ISSN 1004-4140
CN 11-3017/P
Articles Online First have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).
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Imaging Features and Clinical Significance of the Segond Fracture
HE Weihong, FU Xi, FANG Tingsong, WANG Guining, WANG Juan
 doi: 10.15953/j.ctta.2022.112
Abstract(143) HTML PDF(4)
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Objective: To evaluate the imaging features of the Segond fracture and explore its clinical value in lateral instability of the knee joint. Methods: We retrospectively analyzed 45 cases of the Segond fracture. This involved the analysis of the characteristics of the fracture, including the relationship between the fracture and the ligaments around the knee joint, meniscus injury, and the size and location of the fracture block. Moreover, the significance of the Segond fracture in clinical treatment was discussed. Results: Among 45 cases of the Segond fracture, 41 (91.11%) had anterior cruciate ligament (ACL) injury, 31 (68.89%) had anterolateral ligament (ALL) injury, and 12 (26.67%) had iliotibial bundle (ITB) injury. The ALL were all attached to the fracture block, and 25 cases (55.55%) were attached to the ITB. The larger the size of the fracture block and the smaller the distance from the center of Gerdy's nodule, the more likely that the fracture block was attached to the ITB. Conclusion: The Segond fracture is often associated with ACL injury, involving the ALL and ITB. The larger the fracture block and the closer to the center of Gerdy's nodule, the greater the possibility of ITB involvement. Therefore, patients with Segond fractures should be alert to lateral instability of the knee joint.
The Diagnostic Value of Dual-source CT in Adult Atrial Septal Defect with Pulmonary Hypertension
ZHAO Haishan, WANG Cheng, HAN Shuguang, XU Tongtong, WU Xueqing, HU Chunfeng
 doi: 10.15953/j.ctta.2022.199
Abstract(35) HTML PDF(139)
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Objective: To investigate the diagnostic value of dual-source CT (DSCT) in evaluating adults with atrial septal defect (ASD) with pulmonary hypertension (PAH). Methods: Seventy-five adult patients with ASD in our hospital were retrospectively analyzed. The study sample was divided into 2 groups (PAH group (n=40) and non-PAH group (n=35 cases)) according to the mean pulmonary artery pressure (mPAP) obtained by right cardiac catheterization (RHC) (PAH: ≥ 25 mmHg). All patients were examined for congenital heart disease by DSCT one week before RHC. The ascending aorta diameter (AAD), main pulmonary artery diameter (MPAD), right pulmonary artery diameter (RPAD), left pulmonary artery diameter (LPAD), right lower pulmonary artery diameter (RLPAD), the maximum diameter of the short axis of both the ventricles (RVD, LVD), included the angle of the spinal ventricular septum and ASD diameter, were measured on the image. The MPAD to AAD ratio (rPA) and the RVD to LVD ratio (RVD/LVD) were calculated. Differences between the two groups in terms of clinical data, RHC indexes, and CT cardiovascular parameters were evaluated by a t-test. The ROC curve was used to determine the diagnostic efficacy of DSCT in adults with ASD and PAH. Pearson correlation coefficient was used to analyze the association between the CT parameters, mPAP, and PVR. Results: The statistically significant CT indexes between the two groups were MPAD, RPAD, LPAD, RLPAD, RVD including the angle of the spinal ventricular septum, rPA, RVD/LVD, and ASD diameter. Of these, the RPAD and LPAD including the angle of the spinal ventricular septum, rPA, RVD/LVD, and ASD diameter demonstrated moderate diagnostic efficacy for PAH (AUC>0.7). The MPAD, rPA, and ASD diameter with mPAP were moderately positively correlated. The MPAD, rPA, and RVD/LVD with PVR were also mildly positively correlated. Furthermore, the ASD diameter and PVR were highly positively correlated. Conclusion: DSCT is diagnostically valuable for the evaluation of adults with ASD complicated with PAH. In particular, DSCT may be used to provide a comprehensive evaluation before clinical treatment, as well as for long-term follow-up and management.
Seismic Data Reconstruction Based on the POCS Method in the Curvelet Domain with Prior Information
GUO Yundong
 doi: 10.15953/j.ctta.2023.078
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Due to limited acquisition conditions in the field, the seismic data is usually incomplete, which affects the following seismic data processing and seismic interpretation. To solve this problem, the seismic data needs reconstruction. The projection Onto Convex Sets (POCS) method utilizes the sparse characteristics of seismic waveforms in the Curvet domain to reconstruct high signal-to-noise ratio seismic data. This iterative algorithm is stable and has a fast convergence speed. However, during the recovery of seismic data, because the influence of direct waves and the blank area in the upper part of the shot gathers as the iteration progresses, the noise interference in the reconstructed data becomes increasingly severe, resulting in a low signal-to-noise ratio of the final recovered seismic data. Based on the implementation of the POCS iterative threshold algorithm, this article introduces the idea of Prior information constraints to optimize the original algorithm. By first performing coordinate mapping for shot gathers interpolation and then using it as a prior information constraint for interpolation, the impact of noise attenuation is dramatic. Finally, the synthesized seismic shot records were tested with actual shot gathers, and the results illustrated that the new method proposed in this paper can significantly improve the signal-to-noise ratio of reconstructed seismic data and enhance the continuity of seismic wave field events.
Clinical Value of Spectral Imaging Combined with MAR for CTA after Embolization of Intracranial Aneurysms
YAN Qinwen, WANG Yuxiang, ZHANG Jun, HE Lan, HU Gang, XIONG Minchao, QIN Junxiang, YUAN Xuegang
 doi: 10.15953/j.ctta.2023.035
Abstract(19) HTML PDF(2)
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Objective: To evaluate the application value of combining spectral imaging and metal artifact reduction (MAR) in head and neck CTA after the embolization of intracranial aneurysms. Methods: We collected 37 patients who experienced embolization of intracranial aneurysms then received spectral imaging of head and neck CTA. Monochromatic images with energy ranging from 70~140 keV, 120kVp-like mixed energic images, 70~140 keV MAR images, and 120 kVp-like MAR images were generated. The region of interest was placed on the area near the coil and with the most serious metal artifact. CT attenuation and standard deviation were measured, and artifact index (AI) and signal-noise ratio (SNR) were calculated. Two radiologists independently subjectively evaluated the metal artifact and the display of surrounding vessels using Likert 5 scales. The subjective scores and objective parameters between MAR and non-MAR images were compared. The Wilcoxon ranking test, paired sample t test, and independent sample t test were utilized to compare parameters between the groups. Results: MAR images had significantly lower AI than did non-MAR images for all eight monochromatic energies. When energies ranged from 80–110 keV, SNR was higher for MAR images than for non-MAR images, and the difference was statistically significant. With same energies, MAR images had higher artifact and vessel display scores than did non-MAR images. For non-MAR images, the different coil diameters did not make a statistical difference in AI and vessel display scores. For MAR images, a larger coil diameter (>8.79 mm) led to higher AI and lower vessel display scores than did normal diameters (≤8.79 mm). Conclusion: The combination of spectral imaging and MAR could effectively reduce the metal artifact of implants for the embolization of intracranial aneurysms and improve the surrounding vessel display. Moreover, the metal artifact reduction effect was more significant for the coils with smaller diameters.
