Unusual radiological finding in foreign bodies ingestion: three esophageal coins / Hallazgo radiológico inusual en ingesta de cuerpos extraños: tres monedas esofágicas

Abstract Case description: A 5-year-old girl presented to the emergency department with a history of foreign body ingestion. A cervico-thoracoabdominal radiograph demonstrate a foreign body in the esophagus, which seemed to show a double rim sign suspecting a button battery. After an emetic episode and expelling a coin, the child became asymptomatic. Close inspection of the X-ray demonstrated that the image was formed by superimposition of 3 circumferential objects of different sizes. Another X-ray observed the persistence of two superimposed objects. Clinical findings: The girl presented with sialorrhea, odynophagia, and nausea. Vital signs and physical examination were normal. There was no significant medical history. Treatment and Outcome: With the suspicion of multiple impacted esophageal objects, the patient was then taken to the operating room. During the flexible esophagoscopy 2 coins were found in the esophagus, both were removed without difficulty. The patient had an uneventful postoperative recovery and there have been no long-term complications. Clinical relevance: Unusual radiographic findings regarding esophageal foreign bodies have been reported, however, we describe the first case of a child with 3 coins impacted in the esophagus and a new radiological finding in foreign bodies ingestions that allow to avoid misdiagnosis and improve outcomes.

Resumen Descripción del caso: Una niña de 5 años es llevada a urgencias tras la ingesta de un cuerpo extraño. La radiografía cérvico-toraco-abdominal evidenció un cuerpo extraño esofágico con signo de doble halo, lo que hizo sospechar una pila de botón. Tras un vómito con expulsión de una moneda los síntomas desaparecieron. Una inspección minuciosa de la radiografía demostró que la imagen estaba formada por la superposición de 3 objetos circunferenciales de diferentes tamaños. Una nueva radiografía mostró persistencia de dos objetos superpuestos. Hallazgos clínicos: La niña refería odinofagia, náuseas y tenía sialorrea. Los signos vitales y el examen físico eran normales. No tenía antecedentes médicos relevantes. Tratamiento y desenlace: Con la sospecha de impactación esofágica múltiple, la paciente fue llevada al quirófano. Durante la esofagoscopia se encontraron 2 monedas en el esófago que fueron extraídas sin dificultad. La evolución postoperatoria fue favorable y no hubo complicaciones a largo plazo. Relevancia clínica: Aunque se han reportado hallazgos radiográficos inusuales en cuerpos extraños esofágicos, describimos el primer caso de un niño con 3 monedas impactadas en el esófago y un nuevo hallazgo radiológico en la ingesta de cuerpos extraños que permite evitar diagnósticos erróneos y mejorar los desenlaces.

Impaction of Coin Battery in the Appendix / 대한소화기학회지

Coin batteries are often used in daily life devices and can be easily available. Children can swallow coin batteries, resulting in the need to go to hospital, but this is rare in adults. Adults generally eliminate the swallowed coin battery from the digestive system, unless they have congenital structural abnormalities of the digestive system or complications, such as postoperative stenosis. In this case, a 31-year-old man swallowed three coin batteries, approximately 0.4 cm in diameter emergent endoscopy was unable to find any batteries embedded in the ingested food. An attempt was made to rinse out the batteries by bowel preparation. During the hospital stay, the patient complained of acute abdominal pain and fever. In the abdominal CT scan, impaction of the coin battery into the appendix was confirmed. The patient underwent a laparoscopic appendectomy to prevent appendiceal perforation.

Impaction of Coin Battery in the Appendix / 대한소화기학회지

Coin batteries are often used in daily life devices and can be easily available. Children can swallow coin batteries, resulting in the need to go to hospital, but this is rare in adults. Adults generally eliminate the swallowed coin battery from the digestive system, unless they have congenital structural abnormalities of the digestive system or complications, such as postoperative stenosis. In this case, a 31-year-old man swallowed three coin batteries, approximately 0.4 cm in diameter emergent endoscopy was unable to find any batteries embedded in the ingested food. An attempt was made to rinse out the batteries by bowel preparation. During the hospital stay, the patient complained of acute abdominal pain and fever. In the abdominal CT scan, impaction of the coin battery into the appendix was confirmed. The patient underwent a laparoscopic appendectomy to prevent appendiceal perforation.

