Clinical and CT imaging features of immune checkpoint inhibitor-associated pneumonia / 中华放射学杂志

Objective:To explore the clinical and CT imaging features of immune checkpoint inhibitor-associated pneumonia (CIP) and to improve the early diagnostic ability of CIP.Methods:From June 1, 2020 to October 31, 2021, the clinical data and chest CT images of 2 067 patients with advanced malignant tumor treated with immune checkpoint inhibitor (ICI) in the First Medical Center, Chinese PLA General Hospital were retrospectively analyzed. Patients with CIP were enrolled according to the guidelines for CIP diagnosis, and the incidence, time from the start of medication to the onset of CIP, medication cycle, imaging features, imaging patterns, CT grade and outcomes were analyzed. χ 2 test was used to compare the incidence of CIP in patients with or without basic lung disease. Results:Among 2 067 patients with malignant tumors treated with ICI, 67 patients developed CIP, the incidence of CIP was 3.2%. The incidence of CIP was significantly different between 386 patients with basic lung disease (7.00%, 27/386) and 1 681 patients without basic lung disease (2.4%, 40/1 681) (χ 2=21.32, P<0.001). The time from the start of medication to the onset of CIP was 7-367 d (median 52 days), and the duration of medication was 1-12 cycles (median 2 cycles). The imaging features of CIP presented as ground glass opacities in 54 cases (80.6%), solid nodules in 26 cases (38.8%), consolidations in 25 cases (37.3%) and irregular reticular opacities in 24 cases (35.8%). The main radiologic pattern was organizing pneumonia (OP, 34 cases, 50.7%), and followed by diffuse alveolar damage (DAD) pattern (14 cases, 20.9%). According to CT grading, there were 26 cases in low risk grade, 17 cases in moderate risk grade and 24 cases in high risk grade. Of 43 low-and medium-risk grade cases, 25 were OP pattern, accounting for 58.1%, and among 24 high-risk grade patients, 13 were DAD pattern, accounting for 54.2%. Forty-three of the 52 patients were initially untreated, of which 23 patients progressed, 17 had lesion shrinkage, and 3 had resolution, and relapsed in 8 cases after resolution or drug withdrawal. Conclusions:The imaging manifestations of CIP are mainly ground glass opacities, nodules, consolidations, and irregular reticular opacities. The radiologic patterns are mainly OP and DAD. OP is the most common pattern in low-moderate risk grade CIP and DAD is the most common pattern in high risk grade CIP. Patients with basic lung disease are more likely to get CIP.

Analysis of CT features of lepidic predominant subtype and other pathological subtypes in early-stage invasive lung adenocarcinoma appearing as ground-glass nodule / 中华放射学杂志

Objective:To investigate the CT features of lepidic predominant adenocarcinoma (LPA) and other pathological subtypes in early-stage invasive pulmonary adenocarcinoma appearing as ground glass nodule (GGN); and to provide imaging-derived information for the clinical management of GGN.Methods:The clinical and CT data of patients with early-stage invasive pulmonary adenocarcinoma in the First Medical Center of PLA General Hospital from January to December 2019 were retrospectively reviewed. All patients presented with pure GGNs or mixed GGNs with a consolidation-to-tumor ratio (CTR)<0.5, with the pathological results confirmed by surgery. GGNs were divided into LPA and non-LPA (n-LPA) groups according to pathological subtypes. Univariate analysis was used to compare the clinical data and CT characteristics between the two groups. The multivariate analysis was performed for the indicators with statistically significant differences and a multivariate model was generated using the reverse elimination method. The area under the ROC curve (AUC) was used to evaluate the discriminatory power of this model for differentiation of LPA from n-LPA.Results:A total of 630 GGNs from 589 patients were analyzed, with 367 GGNs in LPA group and 263 GGNs in n-LPA group. In univariate analysis, the diameter [(14±5) mm], CT value [(-566±98) HU], and CTR [13.9% (0, 27.3%)] in the LPA group were significantly smaller than those in the n-LPA group [(15±5) mm, (-499±111) HU, 27.8%(7.7%, 40%)], respectively, P<0.05]. The frequency of mGGN, deep lobulation sign, burrs, vascular changes, bronchial changes, and clear tumor-lung interface were significantly higher in the n-LPA group than those in the LPA group ( P<0.05). Multivariate analysis results showed that mean CT values, CTR, deep lobulation sign, burr, vascular changes, and bronchial changes were independent predictors for predicting n-LPA ( P<0.05), which were included in the logistic model. Using the optimal cutoff value of 3.958, the logistic regression model for differentiate LPA from n-LPA had a sensitivity of 76.4%, a specificity of 78.7%, and an area under the curve of 0.840. Conclusion:The CT features are helpful for differentiating lepidic predominant subtype from other subtypes in early-stage invasive pulmonary adenocarcinoma presenting as a GGN.

