The Variation in the Diastolic Period with Interventricular Septal Displacement and Its Relation to the Right Ventricular Function in Pulmonary Hypertension: A Preliminary Cardiac Magnetic Resonance Study.

Background: Pulmonary hypertension (PH) is known to alter the biventricular shape and temporal phases of the cardiac cycle. The presence of interventricular septal (IVS) displacement has been associated with the severity of PH. There has been limited cardiac magnetic resonance (CMR) data regarding the temporal parameters of the cardiac cycle in PH. This study aimed to quantify the temporal changes in the cardiac cycle derived from CMR in PH patients with and without IVS displacement and sought to understand the mechanism of cardiac dysfunction in the cardiac cycle. Methods: Patients with PH who had CMR and right heart catheterization (RHC) examinations were included retrospectively. Patients were divided into an IVS non-displacement (IVSND) group and an IVS displacement (IVSD) group according to IVS morphology, as observed on short-axis cine CMR images. Additionally, age-matched healthy volunteers were included as the health control (HC). Temporal parameters, IVS displacement, ventricular volume and functional parameters were obtained by CMR, and pulmonary hemodynamics were obtained by RHC. The risk stratification of the PH patients was also graded according to the guidelines. Results: A total of 70 subjects were included, consisting of 33 IVSD patients, 15 IVSND patients, and 22 HC patients. In the IVSND group, only the right ventricle ejection fraction (RVEF) was decreased in the ventricular function, and no temporal change in the cardiac cycle was found. A prolonged isovolumetric relaxation time (IRT) and shortened filling time (FT) in both ventricles, along with biventricular dysfunction, were detected in the IVSD group (p < 0.001). The IRT of the right ventricle (IRTRV) and FT of the right ventricle (FTRV) in the PH patients were associated with pulmonary vascular resistance, right cardiac index, and IVS curvature, and the IRTRV was also associated with the RVEF in a multivariate regression analysis. A total of 90% of the PH patients in the IVSD group were stratified into intermediate- and high-risk categories, and they showed a prolonged IRTRV and a shortened FTRV. The IRTRV was also the predictor of the major cardiovascular events. Conclusions: The temporal changes in the cardiac cycle were related to IVS displacement and mainly impacted the diastolic period of the two ventricles in the PH patients. The IRT and FT changes may provide useful pathophysiological information on the progression of PH.

Indication of the prognosis of pulmonary hypertension by using CMR function parameters.

OBJECTIVE: This study aimed to compare the cardiac function among different sub-types of pulmonary hypertension (PH) and to explore the independent predictors of major adverse cardiovascular events (MACE). METHODS: Eighty-seven PH patients diagnosed by right heart catheterization (RHC) were recruited. Patients underwent cardiac magnetic resonance (CMR) and RHC examination within 2 weeks. The CMR images were analyzed to calculate the cardiac functional parameters including right ventricle (RV) and left ventricle (LV) end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), and myocardial mass (MM). The median follow-up time was 46.5 months (interquartile range: 26-65.5 months), and the endpoints were the occurrence of MACE. RESULTS: RVEDVI, LVEDVI, and LVESVI were higher in congenital heart disease-related PH (CHD-PH) than in other sub-types (p < 0.05). RVMM, RVSVI, and RVCI were highest in CHD-PH. There was no significant difference in the prognosis among different sub-types (p > 0.05). Comparing with the non-MACE group, RVEF, TAPSE, and LVSVI significantly decreased in the MACE group, while the RVESVI significantly increased (p < 0.05). TAPSE ≤ 15.65 mm and LVSVI ≤ 30.27 mL/m2 were significant independent predictors of prognosis in PH patients. CONCLUSION: CHD-PH had a higher RV function reserve but lowest LVEF comparing to other subgroups. TAPSE and LVSVI could contribute to the prediction of MACE in PH patients. KEY POINTS: • CMR imaging is a noninvasive and accurate tool to assess ventricular function. • CHD-PH had higher RV function reserve but lowest LVEF. • TAPSE and LVSVI could contribute to the prediction of MACE in PH patients.

Comparative study of computed tomography of normal and lymphoid follicular hyperplasia thymus in myasthenia gravis patients.

