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Objective To evaluate the correlations between CT features and histopathologic subtypes of lung adenocarcinomas presenting as pure ground-glass nodules (pGGN) of 1 cm or less in maximal diameter. Methods CT appearances, pathology and clinical data of 95 patients (97 lesions) who underwent curative resection of lung adenocarcinomas presenting as pGGN≤1 cm in diameter from March 2011 to February 2015 were retrospectively analyzed. Of the 97 lung adenocarcinomas, there were 19 atypical adenomatous hyperplasia (AAH) (19.6%), 31 adenocarcinoma in situ (AIS) (31.9%), 19 minimally invasive adenocarcinoma (MIA) (19.6%) and 28 invasive pulmonary adenocarcinoma (IPA) (28.9%). Fifty (51.5%) were preinvasive (AAH+AIS) and 47 (48.5%) were invasive (MIA+IPA). Lesion size and density were compared among pathologic subtypes using analysis of variance (ANOVA). Lesion size were compared between preinvasive and invasive lesions using 2?independent samples t?test. Lesion location, presence of bubble?like sign, air bronchogram, vessel changes, margin, and tumor?lung interface were compared among histopathologic subtypes using chi?square test. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the cut-off point of size in discriminating preinvasive lesions from invasive lesions. Results Of the 97 lesions, there were no statistically significant differences among histopathologic subtypes in terms of lesion density, presence of bubble?like sign, air?bronchogram, and margin (P>0.05). Mean size of AAH, AIS, MIA and IPA was (0.72 ± 0.19), (0.82 ± 0.14), (0.84 ± 0.11) and (0.85 ± 0.16) cm respectively. There were statistically significant differences among histopathologic subtypes in terms of lesion size (F=3.16, P=0.028). The vessel changes occurred in 2 of AAH, 11 of AIS, 10 of MIA and 17 of IPA. There were statistically significant differences among histopathologic subtypes in terms of vessel changes (χ2=13.22, P=0.004). Lesions with clear tumor?lung interface were in 10 of AAH, 24 of AIS, 17 of MIA, and 26 of IPA. There were statistically significant differences among histopathologic subtypes in terms of tumor?lung interface (χ2=12.67, P=0.005). The optimal cutoff value of lesion size for differentiating preinvasive lesions from invasive lesions was 0.82 cm (sensitivity, 61.7%;specificity, 62.0%). Conclusion Lesion size, vessel changes, and lung?tumor interface may indicate the invasiveness of lung adenocarcinoma presenting as pGGNs of≤1 cm in diameter.
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Objective To evaluate the effect of quick injection combining with slow infusion of Gd-DTPA on T1 relaxation of the blood. Methods Fifteen volunteers were recruited for coronary MRA study using a navigator-gated 3D-FIESTA sequence. Coronary MRA were acquired on the same segments two times at 5 minutes and 15 minutes after Gd-DTPA administration. Contrast agent was injected biphasically with 10 ml at a flow rate of 1.5 ml/s and 20 ml at 0. 05 ml/s to prolong the T1 relaxation effect. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated pre- and post-contrast MRA. Image quality was compared using t-test. Results The SNR and CNR at 5 minutes after contrast injection (35.37 ±6. 84 and 21.57 ± 6. 08 ) were significantly higher than that of pre-contrast MRA ( 27.38 ± 6. 24 and 13.19 ±6. 50). The SNR at 15 minutes after contrast injection (33. 81 ±9. 43) was higher than that of precontrast MRA, but there was no statistically difference(t = 1. 885 ,P =0. 074). The CNR at 15 minutes after contrast injection (21.20 ± 7.65) was significantly higher than that of pre-contrast MRA. The SNR and CNR at 15 minutes after contrast injection were no significant different compared with those at 5 minutes after contrast injection. Conclusion T1-shorting effect in the blood can be prolonged by quick injection combining with slow infusion of Gd-DTPA ,which meet with the need of multiple scans of coronary MRA.
