http://med-sci.cn/cgzcx/en/contents_list.asp?issue=202307 zh-cn An RSS feed for Chinese Journal of Magnetic Resonance Imaging http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.001 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.002 ObjectiveTo investigate the effect of real-time functional magnetic resonance imaging neurofeedback (rtfMRI-NF) on amygdala in patients with insomnia disorder (ID). Materials and MethodsTwenty-nine patients with ID were recruited, and the rtfMRI-NF technique was used for intervention for 3 weeks (once per week). Rest-state functional magnetic resonance imaging data and Pittsburgh Sleep Quality Index (PSQI), Insomnia severity index scale (ISI), Hamilton Depression Scale (HAMD), Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAMA) were collected before and after the intervention. The bilateral amygdala was used as the seed point to calculate functional connectivity (FC) between the amygdala and the whole brain voxels. The paired t-test was used to compare the statistically significant difference brain areas before and after the intervention, and the FC values of the statistically significant difference brain areas after the intervention were extracted to conduct correlation analysis with clinical scale scores. ResultsPSQI, ISI, HAMA and HAMD scores of patients with ID were lower after rtfMRI-NF technique intervention than before intervention (P＜0.05), and there was no statistical significance in BDI scores compared with before intervention. After intervention, the FC values of the left amygdala with left middle temporal gyrus, left medial frontal gyrus, right precuneus and right precuneus increased in patients with ID. FC values decreased in the left amygdala with right parietal gyrus, right superior temporal gyrus, and left middle frontal gyrus (GRF correction, voxel level P＜0.001, mass level P＜0.05). And after intervention, the FC values of the left amygdala with the right precuneus were negatively correlated with PSQI scores (r=-0.477, P＜0.01), and the FC values of the left amygdala with the right top gyrus were negatively correlated with HAMA scores (r=-0.586, P＜0.01). ConclusionsrtfMRI-NF technology can improve the sleep quality and emotional state of the patients with ID, and the mechanism may be related to the changes of functional connections between the left amygdala with the default network, emotional regulation, and cognitive brain regions. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.003 ObjectiveDeveloping a high-accuracy prediction model based on artificial intelligence deep learning DenseNet network and multimodal fusion technology to predict the preoperative isocitrate dehydrogenase (IDH) gene mutation status in glioma patients. Materials and MethodsRetrospective analysis of the preoperative multisequence MRI scan images of 256 (155 IDH wild type and 101 IDH mutant type) patients consecutively admitted to xijing hospital, air force military medical university, from January 2012 to September 2016, and the region of interest was outlined on T1-weighted imaging(T1WI), T2-weighted imaging (T2WI), and contrast-enhanced T1WI sequences; deep learning convolutional neural networks were used to extract and fuse the MRI multimodal features. The model performance differences between the multimodal fusion model and two simple stitching methods of multimodal features were quantitatively compared. ResultsThe multimodal fusion had superior prediction performance than other single-modal simple splicing, achieving good discriminative performance with the training and testing set receiver operating characteristic curve area under the curve of 0.903 [95% confidence interval (CI), 0.845-0.961] and 0.904 (95% CI, 0.842-0.966), respectively; accuracy of 91.3% and 88.7%, respectively. The sensitivity reached 86.4% and 90.5% respectively; the specificity reached 94.5% and 87.5% respectively, and the model consistency was verified using the calibration curve, and the model calibration graph is close to the diagonal line, reflecting that the model has a good prediction effect. The DeLong test results showed a statistical difference (P＜0.05) in the model performance between the two methods of multimodal fusion and ablation, with the former being superior to the latter. ConclusionsMRI multimodal fusion model based on deep learning DenseNet network can achieve non-invasive and low-cost prediction of IDH gene status of glioma before surgery by integrating multimodal MRI image information of tumor. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.004 ObjectiveTo investigate the value of synthetic MRI (Sy-MRI) combined with diffusion weighted imaging (DWI) in predicting the methylation status of O⁶-methylguanine DNA methyltransferase (MGMT) promoter in glioma. Materials and MethodsForty-seven patients with gliomas who underwent tumor resection in the General Hospital of Ningxia Medical University from October 2020 to December 2021 were prospectively collected. All patients were scanned by Sy-MRI and DWI sequence at the GE Architect 3.0 T superconducting MR scanner before operation. According to the pathological results of MGMT promoter methylation after the operation, they were divided into methylation group and non-methylation group. The pre-and post-enhanced Sy-MRI parameter maps (pre-T1, post-T1, pre-T2, post-T2, pre-PD and post-PD) were registered with the DWI-based apparent diffusion coefficient (ADC) map, and then the signal of the glioma parenchyma in the above parameter map was measured. The independent sample student^,s t-test or Mann-Whitney U test was used to compare the differences between the parameters of the methylation group and the non-methylation group of MGMT promoter. Receiver operating characteristic (ROC) curve was used to evaluate the efficacy of independent and combined diagnosis of MGMT promoter methylation, and the DeLong test was used to compare the difference of area under ROC curve (AUC). ResultsThe values of post-T1, pre-T2, post-T2, and post-PD in the MGMT promoter methylation group were lower than those in the non-methylation group, with a statistically significant difference (P＜0.05). The values of pre-T1 and pre-PD had no statistically significant difference between the two groups (P＞0.05). The ADC values in the methylation group were lower than those in the non-methylation group, with a statistically significant difference (P＜0.05). Multivariate