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@#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.
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Objective To explore the value of CT quantitative analysis in differentiating lepidicGpredominant adenocarcinoma (LPA)from invasive nonGlepidicGpredominant adenocarcinoma (INV)manifested as subsolid nodules (SSN).Methods A total of patients with lung adenocarcinoma manifested as SSNs on CT images were divided into LPA group and INV group according to their pathological results.Total volume,solid volume,solid volume percentage,total mass,solid mass,solid mass percentage and threeGdimensional mean CT value of the nodules were calculated after segmenting pulmonary nodules by a 3DGCT segmentation software,meanwhile the oneGdimensional mean CT value and maximal diameter were manually measured.SPSS 22.0 software was used for statistical analysis. Results Solid volume (0.1 6 ±0.3 6 cm3 vs 1.2 6 ±2.1 7 cm3 ,P＜0.00 1),solid volume percentage (4.7 9 ±5.40% vs 2 6.3 3 ± 1 5.6 3%, P＜0.001),total mass (1 180.64±1 751.46 mg vs 2 386.59±3 224.54 mg,P＝0.010),solid mass (151.64±337.53 mg vs 1 257.34± 2 220.9 2 mg,P＜0.00 1 ),solid mass percentage (7.9 8 ± 8.5 8% vs 3 7.2 3 ± 1 8.83%,P＜0.00 1 ),threeGdimensional mean CT value (－492.26±71.21 HU vs －350.73±94.52 HU,P＜0.001 )and oneGdimensional mean CT value (－472.29 ± 1 12.46 HU vs －282.02 ± 1 5 9.13 HU,P＜0.001)in LPA group were found significantly lower than those in INV group.There were no significant differences in the maximal diameter and total volume between LPA group and INV group.Solid volume percentage and solid mass percentage were selected according to stepwise discriminant analysis.The accuracy of Bayes modes by using substitution method and cross validation method were 84.2% and 83.3%,respectively.Conclusion Solid volume percentage and solid mass percentage were important parameters for differentiating LPA from INV.Quantitative analysis of SSN was very helpful to preoperatively evaluate the subtypes and prognosis of lung adenocarcinoma by using 3DGCT segmentation technique.
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Objective Toimprovethepreoperativediagnosisoflungadenocarcinomaaccordingtotherelationshipbetweenthevisceralpleural invasion(VPI)andtheCTfeatures.Methods TheCTfeaturesandthepathologicalmanifestationsof351lungadenocarcinomasconfirmedby surgicalpathologywereretrospectivelyanalyzed.TworadiologistsindependentlyevaluatedtheCTfeatures,includingthelocationand maximumdiameterofthelesion,theminimumdistancefromthelesiontothepleura(DLP)inthree-dimensionalreconstructionimageandthe relationofthelesiontotheadjacentpleura(RAP).TheRAPwasdescribedas5types:(1)nocontactofthethelesionwiththepleura,(2)aline betweenthelesionandthepleurawithoutretractionoftheinvolvedpleura,(3)thelesiontightlyclosedtothepleurawithouttypical pleuraretraction,(4)oneormorelinearstrandsradiatedfromthelesiontothepleuralsurfacewithpleuralretraction,(5)broadcontactofthe lesionandpleurawiththecontactsurfaceoflesionover50% withpleuralretraction.Anexperiencedpathologistevaluatedthehistopathological patternsaccordingtothe7thEditionoftheTNMclassificationforlungcancer(PL0-PL2).AndthePL1andPL2weredescribed as VPI (+)group ,meanwhile the PL0 was as the VPI (-)group .Univariate analysis such as t test,χ 2 or One-W ay analysis of variance was performedtoidentifytheindependentpredictorsinpredictingVPI.Results Significantdifferenceswerefoundinpatientage,lesionlocation, maximumdiameter,andRAPbetweenVPI(+)andVPI(-)groups(P<0.05).Conclusion Whenthepatientwithlungadenocarcinomais over60yearsold,withthelesiondiameterover2.3cm,thepossibilityofvisceralpleuralinvasionwillbeconsideredaccordingtothe relationshipofthelesionandtheadjacentpleura(abuttingpleuralorpleuralindentation).
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Objective To investigate the clinical, radiological and pathological characteristics, treatment and prognosis of pulmonary benign metastasizing leiomyoma (PBML). Methods The clinical and image data of 6 patients with PBML confirmed by pathology from October 2012 to December 2016 were retrospectively analyzed, and the related literature was reviewed. Results Six cases were female, age was from 32 to 55 (43.80 ± 7.17) years. Two cases were found by physical examination, 2 cases had chest distress and asthma, 1 case had chest pain, and 1 case had hemoptysis. Pulmonary abnormalities were detected between 1 month and 15 years after uterine myomectomy. Chest CT showed that multiple lung nodules or masses were observed in 5 patients, among which random distribution was in 3 cases, diffuse military nodule pattern was in 2 cases, and single mass combined with primary lung adenocarcinoma was in 1 case. Fluorine-18-fluorodeoxyglucose positron emission tomography/CT (18F- FDG PET/CT) of one patient showed no obvious uptake of the maximum standardized uptake value. All patients were confirmed histologically with CT guided lung biopsy (2 cases), thoracoscopic lung biopsy (2 cases), and thoracoscopic lobectomy with wedge resection (2 cases). Tumor cells revealed the characteristics of smooth muscle cell differentiation. Immunohistochemistry showed strong positive express of Desmin, SMA smooth muscle specific markers, estrogen receptor and progesterone receptor. Three patients were treated with oral tamoxifen anti estrogen therapy with follow-up from 5 months to 5 years. Four cases had a good prognosis, and 2 cases were lost in follow-up. Conclusions PBML is a rare disease that is prone to occur in women of childbearing age. The clinical symptoms are atypical. Imaging examination and pathology are necessary for diagnosis. Surgery combined with endocrine therapy is effective.