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Objective To illustrate the thoracic CT findings of Behcet disease and to assess the CT diagnostic role in patients with Behcet disease. Methods Thoracic CT images and medical records were retrospectively reviewed in 13 patients with thoracic Behcet disease. The diagnosis was based on the criteria set by the international study group for Behcet disease. Results Of 13 patients, subpleural patchy consolidations were showed in 3, bilateral diffuse ground glass opacities in 3, left low lobe collapse with a right small nodule in 1, subpleural solitary pulmonary nodule in 1, bilateral pleural effusion in 2 ,mediastinal lymphoadenopathy in 2, diffuse bilateral miliary lung nodules in 1 during treatment. Thoracic vascular involvement was presented in 8 patients, two with superior vena cava thrombosis, one with left subclavicle artery aneurysm, one with left low pulmonary artery aneurysm and mural thrombosis, one with bilateral low pulmonary arteries and left basilar artery aneurysm, three with right pulmonary artery thrombosis in which there were two with left pulmonary artery occlusion and one with left basilar artery branch aneurysm. Conclusions Thoracic CT findings of Behcet disease are variable and nonspecific. Contrast-enhanced CT scan can be helpful by showing thrombosis of the superior vena cava and pulmonary artery as well aneurysm of the pulmonary artery.
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Objective To analyze the rationality of 16 or more multi-slice helical CT (MSCT) utilization for solitary pulmonary nodule (SPN) (<3 cm). Methods One hundred and fifty consultant cases with SPN from 133 different hospitals, examined with 16 or more MSCT, were selected in this study. The reconstructed slice thickness of routine CT scan, thin slice reconstruction thickness, 2D or 3D reconstruction, window wide and level setting, contrast enhancement effect were recorded from consultant films. Thoracic CT scan criteria for SPN were proposed according to the scan guidelines at Stanford University and PubMed articles. The rationality of 16 or more MSCT utilization in other hospitals for SPN was analyzed by two radiologists compared with scan criteria. The diagnostic accuracy in other hospitals was evaluated according to the pathologic and treatment results in our hospital. Results Sixteen-MSCT was performed in 92 cases, 64-MSCT in 54 cases and 40-MSCT in 4 cases. In routine thoracic CT scan, 9--10 mm reconstructed slice thickness was selected in 59 cases, 7--8 mm thickness in 12 cases and 5 mmthickness in 79 cases. Consecutive thin slice thickness (<3 mm) was used for SPN only in 46 cases. OnlyMPR and VR were filmed in 9 cases without thin slice reconstructed axial images. :53 cases (35.3%) were rescanned in our hospital due to the unsatisfied image quality. Of 150 cases, 78 cases had pathologic or treatment results in our hospital and 22 cases (14.7%) were proved to be misdiagnosed in other hospitals, and only 2 cases were misdiagnosed in our hospital. Conclusion There are many irrationalities of 16 or more MSCT utilization in our country which influence the diagnostic accuracy of SPN, Unified thoracic CT scan criteria in our country are needed.
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Objective To determine the correlation between coronary artery calcium score (CACS) and carotid calcification, and their risk factors. Methods 162 cases underwent coronary and carotid pre-contrast CT scan with dual-source CT scanner within 2 weeks. The reconstructed parameters were the same. The calcifications of coronary and carotid arteriae were quantified by calculating the Agatston score. The main risk factors such as age, sex, hypertension, total cholesterol, low-density-lipoprotein cholesterol (LDL), high-density-lipoprotein cholesterol (HDL), diabetes, smoking and coronary heart disease history were recorded. The CACS and carotid calcium scores were comparatively analyzed using Spearman's correlative analysis. The relativity between the risk factors and CACS scores, carotid calcium scores. Results In 162 subjects, there was positive relativity between CACS and carotid cal-cium score(r=0.690, P<0.01). Logistic regression analysis showed that CACS were of relativity with age, diabetes, total cholesterol and LDL cholesterol,otherwise, carotid calcium scores only with age and diabetes. Conclusion There is significant correlation be-tween CACS and carotid calcium score, but their risk factors are not same.