logistic regression analysis showed that pre-T2 [OR=1.031, 95% confidence interval (CI): 1.002-1.062, P=0.038], post-T1 (OR=1.003, 95% CI: 1.001-1.007, P=0.015) and ADC (OR=1.041, 95% CI: 1.008-1.072, P=0.047) values were independent factors for predicting MGMT methylation in gliomas. The results of ROC curve analysis showed that the AUC values of pre-T2, post-T1 and ADC for independent diagnosis of MGMT promoter methylation were 0.722, 0.808 and 0.685 respectively, and the AUC of MGMT promoter methylation diagnosed by the combined model of the above three parameters was 0.815. The results of the DeLong test showed that the diagnostic efficacy of the combined parameter model was higher than that of the ADC value, and the difference was statistically significant (P=0.03). There was no significant difference between pre-T2, post-T1 and the AUC value of the combined parameter model (P＞0.05). ConclusionsSy-MRI can well diagnose the methylation of the MGMT promoter in gliomas, and the diagnostic efficiency is significantly higher than that of traditional DWI. The diagnostic efficiency is higher when the Sy-MRI parameter is combined with the ADC value of DWI. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.005 ObjectiveTo assess the diagnostic accuracy of arterial spin labeling (ASL) in the differentiation of high-grade and low-grade brain tumors in children based on Meta-analysis. Materials and MethodsComprehensive search of studies from January 2011 to November 2022 in CNKI, Wanfang Data, MEDLINE (Ovid), Pubmed, Embase, Web of Science and Cochrane Library (Wiley) databases. Data extraction and quality assessment of the retrieved studies were performed according to inclusion and exclusion criteria. Stata 16 and RevMan 5.3 were used for Meta-analysis. ResultsEleven articles were included, and the diagnostic data were absolute cerebral blood flow and relative cerebral blood flow. The mean difference in aCBF was 24.39 mL/min/100 g [95% confidence interval (CI): 3.56-45.22 mL/min/100 g], I²=88%, P＜0.00001; the mean difference in rCBF was 0.92 mL/min/100 g (95% CI: 0.80-1.04 mL/min/100 g), I²=40%, P=0.112. The pooled sensitivity for aCBF was 90% (95% CI: 69%-97%), specificity was 87% (95% CI: 70%-95%), the area under the curve was 0.95 (95% CI: 0.92-0.96), the pooled sensitivity for rCBF was 90% (95% CI: 84%-94%), the specificity was 92% (95% CI: 86%-96%), and the area under the curve was 0.96 (95% CI: 0.94-0.98). ConclusionsASL showed high diagnostic accuracy for distinguishing high-grade brain tumors from low-grade brain tumors in children, and can be used as a potential method for grading brain tumors in children. Relative cerebral blood flow showed less variation among studies than absolute cerebral blood flow. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.006 ObjectiveTo investigate the value of diffusion tensor imaging (DTI) technology in evaluating the integrity and damage degree of perforator atherosclerotic cerebral infarction branch athero-matous disease (BAD) and corticospinal tract (CST), and to help predict clinical prognosis. Materials and MethodsA total of 31 cases of patients with BAD from July 2020 to September 2022 were analyzed. According to the National Institutes of Health Stroke Scale (NIHSS) score and Manual Muscle Test (MMT) score, the patients were divided into prediction groups (recovery group, partial recovery group and paralysis group). At the same time, the fractional anisotropy (FA) of the key region of interest (ROI) and the relative position (adjacent, partially through, through) of CST and BAD infarction site were obtained by DTI, patients were predicted as recovery (relative adjacent), partial recovery (relative partial crossing) and paralysis (relative through); NIHSS score and MMT score were performed at 1, 2, and 4 weeks after treatment, and the evaluation results were taken as the actual values. Pearson correlation analysis and partial correlation analysis were performed to explore the correlation between FA value, CST extent of damage and NIHSS and MMT score, and multivariate linear stepwise regression analysis was used to verify the linear quantitative relationship. ResultsThe FA and apparent diffusion coefficient (ADC) images of 31 patients showed good structure and clear structure. The FA value of the infarct and the corresponding normal brain tissue on the mirror side decreased, and the ADC value decreased, t values were 2.836 and 2.107, and P values were 0.015 and 0.010, respectively, and the differences were significant (P＜0.05). The reconstruction of the corticospinal tract was good, and the visualization rate of the left and right corticospinal tracts was 100%. After fiber bundle reconstruction, 10 patients showed CST adjacent to the infarct but did not cross the infarct. These patients had a good prognosis, and their muscle strength recovered quickly and the recovery degree was obvious. In 11 patients, CST partially passed through the infarct. The prognosis of these patients was slightly worse, and the recovery of muscle strength was slightly worse. All the 10 patients had CST through the infarct. The prognosis of these patients was poor, the course of disease was long, and the muscle strength decreased significantly. Correlation analysis showed that NIHSS score, MMT predicted score and actual score after treatment were positively correlated with FA value of the affected side (all P＜0.05). Multiple linear stepwise regression was performed. The relative position of the affected side CST and the BAD infarct site (adjacent, partially through, and through) had a linear regression relationship with the score of the recovery group, partial recovery group, and paralysis group. ConclusionsDTI technology can effectively evaluate the integrity of BAD and CST, and the evaluation results are highly positively correlated with clinical prediction and actual prognosis, which can provide a basis for clinical treatment and prognosis assessment. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.007 ObjectiveTo investigate the MR radiomics models in predicting postoperative recurrence of craniopharyngioma within 5 years. Materials and MethodsOne hundred and sixty four patients who underwent surgical resection of craniopharyngioma were retrospective studied (87 cases with postoperative recurrence within five years, 77 cases without recurrence). The patients were divided into exercise group and test group as the proportion of 7∶3, Clinical characteristics of the patients were collected. 