CT Findings and Preliminary Exploration of Pathological Analysis of Bronchiolar Adenoma
PAN Xiaohuan, HE Ping, CHEN Huai
 doi: 10.15953/j.ctta.2022.247
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Objective: To summarize and analyze the clinical data, CT signs, and pathological features of bronchiolar adenoma, and to discuss the diagnostic value of bronchiolar adenoma. Methods: In total, 18 cases of pulmonary nodules diagnosed as bronchiolar adenoma via postoperative pathology from January 2020 to December 2020 were retrospectively collected, and the clinical data, chest CT signs, and postoperative pathological features of pulmonary nodules were analyzed. Results: Among the 18 cases, 16 had no clinical chest symptoms, and 2 had chest pain. The patients were 18~65 years old. The mean age was 51.8 years, and the median age (25%~75% quantile) was 52 (49~59) years; 7 patients were male (39%), and 11 were females (61%). The average maximum slice diameter of bronchiolar adenoma was 11.1 mm, and the median diameter (25%~75% quantile) was 8 (6~15) mm. There were 15 cases with lesion distance ≤10 mm from the pleura. CT showed that 8 cases were pure ground-glass nodules (pGGN), 7 cases were part-solid nodules (PSN), and 3 cases had simple cystic space. The mean CT value of bronchiolar adenomas presenting with pGGN was −690.7 HU. The median mean CT value (25%~75% quantiles) was −717.5 (−722~ −681) HU. A spicule sign at the nodular margin was found in 6 of the 18 cases. Pleural traction around nodules was found in 7 cases, and bronchiectasis occurred in nodules in 5 cases. The postoperative gross pathological diameter of 18 nodules was 9.1 mm, and the median diameter (25%~75% quantile) was 7 (6~9) mm. Pathological immunohistochemical antibody CK7 was positive in 18 cases; p40, p63, CK5/6, and TTF-1 were positive in 16 cases. Conclusions: Bronchiolar adenoma often occurs in middle-aged and older women. Preoperative CT diagnosis of subpleural nodules around 10 mm could indicate the disease, and immunohistochemical antibody CK7, p40, and other indicators are qualitative methods for diagnosing bronchiolar adenoma.
Clinical and MRI Characteristics of 56 Patients with Idiopathic Normal Pressure Hydrocephalus
WU Qian, HE Wenjie, ZHANG Xiejun, XIA Jun
 doi: 10.15953/j.ctta.2023.095
Abstract(14) HTML PDF(5)
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Objective: To analyze and summarize the clinical and MRI manifestations of patients with idiopathic normal pressure hydrocephalus (iNPH) diagnosed via surgery in order to improve the understanding of this disease. Methods: We performed a retrospective analysis of the clinical and preoperative MR (including 3D T1WI, T2 WI, and T2 FLAIR) data of 56 patients with iNPH diagnosed via shunt surgery at our hospital to evaluate and describe MR linear parameters and common radiological features. Results: Among the 56 patients with iNPH, 91.1%, 60.7%, and 42.9% showed gait disturbance, cognitive impairment, and urinary disturbance, respectively; the classical triad accounted for 23.2%. The most common comorbidities were hypertension (51.8%), diabetes (28.6%), and PD (12.5%). In the analysis of the 56 patients’ MR images, 82.1% had acute callosal angle and 39.3%, positive disproportionately enlarged subarachnoid space signs (DESH), with a mean DESH score of 5.24±1.27. Conclusion: Patients with confirmed iNPH most often also have hypertension, diabetes mellitus, and PD. The classical triad is less frequent, and the positive rate of typical MR signs is not high. Thus, the accurate diagnosis and prognosis prediction of negative patients remains challenging and should be combined with other clinical examinations to clarify the diagnosis and treatment.
Seismic Facies Analysis Based on Spectral Clustering with Waveform Characteristic Vector
QIN Dewen, ZHANG Yan, YU Jie
 doi: 10.15953/j.ctta.2023.124
Abstract(16) HTML PDF(6)
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Based on the principle of seismic sedimentology, the feature vectors of seismic waveforms are extracted along stratum slices, and spectral clustering analysis is introduced to classify seismic facies. Spectral clustering is an unsupervised machine learning algorithm. Its essence is to simplify the expression of high-dimensional seismic data in the form of feature vectors, which belongs to the process of dimensionality reduction. Considering the traces with specific time windows in the seismic work area as nodes of the graph and the similarity between traces as the weight of the edges, a graph model can be constructed. Spectral clustering must determine the best segmentation method to complete the segmentation of the graph, so that different types of sedimentary characteristics can be distinguished. Physical model and actual data processing and analysis demonstrate that this method is capable of dividing sedimentary facies characteristics and is a new kind of facies analysis tool for reservoir classification, which has good application prospects.
Spectral Computed Tomography for the Diagnosis of Secondary Skeletal Muscle Follicular Lymphoma: A Case Analysis
XU Haiyun, YANG Shuohui
 doi: 10.15953/j.ctta.2023.022
Abstract(69) HTML PDF(12)
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Follicular lymphoma (FL) is one of the frequent varieties of non-Hodgkin's lymphoma (NHL). Secondary skeletal muscle FL is an uncommon extra-nodal lymphoma that is more challenging to identify. Spectral CT imaging can aid in the diagnosis of it. A 52-year-old man who had a bulge in his left inguinal area for two months in 2021. Following a mass aspiration biopsy, cervical lymph node dissection and a bone marrow aspiration biopsy, the patient was diagnosed as follicular lymphoma grade I with bone marrow involvement. Later, the patient had progressive worsening of low back pain for 2 month and underwent a lumbar spectral enhanced-CT scan, which demonstrated the right psoas major muscle and the retroperitoneal swollen lymph nodes were discovered to be homologous lesions, indicating the lymphoma infiltration of the right psoas major muscle. Spectral enhanced-CT is a non-invasive, practical, and reliable alternative technique. By reconstructing and comparing the energy spectrum curves of different tissues to shed light on the nature of the mass, it can aid in the diagnosis of extra-nodal lymphoma, which is of great value in determining the extent of the lesion and guiding the clinical treatment plan.
Diagnosis of Primary Acinic Cell Carcinoma of the Lung Using CT: A Case Analysis
WANG Qiong, PENG Di, CHENG Shaolei, HUANG Zhihua, HU Xingrong
 doi: 10.15953/j.ctta.2023.072
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Acinic cell carcinoma (ACC) is a malignant epithelial salivary gland neoplasm that most frequently occurs in the salivary glands. However, primary ACC of the lung is extremely rare. Due to its low incidence and the lack of related literature, clinicians lack relevant knowledge. It is prone to misdiagnosis, which delays the treatment of patients. Thus, we report a case of primary ACC of the lung confirmed via surgery and pathology, together with a review of relevant literature, in order to summarize the CT imaging manifestations and the value of CT in the diagnosis and treatment of this disease. The aim of this case report was to improve the understanding of primary ACC of the lung and to improve the diagnostic abilities.