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Objective To get a MR imaging protocol for coronary arterial wall in vitro. Methods MR examinations were performed in 10 fresh porcine hearts. Three dimensional fast imaging employing steady state acquisition (3D FIESTA) was used to delineate left anterior descending artery (LAD), while 2D spin-echo T1W was performed with 8-channel head surface coil, temporomandibular surface coil and knee coil with the same parameters. T1WI was obtained with 384×256 and 512×512 in matrix using temporomandibular surface coil, and then T1WI, PDW and T2WI with fat saturation were obtained with different NEX using temporomandibular surface coil after injecting Resovist in LAD. Signal of the LAD wall, lumen, fat tissue adjacent to LAD, myocardium of anterior part of interventricular septum and noise were respectively measured. Signal-to-noise ratio (SNR) of image, contrast to noise ratio (CNR) between the wall and lumen (CNR1), CNR between the wall and surrounding fatty tissue (CNR2) were calculated. Results The SNR and CNR1, CNR2 of SE T1WI with temporomandibular coil were higher than those with 8-channel head surface coil and knee coil. SNR and CNR1, CNR2 of SE T1WI with 384×256 matrix were higher than those with 512×512 matrix. SNR and CNR1, CNR2 using 3 NEX were the highest. Conclusion Good SNR and CNR of porcine coronary wall can be achieved using temporomandibular surface coil, 384×256 in matrix and NEX of 3.
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Objeetive To analyze the attenuation differences of left yentricular myocardium on 64-slice CT coronary artery angiography in adults.Methods of 1130 consecutive patients,119 patients (65 males,54 females,ranged from 27 to 83 years with mean age of 52 years)with no stenosis or stenosis less than 25% in the left anterior descending arteries were enrolled.The standard axial image with 3mm slice thickness just below the aorta valve was selected for measttrement.The regions of interest(0.1 cm× 0.1 cm)in posterior interventricular septum(septal P),anterior interventricular septum(septal A),apex,anterior free wall and posterior free wall of the left ventricle were selected within the myocardium and the mean CT value wag measured.A paired Student t test was used for the comparison of CT values in different areas,P value under 0.05 was considered statistically significant.Results The megn attenuafion of the apical region(69.9±15.5)HU was lower than that of septal A(91.9±15.1)HU(t=11.060,P<0.01)and anterior free wall(79.7±16.9)HU(t=4.639,P<0.01),the mean attenuation in septal(93.8±14.8)HU and posterior free wall(88.0±14.3)HU showed relatively higher values.The myocardial intensity attenuation presented as a U-shape in the left ventricular myoeardium. Conclusions The mean attenuation in the left ventrieular myoeardium demonstrates as U-shape during the coronary artery angiography examination in normal adults.This can be helpful for iudging the extent of myocardial infarctiotr.
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0.05); mean transit time was significantly lower but permeability surface area product higher than benign nodules (P 0.05). ③If the mean transit time ≤ 7 s was selected as cut-off value for malignant lesion, the sensitivity was 68.97%, specificity was 66.67%, accuracy was 68.49%, positive predict value was 88.89%, and negative predict value was 35.71%. When permeability surface area product ≥ 0.20 was selected as the cut-off value for malignant lesion, the sensitivity, specificity, accuracy, positive predict value, and negative predict value were 86.21%, 53.33%, 79.45%, 87.72%, and 50.0%, respectively. CONCLUSION: CT perfusion imaging is a valuable method for assessing the physiological state of solitary pulmonary nodules.
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Objective To compare 16-slice multi-detector spiral computed tomography (MDCT) and breathhold 3D magnetic resonance (MR) coronary angiography in the visualization of coronary arteries and the accuracy of detecting significant (> 50%) coronary stenoses in patients with suspected coronary artery disease. Methods Forty patients were examined by 16-slice CT (GE, Lightspeedl6)and MR (GE,Twinspeed) within 3 days; 31 of them underwent conventional coronary angiography (CAG) within 2 weeks after CT and MR scan. CT was performed with 16× 1.25 mm detector collimation, 0.5 s rotation time and images were reconstructed at 60%-75% of the cardiac cycle. MR was performed with breath hold 3D FIESTA (TR4.0 ms, TE1.7 ms, flip angle 65, slice thickness 3 mm, FOV 280 mm, matrix 256× 192). Mean heart rate was 63 ± 5.8 bpm and β-blocker was used in 24 patients. MR and CT image quality was evaluated in 9 coronary segments (RCA1, RCA2, RCA3, LM, LAD1, LAD2, LAD3, LCX1, LCX2) using a four-point grading scale.Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated for detection of significant stenosis using CAG as the gold standard. Results 16-slice CT showed higher image quality in most coronary segments except RCA2.Forty-three segments were diagnosed as significant stenosis by CAG, 36 and 27 of these were correctly detected by CT and MR respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of 16-slice CT and MR for detecting significant stenosis were 83 %, 84 %, 49 %, 97 % and 63 %, 90 %, 55 %, 93 %, respectively. Conclusion Sixteen-slice CT showed higher image quality in most coronary segments excepted for middle RCA. 16-slice CT had higher sensitivity than MR for detection of coronary significant stenosis, whereas MR had higher specificity than CT. Both CT and MR showed high negative predictive value,which is useful for excluding coronary stenosis in symptomatic patients.
