Radiomic analysis of lung cancer for the assessment of patient prognosis and intratumor heterogeneity / Análise radiômica do câncer de pulmão para avaliação prognóstica do paciente e da heterogeneidade intratumoral

Abstract Objective: To determine whether the radiomic features of lung lesions on computed tomography correlate with overall survival in lung cancer patients. Materials and Methods: This was a retrospective study involving 101 consecutive patients with malignant neoplasms confirmed by biopsy or surgery. On computed tomography images, the lesions were submitted to semi-automated segmentation and were characterized on the basis of 2,465 radiomic variables. The prognostic assessment was based on Kaplan-Meier analysis and log-rank tests, according to the median value of the radiomic variables. Results: Of the 101 patients evaluated, 28 died (16 dying from lung cancer), and 73 were censored, with a mean overall survival time of 1,819.4 days (95% confidence interval [95% CI]: 1,481.2-2,157.5). One radiomic feature (the mean of the Fourier transform) presented a difference on Kaplan-Meier curves (p < 0.05). A high-risk group of patients was identified on the basis of high values for the mean of the Fourier transform. In that group, the mean survival time was 1,465.4 days (95% CI: 985.2-1,945.6), with a hazard ratio of 2.12 (95% CI: 1.01-4.48). We also identified a low-risk group, in which the mean of the Fourier transform was low (mean survival time of 2,164.8 days; 95% CI: 1,745.4-2,584.1). Conclusion: A radiomic signature based on the Fourier transform correlates with overall survival, representing a prognostic biomarker for risk stratification in patients with lung cancer.

Resumo Objetivo: Associar características radiômicas de lesões pulmonares em imagens de tomografia computadorizada com a sobrevida global de pacientes com câncer de pulmão. Materiais e Métodos: Estudo retrospectivo composto por 101 pacientes consecutivos com neoplasia maligna confirmada por biópsia/cirurgia. As lesões foram semiautomaticamente segmentadas e caracterizadas por 2.465 variáveis radiômicas. A avaliação prognóstica foi baseada na análise de Kaplan-Meier e no teste log-rank, de acordo com a mediana dos valores das variáveis. Resultados: Vinte e oito pacientes faleceram (16 por câncer de pulmão) e 73 foram censurados, com tempo médio de sobrevida de 1.819,4 dias (intervalo de confiança 95% [IC 95%]: 1.481,2-2.157,5). Uma característica radiômica (média de Fourier) apresentou diferença nas curvas de Kaplan-Meier (p < 0,05). Um grupo de pacientes de maior risco foi identificado a partir de valores altos da variável: sobrevida de 1.465,4 dias (IC 95%: 985,2-1.945,6) e razão de risco de 2,12 (IC 95%: 1,01-4,48). Um grupo de menor risco foi identificado a partir de valores baixos da variável (sobrevida de 2.164,8 dias; IC 95%: 1.745,4-2.584,1). Conclusão: Este estudo apresentou uma assinatura radiômica em imagens de tomografia computadorizada, baseada na transformada de Fourier, correlacionada com a sobrevida global de pacientes com câncer de pulmão, representando assim um biomarcador prognóstico.

Advances in clinical assessment of bone healing / 中华创伤骨科杂志

The process of bone healing is absolutely complicated and affected by a wide variety of factors. The quality of bone healing directly determines management approaches. Therefore, it is crucial to evaluate accurately outcomes of bone healing. The assessments of bone healing mostly used in current clinical practice are a combination of clinical manifestations and X-ray examination while computed tomography (CT) and ultrasound may be applied alternatively for particular parts and populations. As understanding of bone healing process and bone biomechanical structure is deepening in recent years, both traditional and novel assessments of bone healing have been well refined. This review will expound on the advantages, disadvantages and clinical indications of various assessments, as well as their future development trends, to provide useful information for clinicians.

