Deepgoing study on intrathoracic tuberculous lymphadenitis in adults using multidetector CT / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Studies on intrathoracic tuberculous lymphadenitis in adults are confined to the preliminary CT findings with ordinary CT and ordinary spiral CT. There has been no deepgoing study of multidetector CT to date. Multidetector CT could contribute to better imaging of intrathoracic tuberculous lymphadenitis in adults. The purpose of this study was to explore the multidetector CT features of intrathoracic tuberculous lymphadenitis in adults, and the correlation with clinical symptoms and pathologic changes.</p><p><b>METHODS</b>Multidetector CT findings from 42 consecutive adult patients with intrathoracic tuberculous lymphadenitis were analyzed retrospectively with regard to locations, sizes, numbers, shapes, margins, and densities reviewing precontrast and enhanced images. CT results were correlated with clinical symptoms and pathologic results (n = 37).</p><p><b>RESULTS</b>One hundred and eighty-five intrathoracic lymph nodes that had tuberculous lymphadenitis in 42 patients were distributed mainly in regions 4R (n = 37), 2R (n = 33), 7 (n = 31) and 10R (n = 21), more than 2 regions were implicated in 34 patients. One hundred and twenty-two (72.2%) of the tuberculous lymphadenitis without confluence were oval or round with clear margins. On precontrast scanning, 78.4% of tuberculous lymphadenitis had a homogeneous density. Seven enhancement patterns were demonstrated in 169 tuberculous lymphadenitis from 37 patients with pathologic results: homogeneous enhancement with no clinical symptom (n = 12), corresponded pathologically to tuberculous hyperplasia without caseous necrosis; heterogeneous enhancement with a small central no enhancement area, slight clinical symptoms (n = 22), tuberculous granulomas with a little caseous necroses; peripheral irregular thick wall enhancement with a central area with no enhancement, slight clinical symptoms (n = 52), tuberculous granulomas with some caseous necroses in the center; peripheral thin rim enhancement with a central area having no enhancement, moderate clinical symptoms (n = 36), a few tuberculous granulomas with a great quantity of caseous necroses in the center; peripheral irregular enhancement without central enhancement, extending outside the capsule, severe clinical symptoms (n = 4), caseous necroses ruptured from capsule; peripheral irregular rim enhancement with central separate enhancement, severe clinical symptoms (n = 40), multiple lymph nodes with liquefaction of caseous necroses were adherent and confluent, rim and separation were tuberculous granulomas; no obvious enhancement, severe clinical symptoms (n = 3). Caseous necrosis was usually associated with little tuberculous granulomas.</p><p><b>CONCLUSIONS</b>The main multidetector CT features of intrathoracic tuberculous lymphadenitis in adults are involvement of multiregional lymph nodes with oval or round shape and clear margins, a basically homogeneous density on precontrast scanning, multiple enhancement patterns, and they correlate closely with clinical symptoms. Multidetector CT could reveal pathological changes of intrathoracic tuberculous lymphadenitis in adults.</p>

Preliminary study on MR colonography with air enema in detection of colorectal neoplasms / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The few studies on MR colonography with air enema involved feasibility of bowel distention and imaging quality and lacked detection sensitivity of colorectal neoplasms. The purpose of this prospective study was to assess the detection sensitivity of colorectal neoplasms with the three-dimensional Fourier transform fast spoiled gradient-recalled MR colonography with air enema.</p><p><b>METHODS</b>A total of 30 patients scheduled for optical colonoscopy due to rectal bleeding, positive fecal occult blood test results or altered bowel habits were recruited and successfully underwent entire colorectal examinations with three-dimensional Fourier transform fast spoiled gradient-recalled MR colonography and subsequent optical colonoscopy on the same day. Detection sensitivity of colorectal neoplasms with MR colonography was statistically analyzed on a per-neoplasm size basis by using findings from optical colonoscopy and histopathological examinations as the reference standards.</p><p><b>RESULTS</b>Seventy-six neoplasms were detected with optical colonoscopy, consisting of 1 mm-5 mm (n = 11), 6 mm-9 mm (n = 29) and ≥ 10 mm (n = 36) in diameter. Detection sensitivities of 1 mm-5 mm, 6 mm-9 mm, ≥ 10 mm and ≥ 6 mm colorectal neoplasms with MR colonography were 9.1%, 75.9%, 100% and 89.2%, respectively; overall detection sensitivity for all sizes colorectal neoplasms was 77.6%.</p><p><b>CONCLUSIONS</b>Detection sensitivity of three-dimensional Fourier transform fast spoiled gradient-recalled MR colonography with air enema is low for 1 mm-5 mm colorectal neoplasms, but the detection sensitivity is 89.2% for ≥ 6 mm neoplasms, and all ≥ 10 mm neoplasms could be detected.</p>

