摘要：
Objective This study explored the feasibility of dual-energy computed tomography (DECT) for the diagnosis of mediastinal lymph node (LN) metastasis in patients with lung cancer. Methods Forty-two consecutive patients with lung cancer, who underwent DECT, were included in this retrospective study. The attenuation value (Hounsfield unit) in virtual monochromatic images and the iodine concentration in the iodine map were measured at mediastinal LNs. The slope of the spectral attenuation curve (K) and normalized iodine concentration (in thoracic aorta) were calculated. The measurement results were statistically compared using 2 independent samples t test. Receiver operating characteristic curve analysis, net reclassification improvement, and integrated discrimination improvement were used to evaluate the diagnostic performance of DECT for mediastinal LN metastasis. Results A total of 74 mediastinal LNs were obtained, including 33 metastatic LNs and 41 nonmetastatic LNs. The attenuation value at the lower energy levels of virtual monochromatic images (40-90 keV), K, and normalized iodine concentration demonstrated a significant difference between metastatic LNs and nonmetastatic LNs. The attenuation value at 40 keV was the most favorable biomarker for the diagnosis of mediastinal LN metastasis (area under curve, 0.91; sensitivity, 0.94; specificity, 0.81), which showed a much better performance than the LN diameter-based evaluation method (area under curve, 0.72; sensitivity, 0.66; specificity, 0.82; net reclassification improvement, 0.359; integrated discrimination improvement, 0.330). Conclusions Dual-energy computed tomography is a promising diagnostic approach for the diagnosis of mediastinal LN metastasis in patients with lung cancer, which may help clinicians implement personalized treatment strategies.
作者机构：
[侯芬; 李平] Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, China;[李恒国] Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China;[刘霞; 周智凤] Neuropsychiatric Imaging Center, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, 518000, China
通讯机构：
[Liu, X.] N;Neuropsychiatric Imaging Center, China
期刊：
Quantitative Imaging in Medicine and Surgery,2021年11(1):341-350 ISSN：2223-4292
通讯作者：
Zhang, Kun
作者机构：
[Shen, Hongrong; You, Tian; Guo, Ying; He, Zhuo; Li, Ping; Gao, Hui; Yan, Luyou; Zhang, Yaxi; Zhang, Kun; Zhou, Shuwei; He, Yewen] Hunan Univ Chinese Med, Affiliated Hosp 1, Dept Radiol, 95 Shaoshan Middle Rd, Changsha 410007, Peoples R China.;[Zhang, Kun; Zhou, Shuwei] Hunan Univ Chinese Med, Coll Integrated Tradit Chinese & Western Med, 300 Xueshi Rd, Changsha 410208, Peoples R China.;[Zhu, Lu] Hunan Normal Univ, Affiliated Hosp 1, Hunan Prov Peoples Hosp, Dept Ultrasonog, Changsha, Peoples R China.
通讯机构：
[Zhang, Kun] H;Hunan Univ Chinese Med, Affiliated Hosp 1, Dept Radiol, 95 Shaoshan Middle Rd, Changsha 410007, Peoples R China.;Hunan Univ Chinese Med, Coll Integrated Tradit Chinese & Western Med, 300 Xueshi Rd, Changsha 410208, Peoples R China.
关键词：
Bone density;X-ray computed;lumbar vertebrae;osteoporosis;tomography
摘要：
BACKGROUND: Osteoporosis is a common, progressive disease related to low bone mineral density (BMD). If it can be diagnosed at an early stage, osteoporosis is treatable. Quantitative computed tomography (QCT) is one of the current reference standards of BMD measurement, but dual-energy computed tomography (DECT) is considered to be a potential alternative. This study aimed to evaluate the feasibility and accuracy of phantomless in vivo DECT-based BMD quantification in comparison with QCT. METHODS: A total of 128 consecutive participants who underwent DECT lumbar examinations between July 2018 and February 2019 were retrospectively analyzed. The density of calcium (water), hydroxyapatite (water), calcium (fat), and hydroxyapatite (fat) [D(Ca(Wa)), D(HAP(Wa)), D(Ca(Fat)) and D(HAP(Fat)), respectively] were measured along with BMD in the trabecular bone of lumbar level 1-2 by DECT and QCT. Linear regression analysis was performed to assess the relationship between DECT- and QCT-derived BMD at both the participant level and the vertebral level. Linear regression models were quantitatively evaluated with adjusted R-square, normalized mean squared error (NMSE) and relative error (RE). Bland-Altman analysis was conducted to assess agreement between measurements. P<0.05 was considered statistically significant. RESULTS: Strong correlations were observed between DECT- and QCT-derived BMD at both the participant level and the vertebral level (adjusted R(2) =0.983-0.987; NMSE = 1.6-2.1%; RE(linear) =0.6-0.9%). Bland-Altman plots indicated high agreement between both measurements. D(Ca(Fat)) and D(HAP(Fat)) showed relatively similar and optimal predictive capability for QCT-derived BMD (both: adjusted R(2) =0.987, NMSE =1.6%, RE(linear) =0.6%). CONCLUSIONS: Fast kVp switching DECT enabled accurate phantomless in vivo BMD quantification of the lumbar spine. D(Ca(Fat)) and D(HAP(Fat)) had relatively similar and optimal predictive capability.
