Growth Regularity of Pulmonary Ground Glass Nodules Based on 3D Reconstruction Technology / 中国肺癌杂志

BACKGROUND@#Since the popularization of computed tomography (CT) technology, the detection rate of pulmonary ground glass nodules (GGNs) with imaging follow-up as the main management method has increased significantly. The purpose of this study is to quantitatively analyze the changes of pulmonary GGNs during the follow-up process with three-dimensional reconstruction technology, explore the natural progression of pulmonary GGNs, and provide effective basis for clinical guidance for patients to conduct reasonable management of nodules.@*METHODS@#A total of 115 cases of pulmonary GGNs with regular follow-up in the Combined Outpatient Department of Zhoushan Hospital from March 2015 to November 2022 were enrolled. Quantitative imaging features of nodules were extracted by semi-automatic segmentation of 3D Slicer software to evaluate the growth of nodules and clinical intervention during follow-up.@*RESULTS@#The average baseline age of the patients was (56.9±10.1) yr. The mean follow-up time was (48.8±18.9) months. The two-dimensional diameter of baseline CT scan was (7.9±2.9) mm, and the maximum three-dimensional diameter was (10.1±3.4) mm. The two-dimensional diameter of the last CT scan was (9.9±4.7) mm, and the maximum three-dimensional diameter was (11.4±5.1) mm. A total of 27 cases (23.5%) showed an increase during follow-up, with a median volume doubling time of 822 days and a median mass doubling time of 1,007 days. 32 cases were surgically resected, including 6 cases of invasive adenocarcinoma (IAC), 16 cases of minimally invasive adenocarcinoma (MIA), 8 cases of adenocarcinoma in situ (AIS) and 2 cases of atypical adenomatous hyperplasia (AAH). Five nodules underwent surgical intervention due to the progression of two-dimensional diameter, which was pathologically confirmed as pre-invasive lesions, but their three-dimensional maximum diameter showed no significant change. Nodular morphology, lobulated sign, spiculated sign and vacuole signs all promoted the growth of nodules in univariate analysis. There were significant differences in age, baseline diameter, mean CT value, median CT value, 10% and 90% percentile CT number between the growth group and the stable group (P<0.05). Multivariate Logistic regression analysis showed that age and average CT value were risk factors for nodule growth (P<0.05). Receiver-operating characteristic (ROC) curve analysis results indicated that the age ≥63 years old, the baseline three-dimensional maximum diameter ≥9.2 mm, and the average CT value ≥-507.8 HU were more likely to accelerate the growth of GGNs. The maximum three-dimensional diameter ≥14.4 mm and the average CT value ≥-495.7 HU may be a higher malignant probability.@*CONCLUSIONS@#GGNs show an inert growth process, and the use of three-dimensional measurements during follow-up is of greater significance. For persistent glass grinding nodules ≥63 years old, the baseline three-dimensional maximum diameter ≥9.2 mm, and the average CT value ≥-507.8 HU are more likely to increase. However, most nodules still have good prognosis after progression, and long-term follow-up is safe.

Application value of magnetic resonance imaging in diagnosing central nervous system lymphoma

Objective: To describe the magnetic resonance imaging [MRI] appearance of central nervous system lymphoma

Methods: We retrospectively reviewed MRI images of 40 patients who had pathologically proven primary central nervous system lymphoma [PCNSL] and received treatment in Binzhou People's Hospital, Shandong, China from January to December in 2014. Location, size and form of tumor was observed and relevant data were recorded for analysis