CT findings of fireworks sign in active pulmonary tuberculosis / 中华放射学杂志

Objective To analyze the fireworks signs of active pulmonary tuberculosis on CT, improve the understanding of CT findings of active pulmonary tuberculosis, and provide imaging basis for clinical treatment. Methods From January 2009 to December 2015, 26 patients (20 males, 6 females;age 16-72(39 ± 15) years old) with fireworks signs on CT were included, all patients had active pulmonary tuberculosis confirmed by sputum smear, bronchoalveolar lavage, biopsy or surgical specimen. A retrospective analysis of patient′s CT image data including the position, number, pattern of fireworks signs and other associated abnormalities were performed and the imaging features were summarized, pathological correlation with CT images was performed in patients with surgical or biopsy results. Results The fireworks signs on CT could be divided into three types:halo pattern, reversed halo pattern and homogenous pattern, which were 2, 7, 23 cases respectively in this study. Fireworks signs in 9 cases were located in unilateral lung field and 17 cases in bilateral lung field. Distribution of lesions was common bilaterally, mainly in the apical, posterior (apicoposterior) segments of the upper lobes and the superior segments of the lower lobes. Fireworks sign presented as a solitary lesion in 7 cases, 2 lesions in 3 cases, more than 3 lesions in 16 cases. Other pulmonary abnormalities included cavities, consolidation, tree-in-bud sign, pleural effusion, pleural thickening and mediastinal lymphadenopathy. Pathologically, fireworks sign corresponded to caseous granulomas in the bronchioles and alveoli. Conclusion Fireworks sign is one of CT signs of active pulmonary tuberculosis, which formed by the bronchial dissemination of tuberculosis on CT and the granulomas in bronchioles and alveoli on pathology.

Quantitative research of lung adenocarcinoma with pure ground-glass opacity on CT / 中华放射学杂志

Objective To find the invasion-associated clinical and CT risk factors of lung adenocarcinoma presenting as pure ground glass opacity nodule (pGGN) and to calculate odds ratio valve of each independent risk factor, the total risk value(TRV) of each lesion and an alert value for the management of pGGN. Methods From January 2014 to December 2016, 265 patients with 274 lesions pathologically confirmed lung adenocarcinoma with pGGN on CT who had undergone curative resection were included. Patient′s clinical data and CT features of pGGN were collected. CT features included the location, size, density and edge of pGGN, bubble-like sign, intrinsic abnormal air-bronchogram and vascular changes, tumor-lung interface. All lesions were divided into preinvasive groups (74 lesions) and invasive groups (200 lesions) according to the histopathology. Quantitative data were compared between preinvasive and invasive groups using t test or variance analysis (ANOVA) or nonparametric test. Qualitative data were compared between two groups using chi-square test. Logistic regression analysis was performed to evaluate the clinical and imaging independent risk factors of invasiveness. Receiver operating characteristics curve analysis was used to get the optimal cutoff value (alert value) for lesion invasiveness. Results There were statistically significant differences in patient age, lesion size, bubble-like sign, abnormal air-bronchogram, intrinsic vascular changes and tumor-lung interface between preinvasive and invasive groups (P<0.05). Logistic regression analysis showed that bubble-like sign, abnormal air-bronchogram, tumor-lung interface and lesion size were independent risk factors of invasiveness of pGGN, the OR value and 95％CI were 2.145(1.157—3.977), 3.167(1.211—8.281), 3.253(1.444—7.324), 1.175(1.061—1.303), respectively. The ROC curve demonstrated the optimal cutoff of TRV for predicting invasiveness was 3.5 with the sensitivity of 85.5％and specificity of 69.0％. Conclusions TRV can predict the invasiveness of pGGN. Surgical treatment is recommended if TRV is≥3.5.

