Relationships between intracranial compartment volumes and clinical symptoms in patients with idiopathic normal pressure hydrocephalus before and after cerebrospinal fluid shunt surgery / 中华老年医学杂志

Objective@#To investigate the relationships of intracranial compartment volumes with the severity of clinical symptoms before surgery, and the degree of symptom improvement one year after cerebrospinal fluid(CSF)shunt surgery in patients with idiopathic normal pressure hydrocephalus(iNPH).@*Methods@#Twenty-one patients meeting the diagnosis criteria of international guidelines of iNPH and undergoing CSF shunt surgery in Department of Neurosurgery in our hospital from 2016 to 2017 were included.All patients underwent brain MRI measurement before surgery, and were evaluated by using 3-meter timed up and go test(TUG), minimum mental state examination(MMSE), idiopathic normal pressure hydrocephalus grading scale(iNPHGS)and modified Rankin scale(mRS)before and one year after CSF shunt procedures.The ventricular volume, brain volume, pericerebral CSF volume, total intracranial volume and Evans' index were measured in the pre-operative imaging of the brain.The following four pre-operative intracranial compartment volumes were calculated: the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume.@*Results@#The scores of gait, cognitive function and urinary function were improved after surgery in iNPH patients(all P<0.05). There were no significant difference in the correlation of intracranial compartment volumes(the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index with the severity of clinical symptoms including gait, cognitive function and urinary function before surgery, and with the degree of symptom improvement one year after surgery in iNPH patients(all P>0.05). There was no significant difference in intracranial compartment volumes between patients having improvement in mRS, TUG, MMSE and iNPHGS and patients having no improvement one year after surgery in iNPH patients(all P>0.05).@*Conclusions@#Patients with iNPH can benefit from CSF shunt surgery and have improvements of clinical symptoms including gait, cognitive function and urinary function.Preoperative intracranial compartment volumes(the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index have no correlations with the severity of clinical symptoms before surgery, and have no correlations with the degree of symptom improvement one year after surgery in iNPH patients.For this reason, preoperative intracranial compartment volumes and Evans' index cannot be used to predict whether or not CSF shunt surgery can improve specific clinical symptoms.

Relationships between intracranial compartment volumes and clinical symptoms in patients with idiopathic normal pressure hydrocephalus before and after cerebrospinal fluid shunt surgery / 中华老年医学杂志

Objective To investigate the relationships of intracranial compartment volumes with the severity of clinical symptoms before surgery,and the degree of symptom improvement one year after cerebrospinal fluid(CSF)shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).Methods Twenty-one patients meeting the diagnosis criteria of international guidelines of iNPH and undergoing CSF shunt surgery in Department of Neurosurgery in our hospital from 2016 to 2017 were included.All patients underwent brain MRI measurement before surgery,and were evaluated by using 3-meter timed up and go test(TUG),minimum mental state examination(MMSE),idiopathic normal pressure hydrocephalus grading scale (iNPHGS) and modified Rankin scale (mRS) before and one year after CSF shunt procedures.The ventricular volume,brain volume,pericerebral CSF volume,total intracranial volume and Evans' index were measured in the pre-operative imaging of the brain.The following four pre-operative intracranial compartment volumes were calculated:the relative ventricular volume,brain volume ratio,pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume.Results The scores of gait,cognitive function and urinary function were improved after surgery in iNPH patients (all P ＜ 0.05).There were no significant difference in the correlation of intracranial compartment volumes(the relative ventricular volume,brain volume ratio,pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index with the severity of clinical symptoms including gait,cognitive function and urinary function before surgery,and with the degree of symptom improvement one year after surgery in iNPH patients (all P ＞ 0.05).There was no significant difference in intracranial compartment volumes between patients having improvement in mRS,TUG,MMSE and iNPHGS and patients having no improvement one year after surgery in iNPH patients(all P＞0.05).Conclusions Patients with iNPH can benefit from CSF shunt surgery and have improvements of clinical symptoms including gait,cognitive function and urinary function.Preoperative intracranial compartment volumes(the relative ventricular volume,brain volume ratio,pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index have no correlations with the severity of clinical symptoms before surgery,and have no correlations with the degree of symptom improvement one year after surgery in iNPH patients.For this reason,preoperative intracranial compartment volumes and Evans' index cannot be used to predict whether or not CSF shunt surgery can improve specific clinical symptoms.