The aim of the present study was to evaluate the thymuses of non-thymomatous myasthenia gravis (MG) patients by computed tomography (CT) for differentiating lymphoid follicular hyperplasia (LFH) thymus from normal/involuted thymus in order to assist surgeons in determining whether a non-thymomatous MG patient requires an operation. In the present retrospective review over 10 years, 80 patients who received CT scan and thymectomy at the Affiliated General Hospital of Tianjin Medial University (Tianjin, China) were included. According to the pathological records, 54 of the cases initially detected on CT were confirmed as LFH thymus. Thymic measurements, including anteroposterior and transverse dimensions, width (the longest axis of the lobe on a transverse scan) and thickness (the largest dimension perpendicular to the long axis of the lobe) and CT attenuation of the thymus region, adipose tissue and chest wall musculature in each CT slice were included to assess differences between the LFH group and the normal/involuted thymus group. Although a negative association between patient age and the CT attenuation of the thymus region was identified (r=-0.779, P<0.05, Pearson's correlation test), the LFH thymus group featured nodular changes on CT, while no such changes were observed in the normal/involuted thymus group. The mean age of disease onset in the LFH thymus group was significantly lower than that in the normal thymus group (40.2±17.3 vs. 59.2±9.3 years). Furthermore, significant differences in CT attenuation were identified between the LFH group and the normal/involuted thymus group [-41.21±54.42 vs. -108.23±8.72 Hounsfield units (HU) on unenhanced CT; -25.57±58.65 vs.-117.40±6.22 HU on contrast-enhanced CT]. In the LFH group, the difference in mean CT attenuation between the thymus region and adipose tissue was significant, while no significant difference was observed in the normal/involuted thymus group. In conclusion, CT may be used to distinguish LFH thymus from normal/involuted thymus in MG patients.

[Value of CT Features on Differential Diagnosis of Pulmonary Subsolid Nodules and Degree of invasion Prediction in Pulmonary Adenocarcinoma].

BACKGROUND: Subsolid pulmonary nodules are common computed tomography (CT) findings of primary lung adenocarcinoma. It is of clinical value to determine the clinical treatment strategies based on CT features. The aim of this study is to find the valuable CT characteristics on differential diagnosis and the degree of invasion prediction by a retrospectively analysis of three groups subsolid nodules, including benign, and invasive adenocarcinoma. METHODS: The CT findings of 106 cases of resected sub-solid nodules were retrospectively analyzed. The nodules were firstly divided into benign and malignant groups and the malignant group was further divided into non/micro-invasive group (atypical adenomatous hyperplasia/adenocarcinoma in situ/minimally invasive adenocarcinoma) and invasive adenocarcinoma group. The nodule size, proportion of solid components, tumor-lung interface, shape, margin, pleural traction, air bronchus sign, vascular abnormalities inside the nodule were evaluated. The univariate analysis (χ2 test, non-parametric test Mann-Whitney U test) was performed to screen statistically significant variables and then enrolled in further multivariate Logistic regression analysis. RESULTS: Multivariate logistic regression analysis showed that a clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormalities were important indicators of malignant nodules with hazard ratios of 38.1 (95%CI: 5.0-287.7; P<0.01), 7.9 (95%CI: 1.3-49.3; P=0.03), 7.2 (95%CI: 1.4-37.0; P=0.02), respectively. The proportion of solid components was the only significant indicator for identifying invasive adenocarcinoma from AAH/AIS/MIA , with a risk ratio of 1.04 (95%CI: 1.01-1.06, P=0.01). CONCLUSIONS: SSNs with clear tumor-lung interface, air bronchus sign, and pulmonary vascular abnormality inside nodule are more likely to be malignant. A higher percentage of solid components indicates a higher likelihood to be an invasive lesion in malignant SPNs.

[Characteristics of Ventricular Function in Pulmonary Hypertension Patients 
with Different Shape of Interventricular Septum:
Preliminary Study with Cardiac Magnetic Resonance Imaging].

