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Objective:To investigate the value of CT findings in predicting thetransformation of clinical types of COVID-19.Methods:From January 24 to February 6, 2020, the clinical and chest CT data of patients with common COVID-19 were analyzed retrospectively. A total of 64 patients were enrolled, including 32 males and 32 females, aged 18-76 (45±15) years. Based on the fact whether patients’ conditions had deteriorated into severe type, all the cases were divided into common type group (51 cases) and deteriorated type group (13 cases). Differences of CT findings in the two groups of patients were analyzed, and visual semi-quantitative scores were introduced to evaluate the pneumonia.Results:Compared with the common type group, the deteriorated type group was more likely to involve the left upper lobe, the right middle lobe and the lung far away from the pleura. The differences between the two groups were statistically significant (χ2= 5.897, P=0.027; χ2=8.549, P=0.005; χ2=10.169, P=0.002). The median of the involved lobes were 2 (1,5) in the common type group and 5 (4,5) in the deteriorated type group. The difference between the two groups was statistically significant (Z =-3.303, P=0.001). Taking the involved lobes ( n=4) as the threshold, the sensitivity and specificity of the diagnosis of the common type to the deteriorated type patients were the highest, 76.9% and 74.5% respectively, and the area under the ROC curve was 0.787. Pneumonia score of the deteriorated group was 10 (4,16), higher than that of the common group [4 (1,13)], and the difference was statistically significant ( Z=-4.040, P<0.001). Pneumonia score 8 as the threshold, the sensitivity and specificity of the general severe group were the highest, 69.2% and 86.3% respectively, and the area under ROC curve was 0.863. Conclusions:CT imaging has a profound value in the early prediction of deterioration in clinical type of COVID-19. It can help evaluate the severity of pneumonia in early stage. Range of lesions might be an important indicator for prognosis of common type COVID-19.
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Objective TodetecttheCTfindingsofinterstitialpneumoniainacquiredimmunodeficiencysyndrome (AIDS)patients andtoanalyzedifferentialdiagnosisofdifferenttypesofinterstitialpneumonia.Methods Atotalof168 AIDSpatientswithinterstitial pneumoniabetweenOctober2016andJune2018 wereretrospectivelystudied.PulmonaryCTfindingsweredescribed.Results Among 168cases,44caseswerediagnosedaspneumocystiscariniipneumonia (PCP),40casesascytomegalovirus(CMV)pneumonia,and 84casesasPCPaccompaniedwithCMVpneumonia.Statisticallysignificantdifferenceswerefoundamong3groupsonsignsofpure groundglassopacity,accompaniedwithdistortedfibrousstripes,andaccompaniedwithconsolidationandmultiplecysts(P＜0.05). PuregroundglassopacitiesweremorelikelytobeseeninPCPpatients,whiledistortedfibrousstripeswerelesslikely,comparedto theothertwogroups.Militarynodules,consolidationandmultiplecystspresentedlessinpatientswithPCPcomparedtopatientswith PCPaccompaniedwithCMVpneumonia.ForPCPpatients,lesionsweremorelikelytobetotallyabsorbedaftertreatment,whilefor patientswithCMVpneumoniaandPCPaccompaniedwithCMVpneumonia,fibrousstripesandemphysema/airsacsweremorelikelyto present.Conclusion CTfindingsofinterstitialpneumoniavaryinAIDSpatients,however,signsofdistortedfibrousstripes,multiple cysts,remainingfibrousstripesandemphysema/airsacsaftertreatmentsuggestco-infectionofCMV.
