Short-term efficacy of CT-guided microwave ablation for solitary pulmonary nodules / 中国胸心血管外科临床杂志

@#Objective    To evaluate the clinical feasibility and safety of CT-guided percutaneous microwave ablation for peripheral solitary pulmonary nodules. Methods    The imaging and clinical data of 33 patients with pulmonary nodule less than 3 cm in diameter treated by CT-guided microwave ablation treatment (PMAT) in our hospital from July 2018 to December 2019 were retrospectively analyzed. There were 21 males and 12 females aged 38-90 (67.6±13.4) years. Among them, 26 patients were confirmed with lung cancer by biopsy and 7 patients were clinically considered as partial malignant lesions. The average diameter of 33 nodules was 0.6-3.0 (1.8±0.6) cm. The 3- and 6-month follow-up CT was performed to evaluate the therapy method by comparing the diameter and enhancement degree of lesions with 1-month CT manifestation. Short-term treatment analysis including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) was calculated according to the WHO modified response evaluation criteria in solid tumor (mRECIST) for short-term efficacy evaluation. Eventually the result of response rate (RR) was calculated. Progression-free survival was obtained by Kaplan–Meier analysis. Results    CT-guided percutaneous microwave ablation was successfully conducted in all patients. Three patients suffered slight pneumothorax. There were 18 (54.5%) patients who achieved CR, 9 (27.3%) patients PR, 4 (12.1%) patients SD and 2 (6.1%) patients PD. The short-term follow-up effective rate was 81.8%. Logistic analysis demonstrated that primary and metastatic pulmonary nodules had no difference in progression-free time (log-rank P=0.624). Conclusion    PMAT is of high success rate for the treatment of solitary pulmonary nodules without severe complications, which can be used as an effective alternative treatment for nonsurgical candidates.

Hepatic long-term metastatic malignant insulinoma: one case report and literature review / 中华内分泌代谢杂志

This article reported a case of malignant insulinoma which recurred as liver metastasis 12 years after the initial pancreatic insulinoma resection. The patient was a 48-year-old woman who was firstly diagnosed as pancreatic insulinoma in 2006 and underwent the surgery involved complete resection of a 1.9 cm×1.3 cm tumor located in pancreas. No signs of either invasion or metastasis was detected according to preoperative imaging examination and intraoperative exploration. The tumor was diagnosed as a benign insulinoma according to histopathological results. The patient had no hypoglycemia and the fasting blood glucose was normal during the subsequent 12 years. The patient underwent a fasting blood glucose of 2.8 mmol/L in 2018, and gradually experienced palpitation and cold sweats, which was relieved by eating. She was hospitalized in May 2018 with blood glucose of 1.73 mmol/L and insulin of 1 128 pmol/L. CT and MRI revealed morphologic changes of postoperative pancreas and abnormal liver signal, the liver tumor was finally identified as insulinoma by modified selective intra-arterial calcium stimulated venous sampling (ASVS). Partial liver resection was performed and the histopathological result was neuroendocrine tumor. Therefore, the disease was diagnosed as liver metastatic malignant insulinoma.

Construction of human-computer dialogue teaching and examination system for medical imaging under the guidance of post competence / 中华医学教育探索杂志

With the rapid development of medical imaging technology, there are many corresponding kinds of medical images. The traditional teaching and examination mode based on typical images cannot meet the needs of medical imaging teaching. Therefore, we took the post competence of medical imaging students as the guidance, integrated multidisciplinary medical image resources, and established the human-computer dialogue teaching and examination system for medical images. The system was applied to medical imaging teaching and examination, achieving the standardization and clinical simulation of teaching and examination, and effectively improving the post competence of students.