Correlation between CT perfusion imaging and VEGF, and CD105 expressions in solitary pulmonary nodules / 中国医师杂志

Objective To explore the association of CT perfusion parameters to plasma levels of vascular endothelial growth factor (VEGF) and CD105 in patients with lung cancer to provide a reference for the treatment of patients with vascular targeting anti-selection.Methods Forty eight consecutive patients with diagnosed solitary pulmonary nodules underwent perfusion by 64-slice spiral CT.Among them,31 patients were diagnosed as lung cancers and 17 diagnosed as benign lesions.Statistical methods were used to analyze the differences of CT perfusion parameters [blood flow (BF),blood volume (BV),permeability surface (PS),and mean transit time (MTT)] between benign and malignant lesions,and to observe the correlation between cancer perfusion parameters and VEGF,and CD105.Results Compared to the group of benign lesions,the perfusion parameters BF,BV,and PS in the group of lung cancers were significandy higher than the group of benign lesions (P ＜ 0.05).MTT was not different between two groups (P ＞ 0.05).There were positive correlations between the expressions of VEGF or CD105 and perfusion parameters (BF,BV,and PS) of lung cancers.There were no correlation between perfusion parameter MTT and VEGF or CD105 (P ＞ 0.05).Conclusions CT perfusion parameters BF,BV,and PS can help in differentiating malignant from begin lesions.There is positive correlation between the perfusion parameters (BF,BV,and PS) and VEGF,and CD105 of lung cancers.It indicates that CT perfusion imaging is closely related to tumor angiogenesis,which may provide a non-invasive method to evaluate the blood supply.

Modified inflation-deflation for 146 thoracscopic cone-shaped segmentectomies / 中华胸心血管外科杂志

Objective This study applied " modified inflation-deflation" to identify the intersegmental plane and explored a method to remove pulmonary segments from the lobe on the basis of cone-shaped principle."Cone-shaped" Segmentectomy includes anatomical separation of the hilum(conical tip) and the intersegmental plane(undissociative conical surface).The feasibility was evaluated.Methods We retrospectively reviewed 146 patients with peripheric pulmonary nodules who underwent cone-shaped segmentectomy between September 2013 and August 2016.Under the guidance of preoperative 3D-CTBA (three-dimensional computed tomography bronchography and angiography)the targeted bronchi and arteries were dissected.The intersegmental plane was identified by " modified inflation-deflation" method.The inflation-deflation interface was anatomically separated from hilum to distal region along the intersegmental veins,while leaving 1-2 cm in thickness from far end.The residual intersegmental parenchyma was then dissected using endo staplers.Mean folhow-up was 20.4 months.Results Sixty two single segmentectomies,38 combined segmentectomies,43 subsegmentectomies and 3 subsubsegmentectonies were performed.Twelve diagnoses of benign nodule,15 diagnoses of atypical adenomatous hyperplasia,6 diagnoses of metastatic carcinona and 113 diagnosis of primary puhmonary cancer were confirmed pathologically." Modified inflation-deflation" spent (12.5 ±6.4)minutes to show the clear inflation-deflation line.All the targeted bronchi and arteries were dissected precisely and the intersegmental veins were preserved.All the preserved adjacent segments kept approximately original shape after inflated.The tumor size was(1.4 ±0.7)cm,the surgical margin width was(2.5 ± 1.6)cm.The depth of the separated intersegmental plane was(4.2 ±1.7)cm,and the width of the plane was(6.5 ± 2.2)cm.The operative time was(158.5 ± 42.6)min,the volume of hemorrhage was(25.2 ± 15.7) ml,the postoperative hospital stay was (5.2 ± 2.2) days.The total incidence of complications was 5.5％ (8/146).No death within 30 days occurred.Among 113 primary pulmonary cancers,there were 35 T0 N0M0(adenocarcinoma in situ) and 78 T1a No M0 non-small-cell lung cancers.One patient had local recurrence,and no death occurred during follow-up period.Conclusion Modified inflation-deflation can show clear inflation-deflation line to identify the intersegmental plane.Thoracscopic cone-shaped segmentectomy can achieve a complete anatomical segmentectomy.