Radiomic feature analysis of computed tomography images for the diagnosis of invasive pulmonary adenocarcinoma appearing as ground-glass nodules / 中国基层医药

Objective:To investigate the value of radiomic features of computed tomography (CT) images in the diagnosis of invasive pulmonary adenocarcinoma appearing as part-solid ground-glass nodules.Methods:The clinical data of 100 part-solid ground-glass nodules from 88 patients with pulmonary adenocarcinoma confirmed by pathological diagnosis who received surgical treatment in Taizhou Tumor Hospital, China between February 2016 and April 2019 were retrospectively analyzed. Among these 100 part-solid ground-glass nodules, 56 from 53 patients were diagnosed as invasive pulmonary adenocarcinoma and 44 from 35 patients as non-invasive pulmonary adenocarcinoma. A set of regular risk factors and visually-assessed qualitative CT imaging features were compared with the radiomic features using logistic regression analysis. Three diagnostic models, i.e., a basis model using the clinical risk factors and qualitative CT features, a radiomics model using significant radiomic features, and a nomogram model combining all significant features, were established and their diagnostic efficacy was compared based on receiver operating characteristic (ROC) curves. Decision curve analysis was performed for the nomogram model to explore its potential clinical benefit.Results:Multiple logistic regression analysis showed that three qualitative CT imaging features (pleural traction ( P = 0.006), solid component size ( P = 0.045) and solid component proportion ( P = 0.020)) and quantitative Rad score ( P = 0.046) were significantly correlated with invasive pulmonary adenocarcinoma. The adjusted ratios were 7.189, 0.075, 194.786 and 2.016, respectively. The diagnostic nomogram model based on these four features showed that the area under the ROC curve (AUC) was 0.903 (95% CI: 0.845, 0.975). The diagnostic nomogram model showed a significantly higher performance (AUC = 0.903) in differentiating invasive pulmonary adenocarcinoma from non-invasive pulmonary adenocarcinoma than either the basis model (AUC = 0.853, P = 0.000) or the radiomics model (AUC = 0.769, P < 0.001). Decision curve analysis indicated a potential benefit of using such a nomogram model in clinical diagnosis. Conclusion:Quantitative radiomic features provide additional information regarding clinically-assessed qualitative features for differentiating invasive pulmonary adenocarcinoma from non-invasive pulmonary adenocarcinoma appearing as ground-glass nodules, and a diagnostic nomogram model including all these significant features may be clinically useful in preoperative strategy planning.

Soft Tissue Cephalometric Measurements Among Malaysian Malays and Chinese

Abstract Objective: To obtain the standardized values of individuals of Malaysian Malay and Chinese for further relevant research, such as treatment planning and aesthetical considerations. Material and Methods: In this retrospective study, 440 (305 were Malays and 135 were Chinese) standardized lateral cephalometric radiographs of orthodontic patients selected through simple random sampling are profiled using Holdaway's analysis. The independent t-test was used to assess the disparities in race and gender. The significant level was p<0.05. Results: Significant differences were found between the Malays and Chinese in their skeletal profile convexity, superior sulcus depth, inferior sulcus to the H line and nose prominence. Between Malay females and males, there are significant differences in superior sulcus depth, soft tissue subnasale to H line, basic upper lip thickness, upper lip thickness and nose prominence. Between Chinese males and females, there were differences in their skeletal profile convexity, upper lip to H line, basic upper lip thickness and upper lip thickness. Conclusion: The findings demonstrated the difference between standardized norms and the unique profiles of Malaysian Malays and Chinese. There are significant gender disparities in the soft tissue cephalometric measurements among Malaysian Malay and Chinese subjects.

Risk assessment of hepatocellular carcinoma development for indeterminate hepatic nodules in patients with chronic hepatitis B