Comparative study of StarGVIBE and VIBE sequences in MRI of esophagus / 实用放射学杂志

Objective To explore the feasibility of the Star-VIBE sequence in esophageal MRI,and compare it with the conventional VIBE sequence.Methods Fifteen healthy volunteers underwent Star-VIBE and VIBE sequences scanning after injecting MRI contrast agent.Two groups of MR images were independently scored in the ability to display esophageal wall,respiratory motion artifacts,cardiovascular pulsation artifacts,overall motion artifacts and overall image quality by the two radiologists,respectively.SNR of esophagus,CNR between esophagus and paravertebral muscles were measured and compared.Results Star-VIBE was superior to VIBE in the ability to display esophageal wall,respiratory motion artifacts,cardiovascular pulsation artifacts,overall motion artifacts and overall image quality (the ability to display esophageal wall:Z＝－3.268,P＝0.001;respiratory motion artifacts:Z＝－3.205,P＝0.001;cardiovascular pulsation artifacts:Z＝－4.644, P＝0.000;overall motion artifacts:Z＝－3.904,P＝0.000;overall image quality:Z＝－2.808,P＝0.005),while no significant differences were found on SNR and CNR between the two sequences (SNR:t＝－1.5 3 9 ,P＝0.1 3 5 ;CNR:t＝－0.874,P＝0.3 89 ).Conclusion The Star-VIBE sequence is insensitive to the physiological motion artifacts,and it can provide better image quality than the conventional VIBE sequence in esophageal MRI.

CT differentiation of poor-differentiated gastric neuroendocrine carcinomas from poor-differentiated gastric adenocarcinomas / 实用放射学杂志

Objective To compare the CT findings of poor-differentiated gastric neuroendocrine carcinomas (PD-NECs) and poordifferentiated gastric adenocarcinomas (PD-ADCs),and to increase the diagnostic accuracy rate.Methods In this retrospective study that enrolled 29 gastric PD-NECs and 29 gastric PD-ADCs,whose diagnoses were proven pathologically,we assessed their clinical characteristics and CT findings and then used univariate and multivariate analyses for statistical comparisons.Results The univariate analysis revealed that gastric PD-NECs were significantly smaller (P =0.002),more often showed well-defined margins (P＜0.001),and more frequently accompanied with intact overlying mucosa on CT when compared with gastric PD-ADCs (P ＜0.001).In the multivariate analysis,the presence of intact overlying mucosa (OR=0.028,95 ％ CI:0.001-0.863,P =0.041) and tumor-to-mucosa HU ratio on the arterial phase (OR=0.015,95 ％ CI:0.000-0.495,P =0.019) were two independent factors affecting the identification of gastric PD-NECs and gastric PD-ADCs.Receiver operating characteristic analysis (ROC) showed that the value of tumor-to-mucosa H U ratio on the arterial phase in differentiating them was moderate (AUC=0.72).Conclusion Gastric PD-NECs have better-defined margin,more intact overlying mucosa and higher tumor-to-mucosa HU ratio on the arterial phase than gastric PD-ADCs.

Diagnosis of autoimmune pancreatitis with computed tomography / 中华消化杂志

Objective To investigate the computed tomography (CT) features of autoimmune pancreatitis (AIP).Methods The CT imaging data of 33 patients with AIP confirmed by pathology and/or steroid therapy were retrospectively analyzed.Image analysis including the shape of pancreas, density of lesion, contrast enhancement, the changes of pancreatic duct and biliary duct, peripancreatic appearances and adjacent organ involvement.T test was performed for statistical analysis.Results Among 33 patients with AIP, 23 cases (70%) with pancreatic parenchyma diffuse enlargement, eight cases (24%) with partial enlargement and two cases (6%) with normal pancreas.The lesions appeared hypoattenuating or isoattenuating on plain CT scan.After contrast-enhanced scan, the average CT values of lesions were (75.7±17.0) Hu at arterial phase, which was lower than that of venous phase (90.7±12.0) Hu, and the difference was statistically significant (t=3.378,P=0.002).The lesions demonstrated as progressive enhancement at venous phase.Among 33 patients, the main pancreatic duct was visible in six patients (18%).Sixteen patients (48%) presented with intrahepatic and extrahepatic biliary tract dilatation caused by intrapancreatic common bile duct stenosis.Thickened envelope-like structure around the lesions, presenting as capsule sign was seen in 14 patients (42%).Extra-pancreatic organ involvement was found in seven patients including three cases of kidney involvement.After treated with steroid, seven patients repeated CT which showed different degrees of improvement.Conclusion The main CT findings of AIP are diffuse and partial enlargement of pancreas with progressive enhancement at venous phase, envelope-like structure around pancreas, and stenosis of intrapancreatic common bile duct, which are important in the diagnosis and differential diagnosis of AIP.