Modified inflation-deflation for 146 thoracscopic cone-shaped segmentectomies / 中华胸心血管外科杂志

Objective This study applied " modified inflation-deflation" to identify the intersegmental plane and explored a method to remove pulmonary segments from the lobe on the basis of cone-shaped principle."Cone-shaped" Segmentectomy includes anatomical separation of the hilum(conical tip) and the intersegmental plane(undissociative conical surface).The feasibility was evaluated.Methods We retrospectively reviewed 146 patients with peripheric pulmonary nodules who underwent cone-shaped segmentectomy between September 2013 and August 2016.Under the guidance of preoperative 3D-CTBA (three-dimensional computed tomography bronchography and angiography)the targeted bronchi and arteries were dissected.The intersegmental plane was identified by " modified inflation-deflation" method.The inflation-deflation interface was anatomically separated from hilum to distal region along the intersegmental veins,while leaving 1-2 cm in thickness from far end.The residual intersegmental parenchyma was then dissected using endo staplers.Mean folhow-up was 20.4 months.Results Sixty two single segmentectomies,38 combined segmentectomies,43 subsegmentectomies and 3 subsubsegmentectonies were performed.Twelve diagnoses of benign nodule,15 diagnoses of atypical adenomatous hyperplasia,6 diagnoses of metastatic carcinona and 113 diagnosis of primary puhmonary cancer were confirmed pathologically." Modified inflation-deflation" spent (12.5 ±6.4)minutes to show the clear inflation-deflation line.All the targeted bronchi and arteries were dissected precisely and the intersegmental veins were preserved.All the preserved adjacent segments kept approximately original shape after inflated.The tumor size was(1.4 ±0.7)cm,the surgical margin width was(2.5 ± 1.6)cm.The depth of the separated intersegmental plane was(4.2 ±1.7)cm,and the width of the plane was(6.5 ± 2.2)cm.The operative time was(158.5 ± 42.6)min,the volume of hemorrhage was(25.2 ± 15.7) ml,the postoperative hospital stay was (5.2 ± 2.2) days.The total incidence of complications was 5.5％ (8/146).No death within 30 days occurred.Among 113 primary pulmonary cancers,there were 35 T0 N0M0(adenocarcinoma in situ) and 78 T1a No M0 non-small-cell lung cancers.One patient had local recurrence,and no death occurred during follow-up period.Conclusion Modified inflation-deflation can show clear inflation-deflation line to identify the intersegmental plane.Thoracscopic cone-shaped segmentectomy can achieve a complete anatomical segmentectomy.

Value of multi-slice spiral CT in differential diagnosis of pure ground-glass nodule of 1 cm or less in lung infiltrating adenocarcinoma and before infiltration / 国际肿瘤学杂志

Objective To analyze CT imaging features of lung pure ground-glass nodule (pGGN) of 1 cm or less,and to discuss the differential diagnosis value of multi-slice spiral CT (MSCT) of lung pGGN of 1 cm or less in lung infiltrating adenocarcinoma and before infiltration.Methods A total of 103 patients with lung pGGN≤ 1 cm admitted to the First Hospital of Handan from January 2012 to August 2016 were selected.Of the 103 lung pGGN lesions,there were 67 preinvasive lesions (the preinvasive lesion group) confirmed by operation,including 28 atypical adenomatous hyperplasia and 39 adenocarcinoma in situ.There were 36 invasive lesions (the infiltration group),including 21 minimally invasive adenocarcinoma and 15 invasive adenocarcinoma.All the patients underwent MSCT scanning,and the lesion location,size,CT value,internal density,edge,peripheral vessel and lung-tumor interface were compared between the two pathological types.The receiver operating characteristic curves of the size of the infiltrating lesion and before infiltration were drawn,and the boundary values of the size of the two kinds of pGGN were analyzed and identified.Results The differences of the lesion location (x2 =0.529,P =0.746),vacuole sign (x2 =1.581,P =0.209),aerated bronchus sign (x2 =1.639,P =0.201),edge of the lesion (x2 =0.614,P =0.722) between the two groups were not statistically significant.The proportion of clear lung-tumor interface in infiltration group was higher than that in preinvasive lesion group (86.11％ vs.44.78％;x2 =16.568,P ＜0.001).The proportion of type Ⅰ in the classification of pulmonary vascular relationships in infiltration group was lower than that in preinvasive lesion group (5.56％ vs.41.79％;/x2 =14.894,P ＜0.001),and the proportion of type Ⅲ in infiltration group was higher than that in preinvasive lesion group (38.89％ vs.1.49％;x2 =26.320,P ＜ 0.001) The average maximum diameter of the infiltration group [(0.85 ± 0.17) cm] was greater than that of the preinvasive lesion group [(0.76 ± 0.16) cm],and the difference was statiscally significant (t =2.663,P =0.009).The boundary value to identify the size of the preinvasive and invasive lesions was 0.81 cm,and its sensitivity and specificity rates were 62.1％ and 63.5 ％,and the area under the curve was 0.622.Conclusion Of lung pGGN ≤ 1 cm,invasive lesions are larger,lung-tumor interface is more clear,and the proportion of type Ⅲ in the classification of pulmonary vascular relationships is bigger.MSCT can present the above imaging characteristics of lesions,and it has the important value in differential diagnosis of lung pGGN ≤ 1 cm in infiltrating adenocarcinoma and before infiltration.