BACKGROUND: To study the characteristics of ventricular function in Pulmonary Hypertension (PH) Patients with different shape of Interventricular Septum (IVS) by cardiac magnetic resonance (CMR). METHODS: 36 PH patients diagnosed by right heart catheterization accepted CMR. According to the morphology of IVS, the patients were divided into two groups: the non-deformation group (10 patients) and the deformation group (26 patients). The ventricular function parameters were as follows: RV and LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), cardiac index (CI), ejection fraction (EF), and myocardial mass index (MMI). RESULTS: ANOVA analysis showed that the differences of RVEDVI, RVESVI, RVSVI, RVCI, RVEF, RVMMI, LVEDVI, LVESVI, LVSVI and LVCI were significant among the three groups. Compared with control group, RVSVI (P=0.017), RVEF (P<0.001), LVEDVI (P=0.048) and LVSVI (P=0.015) decreased in IVS non-deformation group. Compared with IVS non-deformation group, RVEDVI (P<0.001), RVESVI (P<0.001), RVCI (P=0.002) and RVMMI (P=0.017) were increased in IVS deformation group; while RVEF (P=0.001), LVEDVI (P=0.003), LVSVI (P<0.001) and LVCI (P=0.029) were decreased. Compared with the control group, RVEDVI (P<0.001), RVESVI (P<0.001), RVCI (P=0.004) and RVMMI (P=0.003) were increased in the IVS deformation group, while RVEF (P<0.001), LVEDVI (P<0.001), LVESVI (P<0.001), LVSVI (P<0.001), LVCI (P<0.001) were decreased. CONCLUSIONS: Ventricular function is different in PH Patients with different IVS shape. The IVS shape can represent the changes of ventricular function in PH patients.

[Analysis of Growth Curve Type in Pulmonary Nodules with
Different Characteristics].

BACKGROUND: Background and objective Follow up by computed tomography (CT) and growth evaluation are routine methods for the differential diagnosis of indeterminate pulmonary nodules in clinical practice. Pulmonary nodules with diverse biological behaviors may show different growth patterns and velocities. The aim of this study is to identify the volume growth curve of both benign and malignant pulmonary nodules. This work also intends to determine these nodules' growth patterns and provide evidence for the establishment of a follow-up strategy. METHODS: The CT data of 111 pulmonary nodules (54 solid, 57 subsolid) were retrospectively evaluated using 3D volumetric software. All of these nodules have been followed up at least twice. Of these nodules, 35 were confirmed as lung cancers, whereas 5 were confirmed as benign by pathology or histology. Moreover, 71 nodules showed no growth in more than 2 years. Stable nodules were defined as low-risk nodules, as confirmed by reevaluation from experts. On the basis of their densities and diameters, the nodules were classified into four types: benign/low-risk solid nodules, malignant solid nodules (diameter ≤1 cm and >1 cm), benign/low-risk subsolid nodules, and malignant subsolid nodules (diameter ≤1 cm and >1 cm). The follow-up interval time (d) were plotted on the x-axis, and the nodules' volume (mm3) and logarithmic volume were plotted on the y-axis. Two radiologists subjectively determined the type of growth curve. Chi-square test was performed to compare the growth curves of benign/low-risk and malignant nodules. RESULTS: Of 18 solid cancers, 12 cases (66%) were found with steep ascendant growth curves. Those of 3 cases (16.7%) were flat ascendant, 2 cases (11.1%) slowly ascendant, and 1 (5.56%) case flat. Of 17 subsolid cancers, 8 cases (47.1%) manifested steep ascendant growth curves. Those of 4 cases (23.5%) were slowly ascendant, 3 (17.6%) flat, and 2 (11.8%) descendant-ascendant. Of 36 benign/low-risk solid nodules, 5 cases (13.9%) manifested descendant growth curves, 17 cases (47.2%) flat, 8 cases (21.6%) slowly ascendant, and 6 cases (16.7%) undulate. Of 40 benign/low-risk subsolid nodules, 4 cases (10%) manifested descendant growth curves, 21 cases (52.5%) flat, 9 cases (22.5%) slowly ascendant, and 6 cases (15%) undulate. The distribution of growth curve types significantly differed between benign/low-risk and malignant nodules (χ2=42.4, P<0.01). CONCLUSIONS: The growth curves of lung cancers are heterogeneous. A steep ascendant curve is the main type for lung cancer, with the exception of flat, slowly ascendant, or even descendant curve. A slowly ascendant curve cannot exclude the diagnosis of lung cancer, especially for subsolid nodules.
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[Threshold Segmentation of Pulmonary Subsolid Nodules on CT Images:
Detection and Quantification of the Solid Component].

