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Background: Ground-glass nodule (GGN) is the most common manifestation of lung adenocarcinoma on computed tomography (CT). Clinically, the success rate of preoperative diagnosis of GGN by puncture biopsy and other means is still low. The aim of this study is to investigate the clinical and radiomics characteristics of lung adenocarcinoma presenting as GGN on CT images using radiomics analysis methods, establish a radiomics model, and predict the classification of pathological tissue and instability of GGN type lung adenocarcinoma., Methods: This study retrospectively collected 249 patients with 298 GGN lesions who were pathologically confirmed of having lung adenocarcinoma. The images were imported into the Siemens scientific research prototype software to outline the region of interest and extract the radiomics features. Logistic model A (a radiomics model to identify the infiltration of lung adenocarcinoma manifesting as GGNs) was established using features after the dimensionality reduction process. The receiver operating characteristic (ROC) curve of the model on training set and the verification set was drawn, and the area under the curve (AUC) was calculated. Second, a total of 112 lesions were selected from 298 lesions originating from CT images of at least two occasions, and the time between the first CT and the preoperative CT was defined as not less than 90 days. The mass doubling time (MDT) of all lesions was calculated. According to the different MDT diagnostic thresholds instability was predicted. Finally, their AUCs were calculated and compared., Results: There were statistically significant differences in age and lesion location distribution between the "noninvasive" lesion group and the invasive lesion group (P<0.05), but there were no statistically significant differences in sex (P>0.05). Model A had an AUC of 0.89, sensitivity of 0.75, and specificity of 0.86 in the training set and an AUC of 0.87, sensitivity of 0.63, and specificity of 0.90 in the validation set. There was no significant difference statistically in MDT between "noninvasive" lesions and invasive lesions (P>0.05). The AUCs of radiomics models B 1 , B 2 and B 3 were 0.89, 0.80, and 0.81, respectively; the sensitivities were 0.71, 0.54, and 0.76, respectively; the specificities were 0.83, 0.77, and 0.60, respectively; and the accuracies were 0.78, 0.65, and 0.69, respectively., Conclusions: There were statistically significant differences in age and location of lesions between the "noninvasive" lesion group and the invasive lesion group. The radiomics model can predict the invasiveness of lung adenocarcinoma manifesting as GGNs. There was no significant difference in MDT between "noninvasive" lesions and invasive lesions. The radiomics model can predict the instability of lung adenocarcinoma manifesting as GGN. When the threshold of MDT was set at 813 days, the model had higher specificity, accuracy, and diagnostic efficiency., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-27/coif). X.Y.C. and J.Z.J. are employees of Siemens Healthineers company. The other authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)

Objective: To study the application value of motion-correction phase sensitive inversion recovery (MOCO-PSIR) to evaluate myocardial fibrosis in the patients with heart failure caused by dilated cardiomyopathy (DCM)., Methods: A prospective study included 60 patients who underwent cardiac MRI enhanced scan from June 2017 to November 2018, including 38 patients who were clinically diagnosed with DCM and 22 patients in the normal control group. All patients were scanned with three late gadolinium enhancement (LGE) sequences: segmented-PSIR, single-shot-PSIR, MOCO-PSIR at the same time. The subjective quality score (level 4) and image signal-to-noise ratio (objective evaluation) of normal and abnormal myocardium were analyzed and compared in three scanning technique groups. The detection rate of myocardial fibrosis and image acquisition time of the three scanning techniques were recorded., Results: In the normal control group (sinus rhythm), subjective score showed no statistical significance. Subjective scoring results in the patients with DCM: MOCO-PSIR>single-shot-PSIR> segmented-PSIR ( P < 0.05). SNR results PSIR-LGE images in DCM patients as well as control group: segmented-PSIR>MOCO-PSIR> single-shot-PSIR ( P < 0.05). In the whole 646 segments analysis of DCM patients, the ratio unable to judge in segmented-PSIR was up to 25.5%, but only 1.4% in MOCO-PSIR. Significant difference was found in the three groups. While in the 374 segments of control group, no statistical difference was found in comparison of incapability to judge. Acquisition time covered left ventricular: (5.6±1.7) min in segmented-PSIR, (0.4±0.2) min in single-shot-PSIR and (4.5±1.1) min in MOCO-PSIR. Pairwise comparison of acquisition time among three scanning techniques was statistically significant ( P < 0.001)., Conclusion: MOCO-PSIR-LGE has better clinical significance than conventional delayed enhanced scan sequences in the diagnosis of myocardial fibrosis in the patients with heart failure caused by dilated cardiomyopathy., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).)