Multi-slice Spiral CT in Diagnosis of Lung Lesions with Cross Interlobar Fissure Symptom / 中国医学影像学杂志

Purpose To explore multi-slice spiral CT (MSCT) features of lesions with cross interlobar fissure symptom in the lung,and through pathological results,to study the differential diagnosis significance of cross interlobar fissure symptom.Materials and Methods Forty-nine patients who were confirmed with lesions in the lung with cross interlobar fissure symptom through surgery,pathological certification or clinical diagnosis from October,2015 to October,2016 were collected.Retrospective analysis was conducted on cross interlobar fissure symptom lesions and other representation in the lung on CT image.Results Sixteen cases were multiple lesions and 33 cases of single cross interlobar fissure lesions.9 cases in the multiple lesions (56.3％) were contagious lesions,including tubercle bacillus,fungus,staphylococcus aureus and klebsiella pneumoniae infection,in which 3 cases (18.7％) were adenocarcinoma,2 cases (12.5％) metastasis,1 case (6.3％) Wegener's granulomatosis and 1 case (6.3％) antineutrophil cytoplasmic anti-body (ANCA) related vasculitis.21 cases in single lesions (63.6％) had malignant tumor,including adenocarcinoma of lung,squamous carcinoma,lymphoma and metastasis,in which 6 cases (18.2％) were sclerosing pneumocytoma or hamartoma with smooth verge and without malignant symptom,and another 6 cases (18.2％) were inflammatory lesions.Conclusion Symptoms of lesions in the lung with cross interlobar fissure growth can be seen in malignant tumor,benign tumor and inflammatory lesions.Multiple lesions are accompanied with cross interlobar symptom which can be seen more often in benign lesions,but also can be seen in malignant tumor (metastasis and intrapulmonary metastasis of lung cancer).Single lesions are also accompanied with cross interlobar symptom which can be seen more often in malignant tumor,but also can be seen in cryptogenic organizing pneumonia and benign tumor.Sometimes,it's very difficult to identify malignant tumor with single cross interlobar distributed cryptogenic organizing pneumonia.When features of benign tumor are very clear,possibility of sclerosing pneumocytoma or hamartoma shall be taken into consideration.

Multi-slice Spiral CT in Differential Diagnosis of Esophageal Leiomyoma and Esophageal Carcinoma / 中国医学影像学杂志

Purpose To explore multi-slice spiral CT (MSCT) in differential diagnosis of esophageal leiomyoma and esophageal carcinoma.Material and Methods Plain chest CT scan and enhanced inspection image of 26 patients with esophageal leiomyoma and 68 patients with esophageal carcinoma at the same term which had been confirmed by surgery and pathology were retrospectively analyzed.Characteristics such as focus size,morphology,density and tumor-air surface,etc were recorded and compared.Results MSCT of esophageal leiomyoma showed uniform density,possible calcification,polylimited influence of esophageal wall,scarcity of depression in focus niche,smooth tumor-air surface,low degree of enhanced amplification,and cerioid expansion of related lumen of larger focus.However,MSCT in esophageal carcinoma was represented by thickened annulus of esophageal wall,no calcification of focus,familiarity of depression in focus niche,rough tumor-air surface and intermediate degree strengthening.Differences of contrast of calcification,polylimited influence of esophageal wall,scarcity of depression in focus niche,smooth tumor-air surface in sophageal leiomyoma with that of esophageal carcinoma were statistically significant (P＜0.05).Conclusion MSCT can accurately identify sophageal leiomyoma and esophageal carcinoma,offering evidence for clinical diagnosis and treatment.

Abnormal air bronchogram within pure ground glass opacity lung adenocarcinoma: value for predicting histopathologic subtypes / 中华放射学杂志

Objective To analyze the value of abnormal air bronchogram for predicting the invasiveness of lung adenocarcinoma with pure ground-glass nodule (pGGN).Methods From April 2014 to February 2016,157 patients with 165 pGGN lung adenocarcinomas confirmed by surgical pathology were selected.There were 30 pre-invasive lesions (AAH+AIS),39 minimally invasive adenocarcinoma (MIA),and 96 invasive adenocarcinoma (IAC).CT characteristics including lesion size,density,abnormal air bronchogram were recorded.All lesions were divided into two groups:normal group (no air bronchogram or normal air bronchogram) and abnormal air bronchogram group.Chi-square test was used to analyze the difference of pathological subtypes between the two groups.Mann-Whitney rank test was used to analyze the size difference of pGGN between the two groups.Two-independent samples t-test was used to analyze the lesion density difference of pGGN between the two groups.Results Of the 165 lesions,85 were found to have air bronchogram,there were 12 lesions in 30 pre-invasive lesions (AAH+AIS),17 in 39 MIAs,56 in 96 IACs.Abnormal air bronchogram were demonstrated in 61 lesions which was 1 in 30 pre-invasive lesions (IACs+AIS),13 in 39 MIAs and 47 in 96 IACs,significant differences were found between two groups (x2=25.943,P＜0.01).The mean size of the IACs were (10.8±4.2) mm for normal group,(17.0±6.7) mm for abnormal air bronchogram group,the mean density were (-519± 118) HU and (-518± 124) HU,respectively.There was a significant difference in lesion diameter between two groups (Z=-6.197,P＜0.01),but not in density (t=-0.042,P=-0.966).Conclusions Abnormal air bronchogram can be used to predict the invasiveness of pGGN lung adenocarcinoma,and is correlated with lesion size,but not with density.