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Objective To analyze quantitatively the effects of lung inflation on the relation of airway dimensions with pulmonary function in patients with COPD.Methods 73 patients with COPD were participated in this research.All subjects would undergo CT scan when in expiration and be evaluated for the lung emphysema index(or LAA%,the percent of total lung area occupied by low at-tenuation area)and airway dimensions,including mean wall thickness (WT),the ratio of mean wall thickness with airway dimensions (WT/AD)as well as the percent of wall area (WA%)in four subsegmental bronchi(right B1,right B10,left B1,left B10).Then,all participants were divided into two groups on the basis of LAA%=1 5%,which were the mild emphysema group (n=34)and the se-vere (n=39),to compare the differences on the correlation of forced expiratory volume in 1 second (FEV1 %)with WA%,WT/AD and WT in both groups.Results There was no correlation of FEV1 % with airway dimensions in the severe emphysema group and WT in the mild group in RB10 (P >0.05).The airway dimensions of the remaining subsegmental bronchi in the mild group had a negatively relationship with FEV1 % (r=-0.382 to -0.799,P <0.05),all of which were better than the severe group (r=-0.371 to -0.687,P <0.05).Except for RB10,the remaining three indexes of airway dimensions were negatively correlated with FEV1 %, especially in RB1.For all subsegmental bronchi,the correlation between airway dimensions and FEV1 % in mild emphysema group were better than the other.Conclusion The effects of degrees in lung inflation on airway dimensions and bronchi obstruction should be taken this interaction into account during CT scan in COPD.
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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.
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Objective To evaluate the diagnostic value of CT and PET-CT characteristics in predicting the presence of epidermal growth factor receptor(EGFR) gene mutations in lung adenocarcinomas. Methods One hundred and sixty-eight lung adenocarcinomas cases confirmed by pathology were enrolled in our study. They were divided into EGFR gene mutations group (89 cases) and wild types group (79cases) according to whether EGFR gene mutation occurred. All patients underwent CT examination. Seventy-five patients underwent PET-CT examination, including 37 gene mutationsand 38 wild types.The demographic (the patients' age, the gender and smoking history), CT characteristics(lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram, ground glass opacity/tumor ratio(G/T) and the maximum diameter of tumor(Dmax)) and PET-CT characteristics(the maximum standardized uptake value, (SUVmax))between these two groups were retrospectively compared. The independent sample t test was used to analyze the difference between these two groups regarding the patients' age,Dmax,SUVmax. The χ2 test was used to demonstrate the difference between these two groups regarding the gender, smoking history and CT features including lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram and G/T.The trend analysis between SUVmax and EGFR gene mutations was performed by usingχ2 test for trend.Results No significant difference was found regarding partial CT characteristics of lesions including lobulation, cavitation, spiculation, pleural-indentation, air-bronchogram (P>0.05),however, the Dmax of EGFR gene mutations group and wild types group were(2.53±1.39),(3.00±1.77)cm, respectively. The amount of G/T>50%in EGFR gene mutations group and wild types group was 21 and 5, respectively. Significant differences were found regarding the G/T and Dmax(χ2=9.538, P50%as diagnostic criterion. Receiver operating characteristic (ROC) results indicated Dmax=1.85 cm was the optimal value in predicting EGFR gene mutations, with the sensitivity and specificity of 76% and 42%, respectively. Meanwhile, SUVmax=6.85 was the optimal value, with the sensitivity and specificity of 71% and 73%, respectively. Moreover,χ2 test for trend showed that an obvious trend was found to associate SUVmax with the incidence of EGFR gene mutations (χ2=15.755, P<0.05). Conclusion SUVmax may be helpful in predicting EGFR gene mutations in lung adenocarcinomas with relatively high diagnostic value.
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Objective To investigate the imaging characteristics of pulmonary mucosa-associated lymphoid tissue(MALT)lym-phoma,in order to improve the diagnosis of this disease.Methods X-ray and CT features of 1 9 cases of pulmonary MALT lympho-ma confirmed by operation or biopsy were retrospectively analyzed.Results Among 1 9 cases,there were 4 cases with a single nod-ule,2 cases with a single consolidation,5 cases with multiple consolidations,2 cases with a single patchy shadow,4 cases with patchy consolidations,1 case with multiple patchy shadows combined with irregular cavities,and 1 case with diffused interstitial changes.Grossus air bronchogram was found in 1 1 cases with nodules,consolidations and patchs.Irregular margin was found in 1 5 cases.Spiculation was found in 3 cases.Pleural retraction was found in 2 cases.Pleural effusion was found in 3 cases.Conclusion Pulmonary MALT lymphoma can be showed as solitary nodule,patchy shadow,consolidation,cavity and diffused interstitial change.Pulmonary MALT lymphoma should be considered if such lesions combined with grossus air bronchogram,irregular mar-gin,spiculation or plural retraction..
