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Background Functional planning based merely on 4DCT ventilation imaging has limitations. In this study, we proposed a radiotherapy planning strategy based on 4DCT ventilation imaging and CT density characteristics. Materials and methods For 20 stage III non-small-cell lung cancer (NSCLC) patients, clinical plans and lung-avoidance plans were generated. Through deformable image registration (DIR) and quantitative image analysis, a 4DCT ventilation map was calculated. High-, medium-, and low-ventilation regions of the lung were defined based on the ventilation value. In addition, the total lung was also divided into high-, medium-, and low-density areas according to the HU threshold. The lung-avoidance plan aimed to reduce the dose to functional and high-density lungs while meeting standard target and critical structure constraints. Standard and dose–function metrics were compared between the clinical and lung-avoidance plans. Results Lung avoidance plans led to significant reductions in high-function and high-density lung doses, without significantly increasing other organ at risk (OAR) doses, but at the expense of a significantly degraded homogeneity index (HI) and conformity index (CI; p p > 0.05). Compared with the clinical plan, the mean lung dose (MLD) in the high-function and high-density areas was reduced by 0.59 Gy and 0.57 Gy, respectively. Conclusion A lung-avoidance plan based on 4DCT ventilation imaging and CT density characteristics is feasible and implementable, with potential clinical benefits. Clinical trials will be crucial to show the clinical relevance of this lung-avoidance planning strategy.

A 22-year-old female with SDHB-positive who presented with palpitation and hypertension after adrenalectomy was performed 18F-FDG PET/CT to detect the primary ectopic pheochromocytoma (PCC) and rule out metastasis. PET/CT is useful for detecting and localizing the primary ectopic PCC.

PurposeThe study is to evaluate the diagnostic performance and image quality of a 20-second breath-hold (BH) 18F-FDG total-body PET acquisition compared with a free-breathing (FB) PET for stage IA pulmonary adenocarcinoma.Materials and MethodsForty-seven patients with confirmed stage IA pulmonary adenocarcinoma were enrolled. All patients underwent total-body 18F–FDG PET/CT and the acquisition time was 300 s, followed by a 20-s BH PET. A 20-s FB PET was extracted from the 300-s PET. The size and volume of lesions were measured on BHCT images. The SUVmax, tumor-to-background ratio (TBR), metabolic tumor volume (MTV), %ΔSUVmax and %ΔTBR of the lesions were measured and recorded. The lesions were further divided by distance from pleura, lesion size, and morphological characteristic for subgroup analysis. ResultsIn the cohort and subgroup analysis, the SUVmax and TBR were significantly increased with 20-BH PET compared with 300-FB PET and 20-FB PET (all p＜0.05). And the %ΔSUVmax and %ΔTBR in D1 groups (≤10 mm in distance) higher than those in D2 and D3 groups (＞10 mm). The diagnostic performance of BH PET was significantly higher than that of FB PET (all p＜0.001). The Bland-Altman plot for agreement on lesion’s volume between BH PET and CT showed good agreement than FB PET.ConclusionThe 20-s BH PET acquisition is more sensitive to quantitative and qualitative analysis for stage IA pulmonary adenocarcinoma. 20-s BH PET/CT acquisition reduces the blurring effect of respiratory motion especially for subpleural nodules (≤10 mm in distance).

This study aims to investigate the image quality and radiation dose of prospective ECG-triggered 128-slice dual-source CT (DSCT) angiography in the delineation of coronary arteries in infants with congenital heart disease (CHD). Sixty-three infants with CHD were randomly assigned into two groups: prospective ECG-triggered sequential protocol (group 1) and high-pitch spiral protocol (group 2). Patients were selected to the protocols randomly. A five-point scoring system was applied to study the capability of detecting coronary arteries. A score of