Diagnostic value of contrast-enhanced CT scans in identifying lung adenocarcinomas manifesting as ground glass nodules / 中华肿瘤杂志

Objective@#To investigate the value of contrast-enhanced CT scans in differential diagnosis of atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimal invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) in patients who manifested as ground glass nodules (GGNs) or mixed GGNs (mGGNs) in unenhanced CT imaging.@*Methods@#The unenhanced and enhanced CT images of 194 patients with GGNs in the lung were retrospectively analyzed, including 64 cases with pre-invasive lesions, 80 cases with MIA, and 50 cases with IAC. The prediction of pathological types was based on maximal diameters and the solid portions of the lesions displayed on unenhanced and enhanced CT images, and then compared with pathological diagnosis.@*Results@#In 64 patients with pre-invasive lesions, the CT value increased in 59 cases after contrast-enhanced administration, whereas the solid portions increased in 5 cases. In the 80 patients with MIA, solid portions increased in 50 cases and the CT value increased in 30 cases after contrast administration. In 50 cases with IAC, almost all of them showed increased solid portions, whereas only 2 cases showed an increase of CT values. In the pre-invasive group and the MIA group, the increase of CT values after contrast administration was (45.88±15.97) HU and (66.47±44.54) HU, respectively, showing statistically significant difference (P=0.001). The increase of solid portions in the MIA group and IAC group was (1.55±0.73) mm and (1.88±0.75) mm, respectively, also showing significant difference (P=0.032).@*Conclusion@#Contrast-enhanced CT scans were more useful than unenhanced CT scans for the diagnosis of lung adenocarcinomas manifesting as GGNs .

The technology feasibility studies and image quality evaluation of computed tomographic pulmonary angiography using dual-energy subtraction / 实用放射学杂志

Objective To assess quantitative and subjective image quality in computed tomography pulmonary angiography (CT-PA)with dual-energy subtraction methods,and to select the best dual-energy subtraction method.Methods 30 consecutive patients underwent CTPA using a single tube,fast voltage switching technique.One set of routine poly-chromatic images (RPI),two sets of monochromatic images with different optimal contrast-to-noise ratios (OCNR)and three sets of dual-energy subtraction images (DE-SI)were obtained by a dedicated workstation with dual-energy software (AW4.5 Advantage WS;GE Healthcare).For all the six sets of images,CNR and the score of global subjective image quality were calculated.Results DESI 3 got the highest CNR,and DESI 1 got the next high CNR.In global subjective image quality,DESI 1 got the highest score.However,when compared with DESI 2,no significant difference was found.Conclusion CTPA with dual-energy subtraction technique is feasible.DESI 1 affords the best bal-ance between quantitative analysis and subjective evaluation compared with other sets of images.

CT diagnosis of different pathological types of ground-glass nodules / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the CT features of ground-glass nodules (GGN) including preinvasive lesions [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)], minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC).</p><p><b>METHODS</b>Ninety-seven GGN lesions confirmed by operation pathology were included in this study. The lesions were divided into three groups: preinvasive lesion group (24 cases), MIA group (39 cases), IAC group (34 cases). The lesion size, 3-dimensional ratio, 2-dimensional ratio in axial images, lesion density, shape, speculation, lobulation, air-containing space and pleural indentation on the preoperative CT images in the three groups were analyzed and compared with pathological results. The data were statistically analyzed using SPSS 17.0.</p><p><b>RESULTS</b>All preinvasive lesions presented as pure GGN on CT image, most showed round-like shape, clear and smooth border. MIA presented as pure GGN or mixed GGN on CT image, most showed round-like shape, with a clear and smooth border. IAC most presented as mixed GGN on CT image, often showed irregular shape. Speculation, lobulation, air-containing space and pleural indentation displayed gradually increasing from preinvasive lesions to MIA and IAC. There were statistically significant differences in lesion size, CT density, shape, air-containing space, speculation, pleural indentation and long diameter of solid component between the MIA and IAC groups (P < 0.05 for all). There were statistically significant differences in CT density values and long diameters of solid component of the lesions between the preinvasive lesion group and MIA group (P < 0.05). The AUC of solid component of the preinvasive lesion group and MIA group was 0.705, and that of the MIA and IAC groups was 0.814.</p><p><b>CONCLUSION</b>Comprehensive analysis of the CT image features of GGNs, especially the solid component in the lesions, may help to the preoperative and differential diagnosis of preinvasive lesions, MIA and IAC.</p>

