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25 April 2020, Volume 19 Issue 02 Previous Issue    Next Issue

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Clinical analysis of 88 patients with myeloproliferative neoplasm XIAO Chao, TAO Ying, SONG Luxi, ZHAO Youshan, WU Lingyun, CHANG Chunkang 2020, 19 (02):  115-121.  DOI: 10.16150/j.1671-2870.2020.02.004 Abstract ( 553 )   HTML ( 1 )   PDF (623KB) ( 73 )   Objective: To explore the clinical features of 88 patients with myeloproliferative neoplasm(MPN) for analyzing the differences between prefibrotic primary myelofibrosis (pre-PMF), essential thrombocytopenia(ET), overt primary myelofibrosis (overt-PMF), and emphasizing the clinical importance of the diagnosis of pre-PMF. Methods: Eighty- eight patients with MPN at our hospital from January 2015 to January 2018 were enrolled. The clinical data including disease classification, routine blood test, splenomegaly, megakaryocyte count, degree of fibrosis in bone marrow and related gene mutations were collected and analyzed. Results: Of the 88 patients, the median age at diagnosis was 61 years (range 20-88 years), 32(36%) patients were over 65 years old, 46 (52%) were male, and 22 (25%) had splenomegaly. There were 51 cases (58%) with JAK2 V617F mutation, 5 cases (6%) with CALR mutation, 2 cases (2%) with MPL mutation, and 30 cases (34%) with triple negative. There were 20 cases of polycythemia vera (PV), 23 cases of ET, and 45 cases of primary myelofibrosis (PMF), including 23 cases of pre-PMF (51% of PMF) and 22 cases of overt-PMF (49% of PMF). Among all the patients with overt-PMF, the mutation rate of CALR gene was as high as 18% (4/22). Clinical manifestations of pre-PMF is milder than that of overt-PMF, with a lower ratio of low hemoglobin and lower platelet count, and a lower mean lactic acid dehydrogenase (P values of 0.048, 0.034, 0.037, respectively). The clinical manifestations of patients with pre-PMF were similar to those of patients with ET, however, the former had a higher proportion of splenomegaly and leukocytosis than the latter (P=0.043 and 0.007). Follow-up showed that patients with ET had longer survival than patients with pre-PMF (P=0.038). In patients with pre-PMF, triple-negative patients had a lower median age and greater number of splenomegaly than patients with JAK2 mutation (P=0.030 and 0.017). Conclusion: MPN is a group of hematological diseases with heterogeneous clonality. Different clinical manifestations and prognosis are presented in patients with pre-PMF and patients with overt-PMF, and it is necessary to distinguish the two diseases. The clinical manifestations of pre-PMF and ET are similar, but the prognosis is different. It is extremely important to distinguish the two diseases by histomorphological diagnosis combined with secondary clinical criteria. Figures and Tables | References | Related Articles | Metrics

