parameters between patients with positive and negative immunohistochemical parameters, and ROC curve was used to analyze the efficacy of spectral parameters in the differential diagnosis of positive and negative different immunohistochemical parameters. Results:Z eff, NIC, K value, CT value, IC value of arterial and venous phase and NCT value of venous phase in negative ER group were higher than those in positive ER group, the difference was statistically significant ( P<0.05). Z eff, NIC, K value, IC, CT difference in arteriovenous phase and IC difference in arteriovenous phase in positive HER2 group were higher than those in negative HER2 patients, the difference was statistically significant (P<0.05). The arterial K value in positive Ki-67 group was higher than that in negative Ki-67 group, the difference was statistically significant ( P<0.05). Taking arterial phase K value of 1.22 as the diagnostic threshold, it had the highest diagnostic efficiency in differential diagnosis of ER positivity versus negativity (area under curve of 0.791, sensitivity of 84.00%, specificity of 65.00%). Taking the arteriovenous phase IC difference of 0.47 mg/ml as the diagnostic threshold, it had the highest performance in differential diagnosis of HER2 positivity versus negativity (area under curve of 0.736, sensitivity of 76.32%, specificity of 65.62%). Conclusion:Dual-layer detector spectral CT has certain diagnostic value for the immunohistochemical expression of breast cancer patients, which can provide reference for clinical diagnosis and treatment.

Objective This study aimed to explore the practice and effect of PAD Class (presentationassimilation-discussion Class) in the teaching of Medical Genetics.Methods We randomly selected a teaching class (117) for PAD Class and the other class (115) for lecture-style teaching.The two classes took the same exam in the end,with the PAD class taking an extra questionnaire on teaching conditions at the same time.The average scores of the two classes were tested by SPSS 19.0.Results The scores of the final exams for PAD and control classes were (72.21 ± 7.42) and (69.77 ± 8.89),differences were statistically significant (t=2.27,P=0.02).Questionnaire results showed that in PAD Class,68.81％ (75/109) of the students could complete homework,93.58％ (102/109) thought that PAD class had (obviously) increased their initiative and enthusiasm for learning,and 53.21％ (58/109) were very satisfied with their learning results.Conclusion PAD Class is suitable for the teaching of Medical Genetics and improves the teaching efficiency.

Objective To observe the relationship between the integrity of Willis circle and aneurysm with MSCT angiography.Methods CTA data of 580 patients with intracranial vascular lesions were retrospectively analyzed.The morphological structure of Willis circle and the occurrence of aneurysm were observed based on axial thin-layer,VR,MIP and MPR images.According to the integrity,Willis circle were divided into type Ⅰ (Willis circle complete),type Ⅱ (the anterior circulation complete but the posterior circulation incomplete),type Ⅲ (the anterior circulation incomplete but the posterior circulation complete) and type Ⅳ (both the anterior and posterior circulation incomplete) for statistical analysis.Results For the classification of Willis circle,there were 118 cases of type Ⅰ (118/580,20.34％),344 of type Ⅱ (344/580,59.31％),25 of type Ⅲ (25/580,4.31％) and 93 cases of type Ⅳ (93/580,16.03％).The incidence of Ⅰ-Ⅳtypes of Willis circle with aneurysm accounted for 16.10％ (19/118),14.83％ (51/344),32.00％ (8/25) and 23.66％ (22/93),respectively.The incidences of aneurysm in patients with different types of Willis circlewere statistically significant (x2=8.013,P=0.046).There was statistical difference of the type of Willis circle between different genders (x2=12.631,P=0.006),and the incidence of aneurysm in females was higher than that in males (25.00％ [63/252] vs 11.28％ [37/328];x2 =18.80,P＜0.025).Conclusion Most Willis circle were not complete,and incomplete Willis circle aneurysm tended to occur in females with higher aneurysm rate.