To investigate the correlation between dynamic morphological parameters of retrospective cardiac gating CT angiography (CTA) and delayed adverse event (DAE) in uncomplicated type B acute aortic dissection (uTB-AAD) patients. Eighty-seven patients initially diagnosed with uTB-AAD were retrospectively reviewed. Dynamic variables obtained by dose-regulated retrospective CTA were recorded, including the minimum relative true lumen diameter (RTLAmin), ratio of the minimum to maximum true lumen relative area (r-RTLA), the maximum diameter of the descending aorta, false lumen, and primary entry tear. Outcome analysis comprised incidences of DAE and early mortality within 3 to 14 days since symptom occurring. Twenty-six patients (29.9%) developed DAE, and two of which (7.7%) died before any interventions. Smaller values of RTLAmin (P = 0.01) and r-RTLA at the upper thoracic descending aorta (UTDA) (P

Background Little is known about the influence of intima dynamic motion on organ ischemia and related outcomes. The purpose of this study is to quantitatively evaluate intima oscillation by CT angiography (CTA), determine its impact on acute kidney injury (AKI) in patients with type B acute aortic dissection (TB-AAD) before thoracic endovascular aortic repair (TEVAR), and further analyze its association with early adverse events postoperatively. Methods Totally, 108 patients with TB-AAD who underwent retrospective ECG-gated CTA and received TEVAR were enrolled. Patients were divided into AKI and non-AKI groups. Area of the true lumen (TLA) was computed at R–R intervals at the upper level of kidney vessel origin every 5% step from 0% to 95%. Additionally, other morphologic parameters that have been identified as risk predictors for adverse events in uncomplicated TB-AAD were evaluated. Results Forty-three (39.8%) patients were sorted into the AKI group. Patients with AKI exhibited a larger value for the relative change of TLA (Crel-TLA) than patients in the non-AKI group (p Conclusion Intima dynamic motion, as quantitatively evaluated by CTA, has a significant influence on renal injury before and after the aortic intervention, as well as other adverse events, which might guide clinical therapy in high-risk patients.

Introduction: Stereotactic body radiotherapy (SBRT) currently adopts non-discriminative prescription regimen. This study attempts to investigate an individualized fraction regimen (IFR) method for SBRT patients with non-small cell lung cancer (NSCLC) based on Uncomplicated and Cancer-free Control Probability (UCFCP). Methods: Twenty patients with NSCLC were retrospectively prescribed with 40 regimens, ranging from 8Gy×5f to 12Gy×5f in step of 0.1 Gy. Taking into consideration of the age and the BMI index of each patient as well, the tumor control probability (TCP), the normal tissue complication probability (NTCP) of the total lung, chest wall and rib, and the secondary cancer probability (SCP) of the total lung were calculated for each plan of the patients. For the 40 regimens, the UCFCP was calculated and the maximum value of UCFCP was the IFR of the specified patient. Besides, IFR of UCP approach which only took account of the TCP and NTCP was also derived and to be compared with the IFR based on the UCFCP method. Results: For all the patients, the UCFCP value showed a bell-shaped trend with the change of prescription dose. Among the 20 patients, the IFRs of 16 patients were different from the original fixed regimen. Of the 16 patients, the IFR of 5 patients exhibited slight changes between UCP and UCFCP methods. Conclusion: The method based on the maximum value of UCFCP function may be helpful to provide IFR for specific SBRT patients with NSCLC, differentiating the patient specific characteristics such as anatomical structures and locations.

To investigate dynamic variables obtained from retrospective computed tomography angiography for ability to predict thoracic endovascular aortic repair (TEVAR) outcomes in patients with complicated type B aortic dissection (cTBAD).Seventy-nine patients with cTBAD who received TEVAR from March 2009 to June 2018 were retrospectively enrolled. Relative true lumen area (r-TLA) was computed at the level of tracheal bifurcation every 5% of all R-R intervals. Parameters that reflect the state of intimal motion were evaluated, including difference between maximum and minimum r-TLA (D-TLA) and true lumen collapse. The endpoints comprised early (≤ 30 days) and late (30 days) outcomes after intervention.Overall early mortality rate was 13.9% (11/79), and early adverse events rate was 24.1% (19/79). Patients who received TEVAR within 2 days of symptom onset demonstrated the worst outcomes. A longer time of r-TLA25% in 1 cardiac cycle (P = .049) and larger D-TLA (P.001) were correlated to an increased early death. In addition, D-TLA was an independent predictor of early mortality. Area under the curve of D-TLA was 0.849 (95% confidence interval 0.730-0.967) for predicting early mortality and 0.742 (95% CI 0.611-0.873) for predicting early adverse events. Survival and event-free survival rates during follow-up were decreased in the D-TLA21.5% group compared with the D-TLA ≤ 21.5% group (all P.001).Larger D-TLA is correlated with worse postoperative outcomes and might be a crucial parameter for future risk stratification in patients with cTBAD.