Spectral filtration Sn 150 kV Combined with Advanced Simulated Iterative Reconstruction in Lumbar Computed Tomography Examination
JIANG Dong, QIN Lixin
 doi: 10.15953/j.ctta.2022.240
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Objective: To study the feasibility of energy spectrum purification Sn 150kV combined with Advanced Simulated Iterative Reconstruction (ADMIRE) in computed tomography (CT) examination of the lumbar spine. Methods: A total of 88 patients aged 25-65 years with body mass indexes (BMI) between 18.5~25kg/m2 were randomly divided into a control group (group A) and an experimental group (group B), with 44 cases in each group. The conventional tube voltage, used for the control group, was 120kV, while the experimental tube voltage was Sn 150kV. All other imaging parameters were consistent. After the inspection, the image quality and radiation dose of the two groups were compared. Results: The objective evaluation of noise in group A and group B were statistically different, with the noise of group A higher than that of group B. The ICC of the three diagnosticians in the subjective evaluation was 0.769, indicating a good consistency of evaluation. The radiation dose of group B was 30.31% lower than that of group A. Conclusion: The combination of energy spectrum purification Sn 150kV and ADMIRE can not only effectively reduce the radiation dose, but can also guarantee a high-quality image, which can be widely used in adult lumbar CT.
CT and MRI Diagnosis of Intracranial Solitary Fibrous Tumor: A Clinical Case Analysis
YAN Xin, ZHAO Jianhua
 doi: 10.15953/j.ctta.2023.126
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Intracranial solitary fibroma (ISFT) is a kind of mesenchymal tissue-derived spindle cell tumor. Patients’ disease progression vary according to the course and location of the tumor. Due to its rarity, radiologists and clinicians lack a comprehensive understanding of ISFT. Hence, the preoperative misdiagnosis rate is high. This case report describes a 52-year-old male patient with intracranial solitary fibroma who presented with headache and weakness of both lower extremities. He underwent radiological examination, including CT and MRI, and was diagnosed with acoustic neuroma. After postoperative pathological tissue biopsy, he was diagnosed with ISFT. He was reviewed one and a half years after surgery; there was no significant discomfort in addition to the paralysis of the left facial nerve and swelling of the left side of the face. This case report retrospectively analyzes the radiological scans and the clinical data of the patient to summarize the key CT and MRI features of ISFT, improving the accuracy of the preoperative diagnosis of this rare disease, and contributing to current knowledge of the precise treatment of ISFT.
Research Progress of X-Ray Diffraction Technology in Security Inspection
HUANG Qingping, JIN Xin, XU Xiaofei, ZHU Guoxi, ZHANG Li
 doi: 10.15953/j.ctta.2023.158
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The frequent occurrence of terrorist incidents has seriously affected the security and order of the international community, bringing unprecedented challenges to the safety of passenger and freight transportation. Effectively combating terrorist activities and ensuring personal and property safety are important demands in the field of public security both domestically and globally. Therefore, how to enhance security inspection capabilities through high-tech means has become an important issue and research hotspot of concern. X-ray diffraction (XRD) technology can identify prohibited substances at the molecular level, with high discrimination, and has broad application prospects in the field of safety inspection. Starting from the basic theory of diffraction, this article briefly describes the current research progress in the structure and recognition algorithms of XRD systems, as well as the advantages of XRD technology. An XRD system was built to verify its effectiveness. Finally, the development direction of XRD was prospected, with the aim of further promoting this technology to play a more important role in the field of public safety.
Study on Forward Numerical Simulation and Instantaneous Seismic Attributes of Natural Gas Hydrate in Permafrost Area
YANG Wenhai, ZHANG Guangdong, TAN Zhi, JIN Cong
 doi: 10.15953/j.ctta.2023.111
Abstract(66) HTML PDF(11)
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Natural gas hydrate is a new energy source with great potential. Studying the seismic response characteristics of natural gas hydrate in permafrost area is crucial to the exploration and development of natural gas hydrate in China's land area. Based on the Kelvin viscoelastic media model, our work establishes a theoretical geological-geophysical model based on the actual geological and stratigraphic conditions of the Qilian Mountain permafrost, uses the staggered-grid finite difference method to perform forward numerical simulation, and performs wave field characteristic analysis and instantaneous seismic attribute extraction of self-excitation and self-receiving seismic records. The results show that the reflected amplitude energy is weaker when the seismic wave passes through the gas hydrate formation. In the range where the instantaneous frequency attribute profile can distinguish the layer thickness, the instantaneous frequency decreases marginally with the increase of the layer thickness. When seismic waves pass through natural gas-bearing formations, the reflected waves show strong reflection characteristics, and the instantaneous frequency energy increases. The instantaneous seismic attribute has better resolution for the wave-impedance interface, especially the instantaneous phase attribute profile. Therefore, the comprehensive analysis of the instantaneous attribute characteristics can provide a basis for the identification and prediction of terrestrial gas hydrates.
Quantitative CT Study of Bone Mineral Density for Adults Residents in Foshan
WU Weizhi, FANG Tingsong, LIANG Zhenhua, ZHU Cuiling, ZHOU Jingyi
 doi: 10.15953/j.ctta.2023.098
Abstract(33) HTML PDF(8)
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Objective: To study the relation between adult vertebral bone mineral density (BMD) and gender and age in Foshan, to explore the average BMD of each age group and osteoporosis (OP) incidence distribution in the region. Methods: Quantitative CT (QCT) was used to examine and record the vertebral BMD of 1065 (male 648, female 417) healthy adults who underwent physical examination in Foshan Hospital of TCM from October 2021 to March 2023, and grouped according to age, T test and variance analysis were used on BMD in different sex and age group. Chi square analysis and correlation analysis were used on the incidence of OP in different sex and age group. Results: There was significant difference in the BMD between male and female of 20~29, 30~39, 40~49 and 60~69, 70~79 years old (P<0.05), women had higher peak BMD than man in young to middle age. In the male groups of 40~49、50~59, 60~69, 70~79 and female groups of 30~39, 40~49, 50~59, 60~69 years old, there were also significant differences in BMD in different age groups of the same sex, and decreased with age. There was significant difference in the incidence of OP between different age groups (P<0.05) in the male and female groups. Age was positively related to the incidence of OP (r=0.517 for male and r=0.636 for female). Conclusion: The vertebral BMD derived from QCT for healthy adults in Foshan are associated with sex and age, peaked at 20~29 years old, and decreased with age. The incidence of OP for male and female increased with age from 40~49 years old.
Research Progress in Imaging Radiomics Based on Computed Tomography and Magnetic Resonance in Ischemic Stroke
WANG Shan, ZHAO Jianhua
 doi: 10.15953/j.ctta.2023.080
Abstract(37) HTML PDF(13)
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Ischemic stroke, also known as cerebral infarction, is a disorder impacting the blood supply to the brain tissue due to complex reasons, resulting in irreversible damage to the infarct site. According to China's sixth census, approximately 1.94 million individuals died of a stroke in 2018. With the increasing age of the Chinese population, stroke is expected to continue affecting human health in the coming decade. Imaging examination is an indispensable means to diagnose the disease and evaluate its prognosis. In recent years, artificial intelligence and radiomics have been widely used in the medical industry, among which convolutional neural network is more prevalent. Mainly, it has shown obvious superiority in the imaging diagnosis of ischemic stroke, and its efficiency is far higher than manual film reading. This article reviews the research progress of imaging omics based on computed tomography (CT) and magnetic resonance in ischemic stroke.