作者机构：
[张堃; 沈宏荣; 胡小丽; 李平] Department of Radiology, the First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, 410007, China;[顾潜彪] Department of Radiology, Hunan Provincial People's Hospital, Changsha, 410005, China;[李磊] Department of Radiology, the Central Hospital of Yongzhou, Yongzhou, 425000, China
通讯机构：
[Zhang, K.] D;Department of Radiology, China
摘要：
Atherosclerosis (AS) is one of the leading causes of cardiovascular disease and has a high rate of morbidity and mortality. Traditional Chinese Medicine (TCM) supplied many therapies for AS treatment for centuries. Among these treatments, BuYangHuanWu decoction (BYHWD) is a classic prescription. In this study, we analyzed the mechanisms of BYHWD in the treatment of AS by using a network pharmacology method. Our results revealed the mechanisms of BYHWD in treating AS, which is highly related to inflammation and apoptosis pathways, moreover, the genes including IL1 beta, TGFB1, TNF, IL6, NF kappa B1 are proved to be the key pharmacological targets for the treatment of AS. Furthermore, an AS rat model was established and the rats in the treatment group received different amounts of BYHWD. Serum lipid levels (TC/TG/HDL-C/LDL-C) and tissue oxidative stress levels (SOD, GSH-Px, CAT and MDA) were ameliorated in a dose-dependent manner. The morphology of the aortic intima in the BYHWD-treated groups was improved. Real-time PCR and Western blot analysis results indicated that inflammatory cytokines were suppressed and that the NF-kappa B signaling pathway was blocked by BYHWD. All of this evidence suggested that BYHWD is an ideal prescription for treating AS.
作者机构：
[潘俊含; 钟泽亚; 李平; 何业文; 周淑伟; 颜路悠; 沈宏荣; 高辉] Department of Radiology, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, 410007, China;College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, 410208, China;[张雅茜] GE Healthcare [Shanghai] Co., Ltd., Shanghai, 201203, China;[张堃] Department of Radiology, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, 410007, China, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, 410208, China
通讯机构：
[Zhang, K.] D;Department of Radiology, China
摘要：
Background: Hydroxyapatite (HAP) is the main component of bone mineral. The utility of using HAP-water decomposition technique with fast kilovoltage (KV)-switching dual-energy computed tomography (DECT) to detect abnormal edema in vertebral compression fractures (VCFs) has not been widely reported. Methods: A total of 31 consecutive patients with 80 VCFs who underwent DF,CT and magnetic resonance imaging (MRI) of the spine were retrospectively enrolled in our study between October 2018 and January 2019. VCFs in MR examinations served as the standard of reference. Two radiologists blindly and independently evaluated color-coded overlay virtual nonhydroxyapatite (VNHAP) images for the presence of abnormal edema. The inter-reader agreement, specificity, sensitivity, accuracy, and predictive values of VNHAP images for edema detection were calculated. The diagnostic accuracy of two readers was compared using McNemar's test. Two additional radiologists performed a quantitative analysis on VNHAP images, receiver operating characteristic (ROC) curve analysis was conducted, and the threshold was calculated. Results: MRI depicted 45 edematous and 35 nonedematous VCFs. For visual analysis, the VNHAP technique showed a sensitivity of 93.3%, a specificity of 97.1%, a positive predictive value (PPV) of 97.7%, a negative predictive value (NPV) of 91.9%, and an accuracy of 95.0%. The inter-reader agreement was almost perfect (k=0.90). The diagnostic accuracy of the two readers showed no significant differences in the assessment of VIII IA P images (P=1.00). Significant differences in CT numbers between vertebrae with and without bone marrow edema were found by quantitative analysis (P<0.01). The area under the curve (AUC) of the VNHAP images was estimated to be 0.917. The threshold of 1,003.2 mg/cm(3) yielded a sensitivity of 88.9% and a specificity of 82.9% for the differentiation of fresh and old VCFs. Conclusions: Fast KV-switching DECT HAP-water decomposition technique had excellent diagnostic performance for identifying acute and chronic VCFs in visual and quantitative analyses.