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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.
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Objective To investigate the efficacy and safety of hypertonie saline enhanced radiofrequency ablation (RFA) in the treatment of liver cancer. Methods The clinical data of 42 patients with primary liver cancer (n = 28) or metastatic liver eancer (n = 14) who had been admitted to First Affiliated Hospital of Nanjing Medical University from September 2001 to December 2007 were collected. Forty-eight lesions were detected with a diameter ranging from 1.2 cm to 7.5 cm. RFA electrode and 20G needle were pricked into the target lesion under the guidance of B ultrasound or computed tomography (CT) through percutaneoas puncture or open approaches. An amount of 5-10 ml hypertonie saline was infused through the needle at regular intervals during RFA. All patients were followed up for 3-79 months. Contrast-enhanced ultrasound and CT scanning were performed postoperatively to determine the efficacy of RFA. The levels of alpha-fetoprotein (AFP) before and after treatment were compared using t test, and the survival of the patients were analyzed using a Kaplan-Meier survival curve. Results The AFP expression changed to negative in 14 out of the 18 AFP-positive patients, with statistical difference (t =7.703, P <0.05). The complete necrosis rate of tumors was 94% (45/48), and the necrosis rate of tumors with diameter of ≤4.0 cm reached 100% (35/35). The incidence of complication was 5% (2/42). No perioperative mortality occurred. The 1-, 2-, 3-year survival rates were 91%, 85% and 70%, respectively. Conclusions Hypertonic saline enhanced RFA in the treatment of liver cancer was proved to be safe and effective.
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Objective To evaluate the application of MSCT angiography in complex congenital heart disease.Methods Images of patient with complex congenital heart disease were acquired by MSCT with dedicated parameters.Target vas in ROI was identified with plain scanning and then contrast scanning were followed.The preset CT value of the target vas was 160 Hu.The computer would expose automatically when the contrast agent reached the value.Results The target vas was scanned continuously when the contrast agent reached the preset value after "bonus injection" of the vain.Then the acquired data were processed into a clear 3D image of cardiac vas.Conclusion 3D CT angiography is a safe,effective and noninvasive imaging modality for complex congenital heart disease.
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Objective To study the technique of multi-slice spiral CT 3D angiography(CTA) and it's clinical appliction.Methods Multi-slice spiral CT angiography(CTA)in 71 cases were analyzed including intracranial vascular CTA 12 cases, thoracic vascular 9 cases, abdominal 23 cases, low extremity 7 cases, carotid 8 cases, renal artery 12 cases. Media contrast were used in 1.5～2ml/kg, the rate of injection were 2.5～3ml/s.Three ways of scan delay time were applied, that was bolus tracking,test bolus and calculating time. Data reconstruction were done with Real time 3D and Fly 3D and MPR in working-station.Results In intracranial CTA, there were intracranial aneurysm 6, AVM 1, normalities 5. On thoracic CTA, lung arterio-venous fistula in 3, lung arterious embolism in 1, thoracic aortic dissection in 3, and normalities in 2 were showed. In abdominal CTA, abdominal aortic aneurysms were 5, dissection were 15, normalities were 3. In renal arteries CTA, left renal artery stenosis were 3, right renal artery stenosis were 2, normalities were 7. In low extremity CTA, artifical vessel was 1, calcification in both femoral artery was 1; aneurysm in both femoral artery was 1,normalities were 4. In carotid artery, calcification in both sides was 1, normalities were 7.The vascular cavity,calcic spots and abdominal aortic dissection could be showed on CTA. Conclusion Multi-slice spiral CT angiography (CTA) can show 3D vascular structure in whole body, CTA is helpful in guiding vascular operation and stent transplantation
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Objective To study CT value in diagnosing cystic lymphangioma.Methods There were 14 cases with cystic lymphangioma confirmed by pathology.Male were 6 cases and female were 8 cases,ranged in age from 1～57 years old,CT scans were performed in all patients.CT findings by comparison to operation and pathology were studied.Results Patients were subdivided into head-neck 4 cases; body 3 cases; viscus 7 cases based on the location of the lesions.The density in all lesions were homogeneous except one case with bleeding,the CT value were ?10 HU.The diameter of the lesions were 5～15cm, the margin of the lesions were clear, the adjacent tissue were compressed. The lesions were cycle or similar cycle, the septum in some lesions and the wall of lesions were thin, the septum and wall could be partially enhanced. The histories of disease were 1～10 years, average 4.5?1.6 years. No pain in patients except one case with bleeding were found, 3 cases in body had just a little uncomfortable.Conclusion The location and extent of cystic lymphangioma can be detected by CT and it is of valuable in guiding clinical treatment.