Value of Multi-detector CT in Detection of Isolated Spontaneous Superior Mesenteric Artery Dissection / 中国医学科学杂志(英文版)

Objective To investigate the role of multi-detector computed tomography (CT) in the diagnosis and classification of isolated spontaneous superior mesenteric artery dissection (ISSMAD). Methods From July 2012 to December 2016, 30 consecutive patients with ISSMAD underwent CT scan at least two times. We retrospectively summarized the clinical characteristics and CT findings of them. The stenosis ratio of true lumen was compared between the patients without bowel ischemia and ones with bowel ischemia. Results There were 5 cases of type I ISSMAD, 14 cases of type 2, 1 case of type 3, 7 cases of type 4 and 3 cases of type V. Intestinal ischemia occurred in 5 patients. The stenosis ratio of true lumen in the patients without bowel ischemia was lower than that with bowel ischemia (45.6% vs. 76.0%, t=-14.5, P=0.000). Five patients with intestinal ischemia underwent superior mesenteric artery stenting and others received conservative therapy. The abdominal pain was alleviated for all the patients after treatment. Follow-up was complete in 30 cases. Follow-up CT angiography of superior mesenteric artery showed dissection remodeling in 12 patients. Conclusion Multi-detector CT is a valuable method in diagnosis and classification of ISSMAD and monitoring the changes of dissection.

Analysis of histopathologic subtypes and CT characteristics of lung adenocarcinomas presenting as pure ground-glass nodule of 1 cm or less in maximal diameter / 中华放射学杂志

Objective To evaluate the correlations between CT features and histopathologic subtypes of lung adenocarcinomas presenting as pure ground-glass nodules (pGGN) of 1 cm or less in maximal diameter. Methods CT appearances, pathology and clinical data of 95 patients (97 lesions) who underwent curative resection of lung adenocarcinomas presenting as pGGN≤1 cm in diameter from March 2011 to February 2015 were retrospectively analyzed. Of the 97 lung adenocarcinomas, there were 19 atypical adenomatous hyperplasia (AAH) (19.6%), 31 adenocarcinoma in situ (AIS) (31.9%), 19 minimally invasive adenocarcinoma (MIA) (19.6%) and 28 invasive pulmonary adenocarcinoma (IPA) (28.9%). Fifty (51.5%) were preinvasive (AAH+AIS) and 47 (48.5%) were invasive (MIA+IPA). Lesion size and density were compared among pathologic subtypes using analysis of variance (ANOVA). Lesion size were compared between preinvasive and invasive lesions using 2?independent samples t?test. Lesion location, presence of bubble?like sign, air bronchogram, vessel changes, margin, and tumor?lung interface were compared among histopathologic subtypes using chi?square test. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the cut-off point of size in discriminating preinvasive lesions from invasive lesions. Results Of the 97 lesions, there were no statistically significant differences among histopathologic subtypes in terms of lesion density, presence of bubble?like sign, air?bronchogram, and margin (P>0.05). Mean size of AAH, AIS, MIA and IPA was (0.72 ± 0.19), (0.82 ± 0.14), (0.84 ± 0.11) and (0.85 ± 0.16) cm respectively. There were statistically significant differences among histopathologic subtypes in terms of lesion size (F=3.16, P=0.028). The vessel changes occurred in 2 of AAH, 11 of AIS, 10 of MIA and 17 of IPA. There were statistically significant differences among histopathologic subtypes in terms of vessel changes (χ2=13.22, P=0.004). Lesions with clear tumor?lung interface were in 10 of AAH, 24 of AIS, 17 of MIA, and 26 of IPA. There were statistically significant differences among histopathologic subtypes in terms of tumor?lung interface (χ2=12.67, P=0.005). The optimal cutoff value of lesion size for differentiating preinvasive lesions from invasive lesions was 0.82 cm (sensitivity, 61.7%;specificity, 62.0%). Conclusion Lesion size, vessel changes, and lung?tumor interface may indicate the invasiveness of lung adenocarcinoma presenting as pGGNs of≤1 cm in diameter.