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2023, 32(5).  
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Characteristics of Clinical and Imaging Features of Severe Coronavirus Disease 2019
ZHANG Yimeng, LIU Mengke, ZHANG Xiaojie, HAO Qi, ZHANG Yan, LI Xingpeng, ZHANG Mingxia, LIU Xiaoyan, WANG Rengui
2023, 32(5): 579-585.   doi: 10.15953/j.ctta.2023.033
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Objective: To retrospectively investigate the clinical manifestations and imaging features of heavy novel coronavirus pneumonia (NCP). Materials and methods: Fifty-two patients with positive chest computed tomography (CT) manifestations and a confirmed diagnosis of COVID-19 in the Infection Unit from November 2022 to January 2023 were included in our study. All patients underwent chest thin-section CT examination and had more complete clinical data from 1 to 14 days after onset. Patients were divided into two groups based on the time interval between onset and CT examination (<7 and ≥7 days), and the differences in CT performance characteristics between the two groups were compared. Results: Among the 52 patients with severe COVID-19, the age range was approximately 53 to 97 years, with a median age of 80 years in 4 men and 18 women. Thirty-three patients (63.5%) with underlying diseases were combined, including 2 (3.8%) with pulmonary disease, 6 (11.5%) with diabetes mellitus, 18 (34.6%) with hypertension, 16 (30.8%) with coronary heart disease, and 7 (13.5%) with cerebrovascular disease. The main symptoms of patients included fever in 44 (84.6%), cough in 43 (82.7%), myalgia in 2 (3.8%), sore throat in 19 (36.5%), chest tightness in 9 (17.3%), diarrhea in 2 (3.8%), and poor appetite in 3 (5.8%). The differences in lesion involvement and lesion size were statistically significant between patients grouped at the time interval between onset and CT examination. Conclusions: Severe COVID-19 is more common in older adult males, mostly combined with underlying disease. CT features include more airway involvement in the short term, and bloodway involvement is more common in those with longer onset.
Analysis of Prognosis of Coronavirus Disease 2019 Using Quantitative Measurement of Deep Learning
ZHAO Jianhua, LIANG Danyan, LYU Gaoxing, YAN Xin, LIU Yu, WANG Xiaolan, CHAI Jun
2023, 32(5): 587-594.   doi: 10.15953/j.ctta.2023.044
Abstract(103) HTML PDF(11)
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Objective: To analyze the differences of chest computed tomography (CT) inflammatory lesions in patients with coronavirus disease 2019 (COVID-19), which were quantitatively measured based on deep learning, to warn the occurrence of severe cases and improve the understanding of the prognosis of COVID-19. Methods: The chest CT scans of 477 local patients with COVID-19 diagnosed for the first time at Inner Mongolia Autonomous Region People's Hospital were retrospectively analyzed. A total of 276 men and 201 women were divided into group A (not serious) and group B (serious) based on whether their diseases turned serious (severe/critical). Comparison was made between the two groups on the basic CT signs, such as lesion distribution, involved lobe side, number, differences in lesion volume, volume proportion, and density based on deep learning. Results: All 477 patients with COVID-19 had epidemiological history, and no statistical difference was noted in age and gender between the two groups. The volume and proportion of the lesions in the whole lung and each lobe of the lung in group B were higher than those in group A. The lesions in group A were mainly in the lower lobe of the right lung, accounting for 3.32% more than that in other lobes. The lower lobe of the left lung was the next, accounting for 2.08%. The volume of lesions in the upper lobe of the left lung was lower than that in other lobes, accounting for only 0.25%. No lesions were noted in the upper lobe of the right lung, middle lobe of the right lung, and upper lobe of the left lung in part of group A. In group B, the lesions were distributed in both lungs and in each lung lobe. The lower lobes of the right lung and left lung were predominant, accounting for 57.86% and 54.76%, respectively. The volume of the middle lobe of the right lung was 34.73% compared with the other lobes. The main lesions in each group were ground-glass density shadows, and the main lesions in group A were −570 ~ −470 HU density, accounting for 13.89%, followed by −470 ~ −370 HU, accounting for 11.07%. Only 3.22% and 4.75% of solid lesions with densities of 30 ~ 70 HU and −70 ~ 30 HU were found. Most of the lesions in group B were ground-glass density shadows, and the focal densities were mainly −570 ~ −470 HU, −470 ~ −370 HU, and −370 ~ −270 HU, accounting for 13.18%, 12.58%, and 12.52%, respectively. No statistical difference was noted between the proportion of lesions with a density of −570 ~ −470 HU and that of group A; however, the volume and proportion of other lesions with different densities were higher than those of group A, showing a trend that the higher the density of the lesions, the higher the proportion of group B was compared with group A. Conclusion: Larger infection volume, more lesion solid components, and multiple CT signs often indicate more severe lung inflammation, which easily progresses to severe disease. Quantitative measurement of chest CT based on deep learning is helpful for the prognosis assessment of COVID-19 and the early warning of severe outcome.
Quantitative Analysis of Computed Tomography Features of Different COVID-19 Infection Virus Variants Using Artificial Intelligence
ZHANG Kai, CHAI Jun, LIU Rui, ZHAO Jianhua, WANG Jingchen
2023, 32(5): 595-602.   doi: 10.15953/j.ctta.2023.043
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Objective: To quantitatively analyze and compare the chest computed tomography (CT) imaging features of patients infected with delta and omicron variants of COVID-19 using artificial intelligence (AI). Method: The clinical data of 294 patients infected with the novel coronavirus delta variant diagnosed at the Fourth Hospital of Inner Mongolia Autonomous Region from February 20, 2022 to April 19, 2022 and 222 patients infected with the omicron variant diagnosed at the People's Hospital of Inner Mongolia Autonomous Region from December 1, 2022 to December 30, 2022 were retrospectively analyzed. CT imaging data were analyzed and divided into delta and omicron groups. Quantitative calculation was performed using deductive predictive pulmonary infection auxiliary diagnostic software, and CT imaging signs and quantitative CT data between groups were compared and analyzed. Results: No statistical significance was noted between the delta and omicron groups in imaging signs, such as ground-glass opacity, ground-glass nodule, cord-like lesion, consolidation, paving stone sign, thickened interlobular septum, and thickened vessels in the lesion. The distribution of lesions along the bronchial vascular bundle was more likely in the omicron than in the delta group. The total lung lesion volume, volume proportion, right middle lobe lesion volume, volume proportion, right inferior lobe lesion volume, and volume proportion in the delta group were higher than those in the omicron group. The proportions of lesions in the delta group in −570 ~ −470 HU, −470 ~ −370 HU, −370 ~ −270 HU, and −270 ~ −170 HU volumes were higher than those in the omicron group. Conclusion: In the early stage of COVID-19, the volume of CT lesions in the patients infected with the delta variant was higher than that in the omicron group, and the distribution of lesions in the omicron group was more likely to have atypical distribution along the bronchial vascular bundle than that in the delta group. The volume and volume proportion of the pneumonia-infected area in patients with COVID-19 were quantitatively evaluated using the AI-assisted diagnosis system for COVID-19 to provide objective reference data for patients' condition assessment.
