急性胰腺炎预后的CT研究进展

急性胰腺炎(AP)早期是诊断与治疗的关键时期,早期影像诊断可对预后进行推测并判断一些重要并发症出现的可能性。目前,CT检查为早期AP最重要的影像检查技术,已建立多种评分系统进行AP严重度的评估,其中应用最广泛的是CT严重度指数(CTSI)及修订的CTSI(MCTSI)。CT评分可较好地预测预后,甚至判断是否出现器官衰竭。CECT所见的低强化及CTP显示的灌注减低是预示胰腺梗死的较好指标,但CT难以预测AP是否出现血管并发症及合并感染。     

人工智能在急性缺血性脑卒中成像中的应用进展

人工智能（AI）技术可采用多种算法模拟人类认知和信息处理过程,与CT和MRI相结合可用于急性缺血性脑卒中成像,包括梗死灶的检测、影像分割、头颈大血管闭塞的检测和病人预后预测等。采用AI技术分析或构建模型有助于临床医师对脑卒中病人的尽早诊疗、及时干预和随访评估。概述AI的概念,并就其在急性缺血性脑卒中病人CT平扫、CT血管成像（CTA）、CT灌注成像（CTP）、MRI中的应用进展进行综述。     

Eliminating routine oral contrast use for CT in the emergency department: impact on patient throughput and diagnosis

This study aimed to assess the effect of eliminating routine oral contrast use for abdominopelvic (AP) computed tomography (CT) on emergency department (ED) patient throughput and diagnosis. Retrospective analysis was performed on patients undergoing AP CT during 2-month periods prior to and following oral contrast protocol change in an urban, tertiary care ED. Patients with inflammatory bowel disease, prior gastrointestinal tract-altering surgery, or lean body habitus continued to receive oral contrast. Oral contrast was otherwise eliminated from the AP CT protocol. Patients were excluded if they would not have typically received oral contrast, regardless of the intervention. Data recorded include patient demographics, ED length of stay (LOS), time from order to CT, 72-h ED return, and repeat imaging. Two thousand and one ED patients (1,014 before and 987 after protocol change) underwent AP CT during the study period. Six hundred seven pre-intervention and 611 post-intervention were eligible for oral contrast and included. Of these, 95?% received oral contrast prior to the intervention and 42?% thereafter. After the intervention, mean ED LOS among oral contrast eligible patients decreased by 97?min, P?<?0.001. Mean time from order to CT decreased by 66?min, P?<?0.001. No patient with CT negative for acute findings had additional subsequent AP imaging within 72?h at our institution that led to a change in diagnosis. Eliminating routine oral contrast use for AP CT in the ED may be successful in decreasing LOS and time from order to CT without demonstrated compromise in acute patient diagnosis.     

螺旋CT平扫对急性胰腺炎的诊断价值

目的探讨急性胰腺炎的CT平扫特征及其诊断价值。方法对经临床明确诊断的30例急性胰腺炎CT表现进行分析评价。结果30例中CT诊断为急性单纯性水肿性胰腺炎13例,表现为胰腺弥漫性或局限性增大,密度轻度减低,轮廓模糊,以及胰周积液。急性出血坏死性胰腺炎17例,表现为胰腺明显增大,密度弥漫性减低,坏死区密度更低,出血区密度高于正常组织,明显的胰周脂肪坏死和积液。结论螺旋CT平扫是急性胰腺炎简便有效的影像检查方法。     

急性胰腺炎的CT诊断

目的探讨CT对急性胰腺炎的诊断价值。方法回顾性分析32例经临床证实急性胰腺炎患者的CT资料,观察其CT表现特征,全部患者均经腹部CT平扫,其中6例又经增强扫描。结果急性轻症胰腺炎19例,急性重症胰腺炎13例。CT主要表现为胰腺弥漫性增大,密度降低,其中,9例有不规则低密度区,17例有胰周积液,1例胰腺内见局限性斑点状高密度出血影。结论 CT检查是诊断急性胰腺炎及其并发症的重要方法。     

人工智能在心血管CT成像中的新进展

随着计算机技术的进步与影像设备性能的大幅提升,人工智能（AI）已成为医学研究的热点。目前,AI在心血管CT成像领域也已广泛应用,可以用于冠状动脉CT血管成像（CCTA）影像质量的优化、心血管组织自动分割、自动计算冠状动脉钙化积分（CACS）、实现冠状动脉狭窄的自动化识别与检测,此外还可以识别心肌缺血、预测心血管事件等。介绍常用的AI技术及其相关的术语,综述当前AI在心血管CT成像中的应用现状,并分析AI应用的局限和未来的展望。     

积极推进人工智能心血管CT成像的研发和应用

心血管成像的快速发展带来了新的机遇和挑战,尤其近年人工智能（AI）技术在该领域的逐渐应用,使得AI心血管CT成像从工作流程的改进到自动图像分割及对心血管疾病的诊断,再到准确的心血管风险预测都展现了应用潜能,可大大简化诊疗工作流程,提升医生诊断效率和准确性。着重介绍AI在心血管CT全流程的研究和应用,并对我国AI心血管CT成像的部分研发工作予以总结分析,以期积极推动人工智能心血管成像在我国的应用。     

64-detector row computed tomography: an improved tool for evaluating the biliary and pancreatic ducts?