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Objective To study the CT characteristics of coexisting pulmonary tuberculosis and lung cancer.Methods One hundred and four patients of coexisting pulmonary tuberculosis and lung cancer proved by histology,cytology or clinical underwent CT examination.All patients were divided into two groups,group Ⅰ were the patients with the lung cancer after tuberculosis or both found simultaneously (group Ⅰ a with peripheral lung cancer and group Ⅰ b with central lung cancer),group Ⅱ with tuberculosis during lung cancer chemotherapy (group Ⅱ a with peripheral lung cancer and group Ⅱ b with central lung cancer).Imaging characteristics of tuberculosis and lung cancer were compared.x2 test and t test were used for the statistical analysis.Results Of 104 patients,there were 92 patients (88.5％) in group Ⅰ and 12 patients (11.5％)in group Ⅱ.Seventy patients (76.1％) of lung cancer and tuberculosis were located in the same lobe and 22 patients (23.9％) in the different lobes in group Ⅰ.There was no significant difference in distribution of tuberculosis between group Ⅰ and group Ⅱ (x2 =4.302,P =0.507).The fibrous stripes,nodules of calcification and pleural adhesion of tuberculosis were statistically significant between the two groups (x2 =22.737,15.193,27.792,P ＜0.05).There were 33 central lung cancers and 71 peripheral lung cancers.In group Ⅰ a (64 patients of peripheral lung cancers),39 patients (60.9％) had typical manifestations and most of the lesions were ≥ 3 cm(n =49,76.6％),solid lesions showed variable enhancement.Conclusions Secondary tuberculosis during lung cancer chemotherapy has the same CT characteristics with the common active tuberculosis.The morphology,enhancement pattern of lesion and follow-up are helpful for the diagnosis of lung cancer after tuberculosis.
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Objective To investigate the value of CT perfusion imaging in evaluation of therapeutic effect and prognosis in radiotherapy for lung cancer.Methods Fifty-one cases of lung cancer who were unable or refused to be operated on,36 males and 15 females,aged 37 - 80,underwent CT perfusion imaging,29 of which only before radiotherapy and 22 before and after radiotherapy twice.The images were collected by cine dynamic scanning (5 mm/4 slices ) and input into the GE AW4.0workstation for data processing.The slice positions of CT imaging were determined according to the largest tumor size in CT scan.Regions of interest of tumor were drawn at the region corresponding to the original images of CT perfusion.Radiotherapy was performed after CT perfusion imaging.Relevant parameters,including blood flow ( BF),blood volume ( BV),mean transit time ( MTT),and permeability surface (PS) were calculated.The treatment response after radiotherapy was evaluated by RECIST.At 2 -4 weeks after the treatment,CT examination was conducted once more.Results The tests of the 51 patients showed that the BV was 13.6 ml·100 g-1,the BF was 129.5 ml·min-1 ·100 g-1,the MTT was 9.1 s,and the PS was 10.0 ml· min- 1· 100 g-1 before radiotherapy.The tests of the 22 of the 51 patients showed that the values of BV and BF after radiotherapy were 7.6 ml· 100 g-1 and 97.8 ml·min-1· 100 g-1,respectively,both lower than those before radiotherapy (11.2 and 108.7 ml·min-1·100g-1,respectively),however,both not significantly ( t =1.28,0.40,P ＞ 0.05 ) ; and the values of MTT and PS after radiotherapy were 8.9 s and 7.8 ml·min-1· 100 g-1,respectively,both not significantly higher than those before radiotherapy ( 7.2 s and 6.8 ml· min -1· 100 g-1,respectively,t =- 1.15,- 0.57,P ＞0.05 ).The mean area of tumor after radiotherapy was 1189.6 mm2,significantly less than that before radiotherapy ( 1920.3 mm2,t =3.98,P ＜0.05).The MTT of the SCLC patients was 12.9 s,significantly longer than that of the NSCLC patients (6.5 s,t =2.54,P ＜0.05).The MTT of the tumor with the area ≤ 10 cm2 was 11.2 s,significantly longer than that of the tumors with an area ＞ 10 cm2(5.8 s,t =2.59,P ＜ 0.05 ).The BV of the responder group was 19.2 ml· 100 g- 1,significantly higher than that of the nonresponder group (4.6 ml· 100 g - 1,t =3.62,P ＜ 0.05 ).There were not significant differences in all the perfusion characteristics between the cases with the disease-free advanced survival time ≤ 10 months and those with disease-free advanced survival time ＞ 10 months.Conclusions CT perfusion imaging helps in diagnosis and radiotherapy of lung cancer to a certain degree.
