ABSTRACT
Ultrasound examination has the advantages of non-radiation, non-invasive, low cost and high efficiency, and is the most commonly used method of liver imaging examination. In recent years, the application of computer vision technology to the intelligent analysis of ultrasound images has become a research hotspot in the field of intelligent healthcare. Through large-scale data training, the intelligent analysis model of ultrasound omics based on machine learning algorithm can assist clinical diagnosis and therapy, and improve the efficiency and accuracy of diagnosis. Based on the literature, the authors summarize the application proprect of computer vision technology assisted ultrasonography in the evaluation of diffuse liver lesions, focal liver lesions, microvascular invasion of liver cancer, postoperative recurrence of liver cancer, and postoperative therapy response to trans-catheter arterial chemoembolization.
ABSTRACT
Objective@# To investigate the clinical features, diagnosis and treatment of osteomyelitis of the jaw caused by an actinomycotic infection and to provide a reference for clinical diagnosis and treatment.@*Methods@#A case of osteomyelitis in the bilateral maxilla and the left zygomatic bone and arch caused by a mixed bacterial infection dominated by Actinomycetes was reviewed and analyzed in combination with the literature. @*Results @#The patient had left upper posterior tooth pain with repeated left facial swelling for 7 months. The patient's left face was swollen before surgery, the left maxillary alveolar bone was necrotic, and the upper palate showed fistula discharge. A maxillofacial magnetic resonance imaging scan excluded tumors and other space-occupying lesions. According to CBCT images, the initial diagnoses were left infraorbital space infection and osteomyelitis of the bilateral maxillary, the left zygomatic bone, the left zygomatic arch and the lateral orbital wall. Necrosis of the left maxilla and the zygomatic bone was excised, the focus was cleared and the focal tooth was extracted under general anesthesia. Histopathological results confirmed osteomyelitis and actinomycotic infection. Anti-inflammatory therapy with penicillin sodium was given before surgery, and piperacillin sodium and tazobactam sodium, dexamethasone sodium phosphate, tranexamic acid and mecobalamine were given after surgery. The patients' 6-month follow-up results showed that the maxillofacial shape was basically symmetrical; no ulceration, pus or abnormal secretion was found in the skin or intraoral mucosa; and the surgical area showed good recovery. A review of the relevant literature showed that Actinomyces is an opportunistic pathogen, and factors such as trauma and dental infection have been implicated in the pathogenesis of osteomyelitis. In addition to surgery, antibiotics are used to treat the disease and multidisciplinary symptomatic treatment combined with supportive treatment is required to achieve a better prognostic effect. @*Conclusion @# Actinomycotic osteomyelitis occurring in the maxilla and the zygomatic bone is an extremely rare disease that can be diagnosed by clinical manifestations, bacteriological examination and biopsy. Appropriate and effective penicillin drugs should be given at the initial stage of treatment, more sensitive antibiotics should be selected according to the results of the drug sensitivity test, and the lesions should be surgically removed when the patient's condition improves. Active symptomatic and supportive treatment should be performed during the treatment period.
ABSTRACT
Objective:To analyze the consistency of clinical imaging and clinicopathological finds of retinoblastoma (RB) optic nerve invasion.Methods:A retrospective case study. Fifteen children with 15 eyes who were diagnosed with RB and underwent enucleation at the Eye Center of Beijing Tongren Hospital from November 2017 to January 2022 were included in the study. Among them, there were 9 males with 9 eyes and 6 females with 6 eyes. The mean age was 1.75±1.61 years. All affected eyes were designated International Classification of Retinoblastoma group E. There were 7 cases with secondary neovascularization glaucoma, 2 cases with closed funnel-shaped detachment of the retina and tumor touching the posterior capsule of the crystal, and 6 cases with tumor touching the back surface of the crystal and posterior chamber of the 15 children. All children underwent CT or magnetic resonance imaging (MRI). Among them, CT examination was performed in 4 cases, MRI examination in 4 cases, and MRI and CT examination in 7 cases. All the children underwent eyeball enucleation, paraffin sections were taken from the eyeball, and sagittal section of the eyeball with optic nerve tissue was taken for pathological examination. Imaging diagnosis was based on optic nerve thickening and/or enhancement. The pathological diagnosis was based on the growth of RB tumor cells across the post-laminar of optic nerve. The pathological diagnosis was