Objective To analyze CT manifestations of inguinal canal lipomas (ICLS).Methods CT datas of 104 pa tients with ICLS was retrospectively analyzed.And the imaging features were observed by MPR.Results The main CT manifestations of the ICLS were fat density in the inguinal canal and were unconnected with the abdominal fat.Among the 104 ICLSpatients,male (90/104,86.54％) was more than famale(14/104,13.46％;x2=55.538,P＜0.001).Thele sions were located at bilateral sides in 8 cases,left side in 66 cases and right side in 30 cases.The lesions in left side were more than those in right side (x2 13.500,P＜0.001).The mean maximum cross-sectional area of ICLS was (3.89 ± 2.12)cm2.There was no statistically significant difference between male and famale in maximum cross-sectional area (t=1.038,P=0.302).Conclusion In ICLS patients,male is more than famale.And more lesions are located at the left side.The CT manifestations of ICLS have certain characteristics,and MPR images are helpful in diagnosing ICLS.

Objective To evaluate early dynamic contrast enhancement CT on multiple organ failure in acute pancreatitis.Methods 333 cases of acute pancreatitis identified by clinical and early dynamic contrast enhancement CT were collected.Patients were divided into organ failure group(OF group,124 cases) and non-organ failure group (notn-OF group,209 cases).All variables including duration of hospitalization,need for intensive care unit,infection,need for operation,mortality and MCTSI,EPIC score were analyzed by U test and x2 test firstly.The variables with significance (P＜0.05) were analyzed by Stepwise Logistic regression further.Results On U test and x2 test,there were significant differences(P＜0.001) between two groups in duration of hospitalization,need for intensive care unit,infection,need for operation,mortality,MCTSI score and EPIC score and APFC + ANC＞ 100 mL,and bilateral pleural effusion/ pulmonary atelectasis.The Stepwise Logistic regression analysis demonstrated that increased MCTSI and EPIC score,APFC+ANC＞ 100 mL and bilateral pleural effusion/pulmonary atelectasis were 4 independent risk factors of multiple organ failure in acute pancreatitis.Conclusion Multiple organ failure in acute pancreatitis can be judged with early dynamic contrast enhancement CT for improved treatment.

Objective To investigate the correlation of the polymorphisms of angiotensin Ⅱtype 1 receptor (AT1R)gene A1166C and angiotensinogen(AGT)gene M235T and blood biochemical indicators with essential hypertension(EH)in the male of Yi nationality in Yunnan province. Methods 92 hypertensive and 70 normotensive of Yi people were recruited in Yunnan province. Their basic information and blood biochemical indicators were obtained by questionnaire and standardized physical examination. The genes polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)technique. Results(1)For the male EH patients of Yi nationality,1166C and 235T allele frequencies were 0.038 and 0.772. No significant differences in allele frequency or genotype frequency were observed between the two groups(P > 0.05).(2)The levels of TC,LDL-C and TG in EH were significantly higher than those in controls(P < 0.05). Conclusion The AT1R A1166C and AGT M235T polymorphisms were not related to the pathogenesis of EH in the male of Yi people. However,the high levels of TC,TG and LDL-C might be the risk factors of EH.

Objective To explore the application value of ECG tube current modulation technology of dual source CT in coronary angiography,compared with retrospectively ECG-gated technique.Methods 200 patients were randomly divided into ECG tube current modulation group (Group A)and retrospectively ECG-gated group(Group B).In Group A,the main parameters were the exposure time windows of full dose,which were set according to different heart rates.χ2 test was adopted in the subjective score,and t test was used in the objective score and radiation dose.Results There was no statistical significance in image quality between the two groups(χ2 =2.125,tnoise =-0.557,P >0.05 );The effective dose (ED)of Group A and Group B were (3.30±0.40)mSv and(6.90±1.76)mSv,respectively.The difference was statistically significant (t ED =-1 9.954,P <0.05).The radiation dosage of Group A was 52% lower than that of Group B.Conclu-sion Compared with retrospectively ECG-gated technique,the ECG tube current modulation technique ensures the image quality, and at the same time it can significantly reduce the radiation dose,therefore,it can be used as a routine examination technique of cor-onary angiography.

