ABSTRACT
Objective To study the imaging features and possible aetiology of osteonecrosis in adults with acute leukemia.Methods Ten adult patients with acute leukemia for osteonecrosis were reviewed retrospectively.All the lesions were confirmed with MRI.Results Four patients with ALL had accepted chemotherapy contained corticosteroids,two of them were performed HSCT,and one patient suffered GVHD.Six patients with AML had accepted chemotherapy without steroids,five of them were performed HSCT,and four patients suffered GVHD.One patient with AML-M3 had accepted chemotherapy including four courses of ATRA.The mean time between diagnosis of osteonecrosis and leukemia was 25.1 months.Nine cases had multiple lesions,one case had single lesion.The lesions involved femurs,tibias,patellas,iliums,and lumbars.Plain radiographs in six patients can not detect any lesion.Circinal reaction ossification could be detected in CT images of four cases.All the cases had typical feature in MRI.Conclusions In adult leukemia patients,osteonecrosis is a complication after chemotherapy or HSCT.Steroids in chemotherapy protocols or treatment for GVHD,ATRA for APML,chemotherapy-induced direct cytotoxic effect or leukemia itself can be the possible risk factor.For the diagnosis,MRI is the most effective way,and CT features of osteonecrosis in leukemia patients are different from those in non-leukemia patients.
ABSTRACT
Objective To investigate the changes of quantitative parameters of dynamic enhanced CT in non-small cell lung cancer before and after targeted therapy,and compare them with the traditional evaluation criteria,in order to find the parameters which can be exploited for timely,objective evaluation of the effect of targeted therapy.Methods The study included 21 patients with targeted therapy who had received dynamic enhanced CT before and after treatment.Enhancement time-density curves were obtained based on the CT values of the lesion at individual time points,and the functional indices:peak height (PH),the time to peak height (Tp),the ratio of PH of the mass to aorta (M/A) and perfusion value were calculated.The effects of the treatment on these indices were evaluated and compared with the effect of the treatment on lesion diameter. Results Twenty-one patients had 33 rechecking results. There was a statistically significant agreement between lesion diameter-based treatment evaluation and perfusion-based treatment evaluation ( U =8.761,P ＜ 0.01 ). The perfusion value decreased in patients with disease regression[before treatment:(0.28 ±0.11 ) ml · min-1 · ml-1,after targeted therapy(0.18 ±0.09) ml ·min-1 · ml-1,t =- 3.2722,P =0.0042],but increased in patients with disease progression[before treatment(0.21 ±0.08) ml · min-1 · ml-1,after targeted therapy:(0.34 ±0.11 ) ml · min-1 · ml-1,t =2.6064,P =0.0403].Conclusions On dynamic enhanced CT in non-small cell lung cancer patients after targeted therapy,perfusion value changed in the same trend as the diameter of tumor.The effectiveness of targeted therapy may be evaluated by perfusion value changes.
ABSTRACT
Objective To investigate the spiral CT findings in hemopathic patients with druginduced pulmonary injury.Methods CT images obtained in 11patients with drug-induced pulmonary injury were retrospectively analyzed.Six patients had antineoplastic agent-induced pulmonary injury and 5 patients had non-neoplastic agent-induced pulmonary injury (immunosuppressor in 2 patients,antifungal in 2 patients,antineoplastic immunomodulators in 1 patient).CT findings were reviewed by a chest radiologist.Results All 11patients had parenchymal abnormalities on MSCT scans,including ground-glass opacities( n =8 ),consolidation( n =5 ),interlobular septal thickening( n =3 ) and focal fibrosis ( n =2 ).The abnormalities were bilateral and asymmetric in all patients.They were mainly in the peripheral lung regions in 6 patients,in the central lung regions in four,and irregularly located in one.The abnormalities involved mainly the lower lung zones in six patients,the upper lung zones in two,and all lung zones homogeneously in three.One patient had fluid in bilateral pleural cavities.Three patients were given the same agent once more after the imaging turned to normal,and they presented with same clinical symptoms and similar but more serious imaging findings.Conclusions Drug-induced pulmonary injury usually manifests as areas of ground-glass opacity and consolidation,which most commonly involves the peripheral lungs and lower lung zones.Drug-induced pulmonary injury shows reproducible but more serious lesions when the patient is given the same agent once more.