3D Slicer software was used to delineate region of interest (ROI) and extract radiomics features. Single factor analysis and least absolute shrinkage and selection operator (LASSO) were used for feature selection, and support vector machine (SVM) algorithm was used to establish the radiomics model and clinical model, the area under the curve (AUC) value was calculated and receiver operating characteristic (ROC) curve was drawn to evaluate the prediction efficacy of the model. ResultsIn the training group, the AUC of radiomics model in predicting the recurrence of craniopharyngioma within 5 years after operation was 0.767 [95% confidence interva (CI): 0649-0.816], the sensitivity was 77%, and specificity was 71%. In the test group, the AUC of radiomics model in predicting the recurrence of craniopharyngioma within 5 years after operation was 0.770 (95% CI: 0.657-0.898), the sensitivity was 71%, and specificity was 86%. ConclusionsThe radiomics model based on contrast-enhanced T1-weighted imaging (CE-T1WI) is effective in predicting the recurrence of craniopharyngioma. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.008 ObjectiveDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) intensity histogram analysis was used to analyze the whole focus of pulmonary inflammatory nodules and lung cancer which diameter 0.8-3.0 cm and to evaluate their value in differential diagnosis. Materials and MethodsThe DCE-MRI data of 123 patients with pulmonary inflammatory nodules and lung cancer confirmed by operation or puncture biopsy and clinical imaging follow-up from July 2019 to June 2022 were analyzed retrospectively, including 63 cases of pulmonary inflammatory nodules and 60 cases of lung cancer. Using FireVoxel software, the region of interest (ROI) of the whole lesion was manually delineated layer by layer on the peak enhancement image and its silhouette image, and the signal intensity histogram parameters of 3D ROI were obtained. Including minimum, maximum, average, median, standard deviation, skewness, kurtosis, entropy, coefficient of variation (CoV), 10th percentile (P10), 25th percentile (P25), 50th percentile (P50), 75th percentile (P75), 90th percentile (P90), etc. The diagnostic ability of intensity histogram parameters for both groups was determined by using thereceiver operating characteristic (ROC) curve. The joint variable (JV) was obtained by logistic regression analysis model, and the diagnostic ability was determined by ROC curve. ResultsIn the histogram parameters of peak enhancement, the minimum, mean, median, P10 and P25 of lung cancer were higher than those of inflammatory nodules, while the CoV and skewness of lung cancer were lower than those of inflammatory nodules, and the difference was statistically significant. Among them, the AUC [0.668, 95% confidence interval (CI): 0.573-0.764] with the minimum value of 155.5 as the threshold is the largest, the diagnostic efficiency is the best, and the sensitivity and specificity are 35.0% and 93.7%. In the histogram parameters of peak enhancement, the minimum, P10 and P25 of lung cancer were higher than those of inflammatory nodules, while the values of CoV and entropy were lower than those of inflammatory nodules, and the difference was statistically significant. Among them, AUC (0.775, 95% CI: 0.692-0.858) with CoV 0.275 as the threshold was the largest, and the diagnostic efficiency was the best, with a sensitivity and specificity of 88.9% and 58.3%. The semi-quantitative parameters derived from time-signal intensity curve (TIC) included time to peak (TTP), contrast enhancement ratio and curve slope. The TTP of lung cancer was shorter than that of inflammatory nodules, but the slope of curve was larger than that of inflammatory nodules, and the difference was statistically significant. The AUC (0.737, 95% CI: 0.647-0.828) of TTP with a threshold of 204.2 seconds was the largest, with a sensitivity and specificity of 58.7% and 85.0%, and AUC (0.732, 95% CI: 0.641-0.822) with a slope of 1.76 was the largest, with a sensitivity and specificity of 61.7% and 82.5%. The combination of histogram parameters and semi-quantitative parameters of the silhouette showed that AUC (0.885, 95% CI: 0.823-0.947) with a threshold of JV of 0.43 was the highest, with a sensitivity and specificity of 88.3% and 79.4%. ConclusionsDCE-MRI intensity histogram based on whole focus can provide information for differential diagnosis of lung cancer and inflammatory nodules, and the diagnostic efficiency of silhouette images is higher. The combined application of histogram parameters and semi-quantitative parameters derived from TIC can further improve the ability to distinguish between malignant nodules and inflammatory nodules, and provide reliable objective basis for differential diagnosis. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.009 ObjectiveTo explore the value of MRI intravoxel incoherence motion (IVIM) in differentiating hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICC). Materials and MethodsThis study included 60 patients with malignant hepatic nodules. All patients underwent IVIM scans on a 3.0 T MRI scanner. The slow apparent diffusion (D_slow), fast diffusion coefficient (D_fast), perfusion fraction (f), distributed diffusion coefficient (DDC) and water diffusion heterogeneity index (α) were obtained. Receiver operating characteristic (ROC) curve analysis was used to compare the efficacy of each parameter in differentiating HCC from ICC. ResultsThe D_slow and DDC values of lesions in the HCC group were significantly lower than in the ICC group (all P＜0.05), the D_fast of lesions in the HCC group were significantly higher than in the ICC group, f and α values did not statistically differ between the HCC and ICC groups. When the cut-off values of D_slow, D_fast and DDC were 0.88×10^-3 mm²/s, 20.82×10^-3 mm²/s, and 1.30×10^-3 mm²/s, respectively, and the sensitivity was 94.1%, 82.4%, 82.4%, the specificity was 72.1%, 65.1%, 67.4%, and the area under the curve (AUC) was 0.846, 0.756 and 0.803, respectively. ConclusionsThe biexponential model and the stretched exponential model can be used to differentiate HCC from ICC, and the D_slow had the highest diagnostic efficiency. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.010 ObjectiveTo investigate the diagnostic value of peritumoral and intratumoral apparent diffusion coefficient (ADC) in the pathological prognostic factors of resectable rectal cancer. Materials and MethodsSixty-eight patients with rectal cancer who received preoperative MRI were retrospectively analyzed. Two radiologists independently placed three circular regions of interest (ROIs) with an area of about 20 mm² in the largest cross section of the tumor, and three oval ROIs with an area of about 22 mm² in the peritumoral region adjacent to the tumor contour. The maximum of tumor ADC (ADCtmax), minimum of tumor ADC (ADCtmin), mean of tumor ADC (ADCtmean), maximum of peritumoral ADC (ADCpmax), mean of peritumoral ADC (ADCpmean) and ADCpmean/ADCtmean (ADC ratio) were obtained, and the differences between groups with different prognostic factors were compared. Independent sample t test, Mann-Whitney U test and χ² test were used to compare whether the difference was statistically significant. The variables with statistically significant differences in univariate analysis were included in multivariate logistic regression analysis to screen out independent risk factors and establish a joint prediction model. Receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC), and the diagnostic efficacy of each parameter and the combined prediction model for pathological prognostic factors was analyzed. DeLong test was used to compare whether the AUC of different parameters and a joint prediction model was statistically different. ResultsThe inter-observer agreement of the parameters was good [intraclass correlation coefficient (ICC)＞0.75]. The ADC ratio of T3 group was higher than that of T1-T2 group, poorly differentiated group was higher than that of moderately well differentiated group, lymph node metastasis (LNM) positive group was higher than that of LNM negative group, tumor deposition (TD) positive group was higher than TD negative group, lymphovascular infiltration (LVI) positive group was higher than LVI negative group, ADCtmean in T1-T2 group was higher than T3 group, LNM negative group was higher than LNM positive group. ADCpmean in T1-T2 group was lower than that in T3 group, TD positive group was higher than that in TD negative group, and LVI positive group was higher than that in LVI negative group, and the differences were statistically significant (P＜0.05). The ROC curve analysis showed that the AUCs of ADC ratio in predicting T3, LNM-positive, high differentiation, TD-positive, and LVI-positive were 0.803 [95% (confidence interval, CI): 0.694-0.911], 0.737 (95% CI: 0.614-0.859), 0.787 (95% CI: 0.628-0.945), 0.706 (95% CI: 0.572-0.841), and 0.802 (95% CI: 0.685-0.919); the AUCs of ADCtmean in predicting T3 and LNM-positive were 0.737 (95% CI: 0.617-0.858) and 0.683 (95% CI: 0.548-0.818); the AUCs of ADCpmean in predicting T3, TD-positive, and LVI-positive were 0.691 (95% CI: 0.566-0.816), 0.702 (95% CI: 0.566-0.838), and 0.763 (95% CI: 0.647-0.880). ConclusionsPeritumoral and intratumoral ADC parameters are important for the diagnosis of pathological factors in resectable rectal cancer, the AUC values of ADC ratio in T stage, LNM, TD and LVI of rectal cancer were higher than those of ADCtmean and ADCpmean. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.011 ObjectiveTo explore the value of blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) in the evaluation of early renal functional hypoxia in patients with type 2 diabetes. Materials and MethodsFifty-five patients with type 2 diabetes were divided into diabetes mellitus group (DM group, n=27) and early diabetic nephropathy group (DN group, n=28) according to the presence or absence of microalbuminuria. Thirty age- and sex- matched healthy volunteers were recruited as normal control group (NC group). The cortical R2^* value (cortical R2^*, CR2^*), medulla R2^* value (medullary R2^*, MR2^*) and medulla/cortical R2^* (R2^* ratio between medulla and cortex, MCR) were calculated by BOLD-fMRI program scan. The intra-group and inter-group comparative analysis was performed. Then receiver operating characteristic (ROC) are plotted. ResultsThe value of MR2^* was significantly higher than that of CR2^* in the three groups (all P＜0.05). There was no significant difference in CR2^* among the three groups (P＞0.05), but the values of MR2^* and MCR in DM group were significantly higher than those in NC group and early DN group (P＜0.05), but there was no significant difference between early DN group and NC group (P＞0.05). MR2^* value, MCR and MR2^*+MCR had good diagnostic value in differentiating NC group from DM group, early DM group and early DN group, the AUC values were 0.884 [95% (confidence interval, CI): 0.802-0.966], 0.802 (95% CI: 0.690-0.915) and 0.891 (95% CI: 0.811-0.971); 0.819 (95% CI: 0.707-0.931), 0.759 (95% CI: 0.630-0.889) and 0.824 (95% CI: 0.714-0.934) respectively. There were no significant difference in diagnostic efficacy among all indexes (P＞0.05). ConclusionsBOLD-fMRI can non-invasively evaluate the early renal damage in patients with diabetes from the level of oxygenation, and can monitor the functional hypoxia changes of renal medulla in the stage of clinical proteinuria, which provides a basis for early clinical diagnosis, timely treatment and improvement of prognosis, and has important clinical value. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.012 ObjectiveTo evaluate the value of radiomics analysis based on T2WI sequence MRI in predicting post-acute pancreatitis diabetes mellitus (PPDM-A). Methods and Materials: Retrospective collection of patients diagnosed with acute pancreatitis (AP) in our hospital from January 2016 to December 2019, through clinical follow-up, they were divided into PPDM-A group (n=57) and normal blood glucose after AP group (n=83). The enrolled patients were randomly divided into the training group (n=98, 40 cases in the PPDM-A group, 58 cases in the normal blood glucose group after AP) and the validation group (n=42, 17 cases in the PPDM-A group, 25 cases in the normal blood glucose group after AP) at a ratio of 7∶3, and the relevant clinical characteristics of the two groups were collected at the same time. 3D Slicer software was used to delineate the edge of pancreatic parenchyma and extract features, variance threshold method, select K Best method and least absolute shrinkage and selection operator (LASSO) were used to extract the final radiomics features. Finally, random forest method was used to establish the clinical model, radiomics model and combined model for predicting PPDM-A. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive performance of the model, and DeLong test was used to compare the predictive efficiency of these models. The calibration curve of the best model was drawn and the Hosmer-Lemesow test was used to verify the goodness of fit of the model. The decision curve analysis (DCA) was used to evaluate the net clinical benefits of each model. ResultsThe AUCs of the clinical model, radiomics model, and combined model in the training group were 0.773 [95% confidence interval (CI): 0.679-0.866], 0.831 (95% CI: 0.750-0.912) and 0.881 (95% CI: 0.816-0.946), respectively. In the validation group, they were 0.664 (95% CI: 0.488-0.839), 0.821 (95% CI: 0.684-0.958) and 0.899 (95% CI: 0.806-0.992), respectively. DeLong test results showed that the prediction performance of the combined model was statistically different from that of the clinical model in both the training and validation groups (training group: P=0.024, validation group: P=0.013). In the training group, there was a significant difference between the combined model and the radiomics model (P=0.047), but no significant difference was observed in the validation group (P=0.090). The Hosmer-Lemeshow test showed that the combined model was well calibrated (P=0.250). The DCA results indicated that both the radiomics model and the combined model had better net clinical benefits in predicting PPDM-A compared to the clinical model. Moreover, when the threshold probability was greater than 12%, the net clinical benefit of the combined model was superior to that of the radiomics model. ConclusionsThe combined model based on clinical features and T2WI radiomics features has a good predictive performance and can be used as an early method to predict the occurrence of PPDM-A. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.013 ObjectiveTo investigate the clinical application value of diffusion weighted imaging (DWI) combined with conventional MRI in making surgical plan of primary debulking surgery (PDS) in patients with advanced ovarian cancer. Materials and MethodsThe imaging data of 57 patients with advanced ovarian cancer confirmed by pathology in our hospital from November 2018 to June 2022 were retrospectively analyzed. All patients underwent abdominal conventional MRI, DWI and enhanced computed tomography (CT), and then PDS surgery was performed. According to the FAGOTTI laparoscopic score and peritoneal cancer index (PCI) and combined with multiple disciplinary team discussion in our hospital, the anatomical areas to be observed in the imaging data of this study were determined. The presence of metastasis in each area was recorded and need for the assistance of corresponding departments was determined. Using intraoperative records and pathology as the gold standard, the diagnostic efficacy of DWI combined with conventional MRI and enhanced CT was compared. χ² test was used to compare the statistical differences between the two groups, and to compare the formulation value of the two methods of imaging examinations in the PDS surgery plan for advanced ovarian cancer. Kappa analysis evaluated the consistency of two radiologists in determining clinical assistance departments. ResultsIn this group of 57 patients, the cases with different surgical plans were recorded as follows: 9 cases of gynecologic surgery alone, 7 cases required the assistance of hepatobiliary surgery department, 5 cases required the assistance of digestive surgery department, 23 cases required the assistance of both liver and gallbladder surgery and digestive surgery department, 5 cases required the assistance of both digestion and urology surgery department, 1 case required the assistance with hepatobiliary surgery and urology department, liver and gallbladder surgery, digestive surgery and urology common assist with surgery in 7 cases. The coincidence of preoperative DWI combined with MRI (38/57) was significantly higher than that of enhanced CT (16/57) (P＜0.001). Intraoperative records showed that 40, 38 and 13 cases needed assistance from digestive surgery, hepatobiliary surgery and urology surgery, respectively. Preoperative DWI combined with MRI plain scan confirmed that 30, 36 and 10 cases needed assistance from above departments, with accuracy of 80.70%, 91.23% and 87.72%, respectively. Preoperative enhanced CT showed 18, 24 and 5 cases from above departments, with the accuracy of 57.89%, 64.91% and 78.95%, respectively. The accuracy of DWI combined with conventional MRI was higher than that of contrast-enhanced CT (χ²=4.762, P=0.027; χ²=4.050, P=0.041) in patients requiring digestive surgery and hepatobiliary surgery. The consistency range of clinical assistance departments determined by two radiologists under different imaging methods was 0.437-0.843, both of which were above medium. ConclusionsCompared with enhanced CT, DWI combined with conventional MRI has higher accuracy and better clinical significance in making surgical plan of PDS for advanced ovarian cancer. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.014 ObjectiveTo investigate the feasibility of the apparent diffusion coefficient (ADC) in the preoperative noninvasive prediction of myometrial infiltration, Ki-67 and P53 expression levels in patients with endometrial cancer (EC). Materials and MethodsRetrospective analysis of 105 patients with EC who underwent preoperative MRI diffusion weighted imaging (DWI) and were confirmed by pathology after operation from January 2017 to December 2021 in the Second Hospital of Lanzhou University. Two independent radiologists measured the ADC value (ADC_max, ADC_mean and ADC_min) of EC on the ADC image by comparing MRI enhancement and DWI images respectively. Statistical methods were used to calculate the correlation between clinical information, ADC values and myometrial infiltration, Ki-67 and P53 expression in EC patients. A nomogram prediction model was constructed and the constructed prediction model was evaluated by plotting the receiver operating characteristic (ROC) curve, calibration curve analysis and decision curve analysis (DCA). ResultsADC_max, ADC_mean and ADC_min were significantly correlated with myometrial infiltration, Ki-67 and P53 expression levels in