To compare accuracy, image quality and radiation dose between high-pitch spiral and sequential modes on 128-slice dual-source computed tomographic (DSCT) angiography in children with congenital heart disease (CHD).Forty patients suspected with CHD underwent 128-slice DSCT angiography with high-pitch mode and sequential mode respectively. All the anomalies were confirmed by the surgical and/or the conventional cardiac angiography (CCA) findings. The diagnostic accuracy, the subjective and objective image quality and effective radiation doses were compared.There was no significant difference in diagnostic accuracy (χ ( 2 ) = 0.963, P 0.05), the objective parameters for image quality (P 0.05) and the image quality of great vessels (u = 167.500, P 0.05) between the two groups. The image quality of intracardiac structures and coronary arteries was significantly better in the sequential mode group than that in the high-pitch group (u = 112.500 and 100.000, P 0.05). The mean effective dose in high-pitch group (0.17 ± 0.05 mSv) was significantly lower (t = 5.287, P 0.05) than that in the sequential mode group (0.29 ± 0.09 mSv).Both the high-pitch and the sequential modes for 128-slice DSCT angiography provide high accuracy for the assessment of CHD in children, while the high-pitch mode, even with some image quality decrease, further significantly lowers the radiation dose.• Modern CT provides excellent anatomical detail of congenital heart disease. • Dual source CT systems offer high-pitch spiral and sequential modes. • The high-pitch mode provides high accuracy for the assessment of CHD. • A few images using the high-pitch mode were occasionally slightly degraded. • But the high-pitch mode significantly lowers the radiation dose.

Aim To retrospectively evaluate the clinical value of dual-source computed tomography (DSCT) coronary angiography in the diagnosis of coronary artery anomalies. Materials and methods A large cohort of 3625 consecutive patients, who underwent DSCT coronary angiography in our institute, was reviewed for coronary artery anomalies. All images were evaluated by two experienced readers using axial source images, multi-planar reformations (MPR), maximum intensity projections (MIP) and volume rendering (VR). Coronary artery anomalies were found in 36 patients (male 20, female 16, mean age 48 years, range 15–76 years). Of the 36 patients, 19 patients also underwent conventional coronary angiography (CCA). Results The incidence of coronary artery anomalies was 0.99% (36/3625). Six different types of coronary artery anomalies were diagnosed by DSCT coronary angiography: (1) 11 anomalies of the right coronary artery; (2) five anomalies of the left coronary artery; (3) 10 anomalies of the left circumflex artery; (4) two single coronary artery; (5) one anomalous pulmonary origin of the coronary artery; (6) seven coronary artery fistula. Evaluation of the CCA resulted in a precise diagnosis in 53% (10/19) patients. Conclusion DSCT coronary angiography is a good diagnostic tool to examine coronary artery anomalies.