Evaluation of in-stent restenosis in coronary artery with high definition computed tomography angiography / 实用放射学杂志

Objective To explore the accuracy of high definition computed tomography angiography (HDCTA)in the evaluation of coronary in-stent restenosis.Methods 93 patients with 159 implanted coronary stents who underwent both HDCTA and CAG were included in the study.The sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV)and diag-nostic accordance rate of HDCTA were calculated.The imaging quality was analyzed by visual estimation.Possible factors that in-fluenced the diagnostic accuracy of HDCTA were evaluated,which included stent location,stent diameter and heart rate in the pa-tients with left anterior descending branch stents.Results Restenosis was found in 21 stents by CAG and 19 stents by HDCTA.The false positive and false negative were 5 and 3,respectively.Sensitivity,specificity,PPV,NPV and diagnostic accordance rate were 90.5%,96.4%,79.2%,98.5% and 95.6% respectively.The image quality was 4 score in 75 stents (47.1%),3 score in 33 (20.8%),2 score in 27 (17%),≤1 score in 24 (15.1%).The image quality of proximal segments,large stents (≥3.0 mm)and slow heart rate (<66 beast per minute)was significantly better than that of distal segments,small stents (<3.0 mm)and fast heart rate (≥6 6 beast per minute).Conclusion HDCTA is a convenient,efficient and non-invasive method for follow-up after im-plantation of the coronary artery stents.

Computerized tomography findings in primary pulmonary fungal infections / 中华传染病杂志

Objective To evaluate the findings of computerized tomography (CT) imaging in patients with primary pulmonary fungal infections.Methods CT findings and clinical data of 18 cases of primary pulmonary fungal infections from 2004 to 2012 were retrospectively analyzed.The diagnoses of all patients were confirmed by pathology or serology.Results The CT of primary pulmonary fungal infections showed soft tissue density nodules in 15 out of 18 cases,and masses in 3 out of 18.By pathology or serological examination,there were 12 cases of Aspergillus infections,3 cases of cryptococcal infections and 3 cases of coccidioidomycosis.The CT findings of all of the 12 cases of Aspergillus infection showed quasi-circular shaped lesions,with lobulation and spiculation (6/12),bronchial through syndrome (3/12),the air crescent sign (6/12),or mediastinal/hilar lymphadenopathies (3/12).Six cases presenting air crescent sign were all diagnosed with primary pulmonary aspergillosis.Among 12 aspergillosis cases,6 cases underwent CT enhancement scan,among which 3 showed no enhancement and 3 showed slight enhancements.The CT findings of all eases of Cryptococcus neoformans infections were cauliflower-like shape,with lobulation,spiculation,and no focal point calcification or mediastinal/hilar lymphadenopathies.After enhancement,all of the lesions were enhanced heterogeneously.The CT findings of all the coccidioidomycosis were irregular shaped lesions with halo sign and mediastinal/hilar lymphadenopathies.All 3 cases of halo signs were diagnosed with primary coccidioidal infections.Conclusions The CT findings of primary pulmonary fungal infections have certain characteristics.Diagnosis could be made based on CT imaging together with clinical manifestations before pathological results are available.