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Objective To investigate CT features of similar Hexheimer's reaction during initial treatment of active pulmonary tuberculosis. Methods The similar Hexheimer's reaction in 44 patients diagnosed by clinic and follow-up CT scans were retrospectively reviewed by three radiologists. Results During initial treatment of active pulmonary tuberculosis, development of radiographic progression were observed in 57 foci, including 28 pulmonary lesions increased at the site of their original lesion or new opacities elsewhere, ipsilateral or contralateral to the original lesion or both, 10 lesions related to the pleura (pleural effusion, pleural tuberculoma), 15 lymphadeneetasis, 3 thymus reactions, and 1 cardiac pericardium thickening, respectively. These reactions appeared from the 20 days to 3. 5 months, then with continuation of the initial chemotherapy for 1.0-3.0 months, the radiographic response was excellent with the areas of progression and the original lesions demonstrating resolution or improvement. Conclusion The CT appearances of similar Hexheimer's reaction during initial treatment of active tuberculosis are specific to a certainty.
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Objective To describe varied features of pulmonary metastases of lung cancer on CT imaging .Methods 194 patients with pulmonary metastases of lung cancer were evaluated on CT scan , including 106 men and 88 women . The median age of the patients was 45 years ( range from 22 to 78 years ) . The histology of the lung cancer included 56 squamous carcinomas(28.9%),107 adenocarcinomas(55.2%),26 small cell carcinomas(13.4%),and 5 adenosquamous carcinomas(2.1%).Results The usual pattern of pulmonary metastases of lung cancer were parenchyma nodules. The unusual form of metastases that were mainly found in adenocarcinomas were cavitary lesions, ground-glass nodules and lesions with unusual signals including lobulated structure, spiculated margin,pleural indentation and air-bronchogram. The manifestations of lymphangial spread to intrapulmonary were extensive uneven thickening of the interlobular septa and fissures, nodular thickening of brochovascular bundles and many fine nodulars distributed along the brochovascular bundles and interlobular septa.Conclusion The manifestations of intrapulmonary metastases of lung cancer are varied morphologic features.
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Objective The purpose of this study was to evaluate the constrast-enhanced CT features and pathologic findings of mediastinal tuberculous lymphadenitis in adults. Methods 39 patients with 180 lymph nodes diagnosed as mediastinal tuberculous lymphadenitis by operation, mediastinoscopy and biopsy were evaluated on enhanced CT scan, including 20 men and 19 women. The median age of the patients was 26 years(range from 16-67 years). Results Five post-contrast patterns of enhancement were found: (1) inhomogeneous enhancement(28.3%,51 nodes); (2) peripheral rim enhancement(26.1%, 47 nodes); (3) homogeneous enhancement(25.0%, 45 nodes); (4)nonenhancement( 14.4%, 26 nodes); (5) separate enhancement(6.11%, 11 nodes); CT-pathologic correlation demonstrated that patterns of enhancement of mediastinal tuberculous lymphadenitis were correlated with distribution of granulation tissue and caseous areas. 28 patients(71.8%) had a combination of enhancement patterns. 11 patients(28.2%) had a single enhancement pattern. Conclusion Constrast-enhanced CT appearance of mediastinal tuberculous lymphadenitis for diameter of 1.0-2.0 cm was homogeneous enhancement, nonenhancement, inhomogeneous enhancement and peripheral rim enhancement; for diameter of ≥2.0 cm was inhomogeneous enhancement, peripheral rim enhancement, homogeneous enhancement and nonenhancement. Peripheral rim enhancement or separate enhancement can suggest a diagnosis of tuberculosis.