Value of multi-slice spiral CT in differential diagnosis of pure ground-glass nodule of 1 cm or less in lung infiltrating adenocarcinoma and before infiltration / 国际肿瘤学杂志

Objective To analyze CT imaging features of lung pure ground-glass nodule (pGGN) of 1 cm or less,and to discuss the differential diagnosis value of multi-slice spiral CT (MSCT) of lung pGGN of 1 cm or less in lung infiltrating adenocarcinoma and before infiltration.Methods A total of 103 patients with lung pGGN≤ 1 cm admitted to the First Hospital of Handan from January 2012 to August 2016 were selected.Of the 103 lung pGGN lesions,there were 67 preinvasive lesions (the preinvasive lesion group) confirmed by operation,including 28 atypical adenomatous hyperplasia and 39 adenocarcinoma in situ.There were 36 invasive lesions (the infiltration group),including 21 minimally invasive adenocarcinoma and 15 invasive adenocarcinoma.All the patients underwent MSCT scanning,and the lesion location,size,CT value,internal density,edge,peripheral vessel and lung-tumor interface were compared between the two pathological types.The receiver operating characteristic curves of the size of the infiltrating lesion and before infiltration were drawn,and the boundary values of the size of the two kinds of pGGN were analyzed and identified.Results The differences of the lesion location (x2 =0.529,P =0.746),vacuole sign (x2 =1.581,P =0.209),aerated bronchus sign (x2 =1.639,P =0.201),edge of the lesion (x2 =0.614,P =0.722) between the two groups were not statistically significant.The proportion of clear lung-tumor interface in infiltration group was higher than that in preinvasive lesion group (86.11％ vs.44.78％;x2 =16.568,P ＜0.001).The proportion of type Ⅰ in the classification of pulmonary vascular relationships in infiltration group was lower than that in preinvasive lesion group (5.56％ vs.41.79％;/x2 =14.894,P ＜0.001),and the proportion of type Ⅲ in infiltration group was higher than that in preinvasive lesion group (38.89％ vs.1.49％;x2 =26.320,P ＜ 0.001) The average maximum diameter of the infiltration group [(0.85 ± 0.17) cm] was greater than that of the preinvasive lesion group [(0.76 ± 0.16) cm],and the difference was statiscally significant (t =2.663,P =0.009).The boundary value to identify the size of the preinvasive and invasive lesions was 0.81 cm,and its sensitivity and specificity rates were 62.1％ and 63.5 ％,and the area under the curve was 0.622.Conclusion Of lung pGGN ≤ 1 cm,invasive lesions are larger,lung-tumor interface is more clear,and the proportion of type Ⅲ in the classification of pulmonary vascular relationships is bigger.MSCT can present the above imaging characteristics of lesions,and it has the important value in differential diagnosis of lung pGGN ≤ 1 cm in infiltrating adenocarcinoma and before infiltration.

