Pulmonary Nodules/Lung Cancer Comprehensive Management Mode: Design and Application / 中国肺癌杂志

BACKGROUND@#Mortality of lung cancer can be decreased by early screening effectively. However, consistent and proficient standards & methods have not been established in China. This study was based on pulmonary nodules/lung cancer comprehensive management platform established by West China Hospital, Sichuan University. Early screening of pulmonary nodules was integrated into standard healthcare of lung cancer system, aiming to improve survivals of lung cancer patients.@*METHODS@#Three cohorts were established: healthy populations, pulmonary nodules cohort and lung cancer patients cohort, and related clinical data will be collected and analyzed. Preliminary plan includes verifying effect of pulmonary nodules screening module.@*RESULTS@#Pulmonary nodules screening was performed in 2,836 employers (>40 years old) of West China Hospital. Lung cancers were diagnosed in 66 participants, all receiving surgery to remove the lesions. 65 of them were with early stage diseases, 1 with lung cancer and brain metastasis.@*CONCLUSIONS@#Proficient screening, follow-up and healthcare can be achieved via pulmonary nodules/lung cancer comprehensive management mode, which will be extended all over west China region in future.

Assessing the severity of acute pulmonary embolism using CT obstruction index and the relationship between its CT obstruction index and D-dimer levels / 实用放射学杂志

Objective To assess the value of pulmonary artery CT obstruction index for the evaluation of the severity of pulmonary embolism (PE),and to investigate the relation between pulmonary artery CT obstruction index and D-dimer levels.Methods 125 patients were diagnosed as PE by computed tomographic pulmonary angiography (CTPA)and D-dimer.Patients were separated into high-risk group and non-high risk group.CT obstruction index,D-dimer levels,diameter of the pulmonary artery were compared between two groups. Spearman’s rank correlation coefficients were used to assess the correlation between the CT obstruction index and the D-dimer levels,diameter of the pulmonary artery.Results CT congestion index of high-risk PE group was obviously higher than that of the non-high risk group (P=0.000).The diameter of pulmonary artery in high-risk PE group was obviously greater than that of the non-high risk group,the difference was statistically significant (P=0.000).No statistically significant difference was found in D-dimer levels between the two groups (P=0.103).There was no correction with CT congestion index and D-dimer levels(P=0.71).Conclusion The D-dimer levels of serum was a predictor of pulmonary embolism,cannot evaluate the severity of PE.CT obstruction index can reflect the severity of PE in some extent as an indicator of PE,there was no correlation with CT obstruction index and D-dimer levels.

Application of computer-aided diagnosis in early detection of pulmonary nodules based on digital chest radiograph / 生物医学工程学杂志

This study aims to explore the clinical value of the computer-aided diagnosis (CAD) system for early detection of the pulmonary nodules on digital chest X-ray. A total of 100 cases of digital chest radiographs with pulmonary nodules of 5-20 mm diameter were selected from Pictures Archiving and Communication System (PACS) database in West China Hospital of Sichuan University were enrolled into trial group, and other 200 chest radiographs without pulmonary nodules as control group. All cases were confirmed by CT examination. Firstly, these cases were diagnosed by 5 different-seniority doctors without CAD, and after three months, these cases were re-diagnosed by the 5 doctors with CAD. Subsequently, the diagnostic results were analyzed by using SPSS statistical methods. The results showed that the sensitivity and specificity for detecting pulmonary nodules tended to be improved by using the CAD system, especially for specificity, but there was no significant difference before and after using CAD system.

Contrast-enhanced multislice CT features and predominant anatomic distribution of mediastinal malignant lymphoma / 生物医学工程学杂志

The objective of this study was to investigate the specific contrast-enhanced MSCT features and predominant anatomic distribution of mediastinal malignant lymphoma. Contrast-enhanced MSCT in 31 cases of mediastinal malignant lymphomas were retrospectively evaluated by analyzing the features of size, morphology, attenuation and anatomic distribution in accordance to the ATS classification of intrathoracic lymph nodes. Nine cases of Hodgkin Disease (HD) and 22 cases of Non-Hodgkin Disease (NHL) were included. The enlarged nodes were found to be homogeneous (HD 72.7%, NHL 88.9%) and partly homogeneous with necrosis (HD 27.3%, NHL 11.1%). HD involved predominantly the lymph nodes in the areas of 2R (77.8%), 3 (55.6%), 4R (88.9%), 4L (55.6%), 5 (66.7%), 6 (55.6%), 7 (66.7%) and 10R (55.6%), while NHL often involved the areas of 2R (68.2%), 3 (54.5%) 4R (59.1%), 4L (50%), 5 (54.5%), 6 (54.5%), 7 (54.5%) and 8 (50%). The following extranodal organs were involved: pericardium (19.4%), pleura (19.4%), great vessels (6.4%), lung (6.4%), chest wall (3.2%) and breast (3.2%). Mediastinal malignant lymphoma had some characteristic manifestations and predominant anatomic distribution shown on contrast-enhanced MSCT, which can provide imaging evidences for diagnosis and for determining the tumor stage.