Multi-slice Spiral CT Manifestations of the Arrhythmogenic Right Ventricular Dysplasia / 中国医学影像学杂志

Purpose To investigate the diagnostic value of the arrhythmogenic right ventricular dysplasia (ARVD) using multi-slice spiral CT (MSCT). Materials and Methods Thirty-four patients who were suspected as ARVD received right ventricular radiography, including 16 ARVD patients and 15 non-ARVD patients regarded as control group. The structural and shaped change of heart on reconstructed images of long axis, short axis and four cavity surface and analyze were observed, and MSCT features of right ventricular radiography characteristics were analyzed for ARVD patients. Results Sixteen cases of ARVD were correctly diagnosed by MSCT, and 14 cases had fatty infiltration including 11 cases of apex of heart, 8 cases of inferior wall, 5 cases of anterior wall, 5 cases of anterior wall of funnel area, 3 cases of diagram, 4 cases of papillary muscle, 6 cases of muscular trabecula and moderator band and 1 case of whole right ventricular free wall. Five cases showed scallop sign, 16 cases excessive trabecular change, 11 cases thinned changes, and 16 cases enlarged changes of right ventricular wall. Conclusion MSCT features of right ventricular for ARVD have relative diagnostic characteristics, and the scallop sign and excessive trabecular change of right ventricular wall are its specific imaging characteristics.

Clinical application of low-dose CT in patients with rib fractures / 中华放射学杂志

Objective To evaluate images quality and diagnostic feasibility of low-dose CT in patients with traumatic rib fractures.Methods Twenty-five patients presented with thoracic iniury were underwent 64-slice spiral CT scanning in inspiration breath-hold technique.Two scan protocols were performed.In one scan protocol noise index(NI)is 11,and in another NI is 21,but the other scan parameters were no difference.The mean value of tube current,the volume CT dose index(CTDIvol),and effective dose(ED)were recorded.Image quality was scored by 2 experienced radiologists using the 5-points scale.The numbers and degrees of rib fractures were recorded.The data were tested by using the Wilcoxon signed rank sum test.The differences of the inter-observer were determined by Kappa statistics.Results The mean CTDIvol and ED in scan protocol with NI of 11 were(13.88±5.17)mGy and(8.14±3.21)mSv,and that with NI of 21 were(3.91±1.57)mGy and(2.31±0.97)mSv.Compared the scan with NI of 11.there was 72%intrinsie dose reduction in the scan with NI of 21.The mean value of tube current in scan with NI of 11 and 21 were(195.88±69.33)mAs and(54.56±21.54)mAs.AIl patients with 11 and Ⅲ degree and most patients with I degree rib fractures that identified by the scan with NT of 11 were detected by the scan with NI of 21.There were no statistical difference between two scaus with the Wilcoxon signed rank sum test.The diagnostic acceptability and image noise score in the scan with NI of 11 were 4.9±0.2 and 4.6±0.5.and that with NI=21 were 3.5±0.5 and 3.3±0.5.There was prefect concordante in the inter-observers in diagnostic acceptability on finding of rib fractures.diagnostic acceptability and image noise(Kappa=0.876,0.820,0.792,P<0.01)between two scan protocols.Conclusion Rib fractures can be diagnosed by the low-dose CT using the scan protocol with NI of 21.

Multislice CT characteristics of coronary atherosclerotic plaques in acute coronary syndrome / 中华放射学杂志

nclude positive vascular remodeling,low plaque density,spotty calcification,and eccentric stenosis.

Application of three compartments of mediastinal anatomy in the diagnosis of space-occupying lesions / 中华放射学杂志

Objective To evaluate three compartments of mediastinal anatomy in the diagnosis of space occupying lesions. Methods CT images of 78 mediastinal lesions confirmed by surgery or/and pathology were retrospectively studied. Results According to the occurrence ratio of occupying lesions, anterio superior mediastinal lesions were lymphadenovarix, thymoma, teratoblastoma, and intrathyroma, etc. In anterio inferior mediastinum, heart tumors, teratoblastoma, fatty tumor were found successively. Posterior mediastinal lesions were lymphadenovarix, neurogenic tumors, esophageal tumors, tracheo broncheal tumors, aneurysms, diaphrageal herniation and so on. Conclusion The results suggested that the mediastinal three compartments protocol was more terse and practical than others in the diagnosis of space occupying lesions before operation.