based on the growth of RB tumor cells across the sieve plate. The area under the curve (AUC) of receiver operating characteristic curve was used to evaluate the diagnostic ability of imaging examination. The sensitivity, PPV and 95% confidence interval ( CI) of imaging examination were obtained based on the confusion matrix. With pathology as the gold standard, intragroup correlation coefficient (ICC) was used to test the consistency of imaging and pathology. Results:All the 15 cases were diagnosed with RB by pathological examination. Of the 15 cases, 7 cases were diagnosed with RB optic nerve invasion by imaging and 8 cases without nerve invasion; 12 cases of RB optic nerve invasion were diagnosed by pathology after operation. Three cases without nerve invasion. Among them, 4 cases had identical imaging and pathological findings. The sensitivity and PPV of MRI and CT were 0.33 (95% CI 0.11-0.64) and 0.57 (95% CI 0.20-0.88), respectively. The value of AUC (the area under the curve) in the ROC curve of MRI and CT were 0.51 (95% CI 0.24-0.77) and 0.52 (95% CI 0.25-0.78), respectively. The AUC values of both were 0.5-0.7, indicating low diagnostic accuracy. ICC test evaluated the consistency of MRI and CT with pathological examination, 0.61 (95% CI 0.97-0.87) and 0.63 (95% CI 0.12-0.88) for MRI and CT, respectively. Therefore, the consistency of MRI, CT and pathology was moderate. Conclusion:Compared with the pathological findings, the sensitivity and accuracy of MRI and CT in the diagnosis of RB optic nerve post-laminar invasion are lower, and the consistency between MRI and CT with pathology is only moderate.
ABSTRACT
Objective:To investigate the application value of contrast-enhanced ultra-sound, enhanced computed tomography (CT) and enhanced magnetic resonance imaging (MRI) in the diagnosis of small hepatocellular carcinoma.Methods:The clinical diagnositic trial was con-ducted. The clinicopathological data of 145 patients with small hepatocellular carcinoma who were admitted to the First Affiliated Hospital of Amy Medical University from January 2019 to June 2021 were collected. There were 121 males and 24 females, aged from 26 to 78 years, with a median age of 54 years. All patients were examined with contrast-enhanced ultrasound, enhanced CT and enhanced MRI, and underwent surgical resection of liver lesions within one month. Observation indicators: (1) postoperative histopathological examinations of patients with small hepatocellular carcinoma; (2) examination of small hepatocellular carcinoma by contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (3) imaging features of small hepatocellular carcinoma in the contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (4) enhancement mode distribution of small hepatocellular carcinoma in the arterial, portal and delayed phases of contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (5) the efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the Cochran′s Q test or the chi-square test. The sensitivity, specificity and accuracy were used to analyze the efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Results:(1) Postoperative histopathological examinations of patients with small hepatocellular carcinoma. There were 154 lesions detected in the postoperative histopathological examinations for the 145 small hepatocellular carcinoma patients, with the tumor diameter as (2.2±0.6)cm. (2) Examination of small hepatocellular carcinoma by contrast-enhanced ultrasound, enhanced CT and enhanced MRI. There were 153, 154 and 154 lesions detected in contrast-enhanced ultrasound, enhanced CT and enhanced MRI for the 145 patients with small hepatocellular carcinoma, respectively, with the detection rate as 99.35%(153/154), 100.00%(154/154) and 100.00%(154/154), showing no significant difference among the 3 imaging examination methods ( Q=2.00, P>0.05). (3) Imaging features of small hepatocellular carcinoma in the contrast-enhanced ultrasound, enhanced CT and enhanced MRI. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, 140 lesions showed "fast-in and fast-out" enhancement, 12 lesions showed "fast-in and slow-out" enhancement and 1 lesion showed isoenhancement in arterial phases and hypoenhancement in portal and delayed phase. Of the 154 lesions reported in enhanced CT for patients with small hepatocellular carcinoma, 112 lesions showed "fast-in and fast-out" enhancement, 13 lesions showed "fast-in and slow-out" enhancement, 14 lesions showed isoenhancement in arterial phase and hypoenhancement in portal and delayed phases, 5 lesions showed rim-like hyperenhancement in arterial phase and hypoenhancement in portal and delayed phases, 5 lesions showed hypoenhancement in the three phases, 3 lesions showed hyperenhancement in the three phases, 1 lesion showed isoenhancement in the three phases and 1 lesion showed isoenhancement in arterial and portal phases and hypoenhancement in delayed phase. Of the 154 lesions reported in enhanced MRI for patients with small hepatocellular