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The objective of this study was to investigate the specific contrast-enhanced MSCT features and predominant anatomic distribution of mediastinal malignant lymphoma. Contrast-enhanced MSCT in 31 cases of mediastinal malignant lymphomas were retrospectively evaluated by analyzing the features of size, morphology, attenuation and anatomic distribution in accordance to the ATS classification of intrathoracic lymph nodes. Nine cases of Hodgkin Disease (HD) and 22 cases of Non-Hodgkin Disease (NHL) were included. The enlarged nodes were found to be homogeneous (HD 72.7%, NHL 88.9%) and partly homogeneous with necrosis (HD 27.3%, NHL 11.1%). HD involved predominantly the lymph nodes in the areas of 2R (77.8%), 3 (55.6%), 4R (88.9%), 4L (55.6%), 5 (66.7%), 6 (55.6%), 7 (66.7%) and 10R (55.6%), while NHL often involved the areas of 2R (68.2%), 3 (54.5%) 4R (59.1%), 4L (50%), 5 (54.5%), 6 (54.5%), 7 (54.5%) and 8 (50%). The following extranodal organs were involved: pericardium (19.4%), pleura (19.4%), great vessels (6.4%), lung (6.4%), chest wall (3.2%) and breast (3.2%). Mediastinal malignant lymphoma had some characteristic manifestations and predominant anatomic distribution shown on contrast-enhanced MSCT, which can provide imaging evidences for diagnosis and for determining the tumor stage.
Subject(s)
Adult , Aged , Female , Humans , Male , Contrast Media , Hodgkin Disease , Diagnostic Imaging , Pathology , Lymph Nodes , Pathology , Lymphoma, Non-Hodgkin , Diagnostic Imaging , Pathology , Mediastinal Neoplasms , Diagnostic Imaging , Pathology , Retrospective Studies , Tomography, Spiral Computed , MethodsABSTRACT
<p><b>BACKGROUND</b>To study the correlation between CT/MRI features and surgical and pathological findings of cancerous invasion of the main pulmonary artery (CIMPA) in lung cancer and to evaluate the role of CT and MRI in making surgical plan.</p><p><b>METHODS</b>CT findings in 15 cases and MRI findings in 13 cases were observed and blindly compared with surgical and pathological findings in this prospective study of 23 cases of central type lung cancer.</p><p><b>RESULTS</b>The CT and MRI features showed as follows: the wall thickening sign in 73.7% of CT and 84.6% of MRI; lumen narrowing sign in 55.3% of CT and 69.2% of MRI; peri-vascular fat sign in 100.0% of both CT and MRI. Two types of CIMPA were visualized: contacted type (10 cases in CT and 7 cases in MRI) and encased type (5 cases in CT and 6 cases in MRI). Surgically, contacted type was found in 10 cases who all underwent lobectomy with sleeve-angioplasty. Encased type was found in 13 cases, among whom unresectable in 2, pneumonectomy in 7, and lobectomy with angioplasty in 4. Of the 21 resected specimen, the cancerous infiltration was demonstrated 100.0% (21/21) in adventitia, 66.7% (14/21) in media and 4.8% (1/21) in intima. There was no significant difference in the deepness of the cancer infiltration between the two types (P>0.05). Acute or chronic inflammatory infiltration which enhanced the thickening of the wall were shown on all specimens. CT and MRI findings were well corresponding to surgical and pathological appearance (Kappa value = 0.61 in CT and 0.84 in MRI).</p><p><b>CONCLUSIONS</b>In our study of CIMPA, CT and MRI features characterized by wall thickening and lumen narrowing without occlusion are closely correlated with pathological findings that cancerous invasion prominently limited adventitia and media with remarkable proliferation of connective tissue, and classifying two types is valuable in making surgical plan.</p>
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<p><b>BACKGROUND</b>To study the CT appearance of lung cancer combined with pleural dissemination and its anatomic characteristics.</p><p><b>METHODS</b>CT findings of 32 cases of lung cancer with pleural dissemination proved by surgery and pathology were analyzed.</p><p><b>RESULTS</b>The main CT manifestations were pleural effusion (24 cases), visceral pleural dissemination with nodules (10 cases), parietal pleural dissemination with nodules (16 cases), and pleural thickening (31 cases). Out of the cases with visceral pleural disseminations, nodules distributed on the lung surface in 9 sites, while on the interlobular pleura in 10 sites. Parietal pleural dissemination with nodules were found in 45 sites which located on the diaphragmatic pleura, the costal pleura, the mediastinal pleura, and the pulmonary ligament. The diameters of the small nodules ranged from 2 to 5 mm, and the large nodules from 5 to 10 mm. There were direct invasion with tumor induced pleural thickening in 10 cases, while indirect invasion in 21 cases. In the later cases, 9 cases had parietal pleural thickening less than 10 mm, 4 circumferential pleural thickening, 5 mediastinal pleural involvement thickening, and 3 pulmonary ligament thickening.