Multi-slice Spiral CT Features of Lung Primary Invasive Mucinous Adenocarcinoma / 中国医学影像学杂志

PurposeTo investigate the multi-slice spiral CT features of lung primary invasive mucinous adenocarcinoma, a rare malignancy with few relevant literature. Materials and Methods Forty-one patients with pathology proven primary invasive mucinous adenocarcinoma of the lungs underwent MSCT examination, of which 27 patients received intravenous contrast. Imaging features were analyzed, and the patients were divided into groups according to morphology, density and enhancement.Results For 41 patients, 40 cases had one lesion, and one case had more than one lesion; the lesions were in the right upper lobe in 5 cases, right middle lobe in one case, right lower lobe in 17 cases, left upper lobe in 5 cases, and left lower lobe in 12 cases. There was solitary lesion in 40 cases. The other patient had multiple lesions. 29 cases showed nodules/masses, while non-mass lesions in 12 cases. Ground glass opacity was seen in 4 cases, single consolidation in 11 cases, and mixed consolidation in 26 cases. There was significant contrast enhancement in nodules/masses compared to non-mass lesions (t=5.00, 6.51 and 14.06,P<0.05).Conclusion MSCT shows a diversity of imaging features of primary invasive mucinous adenocarcinom, including single round lesion, lower lobe in both side; the density is lower than muscle on CT scan, and presents mild to moderate enhancement on enhancement scan round lesions has high density and enhancement range than irregular-shaped lesions.

Imaging Features Multi-slice Spiral CT and PET/CT in Lymphoma with Pulmonary Lesions as the Initial Presentation / 中国医学影像学杂志

PurposeTo discuss the imaging features of multi-slice spiral CT (MSCT) and PET/CT in lymphoma with pulmonary lesions as the initial presentation.Materials and Methods Eighteen cases of lymphoma with pulmonary lesions as initial presentation confirmed by operation and pathology were retrospectively analyzed including Hodgkin lymphoma (HL) in 3 cases and non-Hodgkin lymphoma (NHL) in 15 cases. All 18 patients underwent MSCT, of which 11 also underwent PET/CT. The MSCT manifestations included number of lesions, morphology, density and bronchial change. PET/CT evaluated lesions in other body parts and SUVmax of lung lesions.Results MSCT showed single lung lesion in 6 cases, multiple lung lesions in 12 cases. Masses were seen in 9 cases, non-masses in 7 cases, and mixed type in 2 cases. There was single consolidation in 3 cases and mixed consolidation in 15 cases. Air bronchogram was identified in 15 cases. CT predictive diagnosis was lymphoma in 3 cases, lung cancer in 5 cases, pneumonia in 7 cases, granuloma in 1 patient, and indeterminate in 2 cases. PET/CT showed hypermetabolic lung lesions in 11 patients, mediastinal lymph node in 3 cases, and unilateral supraclavicular lymphadenopathy in 1 case. One patient showed pancreatic tail masses, gastric wall thickening and haunch masses. All 11 patients were diagnosed as malignant tumor, of which 8 cases as lymphoma.Conclusion MSCT manifestations of lymphoma with pulmonary lesions as initial presentation include multiple lesions, polymorphic type and heterogeneity with air bronchogram. PET/CT has better accuracy than MSCT.

Coronary and Carotid Arterial Calcification: The Relativity and Risk Factors / 实用放射学杂志

Objective To determine the correlation between coronary artery calcium score (CACS) and carotid calcification, and their risk factors. Methods 162 cases underwent coronary and carotid pre-contrast CT scan with dual-source CT scanner within 2 weeks. The reconstructed parameters were the same. The calcifications of coronary and carotid arteriae were quantified by calculating the Agatston score. The main risk factors such as age, sex, hypertension, total cholesterol, low-density-lipoprotein cholesterol (LDL), high-density-lipoprotein cholesterol (HDL), diabetes, smoking and coronary heart disease history were recorded. The CACS and carotid calcium scores were comparatively analyzed using Spearman's correlative analysis. The relativity between the risk factors and CACS scores, carotid calcium scores. Results In 162 subjects, there was positive relativity between CACS and carotid cal-cium score(r=0.690, P<0.01). Logistic regression analysis showed that CACS were of relativity with age, diabetes, total cholesterol and LDL cholesterol,otherwise, carotid calcium scores only with age and diabetes. Conclusion There is significant correlation be-tween CACS and carotid calcium score, but their risk factors are not same.