Objective: To evaluate the correlation between image quality and thoracic diameters, anteroposterior diameter (AP) and right-left diameter (RL) for the optimization of reducing radiation dose in coronary artery imaging with Dual-source CT., Methods: 118 patients underwent CT coronary artery imaging (CTCA) were divided into two groups (A and B) according to body mass index (BMI). There were 58 patients in group A with BMI values > or = 25 kg/m2 and < 30 kg/m2; and 60 patients in group B with BMI values < 25 kg/m2. Scan parameters: collimation 64 X 0.6 mm, reconstruction slice thickness 0.75 mm, reconstructin interval 0.7 mm, FOV 150-180 mm, the pitch adjusted according to heart rate automatically. CT imagings were obtained with tube voltage 100 kV, tube current 330 mAs (group A) and 100 kV, tube current 220 mAs (group B). The contrast-noise ratio (CNR), signal to noise ratio (SNR), as well as blind correlation test score values were calculated to establish the relationship among BMI, AP, RL and CNR, SNR., Results: RL of five levels in groups of A, B were correlated to CNRa (P < 0.05). In group A and B (except iii, iv level of Group A), AP were associated with CNRa (P < 0.05). In addition to ii, iv level of group A, v level of group B, BMI were associated with CNRa (P < 0.05). The correlation coefficient of CNRa and RL of group A except ii level was greater than that of CNRa and AP. The correlation coefficient of CNRa, SNRa and RL of group B was greater than that of CNRa, SNRa and AP. Except iii level, the correlation coefficient of CNRa, SNRa and AP of group A was greater than that of CNRa, SNRa and BMI. Except ii level, the correlation coefficient of CNRa and AP of group B was greater than that of CNRa and BMI., Conclusion: Thoracic diameter of RL can be used as a guider to select the appropriate scan protocol in the coronary imaging acqusition with dual-source CT.

Objective: To develop a set of combined criteria of multiple features of chest CT for discriminating between benign and malignant lung lesions., Methods: Patients whose chest CT showed abnormalities were recruited from the West China Hospital in March and April 2010. The patients were examined with bronchoscopy and the results of CT and pathology were compared., Results: A total of 105 patients participated in this study and 85 had confirmed pathological results. The CT identified 27 cases of malignant lesions, 22 of which were confirmed by the pathology. The CT identified 58 cases of benign lesions, 55 of which were confirmed by the pathology. The set of combined criteria of multiple features of chest CT had an accuracy of 90.59%, a sensitivity of 88.00%, and a specificity of 91.67% in diagnosing benign and malignant lung lesions., Conclusion: The combined criteria of multiple imaging signs of CT have good clinical values for diagnosing malignant lung lesions.

Objective: To observe the superior attachment of renal fascia (RF) and the perirenal space (PS) in order to identify the spreading pathway of inflammatory and malignant tumors., Methods: Multidetector computed tomography (MDCT), with double phase enhancement scanning and three dimensional reconstruction of images were performed on 121 healthy adults. The RF attachments upward were observed and their connections with the PS were evaluated., Results: The left anterior renal fascia (ARF) fusing with peritoneum accounted for 27.3% (33/121) and the left ARF fusing with peritoneum of the spleen laterally and with the subdiaphragmatic fascia interiorly accounted for 19.8% (24/121) of the upper attachments of the RF above the upper renal pole (URP). Under the URP, the left ARF fusing with peritoneum accounted for 52.9% (64/121) of the upper attachments of the RF. The right ARF fusing with peritoneum did not display above the URP. The posterior renal fascia (PRF) of both side fused with subdiaphragmatic fascia under the URP. The ARF and PRF of the left and right kidney showed no upward integration. The right PS communicated with the subdiaphragmatic retroperitoneal space (SDRS) that is a bare area of the liver. The left PS communicating with the SDRS accounted for 80.2% (97/121) and the left PS communicating with the SDRS laterally but separating from the SDRS interiorly accounted for 19.8% (24/121) of the SDRS communication., Conclusion: MDCT and three-dimensional reconstruction can remarkably display RF and its superior attachment, as well as the connection between the PS and SDRS.