</p><p><b>CONCLUSIONS</b>Pleural effusion is the main manifestation of lung cancer combined with pleural dissemination. The CT features of lung cancer with pleural dissemination are the parietal and visceral pleural nodules, as well as the pleural thickening. The nodules are likely to distribute on parietal pleura of the diaphragmatic and the costal pleura, and they may transfer to the pulmonary ligament.The early small disseminating nodules are miliary in size, and only can be detected on the pulmonary window of chest CT scan.</p>
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Objective To determine how the pulmonary ligament affects the helical CT appearances of the lower thoracic disease on the basis of the anatomic findings. Methods Four cadavers were cut transversely, with the section thickness of 11.3-13.4 mm. 57 patients with the lower thoracic disease were scanned using Somatom Plus 4, with administration of intravenous contrast material. The correlation of the anatomic findings of the pulmonary ligament and the helical CT appearances of the lower thoracic disease was evaluated. Results On cadaver sections, the right pulmonary ligament attached the lower lobe of the right lung to the esophagus, while the left ligament attached the lower lobe of the left lung to the esophagus or the descending aorta. In 40 pleural effusion and 7 pneumothorax cases, the pulmonary ligament tethered the medial aspect of the collapsed lower lobe and limited the shift of the lower lobe. In 40 pleural effusions, the ligament divided the medial pleural space into an anterior and a posterior compartment. The ligament showed thickness due to the invasion of the lesions of lower lobe including 7 tumors and 3 inflammatory diseases. Conclusion The pulmonary ligament can affect the helical CT appearances of the lower thoracic disease, such as lobe collapse, pleural effusion and pneumothorax; while the intraparenchymal and mediastinal abnormality can extend into the pulmonary ligament.
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Objective To study the CT features of cerebral infarction and the relation to blood glucose level in diabetes mellitus.Methods The CT features and relation to the level of blood glucose were retrosepectively analyzed in 41 cases of cerebral infarction diabetes mellitus.The diagnosis of diabetes mellitus was based on the WHO criteria in all cases.Results The focus of infarction located at the area of base ganglion,brain stem and thalamencephalon in 38 cases(92.7%).Multiple focus was found in 30 cases(73.2%)and there was positive correlation between focus number and the level of blood glucose.Lacuna cerebral infarction was observed in 38 cases(92.7%) and large patchy cerebral infarction in 3 cases.Brain white matter demyelination was complicated in 24 caese(58.5%).Conclusion Cerebral infarction of diabetes mellitus mainly manifestes as multiple lacuna cerebral infarction and has close relation to the level of blood glucose.
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Objective To describe CT features and misdiagnosis of lung cancer in young patients.Methods The clinical data and CT findings of primary bronchogenic carcinoma in 33 young patients proved pathologically were reviewed.Results Masses,nodules andpulmonary consolidation were found in 13,8 and 7 cases on chest CT respectively.The soft nodule in bronchus with obstructive pulmonary atelectasis was found in 3 cases,the thickening of bronchial wall and bronchiarctia with obstructive pulmonary infection,plumonary cavity and multicenter lesion were found in 1 respectively.There were thoracic effusion or with nodulous pleurae in 8 cases,nodules in lungs in 7 cases,enlarged lymph nodes in 6 cases,destruction of thoracic skeleton in 2 cases and mass involving mediastinum or large vessels in 4 cases.The chest metastatic rate was 81.8%.Pulmonary inflammation and tuberculosis were firstly diagnosed in 6 and 15 cases,the misdiagnostic rate was 63.6%.Conclusion Masses,nodules and pulmonary consolidation are the common CT features of lung carcinoma in young patients.Most cases are advanced stage of lung carcinoma and misdiagnosed as pulmonary tuberculosis in initial examination.