BACKGROUND/AIMS: A risk prediction model for the development of hepatocellular carcinoma (HCC) from indeterminate nodules detected on computed tomography (CT) (Rad(CT) score) in patients with chronic hepatitis B (CHB)-related cirrhosis was proposed. We validated this model for indeterminate nodules on magnetic resonance imaging (MRI).METHODS: Between 2013 and 2016, Liver Imaging Reporting and Data System (LI-RADS) 2/3 nodules on MRI were detected in 99 patients with CHB. The Rad(CT) score was calculated.RESULTS: The median age of the 72 male and 27 female subjects was 58 years. HCC history and liver cirrhosis were found in 47 (47.5%) and 44 (44.4%) patients, respectively. The median Rad(CT) score was 112. The patients with HCC (n=41, 41.4%) showed significantly higher Rad(CT) scores than those without (median, 119 vs. 107; P=0.013); the Chinese university-HCC and risk estimation for HCC in CHB (REACH-B) scores were similar (both P>0.05). Arterial enhancement, T2 hyperintensity, and diffusion restriction on MRI were not significantly different in the univariate analysis (all P>0.05); only the Rad(CT) score significantly predicted HCC (hazard ratio [HR]=1.018; P=0.007). Multivariate analysis showed HCC history was the only independent HCC predictor (HR=2.374; P=0.012). When the subjects were stratified into three risk groups based on the Rad(CT) score (<60, 60–105, and >105), the cumulative HCC incidence was not significantly different among them (all P>0.05, log-rank test).CONCLUSIONS: HCC history, but not Rad(CT) score, predicted CHB-related HCC development from LI-RADS 2/3 nodules. New risk models optimized for MRI-defined indeterminate nodules are required.

Application of quantitative imaging technique in the diagnosis of pancreatic cancer / 中国基层医药

Pancreatic cancer is a malignant tumor,and the clinical manifestations are not characteristic,so it is difficult to diagnose at an early stage, and it has a poor prognosis. Image technology has been widely used in clinical,with mature technology,and the application of image technology not only confined to the image display,but also has become a hot spot of research, including dynamic contrast enhancement magnetic resonance imaging (DCE－MRI),intravoxel incoherent motion ( IVIM),CT perfusion imaging,which could analyze quantitatively the permeability and microvascular of lesions,to improve the sensitivity of diagnosis,and to assess quantitatively the effect of drugs,radiation and chemotherapy.

Correlation between ahlbäck classification and gonarthrosis risk factors / Correlação entre a classificacão de ahlbäck e fatores de risco da gonartrose

ABSTRACT Objective: To demonstrate whether or not there is a correlation between the risk factors for gonarthrosis and the radiographic classification of Ahlbäck. Methods: We studied patients with primary gonarthrosis attended at the knee outpatient clinic of the General Hospital of Vila Penteado during their routine visit. We collected data on patient age (years), weight (kg), height (meters), body mass index (BMI = patient weight/height2), personal history of hypertension or diabetes mellitus (positive or negative), sedentarism (physical activity less than three times per week, 30 minutes per session), functional demand (how many blocks walked weekly), time of onset of symptoms (in years) and laterality or bilaterality. The data were correlated with the Ahlbäck classification applied to the radiographs performed at the time of the consultation. Results: A sample of 108 patients was studied. We did not find an association between the Ahlbäck classification and the patient's age, smoking, sedentary lifestyle, laterality, number of blocks walked per week, diabetes mellitus, and sex; however, a positive association was observed in hypertensive patients as well as a weak correlation with height and weight of the patient and moderate correlation with BMI. Conclusion: The Ahlbäck classification is unrelated to most of the risk factors for primary gonarthrosis. Level of evidence III, Case-control study.

RESUMO Objetivo: Demonstrar se existe ou não correlação entre os fatores de risco de gonartrose e a classificação radiográfica de Ahlbäck. Métodos: Estudamos pacientes com gonartrose primária, assistidos no ambulatório de joelho do Hospital Geral de Vila Penteado em sua consulta de rotina. Foram coletados dados referentes a idade do paciente (anos), peso do paciente (kg), altura (metros), índice de massa corporal (IMC= peso do paciente/altura2), antecedente pessoal de hipertensão ou diabetes mellitus (positivo ou negativo), sedentarismo (se pratica atividade física menos de três vezes por semana, 30 minutos por sessão), demanda funcional (quantas quadras caminha semanalmente), tempo do início dos sintomas (em anos) e lateralidade ou bilateralidade. Os dados foram correlacionados com a classificação de Ahlbäck aplicada às radiografias realizadas no momento da consulta. Resultados: Uma amostra de 108 pacientes foi estudada. Não encontramos associação entre a classificação de Ahlbäck e a idade do paciente, tabagismo, sedentarismo, lateralidade, quantidade de quadras percorridas por semana, diabetes mellitus e sexo do paciente, porém verificou-se associação positiva em pacientes hipertensos e correlação fraca com altura e peso do paciente e correlação moderada com IMC. Conclusão: A classificação de Ahlbäck não apresenta relação com a maioria dos fatores de risco de gonartrose primária. Nível de evidência III, Estudo caso-controle.

