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BACKGROUND@#Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia.@*METHODS@#In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared.@*RESULTS@#A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94-0.99), 0.93 (95% CI: 0.85-0.98), and 0.94 (95% CI: 0.87-0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63-0.83), 0.72 (95% CI: 0.62-0.82), and 0.73 (95% CI: 0.62-0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers' interpretation and clinical factor model ( P <0.05).@*CONCLUSIONS@#The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.
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Humans , Retrospective Studies , Pneumonia/diagnostic imaging , Analysis of Variance , Tomography, X-Ray Computed , Lymphoma/diagnostic imagingABSTRACT
Objective:To investigate the effect of Astragaloside Ⅳ on abdominal aorta constriction-induced cardiac hypertrophy by activating the nuclear factor E2-related factor 2/heme oxygenase-1(Nrf2/ HO-1)signaling pathway, so as to improve cardiac function.Methods:From Sep.2017 to Jan.2019, 40 male SD rats were selected and abdominal aortic constriction(AAC)was used to establish a rat model of chronic heart failure.Rats were divided into three ACC groups: the model group, the benazepril HCl group and the Astragaloside Ⅳ group, plus the sham operation group.Rats in the benazepril HCl and Astragaloside Ⅳ groups were given 10 mg·kg -1·d -1 benazepril HCl and 50mg·kg -1·d -1 Astragaloside Ⅳ respectively by gavage, and the sham operation group and the model group were given normal saline of the same volume by gavage.After 8 weeks of treatment, cardiac structure and functional parameters were examined using cardiac color doppler ultrasound, while hemodynamics and morphological changes of myocardial cells were detected by immunofluorescence, serum brain natriuretic peptide(BNP)levels were detected by an enzyme-linked immunosorbent assay(ELISA), and Nrf2 and HO-1 mRNA expression in myocardial tissues were detected by reverse transcription-quantitative real-time PCR(RT-qPCR). Results:Compared with the sham operation group, the ratio of heart weight to femoral neck length(495.47±12.38), the ratio of heart weight to body weight(6.44±0.18), left ventricular end-diastolic diameter(LVEDD)(4.72±0.04 mm), left ventricular posterior wall thickness(LVPWT)(1.87±0.03)mm and the BNP level(151.61±5.67)mmol/L all increased( P<0.05), but the expression of mRNA Nrf2(0.36±0.02)and HO-1(0.27±0.02)decreased( P<0.01)in the model group.Compared with the model group, the ratio of heart weight to femoral neck length(261.88±12.97 and 286.40±12.56), the ratio of heart weight to body weight(3.38±0.13 and 3.71±0.15), left ventricular end-diastolic diameter(5.84±0.05)mm and (6.01±0.10)mm, left ventricular posterior wall thickness[(1.57±0.03)mm and(1.64±0.03)mm]and the BNP level[(99.40±4.97)mmol/L and(120.66±5.80)mmol/L]all decreased( P<0.05), but the mRNA expression of Nrf2(1.06±0.01 and 1.04±0.01)and HO-1(1.08±0.06 and 0.95±0.02)increased in the benazepril HCl and Astragaloside Ⅳ groups, respectively( P<0.01). Conclusions:Astragaloside Ⅳ has an effect of anti-oxidative stress, can inhibit heart failure and improve cardiac function, and its mechanisms may be related to the Nrf2/ HO-1 signaling pathway.
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Objective ToanalyzetheCTfeaturesandthediagnosticvalueofpulmonarychondroma.Methods Tencasesofpulmonary chondromaprovenbypathologywereretrospectivelyanalysed.Thenumber,location,size,shape,margin,calcificationpatternandCT valueofthelesions wereanalysedonnonGenhancedandenhanced CTscans.Results Allthe10casesofpulmonarychondroma showedsolitary,mildlylobulated,wellGcircumscribed masses.6lesionswerelocatedintherightlung,and4lesionswereintheleft lung.Thesizeofthelesionsrangedform1.3cm×0.8cmto10.7cm×9.8cm.OnplainCTimages,9lesions(90%)showedvaried calcification,withpunctatecalcificationin8lesionsandringcalcificationin1lesion.OncontrastGenhanced CTimages,6lesions showedslighthomogeneousenhancement(enhancedvalue≤14HU).Conclusion Pulmonarychondromaisusuallylocatedintheperiphery ofthelung.Thenodulehasasmoothboundary,withsignificantcalcificationandslightlyenhancement,whichcouldbehelpfulindiagnosis ofthedisease.