Objective: To determine the diagnostic value of time-signal intensity curve (TIC) in distinguishing breast malignant tumors from benign lesions., Methods: Forty-four patients with 50 breast lesions were recruited in the study, including 24 pathologically confirmed benign lesions and 26 malignant tumors. All patients received dynamic contrast-enhanced breast MRI scanning a week before surgery. The time-signal intensity curves in the regions of interest (ROI) and eight items of TIC including shape, T peak, E peak, Slope(i), E1, E2, W peak-7, and W peak-9 were compared between benign lesions and malignant tumors. The receive operating characteristic curves (ROC) were depicted for those indicators with significant statistical differences., Results: Six items of TIC including shape, T peak, Slope(i), E1, E2, and W peak-9 were significantly different (P<0.05) between malignant tumors and benign lesions. The sensitivities of shape, T peak, Slope(i), E1, E2, and W peak-9 for diagnosing breast malignant tumors were 92.3%, 95.83%, 80.77%, 61.53%, 69.23%, and 69.23% respectively. Their specificities were 87.5%, 92.3%, 95.8%, 87.5%, 79.17%, and 79.17% respectively. TIC curve shape, T peak and Slope(i) were better than E1, E2 and W peak-9 in diagnosing breast malignant lesions (P<0.05)., Conclusion: Benign and malignant breast tumors can be differentiated according to TIC. TIC curve shape, T peak and Slope(i) are better than E1, E2 and W peak-9 in distinguishing malignant breast tumors from benign lesions.

Objective: The purpose of this study was to investigate the effect of the degree of sternal depression on the cardiac rotation of pectus excavatum as depicted with helical CT., Materials and Methods: Sixty-three patients (53 boys, 10 girls; mean age, 9.7 +/- 7 years) with pectus excavatum who underwent helical chest CT and surgical correction were included in this study. Depth of sternal depression, CT depression index, cardiac rotation angle, and pulmonary vein angle were measured, and the correlation of these parameters was analyzed., Results: The mean sternal depression was 21 +/- 7 mm; CT depression index, 2.7 +/- 1.4; cardiac rotation angle, 55 degrees +/- 9 degrees ; and pulmonary vein angle, 52 degrees +/- 12 degrees . The sternal depression (18 mm) in patients with a CT depression index less than 2.4 was less than that in patients with a CT depression index of 2.4-2.9 (sternal depression, 21 mm) or greater than 2.9 (sternal depression, 28 mm) (p < 0.01). Similarly, the cardiac rotation angle (49 degrees +/- 5 degrees ) in patients with a CT depression index less than 2.4 was smaller than that in patients with a CT depression index of 2.4-2.9 (55 degrees +/- 6 degrees ) or greater than 2.9 (64 degrees +/- 12 degrees ) (p < 0.01). The pulmonary vein angle in patients with a CT depression index less than 2.4 (59 degrees +/- 11 degrees ) was larger than that in patients with a CT depression index of 2.4-2.9 (50 degrees +/- 12 degrees ) or a CT depression index greater than 2.9 (45 degrees +/- 8 degrees ) (p < 0.01). Cardiac rotation angle had a positive correlation with CT depression index (r = 0.75, p < 0.01)., Conclusion: The degree of sternal depression has a positive correlation with the degree of cardiac rotation in pectus excavatum. Helical CT is a valuable technique for evaluating the chest deformity and resultant cardiac rotation.

Objective: To investigate the clinical application of first-pass perfusion MDCT in the assessment of tumor angiogenesis in carcinoma of esophagus and cardia., Methods: CT perfusion was performed with multi-detector row CT (MDCT) in 44 patients with carcinoma of esophagus and esophagogastric junction, who was diagnosed with pathological results and did not received any anti-tumor therapy. Twenty-one patients with peripheral lung cancer but normal esophagus were served as controls. Perfusion parameters were compared between normal and malignant esophagus, between adenocarcinoma and squamous cell carcinoma, as well as between tumors with metastases and those without metastases., Results: Carcinoma of esophagus and esophagogastric junction showed higher blood flow, peak enhancement index, blood volume, and shorter time to peak compared with normal esophagus (P < 0.05). There were no statistically significant differences in perfusion parameters between adenocarcinoma and squamous cell carcinoma (P > 0.05), whereas tumors with metastases showed higher blood flow and shorter time to peak compared with those without metastases (P < 0.05)., Conclusion: MDCT perfusion could assess tumor vascularity in carcinoma of esophagus and esophagogastric junction, and tumor vascularity or angiogenesis was not influenced by its histological type. However, high blood flow and short time-to-peak may be helpful to predict tumor metastases.

