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Objective:To study the value of myocardial perfusion imaging (MPI) and coronary flow reserve (CFR) combined with coronary artery calcium score (CACS) in the diagnosis of obstructive coronary artery disease (CAD).Methods:From January 2019 to December 2020, 96 confirmed or suspective CAD patients (65 males, 31 females; age: 30-81 years) who completed rest/stress MPI, CFR and CACS defection in Fuwai Central China Cardiovascular Hospital were retrospectively analyzed. Coronary angiography (CAG) was used as the diagnostic standard to calculate the sensitivity and accuracy of MPI, CFR and MPI/CFR combined with CACS in the diagnosis of CAD. The χ2 test was used to compare the diagnostic efficiency of different methods. Results:The diagnostic sensitivity of MPI was 76.06%(54/71), and the accuracy was 75.00%(72/96), while the sensitivity increased to 97.18%(69/71; χ2=13.67, P<0.001) and the accuracy increased to 87.50%(84/96; χ2=4.92, P=0.020) with significant differences after combined with CACS. The sensitivity and accuracy of CFR were 91.55%(65/71)and 87.50%(84/96), which increased to 97.18%(69/71; χ2=2.12, P=0.137) and 89.58%(86/96; χ2=0.21, P=0.411) with no significant differences after combined with CACS. The sensitivity of MPI in the diagnosis of three-vessel CAD was 70.00%(21/30), which increased to 100%(30/30; χ2=7.75, P=0.004) after combined with CACS; while the sensitivity of MPI combined with CACS in the diagnosis of single-vessel and double-vessel CAD were not significantly improved ( χ2 values: 3.29, 1.51, P values: 0.114, 0.416). Conclusion:The combination of MPI and CACS can significantly improve the diagnostic efficiency of CAD, contributed by the improvement of the diagnostic sensitivity in three-vessel disease; whereas the diagnostic efficiency of CFR for CAD is not significantly improved after combined with CACS.
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Objective:To explore the imaging features of intraductal pancreatic neuro-endocrine tumor (PNET).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 17 patients with intraductal PNET who were admitted to the First Affiliated Hospital of Naval Medical University (Changhai Hospital of Shanghai) from January 2013 to October 2020 were collected. There were 7 males and 10 females, aged (47±13)years. Preoperative contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) of the pancreas was performed on patients. Observation indicators: (1) imaging features of intraductal PNET, including ① imaging features of CT and ② imaging features of MRI; (2) treatment and histopathological examination of intraductal PNET. Measurement data with normal distribution were described as Mean± SD and count data were described as absolute numbers. Results:(1) Imaging features of intraductal PNET. ① Imaging features of CT: 17 patients underwent preoperative contrast-enhanced CT of pancreas. There were 9 cases with tumor located in the head of the pancreas, 5 cases with tumor located in the neck of the pancreas and 3 cases with tumor located in the body and tail of the pancreas. The tumor diameter of the 17 patients was (8.7±2.5)mm, with a range of 5.2?15.5 mm. The tumor shape was round-like in the 17 patients. All the 17 patients showed isodensity on plain CT and markedly enhancement in arterial, venous and portal phases on enhanced CT. The degree of enhancement of tumor was higher than surrounding normal pancreatic parenchyma. All tumors of 17 patients were located at the truncation of main pancreatic duct (MPD) dilation, showing abrupt change in caliber of MPD without the "beak sign". The diameter of dilated MPD was (11.4±5.3)mm, with a range of 4.5?22.5 mm. Other imaging manifestations of the 17 patients included 11 cases with pancreatic parenchymal atrophy, 1 case with retention cyst, 1 case with choledochal dilation, 1 case with calcification, and all cases without cystic degeneration or hemorrhage. ② Imaging features of MRI: preoperative contrast-enhanced MRI was performed in 14 patients. Five cases showed slightly low signal but 9 cases showed unclear on T1-weighted imaging. Five cases showed low signal, 2 cases showed slightly high signal but 7 cases showed unclear on T2-weighted imaging. Of the 14 patients, 9 cases showed diffusion limited on diffusion weighted imaging and 5 cases showed unlimited diffusion. Nine cases showed marked enhancement in tumor higher than in normal pancreatic parenchyma, but 5 cases were unclear on contrast-enhanced MRI. (2) Treatment and histopathological exmination of intraductal PNET: all the 17 patients underwent surgical treatment, including 9 cases with pancreaticoduodenectomy, 4 cases with distal pancreatectomy and splenectomy, 4 cases with pancreatic segmentectomy. Postoperative histopatho-logical examination results showed 10 cases of G1 and 7 cases of G2, including 1 case of G2 with lymph node metastasis, 1 case of G2 with lymph node and liver metastasis. The pathological gross showed that the tumor body was mainly located in the pancreatic duct and blocked the pancreatic duct, with upstream pancreatic dilation. There were pancreatic acinar atrophy and fibrous tissue hyperplasia. The tumor was grayish-yellow or brownish red, solid, medium in texture and well-defined with the surrounding tissues. Microscopically, the tumor of 17 patients was mainly located in the pancreaic duct and invaded into surrounding pancreatic parenchyma. The cells of tumor were polygonal with a central nucleus, but the mitosis was rare. The cytoplasm was eosinophilic or hyaline. The tumor stroma was mainly collagen fiber with abundant capillary network.Conclusions:The imaging features of intraductal PNET are small size, marked enhancement on contrast-enhanced CT and MRI. The tumor obstructs the MPD with distal MPD dilation and pancreatic parenchyma atrophy.