Bone suppression images improve radiologists'performance on detection of lung nodules on chest radiographs / 实用放射学杂志

Objective To evaluate the performance of bone suppression images on the detection of lung nodules in comparison with the radiologists'reading results.Methods There were 141 standard posteroanterior digital chest radiographs,which included 95 patients with a solitary nodule and 46 controls.In this observational study,4 observers,including 2 radiologists and 2 residents,in-dicated their confidence level regarding the presence of a nodule for each lung,first by use of standard images,then with the addition of bone suppression images.Receiver operating characteristic (ROC)curve analysis was used to evaluate the observers'performance. Results Average nodule size was (1.9±1)cm (range from 0.9 cm to 2.9 cm).The mean value of the area under the ROC curve (AUC)was significantly improved from 0.844 with use of standard images alone to 0.873 with use of bone suppression images (P<0.01).Conclusion The use of bone suppression images can improve radiologists'performance on detection of lung nodules on chest radiographs.

Research advances in diagnosis and treatment strategy of solitary pulmonary nodule / 天津医药

The detection rate of solitary pulmonary nodule (SPN) is significantly increased with the widespread application of chest computed tomography (CT) scans. Therefore, there is rising demand and expectation for more accurate diagnostic tests to characterize SPN. The different diagnostic methods currently used in clinical practice have their advantages and disadvantages. This article reviews the literature pertaining to SNP diagnosis and treatment strategy and above mentioned concerns according to Fleischner society, American College of Chest Physicians (ACCP) and National Comprehensive Cancer Network (NCCN) screening guideline.

The clinical analysis of 146 cases of solitary pulmonary nodules / 重庆医学

Objective To study the relationship between the clinical imaging manifestations and the judgement of benign and malignant of solitary pulmonary nodules (SPN) .Methods A retrospective analysis of 146 patients with SPN which confirmed by pathological diagnosis .According to SPN diameter all SPN were divided into three groups ,the number of SPN which diameter smal-ler than 0 .8 cm were 16 case ,> 0 .8 - 1 .5 cm were 41 cases ,> 1 .5 - 3 .0 cm were 89 cases .Collect patients′ age ,sex ,smoking his-tory ,clinical symptoms and imaging data ,and analyze its relationship with pathological results .Results All the 146 patients were pathological diagnosis ,benign in 52 cases (35 .6% ) ,malignant in 94 cases (64 .4% ) .As the diameter increases ,the malignant rate increased .There was statistical significance in benign and malignant lesions with smoking history and clinical symptoms (P< 0 . 05) .Whether SPN boundary is clear ,have lobulation ,burr ,pleural indentation syndrome and vessel convergence in benign and ma-lignant lesions were statistically significant (P< 0 .05) .Conclusion The feature size and imaging performance of SPN has important reference value for the judgement of benign and malignant .The positive intervention to SPN have great significance on improve sur -vival rate of lung cancer .

A case report on two superimposed foreign body coins in esophagus.

Foreign body ingestion is a common occurence. We report a case of 8 year old male who presented with history of foreign body ingestion (coin). He had frequent episodes of vomiting along with foreign body sensation. Later on two superimposed foreign body coins were removed by rigid oesophagoscopy.

Clinic research of CT guided localization with a hook-wire system for small ground glass opacity pulmo-nary nodules united with single port video-assisted thoracoscopic resection / 国际肿瘤学杂志

Objective To evaluate the clinical effect of CT guided localization with a hook-wire system united with single port video-assisted thoracoscopic resection (VATS)for small ground glass opacity (GGO) pulmonary nodules (CT lesion diameter <1 .5 cm and no pleural changes).Methods Fifteen patients with small GGO pulmonary nodules who underwent CT-guided transthoracic localization with a hook-wire system in operation room after anesthesia were performed with single port VATS from August 2009 to March 201 3.The accuracy of puncture location,complications,resection rate and pathological results were evaluated.Results All patients underwent CT-guided hook-wire localization and single port VATS resection.The success rate of localization was 1 00%,and the average procedure time was (1 3.60 ±2.06)min,only 1 patient occurred mini-mal pneumothorax.The resection rate of single port VATS was 1 00%,and lobectomy performed in 1 patient, segmentectomy in 1 ,and local resection in 1 3.Pathological diagnosis:adenocarcinoma in situ in 9,atypical adenomatous hyperplasia (AAH)in 5,AAH and adenocarcinoma in situ in 1 .Post-operation follow-up showed all patients survived,and no recurrence and metastasis.Conclusion In operation,use of CT guided localiza-tion with a hook-wire system for small GGO pulmonary nodules (CT lesion diameter <1 .5 cm and no pleural changes)united with video-assisted thoracoscopic resection is accurate,quick and safe,and it has good clinical value.