carcinoma, 134 lesions showed "fast-in and fast-out" enhancement, 1 lesion showed "fast-in and slow-out" enhancement, 8 lesions showed isoenhancement in arterial phase and hypoenhance-ment in portal and delayed phases, 5 lesions showed rim-like hyperenhancement in arterial phase and hypoenhancement in portal and delay phases, 2 lesions showed rim-like hyperenhancement in the three phases, 1 lesion showed hyperenhancement in the three phases, 1 lesion showed hypoenhancement in the three phases, 1 lesion showed isoenhancement in arterial and portal phases and hypoenhancement in delayed late phase, 1 lesion showed edge delay enhancement in the three phases. (4) Enhancement mode distribution of small hepatocellular carcinoma in the arterial, portal and delayed phases of contrast-enhanced ultrasound, enhanced CT and enhanced MRI. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, there were 152 lesions with hyperenhancement and 1 lesion with iso or hypoenhance-ment in the arterial phase, there were 55 lesions with hyper or isoenhancement and 98 lesions with hypoenhancement in the portal venous phase, there were 12 lesions with hyper or isoenhancement and 141 lesions with hypoenhancement in the delayed phase. Of the 154 lesions reported in enhanced CT for patients with small hepatocellular carcinoma, there were 133 lesions with hyperen-hancement signal and 21 lesions with iso or hypoenhancement in the arterial phase, there were 53 lesions with hyper or isoenhancement and 101 lesions with hypoenhancement in the portal phase, there were 17 lesions with hyper or isoenhancement and 137 lesions with hypoenhancement in the delayed phase. Of the 154 lesions reported in enhanced MRI for patients with small hepatocellular carcinoma, there were 143 lesions with hyperenhancement and 11 lesions with iso or hypoenhance-ment in the arterial phase, there were 29 lesions with hyper or isoenhancement and 125 lesions with hypoenhancement in the portal phase, there were 5 lesions with hyper or isoenhancement and 149 lesions with hypoenhancement in the delayed phase. There were significant differences in the enhancement mode distribution of lesions in the arterial, portal and delayed phases among contrast-enhanced ultrasound, enhanced CT and enhanced MRI ( χ2=19.47, 13.21, 6.92, P<0.05). (5) The efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, there were 3 lesions misdiagnosed according to the postoperative histopathological examinations. Of the 154 lesions reported in enhanced CT and enhanced MRI for patients with small hepatocellular carcinoma, there were 7 lesions and 2 lesions misdiagnosed according to the postoperative histopathological examinations, respectively. Lesions misdiagnosed in one imaging examination method were correctly diagnosed in the other two imaging examination methods. The sensitivity, specificity, accuracy were 97.4%, 63.0%, 92.3% for contrast-enhanced ultrasound in the diagnosis of small hepatocellular carcinoma. The above indica-tors were 95.5%, 63.0%, 90.6% for enhanced CT and 98.7%, 63.0%, 93.4% for enhanced MRI in the diagnosis of small hepatocellular carcinoma. There was no significant difference in the sensitivity and accuracy among the 3 imaging examination methods ( Q=2.92, 0.00, 1.81, P>0.05). Conclusion:Contrast-enhanced ultrasound, enhanced CT and enhanced MRI all have good diagnostic value in diagnosis of small hepatocellular carcinoma, and they complement each other.
ABSTRACT
AIM: To observe the imaging characteristics of multi-modal imaging in perifoveal exudative vascular anomalous complex(PEVAC).METHODS: A retrospective case analysis. There were 11 patients(11 eyes)diagnosed as PEVAC by multi-modal imaging in our hospital included in this study from February 2021 to February 2022. All patients underwent the examinations of best corrected visual acuity(BCVA), fundus photography, fluorescein fundus angiography(FFA), spectral-domain optical coherence tomography(SD-OCT)and optical coherence tomography angiography(OCTA).RESULTS: On fundus examination, six out of eleven eyes presented as a unilateral and isolated lesion with diameter ≥150μm, five out of eleven eyes presented as multiple lesions(ranging from 2 to 4)and the diameter of each lesion <150μm, seven eyes with retinal edema and/or hard exudation. FFA revealed an oval-like hyper-fluorescent lesion of parafoveal in the late phase with enhancement but no leakage. Late peripheral telangiectasia leakage is seen with oedema. OCTA examination revealed a parafoveal small mass hyper-reflex showed aneurysmal dilation in the superficial and deep capillary, and capillary rarefaction was observed around the lesion. B-scan showed strong blood flow signal inside. Anti-vascular endothelial growth factor(VEGF)therapy was performed in 4 patients with macular edema. However, there was no notable improvement after treatment.CONCLUSION: Multi-modal imaging can help confirm the diagnosis and differential diagnosis of PEVAC, there is a poorly response to anti-VEGF therapy.
