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Objective:To explore the difference of the vessel and plaque characteristics, myocardial perfusion and cardiac function between patients with ischemia with non-obstructive coronary artery disease (INOCA) and obstructive coronary artery disease (CAD).Methods:From July 2021 to June 2022, 101 patients with angina were referred to dynamic computed tomography myocardial perfusion (CTP) and coronary computed tomography angiography (CCTA) and retrospectively included in our hospital. Based on the results of CTP and CCTA, patients were divided into INOCA (27 cases), moderate obstructive CAD (26 cases) and severe obstructive CAD (48 cases). The anatomical coronary artery stenosis, plaque characteristics and myocardial perfusion features of all patients were analyzed. Furthermore, left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were obtained on full-phase reconstruction CCTA image by using Medis Suite 3.2 postprocessing software. Multigroup analysis used one way ANOVA or Kruskal Wallis H test. Results:Patients with INOCA were younger than patients with moderate and severe obstructive CAD ( P<0.001). INOCA patients (7.4%, 2/27) had lower rate of positive remodeling than both moderate (57.7%, 15/26, P<0.001) and severe obstructive CAD patients (33.3%, 16/48, P=0.017). The percentage of ischemic myocardium volume in patients with INOCA were similar with those in patients with severe CAD (all P>0.05), but significantly higher than those in patients with moderate CAD (all P<0.05). No significant difference in terms of GLS was detected between patients with INOCA [-17.4% (-21.6%, -11.6%)] and severe CAD [-17.6% (-21.9%, -14.8%), P=0.536], however, patients both with INOCA and severe CAD also had higher GLS than patients with moderate obstructive CAD [-22.3% (-29.8%, -19.0%), all P<0.05]. Conclusions:Based on"one-stop-shop"CTP combined with CCTA imaging, early cardiac functional changes including abnormal myocardial perfusion and myocardial strain in INOCA patients were similar to those in patients with severe obstructive CAD and more severe than those in patients with moderate obstructive CAD.
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Objective:To construct a porcine model of ischemia with non-obstructive coronary artery (INOCA) and explore the diagnostic value of a one-stop noninvasive method including CT myocardial perfusion imaging (CT-MPI) and coronary CT angiography (CCTA).Methods:Twelve swines were divided into the experimental group (9) and the normal group (3). Coronary microvascular dysfunction (CMD) porcine model was constructed in the experimental group by inducing diabetes mellitus, chronic kidney disease, and hypercholesterolemia. Invasive coronary angiography (ICA) and functional examination were performed on all 7+3 trial swines to clarify the INOCA diagnosis after completion of the modeling. Then, CT-MPI and CCTA were performed on all individuals to explore the CT-MPI and CCTA characteristics of INOCA porcine models. CT-MPI parameters, including myocardial blood flow (MBF), and myocardial blood volume (MBV) in rest and stress conditions, and CCTA parameters, including severity of stenosis and CAD-RADS, were analyzed.Results:ICA and functional tests showed that all swines in the experimental group met the diagnostic criteria for INOCA, which meant that INOCA porcine model was constructed successfully. CCTA results confirmed that there was no obstructive coronary stenosis in all 10 swines which were examined, which was consistent with ICA findings. CT-MPI results demonstrated that the mean MBF values, as well as the mean MBV values, in the rest and stress condition of each swines in the experimental group were lower than those of the control group. In contrast to the control group, the mean MBF and MBV values of swines in the experimental group in stress condition were generally lower than those in resting condition.Conclusions:In this study, a porcine model of CMD is successfully constructed by inducing hypercholesterolemia+diabetes mellitus+chronic kidney disease. ICA and invasive functional tests show that this CMD model meet the diagnostic criteria for INOCA. It has been confirmed that one-stop CT multimodality examination including CT-MPI and CCTA can be used for the diagnosis of INOCA as a noninvasive diagnostic method.