BACKGROUND: The detection and quantification of solid components in pulmonary subsolid nodules (SSN) are of vital importance on differential diagnosis, pathological speculation and prognosis prediction. However, no objective and wide-accepted criterion has been built up to now. The purpose of this study is to explore the optimal threshold that can be used for the detection and quantification of solid components in SSNs by using threshold segmentation method on computed tomography (CT) images. METHODS: CT images of 102 SSNs were retrospectively analyzed. To establish a reference standard, the observers made judgments on whether the solid component existed in every SSN and did manual measurements of the volume of solid component with the help of software. Threshold segmentations of every nodule were then performed using different threshold settings and all of the measured volumes were assumed to be solid volumes, then solid-to-total volume ratios were calculated. The results were compared with the reference standards using the receiver operating characteristic curve and Wilcoxon test. RESULTS: The application of thresholds as -250 HU or -300 HU resulted in high diagnostic value on the detection of solid component, with area under curve values as 0.982 and 0.977, respectively; the cut-off values of solid-to-total volume ratio were 1.10% and 6.14%, respectively; the median volumes of solid components were 202.7 mm3 (598.2 mm3), 247.1 mm3(696.0 mm3), which were not significantly different from the reference standard[199.5 mm3 (743.1 mm3)](P=0.125,1, 0.061,3). CONCLUSIONS: Threshold segmentation on chest CT images is valuable to detect and quantify the solid component on SSNs, the thresholds as -250 HU and -300 HU are recommended.
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[Measurements of Pulmonary Artery Size for Assessment of Pulmonary Hypertension by Cardiovascular Magnetic Resonance and Clinical Application].

BACKGROUND: Pulmonary hypertension (PH) often leads to dilatation of main pulmonary artery (MPA). MPA measurements can be used to predict PH. This aim of this study is to investigate power of MPA vessel indices, which are acquired from cardiovascular magnetic resonance, to evaluate PH. METHODS: Cardiovascular-magnetic-resonance-determined parameters of MPA were acquired and calculated in 83 PH patients, whose diagnosis were confirmed with right heart catheterization and 49 healthy volunteers; these parameters included MPA diameter (DPA), ratio of DPA and ascending aorta diameter (DPA/DAo), max mean diameter (MDmax), min mean diameter (MDmin), fraction transverse diameter (fTD), fraction longitudinal diameter (fLD), and distensibility. RESULTS: Compared with control group, DPA, DPA/DAo, MDmax, and MDmin were significantly higher in patients with PH (P<0.001); fTD, fLD, and distensibility significantly decreased (P<0.001). fTD was lesser than fLD in control group (P<0.001), whereas difference was not observed in PH (P=0.305). MPA indices were significantly correlated with mean pulmonary arterial pressure (mPAP) (P<0.05), and strongest correlation was observed for DPA/DAo (r=0.534, P<0.001). By receiver operating characteristic analysis, MDmin>28.4 mm, and MDmax>32.4 mm (area under the curve, AUC=0.979, 0.981) showed best performance in predicting PH, yielding highest specificity at 100%. CONCLUSIONS: Noninvasive cardiovascular-magnetic-resonance-derived MPA measurements provide excellent and practical reference in clinical settings for detecting PH.

Noninvasive prediction of pulmonary artery pressure and vascular resistance by using cardiac magnetic resonance indices.

BACKGROUND: Cardiac magnetic resonance (CMR) has promise of being able to provide frequent cardiac morphology and function evaluations noninvasively for repeated follow-ups of pulmonary arterial hypertension (PAH) patients after the initial right heart catheterization (RHC) diagnosis. By using the noninvasive CMR indices, the present study aimed to formulate and validate a prediction model of mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR). METHODS: Both Derivation Cohort (N=25) and Validation Cohort (N=25) of PAH patients underwent CMR and RHC within one week. Fast cine and phase-contrast sequences were used to calculate CMR indices, including ventricular mass index (VMI), interventricular septum curvature ratio (CR), and positive pulmonary arterial flow (QP). The gold standard mPAP (mPAPRHC) and PVR (PVRRHC) were measured from RHC. mPAP was calculated using CMR indices (mPAPCMR) from the Derivation Cohort. Multiple linear regression was applied for analysis. RESULTS: The equation predicting mPAP was mPAPCMR=28.837VMI-26.479CR-0.201QP+57.021. The equation was then applied to the Validation Cohort to verify the accuracy of the prediction equation. mPAPCMR was correlated linearly with mPAPRHC as mPAPRHC=0.8055mPAPCMR+7.9056 (r2=0.6470, p<0.001). Moreover, PVR calculated from CMR (PVRCMR) was also correlated with the PVRRHC in both the Derivation Cohort (r2=0.4092, p<0.001) and the Validation Cohort (r2=0.3480, p<0.001). CONCLUSION: The application of the mPAPCMR and PVRCMR technique could potentially provide a noninvasive method to evaluate the hemodynamics for PAH patients during follow-ups as well as right ventricle function assessment.