ABSTRACT
Objective @#To discuss and summarize the preventive measures and treatment methods for aspiration/ingestion during dental procedures.@*Methods @# One case of aspiration during an implant operation was reported, and the literature on aspiration/ingestion during oral procedures was reviewed.@*Results@#An implant screwdriver accidentally slipped into the mouth of the patient during implant surgery. The patient experienced no obvious discomfort except a few coughs. The surgeon and assistant paused the procedure immediately to search for the screwdriver, but it was not found. The patient declared that there was no special abnormality, such as breathing disorder or chest distress, so we considered that the foreign body was ingestion. After the implant surgery was completed, no foreign body was found in the stomach via gastroscopy. Chest X-ray and CT showed a dense metal shadow in the lower lobe of the left lung. Under local anesthesia, bronchoscopy and biopsy forceps were used by respiratory physicians to clip out the foreign body. After removal of the foreign body, the patient had no obvious discomfort but a slight cough. Cephalexin and metronidazole were given for three days to prevent infection. Three days later, the patient had no complaints of respiratory discomfort. After reviewing the literature, we found that the operation should be paused immediately after aspiration/ingestion occurs during dental procedures and that the dental chair should be laid down to prevent the foreign body from descending deeper, which may increase the difficulty of removal and cause gastrointestinal and respiratory tract injury. The position of the foreign body should be determined by imaging examination, and the corresponding means to remove the foreign body should be performed.@*Conclusion @# Patients may have no obvious symptoms after aspiration/ingestion during dental procedures, and the foreign body can be removed after imaging examination.
ABSTRACT
Objective To investigate the clinical application value of contrast-enhanced ultrasound (CEUS) in hepatic artery thrombosis (HAT) after pediatric liver transplantation. Methods Clinical data of 126 pediatric recipients undergoing liver transplantation were retrospectively analyzed. The incidence of HAT after pediatric liver transplantation was summarized. Color Doppler ultrasound and CEUS manifestations of HAT were compared. Results According to color Doppler ultrasound, 17 cases were highly suspected with HAT. Nine cases were highly suspected with HAT by CEUS, who were subsequently confirmed by CT angiography (CTA) or surgery. CEUS manifestations of HAT showed that hepatic artery was not seen surrounding the portal vein during the arterial phase or even portal venous phase. Hepatocyte necrosis occurred in 4 patients with HAT, and no perfusion of intrahepatic contrast agent was observed on CEUS. Conclusions CEUS yields high clinical application value in the diagnosis of HAT after pediatric liver transplantation. It has significant advantages compared with traditional CTA, which could be widely applied in clinical practice.
ABSTRACT
The clinical data of 5 patients with pneumonia type lung cancer from January 2017 to January 2020 were retrospectively analyzed.The results showed that the clinical symptoms of the 5 patients were cough and expectoration.The infection index was mildly abnormal, and the tumor marker index was increased.After anti infection treatment, the effect was not good.The diagnosis of pneumonia type lung cancer was confirmed by improving the fiberoptic bronchoscopy biopsy.Due to the lack of specificity of clinical manifestations, if the early diagnosis of pneumonia type lung cancer can not be confirmed, the chest imaging can be reviewed after anti infection treatment, and the pathological basis can be obtained by timely improvement of fiberoptic bronchoscopy, bronchoalveolar lavage and lung biopsy.
ABSTRACT
Intersphincteric resection (ISR) is a limited sphincter preserving surgery for low rectal cancer. The 4K laparoscopic system has the advantage of enhancing the accurate recognition of anatomical structures for operators. The authors investigate the imaging evaluation and technical standard of 4K laparoscopic ISR of low rectal cancer through surgical examples.
