diff --git a/IRaCIS.Core.Application/Service/ReadingCalculate/Dto/CriterionCalculateDto.cs b/IRaCIS.Core.Application/Service/ReadingCalculate/Dto/CriterionCalculateDto.cs
index 181920845..adcca1fe9 100644
--- a/IRaCIS.Core.Application/Service/ReadingCalculate/Dto/CriterionCalculateDto.cs
+++ b/IRaCIS.Core.Application/Service/ReadingCalculate/Dto/CriterionCalculateDto.cs
@@ -22,6 +22,11 @@ namespace IRaCIS.Core.Application.ViewModel
 
 	}
 
+    public class GetSplitPPdInDto
+    {
+		public Guid RowId { get; set; }
+	}
+
 	public class ReadingTaskQuestionAnswerDto : ReadingTaskQuestionAnswer
     {
         public QuestionType QuestionType { get; set; }
diff --git a/IRaCIS.Core.Application/Service/ReadingCalculate/LuganoCalculateService.cs b/IRaCIS.Core.Application/Service/ReadingCalculate/LuganoCalculateService.cs
index 7e4d51382..8c0d89da3 100644
--- a/IRaCIS.Core.Application/Service/ReadingCalculate/LuganoCalculateService.cs
+++ b/IRaCIS.Core.Application/Service/ReadingCalculate/LuganoCalculateService.cs
@@ -13,6 +13,7 @@ using MassTransit;
 using System.Reflection.Metadata.Ecma335;
 using System.Linq;
 using NPOI.SS.Formula.Functions;
+using DocumentFormat.OpenXml.Drawing.Charts;
 
 namespace IRaCIS.Core.Application.Service.ReadingCalculate
 {
@@ -885,19 +886,106 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
                     var stateQuestion = await _readingTableQuestionTrialRepository.Where(x => x.ReadingQuestionId == targetQuestion.Id && x.QuestionMark == QuestionMark.State).FirstOrDefaultAsync();
                     if (stateQuestion != null)
                     { 
+
+                        // 找到主病灶的状态
                         var state =await _readingTableQuestionAnswerRepository.Where(x=>x.VisitTaskId==inDto.VisitTaskId&&x.RowIndex== (int)Math.Floor(inDto.RowNumber)&&x.TableQuestionId== stateQuestion.Id).Select(x=>x.Answer).FirstOrDefaultAsync();
 
+                        // 长径
+						var majorAxis = (await _readingTableQuestionAnswerRepository.Where(x => 
+                        x.VisitTaskId == inDto.VisitTaskId && 
+                        x.RowIndex == (int)Math.Floor(inDto.RowNumber) && 
+                        x.ReadingTableQuestionTrial.QuestionMark == QuestionMark.MajorAxis &&
+                        x.QuestionId== targetQuestion.Id
+						).Select(x => x.Answer).FirstOrDefaultAsync()).IsNullOrEmptyReturn0();
+
+						// 短径
+						var shortAxis = (await _readingTableQuestionAnswerRepository.Where(x =>
+						x.VisitTaskId == inDto.VisitTaskId &&
+						x.RowIndex == (int)Math.Floor(inDto.RowNumber) &&
+						x.ReadingTableQuestionTrial.QuestionMark == QuestionMark.ShortAxis &&
+						x.QuestionId == targetQuestion.Id
+						).Select(x => x.Answer).FirstOrDefaultAsync()).IsNullOrEmptyReturn0();
+
 						// 找到ppd问题
 						var ppdQuestion = await _readingTableQuestionTrialRepository.Where(x => x.ReadingQuestionId == targetQuestion.Id && x.QuestionMark == QuestionMark.PPD).FirstOrDefaultAsync();
 
                         if(ppdQuestion!=null)
                         {
-                            var ppdAnswerList= await _readingTableQuestionAnswerRepository.Where(x => x.VisitTaskId == inDto.VisitTaskId  && x.TableQuestionId == stateQuestion.Id)
-                                .Where(x=>  x.RowIndex >= (int)Math.Floor(inDto.RowNumber) && x.RowIndex< ((int)Math.Floor(inDto.RowNumber)+1))
-                                .Select(x => x.Answer).ToListAsync();
+                            var ppdAnswerList= await _readingTableQuestionAnswerRepository.Where(x =>
+                               x.VisitTaskId == inDto.VisitTaskId &&
+							   x.ReadingTableQuestionTrial.QuestionMark == QuestionMark.PPD &&
+						       x.QuestionId == targetQuestion.Id &&
+							   x.RowIndex >= (int)Math.Floor(inDto.RowNumber) && x.RowIndex < ((int)Math.Floor(inDto.RowNumber) + 1)
+							   ).Select(x => x.Answer).ToListAsync();
 