Clinical application of clock dial integrated positioning for small pulmonary nodules in VATS / 中华胸心血管外科杂志

Objective With the popularization of low dose chest CT examination,a large number of patients with pulmonary nodules(10 mm ＜ D≤20 mm) or small nodules(4 mm ＜ D≤10 mm) emerged.How to accurately position pulmonary nodules especially small nodules in video-assisted thoracoscopic surgery(VATS) is the key.This study explores the positioning method for small pulmonary nodules in VATS.Methods From January 2012 to June 2014,we used a method named clock dial integrated positioning in 316 patients with pulmonary nodules who underwent limited resection or lobectomy in VATS,obtained satisfactory results.Results The accuracy of clock dial integrated positioning method in judgments was 99％ (313/316).296 cases underwent thoracoscopic sublobectomy,including thoracoscopic pulmonary segmental resection in 141 cases and thoracoscopic wedge resection in 155 cases.20 cases underwent thoracoscopic lobectomy.Among them 17 cases had multinodules which were in the different pulmonary segments of the same lobe.Underwent thoracoscopic lobectomy.The positions of 3 cases were error during early cases,underwent VATS lobectomy.The postoperative pathology:194 cases were lung cancer.37 cases were metastatic tumor.85 cases were benign lesions.Conclusion Combined with the clinical treatment experience,we believe that the clock dial integrated positioning method is effective for positioning in VATS.Clinical VATS experiences accumulations are also needed.

Comparative Study of Focal Pulmonary Ground Glass Nodule Between Findings of High Resolution CT and Pathology Classiifcation of IASLC/ATS/ERS / 中国医学影像学杂志

Purpose To evaluate the correlations between high resolution CT (HRCT) findings and IASLC/ATS/ERS pathological classification of ground glass nodule (GGN). Materials and Methods 121 patients with confirmed GGN were selected, and divided into benign group (22 cases), PIL group (21 cases), microinvasive carcinoma group (26 cases) and invasive carcinoma group (52 cases), then the imaging, pathology and prognosis data of patients with pulmonary GGN were reviewed, and the differences among GGN of different pathological types were analyzed.Results Maximum diameter, margin, vacuole sign, solid component, shape and blood vessels through of GGN were significantly different among the four groups (χ2=9.945-31.068,P<0.05). Maximum diameter and margin were significantly different between invasive adenocarcinoma and other groups (P<0.008); vacuole sign of the benign group was significantly different with other groups (P<0.008); the existence of solid component and shape were significantly different between invasive adenocarcinoma and minimally invasive adenocarcinoma (P<0.008); there was significant difference of blood vessels through between invasive adenocarcinoma and benign lesions (P<0.008). Among the 121 lesions, no metastasis except one invasive adenocarcinoma case complicated with distant metastasis.Conclusion Maximum diameter of GGN greater than 16.35 mm, with spiculation or lobulation represent invasive adenocarcinoma; vacuole sign within the GGN represent malignancy; with solid component and irregular shape can be used to identify invasive adenocarcinoma from minimally invasive adenocarcinoma; while blood vessels through can be used to identify invasive adenocarcinoma from benign lesions; the prognosis of GGNs is well with only 0.83% probability of distant metastasis.

Comparative study of MSCT and pathological findings of solitary pulmonary nodules / 重庆医学

Objective To evaluate the diagnostic value of MSCT in Solitary Pulmonary Nodules (SPN) with different pathologic types .Methods Four-five SPN with pathological findings including 16 benign cases and 29 malignant cases were retrospectively an-alyzed ,and performed with MSCT scanning .Observation of the distribution ,morphology and internal characteristics of SPN by post-processing technique were done ,and the results were compared with pathological findings .Results Among 45 SPN ,the benign nodules included 6 cases of inflammatory pseudotumor ,4 cases of tuberculoma ,3 cases of hamartoma ,2 cases of cryptococcus and 1 case of hemangioendothelioma ,and the malignant nodules included 21 cases of adenocarcinoma ,3 cases of squamous carcinoma ,2 ca-ses of small cell carcinoma and 3 cases of alveolar cell carcinoma .Average diameter of benign nodules was 2 .1 cm ,and 2 .6 cm for the malignant nodules .All SPN ,including 5 cases in the inner zone ,12 in the medial zone and 28 in the lateral zone ,the percentages with malignant signs at the corresponding parts were 40% (2/5) ,50% (6/12) ,75% (21/28) ,there was significant difference be-tween distributions(P0 .05);the incidences of leaf sign ,burr sign ,pleural indentation sign ,cavitas and bronchial air sign ,blood vessels cluster sign of malignant nodules were higher than that of the benign nodules(P<0 .05) ,and the inflammatory pseudotumor and adenocarcinoma owned similar characteristics ;the incidence of calcification in tuberculoma and hamartoma was high ,while cavitas in tuberculosis and lung cancer were high .Conclusion MSCT can sufficiently display the distribution ,morphology and internal characteristics of SPN , and can help make qualitative diagnosis of benign and malignant SPN ,providing great practical value in clinical treatment .