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Chronic neutrophilic leukemia with leukemia-like reaction as the first-onset manifestation: a report of 2 cases and literature review PENG Zhenping, XIANG Xixi, ZHANG Sujiang, LI Jiaming 2020, 19 (02):  122-128.  DOI: 10.16150/j.1671-2870.2020.02.005 Abstract ( 400 )   HTML ( 2 )   PDF (1300KB) ( 112 )   Objective: To investigate the clinical characteristics and differential diagnosis of chronic neutrophil leukemia (CNL). Methods: The clinical data, characteristics of cell morphology, pathological and immunohistochemical features of bone marrow biopsy from 2 cases of CNL were retrospectively analyzed, and the relevant literatures were reviewed. Results: Both CNL patients were middle-aged male with leukocytosis as primary complaint. The peripheral blood examination revealed an elevated leukocyte counts with mostly mature neutrophils and increased neutrophil alkaline phosphatase (NAP) score. The proliferation of nucleated cells in bone marrow was significantly increased with higher proportion of neutral lobular granulocytes. Both patients were negative for BCR-ABL fusion gene and JAK2 V617F gene mutations. The case 1 was diagnosed as CNL with detection of CSF3R T618I mutation, and presented a feature of chronic myelomonocytic leukemia in the peripheral blood two and a half years later. The condition progressed rapidly thereafter. The granulocytic sarcoma was identified in thoracic vertebras 3 months later and the disease had transformed into acute myeloid leukemia in the 4th month. The patient was not responsive to the standard chemotherapy regimen combined with Dicitabine, and eventually died of a cerebral hemorrhage. Case 2 was initially diagnosed as leukemia-like reaction, but suffered from massive splenomegaly, aggravation of anemia and increased serum monoclonal IgA-λ 2 years later. The repea-ted examination of bone marrow then showed CNL accompanied with multiple myeloma (MM). Case 2 achieved completely remission for both MM and CNL after chemotherapy with Vanke as the main regimen. Conclusion: CNL is an extremely rare type of chronic leukemia, with non-specific clinical manifestations and complicated prognosis. CNL may coexist with other hematologic neoplasms, and there is a high risk of conversion to AML. The molecular diagnosis standard characte-rized by CSF3R gene mutation is conductive to the diagnosis and treatment of CNL. Figures and Tables | References | Related Articles | Metrics

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Craniofacial features with disproportionate short stature and acanthosis nigricans caused by a R248C mutation in FGFR3: A case report and literature review ZHANG Juanjuan, ZHANG Wanyu, HAN Xiaowei, XIAO Yuan, LU Wenli, LÜ Sheng 2020, 19 (02):  129-134.  DOI: 10.16150/j.1671-2870.2020.02.006 Abstract ( 627 )   HTML ( 2 )   PDF (1112KB) ( 112 )   Objective: To analyze the correlation between clinical phenotype and genotype in a patients presenting with Crouzon-like facial appearance, disproportionate short stature and acanthosis nigricans (AN) caused by fibroblast growth factor receptor 3 gene（FGFR3） mutation. Methods: The 13-year-old boy presented craniofacial dysmorphic features, with disproportionate short stature and severe acanthosis nigricans. The clinical data was retrieved and the laboratory parameters of glucose and lipid metabolism, and endocrine hormone were acquired. The results of skin pathology and bone X-ray exami-nation were analyzed. The DNA sample was extracted from peripheral blood withdrawn from the proband and family members for whole-exome sequencing (WES) and Sanger sequencing. Results: Laboratory examination revealed normal hormone level and slight insulin resistance without hyperglycemia. Skeletal survey showed no evidence of midface hypoplasia, brachycephaly or achondroplasia. Skin biopsy identified cutaneous papillomatosis consistent with the manifestations of AN. A spontaneous mutation (NM_00142: c.742C>T; Chr4: 1803564; p. R248C) was identified in FGFR3 by whole-exome sequen-cing, a causative gene established by American College of Medical Genetics and Genomics (ACMG) guidelines. Conclusions: The report described for the first time a case presenting Crouzon-like facial appearance with mild skeletal dysplasia and progressive acanthosis nigricans caused by classical R248C mutation in FGFR3. Sequencing of FGFR3 should be consi-dered in patients with short stature or subtle dysmorphic features, especially accompanied by signs of early onset AN. Figures and Tables | References | Related Articles | Metrics