Analysis of Chest Computed Tomography Manifestations of Coronavirus Disease 2019 in Different Age Groups
ZHAO Jianhua, LIANG Danyan, WANG Xiaolan, CHAI Jun
2023, 32(5): 603-611.   doi: 10.15953/j.ctta.2023.045
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Objective: This study aimed to analyze the chest computed tomography (CT) imaging features of coronavirus disease 2019 (COVID-19) in people of different ages and improve the understanding of the imaging manifestations of COVID-19. Methods: Chest CT data of 476 cases with COVID-19 were retrospectively analyzed, including 275 males and 201 females. The patients were divided into four groups according to different age groups: groups A (0~45 years old) 33, B (45~60 years old) 72, C (60~75 years old) 203, and D (over 75 years old) 168. A comparison was made between the four groups of patients with chest CT lesions involving lobe side, number and density, distribution, and other basic CT signs, as well as differences in lesion volume, volume proportion, and density based on deep learning. Results: All the 476 patients with COVID-19 had an epidemiological history, and there was no statistically significant difference in sex between the groups. The lesions in the lower lobes of both lungs were the most common in the four groups. The lesions in group A were mostly located in the unilateral lung, while those in groups C and D were mostly distributed in both lungs. The volume and proportion of lesions increased with age in each group, and the distribution was mainly in the lower lobe of both lungs. In groups A, C, and D, the right lower lobe was the most common and had the largest volume and proportion, while in group B, the left lower lobe had the largest volume and proportion. Compared with group A, all indexes of group C increased, and the difference was statistically significant; the lesion volume of the right inferior lobe of the lung was statistically significant compared with group B. The volume of lesions in the left upper lobe of the lung in group D was significantly increased compared with that in groups A and B, and the volume and proportion of lesions in the whole lung, upper, middle, and lower lobes of the right lung, and the lower lobe of the left lung in group D were significantly increased compared with that in groups A, B and C, and the difference was statistically significant. In group A, the density of pure ground glass was the most common, followed by the density of mixed ground glass, and the density of solid change was rare. The solid density of lesions in group D was more common, most of which showed mixed ground glass density. The incidence of pure ground glass, mixed ground glass, and solid density lesions was higher in groups B and C than that in groups A and D. The lesion density in each group was mainly ground glass density, and the CT value ranged from −570 to −470 HU and −470 to −370 HU. The lesion volume in each CT value range of group D was higher than that in groups A, B, and C, and the volume proportion was higher than that in group A, and the difference was statistically significant. Conclusion: All patients with COVID-19 in this group have an epidemiological history. Being familiar with chest CT features of people of different ages can make clinical diagnosis and treatment more targeted and provide a reference for COVID-19 disease monitoring and individualized prevention and treatment measures.
Chest Computed Tomography Findings of Patients with Severe COVID-19 Complicated with Other Pathogens
WANG Xing, YUAN Libo, WANG Wei, LIU Jiaojiao, ZHANG Yanyan, LI Hongjun, CHEN Budong
2023, 32(5): 613-620.   doi: 10.15953/j.ctta.2023.054
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Objective: To describe the characteristics of chest computed tomography (CT) findings of patients with severe COVID-19 complicated with other pathogens. Method: Chest CT data and outcomes of patients with severe COVID-19 complicated with other pathogens were retrospectively analyzed. Results: Twenty-seven patients were included in the study. Etiological examination showed that bacteria were isolated in 13 patients, fungi in 2 patients, and bacteria and fungi in the remaining 12 patients. Multiple lung lesions were found in the chest CT images of all 27 patients. Excluding the chest CT images of 6 patients with typical novel coronavirus pneumonia features, the remaining 21 cases mostly showed scattered or diffuse ground-glass, mixed density, patchy, and patchy-solid shadows distributed in the lung segments or lobes. Some of them were scattered in nodules or central lobular nodules, with the thickened interlobular septum showing "paving stone sign" and "vascular thickening sign" in the ground glass shadow, and air bronchial air images were visible in the solid shadows. Pleural effusion was found in most cases, with pulmonary air sacs in few cases, and mild lymph node enlargement in scattered cases. According to the outcomes, the patients were grouped into 6 patients who survived and 21 patients who died. The proportion of ground glass shadow and ground glass with solid shadow in the lung of the patients who died was higher than that of the patients who survived, and the other imaging findings were not statistically different. Conclusion: Secondary infections in patients with severe COVID-19 were mainly bacterial and fungal infections, with most infections were mixed pathogens. Chest CT images mainly showed ground glass, mixed density shadow, consolidation shadow, and nodular shadow without specific location distribution, and most cases were accompanied with pleural effusion, a few with lung sacs, and scattered cases with mild enlargement of chest lymph nodes, pavement stone sign, and vascular thickening sign. It showed the diverse imaging features of COVID-19 cases complicated with bacterial and fungal infections.
Correlation between Clinical Outcome and Computed Tomography Findings in Coronavirus Disease 2019
CHAI Jun, LIANG Danyan, WANG Xiaolan, ZHAO Jianhua
2023, 32(5): 621-626.   doi: 10.15953/j.ctta.2023.048
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Objective: To analyze the differences in chest computed tomography (CT) findings in patients infected with Omicron strain BF.7 of coronavirus disease 2019 (COVID-19) with different clinical outcomes, and to improve the understanding of COVID-19 imaging. Methods: The features of chest CT images from 126 patients infected with Omicron BF.7 strain at the People's Hospital of Inner Mongolia Autonomous Region were retrospectively analyzed, and divided into ‘group A’ (not serious) and ‘group B’ (serious) according to whether they progressed to critically ill patients. There were 103 cases in group A, including 65 males and 38 females, with an average age of (73.98±11.53) years. There were 23 patients in group B, including 16 males and 7 females, with an average age of (73.43±12.53) years old. The differences in age, gender, and chest CT lesion distribution, density, and lung lobe involvement were compared between the two groups. Results: All 126 COVID-19 patients had an epidemiological history, and there was no statistical significance in age and sexes between the two groups. The volume proportion of lesions in the upper and lower lobes of the left lung, the upper, middle, and lower lobes of the right lung, and both lungs in group B was higher than that in group A. The lesions were primarily ground glass shadow and consolidation, and the range was larger than group A. Conclusion: The age and chest CT findings of patients who developed severe COVID-19 are different from those who do not. The analysis of imaging characteristics can provide reference for clinical diagnosis, treatment, and prognostic assessment.