EC patients (P＜0.05). The International Federation of Gynecology and Obstetrics (FIGO) stage was only significantly associated with myometrial infiltration and Ki-67 expression levels in EC patients (P＜0.05). The ADC_max, ADC_mean and ADC_min were combined with FIGO stage to construct the nomogram model. The nomogram model, ADC_max, ADC_mean, ADC_min and FIGO stage predicted area under the curve (AUC) values of 0.809, 0.707, 0.693, 0.694 and 0.599 for myometrial infiltration, respectively. The AUC values for predicting Ki-67 expression levels were 0.897, 0.879, 0.849, 0.808 and 0.550, respectively. The nomogram model was constructed by combining ADC_max, ADC_mean and ADC_min. The AUC values predicted P53 expression levels by the nomogram, ADC_max, ADC_mean and ADC_min were 0.665, 0.615, 0.641 and 0.654, respectively. ConclusionsThe nomogram prediction model based on ADC values combined with FIGO stage can be used as a useful method for the preoperative non-invasive assessment of myometrial infiltration, Ki-67 and P53 expression in EC patients. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.015 ObjectiveTo determine the value of magnetization transfer imaging (MTI) in diagnosing prostate cancer (PCa) and assessing the histologic grade. Materials and MethodsThis study was conducted prospectively. A total of 134 patients with clinical suspicion of PCa underwent biparametric MRI with magnetization transfer (MTr) technology, and followed by biopsy or radical prostatectomy. According to the results of pathologic diagnosis, all patients were divided into two groups PCa and benign prostatic hyperplasia (BPH). The patients in PCa group were divided into low- and high score groups (Ls group and Hs group) based on the new Gleason grade groups (GGG) system. The feasibility of MTr in prostate imaging is evaluated. The magnetization transfer ratio (MTR) were compared between the PCa group and BPH group, and prior to the different grade in PCa group. The efficacy of T2WI and diffusion-weighted imaging (DWI) sequences with or without MTr pulse in the diagnosis of PCa and the stratification of low- or high-grade PCa was compared. ResultsAfter applying MTr technology, the image quality of T2WI and DWI images were optimized. There was high consistency of MTR measure between intraobserver and interobserver. After MTr pulse was applied to DWI sequence, the diagnostic efficacy of PCa (pre-MTr AUC=0.779, post-MTr AUC=0.850) and the differentiation of Ls and Hs (pre-sMTr AUC=0.697, post-MTr AUC=0.818) were effectively improved. Measured the MTR between BPH and PCa group, a significant difference between groups was found in the DWI sequence trial (t=-1.85, P=0.06), but not in the T2 sequence trial (t=-3.39, P=0.01). Measured the MTR between Ls group and Hs group, a statistically insignificant difference was found in the T2WI sequence trial (t=-0.53, P=0.59), but not in the DWI sequence trial (t=3.42, P=0.01). ConclusionsMTI can improve the performance for the PCa detect and identify high grade lesions, especially the MTR in DWI sequence showed great potential in diagnosing and grading PCa. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.016 ObjectiveTo explore the value of apparent diffusion coefficient minimum (ADC_min) in differential diagnosis of early prostate cancer (PCa) and chronic prostatitis in peripheral zone. Materials and MethodsThe MRI data of 65 patients of early PCa and 39 patients of chronic prostatitis with pathology confiemed were retrospectively analyzed, the lesions were all located in the peripheral zone of prostate, the mean apparent diffusion coefficient (ADC_mean) and ADC_min of the parenchyma of the lesion were measured, the difference of ADC_mean and ADC_min between the two groups were analyzed. The receiver operating characteristic (ROC) curve and DeLong test were used to evaluate and compare the diagnostic efficiency of ADC_mean and ADC_min for early PCa and chronic prostatitis in peripheral zone. ResultsThe ADC_mean and ADC_min in the early PCa group were lower than those in the chronic prostatitis group, and differences between groups were statistically significant (P＜0.001). The area under the curve (AUC) of ADC_mean and ADC_min were 0.888 and 0.935, there was statistical difference in diagnostic performance by DeLong test (P＜0.05). The optimal cut-off value of ADC_mean was 1.008×10^-3 mm²/s, the sensitivity and specificity or the diagnosis of early PCa were 81.54%, 94.87%, respectively. The optimal cut-off value of ADC_min was 0.861×10^-3 mm²/s, the sensitivity and specificity for the diagnosis of early PCa were 83.08%, 94.87%, respectively. ConclusionsThe diagnostic efficacy of ADC_min in differentiating early PCa and chronic prostatitis in the peripheral zone is better than that of ADC_mean, which has good clinical reference value. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.017 ObjectiveTo investigate the value of synthetic MRI (SyMRI) sequences for quantitative detection of the muscles around the knee joints before and after amateur marathon runners participated in a marathon. Materials and MethodsTwenty-four amateur marathon runners (48 knees), 21 males and 3 females, aged 24 to 50 (40±6) years, were prospectively recruited. All subjects were examined with GE SIGNA Pioneer 3.0 T MRI. SyMRI sequences of both knees were performed 1 week before the marathon, 48 hours after the marathon, and 1 month after the marathon. Conventional contrast-weighted images as well as 3 quantitative profiles of T1, T2, and proton density (PD) were obtained after scanning. ITK-SNAP software was applied in the post-processing platform to measure the T1, T2, and PD values of the semimembranosus, biceps femoris, lateral femoris, medial femoris, medial head of the gastrocnemius, and lateral head of gastrocnemius, popliteus, and tibialis anterior muscles in sagittal images of the knee joint. The differences in T1, T2, and PD values of each muscle were analyzed before and 48 hours after the race and 1 month after the race. ResultsAll subjects showed no significant abnormalities in muscle morphology or signal around the knee during the examination (P＞0.05). The values of T1, T2 and PD of the muscles around the knee joint measured by two radiologists were good consistent, with ICC values of 0.801, 0.909 and 0.921, respectively. Most muscle subregions had elevated T1, T2, and PD values 48 hours after the marathon compared to pre-race, and decreased after 1 month of post-race rest. There were statistically significant changes in T2 values for semimembranosus, biceps femoris, lateral femoris, medial femoris, medial head of the gastrocnemius, and lateral head of gastrocnemius (P＜0.05), and statistically significant changes in PD values for medial femoris (P＜0.05). ConclusionsThe quantitative parameter values of SyMRI sequences can be useful for detecting dynamic changes in the knee muscles before and after marathon exercise. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.018 ObjectiveTo investigate the diffusion tensor imaging (DTI) of thigh muscles in patients with polymyositis (PM) and dermatomyositis (DM). Materials and MethodsForty-six patients with PM/DM diagnosed in our hospital from September 2019 to March 2022 were selected as PM/DM group. Thirty-two healthy volunteers who came to our hospital at the same time without muscle diseases were selected as control group. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were compared among the PM/DM edema muscles, unaffected muscles (non-edema muscles) and normal muscles of ROI region. The one way analysis of variance test, receiver operating characteristic (ROC) curve and Spearman rank correlation analyses were used to analysis the mean ADC, FA of DTI in PM/DM group and control group. P values＜0.05 were considered statistically significant. ResultsThe mean ADC value of edema muscles in the PM/DM group was higher on average and showed a statistically significant difference when compared with unaffected muscles and normal muscles (P＜0.05), while the mean ADC value was no statistical difference between unaffected muscles and normal muscles (P＞0.05). There was no significant difference in the mean FA value between the three groups (P＞0.05).The optimal cut-off value of ADC between edema muscles and normal muscles was 1.62×10^-3 mm²/s, sensitivity was 87.5%, specificity was 85.0% and AUC was 0.869. Correlation analysis showed that mean ADC value of edema muscles were positively correlated with creatine kinase (CK; r=0.583, P＜0.001), but there was no significant correlation between mean FA value of edema muscles with CK (P＞0.05). ConclusionsDTI can be used to quantitatively analyze pathological features of edema muscles in patients with PM/DM, DTI can be a good ability for diagnose PM/DM. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.019 ObjectiveTo investigate the pathological types of hypoxic brain injury in neonatal rats after asphyxia by conventional magnetic resonance imaging (MRI) and susceptibility-weighted imaging (SWI), and to explore the effects of hypoxia on the cortex and hippocampus. Materials and MethodsNeonatal 7-day-old rats were randomly divided into asphyxiation and control groups. Pups in the asphyxiation group were placed in a closed chamber for a hypoxia with the oxygen concentration with 1% (5 min)-reoxygenation with the oxygen concentration of 21% (3 min) cycle for a cumulative hypoxia time of 30 min; control rats were placed in the same chamber with air for the same time. Behavioral changes and changes in general conditions of baby rats during and after hypoxia were observed during asphyxia. Abnormal behavioral observations were made and recorded at 1 d, 3 d and 7 d after hypoxia. T1WI, T2WI and SWI sequences were performed at 1 d, 3 d and 7 d after modelling. Hematoxylin-Eosin staining was performed according to the site of abnormal MRI signal to observe the type of pathological injury in the abnormal signal area. Neuronal survival in the cortical, dentate grrus (DG), CA1 (corn ammonis 1) and CA3 (corn ammonis 3) regions of the hippocampus of young rats was observed by Nissl staining; the expression of apoptosis-related protein Caspase-3 was detected by immunohistochemical staining. ResultsSeizures were observed in pups at 1 d, 3 d and 7 d after hypoxia. MRI and SWI showed types of brain injury including enlarged ventricles, foci of cerebral softening, intraventricular and parenchymal hemorrhage and microvascular dilatation. Nissl staining showed a decrease in neurons in the cortical and hippocampal DG regions at 1 d, 3 d and 7 d after hypoxia compared to the control group (P＜0.05), and a decrease in neurons in the CA3 region at 7 d after hypoxia (P＜0.05). Immunohistochemical staining showed that the expression of Caspase-3 in the DG region of the hippocampus was higher than that of the control group at 1 d, 3 d and 7 d after hypoxia (P＜0.05), and the expression in the cortex was higher than that of the control group at 3 d and 7 d after hypoxia (P＜0.05); the expression in the CA1 and CA3 regions of the hippocampus was higher than that of the control group at 7 d after hypoxia (P＜0.05). ConclusionsMRI and SWI show that brain damage can be present early in acute intermittent hypoxia and that hypoxic brain damage can lead to seizures. This suggests that MRI and SWI should be used as routine clinical investigations in children with a history of asphyxia and suspected brain injury, and that early clinical intervention should be undertaken. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.020 ObjectiveTo investigate the value of 3.0 T MRI three dimension volumetric interpolated breath-hold examination (3D-Vibe) and T2 mapping in the evaluation of triangular fibrocartilage complex (TFCC) injury and quantitative analysis of cartilage. Materials and MethodsRoutine, 3D-Vibe and T2 mapping sequence scanning of bilateral wrist joints was performed in 35 patients with TFCC injury and 30 healthy controls. The T2 values of radial cartilage, triangular fibrocartilage disc (TFC), fibrovascular tissue, meniscus and ulnar attachment were measured respectively in T2 mapping imaging. ResultsThere was no significant difference in T2 value between the meniscus injury group and healthy group (P＞0.05), and the overall mean of T2 values between the injury group and the healthy group in other regions showed statistical difference (P＜0.01). The T2 values of each region in the injury group were statistically significant (P＜0.05). The overall mean of T2 values in different age groups was statistically different (P＜0.05). The classification and course of disease had a significant effect on the T2 value of patients with TFCC injury (P＜0.01); Age and sex had no significant effect on T2 value of patients with TFCC injury (P＞0.05). ConclusionsThe 3.0 T MRI 3D-Vibe and T2 mapping imaging techniques are helpful for the evaluation of TFCC injury and quantitative analysis of cartilage. The T2 value can reflect the molecular biological changes of cartilage injury, which is susceptible to injury classification and course of disease, but not affected by age and gender. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.021 ObjectiveBased on cycle generative adversarial network (CycleGAN), using unpaired patient head MR image data to achieve mutual conversion between water-suppressed T2WI images and diffusion weighted imaging (DWI) images, and to evaluate the quality of the generated synthetic DWI images. Materials and MethodsBrain water-suppressed T2WI images and DWI images of 200 cases were collected. There were 100 cases in the training set and 100 cases in the test set, including 50 cases of acute cerebral infarction. CycleGAN model included two generators and two discriminators. Firstly, two generators were constructed based on convolutional neural networks (CNN). One generator converted water-suppressed T2WI images into synthetic-DWI images, and the other generator converted DWI images into synthetic-T2WI images. Then, two discriminators were constructed based on CNN, which were used to discriminate the real image and the generated synthetic image and update the parameters. The generator and discriminator work alternately to complete the training of CycleGAN model. The image quality of synthetic-DWI was evaluated by MAE, ME, PSNR, SSIM and subjective score. A total of 50 cases of acute cerebral infarction were divided into DWI images and sDWI images, and DICE coefficient was calculated. ResultsThe MAE, ME, PSNR and SSIM values of the synthetic and true DWI images were 34.991±0.989, 15.982±0.978, 26.642±3.428 and 0.927±0.039, respectively. More than 80% of the synthetic DWI images had no or only slight image distortion or artifact. The DICE coefficients of true DWI and synthetic DWI images after infarction segmentation were 0.898±0.324 and 0.849±0.259, respectively. ConclusionsThe CycleGAN model and unpaired image data can generate high-quality synthetic DWI images and reduce the scanning time for patients who need rapid magnetic resonance imaging. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.023 ^,s disease (AD) is currently considered to be a continuous AD spectrum (ADS) disease that includes subjective cognitive decline (SCD), mild cognitive impairment (MCI), and AD-derived dementia. Studies have confirmed that vascular injury and destruction of blood-brain barrier are involved in the onset and development of AD spectrum (ADS) disease. MR perfusion imaging can better display these pathological changes through quantitative analysis of cerebral blood flow changes, and image indicators of some abnormal perfusion brain areas can be used as biomarkers for early diagnosis. This paper summarizes and analyzes the characteristics of MR perfusion imaging technology at the present stage and its application research in ADS diseases, in order to provide some references for MR perfusion imaging in subsequent relevant studies. Meanwhile, it is proposed that fusion multimodal MRI can provide more imaging information reflecting the biological changes of the disease, and provide an objective imaging basis for the early non-invasive diagnosis of ADS diseases. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.024 ^,s disease (PD) is one of the most important non-motor manifestations. In recent years, with the update of imaging equipment and the development of image processing technology, brain structural and functional imaging can observe the density, volume and structural integrity of brain tissue, providing an important help for clinical analysis of cognitive function changes. In this paper, voxel-based morphometry (VBM), surface-based morphometry (SBM), diffusion tensor imaging (DTI) and resting-state functional MRI (rs-fMRI) are discussed, we analyze and summarize the characteristics and advantages of different research means, for research scholars to further explore, specifically propose the development direction of future imaging research in the diagnosis of cognitive impairment in PD, to provide important imaging help for clinical analysis of cognitive function changes, to help patients diagnose cognitive decline and predict the decline trend, and improve the quality of life. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.025 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.026 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.027 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.028 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.029 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.030 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.031 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.032 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.033 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.034 ^,s life and health. Early diagnosis and treatment are very important to improve the quality of life of breast cancer patients. Conventional multi-sequence MRI is expensive and takes a long time for scanning, post-processing and reading by physicians, which limits the wide application of MRI in clinical practice. Abbreviated breast MRI (AB-MRI) is expected to solve practical clinical problems. AB-MRI protocol is more acceptable to patients and has a promising future as a screening method for breast cancer. So far, the preoperative application of AB-MRI to evaluate the degree of breast cancer disease and neoadjuvant chemotherapy response is still insufficient, and more large-scale prospective studies are still needed. This paper summarizes the concept of AB-MRI, its sequence design and clinical application. It includes the screening of breast cancer in different risk groups, the differentiation of benign and malignant breast tumors, the preoperative staging of breast cancer, and the evaluation of response to neoadjuvant chemotherapy and other clinical applications. The purpose is to help radiologists strengthen their understanding and application of AB-MRI scheme, and help improve the level of accurate diagnosis and treatment of breast cancer. ]]> Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.035 Thu,20 Jul 2023 00:00:00 GMT http://med-sci.cn/cgzcx/en/en_articlexml.asp?doi=10.12015/issn.1674-8034.2023.07.036 Thu,20 Jul 2023 00:00:00 GMT