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The performance of the inferior vena cava collapse index(IVC-CI) measured by ultrasound on predicting supine hypotension syndrome(SHS) in parturients following spinal anesthesia YAO Shifa, NIU Jianmei, XU Tao 2020, 19 (02):  135-138.  DOI: 10.16150/j.1671-2870.2020.02.007 Abstract ( 538 )   HTML ( 2 )   PDF (410KB) ( 84 )   Objective: To evaluate the performance of the inferior vena cava collapse index(IVC-CI) measured by ultrasound on predicting supine hypotension syndrome (SHS) in parturients following spinal anesthesia. Methods: A total of 102 single-fetus parturients scheduled for cesarean section were prospectively enrolled in the study. The inferior vena cava maximal diameter during quiet expiration (IVCe) and expiration(IVCi) in both supine and left lateral position were measured by ultrasound to calculate IVC-CI and IVC-CI in different position(ΔIVC-CI) sprior to spinal anesthesia. The ΔIVC-CI was deduced to represent the impact of postural change. The parameters including IVCe, IVCi, IVC-CI and ΔIVC-CI were compared between parturients with and without SHS. Result: Fifty-four parturients presented SHS after spinal anesthesia. The parturients were predisposed to lower IVCe and IVCi, and higher IVC-CI in supine position than left lateral position(P<0.01). There was no difference in IVCe, IVCi and IVC-C of parturients between with and without SHS in left lateral position(P>0.05). The IVCe and IVCi measured in supine position were lower, and IVC-CI in supine position and ΔIVC-CI were higher in parturients with SHS (P<0.01). The areas under ROC curve (AUC) of IVC-CI and ΔIVC-CI for prediction of SHS were 0.941 and 0.927. With the cutoff value of 41.43% and 14.09%, the sensitivity and specificity of IVC-CI and ΔIVC-CI for predicting SHS in supine position were 88.9% and 98.8%, and 87.0% and 87.5%, respectively. Conclusion: The IVC-CI measured in supine position and ΔIVC-CI by ultrasound prior to spinal anesthesia could be used to assess the risk of incidence of SHS. Figures and Tables | References | Related Articles | Metrics

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Serum uric acid and Parkinson disease: a population-based prospective study SHAO Dandan, FU Yang, LUO Qi, CHEN Jie, MA Jianfang, HUANG Lei 2020, 19 (02):  139-144.  DOI: 10.16150/j.1671-2870.2020.02.008 Abstract ( 276 )   HTML ( 3 )   PDF (592KB) ( 42 )   Objective: To explore the association of serum uric acid (UA) level and the risk of Parkinson disease (PD) in Chinese. Methods: The population-based cohort study was conducted in subjects over 50 years old in districts of Shanghai from 2011 through end of 2017. The individuals had base line serum uric acid levels determined and were followed for incidence of PD. The association of serum uric acid level and risk of PD was analyzed with Cox regression. Results: The Cox regression analysis revealed no significant association between hyperuricemia and the incidence of PD without (HR=2.072, 95%CI: 0.701-6.121, P=0.188), or with adjustment with age, gender and other confoun-ding factors (HR=3.368, 95%CI: 0.904-12.546, P=0.070). Conclusion: The prospective study shows no significant asso-ciation between hyperuricemia and the incidence of PD. Figures and Tables | References | Related Articles | Metrics

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The three-dimensional balanced steady state free precession magnetic resonance imaging sequence in diagnosis of anomalous origin of the coronary artery from the pulmonary artery in children GU Xiaohong, SUN Aimin, WANG Qian, ZHU Ming, ZHONG Yumin 2020, 19 (02):  145-150.  DOI: 10.16150/j.1671-2870.2020.02.009 Abstract ( 369 )   HTML ( 1 )   PDF (656KB) ( 87 )   Objective: To evaluate the value of three-dimensional balanced steady state free precession sequence (3D b-SSFP) magnetic resonance imaging (MRI) sequence in diagnosis of anomalous origin of the coronary artery from the pulmonary artery（ACAPA）. Methods: The whole heart MRI3D b-SSFP performed on 21 children with an age of (33.67±43.32) months was retrospectively analyzed. All the subjects had DSA or surgical operation confirmed ACAPA, and 19 cases were isolated heart abnormality. The imaging quality of 3D b-SSFP was evaluated and inter-observer agreement was validated by the Kappa coefficient. Relationship between heart rate and imaging quality was assessed by regression analysis. The diagnostic accuracy of 3D b-SSFP for ACAPA was assessed by comparison with findings from DSA or surgical operation. Results: The subjective scores on the image quality from two observers were 2.84±0.82 and 2.83±0.83, and inter-observer agreement was 81.8% (95% CI 57.0%-86.6%). The heart rate (HR) of investigated subjects was(105.85±18.20) beat/min, and the left ventricular end diastolic volume and ejection fraction were (79.63±37.46) mL/m2 and (34.28±21.39)% respectively. Left ventricular late gadolinium enhancement(LGE) was positive in 8 of 10. Regression analysis showed negative correlations between vessel sharpness and HR in both 2 observers, and correlation coefficients were -0.277 and -0.263, respectively. MRI3D b-SSFP identified ACAPA in 18 out of the 21 cases investigated, yielding a diagnostic accuracy of 85.71%. The MRI imaging of 2 cases was beyond recognition due to blurred edge and 1 case was misdiagnosed as normal. Conclusion: Cardiac MRI displays cardiac anatomy and coronary artery and facilitates evaluation of cardiac function. The 3D b-SSFP is a valuable MRI sequence for diagnosing ACAPA. Figures and Tables | References | Related Articles | Metrics