Iterative reconstruction improves imaging quality of low er -radiation CT perfusion in patients w ith acute ischemic stroke / 国际脑血管病杂志

Objective To investigate w hether the iterative reconstruction (iDose 4 ) technique improves imaging quality of the low-radiation-dose w hole brain CT perfusion (CTP). Methods Thirty-five consecutive patients w ith clinical y suspected ischemic stroke w ere col ected. Bril iance 256 iCT w as used to perform low-radiation-dose w hole brain CTP, and the filtered back projection (FBP) and iDose 4 algorithm w ere used to conduct image reconstruction. The noise and signal to noise ratio of the 2 kinds of reconstruction algorithms, as w el as the imaging quality of each parameter map w ere compared. Results The effective dose of the w hole brain CTP w as 2.2 mSv. Compared w ith FBP, the noise of each region of interest in the iDose4 Tmax map was decreased significantly ( P<0.05) and the signal to noise ratio was increased significantly (P<0.05). The imaging quality scores (median, interquartile range) reconstructed by FPB group w ere significantly low er than by iDose 4 for cerebral blood flow (CBF) map ( 5.00 [3.00-6.00]vs. 6.00 [5.00-6.00]; Z= -2.784, P=0.005), cerebral blood volume (CBV) map ( 6.00 [5.00-6.00] vs. 6.00 [6.00-7.00]; Z= -3.674, P<0.001), and mean transit time (MTT) map (4.00 [3.00-5.00] vs. 5.00 [4.00-6.00]; Z=3.394, P=0.001). The proportions of the poor quality in CBF map ( 34.3%vs. 11.4%;χ2 =7.036, P=0.030), CBV map (11.4%vs.2.9%; χ2 =7.485, P=0.024 ) and MTT map (28.6%vs.11.4%;χ2 =5.318, P=0.070) reconstructed by FBP w ere significantly higher than by iDose 4 . Conclusions The iDose4 technique may improve imaging quality of low er-radiation-dose CTP.

Mammographic Breast Density Evaluation in Korean Women Using Fully Automated Volumetric Assessment

The purpose was to present mean breast density of Korean women according to age using fully automated volumetric assessment. This study included 5,967 screening normal or benign mammograms (mean age, 46.2 +/- 9.7; range, 30-89 years), from cancer-screening program. We evaluated mean fibroglandular tissue volume, breast tissue volume, volumetric breast density (VBD), and the results were 53.7 +/- 30.8 cm3, 383.8 +/- 205.2 cm3, and 15.8% +/- 7.3%. The frequency of dense breasts and mean VBD by age group were 94.3% and 19.1% +/- 6.7% for the 30s (n = 1,484), 91.4% and 17.2% +/- 6.8% for the 40s (n = 2,706), 72.2% and 12.4% +/- 6.2% for the 50s (n = 1,138), 44.0% and 8.6% +/- 4.3% for the 60s (n = 89), 39.1% and 8.0% +/- 3.8% for the 70s (n = 138), and 39.1% and 8.0% +/- 3.5% for the 80s (n = 12). The frequency of dense breasts was higher in younger women (n = 4,313, 92.3%) than older women (n = 1,654, 59.8%). Mean VBD decreased with aging or menopause, and was about 16% for 46-year-old-Korean women, much higher than in other countries. The proportion of dense breasts sharply decreases in Korean women between 40 and 69 years of age.