ABSTRACT
Objective:To investigate the computed tomography (CT) features of primary liver leiomyosarcoma (PHLMS).Methods:The retrospective and descriptive study was conducted. The clinical and imaging data of 10 patients with PHLMS who were admitted to 4 medical centers including 3 cases in Wenzhou Central Hospital, 3 cases in the Second Affiliated Hospital of Wenzhou Medical University, 2 cases in Wenzhou People's Hospital and 2 cases in Yueqing People's Hospital from January 2011 to December 2020 were collected. There were 5 males and 5 females, aged from 41 to 83 years, with a median age of 55 years. All 10 patients underwent abdominal CT examination. Observation indicators: (1) CT features; (2) treatment and pathological examination; (3) follow-up and survival. Follow-up using postoperative outpatient or inpatient examination to detect patient survival was conducted. Patients underwent imaging examination to detect tumor recurrence. Follow-up was up to December 2020. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) CT features: results of CT examination showed that each of the 10 patients had only one single tumor, including 3 cases with tumor on the left lobe of liver and 7 cases with tumor on the right lobe of liver. The tumor diameter of the 10 patients was 8.0 cm(range, 4.5-13.5 cm). Results of plain CT scan of 10 patients showed that 7 cases had tumor in expansive growth as round or oval, with clear boundaries and the tumor parenchyma showing low-density signals and patchy lower density area can be seen in the center, and 3 cases had tumor in infiltrative growth as patchy, with unclear boundaries and the tumor parenchyma showing iso-density signals. The CT scan value of 10 patients was 40 HU(range, 23-47 HU). Results of enhanced CT scan at arterial phase of the 7 cases with tumor in expansive growth showed that 3 cases undergoing tumor parenchyma with uneven mild enhancement signals, 3 cases undergoing tumor parenchyma with uneven moderate enhancement signals and 1 case undergoing tumor parenchyma with uneven significant enhancement signal. The CT scan value of 7 cases was 68 HU(range, 62-88 HU). Results of enhanced CT scan at arterial phase of the 3 cases with tumor in infiltrative growth showed that the peripheral region had high signal than the central region. The CT scan value of 3 cases was 73 HU(range, 67-90 HU). Results of enhanced CT scan at portal vein phase in the 7 cases with tumor in expansive growth showed that the tumor parenchyma showing continuous and progressive mild and moderate enhancement with uneven density, and the CT scan value was 63 HU(range, 55-78 HU). Of the 7 cases, 3 cases showed the enhancement range of tumor parenchyma with the trend of fusion and filling, and 4 cases showed small patchy or nodular enhancement and grid like enhancement in the center and periphery of the tumor. Results of enhanced CT scan at portal vein phase in the 3 cases with tumor in infiltrative growth showed that the enhancement withdrew, the density was uneven, and the CT scan value was 58 HU(range, 50-62 HU). Results of enhanced CT scan at delayed phase in 10 patients showed that the enhancement in the tumor withdrew slowly, and the CT scan value was 53 HU(range, 50-60 HU). Of the 10 patients, 4 cases showed decreased density of enhanced nodules around the tumor and 6 cases showed partially fused and filled to the center of tumor with no enhancement in the necrotic part. (2) Treatment and pathological examination: all 10 patients underwent completed tumor resection successfully, and no metastasis was found in liver or the hilar region. Results of postoperative pathological examination showed that each of the 10 patients had only one single visible tumor with tumor diameter of 8.0 cm(range, 4.5?13.5 cm). Of the 10 patients, 7 cases had tumor with complete or incomplete pseudocapsule with clear boundary and 3 cases had tumor without pseudocapsule and the boundary was unclear. All 10 patients had tumor with hard parenchyma and the section was mostly gray and fish like. Among them, patchy or punctate necrosis was seen in 7 cases, small patchy or punctate hemorrhage was seen in 3 cases, and small patchy calcification was seen in 2 cases. Microscopically, the tumor tissue was crisscross, the tumor cells were in spindle shaped, the nuclei were in round, oval, blunt at both ends or in thin rod like, with obvious heteromorphism, large and deeply staining, and obviously division. Immunohistochemical staining showed positive staining of smooth muscle actin, desmin and vimentin. (3) Follow-up and survival: all 10 patients were followed up postoperatively for 6 to 130 months, with a median follow-up time of 55 months. The overall survival time of 10 patients were 10 to 120 months, with a median overall survival time of 46 months. Of the 10 patients, 2 cases died of tumor recurrence and distant metastasis 10 and 11 months after operation, respectively and 8 cases survived >12 months.Conclusions:Results of plain CT scan of PHLMS show clear or unclear cysts and solid masses with uneven density. Results of enhancement CT scan of PHLMS show persistent uneven enhancement in tumor parenchyma and the surrounding area.