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Objective To analyze the spatial point pattern distribution characteristics of hemorrhagic fever with renal syndrome (HFRS) in Jingzhou city, Hubei province during the two seasons spring- summer and autumn-winter of 2017, to discuss its high incidence area and reason, and to provide basis for the resource allocation of public health. Methods The analytical data was collected from Infectious Disease Reporting Information System in China, and the spring-summer season was from March to August of 2017, while the autumn-winter was from the September of 2017 to the February of 2018. The Ripley's K-function and kernel density estimation were applied to analyze the spatial point pattern distribution and compare the distribution characteristics of spatial point pattern between the two seasons. Results In 2017, 133 cases of HFRS were reported in Jingzhou city, including the spring- summer and autumn-winter two pick incidences. The strongest aggregation distance was 17.77km in spring-summer season, and 14.40 km in autumn-winter season. The spatial gathering center was located in the north of Jianli County in spring-summer, and it moved to the south of Jiangling County and Shashi District in autumn-winter. Conclusions The key areas for the prevention and control of HFRS in Jingzhou City are Jiangling County, the southern part of Shashi District and the northern part of jianli county. The key groups are the residents of the urban-rural junction in the southern part of Shashi City, residents along the route of large-scale projects, and farmers engaged in agricultural planting or crayfish breeding in the gathering areas.
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Objective@#To study the segment of liver according to the large amount of three-dimensional(3D) reconstructive images of normal human livers and the vascular system, and to recognize the basic functional liver unit based on the anatomic features of the intrahepatic portal veins.@*Methods@#The enhanced CT primitive DICOM files of 1 260 normal human livers from different age groups who treated from October 2013 to February 2017 provided by 16 hospitals were analyzed using the computer-aided surgery system.The 3D liver and liver vascular system were reconstructed, and the digital liver 3D model was established.The vascular morphology, anatomical features, and anatomical distributions of intrahepatic portal veins were statistically analyzed.@*Results@#The digital liver model obtained from the 3D reconstruction of CAS displayed clear intrahepatic portal vein vessels of level four.Perform a digital liver segments study based on the analysis of level four vascular distribution areas.As the less anatomical variation of left hepatic portal vein, the liver was classified into four types of liver segmentation mainly based on right hepatic portal vein.Type A was similar to Couinaud or Cho′s segmentation, containing 8 segments(537 cases, 42.62%). Type B contained 9 segments as there are three ramifications of right-anterior portal vein(464 cases, 36.82%). The main difference for Type C was the variation of right-posterior portal vein which was sector shape(102 cases, 8.10%). Type D contained the cases with special portal vein variations, which needs three-dimensional simulation to design individualized liver resection plan(157 cases, 12.46%). These results showed that there was no significant difference in liver segmental typing between genders(χ2=2.179, P=0.536) and did not reveal any significant difference in liver segmental typing among the different age groups(χ2=0.357, P=0.949).@*Conclusions@#The 3D digital liver model can demonstrate the true 3D anatomical structures, and its spatial vascular variations.The observation of anatomic features, distribution areas of intrahepatic portal veins and individualized liver segmentation achieved via digital medical 3D visualization technology is of great value for understand the complexity of liver anatomy and to guide the precise hepatectomy.
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Objective To assess the integrity and standardization of structured MRI report for rectal cancer of the affiliated hospital of qingdao university,referring to National Comprehensive Cancer Network (NCCN) guidelines for colorectal cancer (Version 2015)and foreign authoritative research results,and put forward some suggestions to improve the quality.Methods A total of 110 structured MRI reports of 107 patients with rectal cancer were included in the study.The inclusion rates of 8 indexes were evaluated,including tumor site,distance from upper to lower border of tumor (DIS),tumor invasive depth (T staging),anal complex staging (A staging),nodal staging (N staging),the circumferential resection margin (CRM),extramural vascular invasion (EMVI) and metastases staging (M staging),which were compared with research results of structured reports in abroad by using Pearson chi-square test.Results There was a significant difference in the description of N staging (x2 =8.424,P＜0.05) between our research and foreign study,in 110 structured MRI reports.There was no significant difference in the description of tumor site (x2 =0.00,P＞0.05),DIS (x2 =0.041,P ＞0.05),T staging (x2 =3.256,P＞0.05) and CRM(x2 =2.957,P＞0.05) between the two groups.A staging,EMVI and M staging were not described.Conclusion Our structured MRI reports for rectal cancer basically meet international research standards.Structured MRI reports have advantages,and deserve to be further studied and promoted.