Objective: Five measurements of the calcaneus taken on digital radiography (DR) of adults of Han Population of Sichuan Province were selected to determine sex by multivariate discriminant analysis., Methods: Lateral radiographs of calcaneus taken from 393 subjects were collected. The samples were randomly divided into the experimental group (148 males and 186 females) and the examined group (26 males and 33 females). Five measurements were taken from the radiography. The analysis of variance (AVON) was carried out to determine if there was significant difference between the male and female. The discriminant functions were drawn by Fisher discriminant analysis. The effects of all obtained functions were evaluated with the examined samples., Results: There was statistically significant difference in the five measurements between the males and the females (P<0.05). Six groups of discriminant functions were obtained with an accuracy ranged from 78.4% to 88.9%. When applied on the examined samples, the sex discriminant accuracy varied from 79.7% to 86.4%., Conclusion: These five measurements acquired from the lateral radiographs of calcaneus could be used for sex assessment during forensic identification of individuals.

Objective: To use the time-density curves (TDCs) to quantitatively distinguish the true from false lumen of aortic dissection (AD)., Methods: 28 cases with AD underwent the dynamic scanning of 16-slice spiral computer tomography (SCT). We used the CT Dynamic Evaluation software to determine the circulation times of the true and false lumens of the AD and got the TDCs, and then analyzed the circulation times and CT values of the true and false lumens by using matched t-test for dependent samples., Results: The TDCs of the true and false lumens of the AD were achieved in all 28 patients. The peak CT values [(71.87 +/- 35.14) HU] of the true lumen were higher than those [(45.58 +/- 24.00) HU] of false lumen (P < 0.05); while the time to peak [(23.43 +/- 5.73) s] of the true lumen were earlier than that [(29.46 +/- 6.27) s] of false lumen (P < 0.05). The patterns of TDCs of the true lumen appeared to be rapid rise followed by rapid decline in 22 cases (78.6%) and rapid rise with gradual decline in 6 (21.4%), while the patterns of TDCs of the false lumen showed gradual rise followed by gradual decline in 18 cases (64.3%) and rapid rise with gradual decline in 10 (35.7%)., Conclusion: The TDCs of the true and false lumens showed: the peak CT values of the true lumen were higher than those of false lumen; while the time to peak of the true lumen were earlier than that of false lumen. So, the time-density curve, is used as an original and quantitative method to distinguish the true from false lumen in AD.

Objective: To establish the regression equations and to evaluate the feasibility of measuring dimensions of cervical vertebrae with lateral films of computer radiography (CR)., Methods: Anterior heights and posterior heights of C3-C7 were measured in the lateral films of the cervical vertebrae in 150 adult males from Sichuan Han population in China The body height of each individual was recorded. Linear regression analysis between the height of the cervical vertebrae and body height was performed to establish the regression equations for stature estimation. In addition, the paired t-test between the predictive value and the actual body height, the residual analysis, the test of equal scedasticity and colinearity were performed in all equations., Results: Thirty one statistically significant simple regression equations and 20 statistically significant multiple regressions equations were established. The coefficiencies of multiple correlations were from 0.656 to 0.259 and the standard errors of estimate were between 4.30 cm and 5.79 cm. Conclusion All equations established could be used to estimate the body height of the Han population of Sichuan adult males. It could be helpful to estimate statures from the CR films based on the dimensions of cervical vertebrae.

Objective: To obtain regression formula for estimation of stature in Han population in Sichuan Province from length of the upper extremity long bones by digital radiography., Methods: The statures of 365 healthy adults and digital radiographs of their right upper extremity long bones were measured. All statistical dispositions were done in SPSS including description and regression analysis., Results: Twenty-seven simple regression and 3 multiple regression formulae with statistic significance in estimation of the stature from the sum of the length of the upper extremity long bones were established. Regression coefficient was higher in ulna than in radius, in male than in female, and was more accurate in multiple regression formulae than in simple regression formulae., Conclusion: Digital radiograph measurement of the length of the upper extremity long bones seems to be a simple and practical method to estimate human stature in forensic practice.