Correlation Analysis between Dynamic Changes in Computed Tomography Findings and Clinical Outcomes in Cases Infected with Different Strains of Coronavirus Disease 2019
LIU Rui, WU Tingting, GOU Shaobo, XUE Ruihong, JIA Yanru, CHAI Jun
2023, 32(5): 627-635.   doi: 10.15953/j.ctta.2023.059
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Objective: To analyze and compare chest computed tomography (CT) findings and evolutionary characteristics of different strains of novel corona virus pneumonia and to explore the correlation of CT findings and strain characteristics with clinical outcomes. Methods: Chest CT images of 75 cases of the original strain, 130 cases of the Delta variant, and 562 cases of the Omicron variant from the Inner Mongolia Autonomous Region, were collected and sorted. The CT manifestations and their changes for different strains were analyzed and compared. Results: The proportion of patients with mild disease in the Omicron variant group (499 cases, 88.79%) was significantly higher than that in the original strain (9 cases, 12.00%) and Delta variant groups (47 cases, 36.15%). Compared to the original strain group, the Delta variant group showed higher incidences of mild cases% (47 cases, 36.15% vs. 9 cases, 12.00%) and lower incidences of severe cases (14 cases, 16.87% vs. 19 cases, 28.79%). A total of 96.97% (64 cases) of the original strain group, 93.98% (78 cases) of the Delta variant group, and 98.41% (62 cases) of the Omicron variant group showed ground-glass opacities, which were the main manifestations on the first CT scan. There was no statistically significant difference among the three groups. In terms of morphology and distribution of ground-glass opacity, 12 cases (19.05%) of the Omicron group showed acinular nodule ground-glass opacity, which was significantly higher than that shown by the original strain group (2 cases, 3.03%) and the Delta variant group (3 cases, 3.61%). The lesions in the three groups were mainly distributed along the subpleural lung regions. However, the Omicron variant group had a higher distribution ratio along the bronchial vascular bundle than the original strain and Delta variant groups. In terms of concomitant signs, concomitant consolidation and cable proportion were significantly lower on the first CT image. The proportions of concurrent consolidation in the original strain, Delta variant, and Omicron variant groups were 3.03% (2 cases), 6.02% (5 cases), and 5.00% (1 case), respectively. The proportions of accompanying cables in the original strain, Delta variant, and Omicron variant groups were 12.12% (8 cases), 15.66% (13 cases), and 20.00% (4 cases), respectively. The imaging findings of the lesions in the original strain and Delta variant groups changed over the course of the disease. In the original strain group, 39.39% (26 cases) had realistic changes based on the original ground-glass opacity and 53.03% (35 cases) had a cord based on the original ground-glass opacity. This proportion was significantly higher than the proportion of consolidation and cord based on the first CT. In the Delta variant group, 44.58% (37 cases) of patients showed inflammatory consolidation based on the original ground-glass opacity and 61.45% (51 cases) of patients showed a cord based on the original ground-glass opacity. In the Omicron variant group, 34.38% (11 cases) had inflammatory consolidation based on the original ground-glass opacity and 71.88% (23 cases) had cord based on the original ground-glass opacity, both of which were significantly higher than the proportions of primary inflammatory consolidation and cord. The median number of days from apparent absorption to onset in the original strain, Delta variant and Omicron variant groups were 16 days, 16 days, and 9 days, respectively. Conclusions: The dynamic changes in chest CT findings of cases infected with different strains of COVID-19 can reflect the evolution of lesions with the clinical course of the disease. This prediction has clinical application value in determining the course of COVID-19 and disease management.
Clinical Characteristics and Imaging Features of COVID-19 at Initial Diagnosis in Fever Clinic
LIU Xiaoyan, BAO Zhongying, DUAN Shuhong, ZHANG Jie, ZHANG Mingxia, SUN Ying, LI Ling, WANG Rengui
2023, 32(5): 636-644.   doi: 10.15953/j.ctta.2023.149
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Objective: Objective: To explore and analyze the clinical features and chest thin-slice non-enhanced computed tomography (CT) imaging features of patients with coronavirus disease 2019 (COVID-19) at initial diagnosis in a fever clinic. Methods: A retrospective analysis was performed on 140 patients with COVID-19 at initial diagnosis in a fever clinic, including 101 and 39 cases in the moderate and severe and critical groups , respective-ly. Baseline, clinical characteristics, complete blood count + C-reactive protein (CBC+CRP), and chest thin-slice non-enhanced CT imaging characteristics of the patients were analyzed. Results: (1) The comparison between the moderate and severe and criti-cal groups showed that there were statistically significant differences in age (66.05±14.38 vs. 77.90±13.12,), course of initial diagnosis (5.40±3.81 vs. 3.97±3.12), SPO2 (97.88±1.73 vs. 92.92±4.01), and Tmax (38.32±0.66 vs. 38.68±0.63).(2) CT features between the two groups showed statistically significant differences in semi-quantitative volume (18.85±13.51 vs. 34.41±19.34). (3) The comparison between the moderate and severe and critical groups showed that there were statistically significant differ-ences in CRP (29.42±26.93 vs. 80.67±48.01), LYM (1.64±0.68 vs. 0.95±0.64), and NLR (3.48±2.46 vs. 9.36±10.42). (4) Six indicators, namely age, the course of initial diagnosis, SPO2, semi-quantitative volume, CRP, and LYM, were screened for multivariate logistic regression analysis. The result show that age (OR=1.090, 95%CI 1.006 ~ 1.181), semi-quantitative (OR=1.086, 95%CI 1.086 ~ 1.019), and SPO2 (OR=0.261, 95%CI 0.089 ~ 0.762), are related to the occurrence of severe and critical COVID-19 infection, and the difference is statistically significant; CRP (OR=1.054, 95%CI 1.023 ~ 1.087) and LYM (OR=0.039, 95%CI 0.04 ~ 0.391) are related to the occurrence of severe and critical COVID-19 infection, and the difference is significant statistically significant. Conclusion: Age, lower SPO2 and LYM, a shorter course; a higher Tmax, semi-quantitative volume, CRP, and NLR are associ-ated with severe and critical cases and required early identification.
The Value of Chest Computed Tomography in the Review of Patients with Novel Coronavirus Pneumonia
LIU Mengke, ZHANG Yimeng, LI Xingpeng, ZHANG Xiaojie, ZHANG Yan, HAO Qi, LI Ling, DU Changyue, WANG Rengui
2023, 32(5): 645-651.   doi: 10.15953/j.ctta.2023.034
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Objective: To retrospectively analyze the clinical value of chest plain computed tomography (CT) for the initial diagnosis and dynamic changes of early novel coronavirus pneumonia (2019 novel Coronavirus, 2019-nCoV, referred to as new coronavirus pneumonia). Materials and methods: Fifty-two patients with confirmed new coronavirus pneumonia diagnoses and positive chest CT manifestations from November 12, 2022, to January 6, 2023, in the infection department of our hospital were collected. All patients had two chest thin-section CT examinations within 1 month from the onset of the disease and had complete clinical data. Patients were divided into two groups according to their age (60 years and >60 years), and the differences in CT performance characteristics between the two groups were compared. The CT review of all patients was also observed. Results: Among the 52 patients, 52 involved the lungs (100%), 24 involved the airways (46.2%), and 21 involved the bloodways (40.4%). Comparison between age groups showed statistically significant differences in lesion location (single/both lungs, airways), tree-in-bud pattern, large morphology, fibrous striae, interstitial changes, and pleural thickening. Among the 52 patients, review CT showed lesion progression in 18 cases (34.6%), which showed an increase in extent in 18 cases (100%), aggravation of solid changes in 7 (38.9), aggravation of GGO in 14 (77.8%), and increase in pleural effusion in 6 (33.3%); review CT showed lesion remission in 18 cases (34.6%), which showed a decrease in extent in 31 (91.2%), 6 (17.6%) with reduced density, 12 (35.3%) with fibrosis, 2 (5.9%) with complete resorption, and 4 (11.8) with reduced pleural effusion. Conclusion: The CT scan of the chest in neocoronary pneumonia has certain characteristics, and for the first time, it mostly showed multiple patchy signs or large patchy ground glass opacity (GGO) with mainly subpleural distribution in the periphery of both lungs, mostly accompanied by "halo sign," "anti-halo sign," and "paving stone sign." The lung is more susceptible to change following treatment. After treatment, the lung lesions change rapidly, with most patients showing absorption and shrinkage, density fading, or fibrosis and a few patients showing increased extent, solidity or aggravation of GGO, and pleural effusion. Chest plain CT helps clinicians in the early diagnosis and dynamic evaluation of neocoronary pneumonia.