Results: Foci of 40 cases of PCNSL all located in brain, among which. 18 cases were single [45.0%] and 22 cases were multiple [55.5%]. Of 96 Foci, 84 were supratentorial, 12 were subtentorial. Enhanced MRI scanning showed that, most Foci had significant homogenous enhancement, shaping as multiple nodular or lumpy, and few had ring-enhancement. MRI suggested that, T1 signal of most Foci concentrated on low signal segment and T2 signal gathered on high signal segment, suggesting a significant homogeneous enhancement; moreover, mild and medium edema surrounded the tumor. They were pathologically confirmed as B cell derived non-hodgkin lymphoma. Except one case of Burkitt lymphoma, the others were all diffuse large B cell lymphoma which was observed with diffuse distribution of cancer cells [little cytoplasm, large nucleus, rough perichromatin granule] in same size. Fifteen cases were observed with sleeve-like infiltration of cancer cells around blood vessels. No case was found with hemorrhage, necrosis or calcification

Conclusion: Pathological foundation of PCNSL determines its characteristic MRI performance. Typical case of PCNSL can be diagnosed accurately by MRI

Clinical value of mammography in diagnosis and identification of breast mass

Objective: To study the effect and clinical value of mammography in the diagnosis of breast lump so as to improve the diagnosis level of breast cancer

Methods: A retrospective analysis was carried out on clinical data of 110 patients with mammary lump confirmed by pathology to study the compliance of mammography diagnosis and Pathology diagnosis in breast lump, and the detection of microcalcifications, phyllode, and observe the image performance of mammography. Taking infitrating ductal carcinoma [IDC] as an example, the correlation of image performance and clinical pathological features of different types was studied so as to predict if mammography performance was effective in the treatment and prognosis in breast cancer

Results: Taking Breast Imaging Reporting and Data System [Bl-RADS] grade 4A as the critical point, the sensitivity, specificity and accuracy of mammography was 90.80% [109/120], 84.60% [126/149] and 87.40% [235/269]; taking Bl-RADS grade 4B as the critical point, the sensitivity, specificity and accuracy of mammography was 85.00% [102/120], 93.30% [139/149] and 89.60% [241/269]; the correlation analysis suggested that, there was some kind of correlation between the mammography performance and clinical features of breast cancer

Conclusion: Mammography is worth being promoted in clinic for its significant clinical value in diagnosing and identifying breast lump

CT Features of Solid Components in Pulmonary Mixtured Ground-glass Opacity / 中国医学影像学杂志

Purpose To evaluate the CT features and pathological manifestations of the solid components of mixture ground-glass opacity (GGO) in adenocarcinoma in situ (AIS), minimally invasive adenocarcinom (MIA) and invasive adenocarcinoma (IAC), to analyze the qualitative diagnosis value of solid components of mixture GGO in the diagnosis of AIS, MIA and IAC, to provide reference for the selection of clinical treatment.Materials and Methods Eighteen patients with AIS, 53 patients with MIA and 28 patients with IAC (the maximum diameter smaller than 2 cm) proved by surgery and pathology with CT features appearing as mixture GGO were retrospectively analyzed, CT features of the solid components in three groups were analyzed and compared with pathology.Results The solid components in AIS mainly appeared as punctiform or polygon, with extensive distribution, solid nodules were usually single (17 cases, 94.44%), located in the middle of the lesion (14 cases, 77.78%), with clear binderies (16 cases, 88.89%) and the same density with vessels in the same axis (13 cases, 72.22%); the majority of solid components in MIA appeared as circular or elliptical (33 cases, 62.26%), less than or equal to 5 mm (48 cases, 90.57%), with eccentric or multi-point distribution (45 cases, 84.90%), the boundaries were less sharp (40 cases, 75.47%), with slightly lower density than that of the vasculars in the same level (34 cases, 64.15%); the solid components in IAC mainly appeared as irregular lesions (21 cases, 75.00%), lager than 5 mm (24 cases, 85.71%), with eccentric growth (20 cases, 71.43%) and less sharp boundary (15 cases, 53.57%), the integration of multiple nodules could also be observed. There were statistically significant differences in the CT features of solid components within the lesions among the three groups (P<0.01).Conclusion It is possible to predict the pathological typing and the prognosis of pulmonary mixture GGO in a certain extent according to the different CT features of the solid components in it, and to guide clinical treatment principles.