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The morphology and function of left atrial appendage in the risk assessment of stroke in patients with non-valvular atrial fibrillation WANG Chenchen, YANG Wenbo, HUA Wei, CHEN Yefen, SU Xiuxiu, GONG Junshi, FANG Yuehua 2020, 19 (02):  151-156.  DOI: 10.16150/j.1671-2870.2020.02.010 Abstract ( 301 )   HTML ( 3 )   PDF (665KB) ( 104 )   Objective: To explore anatomic structure and function of left atrial appendage (LAA) in the risk assessment of cardiogenic stroke in patients with atrial fibrillation (AF). Methods: A total of 223 patients with non-valvular atrial fibrillation (NVAF), including 70 with and 153 without episodes of cardiogenic stroke, were enrolled in the study. The transthoracic and transesophageal echocardiography were retrieved and analyzed along with clinical data. Results: Between subjects with and without episodes of stroke, there were significant differences in demographic and laboratory parameters, including age, prevalence of hypertension or diabetes, glomerular filtration rate, atrial size of both sides, opening inner diameter of each angle of LAA, depth of the LAA, ratio of the depth/opening inner diameter, spontaneous echo contrast (SEC) in LAA and the blood flow (P<0.05). Patients with cactus- or cauliflower-shaped LAA had a higher incidence of stoke than those with wing- or wind vane-shaped LAA. Multivariable logistic regression analysis showed that higher sum of opening inner diameters and higher blood flow velocity in LAA were protective factors against stroke, and the higher sum of depths in LAA was an independent risk factor for stroke. When the cutoff values for the sum of opening inner diameters, the blood flow velocity and the sum of depths in LAA were set as≤71 mm, ≤41 cm/s and≥103 mm, the sensitivity and specificity of each parameter for stroke predication were 91% and 83%, 79% and 46%, 74% and 89% respectively. Conclusion: The incidenceof cardiogenic stroke is associated with anatomic features of LAA, such as cactus- or auliflower-shaped LAA, the sum of opening inner diameters and depths of LAA, and blood flow velocity in LAA. Evaluation of anatomy and function of LAA might facilitate stroke prediction as a supplement of CHA2DS2VASc score in patients with AF. Figures and Tables | References | Related Articles | Metrics