CT features in predicting the pathological classification and prognosis in gastroenteric neuroendocrine neoplasm / 实用放射学杂志

Objective To analyze the correlations between the CT features and pathological classifications of gastroentric neuroendocrineneoplasm(GE-NEN) and to evaluate the association between prognostic value and CT features.Methods 45 cases pathologically and immunohistochemically proved GE-NEN were studied retrospectively.The correlation between the CT features (tumor's volume,shape,enhancement patterns and TNM stage) and pathological classifications was analyzed.Meanwhile,the association between the CT features and patients' overall survival was evaluated by Kaplan Meier method using Log-rank test and multivariate analysis in Cox proportional hazard model.Results The CT features were proved to be associated statistically with pathological classifications including the tumor's volume,shape,with or without areas of cystic change,necrosis or ulceration,T stage and lymphadenopathy (P ＜ 0.05).On the other side,the patients' overall survivals were associated with age,pathological classifications,volume of tumors,with or without areas of cystic change,necrosis or ulceration and TNM stage.Age,areas of cystic change,necrosis or ulceration and metastases were the independent prognostic factors.Conclusion Contrast-enhanced CT can be useful in the classification of GE-NEN and predicting the patient's survival.

CT imaging features of peritoneal metastasis of gastric cancer / 中华消化外科杂志

Objective To summarize the CT imaging features of peritoneal metastasis of gastric cancer (GC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 78 GC patients with peritoneal metastasis who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2013 to September 2016 were collected.All the patients underwent plain and enhanced scans of CT,and imaging data were converted to the multiplanar reformation (MPR) and maximum intensity projection (MIP).Observation indicators:(1) CT imaging features of primary lesion of GC;(2) CT diagnostic accurary and imaging features of GC with peritoneal metastasis;(3) CT imaging features of lymph nodes and other abdominal organ metastasis;(4) treatment and follow-up.Patients selected treatment plan according to results of laboratory and imaging examinations and patient's will.Follow-up using outpatient examination,telephone interview and correspondence was performed to detect the treatment method and patients' prognosis up to December 2016.The survival time was from post-treatment to death or end of follow-up.Measurement data with skewed distribution were described as M (range).Results (1) CT imaging features of primary lesion of GC:primary tumor location of 78 patients:tumor located in the antrum,leather bottle stomach,gastric cardia,lesser curvature,gastric antrum and body and greater curvature were detected in 40,11,9,9,5 and 4 patients,respectively.All the 78 patients were in T4 stage,including 43 with T4a stage and 35 with T4b stage.(2) CT diagnostic accurary and imaging features of GC with peritoneal metastasis:of 78 patients,57 were found with peritoneal metastasis by CT examinations before chemotherapy,15 with peritoneal metastasis by exploratory laparotomy or open surgery and 6 with peritoneal metastasis by follow-up CT re-examinations after gastrectomy.Seventy-two patients were diagnosed as GC with peritoneal metastasis by CT scans,and final diagnosis,missed diagnosis and overdiagnosis were detected in 78,9 and 3 patients,respectively.The precision,sensitivity,specificity,positive and negative predictive values of CT diagnosis were respectively 98.7％,88.5％,99.6％,95.8％ and 98.9％.Location and manifestation of 78 GC with peritoneal metastasis patients:① Peritoneal effusions:71 patients were accompanied with peritoneal effusions,including 21 with the slight peritoneal effusions and 50 with moderate and massive peritoneal effusions.② Greater omentum thickening:greater omnentum of 59 patients showed sheet,flocculent and nodular thickening,with a mass and cake-like change.③ Peritoneal thickening:54 patients had peritoneal thickening,with the main of nodulelike and thick lines-like thickening;thickening occurred mainly in around the liver,peritoneal cavity and pelvic floor;11 patients were found with obvious left anterior renal fascia thickening.④ Mesenteric thickening:46 patients were found with mesenteric thickening and edema,showing increased fat density with multi-node shadow.⑤ Lesser omentum and hepatogastric ligament:18 patients were found with increased fat density of lesser omental bursa,showing striped and nodular shadow.⑥ Transverse mesocolon:increased local fat density with striped-and nodular-like changes were seen in 15 patients after coronal and sagittal planes reconstruction,including 5 with local wall thickening of transverse colon.⑦ Ovary:8 patients had ovarian metastases,including 6 with bilateral metastases and 2 with unilateral metastasis;diameter of metastatic tumor was 3-12 cm.⑧ Intestinal canal:6 patients had local intestinal wall thickening,including 3 in small intestine and 3 in transverse colon,thickening tissues were mainly located in the mesentery,showing obvious intestinal wall enhancement.⑨ Liver capsule node:2 patients showed multi-node abnormal enhanced lesions under liver capsule.(3) CT imaging features of lymph nodes and other abdominal organ metastasis:78 patients were accompanied with lymph nodes enlargement,including 41 in N2 stage and 37 in N3 stage;liver metastases were detected in 13 patients;5 had adrenal metastases,including 3 with bilateral metastases and 2 with unilateral metastasis;4 had lower GC invading the pancreatic head and body;2 had upper GC invading the liver and spleen;1 had leather bottle stomach invading the pancreatic head and neck,and inducing to obstruction of biliary tract.(4) Treatment and follow-up:of 78 patients,62 underwent systemic chemotherapy,6 underwent systemic chemotherapy and intraperitoneal hyperthermic perfusion chemotherapy,5 underwent systemic chemotherapy and local radiotherapy and 5 underwent palliative operations due to gastrointestinal tract obstruction or bleeding.Of 78 patients,69 were followed up for 15 months (range,3-21 months),and 9 lost to follow-up.The median survival time of 69 follow-up patients was 12 months (range,3-19 months).Conclusions CT imaging features of peritoneal metastasis of GC show specific sites of metastasis and performance.Combining with CT axial images and images of coronal and sagittal planes reconstruction,adjusting appropriate window width and level would be benefit to observe primary lesions of GC and peritoneal metastasis.