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Objective To compare the accuracy, image quality and radiation dose between prospective ECG?gated sequential and high?pitch acquisition on 128?slice dual?source CT (DSCT) angiography in infants and children with congenital heart disease (CHD). Methods Ninety?two children with CHD from October 2011 to February 2013 were prospectively enrolled and assigned into two groups according to random number table. Forty?six patients underwent DSCT angiography with sequential mode, and the other 46 patients were examined with high?pitch mode. With surgical and/or DSA results as the standard, the diagnostic accuracy and sensitivity of the two groups for the intracardiac structures, extracadiac and coronary artery anomalies were evaluated, and the comparison was analyzed by Fisher exact test. A 5?grade scoring system was used to interpret the image quality of intracardiac structures, great vessels and the proximal and middle segments of coronary arteries. Interobserver agreement on grades of image quality was assessed by Kappa statistics. The image quality scores were compared using the Mann?Whitney U test. The Student t test or the Mann?Whitney U test was used to analyze the differences between the two groups regarding to patients' age, weight , heat rate, CT attenuation, image noise and SNR in the ascending aorta and the pulmonary trunk as well as radiation dose. Results All 92 patients successfully underwent DSCT angiography. The diagnostic accuracies of intracardiac anomalies by high?pitch group and sequential group were 95.65%(88/92) and 99.28%(274/276), showed significant difference between the two groups (P0.05) .There was no significant difference in the diagnostic accuracy and sensitivity of extracadiac anomalies between the two groups (P>0.05). The diagnostic accuracies of coronary artery anomalies by high?pitch group and sequential group were 93.48%(43/46) and 100.00%(46/46), showed no significant difference between the two groups (P>0.05), but there was significant difference in the sensitivity of coronary artery anomalies (50.00%(3/6) , 100.00% (11/11)) (P0.05). The median image quality scores of intracardiac structures and proximal and middle segments of coronary arteries respectively by high?pitch group were 4.00 and 3.00, and 5.00 and 4.00 respectively by sequential group. The image quality of intracardiac structures (U=594.500, P<0.05) and proximal and middle segments of coronary arteries (U=397.500, P<0.05) was significantly better in the sequential group than that in the high?pitch group. There was no significant difference between the two groups in CT attenuation, noise and SNR of the ascending aorta and pulmonary trunk. The mean effective doses of the high?pitch group and the sequential group were(0.27±0.11)and(0.39±0.17)mSv, and showed significant difference between the two groups (t=4.316, P<0.05). Conclusions Both sequential and high?pitch mode of 128?slice DSCT angiography provide high accuracy for the assessment of CHD in infants and children, while the high?pitch mode, though with some image quality declined, shows further significantly lower radiation dose.
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<p><b>BACKGROUND</b>Accurate assessment of intra- as well as extra-cardiac malformations and radiation dosage concerns are especially crucial to infants and children with interrupted aortic arch (IAA). The purpose of this study is to investigate the value of prospective electrocardiogram (ECG)-triggered dual-source computed tomography (DSCT) angiography with low-dosage techniques in the diagnosis of IAA.</p><p><b>METHODS</b>Thirteen patients with suspected IAA underwent prospective ECG-triggered DSCT scan and transthoracic echocardiography (TTE). Surgery was performed on all the patients. A five-point scale was used to assess image quality. The diagnostic accuracy of DSCT angiography and TTE was compared with the surgical findings as the reference standard. A nonparametric Chi-square test was used for comparative analysis. P <0.05 was considered as a significant difference. The mean effective radiation dose (ED) was calculated.</p><p><b>RESULTS</b>Diagnostic DSCT images were obtained for all the patients. Thirteen IAA cases with 60 separate cardiovascular anomalies were confirmed by surgical findings. The diagnostic accuracy of TTE and DSCT for total cardiovascular malformations was 93.7% and 97.9% (P > 0.05), and that for extra-cardiac vascular malformations was 92.3% and 99.0% (P < 0.05), respectively. The mean score of image quality was 3.77 ± 0.83. The mean ED was 0.30 ± 0.04 mSv (range from 0.23 mSv to 0.39 mSv).</p><p><b>CONCLUSIONS</b>In infants and children with IAA, prospective ECG-triggered DSCT with low radiation exposure and high diagnostic efficiency has higher accuracy compared to TTE in detection of extra-cardiac vascular anomalies.</p>
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Female , Humans , Infant , Infant, Newborn , Male , Aorta, Thoracic , Diagnostic Imaging , Pathology , Coronary Angiography , Methods , Electrocardiography , Methods , Radiation DosageABSTRACT
Objective To explore the clinical value of prospective electrocardiography-triggering high-pitch spiral acquisition by dual-source CT (HP mode ) in children with congenital heart diseases (CHD).MethodsThirty-six patients ( mean age:0.67 years,range:1 month to 2 years and 6 months; 25 males;mean weight:7.7 kg)underwent prospective ECG-triggering high-pitch spiral acquisition.The dose length product (DLP) was recorded to calculate effective dose ( ED ).Two experienced radiologists made diagnosis and assessed the overall image quality by a five-point scale independently.The consistency of their judgment was determined by Kappa statistics.Surgeries were performed in 29 patients,and conventional cardiac angiography(CCA) was performed in 7 patients.The accuracy,sensitivity and specificity of HP mode were calculated based on the surgical or CCA findings.ResultsThe DLP was (5.12 ± 1.64) mGy.cm with a range of 2.4 mGy · cm to 9.2 mGy · cm and ED was (0.125 ± 0.027 ) mSv ranging from 0.078 mSv to 0.179 mSv.The average subjective image quality score was 4.2 ± 0.7.All images were diagnosable.Two radiologists made good agreement ( K =0.774,P ＜ 0.05 ).The accuracy,sensitivity and specificity of HP mode were 98.9％,94.2％ and 99.8％,respectively.ConclusionLow radiation dose with the accurate diagnosis of anomalies makes HP mode a new choice for children with CHD.