[Three Dimensional Volumetric Analysis of Solid Pulmonary Nodules on Chest CT: 
Cancer Risk Assessment].

BACKGROUND: The management of pulmonary nodules relies on cancer risk assessment, in which the only widely accepted criterion is diameter. The development of volumetric computed tomography (CT) and three-dimensional (3D) software enhances the clarity in displaying the nodules' characteristics. This study evaluated the values of the nodules' volume and 3D morphological characteristics (edge, shape and location) in cancer risk assessment. METHODS: The CT data of 200 pulmonary nodules were retrospectively evaluated using 3D volumetric software. The malignancy or benignity of all the nodules was confirmed by pathology, histology or follow up (>2 years). Logistic regression analysis was performed to calculate the odds ratios (ORs) of the 3D margin (smooth, lobulated or spiculated/irregular), shape (spherical or non-spherical), location (purely intraparenchymal, juxtavascular or pleural-attached), and nodule volume in cancer risk assessment for total and sub-centimeter nodules. The receiver operating characteristic (ROC) curve was employed to determine the optimal threshold for the nodule volume. RESULTS: Out of 200 pulmonary nodules, 78 were malignant, whereas 122 were benign. The Logistic regression analysis showed that the volume (OR=3.3; P<0.001) and the 3D margin (OR=13.4, 9.8; both P=0.001) were independent predictive factors of malignancy, whereas the location and 3D shape exhibited no total predictive value (P>0.05). ROC analysis showed that the optimal threshold for malignancy was 666 mm³. For sub-centimeter nodules, the 3D margin was the only valuable predictive factor of malignancy (OR=60.5, 75.0; P=0.003, 0.007). CONCLUSIONS: The volume and 3D margin are important factors considered to assess the cancer risk of pulmonary nodules. Volumes larger than 666 mm³ can be determined as high risk for pulmonary nodules; by contrast, nodules with lobulated, spiculated, or irregular margin present a high malignancy probability.

[Evaluation of Pulmonary Hypertension with CMR: Pulmonary Hypertension 
Patients and Healthy Volunteers Control Study].

BACKGROUND: The clinical course of pulmonary hypertension (PH) is one of progressive deterioration interspersed with episodes of acute decompensation. It is difficult to predict when patients will die because death may come either suddenly or slowly due to progressive heart failure. The aim of this study is to investigate morphology, function and hemodynamics in PH, compared with healthy people, and to investigate the clinical value of detection of PH by use of cardiac magnetic resonance (CMR) parameters. METHODS: CMR was performed in 56 PH patients collected from Tianjin Medical University General Hospital from January 2012 to December 2014 and 22 healthy controls. The following parameters were calculated: right ventricle (RV) end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), myocardial mass (MM), RV fractional area change (RVFAC), interventricular septal curvature (CIVS), left ventricular free wall curvature (CFW), and CIVS/CFW, main pulmonary artery (MPA) positive peak velocity, maximal area, minimal area and distensibility. Comparisons of CMR measurements between PH patients and controls were analyzed by using the student t-tests. Receiver operating characteristic (ROC) curve analysis was used to compare the PH diagnostic abilities for four parameters (MPA positive peak velocity, distensibility, curvature ratio, and RVFAC) and combined CMR parameter. P<0.05 was considered significant. RESULTS: Compared with healthy controls, RV morphology, function and hemodynamics of PH group declined and deteriorate obviously. The ROC curve analysis showed that among the four parameters distensibility of MPA had the highest AUC value (AUC=0.95). Additionally, combined CMR parameter (positive peak velocity+distensibility+curvature ratio+RVFAC) had even higher AUC (AUC=0.988). CONCLUSIONS: Comprehensive CMR parameters is conducive to accurately reflect the overall state RV-pulmonary circulation in patients with PH.
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[Clinicoradiologic characteristics of active pulmonary tuberculosis with perilymphatic involvement].