An experimental study of comparing digital tomosynthesis and multi-slice CT scanning for the detection of pulmonary nodules using the anthropomorphic chest phantom / 中华放射学杂志

ObjectiveTo compare detection rate of pulmonary nodules and the radiation doses of digital tomosynthesis (DTS) and MSCT chest scanning by using the anthropomorphic chest phantom which containsthermoluminescent dosimeters( TLD ) and simulated pulmonary nodules.Methods The radiation doses of DTS and MSCT scanning were measured by using the anthropomorphic chest phantom which contains 45 TLD and simulated pulmonary nodules.The radiation doses of najor organs were converted into effective dose ( ED ). Three radiologists of different clinical experiences independently reviewed and recorded the density,diameter and position of pulmonary nodules.The sensitivity of nodule detection by DTS and MSCT were compared by Fisher exact test and Chi-square test. The paired t test was conducted to analyze the dose levels of DTS and MSCT.ResultsThe sensitivity of detection nodule by DTS and MSCT were 66.7％ (30/45) and 91.1％ (41/45) respectively.Statistically significant difference between the two examinations existed ( x2 =8.073,P ＜ 0.05).The sensitivity of detection - 650 HU ground glass opacity pulmonary nodule by MSCT and DTS were 93.3％ (14/15) and 73.3％ (11/15) respectively.There was no significant difference between DTS and MSCT ( P ＞ 0.05 ).The sensitivity of detection - 800 HU ground glass opacity nodule and ground glass opacity nodule (d ＜ 8 mm) by DTS were 33.3％ (5/15) and 16.7％ (2/12) respectively,which were lower than those by CT[80.0％ (12/15) and 66.7％ (8/12)].The radiation doses of DTS for various organs in the chest were lower than those of CT. Statistical significant difference between DTS and MSCT existed ( lung t =19.69,thoracic vertebral t =30.01,heart t =16.33,liver t =5.06,breast t =9.43,thyroid gland t =8.05 ;P ＜ 0.05).The effective doses of the DTS and MSCT were 0.65 and 7.71 mSv respectively.ConclusionsThere is no difference between the DTS and MSCT in the detection rate of -650 HU ground glass opacity nodule.For detecting the ground glass opacity nodule ( - 800 HU) and ground glass opacity nodule (d ＜ 8 mm),MSCT is superior to DTS. However,the radiation dosage of DTS is 8.41％ of the MSCT scanning.

Preliminary application of self-made acuductor of CT-guided aspiration biopsy for solitary pulmonary nodules / 中华全科医师杂志

Sixty-four patients with solitary pulmonary nodules were included in this study. The diameter of pulmonary nodules was equal or less than 3.0 cm and no contact with the adjacent pleura. They were divided into study group( with acuductor locating method)and conventional group (with conventional method). The results showed that the one-time success rates were 97％ (31/32)in study group and 72％(23/32) in conventional group, the diagnostic accuracy were 94％ ( 30/32 ) and 88 ％ ( 28/32 ), respectively,while the successful puncture time were( 13. 5 ±4. 9)min and( 18. 7 ±5. 7) min, respectively. In study group,the complication rate was 9％ (3/32), while 28％ ( 9/32 ) in conventional group. There were statistical differences between the two groups. CT-guided aspriation biopsy for solitary pulmonary nodules with self-made acuductor can obviously improve one-time success rate and reduce the complication rate and operative time.