The imaging evaluation of patients with suspected pancreaticobiliary abnormality includes noninvasive imaging modalities such as sonography and MRI. The use of computed tomography (CT) has typically been limited to the evaluation and staging of malignancy affecting the pancreas and biliary tree. With the increasing use of CT in abdominal imaging for patients with a wide variety of indications, biliary and pancreatic abnormalities are being initially identified with increasing frequency on CT. The evolution of CT technology to multi-detector channel row (MDCT) scanners, currently culminating in use of 64-detector-row MDCT scanners, has provided unprecedented image quality. We have recently installed three 64-MDCT scanners in our institution and, in this article, we describe our experience in their application to imaging of the pancreatic and biliary ducts. Our current protocols for imaging the biliary tree and pancreatic duct using this technology are discussed. Additionally, the advantages of novel interpretation techniques including multi-planar and minimum intensity projection reformations are detailed. Various diseases affecting the pancreaticobiliary tree are briefly discussed along with their typical imaging evaluation. The application of 64-MDCT technology to these abnormalities is described along with expected imaging findings on CT. The imaging findings of various pancreaticobiliary abnormalities using 64-MDCT scanner technology encountered at our institution are illustrated. In summary, 64-MDCT technology offers several technical advances which may increase utilization of CT in the evaluation and diagnosis of pancreaticobiliary abnormalities.     

慢性阻塞性肺疾病的人工智能研究进展

人工智能（AI）已广泛应用于慢性阻塞性肺疾病（COPD）的研究,在COPD的临床筛查、预诊分级、风险评估、医学成像和远程监护等方面均取得一定进展。AI不仅可以对未患病人群进行早筛、早诊及早治,也可为COPD病人的治疗和管控提供众多的可行方案。重点就AI在肺气肿量化、CT纹理分析、解剖结构分割等影像诊断应用进展予以综述。     

Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel on Artificial Intelligence in Interventional Radiology: From Code to Bedside

Artificial intelligence (AI)-based technologies are the most rapidly growing field of innovation in healthcare with the promise to achieve substantial improvements in delivery of patient care across all disciplines of medicine. Recent advances in imaging technology along with marked expansion of readily available advanced health information, data offer a unique opportunity for interventional radiology (IR) to reinvent itself as a data-driven specialty. Additionally, the growth of AI-based applications in diagnostic imaging is expected to have downstream effects on all image-guidance modalities. Therefore, the Society of Interventional Radiology Foundation has called upon 13 key opinion leaders in the field of IR to develop research priorities for clinical applications of AI in IR. The objectives of the assembled research consensus panel were to assess the availability and understand the applicability of AI for IR, estimate current needs and clinical use cases, and assemble a list of research priorities for the development of AI in IR. Individual panel members proposed and all participants voted upon consensus statements to rank them according to their overall impact for IR. The results identified the top priorities for the IR research community and provide organizing principles for innovative academic-industrial research collaborations that will leverage both clinical expertise and cutting-edge technology to benefit patient care in IR.     

CT imaging of acute pulmonary embolism

CT pulmonary angiography (CTPA) has become the de facto clinical "gold standard" for the diagnosis of acute pulmonary embolism (PE) and has replaced catheter pulmonary angiography and ventilation-perfusion scintigraphy as the first-line imaging method. The factors underlying this algorithmic change are rooted in the high-sensitivity and specificity, cost-effectiveness, and 24-hour availability of CTPA. In addition, CTPA is superior to other imaging methods in its ability to diagnose and exclude, in a single examination, a variety of diseases that mimic the symptoms of PE. This article reviews the current role of CTPA in the diagnosis of acute PE as well as more recent developments, such as the use of CT parameters of right ventricular dysfunction for patient prognostication and the assessment of lung perfusion with CT.     