Accuracy of evaluate coronary soft plaque by multi-slice CT / 中华放射学杂志

Objective To evaluate accuracy of density measurements within coronary plaque by multi-slice spiral CT and factors that influence measurements. Methods Four adult cadaver hearts were used. Thrombus and pericardial fat which acquired from specimen (size 2.0, 1.5, 1.0 and 0.5 mm respectively) were placed into coronary artery to simulate coronary plaques. The contrast medium (three different concentrations 1: 30, 1:40, and 1:50) were injected into coronary artery. The raw date were reconstructed with two slice width ( 1. 00 and 0. 75 mm). Results When contrast medium concentrations was 1: 30, the CT values of thrombus were 109 HU ( slice width 1. 00 mm, size 2. 0 mm) , 115 HU ( slice width 1.00 mm, size 1.5 mm), 101 HU (slice width 0.75 mm, size 2.0 mm), 113 HU ( slice width 0. 75 mm,size 1. 5 mm) ; the CT values of fat were - 23 HU ( slice width 1. 00 mm, size 2. 0 mm) , -17 HU(slice width 1.00 mm, size 1.5 mm) , -9 HU(slice width 1.00 mm, size 1.0 nun), -27 HU ( slice width 0.75 mm, size 2. 0 mm) , - 19 HU (slice width 0.75 mm, size 1. 5 mm) , - 13 HU (slice width 0. 75 mm,size 1. 0 mm). When contrast medium concentrations was 1: 40, the CT values of thrombus were 79 HU( slice width 1.00 mm,size 2.0 mm) , 87 HU( slice width 1.00 mm, size 1. 5 mm) , 115 HU( slice width 1. 00 mm,size 1. 0 mm) , 73 HU(slice width 0. 75 mm,size 2. 0 mm) , 80 HU(slice width 0. 75 mm, size 1. 5 mm) , 110 HU( slice width 0. 75 mm, size 1. 0 mm) ; the CT values of fat were - 31 HU ( slice width 1. 00 mm, size 2. 0 mm) , - 22 HU ( slice width 1. 00 mm, size 1. 5 mm) , - 10 HU ( slice width 1.00 mm,size 1.0 mm) , -35 HU(slice width 0. 75 mm,size 2.0 mm) , -25 HU(slice width 0. 75 mm, size 1. 5 mm) , - 19 HU ( slice width 0. 75 mm, size 1. 0 mm). When contrast medium concentrations was 1:50, the CT values of thrombus were 53 HU ( slice width 1. 00 mm, size 2. 0 mm) , 60 HU ( slice width 1.00 mm,size 1.5 mm) ,63 HU(slice width 1.00 mm,size 1.0 mm) ,51 HU(slice width 0.75 mm,size 2. 0 mm) ,64 HU( slice width 0. 75 mm,size 1. 5 mm) ,67 HU( slice width 0. 75 mm,size 1. 0 mm) ,145 HU (slice width 0. 75 mm, size 0. 5 mm) ; the CT values of fat were - 39 HU ( slice width 1. 00 mm, size 2. 0 mm) , -28 HU( slice width 1. 00 mm,size 1. 5 mm) , - 22 HU( slice width 1. 00 mm,size 1. 0 mm) , 17 HU(slice width 1. 00 mm,size 0. 5 mm) , -41 HU(slice width 0. 75 mm,size 2. 0 mm), -36 HU(slice width 0. 75 mm, size 1. 5 mm ) , - 27 HU ( slice width 0. 75 mm, size 1. 0 mm ) , 3 HU ( slice width 0. 75 mm, size 0. 5 mm ) . The density values of thrombus were correlated with size ( t = - 6. 624, P 0. 05) not found statistically significant may be caused by both too close slice width (1.0 mm and 0. 75 mm) and few samples. The slice width(t= -2. 595,P

The diagnostic significance of CT tumor angioimaging on the peripheral lung cancer / 中华放射学杂志

2 cm).Immunohistochemistrical stain slice of operative specimen showed a lots of vascular endothelial cells and small vessels,which correlated with the tumor angioimaging area on CT images.The sensitivity,specificity,and positive predictive valve of tumor angioimaging in the lung cancers were 47.2%,91.3%,and 95.5%,respectively.Conclusion The “tumor angioimaging” sign can be regarded as another specific feature in peripheral lung cancer with contrast CT.