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Objective To prospectively evaluate the diagnostic ability of the lesions′ morphology, signal intensity time course, and early phase enhancement rate in dynamic MRI of the breast. Methods Forty cases with breast lesions were examined with a new Efgre 3D dynamic MR imaging series. Time signal intensity curves of the lesions were obtained and classified according to their shapes as monophasic, biphasic, or washout. Early phase enhancement rates of the lesions were calculated. The diagnostic indices were got by lesions′ morphology criterion, the time signal intensity curves criterion, and the enhancement rate criterion. Results There were 23 malignant and 18 benign lesions. The distribution of curve types for malignant lesions was monophasic (5%), biphasic (18%), and washout (77%). The distribution of curve types for benign lesions was monophasic (72%), biphasic (11%), and washout (17%). The distribution proved significantly difference (? 2=20.68, P
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Objective To determine the value of helical CT for the follow up of patients with abdominal aortic aneurysms(AAAs) after graft implantation. Methods Twenty six patients with AAAs underwent helical CT within 3 days after graft placement. Additional follow up CT scans were obtained in 22 patients 3 months after placement. The diameter of the aneurysmal sac, complications of the procedure, position, shape, and patency of the device were recorded. Results CT scans obtained within 3 days after placement showed complete thrombosis of the aneurysm in 20 patients, and 6 patients with perigraft channels; 3 months later, of 17 thrombosed aneurysms, 9 decreased in diameter, 7 remained unchanged, and 1 increased in diameter; of 5 aneurysms with perigraft channels, 2 decreased in diameter, 2 were stable, and 1 became enlarged. 20 of 26 patients (76.92%) were successful with endovascular repaire. Conclusion Helical CT is a valuable means in follow up of the patients after endovascular repair.
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Objective To evaluate the prevalence rate of pulmonary malignant disease detected by low dose spiral CT in people at high risk of lung cancer. Methods Low dose spiral CT scans and chest radiographs in 300 symptom free volunteers from an on going screening study were prospectively evaluated. The study has enrolled 240 smokers, aged 45 years or older, with at least 10 pack years of cigarette smoking and 60 individuals with chronic obstructive pulmonary disease, and without previous cancer history, who were medically fit to undergo thoracic surgery. Low dose CT scans were performed with SR 7000 scanner using spiral mode, 120 kV, 50 mA, pitch 2, 5mm thickness reconstruction and Lightspeed Plus multi slice scanner using spiral mode, 120 kV, 50 mA, pitch 6 to produce 2.5 mm thick image at 2.5 mm increments. All images were assessed with cine display mode on workstation monitor. Results Non calcified nodules were detected in 56 (19%) participants by low dose CT, compared with 9 (3%) by chest radiography. Malignant disease was detected in 4 (1.3%) by CT and 3 (1%) by chest radiography. All 4 cancers were stage I. Lobar or segmental bronchial abnormalities were detected in 9 (3%) participants by CT. Among them, 3 (1%) proved to be early central lung cancer. No bronchial abnormality was detected by chest radiography. The sensitivity and specificity of cancer screening was 43% and 89%, respectively for chest radiograph, 100% and 80%, respectively for CT. The sensitivity of CT was significantly higher than that of radiograph, whereas the specificity showed no statistical difference. Conclusion Preliminary screening study indicates that low dose CT can greatly improve the likelihood of detection for small non calcified nodules and mild bronchial abnormalities, and thus of peripheral and central lung cancer at an earlier stage.