Multi-detector CT: review of its use in acute GI haemorrhage

The advent of multi-section computed tomography (CT) technology allows the non-invasive assessment of the arterial tree. Using current software, it is now possible to produce high-quality, angiographic-like images that can be used to plan and guide therapeutic procedures. One such clinical situation is the assessment of patients with acute gastrointestinal (GI) haemorrhage. Multi-section CT has a number of advantages over conventional angiography in this situation. The simplicity and non-invasive nature of the technique compared with conventional angiography make CT angiography possible in situations where conventional angiography is not available. Movement artefact from respiration and peristalsis is a common problem in the interpretation of conventional angiography; this is essentially abolished with rapid acquisition times and the use of multi-planar images to remove overlying bowel loops. Cross-sectional imaging with the ability for multi-planar reconstruction allows the accurate anatomical localization of the bleeding site, as well as an assessment of the underlying pathology: this can be used to plan therapy (embolization or surgery). The aim of this paper is to review the current use of CT in the investigation of patients with GI haemorrhage, illustrated with images from our Institution. For patients in whom GI endoscopy has failed to establish a diagnosis, we propose multi-section CT angiography as the initial imaging investigation in acute GI haemorrhage.     

急性胰腺炎继发肝脏损害的多层螺旋CT表现

目的：观察急性胰腺炎一过性肝脏损伤的CT表现,探讨其发生机制。方法回顾分析80例急性胰腺炎患者的肝脏CT表现。结果80例患者中,88％（70/80）的患者CT检查中出现肝脏密度改变,均表现为肝脏密度的降低,其中19％（15/80）肝实质密度呈不均匀减低,69％（55/80）肝实质密度呈弥漫性均匀减低,余12％（10/80）患者肝实质密度在CT扫描中无变化。66例肝实质密度异常患者在首次检查后的7 d至2个月行CT复查,66例患者肝脏CT值都较首次CT检查时增高,其中55例完全恢复到正常肝实质密度。结论绝大多数急性胰腺炎患者在首次CT检查中可以发现肝脏异常改变,主要表现为肝脏密度的减低,这种改变是一过性的,且与急性胰腺炎的严重程度相关。     

Prospective evaluation of nonenhanced MR imaging in acute pancreatitis

PURPOSE: To compare the value of nonenhanced (NE) magnetic resonance imaging (MRI) (NE-MRI) with contrast-enhanced (CE) computed tomography (CT) (CE-CT) scan in assessing acute pancreatitis (AP) and in evaluating the severity index (SI) with clinical outcome. MATERIALS AND METHODS: Patients with AP were prospectively investigated by CE-CT scan and NE-MRI on admission. MRI was performed with fat-saturated T1-weighted imaging, T2-weighted imaging, and MR cholangiopancreatography (MRCP). Balthazar's grading system was used to evaluate the NE-MRI severity index (CTSI, MRISI) and it was compared to the clinical outcome. RESULTS: A total of 90 patients (median age = 55 years) were included in the study. AP was of biliary etiology in 37 patients (41%). On admission, AP was assessed as grade III by CTSI in four patients (4%), whereas 19 patients were classified grade III by MRISI. The coefficient correlation between CTSI and MRISI was good, with r = 0.6 (P < 0.001). Considering CE-CT scan as the gold standard, sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of NE-MRI for detecting severe AP based on imaging criteria were 100%, 82.6%, 100%, and 21%, respectively. NE-MRI discriminates normal pancreatic parenchyma from edema and necrosis with a correlation between morbidity (P < 0.008). CONCLUSION: NE-MRI seems to be a reliable method of staging AP severity in comparison to CE-CT scan.     

CT imaging in acute pulmonary embolism: diagnostic strategies

Computed tomography pulmonary angiography (CTA) has increasingly become accepted as a widely available, safe, cost-effective, and accurate method for a quick and comprehensive diagnosis of acute pulmonary embolism (PE). Pulmonary catheter angiography is still considered the gold standard and final imaging method in many diagnostic algorithms. However, spiral CTA has become established as the first imaging test in clinical routine due to its high negative predictive value for clinically relevant PE. Despite the direct visualization of clot material, depiction of cardiac and pulmonary function in combination with the quantification of pulmonary obstruction helps to grade the severity of PE for further risk stratification and to monitor the effect of thrombolytic therapy. Because PE and deep venous thrombosis are two different aspects of the same disease, additional indirect CT venography may be a valuable addition to the initial diagnostic algorithm—if this was positive for PE—and demonstration of the extent and localization of deep venous thrombosis has an impact on clinical management. Additional and alternate diagnoses add to the usefulness of this method. Using advanced multislice spiral CT technology, some practitioners have advocated CTA as the sole imaging tool for routine clinical assessment in suspected acute PE. This will simplify standards of practice in the near future.     

Technology and archives in radiology research: a sampling analysis of articles published in the AJR and Radiology. American Journal of Roentgenology.