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Objective To investigate the CT features and the diagnostic value in invasive mole. Methods Eleven cases (age, 30 to 53 years, mean 40 years)with invasive mole proved by operation and pathology were studied, including 3 cases during peri menopausal period of eight months, ten months and twelve months respectively. All cases were scanned by CT and enhanced study was done. Results All cases showed enlargement of uterus of varying degrees. On CT, the density of uterine cavity was similar to that of water, intermingled with spotty patchy and hazzy circular isodense shadows. High density stripe like bleeding foci were found in 3 cases.The outline of uterine cavity was locally disrupted in all case and the muscle layer was thickened in 3 cases. On enhanced CT scan, the lesions in the uterine cavity appeared markedly hyperdense, just like “the crater” and the “mole sign” .The muscle layers at the site of disruption showed inhomogeneous enhancement after contrast injection. Conclusion The CT features of invasive mole are characteristic, with important diagnostic value, especially for those during peri menopausal period.
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Objective To study the imaging manifestati ons and diagnostic evaluation of rounded atelectasis.Methods Imaging manifestation of round atelectasis in 4 c ases confirmed by pathology with complete clinical data,plain chest radiographs and CT were analysed.Results The lesions in 4 cases appeared as circular or el liptic masses with clear boundary,2.6～6.5 cm in diameter,located at subpleura o f lower lobule of lung,accompanied with pleural thickening.There was a acute angl e between the tumor and thickened pleura.The lucency of the lung adjacent to tum or incneased.The cordike structures consisted of blood vessels and bronchil ente red into tumors,which made the lateral boundary of tumor to hilum of lung obscur ed.“comet tail sign”and “air-brochogram sign”were seen in 3 cases.Conclusion The round atelectasis is of typical findings o n plain chest films and CT scans which play a very important role in diagnosis a nd differential diagnosis.
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Objective To explore the imaging features of bone tumor of fibrous tissue origin.Methods 31 patients with bone tumor of fibrous tissue or igin confirmed by pathology were analyzed. All patients were examined by X-ray, of them, 6 by CT in the meantime.Results Non-ossifying fibroma(NOF n=14)occured commonly i n long bone,the imaging findings presented sacculated and expanded bone destruct ion which was encircled by sclerotic borders,bony septum could be observed iusid e the lesion.Ossifying fibroma(OF n=10)occured more in maxillofacial bone,there were circle or elliptical and expansive bone change,and most of them associated with local bone malformation.Depending on the ossified degree,the density of les ion,could be hyperdense,ground-glass opacity,cyst or mixed density,defined borde r,partly associated with sclerotic borders.Desmoplastic fibroma of bone(DF n=1) presented multiple patchy bony erosion at lateral of lower part of femur,and ext ending to articalar facies,ill-defined border,and soft tissue slightly swelling. Fibrosarcoma of bone(FS n=6) occured commonly in long bone,presened bitted-like or greater patchy osseous absorption with soft fissue mass,rarely periosteal rea ction and calcification.58.08% patients(18/31) were accurately diagnosed.The nat ure of 6 patients was undefined.Misdiagnosis was made in 7.Conclusion Most of NOF and OF are of specific imaging fin dings and can be accurately diagnosed before cperation.DF is of slight symptoms with invaded growth and is easily misdiagnosed.In the imaging features of FS are apparently different with various type and histological differentiation,it must be differentiated from other diseases.