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Objective To study the CT findings of early central lung cancer and correlative pathologic basis, and to evaluate the role of CT in the differential diagnosis of central lung cancer Methods Seventeen patients with early central lung cancer and 10 patients with benign lesions resembling the central lung cancer were analyzed Thin section CT was performed with a section thickness of 3 mm or 1 5 mm at Philips SR 7000 or GE Lightspeed Plus scanner The visibility of the lesions was correlated with bronchoscopic and histopathologic findings Results All 17 lesions were visualized at CT Three lesions showed focal bronchial wall thickening and internal bronchial wall irregularity, bronchial mucous coarsening, redness and swollening at bronchoscopy Fourteen lesions showed focal narrowing or obliteration of the bronchial lumen, 4 complicated with subsegmental bronchial mucoid impaction, 10 with obstructive pneumonia or atelectasis Corresponding bronchoscopic view disclosed intraluminal polypoid protrusions The epithelia were involved in 1 case, subepithelia in 5, and cartilaginous involvement in 11 according to the depth of invasion of the bronchial wall at histopathology Among 10 patients with benign lesions, 6 cases were suspected as bronchogenic carcinoma and the possibility of bronchogenic carcinoma was not excluded at CT in 4 cases There were 5 patients with uneven thickening of internal bronchial wall, 2 with lumen blood clots, 1 with lumen nodule, and no abnormalities in 2 patients at bronchoscopy Conclusion Thin section CT has been proved to be a reliable method for demonstrating the mild changes of the bronchi and to be a valuable tool for the diagnosis of early central lung cancer
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Objective To evaluate the efficacy of multislice helical CT(MSCT) in the diagnosis of coronary artery disease Methods 30 patients were studied with MSCT CT data were reconstructed to demonstrate the abnormalities of coronary artery and the results were compared with that of angiography Results In patients with heart rate less than 60 BPM, there was no difference to show the main branch of left coronary artery and left descending artery compared with more than 60 BPM( P =0 197 and 0 128,Fisher′exact);and obvious differences in showing left circumflex artery (? 2=5 88, P
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Objective To present the multislice helical CT (MSCT) and chest radiographic findings of congenital bronchial atresia (CBA) in order to improve the diagnosis of CBA.Methods Eleven patients with CBA, who had histological results in 3 cases, bronchoscopy in 6 cases and more than 1 year follow-up in 2 cases, underwent MSCT with 10 mm slice thickness. 1.25 mm thickness images with 1 mm reconstruction interval were performed on 16-slice helical CT, and multiplanar reconstruction (MPR), maximum intensity projection (MIP) and minimum intensity projection (MinIP) were made at a dedicated workstation. The involved segment of lung, shape of bronchocele and hyperinflation around bronchocele were recorded. Results On CT findings, all 11 patients demonstrated bronchocele and peripheral emphysematous changes which were shown in 8 cases on chest radiographs. An air-fluid level within the bronchocele was seen in 3 cases by MSCT and 2 by chest radiographs. The segmental bronchus was affected in 10 cases and the subsegmental in 1 case. 3 CBAs were in the left and 8 in the right. 6 patients with CBA presented a rounded, branching opacity emanating from the hilum and 5 were seen as a peripheral nodule. Conclusion The presence of a bronchocele and surrouding emphysematous change is the typical radiologic finding of CBA. MSCT can provide more information than X-ray chest radiograph for the diagnosis of CBA.