OBJECTIVE: To evaluate the prevalence of perilymphatic involvement and clinicoradiologic characteristics of active pulmonary tuberculosis according to the distribution of micronodules on CT images. METHODS: A total of 124 in-patients with active pulmonary tuberculosis in Haihe Clinical College of Tianjin Medical University from September 2013 to March 2015 were enrolled in this study, all patients underwent CT before antituberculosis therapy.A retrospective investigation of CT images focused on the distribution of micronodules, as well as other major CT features of active pulmonary tuberculosis.Clinical and CT findings of the three groups which based on the distribution of micronodules (perilymphatic, centrilobular and mixed) were compared. RESULTS: All patients existed micronodules.Among these patients, the number of the perilymphatic micronodules, interlobular septal thickening, intralobular septal thickening, bronchial or bronchovascular bundle thickening, galaxy or cluster sign, reversed halo sign was 80(64.5%), 83(66.9%), 56(45.2%), 56(45.2%), 17(13.7%) and 4(3.2%), respectively.There were 35, 36 and 45 cases who were classified into the perilymphatic, centrilobular and mixed groups, respectively.Interlobular septal thickening (88.6% vs 38.9%), intralobular septal thickening (97.1% vs 0), bronchial or bronchovascular bundle thickening (74.3% vs 19.4%) and galaxy or cluster sign (37.1% vs 0) in perilymphatic group were higher than those of centrilobular group, consolidation or macronodule (80% vs 100%) and cavitation (42.9% vs 77.8%) in perilymphatic group were lower than those of centrilobular group. Age (32±16 vs 41±14), the rate of sputum acid-fast bacilli smears staining positive (28.6% vs 58.3%) and sputum culture positive for Mycobacterium tuberculosis (54.3% vs 94.4%) in perilymphatic group were lower than those of centrilobular group. CONCLUSIONS: CT findings representing pulmonary perilymphatic involvement are relatively common in patients with active tuberculosis, galaxy or cluster sign and reversed halo sign are uncommon. The patients with tuberculosis are relatively younger who principally showed pulmonary perilymphatic involvement, and detection of sputum Mycobacterium tuberculosis in these patients is relatively lower.

[Semi-quantitative study of structural abnormalities and changes of oxygenation function using CT in patients with post primary tuberculosis].

OBJECTIVE: To investigate the relationship between structural abnormalities with semi-quantitative score of CT and changes of oxygenation function in patients with post primary tuberculosis. METHODS: 110 in-patients with post primary tuberculosis in Haihe clinical college of Tianjin medical university from January 2014 to August 2014 were enrolled in this study, all patients underwent CT and blood gas analysis. All lesions in lung as a whole and different CT signs of lesions were evaluated by retrospective semi-quantitative score respectively, total scores obtained by adding the scores of different lesions. The correlation between these scores and the results of blood gas analysis were evaluated. CT scores were compared between group 1 (PaO2/FiO2<300 mmHg) and group 2 (PaO2/FiO2≥300 mmHg) of patients. RESULTS: Overall score of lung lesions and total scores which obtained by adding the score of different signs in patients showed correlation with PaO2/FiO2, and the method of overall score of lung lesions was easy to do. Scores of nodules and tree-in-bud pattern, consolidation, bronchial lesions, cavity showed correlation between PaO2/FiO2. There was no correlation between score of ground-glass opacity and PaO2/FiO2. Nodules and tree-in-bud pattern were more common in post primary tuberculosis, 87.3% (96/110) and 70% (77/110) respectively. Lobular consolidation was dominant in consolidation of patients, 83.6% (92/110). Bronchial wall thickening and bronchiectasis had higher incidence in larger airways, 87.3% (96/110) and 75.5% (83/110) respectively. Cavities were given priority to with thin walled, 53.6% (59/110). Overall score of lung lesions and scores of bronchial lesions, consolidation, cavity in groups 1 were significantly higher than group 2. CONCLUSIONS: Semi-quantitative score of CT can better quantify structural abnormalities of the lung, sensitively reflect changes of oxygenation, and bronchial lesions play an important role in the process of post primary tuberculosis.