CT and MRI findings of cancerous invasion of the main pulmonary artery in lung cancer: the correlation with pathologic features and the value in making surgical plan / 中国肺癌杂志

<p><b>BACKGROUND</b>To study the correlation between CT/MRI features and surgical and pathological findings of cancerous invasion of the main pulmonary artery (CIMPA) in lung cancer and to evaluate the role of CT and MRI in making surgical plan.</p><p><b>METHODS</b>CT findings in 15 cases and MRI findings in 13 cases were observed and blindly compared with surgical and pathological findings in this prospective study of 23 cases of central type lung cancer.</p><p><b>RESULTS</b>The CT and MRI features showed as follows: the wall thickening sign in 73.7% of CT and 84.6% of MRI; lumen narrowing sign in 55.3% of CT and 69.2% of MRI; peri-vascular fat sign in 100.0% of both CT and MRI. Two types of CIMPA were visualized: contacted type (10 cases in CT and 7 cases in MRI) and encased type (5 cases in CT and 6 cases in MRI). Surgically, contacted type was found in 10 cases who all underwent lobectomy with sleeve-angioplasty. Encased type was found in 13 cases, among whom unresectable in 2, pneumonectomy in 7, and lobectomy with angioplasty in 4. Of the 21 resected specimen, the cancerous infiltration was demonstrated 100.0% (21/21) in adventitia, 66.7% (14/21) in media and 4.8% (1/21) in intima. There was no significant difference in the deepness of the cancer infiltration between the two types (P>0.05). Acute or chronic inflammatory infiltration which enhanced the thickening of the wall were shown on all specimens. CT and MRI findings were well corresponding to surgical and pathological appearance (Kappa value = 0.61 in CT and 0.84 in MRI).</p><p><b>CONCLUSIONS</b>In our study of CIMPA, CT and MRI features characterized by wall thickening and lumen narrowing without occlusion are closely correlated with pathological findings that cancerous invasion prominently limited adventitia and media with remarkable proliferation of connective tissue, and classifying two types is valuable in making surgical plan.</p>

CT features and anatomic distribution of pleural dissemination in lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To study the CT appearance of lung cancer combined with pleural dissemination and its anatomic characteristics.</p><p><b>METHODS</b>CT findings of 32 cases of lung cancer with pleural dissemination proved by surgery and pathology were analyzed.</p><p><b>RESULTS</b>The main CT manifestations were pleural effusion (24 cases), visceral pleural dissemination with nodules (10 cases), parietal pleural dissemination with nodules (16 cases), and pleural thickening (31 cases). Out of the cases with visceral pleural disseminations, nodules distributed on the lung surface in 9 sites, while on the interlobular pleura in 10 sites. Parietal pleural dissemination with nodules were found in 45 sites which located on the diaphragmatic pleura, the costal pleura, the mediastinal pleura, and the pulmonary ligament. The diameters of the small nodules ranged from 2 to 5 mm, and the large nodules from 5 to 10 mm. There were direct invasion with tumor induced pleural thickening in 10 cases, while indirect invasion in 21 cases. In the later cases, 9 cases had parietal pleural thickening less than 10 mm, 4 circumferential pleural thickening, 5 mediastinal pleural involvement thickening, and 3 pulmonary ligament thickening.</p><p><b>CONCLUSIONS</b>Pleural effusion is the main manifestation of lung cancer combined with pleural dissemination. The CT features of lung cancer with pleural dissemination are the parietal and visceral pleural nodules, as well as the pleural thickening. The nodules are likely to distribute on parietal pleura of the diaphragmatic and the costal pleura, and they may transfer to the pulmonary ligament.The early small disseminating nodules are miliary in size, and only can be detected on the pulmonary window of chest CT scan.</p>

Analysis of Helical CT Findings of the Bronchial Stump or Anastomosis after Pulmonectomy for Central Bronchial Carcinoma / 实用放射学杂志

Objective To analyse the normal helical CT appearances of the bronchial stump or anastomosis after pulmonectomy for central bronchial carcinoma.Methods The available 110 contrast-enhanced spiral CT images in 55 patients undergone different surgical procedures for central bronchial carcinoma were evaluated retrospectively.Results The CT findings of bronchial anastomosis in shape appeared as smooth,concave and convex,sharp angle,obtuse angle,spininess,irregulated or short tube.The thickness of anastomosis was (3.26?1.46) mm.Conclusion Spiral CT can display the bronchial anastomosis clearly after pulmonectomy for central bronchial carcinoma.