OBJECTIVE: Our aim was to determine the use of advanced technology and archiving and the contribution of countries other than United States in the articles published in the American Journal of Roentgenology (AJR) and Radiology. We analyzed the association of these features with the type of research, the main technical features of the modalities used, and the countries of origin. MATERIALS AND METHODS: We determined the proportion of articles published in 18 randomly selected issues of the AJR and Radiology that required advanced imaging techniques and relied on the analysis of archived data. "Advanced technology" was defined as imaging techniques that serve a purpose other than simple anatomic imaging or that are not widely available because of the high cost of the technology, such as functional imaging and computer programming designed for an individual study or simulation studies. We analyzed the association of these features with the country of origin, the topic, and the methodology used. RESULTS: Sixteen percent of the studies required advanced technology. MR imaging, CT, and sonography were the most frequently used modalities (31%, 27%, and 15% of studies, respectively). Archiving was used in 37% of the studies, and 67% of the original articles were prospective. The articles most commonly originated in North America (67%), Europe (20%), and Asia (12%). CONCLUSION: Only a small percentage of published research studies required advanced technology and approximately one third of the studies used archiving. These results may suggest that other criteria, such as the design of the study, its relevance for daily clinical use, and the originality of the paper, have a major impact on the acceptance of papers in clinically oriented radiology journals.     

急性胰腺炎病程的动态变化及影像学评价

急性胰腺炎（AP）的病程是一个动态变化的过程。AP严重程度的评价系统包括临床评分系统及影像评分系统,可以不同程度地评价间质水肿性胰腺炎和坏死性胰腺炎的病程变化。正确认识AP动态病程的变化对于该病的早期诊断、治疗、改善病人预后以及降低死亡率具有重要意义。就AP不同时期病程的临床特点及影像表现进行综述。     

Imaging of pancreatic ductal adenocarcinoma: State of the art

Significant advances in imaging technology have changed the management of pancreatic cancer. In computed tomography (CT), this has included development of multidetector row, rapid, thin-section imaging that has also facilitated the advent of advanced reconstructions, which in turn has offered new perspectives from which to evaluate this disease. In magnetic resonance imaging, advances including higher field strengths, thin-section volumetric acquisitions, diffusion weighted imaging, and liver specific contrast agents have also resulted in new tools for diagnosis and staging. Endoscopic ultrasound has resulted in the ability to provide high-resolution imaging rivaling intraoperative ultrasound, along with the ability to biopsy via real time imaging suspected pancreatic lesions. Positron emission tomography with CT, while still evolving in its role, provides whole body staging as well as the unique imaging characteristic of metabolic activity to aid disease management. This article will review these modalities in the diagnosis and staging of pancreatic cancer.     

Current and future status on cardiac computed tomography imaging for diagnosis and risk stratification

Computed tomography (CT) permits cross-sectional imaging with high spatial resolution and has, during the past years, undergone tremendous development mainly concerning the temporal resolution. By use of multidetector spiral technology, as well as electrocardiography-gated image acquisition and reconstruction techniques, 16- and 64-slice CT permits visualization of cardiac morphology and function. In this context, however, CT imaging does not play a major clinical role because other imaging methods (mainly echocardiography) usually provide all necessary information. Under certain conditions, multidetector CT also permits visualization of the coronary arteries. Detection of coronary calcification, as well as coronary CT angiography, can provide clinically useful information if applied to suitable patient groups. It is foreseeable that CT angiography will become part of the routine workup in some subsets of patients with suspected coronary artery disease, either alone or in combination with other imaging techniques. Among the limitations of cardiac CT are the requirement of a regular (and preferably low) heart rate, the associated x-ray exposure, and the need for an iodinated contrast agent for most applications. It is important to note that reliable and accurate results will require use of the most advanced CT scanner technology, optimal image quality, and sufficient experience in the acquisition and interpretation of cardiac CT data sets.     

急性胰腺炎高敏C反应蛋白水平与CT分级的对照研究

目的探讨高敏C反应蛋白(hs-CRP)水平与CT分级在急性胰腺炎(AP)的诊断、严重程度及预后评估中的价值。方法动态观察48例轻症急性胰腺炎(MAP)患者和51例重症急性胰腺炎(SAP)患者的hs-CRP水平,并与其相应的Balthazar CT分级相比较分析。结果48例MAP患者hs-CRP水平在正常值的10～20倍之间,其Balthazar CT分级为A级12例,B级28例,C级8例;51例SAP患者hs-CRP水平均高于正常值30倍以上,其CT分级为D级29例,E级22例。Spearman相关性分析显示,hs-CRP水平与CT分级成正相关(r=0.864,P=0.000)。轻症与重症组之间hs-CRP水平比较,差异具有统计学意义(P<0.05)。结论 Balthazar CT分级可以准确反映SAP的病理变化,但对MAP的诊断有一定困难。动态监测hs-CRP水平可作为AP早期诊断、严重程度及预后判断的一个独立的评估指标。