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Objective To analyze preoperative CT angiography (CTA)imaging features of cervical arteries in patients with acute type A aortic dissection followed by postoperative neurological dysfunction (ND),and the correlations between risk factors and ND.Methods Clinical and imaging data of 110 patients who underwent repair of acute type A aortic dissection were analyzed retrospectively.The samples were categorized into two groups based on the presence or absence of ND.The clinical,perioperative and imaging data were compared between the ND group and the non ND (NND)group.Univariate and multivariate analyses were performed to identify predictors related with ND.Results A total of 100 patients were finally included in this study,and 18 patients(18%)developed with ND after aortic surgery.No significant differences in clinical and perioperative variables were observed between the ND group and the NND group (P＞0.05).However,on preoperative CT images,a dissection entry localized in the aortic arch (94.4% in the ND group), common carotid artery tear (83.3% in the ND group)and unilateral internal carotid artery density decrease (44.4% in the ND group) were all significantly higer than those in th NND group (P＜0.05 ).No significant difference were observed in true lumen stenosis of ascending aorta (P=0.053),retrograde dissection (P=0.913)and intimal tear (P=0.267)between ND group and NND group.The Logistic regression analysis revealed that a dissection entry localized in aortic arch (OR=21.325,P=0.008),common carotid artery tear (OR=14.441,P=0.022)and unilateral internal carotid artery density decrease (OR=9.141,P=0.024)were independent determinants of postoperative ND.Conclusion Preoperative CTA of cervical arteries can provide more imaging features,that may be indicative of postoperative ND.
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Objective To analyze the clinical features and imaging findings of lesser trochanter osteoidosteoma,and to discuss the causes of its misdiagnosis as chronic osteomyelitis.Methods The clinical features,X-ray,CT and MRI findings of 6 cases with pathologically confirmed osteoidosteoma in the lesser trochanter were reviewed retrospectively.Symptoms included knee pain (1 case),thigh pain (4 cases)and hip joint pain(1 case);claudication(2 cases),and night pain(1 case).Five patients had right-side,and 1 patient had left-side involvement.All the 6 cases were misdiagnosed as chronic osteomyelitis before operation.Results Four patients had CT scan,which showed intra-cortical niduses at the lesser trochanters with peri-focal sclerosis,joint capsule swelling and joint effusion. Five patients had MRI exams,MR images showed bone marrow edema,synovial thickening,joint capsule swelling and joint effusion in all the 5 cases,but only 2 showed niduses.Six patients had X-ray imaging exams,X-ray images showed bone sclerosis without radiolucent nidus.Conclusion Osteoidosteoma in the lesser trochanter may display atypical clinical features that might be difficult to be differentiated from chronic osteomyelitis without sufficient examination.CT is best in showing niduses,except some niduses with atypical shape,superficial location and high-density calcification.MRI-T2WI is sensitive in showing the inflammation and bone marrow edema with high signal intensity,which may affect nidus displaying.X-ray images can only display bone sclerosis without niduses.
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Objective To investigate the manifestations and features of CT for glandular cystitis as well as cystic cystitis.Methods Clinical manifestations and CT imaging features of 39 cases with biopsy-proved glandular cystitis or cystic cystitis were analyzed retrospectively.Results Among 39 cases,33 were glandular cystitis and 6 were cystic cystitis.Two out of the 33 cases with glandular cystitis had a negative CT scan,and 31 had a positive CT scan among which 4 cases with extensive lesions showed diffuse thickening of the bladder wall,and 27 were with localized lesions.Furthermore,19 out of the 27 cases showed localized thickening of the bladder wall with smooth edge,which was a continuation of surrounding normal bladder wall;8 showed nodular lesions.17 of the 33 cases with glandular cystitis underwent contrast-enhanced CT scan which showed mildly enhancement consistent with or slightly stronger than the normal bladder wall in 15 cases and moderate uneven enhancement in 2 cases.The 6 cases with cystic cystitis showed diffuse thickened rough bladder wall.There were cystic shadows of various sizes in the inner wall of the bladder partially protruding into the bladder,which presented as a"beaded shape"manifestation.Conclusion The characteristic manifestations of glandular cystitis as well as cystic cystitis on CT scan are of great significance in diagnosing both of the diseases.
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Objective To investigate CT and MRI findings of giant cell tumors of the temporal bone(GCTTB).Methods CT and MRI features of 5 cases pathologically proven GCTTB were retrospectively reviewed.The lesion characteristics,including location, size,shape,margin,attenuation on CT scans,signal intensity on MR images,and enhancement pattern were documented and analyzed.Results In all 5 patients,the lesions were located adj acent to the mandibular fossa.These lesions were round or oval in shape,predominantly demonstrated as expansive lytic bone destruction containing hyperattenuating septa,calcifications,non-sclerotic borders,and discontinuous bony shells,with“boundary angle”sign.No soft tissue masses were found around the lesions.These lesions with different content demonstrated various MRI signal intensity,and the solid component enhanced intensely.Conclusion GCTTB is rare.Features such as expansive growing pattern,discontinuous bony shell,intralesional septa,calcification,and “boundary angle”sign are common,which may help in the radiographic diagnosis of giant cell tumor.