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ObjectiveTo investigate the value of prospective ECG-gated dual-source CT (DSCT)in the diagnosis of coarctation of aorta ( CoA ).MethodsSixteen patients clinically suspected of CoA underwent prospective ECG-gated DSCT angiography and color Doppler flow imaging (CDFI). The diagnostic accuracy of DSCT and CDFI were compared according to the results of operation or DSA.The nonparametric chi-square test was used for the statistics.ResultsSixteen patients were diagnosed as CoA by DSCT,4 were complicated with artial septal defect (ASD),9 with ventricular septal defect (VSD),1 with transposition of the great arteries,3 with dysplasia of aortic arch,7 with patent ductus arteriosus (PDA),1 with abnormal origin of the coronary artery, 1 with bronchus artery dilation. Fifteen patients were diagnosed as CoA by CDFI,1 was diagnosed as interruption of aortic arch. Four were complicated with ASD,9 with VSD,2 with bicuspid aortic valve (BAV),1 with transposition of the great arteries,2 with dysplasia of aortic arch,7 with PDA,1 with bronchus artery dilation.Abnormal origin of the coronary artery was not found.The diagnostic accuracy of DSCT and CDFI were 97.2％ ( 140/144)and 97.9％ (141/144)respectively,there was no significant difference (x2 =0.00,P ＞ 0.05 ).The sensitivity of DSCT and CDFI were both 93.2％ ( 41/44 ),the specificity were 99.0％ (99/100) and 100.0％ (100/100).The mean effective radiation dose was 0.42 mSv. Conclusion Prospective ECG-gated DSCT is a good imaging technique for the diagnosis of aortic coarctation in children.
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Objective To explore the application of low-dose prospective ECG-triggering dualsource CT (DSCT) angiography in infants and children with Kawasaki disease (KD).MethodsNineteen children diagnosed of Kawasaki disease underwent low-dose prospective ECG- triggering DSCT angiography (DSCTA) with free breathing and transthoracic echocardiogram (TTE).The overall imaging quality was graded on a five-point scale. Interobserver agreement in subjective image quality grading was assessed by Kappa statistics.The location,number and size of the aneurysms and dilations were recorded and compared with those of TTE.Pearson correlation analysis was used to evaluate the agreement on measurements between DSCTA and TTE.The average effective dose of DSCTA in all 19 children was calculated.ResultsDSCTA was performed successfully in all 19 children.A total of 91.5 ％ (226/247) segments permitted visualization with diagnostic image quality. Fifteen patients were diagnosed with coronary artery lesions. A total of 28 aneurysms and 15 arterial aneurysmal dilations were detected by DSCTA,while 19 aneurysms and 13 arterial aneurysmal dilations were found by TTE.TTE failed to detect 9 aneurysms (2 in the distal right coronary artery,2 in the posterior descending artery,1 in the middle of left anterior descending artery,1 in the middle of left circumflex artery,2 in the distal of LCX and 1 in the obtuse marginal branch)and 2 arterial aneurysmal dilations (1 at the diagonal branch and 1 at obtuse marginal branch). The concordance of DSCTA and TTE in measurement of diameter and length of these aneurysms and aneurysmal dilatations are good (0.63 ± 0.20) and (0.58 ± 0.20) cm vs ( 1.49 ± 0.83 ) and ( 1.22 ± 0.66) cm ( r =0.989 and 0.965,P ＜ 0.05 ).There was a good agreement on overall image quality ( Kappa =0.87 ). The mean effective dose was(0.24 ± 0.08) mSv.ConclusionProspective ECG-triggering DSCTA with very low effective radiation dose is safe,reliable and more sensitive than TTE on diagnosing of coronary artery lesions,especially in the distal lesions,in infants and children with KD.