ABSTRACT
Objective:To explore the clinical characteristics and early diagnosis of cerebral infarction in critically ill children.Methods:The clinical data of the children who were diagnosed with cerebral infarction in PICU at Shengjing Hospital of China Medical University from January 2013 to September 2019 were analyzed retrospectively.Results:There were 27 children in this study, including 15 males and 12 females.The age of onset ranged from 1 month to 13 years old, with age of 3.0(0.7, 8.0) years old.Among 27 cases, there were ten cases of infection(37.0%), six cases of trauma(22.2%), three cases of congenital heart disease (11.1%), two cases of cerebrovascular disease (7.4%), one case of diabetic ketoacidosis(3.7%) and two cases of autoimmune factors(7.4%). The cause was unknown in three cases(11.1%). The main clinical manifestations were convulsion in 11 cases(40.7%), status convulsion in five cases(18.6%), limb dysfunction in four cases(14.8%), disturbance of consciousness in fvie cases(18.5%) and facial paralysis in four cases(14.8%). Among 27 cases, mechanical ventilation was performed in 12 cases (44.4%). The levels of D-dimer in all children were increased in varying degrees.After improvement and discharge, two children developed secondary epileptic sequelae.Head CT examination was performed in 20 cases, of which 11 cases showed definite cerebral infarction, eight cases of temporal lobe lesions and three cases of basal ganglia lesions.MRI+ MRA examination of the head in 27 cases showed that there were cerebral infarction and the infarct area large.Conclusion:The high incidence age of cerebral infarction in critically ill children is infantile.The most common diseases are infection, trauma, congenital heart disease, and the first clinical manifestations are convulsion and coma.Imaging examination showed that a high proportion of children had large area infarction, and the diagnostic effect of MRI is better than that of CT.D-dimer may be helpful for early clinical diagnosis.
ABSTRACT
Abstract The Coronavirus 2019 disease (COVID-19), was declared a pandemic by the World Health Organization on March 11, 2020, and registered the first case in Costa Rica on March 6, 2020, and 105 days later reported 2058 cases, with a wide age range (0-92 years). Its etiologic agent is the beta coronavirus SARS-CoV-2 with confirmed human- to-human transmission, mainly by the respiratory route. The presence of asymptomatic carriers of the virus and its transmission even without the manifestation of symptoms challenges health professionals worldwide. For this reason, assuming all patients who need dental care as possible carriers of the SARS-CoV-2 is mandatory and consequently, applying biosecurity measures with strict criteria. In the present literature review, we aim to recommend biosecurity measures to be applied during imaging examinations of dental patients due to the Coronavirus-2019 pandemic. We found that in the absence of treatment for COVID-19 disease and because of its high transmissibility, the most effective measures to prevent its spread are those allowing its containment. Therefore, the authors recommend: 1) acquiring imaging exams just in case of dental urgencies or emergencies, 2) prioritizing the use of extraoral exams, such as panoramic radiography or CBCT, under the principle of ALADAI and 3) the intraoral exams should be used just in case of a lack of extraoral imaging devices, or because of the need to solve diagnostic tasks in which they have a superior diagnostic value than those of the extraoral examinations.
Resumen La enfermedad Coronavirus 2019, fue declarada pandemia por la Organización Mundial de la Salud el 11 de marzo de 2020; el primer caso registrado en Costa Rica fue el 6 de marzo de 2020, y 105 días después reportó 2058 casos, con un amplio rango de edad (0-92 años). Su agente etiológico es el beta coronavirus SARS- CoV-2. La transmisión de humano a humano está bien confirmada principalmente por la vía respiratoria. La presencia de portadores asintomáticos del virus y su transmisión, incluso sin la manifestación de síntomas, desafía a los profesionales de la salud. Por esta razón, es obligatorio asumir todos los pacientes que necesitan atención dental como posibles portadores del SARS-CoV-2 y, en consecuencia, aplicar medidas de bioseguridad con criterios estrictos. En la presente revisión de la literatura, nuestro objetivo es recomendar las medidas de bioseguridad que se aplicarán durante los exámenes de imágenes de pacientes dentales debido a la pandemia de Coronavirus-2019. Encontramos que en ausencia de tratamiento para la enfermedad de COVID-19 y debido a su alta transmisibilidad, las medidas más efectivas para prevenir su propagación son aquellas que permitan su contención. Por lo tanto, se recomienda: 1) adquirir exámenes por imágenes solo en caso de urgencias o emergencias dentales, 2) priorizar el uso de exámenes extraorales, como la radiografía panorámica o CBCT, bajo el principio de ALADAIP y 3) se deben usar los exámenes intraorales solo en caso de falta de dispositivos de imágenes extraorales, o por la necesidad de resolver tareas de diagnóstico en las que tienen un valor de diagnóstico superior al de los exámenes extraorales.