Objective: To determine the CT features and anatomic-pathologic basis of the 16-slice Spiral CT (SCT) for aortic dissection (AD)., Methods: Forty-two cases with typical aortic dissection (AD) and 12 cases with intramural hematoma (IMH) underwent 16-slice SCT, performed with unenhanced, contrast-enhanced scanning and three-dimensional reconstruction. More attention was put on the true and false lumen, intimal flap, the entry tear and the involvement of branches of AD., Results: (1) True and false lumen and intimal flap of AD could be shown in all of 42 cases (100%), the entry tears were revealed in 41 cases (97.6%), and the true and false lumen and intimal flap extended spirally in 41 cases (97.6%). (2) For intramural hematoma (IMH), unenhanced CT depicted crescent-shaped areas with high attenuation extending along the walls of the aorta in 10 cases (83.3%), and low attenuation in 2 cases (16.7%), while contrast-enhanced CT showed no enhancement of attenuation in the crescent-shaped areas in all 12 cases. Nine cases (75%) of IMH were associated with penetrating aortic ulcer., Conclusions: The axial and three-dimensional images of 16-slice SCT can fast and exactly reveal the pathological and anatomical features of AD, and provide detailed imaging information for clinical therapy. It's very important for the selection of treatment methods.

Objective: To study identical indexes of frontal sinus in different locative computer radiology., Methods: Frontal sinus radiographs were analysed by combining indexes of kinds of distances and patterns, further using descriptive study to describe frontal sinus and to analyse data statistically., Results: The 8-identical classification of frontal sinus was proposed, basing on the ratio of frontal sinus width and orbit width, the bilateral asymmetry, the superiority of side, the numbers of arches of upper borders (left and right), the partial septa (left and right) and the location of the central septa. There was no statistical significance of sinus between sexes (P>0.05)., Conclusion: Frontal sinus is tremendous inter-individual variation so it can be used for identification, but it can not be used for sex determination.

Objective: To evaluate the effects of low-dose helical CT with different scanning collimation on the visualization of segmental bronchi and to determine the optimal scanning collimation in CT screening for early central lung cancer., Methods: Forty healthy volunteers were randomly assigned to undergo the low-dose helical CT at 120 kVp, 50 mA, 0.75 s and pitch 1. One group (n = 20) underwent the sequential subsection scan of chest with the collimation of 10 mm for the apical and basilar zone, and of 8 mm and 5 mm for the hilar zone. The other (n = 20) went through CT scan with 10 mm collimation of the whole lung. The visualizations of lobar, segmental bronchi were compared at different collimations. ANOVA and multiple comparison were performed., Results: The visualization of segmental bronchi on low-dose scan at 10 mm collimation was 60%, being lower than that at 8 mm (88%) or 5 mm (91%) collimation (P < 0.01). The segmental bronchi of right upper lobe were easily identified at collimation of 10 mm (82%), 8 mm (96%) and 5 mm (98%), as well as those of left upper lobe at 10 mm (83%), 8 mm (95%) and 5 mm (97%), whereas those of lingular lobe were difficultly identified at 10 mm (30%), 8 mm (60%) and 5 mm (70%)., Conclusion: The lobar and segmental bronchi were visualized reliably by CT with 50 mA and 8 mm collimation, and therefore the sequential subsection scan of chest divided into three zones can be adapted to CT screening for early lung cancer.

Objective: To determine the correlation between helical CT findings and pulmonary function test (PFT) results from patients with idiopathic pulmonary fibrosis(IPF)., Methods: Helical CT scan was performed in 32 cases with clinically and/or pathologically proved idiopathic pulmonary fibrosis. Pulmonary function test for each patient was performed within 5 days before or after CT scan. The correlation between CT findings and pulmonary function test results was assessed., Results: Pulmonary function test revealed characteristic restrictive ventilatory defect with reduction of total lung capacity, residual volume, vital capacity, and diffusing capacity of the lung for carbon monoxide. The patients with different severities of pulmonary function impairment had different CT features. 4 of 5 cases with slight impairment of the pulmonary function had the ground-glass opacity, 11 cases with moderate impairment showed the thickened interlobular septa (11/11, 100%), thickened lobular interstitium (9/11, 82%), distorted lobular structures (11/11, 100%) and thickened bronchovascular bundles (10/11, 91%). 16 cases with marked impairment showed the honeycombing (16/16, 100%) and the traction bronchiectasis (9/16, 55%)., Conclusion: CT can provide significant information for the assessment of the pathologic severity of idiopathic pulmonary fibrosis. There is good correlation between CT findings and pulmonary function test results. CT combined with pulmonary function test can predict the progression, long term survival and response to therapy.