                             var allPPd = ppdAnswerList.Select(x => x.IsNullOrEmptyReturn0()).Sum();
 
+                            // 是否符合疾病进展
+                            var accord = false;
+
+                            var lowPPDInfo = await GetLowPPDInfo(new GetPPDInfoInDto()
+                            {
+                                RowIndex = (int)Math.Floor(inDto.RowNumber),
+                                VisitTaskId = inDto.VisitTaskId,
+                                QuestionId = inDto.QuestionId,
+                            });
+
+                         
+                            if (lowPPDInfo.NadirPPD != 0)
+                            {
+                                //15mm < 当前靶病灶LDi≤20mm  &&
+                                //&& 相比最低点PPD增加百分比 ≥50％  &&
+                                //(相比PPD最低点LDi增加值 ≥5 mm
+                                //or相比PPD最低点SDi增加值≥5 mm)
+                                if (15 < majorAxis && majorAxis <= 20 &&
+                                    (allPPd - lowPPDInfo.NadirPPD) * 100 / lowPPDInfo.NadirPPD >= 50 &&
+                                    (majorAxis - lowPPDInfo.LowPPDLDi >= 5 ||
+                                    shortAxis - lowPPDInfo.LowPPDSDi >= 5)
+                                    )
+                                {
+                                    accord = true;
+								}
+
+								//当前靶病灶LDi>20 mm
+								//相比最低点PPD增加百分比 ≥50％
+								//	(相比PPD最低点LDi增加值 ≥10 mm
+								//  或者相比PPD最低点SDi增加值Sdi ≥10 mm)
+								if ( majorAxis > 20 &&
+									(allPPd - lowPPDInfo.NadirPPD) * 100 / lowPPDInfo.NadirPPD >= 50 &&
+									(majorAxis - lowPPDInfo.LowPPDLDi >= 10 ||
+									shortAxis - lowPPDInfo.LowPPDSDi >= 10)
+									)
+								{
+									accord = true;
+								}
+
+							}
+
+                            // 符合疾病进展
+                            if (accord)
+                            {
+                                await _readingTableQuestionAnswerRepository.UpdatePartialFromQueryAsync(x =>
+                                x.VisitTaskId == inDto.VisitTaskId &&
+                                x.RowIndex == (int)Math.Floor(inDto.RowNumber) &&
+                                x.ReadingTableQuestionTrial.QuestionMark == QuestionMark.State &&
+                                x.QuestionId == targetQuestion.Id, x => new ReadingTableQuestionAnswer()
+                                {
+                                    Answer = TargetState.DiseaseProgression.GetEnumInt()
+                                }
+                                );
+                            }
+                            else if (state == TargetState.DiseaseProgression.GetEnumInt())
+                            {
+								await _readingTableQuestionAnswerRepository.UpdatePartialFromQueryAsync(x =>
+									x.VisitTaskId == inDto.VisitTaskId &&
+									x.RowIndex == (int)Math.Floor(inDto.RowNumber) &&
+									x.ReadingTableQuestionTrial.QuestionMark == QuestionMark.State &&
+									x.QuestionId == targetQuestion.Id, x => new ReadingTableQuestionAnswer()
+									{
+										Answer = TargetState.Exist.GetEnumInt()
+									}
+									);
+							}
 
 
 						}
@@ -910,6 +998,28 @@ namespace IRaCIS.Core.Application.Service.ReadingCalculate
         }
 
 
+        /// <summary>
+        /// 获取分裂病灶的PPd之和 不包括当前的主病灶
+        /// </summary>
+        /// <returns></returns>
+        [HttpPost]
+        public async Task<decimal> GetSplitPPdSum(GetSplitPPdInDto inDto)
+        {
+            var rowinfo = await _readingTableAnswerRowInfoRepository.Where(x => x.Id == inDto.RowId).FirstNotNullAsync();
+
+
+			var ppdAnswerList = await _readingTableQuestionAnswerRepository.Where(x =>
+							x.VisitTaskId == rowinfo.VisitTaskId &&
+							x.ReadingTableQuestionTrial.QuestionMark == QuestionMark.PPD &&
+							x.QuestionId == rowinfo.QuestionId &&
+							x.RowIndex > (int)Math.Floor(rowinfo.RowIndex) && x.RowIndex < ((int)Math.Floor(rowinfo.RowIndex) + 1)
+							).Select(x => x.Answer).ToListAsync();
+
+			var allPPd = ppdAnswerList.Select(x => x.IsNullOrEmptyReturn0()).Sum();
+
+            return allPPd;
+		}
+
 		#region 将上一次的访视病灶添加到这一次
 
 		/// <summary>