Subject(s)
Containment of Biohazards , Dental Health Services , COVID-19ABSTRACT
Novel coronavirus pneumonia (NCP named as COVID-19 internationally) is a kind of highly infectious disease. To take the non-designated hospitals for novel coronavirus pneumonia as the example, based on the characteristics of novel coronavirus, the infection factors involved in nuclear medical imaging examinations were analyzed in this paper, and proposals were put forward to improve the protection and control in the following seven aspects, including the examinees, the staff, the workplace, the instruments, the disposal of medical waste, and the medical supply, and procedures. It is expected to prevent the patients and staff from the infection of NCP during nuclear medicine imaging examinations.
ABSTRACT
Biliary stricture is a common clinical disease with various etiologies, which can be divided into benign and malignant biliary stricture. Accurate identification of benign and malignant nature of biliary stricture is of great importance for the determination of etiology, treatment and prognosis. At present, there is no consensus on the methods for diagnosis of biliary stricture, and the selection of diagnostic tools in clinical practice is diverse and without uniform standard. This article reviewed the progress in research on diagnosis of benign and malignant biliary stricture.
ABSTRACT
This article reported a case with primary cystic echinococcosis in the left femur.
ABSTRACT
Objective To evaluate the clinical application of 15-channel phased-array head coil and 6-channel dS Flex M surface coil in MRI imaging of temporomandibular joint.Methods Totally 50 patients were randomly equally assigned into two groups, of whom, one group used a 15-channel phase-array head coil for MRI scanning, and the other applied a 6-channel dS Flex M surface coil. The same regions of interest were set up to measure and analyze the signal to noise ratio (SNR)and contrast to noise ratio (CNR)of each region respectively.SPSS 19.0 software was used for quantitative analysis. Results The head coil had the SNR and the CNR higher than those of the surface coil.The head coil and Flex surface coil had the imaging diagnosis rates being 95.83% and 91.67% respectively,and there was no significant difference between them(P>0.05). Conclusion Both phase-array head coil and dS Flex M surface coil can be used for temporomandibular joint MRI imaging, and it's suggested that conventional imaging be executed with dS Flex M surface coil and functional imaging be implemented with head coil.
ABSTRACT
The intraocular tumor has a serious impact on patient's vision and even life.Early and correct diagnosis can guide the treatment,most patients can retain the eyeball and visual function to some extent,and even save their lives.We have been engaged in the diagnosis and treatment of intraocular tumors for nearly 20 years.We have summarized the important ideas for the diagnosis of intraocular tumors.At present,the diagnosis of intraocular tumors mainly depends on fundus examination combined with various imaging examinations.For the diagnosis of intraocular tumors,ophthalmologists should establish a systematic clinical thinking mode according to the mechanism,tissue source,morphological characteristics and imaging features of different intraocular tumors,so as to achieve early diagnosis and guide correct treatment.The diagnostic thinking of intraocular tumors is described in detail in our article.