Extra-pleural solitary fibrous tumor: imaging and histopathologic features / 实用放射学杂志

Objective To analyze the imaging and histopathologic features of extra-plural solitary fibrous tumor (SFT) and to improve the diagnose diagnostic ability.Methods The images and pathologic features of 32 SFT cases confirmed by pathology were retrospectively reviewed.Results Of 32 SFT cases, there were 5 cases in the head, 3 cases in the orbit, 1 case in the nasal sinuses, 1 case in the bronchus, 2 cases in the stomach,1 case in the pancreas, 3 cases in the kidney, 3 cases in the retroperitoneum, 4 cases in the pelvic cavity, 6 cases in the soft tissues, 3 cases near the vertebra.6 cases were malignant,8 cases were borderline,18 cases were benign.The tumors located in abdominal and pelvic tumors were larger,the average diameter of the tumors was 13.6 cm.The volumes of the other tumors were smaller, the average diameter was 4.2 cm.The majority of the tumors showed clear boundary, smooth edge or lobulated soft tissue mass, partial necrosis, rare cystic degeneration and calcification.MR images showed hypo to isointensity on T1WI and hyper to isointensity on T2WI.After enhanced enhancement, multiple small circuitous vessels could be found in or around the mass.The tumor showed slightly enhanced in the arterial phase and moderately to obviously heterogeneously enhancement in the venous phase.In addition, part of the tumors can could be seen positive-negative signal changes.The positive expression rate of immunohistochemical indexes were: CD34 100%, CD99 68.8%, Bcl-2 62.5%, Vimentin 46.9%, Ki-67>5% 43.8% respectively.

Evaluation of Hemodynamics of Posterior Circulation Distal Ischemia with Perfusion-weighted MR Imaging / 实用医学杂志

Objective To explore the way to evaluate hemodynamics of posterior circulation distal ischemia with PWI. Methods Thirty-two patients with vertebral basilar artery severe stenosis were reviewed and compared with thirty normal persons. Information and data of PWI and MRA were collected and analyzed. Following parameters were observed, index of vascular stenosis, collateral vessels, cerebral blood flow (rCBF), cerebral blood volume (rCBV), and mean transit time (rMTT). Results All the patients had at least one vertebral basilar artery with more than 70% stenosis. There were 17 cases with severe vertebral artery stenosis , 20 cases with severe basal artery stenosis , 8 cases with severe superior cerebellar artery stenosis , 17 cases with posterior cerebral artery stenosis , 22 cases with after the traffic artery open , 11 cases with soft meningeal arteries show and 12 cases with small artery show. The ratio of ROI with frontal white matter was lower than the rCBF and rCBV in the country group. MTT value was extended and P value of the parameters in both groups was less than 0.05, reflecting the statistical difference. Conclusions PWI combined with MRA can effectively evaluate the posterior circulation distal ischemia area and tissue perfusion , as well as the hemodynamic status of ischemia area.

Combination of MOOC and classroom teaching：the new idea of reform in medical imaging teach-ing / 中华医学教育探索杂志

MOOC is a new online teaching model. Learners complete the course of study through on-line autonomous learning, communication with others, receiving system assessment and evaluation. In medi-cal imaging teaching, the combination of MOOC and traditional classroom teaching is a new way of med-ical imaging teaching reform. It will be beneficial to integration and making full use of high quality teaching resources, which plays an important role in the discipline development and the teaching quality improve-ment.