The HRCT Scan of Normal Middle-inner Ear / 实用放射学杂志

Objective　To study the scan technique that can completely demonstrate the structures of middle-inner ear.Methods　Ninety volunteers underwent 30° axial and 105° coronal HRCT scan.The manifestations of the ministructures of middle-inner ear were observed and their demonstration rate was calculated.The demonstration of different structures of middle-inner ear was evaluated and compared on HRCT.Results　(1)The scan planes of 30° axial and 105° coronal were correspondent to some structures of middle-inner ear and could completely demonstrate them.(2)30° axial and 105° coronal HRCT scan had their own advantages respectively in demonstrating the structures of middle-inner ear.Conclusion　The technique of 30° axial and 105° coronal HRCT scan of middle-inner ear is useful in demonstrating the structures,including the nerve,joint,ligament etc and the relationship among them.

Effects of the pulmonary ligament on helical CT appearances of lower thoracic disease: anatomic-radiologic study / 中华放射学杂志

Objective To determine how the pulmonary ligament affects the helical CT appearances of the lower thoracic disease on the basis of the anatomic findings. Methods Four cadavers were cut transversely, with the section thickness of 11.3-13.4 mm. 57 patients with the lower thoracic disease were scanned using Somatom Plus 4, with administration of intravenous contrast material. The correlation of the anatomic findings of the pulmonary ligament and the helical CT appearances of the lower thoracic disease was evaluated. Results On cadaver sections, the right pulmonary ligament attached the lower lobe of the right lung to the esophagus, while the left ligament attached the lower lobe of the left lung to the esophagus or the descending aorta. In 40 pleural effusion and 7 pneumothorax cases, the pulmonary ligament tethered the medial aspect of the collapsed lower lobe and limited the shift of the lower lobe. In 40 pleural effusions, the ligament divided the medial pleural space into an anterior and a posterior compartment. The ligament showed thickness due to the invasion of the lesions of lower lobe including 7 tumors and 3 inflammatory diseases. Conclusion The pulmonary ligament can affect the helical CT appearances of the lower thoracic disease, such as lobe collapse, pleural effusion and pneumothorax; while the intraparenchymal and mediastinal abnormality can extend into the pulmonary ligament.

The Study of Relationship Between the CT Features and Blood GlucoseLevel in Cerebral Infarction of Diabetes Mellitus / 实用放射学杂志

Objective To study the CT features of cerebral infarction and the relation to blood glucose level in diabetes mellitus.Methods The CT features and relation to the level of blood glucose were retrosepectively analyzed in 41 cases of cerebral infarction diabetes mellitus.The diagnosis of diabetes mellitus was based on the WHO criteria in all cases.Results The focus of infarction located at the area of base ganglion,brain stem and thalamencephalon in 38 cases(92.7%).Multiple focus was found in 30 cases(73.2%)and there was positive correlation between focus number and the level of blood glucose.Lacuna cerebral infarction was observed in 38 cases(92.7%) and large patchy cerebral infarction in 3 cases.Brain white matter demyelination was complicated in 24 caese(58.5%).Conclusion Cerebral infarction of diabetes mellitus mainly manifestes as multiple lacuna cerebral infarction and has close relation to the level of blood glucose.

CT Features and Misdiagnosis of Lung Cancer in Young Patients / 实用放射学杂志

Objective To describe CT features and misdiagnosis of lung cancer in young patients.Methods The clinical data and CT findings of primary bronchogenic carcinoma in 33 young patients proved pathologically were reviewed.Results Masses,nodules andpulmonary consolidation were found in 13,8 and 7 cases on chest CT respectively.The soft nodule in bronchus with obstructive pulmonary atelectasis was found in 3 cases,the thickening of bronchial wall and bronchiarctia with obstructive pulmonary infection,plumonary cavity and multicenter lesion were found in 1 respectively.There were thoracic effusion or with nodulous pleurae in 8 cases,nodules in lungs in 7 cases,enlarged lymph nodes in 6 cases,destruction of thoracic skeleton in 2 cases and mass involving mediastinum or large vessels in 4 cases.The chest metastatic rate was 81.8%.Pulmonary inflammation and tuberculosis were firstly diagnosed in 6 and 15 cases,the misdiagnostic rate was 63.6%.Conclusion Masses,nodules and pulmonary consolidation are the common CT features of lung carcinoma in young patients.Most cases are advanced stage of lung carcinoma and misdiagnosed as pulmonary tuberculosis in initial examination.

The Value of Spiral CT Examination in Central Bronchial Carcinoma Post-operation / 实用放射学杂志

Objective To assess the usefulness of spiral CT examination in detecting the local recurrence and the metastatic lymph nodes of chest in the patients with post-pulmonectomy for central lung cancer.Methods The data of 110 contrast spiral CT of chest in 55 patientswith central bronchial carcinoma post-operation were retrospectively analysed.Results 12 person-time in 9 cases recurred in thebronchial stump or anastomose.The short diameter of lymph nodes in the thorax ≥1 cm was showed in 33 person-time of 26 cases,of them,14 cases was considered as metastasis in combination with the clinical data.Conclusion Spiral CT is the one of the best examination indetecting the post-operation recurrence in the patients with central bronchial carcinoma,but it is still of limitation in evaluating the nature of lymph nodes.