Objectives To evaluate the feasibility of dose-modulated retrospective ECG-gated thoracoabdominal aorta CT angiography (CTA) assessing abdominal aortic intimal flap motion and investigate the motion characteristics of intimal flap in acute aortic dissection (AAD). Materials and methods 49 patients who had thoracoabdominal aorta retrospective ECG-gated CTA scan were enrolled. 20 datasets were reconstructed in 5% steps between 0 and 95% of the R-R interval in each case. The aortic intimal flap motion was assessed by measuring the short axis diameters of the true lumen and false lumen 2 cm above of celiac trunk ostium in different R-R intervals. Intimal flap motion and configuration was assessed by two independent observers. Results In these 49 patients, 37 had AAD, 7 had intramural hematoma, and 5 had negative result for acute aortic disorder. 620 datasets of 31 patients who showed double lumens in abdominal aorta were enrolled in evaluating intimal flap motion. The maximum and minimum true lumen diameter were 12.2 ± 4.1 mm (range 2.6 ∼ 17.4) and 6.7 ± 4.1 mm (range 0 ∼ 15.3) respectively. The range of intimal flap motion in all patients was 5.5 ± 2.6 mm (range 1.8 ∼ 10.2). The extent of maximum true lumen diameter decreased during a cardiac cycle was 49.5% ± 23.5% (range 12% ∼ 100%). The maximum motion phase of true lumen diameter was in systolic phase (5% ∼ 40% of R-R interval). Maximum and minimum intimal flap motion was at 15% and 75% of the R-R interval respectively. Intimal flap configuration had correlation with the phase of cardiac cycle. Conclusions Abdominal intimal flap position and configuration varied greatly during a cardiac cycle. Retrospective ECG-gated thoracoabdominal aorta CTA can reflect the actual status of the true lumen and provide more information about true lumen collapse. This information may be helpful to diagnosis and differential diagnosis of dynamic abstraction.

Purpose To compare the image quality and diagnostic accuracy between sinogram affirmed iterative reconstruction (SAFIRE) algorithm and filtered back projection (FBP) reconstruction algorithm at 70 kVp-tube-voltage DSCT angiography in children with congenital heart disease (CHD). Materials and Methods Twenty-eight patients (mean age: 13 months; range: 2–48 months; male: 16; female: 12; mean weight: 8 kg) with CHD underwent 70 kVp DSCT angiography. Imaging data were reconstructed with both FBP and SAFIRE algorithms. Subjective image quality was evaluated on a five-point scale. The parameters of image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) on the objective image quality were compared for the two reconstruction algorithms. Surgery was performed in 20 patients, whereas conventional cardiac angiography (CCA) was performed in 8 patients. The diagnostic accuracy was evaluated on the surgical and/or CCA findings. The effective radiation doses were calculated. Results Compared to FBP algorithm, SAFIRE algorithm had significantly higher scores for subjective image quality (P0.05). The mean effective dose for 70 kVp DSCT angiography was 0.30±0.13 mSv. Conclusions The SAFIRE algorithm can significantly reduce image noise and improve the image quality at 70 kVp DSCT angiography for the assessment of CHD in children.

NAD(P)H oxidase (Nox)2 and Nox4 are the isoforms of Nox expressed in the macula densa (MD). MD-derived superoxide (O2−), primarily generated by Nox2, is enhanced by acute ANG II stimulation. However, the effects of chronic elevations in ANG II during ANG II-induced hypertension on MD-derived O2− are unknown. We infused a slow pressor dose of ANG II (600 ng·min−1·kg−1) for 2 wk in C57BL/6 mice and found that mean arterial pressure was elevated by 22.3 ± 3.4 mmHg ( P < 0.01). We measured O2− generation in isolated and perfused MDs and found that O2− generation by the MD was increased from 9.4 ± 0.9 U/min in control mice to 34.7 ± 1.8 U/min in ANG II-induced hypertensive mice ( P < 0.01). We stimulated MMDD1 cells, a MD-like cell line, with ANG II and found that O2− generation increased from 921 ± 91 to 3,687 ± 183 U·min−1·105 cells−1, which was inhibited with apocynin, oxypurinol, or NS-398 by 46%, 14%, and 12%, respectively. We isolated MD cells using laser capture microdissection and measured mRNA levels of Nox. Nox2 and Nox4 levels increased by 3.7 ± 0.17- and 2.6 ± 0.15-fold in ANG II-infused mice compared with control mice. In MMDD1 cells treated with Nox2 or Nox4 small interfering (si)RNAs, ANG II-stimulated O2− generation was blunted by 50% and 41%, respectively. In cells treated with p22 phox siRNA, ANG II-stimulated O2− generation was completely blocked. In conclusion, we found that a subpressor dose of ANG II enhances O2− generation in the MD and that the sources of this O2− are primarily Nox2 and Nox4.