Giant right coronary artery aneurysm secondary to Kawasaki disease in child: a case report.

Coronary artery aneurysm or ectasia was reported in approximately 15% to 25% of the affected children, particularly in the proximal end of the main blood vessel and the left anterior descending part. Rare patients have been reported with aneurysm in the distal end of the right coronary artery. In this case report, we present a rare case with aneurysm in the distal end of the right coronary artery. Multi-slice computed tomography was performed for the coronary angiography. Aspirin (10 mg/kg body weight per day) and gamma globulin (2 kg/kg body weight) was administrated via intravenous injection. The patient is currently in a healthy status with a 12-month follow up.

[Three-dimensional Mass Measurement of Subsolid Pulmonary Nodules on Chest CT: Intra and Inter-observer Variability].

BACKGROUND: Subsolid pulmonary nodules tend to exhibit considerably slower growth rates than solid lesions, nevertheless, higher malignancy probability. The diagnosis of indeterminate nodules largely depends on the growth evaluation during follow-up. The growth can manifested as an increase in size or the appearance and/or subsequent increase of solid components. The mass reflect the product of volume and density and can be more sensitive in growth evaluation. However, the repeatability needs a further validation. The purpose of this study is to assess the intra and inter-observer variability of mass measurement for subsolid nodules. METHODS: 80 subsolid nodules in 44 patients were retrospectively enrolled. Both the volume and mass were measured by two radiologists using blind method independently. Intra-observer and inter-observer variability were analyzed and compared by Bland-Altman method intra-class correlation test and Wilcoxon test. RESULTS: Software achieved satisfied segmentation for 92.5% nodules. Of them, 35% underwent manual modification. The 95% limits of agreement for intra-observer variability were -11.5%-10.4% for mass and -8.4%-8.8% for volume. The 95% limits of agreement for inter-observer variability were -17.4%-19.3% for mass and -17.9%-19.4% for volume.The intra-class correlation foefficients between volume and mass measument was 0.95 and 0.93 (both P<0.001) and no significant differences (P=0.78, 0.09) was found for intra- and inter-observer variability. Manual modification of the segmentation caused the worse mass measurement repeatability in spite of the reader satisfaction. CONCLUSIONS: The repeatability of mass measurement has no significant difference with that of volume measurement and may act as a reliable method in the follow-up of subsolid nodules.

[Acute response of right ventricular function to iloprost inhalations in patients with pulmonary arterial hypertension: preliminary evaluation 
with cardiac magnetic resonance imaging].

BACKGROUND: Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation. Without treatment, PAH progresses rapidly to right ventricular (RV) failure and even death. Cardiac magnetic resonance imaging (CMRI) has been an accurate and reproducible tool to assessment of RV morphology and function, which are important factors in the prognosis of patients with PAH. The aim of this study is to investigate acute RV response to inhalation of aerosolized iloprost in patients with PAH using CMRI. METHODS: From March 2012 to March 2014, 48 patients with PAH underwent CMRI before and immediately after inhalation of iloprost with a single dose of 20 µg over 15 min-20 min. RV function parameters derived from CMRI images were analyzed before and after iloprost inhalation, including end-diastolic volume (EDV), end-diastolic area (EDA), end-systolic volume (ESV), end-systolic area (ESA), stroke volume (SV), ejection fraction (EF) and cardiac output (CO). Percentage of RV area change was also calculated [%RVAC=(EDA-ESA)/EDA×100%]. Wilcoxon's Sign Rank Test or Paired Samples t-Test was used to compare the differences of RV function parameters before and after inhalation. RESULTS: After iloprost inhalation, all patients showed significant decrease in RV EDV and RV ESV (P=0.007, P<0.001 respectively). Whereas, there were significant increase in RV SV (P=0.014), RV EF (P=0.009) and %RVAC (P=0.006). RV CO had no significant difference before and after inhalation (P=0.851). CONCLUSIONS: Inhalation of iloprost can immediately improve RV function in patients with PAH, and noninvasive evaluation of the acute response with CMRI is feasibility.