Objective To observe the imaging features of partiallythreaded screw fixation using in various kinds of C2 pedicel fracture.Methods CT image materials of 160 Chinese Han patients who suffered from atlantoaxial injury without vertebral body and pedicle fracture of C2 was included in this study,including 120 males and 40 females.Pedical trajectory selected according to Ebraheim method in threedimensional CT reconstruction was analyzed in ADW 4.4 workstation.The posterior wall fracture of C2 vertebral body,isthmus fracture and fractures under C2 laminar were simulated according to clinical observation.The trajectory length (partiallythreaded screw length) from entry point to anterior cortical bone of C2,bolt shank length from entry point to fracture line and fillet of screw length from fracture line to anterior cortical bone of C2 were measured.Relations between height,gender and partiallythreaded screw length bolt shank and fillet of screw length was evaluated.Results Male height was 167±7.9 cm on average,and female was 156±6.6 cm.The length of partiallythreaded screw was 29 mm in male and 25 mm in female on average.Height and gender was positively correlated with partiallythreaded screw length.In posterior wall fracture of C2 vertebral body,length of bolt shank was an average of 17 mm in male and 15mm in female,while fillet of screw length was 12 mm in male and 10 mm in female.The mean length of bolt shank was 14mm in male and 13 mm in female,while mean fillet of screw length was 15 mm in male and 12 mm in female in isthmus fracture.In fractures under C2 laminar,length of bolt shank was 10 mm in male and 9 mm in female on average,while mean fillet of screw length was 18 mm in male and 15mm in female.Conclusion The length of partiallythreaded screw used in posterior axial pedicle fracture may have a close correlation to length and height.The length of bolt shank and fillet of screw was different according to the position of the fracture.

Objective To evaluate hepatic functional reserve and operational risks of primary hepatic carcinoma in Child A using functional CT.Methods In 128 cases of primary hepatic carcinoma of Child A undergoing hepatoectomy and identified by pathology, CT perfusion scanning and measurement of remannent hepatic volume were done before operation and whole patients were divided in-to acute hepatic failure group(AHF group,33 cases)and non-acute hepatic failure(non-AHF group,95 cases).All variables were ana-lyzed by one way analysis of variance(one-way ANOVA)firstly.The variables with significance (P<0.05)were analyzed with Step-wise Logistic regression further.Results One-way ANOVA result:There were significant difference between two groups in RHVS measured by CT,PVP,HBF,HBV,serum creatinine,thrombinogen activity,total bilirubin and intraoperative blood loss (P<0.05).The StepwiseLogistic regression analysis demonstrated that decreased RHVS and the lowed PVP were the independent risk factors of AHF complicated to hepatoectomy of primary hepatic carcinoma(P<0.01).Conclusion Hepatic functional reserve and operational risks of primary hepatic carcinoma could be j udged with functional CT before operation .

Objective To explore the feasibility and value of MSCT for the evaluation of hypophysoma before and after endonasal transphenoidal microsurgery.Methods 82 patients with hypophysoma intended to be treated by endonasal transphenoidal microsur-gery,were examined by 64-slice head CT angiography (CTA).All the images were transmitted to workstation and reconstructed by MIP、VR and MPR.The hypophysoma were typed according to the relationship between hypophysoma and its surrounding vessels. The shortest and longest diameter between internal carotid arteries of two sides,tumor length and width,the diameter between ex-ternal naris and the rear wall of sphenoid top and the length from external naris to the rear wall of tumor top were measured in VR images.Sphenoid division was observed in coronal plane image.Major vascular injury,bleeding,and residual tumor situation were observed on postoperative CT review.The surgery effect was evaluated by three associate professorwith SPSS 13.0.Results 39 ca-ses were type-A,30 were type-B,13 were type-C,tumor length ranged from 1.7 cm to 3.9 cm,width ranged from 1.3 cm to 2.5 cm,the diameter between external naris and the rear wall of sphenoid top and the length between external naris and the rear wall of tumor top were 6.9 cm~7.6 cm and 9 cm~12.2 cm.There are 1 5 cases of sphenoid without division,34 cases with one divi-sion,26 cases with two division and at least three division in 7 cases.The surgery effect was better in those which tumor size was relatively smaller compared to the diameter of the internal carotid artery.The evaluation of endoscopic endonasal transsphenoidal surgery with three types of pituitary adenomas had a significant difference (P <0.05).Conclusion MSCT can preferably reflect the spatial location relationship between pituitary adenimas and its surrounding structure,and it is effective evaluation methods for pre-operative and postoperative evaluation of transnasal microsurgical resection.