Pedicle exposure technique for atlas screw fixation:a radiological research / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the meaning of pedicle exposure technique for screw fixation on atlas with the vertebral groove height less than 4 mm by using reconstructive computed tomography.</p><p><b>METHODS</b>From April 2015 to June 2015, 84 pedicles of 51 patients with groove heights less than 4 mm were studied by digital reconstruction respectively. Parameters of atlas pedicle screw fixation were measured.</p><p><b>RESULTS</b>Among the 51 cases, the vertebral groove height was (3.28±0.51) mm. Lateral mass heights, lateral mass widths and the transition area heights between lateral mass and posterior arch were fit for 3.5 mm screw implanting. Ideal pedicle screw trajectory lengths from 0° to 15° (0°, 5°, 10°, 15°) were (27.36±1.81), (27.01±1.68), (27.07±1.75), (27.48±1.72) mm, exposed trajectory lengths from 0° to 15°(0°, 5°, 10°, 15°) were(23.44±1.79), (23.87±1.84), (24.58±1.89), (25.56±2.01) mm, trajectory length of lateral mass was (20.78±2.05) mm. The mean CT values on 5 sections through pedicle trajectory and lateral mass trajectory were (701.89±141.48) HU and (599.11±137.33) HU, respectively. There were no significant differences between ideal pedicle trajectory lengths from 0° to 15°(>0.05). Exposed trajectory lengths was significantly increased accompanying with medial angles increasing (<0.05), and was longer than trajectory lengths of lateral mass (<0.05). CT value of pedicle screws was higher than CT value of lateral mass screws significantly (<0.01).</p><p><b>CONCLUSIONS</b>Screws can be implanted in atlas with vertebral groove height less than 4 mm by using pedicle exposure technique. Few trajectory lengths will be sacrificed with favorable pull out strength due to adequate bone mass purchased.</p>

Chitosan-based biomaterials used in critical-size bone defects: radiographic study in rat's calvaria / Biomateriais a base de quitosana na correção de defeitos ósseos críticos criados em calvaria de ratos: avaliação radiográfica

Objetivo: Este estudo avaliou através de imagens radiográficas digitais, a ação de biomateriais de quitosana e de cloridrato de quitosana, com baixo e alto peso molecular, utilizados na correção de defeitos ósseos de tamanho crítico (DOTC)em calvária de ratos. Material e MétodoO: DOTCs com 8 mm de diâmetro foram criados cirurgicamente na calvária de 50 ratos Holtzman. Em 10 animais o defeito foi preenchido foram preenchidos com coágulo sanguíneo (controle negativo). Os 40 animais restantes foram divididos de acordo com o biomaterial utilizado no preenchimento do defeito (quitosana de baixo peso e de alto peso molecular, e cloridrato de quitosana de baixo e de alto peso molecular), e foram avaliados em dois períodos experimentais (15 e 60 dias), totalizando 5 animais/biomaterial/período de avaliação. Resultado: A avaliação radiográfica foi feita utilizando duas radiografias digitais do crânio do animal: uma tomada logo após o defeito ósseo ser criado e a outra no momento do sacrifício. Nessas imagens, foi avaliada a densidade óssea radiográfica inicial e a final na área do defeito, que foram comparadas. As análises na densidade óssea radiográfica indicaram aumento da densidade óssea radiográfica dos DOTCs tratados para todos os biomateriais testados, em ambos os períodos. Resultados semelhantes foram encontrados no grupo controle. Conclusão: Conclui-se que os biomateriais de quitosana testados não foram capazes de aumentar a densidade radiográfica em DOTC realizados em calvária de ratos.

Objective: This study evaluated, using digital radiographic images, the action of chitosan and chitosan hydrochloride biomaterials, with both low and high molecular weight, used in the correction of critical-size bone defects (CSBD's) in rat's calvaria. Material and Method: CSBD's with 8 mm in diameter were surgically created in the calvaria of 50 Holtzman rats and these were filled with a blood clot (Control), low molecular weight chitosan, high molecular weight chitosan, low molecular weight chitosan hydrochloride and high molecular weight chitosan hydrochloride, for a total of 10 animals, which were divided into two experimental periods (15 and 60 days), for each biomaterial. The radiographic evaluation was made using two digital radiographs of the animal's skull: one taken right after the bone defect was created and the other at the moment of the sacrifice, providing the initial and the final radiographic bone density in the area of the defect, which were compared. Result: Analysis of radiographic bone density indicated that the increase in the radiographic bone density of the CSBD's treated with the proposed biomaterials, in either molecular weight, in both observed periods, where similar to those found in control group. Conclusion: Tested chitosan-based biomaterials were not able to enhance the radiographic density in the CSBD's made in rat's calvaria.