Lesion detection value of Cine sequence in the small intestinal Crohn’s disease:a preliminary study / 实用放射学杂志

Objective To evaluate the detection rate of lesions of patients with Crohn’s Disease(CD)tusing combining the con-ventional MR and Cine MRE(MR enterography).Methods MRI images of twenty-nine patients with CD confirmed by clinic were analyzed retrospectively.Scan sequences include coronal Cine MRE,and standard MR protocol (FIESTA,SS-FSE,LAVA C+). Two radiologists analyzed the images with double blind method to explored whether there were significant differences existing be-tween having or having not Cine MRE on lesion detection rate (wall thickness,stenosis,comb sign,adhesions,fistulas).Results The number of lesions detected by standard MR combined with Cine MRE compared with standard MR alone were 82/80 (P =0.1 6) for wall thickening,52/43 (P =0.03)for stenosis,6/7 (P =0.36)for the comb sign,5/7(P =0.66)for adhesions,2/2for fistulas re-spectivily.Conclusion It is meaningless to combine Cine MRE with standard MR in lesions detection in patients with CD,Cine ima-ges can accurately determine diseased bowel stenosis,and show the adhesive location.On the basis of standard MR,Cine MRE can be added in patients with CD when necessary.

Application of medical image processing, transmission and on-line learning system in medical imaging teaching / 中华医学教育探索杂志

Using the Medical Imaging Experimental Teaching Demonstration Center of Nanjing Medical University and related web site as a platform, we have established a case library and online learning system which fused medical imaging, pathology and anatomy images according to the human organ system. The system has achieved a“medical imaging”teaching real-time, diversified, systematic and clinical simulation technology. Medical students can perform image processing, simulate writing reports and discuss online using this system. Teachers can use the system to carry out teaching reform-problem-based learning (PBL), and the integration of teaching with horgan systems and case based curriculum.

CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules before video-assisted thoracoscopic resection:the clinic application / 中华胸心血管外科杂志

Objective To evaluate the clinical application of CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules (SPNs) before video-assisted thoracoscopic resection.Methods CTguided localization the SPNs before resection in 56 patients and 60 nodules,then underwent video-assisted thoracic surgery (VATS) resection.Among 56 patients,19 males and 37 females,aged from 35 to 81 years,mean age was (61.1 ±8.9)years.Results SPNs diameter (6.80 ±4.12) mm,distance from the parietal pleura (15.38 ±4.63) mm.CT-guided localization success rate was 100％,positioning time (10.76 ± 8.17) min,8.9％ (5/56) had micro pneumothorax aftet positioning,7.1％ (4/56) occurrence of needle tract bleeding,no conservative treatment.VATS resection rate was 100％.The pathology of 60 lesions were shown:Bronchiolo-alveolar carcinoma(BAC) were 33 lesions(55.0％),BAC and adenocarcinoma were 11 lesions(18.3％),Atypicaladenomatous hyperplasia (AAH) were 7 lesions (11.8％),Inflammation were 4 lesions (6.7％),Harmatoma were 3 lesions(5.0％),Tuberculoses were 2 lesions(3.3％).Conclusion CT-guided localization with combination of methylene blue and a Hookwire system before video-assisted thoracoscopic resection is a promising technique for small solitary pulmonary nodules.It could play an important role in accurate localization of small pulmonary nodules,and it is a safe technique with clinical application.

Investigation on the Thrombolytic Effect of Transcatheter Intra-Arterial Infusion of Urokinase,Injectio Salviae Miltiorrhizae and Heparin / 介入放射学杂志

Purpose:To evaluate the thrombolytic effect of transcatheter intra-arterial infusion of urokinase injectio salviae miltiorrhizae and heparine.Materials and methods:A 5F catheter was delivered to the thrombotic site via femoral artery,then infused urokinase.Injectio salviae mihionrrhizae via catheter.During and after the procedure heparin was given for antico- agulation.Finally to evaluate the effect by femoral arteriograms.Results:Blood circulation of 10 eases were inproved with complete pateney.One case wasn't very fluent and the last one remained obstructed.Total effective rate was 92%.Conclusion:Transcatheter Intraarterial thrombolysis by combing urokinase,injeetio salviae miltiorrhizae and heparin was a effective and safe theraputic method.