Imaging Features of Patients with Coronavirus Disease 2019 with/without Underlying Diseases
ZHANG Yan, HUANG Ruibin, DUAN Yongli, LIU Wei, LI LING, HAO Qi, LI Xingpeng, LIU Mengke, ZHANG Yimeng, SUN Xiaoli, LIU Xiaoyan, WANG Rengui
2023, 32(5): 652-658.   doi: 10.15953/j.ctta.2023.030
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Objective: To explore the imaging characteristics of patients with novel coronavirus pneumonia (COVID-19) combined with different underlying diseases. Materials and methods: COVID-19 was diagnosed in 153 patients at Beijing Shijitan Hospital, Capital Medical University, from November 16, 2022 to December 16, 2022, and data were retrospectively collected. All patients underwent chest CT scan from 1 to 14 days after onset and were divided into two groups based on the presence or absence of underlying diseases. Forty-three patients had underlying diseases, and 110 patients had none. We compared the differences between the two groups. Result: The comparison between the two groups showed statistically significant differences in age, cough, bilateral lung distribution, diffuse distribution, honeycomb-like changes in the lungs, patchy distribution, large patchy distribution, band distribution, crazy-paving sign, air bronchogram sign, traction bronchiectasis, and pleural effusion. Conclusion: Fever and cough are the most common clinical symptoms in patients with COVID-19. Chest CT showed multiple lesions in both lungs. The most common types of lesions were thickening of bronchovascular bundle and GGO. Patients with underlying diseases had more honeycomb-like changes, crazy-paving sign, air bronchogram sign, traction bronchiectasis, and pleural effusion than those without underlying diseases. Chest thin-slice CT scan provides a key reference for the early detection and diagnosis of the disease.
High-resolution Computed Tomography (HRCT) Characteristics of Coronavirus Disease 2019 (COVID-19) in Patients with Diabetes
LIANG Yuhong, ZHONG Xixi, YAO Xinqun, HUANG Shiqi, LUO Lian, LYU Yaping
2023, 32(5): 659-665.   doi: 10.15953/j.ctta.2023.031
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Objective: To explore the characteristics of high-resolution computed tomography (HRCT) in diabetes complicated with coronavirus disease 2019 (COVID-19)-associated pneumonia. Materials and Methods: This study included 584 patients (359 males and 225 females), aged between 60~99 years old (mean, (76±9) years), with positive chest computed tomography (CT) findings and diagnosed with COVID-19 in our hospital from December 14, 2022, to January 10, 2023. Of these, 225 patients were diabetic and 359 were non-diabetic. The features of the chest HRCT from patients with diabetes mellitus complicated with COVID-19 and those without diabetes mellitus complicated with COVID-19 were compared. Moreover, 363 patients in the acute stage of COVID-19 (defined as the time interval between onset and CT examination <7 days) were selected for subgroup analysis, and the HRCT characteristics of COVID-19 between the diabetes group and the non-diabetic group in the acute stage. Results: The location, distribution, morphology, and concomitant signs of pulmonary lesions between the two groups of patients with COVID-19 did not differ significantly. Conversely, statistically significant differences in density (fine mesh, uneven density) and lesion margin (fuzzy lesion margin) were detected. In particular, the grid, uneven, and fuzzy signs on lung imaging were significantly higher in the non-diabetic group than that in the diabetic group. Additionally, 54 patients (24%) in the diabetic group and 127 patients (35.38%) in the non-diabetic group demonstrated fine mesh shadows. There were 181 patients (80.44%) in the diabetic group and 313 patients (87.19%) in the non-diabetic group with uneven density. Furthermore, 205 patients (91.11%) in the diabetic group and 344 patients (95.82%) in the non-diabetic group had blurred edges. There was significantly less pulmonary grid shadowing in the acute subgroup with diabetes (35, 24.65%) than in the acute subgroup without diabetes (82, 37.10%). Conclusion: The features of chest HRCT in patients with diabetes mellitus and COVID-19 are mainly exudation, uniform density, and a clear edge, while the interstitial changes are not obvious compared with patients in the non-diabetic group.
Analysis of Thin Slice Computed Tomography Features of Coronavirus Disease 2019 Related Vascular Abnormalities
LI Xingpeng, YUAN Hui, DU Changyue, LIU Xiaoyan, LI Ling, LIU Mengke, ZHANG Yimeng, ZHANG Yan, HAO Qi, DUAN Shuhong, WANG Rengui
2023, 32(5): 667-674.   doi: 10.15953/j.ctta.2023.026
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Objective: This study aimed to explore the clinical value of thin slice computed tomography (CT) plain scan in the analysis of CT features of vascular abnormalities associated with coronavirus disease 2019 (COVID-19). Materials and methods: A total of 73 patients with COVID-19 confirmed by the Department of Infection of Beijing Shijitan Hospital from December 5, 2022 to December 17, 2022, were included in the study. Chest thin CT plain scan images showed that the lesions involved blood vessels were retrospectively collected. All patients had complete chest thin CT plain scan and relatively complete clinical data. According to age (>60 and ≤60 years), the patients were divided into the young and elderly groups. The chest imaging manifestations of all patients were observed and statistically analyzed between different age groups. Results: Among the 73 patients with COVID-19, the imaging indexes with statistical significance between the young and elderly groups were as follows: the distribution of the lesion around the central blood vessel, size of the lesion (10~30 mm), size of the lesion (>30 mm), percentage of the lesion to the volume of the lung lobe (≤30), percentage of the lesion to the volume of the lung lobe (>50) (white lung), shape of the lesion was large, the dominant type of the lesion was acinar, vascular distortion, vascular margin fuzzy, and tree-bud sign thick fiber rope. Conclusion: (1) Chest thin-slice CT plain scan can identify the number, location, involved location, scope, vascular abnormality, and pathological type of COVID-19-related vascular abnormality, which has certain significance for the qualitative and differential diagnosis of COVID-19 vascular abnormality. (2) The chest thin CT plain scan is of great significance for finding elderly patients with COVID-19 involving blood vessels. (3) COVID-19-related "blood vessel thickening" can be caused by either the diameter of the blood vessel itself or the inflammatory edema of the perivascular interstitium.