Clinical features, laboratory findings and imaging appearances of venous diethylene glycol poisoning in patients with liver disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There was a hospital outbreak of venous diethylene glycol poisoning in Guangzhou, China. It is the only massive episode of venous diethylene glycol poisoning in history. Here we report its clinical features, laboratory findings, and imaging appearances.</p><p><b>METHODS</b>The clinical features of 15 venous diethylene glycol poisoning patients with liver disease were analyzed and summarized. Their laboratory findings and imaging appearances were comparatively analyzed before and after poisoning.</p><p><b>RESULTS</b>All poisoned patients presented with oliguric acute renal failure with anuria after a mean of 6 days. Carbon dioxide combination power of 13 patients dropped after a mean of 9 days with valley value on the 10th day, when metabolic acidosis developed. Gastroenteric symptoms or aggravation of gastroenteric symptoms were displayed in 11 patients after a mean of 9 days. Neurological system impairment was observed in 10 patients after a mean of 14 days. Seven patients had low fever after a mean of 6 days. Causes of death of 14 patients included multiple organ dysfunction syndrome, severe lung infection and massive haemorrhage of digestive tract. Blood creatinine and urea nitrogen were abnormal after a mean of 5 days with peak value on the 11th and 14th days, respectively. Serum calcium had no obvious change, and phosphorus was distinctively increased. Liver functions did not change significantly. Poisoned patients had higher white blood cell counts, but lower red blood cell counts and hemoglobin value. Of the 7 patients who exhibited mild, moderate or severe patchy consolidation shadowing in the lung, 2 manifested mild or severe gaseous distention and dilation of gastroenteric tract.</p><p><b>CONCLUSIONS</b>Main features of venous diethylene glycol poisoning in patients with liver disease include oliguric acute renal failure, metabolic acidosis, gastroenteric symptoms or aggravation of gastroenteric symptoms, neurological system impairment and low fever, with a mortality rate of 93.33% in poisoned patients. There is also higher white blood cell counts and anemia, patchy consolidation shadowing in the lung, gaseous distention and dilation of gastroenteric tract, which occurs later than mild patchy consolidation shadowing and earlier than moderate patchy consolidation shadowing in the lung.</p>

Diagnostic capability of multidetector CT for arterioportal shunt in hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the capability of multidetector CT (MDCT) for the diagnosis of arterioportal shunt (APS) associated with hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Two hundred and eighty-two patients with HCC were examined by both enhanced thin slice MDCT scanning in early hepatic arterial phase, late hepatic arterial phase, portal venous phase and digital subtraction angiography (DSA). The criteria for diagnosis of APS: (1) Earlier enhancement or stronger opacification of main portal trunk and/or the first order branches compared with that of superior mesenteric vein or splenic vein; (2) Earlier enhancement or stronger opacification of the second order and smaller portal venous branches compared with that of main portal trunk. The presence and degree of APS demonstrated with MDCT and DSA were analysed by double blind method.</p><p><b>RESULTS</b>In 282 HCC patients, 56 were complicated with APS. MDCT demonstrated central APS in 48 patients with 41 severe and 7 moderate shunt, one revealing no APS by DSA due to the giant HCC focus. Among 7 patients with light peripheral APS, two lesions were not revealed by DSA due to faint shunt and the last lesion in the patient with mixed APS was revealed both by APS and DSA.</p><p><b>CONCLUSION</b>Multidetector CT was a simple, effective and noninvasive new technique for the diagnosis of arterioportal shunt associated with hepatocellular carcinoma.</p>

Diffusion tensor imaging and three-dimensional brain fiber tracking for the diagnosis of multiple sclerosis / 中华放射学杂志

Objective To demonstrate the diffusion tensor imaging(DTI)characteristics of multiple sclerosis(MS)plaques,periplaque white matter regions and normal appearing white matter (NAWM)regions in patients with MS,and to evaluate the clinical values of DTI and three-dimensional brain fiber tracking for the diagnosis of MS.Methods Conventional MRI and DTI were performed in 32 patients with MS and 32 age-matched control subjects.Fractional anisotropy(FA)and apparent diffusion coefficient(ADC)maps were generated and coregistered with T_2-weighted MR images,FA and ADC values were calculated in regions of interest in plaques,periplaque white matter regions,NAWM regions and white matter regions in control subjects.And three-dimensional brain fiber tracking maps were generated by using the DTI.Results TheADCwas(1.233?0.119)?10~(-3)mm~2/s in MS plaques,(0.973?0.098)?10~(-3) mm~2/s in periplaque white matter regions,(0.748?0.089)?10~(-3)mm~2/s in NAWM,and(0.620? 0.094)?10~(-3)mm~2/s in control subjects.The FA was 0.225?0.052 in MS plaques,0.311?0.050 in perip]aque white matter regions,0.421?0.070 in NAWM,and 0.476?0.069 in control subjects. Significant differences in FA and ADC values were observed among all white matter regions(P