This paper aims at drawing and analyzing the Articulation Places during production of Mandarin Chinese consonants by means of Electropalatography (EPG). Their tongue characteristics of onset are obtained: the articulation places of plosives are latter than the same manner of place of affricates, and the concentration degree of tongue-palate contact from both sides to the middle concentration degree is slightly higher; the tongue and hard palate contact of affricates is bigger than fricatives', tongue position is also slightly higher than fricatives'; aspiration will have an influence on target palate position, aspiration consonants' TC、AC is smaller than unaspiration's generally, tongue position of unaspiration is slightly higher than aspiration's.

The aim of this study was to prospectively evaluate the initial application and value of prospective electrocardiogram (ECG)-triggered dual-source CT coronary angiography (DSCTCA) in the diagnosis of infants and children with coronary artery aneurysms due to Kawasaki disease.19 children [12 males; mean age 13.47 months, range 3 months to 5 years; mean heart rate 112 beats per minute (bpm), range 83-141 bpm] underwent prospective ECG-triggered DSCTCA with free breathing. Subjective image quality was assessed on a five-point scale (1, excellent; 5, non-diagnostic) by two blinded observers. The location, number and size of each aneurysm were observed and compared with those of transthoracic echocardiography (TTE) performed within 1 week. Interobserver agreement concerning the subjective image quality was evaluated with Cohen's κ-test. Bland-Altman analysis was used to evaluate the agreement on measurements (diameter and length of aneurysms) between DSCTCA and TTE. The average effective dose required for DSCTCA was calculated for all children.All interobserver agreement for subjective image quality assessment was excellent (κ=0.87). The mean ± standard deviation (SD) aneurysm diameter with DSCTCA was 0.76 ± 0.36 cm and with TTE was 0.76 ± 0.39 cm. The mean ± SD aneurysm length with DSCTCA was 2.06 ± 1.35 cm and with TTE was 2.00 ± 1.22 cm. The Bland-Altman plot for agreement between DSCTCA and TTE measurements showed good agreement. The mean effective dose was 0.36 ± 0.06 mSv.As an alternative diagnostic modality, prospective ECG-triggered DSCTCA with excellent image quality and low radiation exposure has been proved useful for diagnosing infants and children with coronary artery aneurysms due to Kawasaki disease.Prospective ECG-triggered DSCTCA for infants and children allows rapid, accurate assessment of coronary aneurysms due to Kawasaki diseases, compared with TTE.

To explore the clinical value of low-dose prospective ECG-triggering dual-source CT (DSCT) angiography in infants and children with complex congenital heart disease (CHD) compared with transthoracic echocardiography (TTE). Thirty-five patients (mean age: 16 months, range: 2 months to 6 years; male 15; mean weight: 12 kg) underwent low-dose prospective ECG-triggering DSCT angiography and TTE. Surgeries were performed in 29 patients, and conventional cardiac angiography (CCA) was performed in 8 patients. The accuracy was calculated based on the surgical and/or CCA findings. The overall imaging quality was evaluated on a five-point scale. A total of 146 separate cardiovascular deformities were confirmed. DSCT missed three atrial septal defects and a patent ductus arteriosus. The accuracy of DSCT angiography and TTE was 97.3% (142/146) and 92.5% (135/146), respectively. Overall test parameters for DSCT angiography and TTE were similar (sensitivity, 97.3% vs 92.5%; specificity, 99.8% vs 99.8%). The average subjective image quality score was 4.3 ± 0.7. The mean effective dose was 0.38 ± 0.09 mSv. Prospective ECG-triggering DSCT angiography with a very low effective radiation dose allows the accurate diagnosis of anomalies in infants and children with complex CHD compared with TTE. It has great promise to become a commonly used second-line technique for complex CHD.