The Clinical Value of Thin-section Chest Computed Tomography Scan for the Classification of Coronavirus Disease 2019 (COVID-19)
HAO Qi, LIU Xiaoyan, ZHANG Yan, LI Xingpeng, ZHANG Yimeng, LIU Mengke, ZHANG Xiaojie, LI Ling, GUO Jia, DU Changyue, SUN Ying, HUO Meng, ZHANG Mingxia, LIU Wei, DUAN Yongli, DUAN Shuhong, WANG Rengui
2023, 32(5): 675-683.   doi: 10.15953/j.ctta.2023.041
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Objective: To investigate the clinical value of thin-section chest computed tomography (CT) in the typing of coronavirus disease 2019 (COVID-19). Methods: A retrospective analysis was performed on 134 patients diagnosed with COVID-19 in our hospital’s Department of Infectious Diseases from December 20, 2022, to December 31, 2022. All patients underwent thin-section chest CT scan with complete clinical data. According to clinical classification, patients were divided into the non-severe and severe groups. Clinical data and imaging features of the two groups were compared and analyzed, and statistical analysis was conducted. Results: There was a statistically significant difference with respect to diabetes mellitus between the two groups, and the incidence of diabetes mellitus in the severe group (45.8%) was higher than that in the non-severe group (25.5%); There were no significant differences in sex, age, average course of disease, and clinical symptoms between the two groups; There were significant differences in the number of lesions, symmetrical distribution, predominant peripheral distribution, diffuse distribution, blurred edge, morphology of large flake and band, vascular bundle thickening, paving stone sign, arcade sign, and fried egg sign between the two groups, the number of lesions >10, diffuse distribution, morphology of large flake and band, vascular bundle thickening, paving stone sign, and arcade sign were more common in the severe group than in the non-severe group, while predominant peripheral distribution, blurred edge, and fried egg sign were more common in the non-severe group than in the severe group. Conclusions: Thin-section chest CT scan can identify the abnormal imaging manifestations of the lung in patients with COVID-19 and evaluate the number, distribution range, and morphological characteristics of the lesions. Combined background diseases, number, distribution characteristics, blurred edge, large flake and band morphology, vascular bundle thickening, paving stone sign, arcade sign, and fried egg sign can effectively indicate the classification of patients with COVID-19. This can provide imaging evidence for the diagnosis and treatment of COVID-19.
Differential Diagnosis of COVID-19 and Community-acquired Pneumonia Using Different Machine Learning Methods
KANG Zhaoting, OUYANG Xuehui, CHAI Jun
2023, 32(5): 685-694.   doi: 10.15953/j.ctta.2023.079
Abstract(51) HTML PDF(4)
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Purpose: Utilizing deep learning techniques, this study aimed to develop an artificial intelligence model that automatically annotates lesion computed tomography (CT) data, accurately and rapidly distinguishing novel coronavirus pneumonia (COVID-19) from other community-acquired pneumonia cases. Methods: A retrospective analysis was conducted on data from 248 patients with COVID-19 and 347 patients with other types of pneumonia. The COVID-19 cases were differentiated from other pneumonia cases during classification. After performing artificial intelligence-based lung segmentation, the extracted abnormal CT image features were dimensionally reduced and inputted into various classical machine learning models, Three-dimensional convolutional neural network (3D CNN), and attention-Multiple-instance learning (MIL) deep neural network architectures. The diagnostic performance of the models was evaluated using metrics such as receiver operating characteristic (ROC) curves, Precision Recall (PR) curves, Area Under Curve (AUC), sensitivity, specificity, and accuracy. Results: Among the classical machine learning models, K-Nearest Neighbor (KNN)demonstrated good performance, with an AUC of 0.793, Average Precision (AP) of 0.886, Balanced F Score (F1-score) of 0.7608, accuracy of 0.7512, sensitivity of 0.7754, and precision of 0.7691 on the external test set. The classical 3D CNN model exhibited satisfactory performance on the external test set with an AUC of 0.635, AP of 0.816, F1-score of 0.7144, accuracy of 0.7783, sensitivity of 0.6603, and precision of 0.6200. The attention-MIL model showed better robustness on the external test set, achieving an AUC of 0.851, AP of 0.935, F1-score of 0.8193, accuracy of 0.9155, sensitivity of 0.7414, and precision of 0.7646. Conclusion: Compared to the radiomics-enhanced and 3D CNN models, the deep learning attention-MIL model exhibited better performance in the differential diagnosis of COVID-19 and other community-acquired pneumonia.
Characteristics and Evolution of Computed Tomography Images in Coronavirus Disease 2019 Pneumonia
LIU Ronghui, HE Lei, YE Yufang, ZHANG Shuqian, CHEN Yingmin
2023, 32(5): 695-701.   doi: 10.15953/j.ctta.2023.047
Abstract(86) HTML PDF(6)
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Objective: To analyze the computed tomography (CT) imaging features and evolution of different stages of coronavirus disease 2019 (COVID-19). Methods: A retrospective analysis was conducted on the CT images of 113 patients diagnosed with COVID-19 at Hebei Provincial People's Hospital between December 2022 and January 2023 to observe the trends of imaging changes. Results: All 113 patients were clinically diagnosed with COVID-19. Among these, 32, 41, 20, 15, and five patients underwent CT examination once, twice, three times, four times, and five times, respectively. A total of 259 CT examinations were performed in this group of 113 patients. Among them, 32 were early-stage (within 7 days of COVID-19 infection) examinations, 87 were progression-stage CT examinations, and 140 were recovery-stage CT examinations. Analysis of the imaging features of each CT examination of the patients was performed to identify the imaging features and evolution rules of COVID-19. Among the 32 examinations performed in 32patients with early-stage disease (within 7 days of COVID-19 infection), 26 cases showed ground-glass density shadows and six cases additionally showed solid nodules. In the progression stage (8 ~ 30 days after COVID-19 infection), among the 87 CT examinations in 74 patients, 62, 11, and one patient underwent examinations one, two, and three times, respectively. The 87 examinations revealed there 32 cases with ground-glass density shadows and 55 cases with additional solid nodules. In the recovery stage (12 ~ 57 days after COVID-19 infection), 89 patients underwent 140 CT examinations. Among these, 48, 32, eight, and one patient underwent CT examinations once, twice, three times, and four times, respectively. Among the 140 CT examinations, 48 cases showed ground-glass density shadows, while 90 cases additionally showed solid nodules. Moreover, 112 patients had multiple lesions in multiple lobes, with only one case having multiple lesions in a single lobe. Regarding the distributions, in the early stage, 13 cases had subpleural distributions and 19 cases had peribronchovascular and subpleural distributions. In the progression stage, 24 cases had subpleural distribution, and 63 cases had peribronchovascular and subpleural distributions. In the recovery stage, 48 cases had subpleural distribution, two cases showed complete absorption and improvement, and 90 cases had peribronchovascular and subpleural distribution, with 48 cases accompanied by reticular shadows. Regarding thickening of the interlobular septa and vessels within the lesions, in the early stage, 32 cases showed thickening of the interlobular septa and vessels within the lesions. In the progression stage, 85 cases showed thickening of the interlobular septa and 87 cases showed thickening of vessels within the lesions. In the recovery stage, five cases showed thickening of the interlobular septa, one case showed thickening of vessels within the lesions, and 48 cases were accompanied by linear shadows. Finally, in the early stage, one case showed bronchial gas inflation. In the progression stage, six cases showed pleural effusion, six cases showed bronchial inflation, and three cases showed pulmonary emphysema. In the recovery stage, two cases showed bronchial inflation and one case showed pleural effusion. Conclusion: The characteristics of CT images differed in patients with new coronary pneumonia at different times. Understanding this evolution is important to guide clinical treatment.