Application of multimodal CT exanination in acute cerebral infarction / 国际脑血管病杂志

Acute cerebral infarction needs a fast and effective imaging examination to help determine the diagnosis,analyze the causes,guide the treatment,and determine the prognosis.Multimodal CT examination obtains a wide range of reformation in a single scan,including anatomy,hemodynamics and etiology,and provides objective imaging evidence for comprehensive evaluation and appropriate treatment of cerebral infarction.This article reviews the application of this technology in acute cerebral infarction.

Efficacy of quantitative CT in assessment of fracture healing / 中华创伤杂志

Objective To investigate the efficacy and accuracy of quantitative computed tomography (QCT) in assessment of fracture healing. Methods Twenty-four healthy New Zealand rabbits were enrolled in the study and randomly divided into two groups, ie, Croup A (union model group, transverse fracture open created on mid-shaft of tibia and inter-fixed by kirschner wire) and Group B (non-union model group, transverse fracture with 5 mm defect on mid-shaft of tibia open created, then sealed with bone wax on fracture gap and medulla cavity, inter-fixed by kirschner wire). At 2, 4, 8 and 12 weeks, Kirschner wire was withdrawn and plain X-ray and QCT scanning were performed on the bilateral tibia. Then, rabbits were scarified and its bilateral tibia were desected and histologically examined. The result of X-ray and histological analysis was used as the "golden standard" for evaluation of fracture healing. Receiver operating characteristic curve (ROC) was used to analyze the evaluation performance of QCT. The corresponding segments of the contralateral healthy tibia were used as control to investigate the change of QCT parameters. Results In Group A, X-ray and histological analysis verified clear fracture line filled with irregular callus at 2 and 4 weeks but proved vague or vanishing fracture line and continuous and intact cortex of irregular callus at 8 and 16 weeks. In Group B, X-ray and histology analysis found clear fracture line with inactive ossification at 2 and 4 weeks but vague fracture line with scarce osteocyte and bone trabecula at 8 and 16 weeks. ROC analysis of QCT results showed the following results; (1) the areas under curve (accuracy) of material parameters including bone mineral density (BMD) and bone mineral content (BMC) were 0.781 and 0.750 respectively; (2) structure parameter-cross-sectional area (CSA) and the area under curve of cross-sectional moment of inertia (CSMI) were 0.781 and 0.469 respectively (P <0.05); (3) the areas under curve of the extending parameters bone strength indices (BSICSA) and CSMI bone strength indices ( BSICSMI) were 0. 913 and 0. 813 respectively (P < 0.05); (4) the area under curve (accuracy) of BSICSA, CSA and BMD were 0.905, 0.921 and 0.905 respectively (P<0.05). Conclusions QCT has potential in distinguishing fracture union and nonunion models in measurement of local fracture pattern. The screening parameters with more accuracy are BSICSA, CSA, BMD, which have advantages of accuracy and specialty in assessing fracture healing.

Application of phase-contrast imaging with synchrotron radiation hard X-ray in repair of traumatic femoral defect / 中华创伤杂志