To evaluate the feasibility of high-pitch spiral CT in imaging vascular anomalies (VAs) with affluent blood flow in the head and neck of infants and children.For patients with suspected VAs and affluent blood flow pre-detected by ultrasound, CT was performed with high-pitch mode, individualized low-dose scan protocol and three-dimensional (3D) reformation. A five-point scale was used for image quality evaluation. Diagnostic accuracy was calculated with clinical diagnosis with/without pathological results as the reference standard. Radiation exposure and single-phase scan time were recorded. Treatment strategies were formulated based on CT images and results and were monitored through follow-up results.20 lesions were identified in 15 patients (median age of 11 months). The mean score of image quality was 4.13 ± 0.74. 7 patients (7/15, 46.67%) were diagnosed with haemangiomas, 6 patients (6/15, 40%) were diagnosed with venous malformations and 2 patients (2/15, 13.33%) were diagnosed with arteriovenous malformations. The average effective radiation doses of a single phase and of the total procedure were 0.27 ± 0.08 and 0.86 ± 0.21 mSv. The average scanning time of a single phase was 0.46 ± 0.09 s. After treatment, 13 patients (13/15, 86.67%) achieved excellent results, and 2 patients (2/15, 13.33%) showed good results in follow-up visits.High-pitch spiral CT with an individualized low-dose scan protocol and 3D reformation is an effective modality for imaging VAs with affluent blood flow in the head and neck of infants and children when vascular details are needed and ultrasound and MRI could not provide the complete information.This study proposes an alternative modality for imaging VAs with affluent blood flow.

Purpose To investigate the value of prospective ECG-gated high-pitch 128-slice dual-source CT (DSCT) angiography in the diagnosis of congenital extracardiac vascular anomalies in infants and children in comparison with transthoracic echocardiography (TTE). Methods Eighty consecutive infants or children clinically diagnosed of congenital heart disease and suspected with extracardiac vascular anomaly were enrolled, and 75 patients were finally included in this prospective study. All patients underwent prospective ECG-gated high-pitch DSCT angiography after TTE with an interval of 1–7 days. The diagnostic accuracy and sensitivity of high-pitch DSCT angiography and TTE were compared according to the surgical/CCA findings. The image quality of DSCT was assessed using a five-point scale. The effective radiation dose (ED) was calculated. Results A total of 17 congenital heart diseases and 162 separate extracardiac vascular anomalies were confirmed by surgical/CCA findings in 75 patients. The diagnostic accuracy of high-pitch DSCT angiography and TTE was 99.67% and 97.89%, respectively. The sensitivity of high-pitch DSCT angiography and TTE was 97.53% and 79.62%, respectively. There was significant difference regarding to the diagnostic accuracy and the sensitivity between high-pitch DSCT angiography and TTE (χ2 = 23.561 and 28.013, P

Objective To explore the clinical value of low-dose prospectively electrocardiogram-gated axial dual-source CT angiography (low-dose PGA scanning, CTA) in patients with pulsatile bilateral bidirectional Glenn shunt (bBDG) as an alternative noninvasive method for postoperative morphological estimation. Methods Twenty patients with pulsatile bBDG (mean age 4.2±1.6 years) underwent both low-dose PGA scanning and conventional cardiac angiography (CCA) for the morphological changes. The morphological evaluation included the anatomy of superior vena cava (SVC) and pulmonary artery (PA), the anastomotic location, thrombosis, aorto-pulmonary collateral circulation, pulmonary arteriovenous malformations, etc. Objective and subjective image quality was assessed. Bland–Altman analysis and linear regression analyses were used to evaluate the correlation on measurements between CTA and CCA. Effective radiation dose of both modalities was calculated. Results The CT attenuation value of bilateral SVC and PA was higher than 300 HU. The average subjective image quality score was 4.05±0.69. The morphology of bilateral SVC and PA was displayed completely and intuitively by CTA images. There were 24 SVC above PA and 15 SVC beside PA. Thrombosis was found in 1 patient. Collateral vessels were detected in 13 patients. No pulmonary arteriovenous malformation was found in our study. A strong correlation (R2>0.8, P0).The mean effective dose of CTA and CCA was 0.50±0.17 mSv and 4.85±1.34 mSv respectively. Conclusion CT angiography with a low-dose PGA scanning is an accurate and reliable noninvasive examination in the assessment of morphological changes in patients with pulsatile bBDG.