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Objective To demonstrate the origin of the right inferior phrenic artery(RIPA) in normal and hepatocellular carcinoma(HCC) patients and provide valuable anatomical information for angiographers before and after transcatheter arterial chemoembolization(TACE).Methods Four hundred and forty consecutive patients including 133 HCC cases who had biphase abdominal CT were assessed in this study.The routine abdominal enhanced CT scan(GE,LightSpeed16) was performed with 120 kV,200—240 mAs,10 mm collimation,1.375 pitch,and 10 mm reconstruction interval at 22—25 seconds for arterial phase triggered by timing bolus,60 seconds for portal venous phase after injection of 100 ml contrast material(300 mg I/ml) at a rate of 3.5 ml/s.Multiplanar reconstruction(MPR) and maximum intensity projection(MIP) images were generated using 1.25 mm images reconstructed with 1 mm interval in arterial phase and reviewed by two radiologists.An enhanced artery medial-posterior to the IVC,originated from aorta or its branches to the diaphragmatic dome was interpreted as the RIPA.Results The RIPA was showed in all(440 patients)(100%).Among 218(49.5%) RIPAs originated from the aorta,140 were from the right side of the aorta,22 from the left side of the aorta,56 from the anterior wall of the aorta,36 RIPAs had the same origin with the left inferior phrenic artery.Among 138(31.4%) RIPAs from the celiac artery,10 RIPAs had the same origin with the left gastric artery,and 33 RIPAs had the same origin with the left inferior phrenic artery.78(17.7%) were from the right renal artery,6(1.4%) were from the left gastric artery(the left gastric artery from aorta).The dilatation of the RIPA was demonstrated in 16 of(133 hepatocellular) carcinoma patients.Conclusion Multislice helical CT could demonstrate the origin of the RIPA in arterial phase and provide useful anatomical information for angiographer before and after TACE.
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0.05) and CT values of mesenteric panniculitis on unenhanced scan were significantly higher than those of the same patients′retroperitoneal fat(-91——115 HU)(P
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Objective To characterize the imaging features of mediastinal cysts and gain a better understanding of atypical manifestations of various mediastinal cysts and improve the level of diagnosis. Methods The CT and/or MR images(CT n=28, MRI n=26, CT and MRI n=10), surgical information, and pathologic material in 44 histopathologically proved cases of mediastinal cyst were retrospectively reviewed. Results The mediastinal cysts were located in the anterior mediastinum(n=13), middle mediastinum(n=18), anterior-middle mediastinum (n=2) and posterior mediastinum(n=11). Bronchogenic cysts and pericardial cysts were atypically located in 7/20(35%)and 5/6 respectively. The density of 42.9% cysts on CT was close to that of water. Each of the cysts had a high signal intensity that was equal to or greater than cerebrospinal fluid on T_2-weighted MR images. One cyst showed marked loss of signal on MR hydrography. The signal intensities of the cysts were variable on T_1-weighted images. The signal intensity of MRI was not homogeneous in 5 and the reasons were different. Fourteen cases were misdiagnosed. Conclusion 1.The cysts with soft-tissue attenuation on CT in the anterior and posterior mediastinum may be easily misdiagnosed as neoplasm. Pericardial cysts located in the paratrachea may be easily misdiagnosed as bronchogenic cysts .2. MRI can be used to diagnose the cysts with high density on CT.3. Heterogeneous signal on MRI and loss of signal on MR hydrography might be the reasons for misdiagnosis.
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Objective To explore CT features of thin-wall cavity change of pulmonary metastases from renal clear cell carcinoma after molecular targeted treatment and its clinical significance.Methods Clinical and imaging data of 2 patients with thin-wall cavity of pulmonary metastases originating from renal clear cell carcinoma after molecular targeted drug Pazopanib were reported and analyzed retrospectively.Results After resection of primary renal tumors,multiple solid metastatic lesions in the lung were detected and the lesions showed ring enhancement on the post-contrast images.After 3-month Pazopanib treatment,most of the lesions presented thin-wall cavity change.Case 1 showed slowly disease progression while case 2 suffered from spontaneous pneumothorax and died 2 months later.Conclusion Necrosis of pulmonary metastases originated from renal carcinoma can be impelled by molecular targeted Pazopanib treatment,which helped to the formation of cystic thin-wall cavity,but the influence on the prognosis still remains uncertain.
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50%) in patients with suspected coronary artery disease.Methods Both coronary MDCT angiography (CTA) and MR angiography (MRA) was performed within 3 days in 40 patients with suspected coronary artery disease, and conventional coronary angiography (CAG) was performed within 2 weeks after MDCT and MR scan in 31 patients. CTA was performed with a 16-MDCT scanner. MRA was performed on a 1.5 T MR scanner with breathhold 3D fast imaging employing steady state acquisition sequence. CTA and MRA image quality was evaluated in 9 coronarysegments by two experienced radiologists in concensus using a four-point grading scale. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for detection of significant stenosis on a segmental basis using CAG as reference and gold standard. Results MDCT showed higher image quality in most coronary segments except middle RCA (P