Objective To compare the effectiveness of nano-hydroxyapatite/collagen (nHAC)and autologous mesenchymal stem cells (AMSCs) for the repair of femoral defect in a rabbit model with femoral defect under the monitoring of the synchrotron radiation hard X-ray. Methods The rabbit models of traumatic bone defect were established and completely randomized into three groups. The femoral defects filled with nothing were used as control group (Group A) , the femoral defects filled with nHAC as Group B and the femoral defects filled with nHAC + AMSCs as Group C. Phase-contrast imaging with synchrotron radiation hard X-ray was applied to detect the degradation and repair process of each group at postoperative weeks 4, 8 and 12, respectively. Results Phase-contrast imaging with synchrotron radiation hard X-ray could display the reparative process. Four weeks after operation, there was collapse in some defect areas in Group A, and the degradation of nHAC and new bone formation were observed in Groups B and C. Eight weeks after operation, fibrous tissues were observed in the defect area in Group A, while osteogenesis and nHAC degradation were more obvious in Groups B and C. Twelve weeks after operation, the defect areas were still unhealed and were substituted by fibrous tissues in Group A, tissue densities of defect areas in Group C were identical with periphery areas, and trabecular bones were formed in Group C. There were statistical differences in the osteogenesis between Group A and Groups B and C,with Group C the best. Conclusion Phase-contrast imaging with synchrotron X-ray can detect the reparative process at a micro-level and plays an important role in the development of tissue engineering.

Value of Coronal Reformatted Images Using Multi-detector Computed Tomography for Nodal Staging in Non Small Cell Lung Cancer Cases

PURPOSE: The aim of our study was to evaluate the value of coronal reformatted images using multi-detector computed tomography (MDCT) imaging in non small cell lung cancer (NSCLC) for the determination of lymph node (LN) metastasis. MATERIALS AND METHODS: Chest CT scans using MDCT were performed in 43 patients with pathologically proven NSCLC. The images were reconstructed with a 3 mm thickness in the axial and coronal planes. The axial images were examined for LN metastasis with and without the coronal reformatted images by the consensus of two radiologists on two separate occasions. RESULTS: In total, 214 nodal groups were dissected, of which, 33 (15.4%) were pathologically proven as LN metastasis. The sensitivity of diagnosis was higher when assessing both the axial and coronal reformatted images compared to the axial images alone (51.5% vs. 33.3%), whereas the specificity and accuracy was lower when examining both the axial and coronal reformatted images (65.7% vs. 87.8% and 63.6% vs. 79.4%). Despite this, the additional coronal reformatted images provided additional anatomical information which was helpful in the assessment of accurate nodal stations and the decline of the pitfalls. CONCLUSION: The value of coronal reformatted images for the diagnosis of nodal metastasis in NSCLC may still be unclear; however, the coronal reformatted images may lend support to the axial images in being able to provide additional anatomical information.

The matched control study between medical imaging and pathologic findings in ossification of the ligamentum flavum of the thoracic spine / 中华骨科杂志

Objective To analyze and classify the characteristic of plain X-ray, CT scan, MRI and pathologic findings in ossification of the ligamentum flavum of the thoracic spine. Providing the clinic criterion to verify the extent and progression of ossification of ligaments based on medical imaging findings. Methods Twenty-four patients with thoracic myelopathy due to ossification of the ligamentum flavum underwent surgical decompression posteriorly. There were 18 males and 6 females with age ranging from 42-76 years (mean, 57.9 years). The morphology of ossification on the CT scan was divided into isotype and non-isotype. The signal intensity of ossification was compared with that of spinal cord on T2 stage in MRI, whose results were divided into four types, such as no signal, low signal, iso signal and high signal. There were two types of ossification in pathologic findings, the mature and immature ossification. 73 segments of ossified ligaments removed from surgery were evaluated and classified individually on the base of their X-ray, CT scan, MRI and pathologic findings. 27 segments of ossified ligaments were examined immunohistochemically by use of TGF-?1 antibody. The relationship between classification of X-ray, CT scan, MRI and pathology of the ossified ligaments were compared on the basis of individual segment, to determine whether there was correlation between these findings. Results The relationship between the pathologic findings of the 73 ossified fragments and the manifestation for the CT classification and MRI signal showed: 18 isotype ossification on CT scan turn out to be mature; and among the 55 non-isotype ossification, 51 were immature and 4 were mature. 22 no signal ossifications on MRI were confirmed as mature type; all the 50 low signal ossifications were immature type; and 1 iso signal ossification was immature type. 100% were matched between MRI and pathological findings, 94.5% matched between CT and pathological findings. Conclusion The extent and progression of ossification of ligaments may be verified and predicted clinically on the base of CT scan and MRI findings, which provide the clinic criterion to guide the extent and timing of decompression.