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Perfomence of MRI intravoxel incoherent motion diffusion weighted imaging parameters in diagnosing active Crohn's disease WU Shuang, XIE Qian, GUAN Xueni, ZHANG Sufang, GAO Xinfang, LIANG Zonghui 2020, 19 (02):  157-161.  DOI: 10.16150/j.1671-2870.2020.02.011 Abstract ( 487 )   HTML ( 1 )   PDF (856KB) ( 68 )   Objective: To explore the performance of MRI intravoxel incoherent motion diffusion weighted imaging（IVIM-DWI） parameters in diagnosing active Crohn′s disease(CD). Methods: The MRI IVIM-DWI scan was performed on 30 patients with active ileocolonic CD diagnosed by endoscopy. The IVIM-DWI parameters, including apparent diffusion coefficient（ADC）, diffusion coefficient of the true water molecule （D）, microcirculation perfusion coefficient （D*） and perfusion fraction（f）, within the walls of involved ileocolon (CD group ) and normal intestinal at the same level (control group) were determined. The parameters were compared between CD and control groups. Receiver operator characteristic(ROC) analysis was performed to evaluate the diagnostic performance of each parameter. Results: ADC, D* and f values in CD group were significantly lower than those in control group (P<0.05). There was no statistically significant difference in D values between the two groups(P>0.05). The optimal cut-off value of ADC, D*, f for diagnosing CD were 1.00×10-3 mm2/s, 26.50×10-3 mm2/s, 40.4%, with the area under the ROC curves of 0.952, 0.726, 0.799, respectively. Conclusion: MRI intravoxel incoherent motion diffusion weighted imaging （IVIM-DWI） parameters, such as ADC, D*and f values, are helpful for diagnosis of active CD, and ADC value has the highest diagnostic performance. Figures and Tables | References | Related Articles | Metrics

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Correlation of spindle parameters of human mature oocytes with the outcomes of ICSI performed with mini-stimulation protocol HUANG Ya, WU Yunlong, XU Li, GE Fengju, CHEN Yaning, QI Xiujuan 2020, 19 (02):  162-167.  DOI: 10.16150/j.1671-2870.2020.02.012 Abstract ( 266 )   HTML ( 1 )   PDF (603KB) ( 99 )   Objective: To investigate correlation of human oocyte spindle and its retardant value with the outcome of embryo development after ICSI using mini stimulation protocol. Methods: A total of 354 patients placed on ICSI cycles were enrolled from December 2017 through June 2019, and the relevant clinical and laboratory data were retrieved and retrospectively analyzed. The rates of normal fertilization, cleavage, quality embryo, blastocyst formation and pregnancy were compared between individuals with and without visible spindle (SP+, SP- group). In SP+ group, The retardant value was calculated and compared between patients with normal and abnormal fertilization; cleavage and non-cleavage; quality and non-quality embryo; blastocyst formation and non-blastocyst formation; clinical pregnancy and non-clinical pregnancy. Results: The rates of normal fertilization, cleavage, quality embryo, blastocyst formation and clinical pregnancy in patients of SP+ group were significantly higher than those in SP- group （83.72% vs 72.22%, 98.14% vs 85.16%, 73.07% vs 62.50%, 50.67% vs 36.76%, 45.56% vs 27.27%, P<0.05）, while the rate of abnormal fertilization in SP+ group was lower（4.26% vs 16.11%, P<0.0001）. The spindle retardant value in patients with normal fertilization, cleavage, quality embryo and pregnancy were significantly higher than those without （2.01 vs 1.81, 2.03 vs 1.66, 2.03 vs 1.91, 2.20 vs 2.02、2.19 vs 2.01, P<0.05), however, there was no significant difference in spindle volume, area and spindle angle with the first polar body. With the increase of age in patients, the number of SP+ eggs obtained per patient decreased[<35 years old, 3.30; 35-40 years old, 2.91; ≥40 years old, 2.46] (P=0.025). Conclusion: ICSI using oocytes with visible spindle may enable higher rate of normal fertilization, cleavage, blastocyst formation and lower rate of abnormal fertilization. The embryos developed from oocytes with higher spindle retardant value could improve the clinical pregnancy rate. Figures and Tables | References | Related Articles | Metrics