High resolution MR imaging of porcine coronary arterial wall in vitro / 中国医学影像技术

Objective To get a MR imaging protocol for coronary arterial wall in vitro. Methods MR examinations were performed in 10 fresh porcine hearts. Three dimensional fast imaging employing steady state acquisition (3D FIESTA) was used to delineate left anterior descending artery (LAD), while 2D spin-echo T1W was performed with 8-channel head surface coil, temporomandibular surface coil and knee coil with the same parameters. T1WI was obtained with 384×256 and 512×512 in matrix using temporomandibular surface coil, and then T1WI, PDW and T2WI with fat saturation were obtained with different NEX using temporomandibular surface coil after injecting Resovist in LAD. Signal of the LAD wall, lumen, fat tissue adjacent to LAD, myocardium of anterior part of interventricular septum and noise were respectively measured. Signal-to-noise ratio (SNR) of image, contrast to noise ratio (CNR) between the wall and lumen (CNR1), CNR between the wall and surrounding fatty tissue (CNR2) were calculated. Results The SNR and CNR1, CNR2 of SE T1WI with temporomandibular coil were higher than those with 8-channel head surface coil and knee coil. SNR and CNR1, CNR2 of SE T1WI with 384×256 matrix were higher than those with 512×512 matrix. SNR and CNR1, CNR2 using 3 NEX were the highest. Conclusion Good SNR and CNR of porcine coronary wall can be achieved using temporomandibular surface coil, 384×256 in matrix and NEX of 3.

Rationality of 16 or more multi-slice helical CT utilization for solitary pulmonary nodule / 中华放射学杂志

Objective To analyze the rationality of 16 or more multi-slice helical CT (MSCT) utilization for solitary pulmonary nodule (SPN) (<3 cm). Methods One hundred and fifty consultant cases with SPN from 133 different hospitals, examined with 16 or more MSCT, were selected in this study. The reconstructed slice thickness of routine CT scan, thin slice reconstruction thickness, 2D or 3D reconstruction, window wide and level setting, contrast enhancement effect were recorded from consultant films. Thoracic CT scan criteria for SPN were proposed according to the scan guidelines at Stanford University and PubMed articles. The rationality of 16 or more MSCT utilization in other hospitals for SPN was analyzed by two radiologists compared with scan criteria. The diagnostic accuracy in other hospitals was evaluated according to the pathologic and treatment results in our hospital. Results Sixteen-MSCT was performed in 92 cases, 64-MSCT in 54 cases and 40-MSCT in 4 cases. In routine thoracic CT scan, 9--10 mm reconstructed slice thickness was selected in 59 cases, 7--8 mm thickness in 12 cases and 5 mmthickness in 79 cases. Consecutive thin slice thickness (<3 mm) was used for SPN only in 46 cases. OnlyMPR and VR were filmed in 9 cases without thin slice reconstructed axial images. :53 cases (35.3%) were rescanned in our hospital due to the unsatisfied image quality. Of 150 cases, 78 cases had pathologic or treatment results in our hospital and 22 cases (14.7%) were proved to be misdiagnosed in other hospitals, and only 2 cases were misdiagnosed in our hospital. Conclusion There are many irrationalities of 16 or more MSCT utilization in our country which influence the diagnostic accuracy of SPN, Unified thoracic CT scan criteria in our country are needed.