Dual-energy CT in the evaluation of solitary pulmonary nodules by virtual non-enhanced images:initial experience / 中华放射学杂志

Objective To determine the accuracy and radiation dose of dual-energy computed tomography (CT) in evaluating solitary pulmonary nodules (SPNs) by virtual non-enhanced images.MethodsSixty-one patients with SPNs including 39 malignant and 18 benign nodules proved by pathology underwent DECT scans. The CT values of SPNs on enhanced weighted average and virtual non-enhanced images were compared by using Liver VNC processing unit in terms of their diagnostic accuracy for distinguishing malignant and benign nodules with a 20 HU threshold. Diagnostic accuracy was compared. In 28 patients of all patients, image noise and quality score of the non-enhanced and virtual non-enhanced images were compared, and radiation doses of each patient were recorded. The paired t test was used to analyze the noise difference between the plain scan and virtual non-enhanced scan. The Mann-Whitney U test was used to analyze statistically significant differences of the image quality score and radiation dose between the non-enhanced scan and virtual non-enhanced scan. ResultsThe sensitivity, specificity and accuracy for distinguishing benign and malignant nodules by using the virtual non-enhanced image of were 89. 7％(35/39), 72.2％ (13/18), 84.2％ (48/57)respectively.The noise of common CT and virtual nonenhanced images were(8. 49 ± 1. 94) HU and( 10. 14 ± 2. 18 ) HU, and there were statistically difference (t＝9.45,P＜0. 01 ). The quality scores of common CT and virtual non-enhanced images were (4.71 ±0. 46 ) and ( 4.42 ± 0. 57 ), and there were no statistical difference ( U ＝ 290. 00, P ＞ 0. 05 ). The radiation doses of common CT and DECT were ( 3. 72 ± 0. 48 ) mSv and ( 3.78 ± 0. 45 ) mSv, and there were no statistical difference ( U ＝ 350. 50,P ＞ 0. 05 ). ConclusionDECT by using virtual non-enhanced images is useful tool to distinguish the benign and malignant SPN without additional radiation dose.

CT imaging of bronchus related to solitary pulmonary lesion: comparison of minimum intensity projection and multi-planar reconstruction / 中华放射学杂志

Objective To investigate the clinical value of 64-slice computed tomography with MinIP and MPR for imaging the bronchus related to a solitary pulmonary lesion (SPL). Methods Seventy-five subjects with solitary pulmonary lesions underwent chest 64-slice CT and their bronchi were analyzed retrospectively. All images of thin-section (0.625 mm) were reconstructed with MPR and MinIP into images of 1, 2, 3, and 5 mm thickness and 1 mm gap in two orthogonal planes along the long axis of bronchus related to the SPL. The image quality of four series of MinIP and MPR images was evaluated in the aspect of bronchus visibility and pulmonary vascular masking. One-way ANOVA with Bonferroni correction and interclass correlation coefficient were used in the statistical analysis. Results (1) The mean scores of display of the bronchi on MinIP images of four series (4.85, 4.77 and 4.84, 4.63 and 4.67, 4.25 and 4.28, in 1, 2, 3, and 5 mm thickness, respectively) and on MPR images of 1 or 2 mm thickness (4.77 and 4.76, 4.04 and 4.27, in 1 and 2 mm thickness, respectively) were good or excellent. MPR images of 1 mm thickness and MinIP images of 1-3 mm thickness showed no significant differences (t=0.318, P> 0.05 for all), but they were superior to MinIP images of 5 mm thickness (t=6.318 and 6.610, P＜0.01). MPR images of 2 mm thickness were inferior to MinIP images of 1-3 mm thickness (t=5.003-8.958, P＜0.01), but there was no significant difference between MPR images of 2 mm thickness and MinIP images of 5 mm thickness (t=1.794 and 0.3181, all P> 0.05). (2) The effect of suppression of pulmonary vascular markings on MinIP images was better with the increase of slice thickness (F=45.312 and 40.415, P＜0.01). The mean scores of MinIP images of 3 mm and 5 mm thickness (4.67 and 4.64, 5.00 and 4.97, for 3 and 5 mm thickness, respectively) were good or excellent, but MinIP images of 2 mm thickness were just acceptable. Conclusion MinIP images of 3 mm thickness may display the bronchus related to SPL more clearly.