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The clinical evaluation and optimization of alarm Threshold setting for Sysmex UF5000 UTI CHEN Chen, ZHANG Yue, HU Xiaobo 2020, 19 (02):  168-171.  DOI: 10.16150/j.1671-2870.2020.02.013 Abstract ( 446 )   HTML ( 6 )   PDF (471KB) ( 113 )   Objective: To explore and optimize the settings of alarm in Sysmex UF5000 urinary tract infection (UTI) system to assist the diagnosis of UTI. Methods: A total of 2 871 urine samples were collected and tested by Sysmex UF5000 urine sediment analyzer. The diagnostic accurate rate, sensitivity, and specificity of the default alarm threshold settings of the instrument for UTI were calculated regarding to the clinical diagnosis of UTI. The thresholds of white blood cell count (WBC) and bacterial count (BACT) were optimized to meet the local hospital need. Results: The accurate rate of instrumental alarm settings for diagnosing UTI was 70.61%, with a sensitivity of 94.23% and specificity of 70.61%. At the default setting, the diagnostic sensitivities of WBC (WBC>10/μL) and BACT (BACT>10/μL) were 94.23% and 94.12%, while specificities were 58.02% and 68.98%. The optimal cutoff values for WBC and BACT determined by ROC curve were 24.9/μL and 1 157.3/μL, respectively. However, when sensitivities of WBC and BACT were set as 95%, the specificities of both parameters were 56.8% and 57.01%, yielding the cut-off values as 26.7/μL and 60.1/μL, respectively. Clinical validation showed that best sensitivity and specificity of the system was achieved(sensitivity 93.34%, specificity 71.17%) when the WBC and BACT were reset at 26.7/μL and 1 157.3/μL, respectively. Conclusion: Optimized the alarm threshold of the Sysmex UF5000 achieve higher sensitivity and specificity, assisting rapid diagnosis of clinical UTI. Figures and Tables | References | Related Articles | Metrics

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The pre-operative CT parameters and perioperative manangement of pheochromocytoma MA Wenming, LI Qiang, ZHUO Ran, MAO Yongxin, DAI Jun, LUO Yan, SUN Fukang 2020, 19 (02):  172-176.  DOI: 10.16150/j.1671-2870.2020.02.014 Abstract ( 342 )   HTML ( 1 )   PDF (521KB) ( 64 )   Objective: To explore the value of pre-operative CT scanning for preoperative, intraoperative, and postope-rative evaluation of patients with pheochromocytoma. Methods: A total of 164 patients with pheochromocytoma were enrolled from January 2014 through April 2019. Correlation of pre-operative CT imaging parameters product of enhanced CT value in the lesion and tumor size (EV) with levels of preoperative metanephrine (MN) and normetanephrine (NMN), loss of intraoperative blood, postoperative complications were analyzed. Results: Both pre-operative NMN and MN were positively correlated with EV (P<0.001, P=0.001). Multivariate analysis showed that NMN was an independent factor for increment of EV(P=0.001). EV had a significant positive correlation with intraoperative dosage of phentolamine (P<0.001) and blood loss (P<0.001). Receiver operator characteristic (ROC) curve analysis showed that when EV was greater than 4 719.65 HU·cm3 (P<0.001, AUC=0.890), the risk of major intraoperative blood, defined as loss >800 mL, increased significantly. EV was positively correlated with incidence of postoperative complications (P<0.001). When EV was greater than 15 610.62 HU·cm3 (P<0.001, AUC=0.799), the risk of postoperative complications >Ⅱ significantly increased. Conclusions: CT-based imaging parameter EV is highly correlated with intraoperative phentolamine dosage, incidence of postoperative complications and levels of pre-operative NM, NMN. Pre-operative CT scanning might provide important information for preoperative preparation, intraoperative anesthesia and prevention of postoperative complications in the manangement of pheochromocytoma. Figures and Tables | References | Related Articles | Metrics