Thoracic CT findings of Behcet disease / 中华放射学杂志

Objective To illustrate the thoracic CT findings of Behcet disease and to assess the CT diagnostic role in patients with Behcet disease. Methods Thoracic CT images and medical records were retrospectively reviewed in 13 patients with thoracic Behcet disease. The diagnosis was based on the criteria set by the international study group for Behcet disease. Results Of 13 patients, subpleural patchy consolidations were showed in 3, bilateral diffuse ground glass opacities in 3, left low lobe collapse with a right small nodule in 1, subpleural solitary pulmonary nodule in 1, bilateral pleural effusion in 2 ,mediastinal lymphoadenopathy in 2, diffuse bilateral miliary lung nodules in 1 during treatment. Thoracic vascular involvement was presented in 8 patients, two with superior vena cava thrombosis, one with left subclavicle artery aneurysm, one with left low pulmonary artery aneurysm and mural thrombosis, one with bilateral low pulmonary arteries and left basilar artery aneurysm, three with right pulmonary artery thrombosis in which there were two with left pulmonary artery occlusion and one with left basilar artery branch aneurysm. Conclusions Thoracic CT findings of Behcet disease are variable and nonspecific. Contrast-enhanced CT scan can be helpful by showing thrombosis of the superior vena cava and pulmonary artery as well aneurysm of the pulmonary artery.

Quick injection combining with slow infusion of contrast media on coronary MR angiography / 中华放射学杂志

Objective To evaluate the effect of quick injection combining with slow infusion of Gd-DTPA on T1 relaxation of the blood. Methods Fifteen volunteers were recruited for coronary MRA study using a navigator-gated 3D-FIESTA sequence. Coronary MRA were acquired on the same segments two times at 5 minutes and 15 minutes after Gd-DTPA administration. Contrast agent was injected biphasically with 10 ml at a flow rate of 1.5 ml/s and 20 ml at 0. 05 ml/s to prolong the T1 relaxation effect. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated pre- and post-contrast MRA. Image quality was compared using t-test. Results The SNR and CNR at 5 minutes after contrast injection (35.37 ±6. 84 and 21.57 ± 6. 08 ) were significantly higher than that of pre-contrast MRA ( 27.38 ± 6. 24 and 13.19 ±6. 50). The SNR at 15 minutes after contrast injection (33. 81 ±9. 43) was higher than that of precontrast MRA, but there was no statistically difference(t = 1. 885 ,P =0. 074). The CNR at 15 minutes after contrast injection (21.20 ± 7.65) was significantly higher than that of pre-contrast MRA. The SNR and CNR at 15 minutes after contrast injection were no significant different compared with those at 5 minutes after contrast injection. Conclusion T1-shorting effect in the blood can be prolonged by quick injection combining with slow infusion of Gd-DTPA ,which meet with the need of multiple scans of coronary MRA.

Spatial heterogeneity of left ventricular myocardium attenuation during 64 multi-slice CT coronary artery angiography / 中华放射学杂志

Objeetive To analyze the attenuation differences of left yentricular myocardium on 64-slice CT coronary artery angiography in adults.Methods of 1130 consecutive patients,119 patients (65 males,54 females,ranged from 27 to 83 years with mean age of 52 years)with no stenosis or stenosis less than 25% in the left anterior descending arteries were enrolled.The standard axial image with 3mm slice thickness just below the aorta valve was selected for measttrement.The regions of interest(0.1 cm× 0.1 cm)in posterior interventricular septum(septal P),anterior interventricular septum(septal A),apex,anterior free wall and posterior free wall of the left ventricle were selected within the myocardium and the mean CT value wag measured.A paired Student t test was used for the comparison of CT values in different areas,P value under 0.05 was considered statistically significant.Results The megn attenuafion of the apical region(69.9±15.5)HU was lower than that of septal A(91.9±15.1)HU(t=11.060,P＜0.01)and anterior free wall(79.7±16.9)HU(t=4.639,P＜0.01),the mean attenuation in septal(93.8±14.8)HU and posterior free wall(88.0±14.3)HU showed relatively higher values.The myocardial intensity attenuation presented as a U-shape in the left ventricular myoeardium. Conclusions The mean attenuation in the left ventrieular myoeardium demonstrates as U-shape during the coronary artery angiography examination in normal adults.This can be helpful for iudging the extent of myocardial infarctiotr.

Application of CT perfusionimaging in assessing the physiological state of solitary pulmonary nodules / 中国组织工程研究

0.05); mean transit time was significantly lower but permeability surface area product higher than benign nodules (P 0.05). ③If the mean transit time ≤ 7 s was selected as cut-off value for malignant lesion, the sensitivity was 68.97%, specificity was 66.67%, accuracy was 68.49%, positive predict value was 88.89%, and negative predict value was 35.71%. When permeability surface area product ≥ 0.20 was selected as the cut-off value for malignant lesion, the sensitivity, specificity, accuracy, positive predict value, and negative predict value were 86.21%, 53.33%, 79.45%, 87.72%, and 50.0%, respectively. CONCLUSION: CT perfusion imaging is a valuable method for assessing the physiological state of solitary pulmonary nodules.