ABSTRACT
Objective To summarize the magnetic resonance imaging (MRI) features of the persistcnt perineal sinus (PPS).Methods The retrospective and descriptive study was conducted.The clinical data of 7 patients with PPS who were admitted to the Nanjing University of Traditional Chinese Medicine between July 2010 and January 2017 were collected.Patients received horizontal,anteroposterior axes and coronal scanning of MRI after abdominoperineal resection (APR) of rectal cancer.Two physicians read collectively films and then achieved consistent results if there was a disputed result.Observation indicators:(1) MRI features;(2) treatment and follow-up situations.Patients underwent resection of PPS according to results of MRI examination,and then regular pathological examination.Follow-up using telephone interview was performed to detect sinus recurrence and reoperation up to April 2017.Results (1) MRI features:① Lesion location:lesions of PPS in 7 patients were located at the presacral areas,top side was up to the third sacral plane,and lower side extended down to the pubic area.② Morphology and signal:sinus tract of 7 patients showed irregular flaky and tubular abnormal signals;fibrotic sinus tract wall showed low signals in T1 weighted imaging (T1WI) and T2WI;contents of sinus tract in 7 patients showed low signal in T1WI and high signals in T2WI and T2WI-fat suppression (T2WI-FS).Of 7 patients,uniform signal and mixed signal were respectively detected in 2 and 5 patients.③ Branches and cystic spaces:1 patient had a branch at the tip of the coccyx,extending to the rear of the sacral vertebra.The top of sinus tract in 4 patients enlarged to form a cavity.④ Signs of infection:signs of infection in 3 patients included blurred and exuded fat gaps around the sinus tract,unclear and partially adhesion with pelvic organ;the pelvic floor muscles in 1 patient were thickened and swollen,with a high signal in T2WI-FS;flaky fluid shadows in 2 patients were seen in the posterior sinus,with a high signal in T2WI-FS,showing a tissue edema of anterior sacrum.⑤ Enhancement features:result of MRI examination of 1 patient showed mild and heterogeneous enhancement of sinus.(2) Treatment and follow-up situations:among 7 patients undergoing sinus resection,2 received curettage of superior sinus due to high location,and 5 received successfully operation.All patients underwent postoperatively regular antibiotic therapy.The healing time was 14-78 days,with an average time of 42 days.The postoperative pathological examination showed different degrees of inflammatory cell infiltration.Seven patients were followed up for 2-74 months,with an average time of 40 months.Of 7 patients,sinus in 6 patients was healed,1 had recurrence of sinus and didn't receive therapy.Seven patients didn't undergo debridement or transposition of skin flap again.Conclusion The MRI imaging features of PPS includes flaky and tubular abnormal signal in the the anterior sacrum,low signal in T1WI,high signals in T2WI and T2WI-FS,and the enhanced scanning of sinus duet shows mild and heterogeneous enhancement.
ABSTRACT
Objective To investigate the cumulative effective dose (CED) of ionizing radiation received by patients with Crohn's disease(CD) and to identify the risk factors associated with high levels of radiation in patients with Crohn's disease. Methods A total of 230 patients were enrolled. The classification of CD was according to the Montreal standards, and the CED of each patient was calculated retrospectively based on standards tables. High levels of radiation was defined as no less than 50 mSv CED. Patients who accepted no less than 50 mSv CED were assigned to high level of the radiation group, and those who accepted simultaneously less than 50 mSv CED were assigned to the control group. The risk factors for patients associating with high levels of radiation were analyzed by Logistic regression. Results CT enterography and abdominopelvic CT accounted for 52. 1％ and 39. 6％, respectively, and add up to 91. 7％ of total CED. The mean CED received per patient was 34. 07 mSv (95％ CI:30. 845～37. 304), and 51 patients (22. 2％ of total patients) with CD were exposed to no less than 50 mSv CED. Patients with long disease duration, surgical intervention, ileal location, stricturing or penetrating pattern received a higher dose of radiation. In a Logistic regression, stricturing or penetrating pattern(OR =3. 711, 95％ CI:2. 239 ～ 6. 151, P ＜0. 001) and the requirement for azathioprine (OR =4. 218, 95％ CI: 1. 221 ～14. 579,P=0. 023) were independent risk factors for the high levels of radiation in CD. Conclusion More than one in five of patients with CD are exposed to high levels of ionizing radiation, mainly caused by CT examination. Stricturing or penetrating pattern and the usage of azathioprine are independent risk factors for the high levels exposure of radiation in CD patients. During the clinical management and follow-up, it is important to either monitor the effective dose received per patient, minimizing unnecessary CT examination, or to transform to use no radiation imaging examination, such as MR enterography.
ABSTRACT
Breast cancer is the second malignant tumor of female reproductive system.With the development of modern medical imaging technology,conventional ultrasound and mammography are the most popular methods in breast examination and cancer screening.While CT,MRI and nuclear medicine diagnosis act as the additional methods of breast cancer diagnosis.In addition,CEUS and biopsy might be used in diagnosis of lesion lacking imaging characteristics.The imaging methods in diagnosis of breast lesions were reviewed in this paper.