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Application of plastic-embedded bone marrow biopsy in diagnosing myelodysplastic syndrome with thrombocytopenia YE Chenglin, YAO Yonghua, CHEN Zhen, JIA Lin 2020, 19 (02):  177-181.  DOI: 10.16150/j.1671-2870.2020.02.015 Abstract ( 363 )   HTML ( 1 )   PDF (671KB) ( 109 )   Objective: To explorethe value of megakaryocyte immunolabeling performed on bone marrow biopsy section embedded in glycol-methacrylate (GMA) plastic in the diagnosis of myelodysplastic syndrome (MDS) with thrombocytopenia. Methods: Bone marrow biopsy samples acquired from 47 patients with thrombocytopenia were processed with glycol-methacrylate (GMA) embedding technique, and megakaryocyte immunolabeling were performed. Results: Bone marrow biopsy plastic embedded technology improved themorphologic diagnosis of MDS, and megakaryocyte immunolabeling enabled identification of the small or micor sized megakaryocyte. Out of the cases examined, 8 were diagnosed as myelodysplastic syndrome (MDS), including 3 cases of myelodysplastic syndrome-single lineage dysplasia (MDS-SLD), 1 case of 5q- syndrome and 4 cases of myelodysplastic syndrome-multilineage dysplasia (MDS-MLD). All of the 8 cases were positive for megakaryocyte markers, and 6 cases of them showed clear abnormal localization of immature precursor (ALIP) in the section, and 3 cases had chromosomal abnormalities detected. Conclusion: Combination of GMA plastic embedded technology and megakaryocyte immunolabeling facilitate the diagnosis of MDS with thrombocytopenia. Figures and Tables | References | Related Articles | Metrics

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Application of different tube voltage-current protocol in combination with KARL iterative reconstruction in CT chest scanning for novel coronavirus pneumonia screening CHANG Rui, YANG Yanzhao, KONG Deyan, XU Jiaxu, CAO Qiqi, YANG Wenjie, YAN Fuhua, DONG Haipeng 2020, 19 (02):  182-187.  DOI: 10.16150/j.1671-2870.2020.02.016 Abstract ( 425 )   HTML ( 1 )   PDF (798KB) ( 51 )   Objective: To explore application of different tube voltage-tube current scanning protocol in combination with KARL iterative reconstruction in CT chestscanning for coronavirus pneumonia screening. Methods: The study prospectively enrolled 120 patients with fever subjected to CT chest scanning, who were randomly assigned to groups exa-mined with different scanning protocols: 120 kV tube voltage and automatic tube current modulation with 60 mAs effective tube current (Group A); 120 kV tube voltage and 30 mA fixed tube current (Group B); 100 kV tube voltage and automatic tube current modulation with 60 mAs effective tube current (Group C); 100 kV tube voltage and 30 mA fixed tube current (Group D). The traditional FBP algorithm reconstruction and KARL iterative reconstruction were adopted in the study. The comprehensive image quality was evaluated subjectively based on noise and artifacts. Images reconstructed with FBP algorithm and KARL iterative reconstruction were compared by Wilcoxon test and Kruskal-Wallis test. The image noise within the regions of interest was measured, and the radiation dosage of each protocol in different groups was calculated. Radiation dosage and image noisefor each group were compared with t-test and ANOVA analysis. Results: The radiation dosage of group A, B, C, D were 2.5±0.4, 1.2±0.1, 1.6±0.2 and 0.8±0.1 mSv respectively. The lower tube voltage and tube current decreased the radiation dosage significantly (F=256.316, P<0.001). Image processed with KARL iterative reconstruction had lower noise and better subjective image quality than those treated with FBP reconstruction (P<0.05). At lower radiation dosage, the image acquired with tube voltage of 100 kV and a fixed tube current of 30 mA and processed by KARL iterative reconstruction achieved a score of 4.0 for overall subjective image quality. Conclusion: Compared with FBP reconstruction, KARL iterative reconstruction might reduce noise and improve image quality. With lower radiation dosage, the CT chest scanning protocol with a tube voltage of 100 kV and a fixed tube current of 30 mA in combination of KARL iterative reconstruction is optimum choice for novel coronavirus pneumonia screening. Figures and Tables | References | Related Articles | Metrics