Multi-detector CT angiography for the assessment of anterior spinal artery and artery of Adamkiewicz patency in patients suspected of having thoracic aortic pathology / 老年心脏病学杂志（英文版）

Objective To evaluate the visualization of the anterior spinal artery (ASA) and the artery of Adamkiewicz (AKA) as well as the affecting factors for the detection rate using multidetector row CT (MDCT). Methods Ninety-nine consecutive patients (31 women and 68 men; age range, 25-90 years; average age 61.3 years) with suspicion for thoracic aortic lesions necessitating surgical intervention (31 aortic aneurysm, 45 dissection, 5 intramural hematoma, and 18 normal), underwent 16-slice MDCT angiography from the aortic arch to the aortic bifurcation. Transverse sections, multiplanar reformations (MPR) and thin maximum intensity projections (MIP) were used to assess the ASA and AKA. The level of the ASA and AKA origins and CT acquisition parameters were recorded. The contrast-to-noise ratio (CNR) of the image, an index of the mass of the T11 body (vertebral mass index), the subcutaneous fat thickness,and the CT value within the aortic arch and at the T11 level were measured. The detection of the ASA and AKA was evaluated relative to the acquisition parameters, scan characteristics, and aortic lesion type. Differences were assessed with Wilcoxon rank-sum and t tests. Results The ASA was visualized in 51 patients (52%) and the AKA in 18 patients (18 %). The ASA was identified in 36/67 (54%)patients with 1.25 mm thickness and in15/32 (47%) patients with 2.5-3.0 mm thickness. This difference did not achieve significance (P=0.13). The detection rate of the ASA and the AKA was influenced by vertebral mass index and the CNR (P＜0.05). The amount of subcutaneous fat affected the detection rate of the ASA (P＜0.05) but not the AKA. In CT scans with ASA detection, the mean CT values in the aorta at the arch and at T11 were 360 and 358 HU, respectively; whereas in CT scans without ASA detection, the CT values in the aorta at the arch and at T11 were lower (297 and 317 HU, respectively; both P＜0.05). Conclusion The ASA and AKA were less frequently detected in our cohorts than previous reports. The visualization of the ASA and AKA was significantly affected by aortic enhancement, the vertebral mass index, and the CNR.

Comparison of 16 slice multi-detector computed tomography and breath hold 3D magnetic resonance angiography in the detection of coronary stenosis / 老年心脏病学杂志（英文版）

Objective To compare 16-slice multi-detector spiral computed tomography (MDCT) and breathhold 3D magnetic resonance (MR) coronary angiography in the visualization of coronary arteries and the accuracy of detecting significant (＞ 50%) coronary stenoses in patients with suspected coronary artery disease. Methods Forty patients were examined by 16-slice CT (GE, Lightspeedl6)and MR (GE,Twinspeed) within 3 days; 31 of them underwent conventional coronary angiography (CAG) within 2 weeks after CT and MR scan. CT was performed with 16× 1.25 mm detector collimation, 0.5 s rotation time and images were reconstructed at 60%-75% of the cardiac cycle. MR was performed with breath hold 3D FIESTA (TR4.0 ms, TE1.7 ms, flip angle 65, slice thickness 3 mm, FOV 280 mm, matrix 256× 192). Mean heart rate was 63 ± 5.8 bpm and β-blocker was used in 24 patients. MR and CT image quality was evaluated in 9 coronary segments (RCA1, RCA2, RCA3, LM, LAD1, LAD2, LAD3, LCX1, LCX2) using a four-point grading scale.Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated for detection of significant stenosis using CAG as the gold standard. Results 16-slice CT showed higher image quality in most coronary segments except RCA2.Forty-three segments were diagnosed as significant stenosis by CAG, 36 and 27 of these were correctly detected by CT and MR respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of 16-slice CT and MR for detecting significant stenosis were 83 %, 84 %, 49 %, 97 % and 63 %, 90 %, 55 %, 93 %, respectively. Conclusion Sixteen-slice CT showed higher image quality in most coronary segments excepted for middle RCA. 16-slice CT had higher sensitivity than MR for detection of coronary significant stenosis, whereas MR had higher specificity than CT. Both CT and MR showed high negative predictive value,which is useful for excluding coronary stenosis in symptomatic patients.