Evaluation of apparent diffusion coefficient associated with pathological grade of lung carcinoma, before therapy.

PURPOSE: To investigate the feasibility and utility of apparent diffusion coefficient (ADC) in predicting the tumor cellular density and grades of lung cancers. MATERIALS AND METHODS: Forty-one consecutive patients (26 men and 15 women; mean age, 59.9 years) with histologically proven lung cancers were enrolled in the study and underwent MR examination. ADC values and tumor cellular density of different histological grades were analyzed. The relationship of the ADC with tumor cellular density and grades were also evaluated. RESULTS: The ADC values of lung cancer in grade III was significantly lower than those in grade I and grade II (P = 0.008 and 0.011, respectively). The cellular density in grade III was significantly higher than other two grades (P = 0.029 and 0.022, respectively). ADC value of lung cancer correlated negatively with grades and tumor cellular density (P = 0.001 and P = 0.001, respectively). According to the ROC analysis, the cutoff value of ADC was 1.175 × 10(-3) mm(2) /s with the optimal sensitivity (88.2%) and specificity (62.5%), respectively. CONCLUSION: ADC measurement of lung cancer was a helpful method to evaluate the pathological grade and tumor cellular density. The quantitative analysis of ADC in conjunction with conventional MR findings could provide more valuable information for the assessment of pulmonary tumor. J

[Association between echocardiography derived right ventricular function parameters with cardiac magnetic resonance derived right ventricular ejection fraction and 6-minute walk distance in pulmonary hypertension patients].

OBJECTIVE: To explore the association between transthoracic echocardiography (TTE) derived right ventricular (RV) function parameters with cardiovascular magnetic resonance imaging (CMR) derived RV ejection fraction (RVEF) and 6 minute walk distance (6MWD) in pulmonary hypertension (PH) patients. METHODS: A total of 40 PH patients (37 pulmonary artery hypertension (PAH) and 3 chronic thromboembolic pulmonary hypertension (CTEPH)) hospitalized in our department between March 2011 and March 2013 were enrolled in this study. PH diagnosis was established by right heart catheterization and TTE, CMR and 6MWT were performed within one week post TTE examination. TTE parameters included: tricuspid annular peak systolic excursion (TAPSE), isovolumic contraction acceleration (IVA), peak systolic velocity (S') at the lateral tricuspid annulus derived from tissue Doppler imaging, RV myocardial performance index (MPI) and RV fractional area change (FAC). RVEF was obtained from CMR. RESULTS: S' (r = 0.69, P < 0.001), TAPSE (r = 0.65, P < 0.001), FAC (r = 0.62, P < 0.001), IVA (r = 0.43, P = 0.006), MPI (r = -0.38, P < 0.05) correlated significantly with RVEF obtained from CMR. The best parameter to detect RVEF ≤ 20% was S' < 8.79 cm/s (area under the ROC curve was 0.92 (95% CI: 0.72-0.84), sensitivity 0.91, and specificity 0.80) . No correlation was found between TTE parameters and 6MWD and between RVEF obtained from CMR and 6MWD. CONCLUSION: S', derived from tissue Doppler imaging correlates best with RVEF obtained from CMR and may facilitate simple and quantitative assessment of RV function. The best parameter to detect RVEF ≤ 20% is S' < 8.79 cm/s.

Diagnosis and treatment of SAPHO syndrome: A case report.

The present study reports a rare case of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome in an adult male. The 42-year-old man complained of skin lesions, chest pain and lumbago. Laboratory evaluations demonstrated an elevated erythrocyte sedimentation rate and increased levels of C-reactive protein. Computerized tomography, bone scintigraphy and magnetic resonance imaging revealed multiple bone lesions. A diagnosis of SAPHO syndrome was made. Non-steroidal anti-inflammatory drugs, alendronate sodium and steroids were administered, which resulted in clinical improvement. The current case study demonstrates that skin manifestation and multiple imaging modalities are important in generating a definite diagnosis of SAPHO syndrome, and that early treatment is vital for a positive outcome.

Prediction of early response to chemotherapy in lung cancer by using diffusion-weighted MR imaging.

PURPOSE: To determine whether change of apparent diffusion coefficient (ADC) value could predict early response to chemotherapy in lung cancer. MATERIALS AND METHODS: Twenty-five patients with advanced non-small cell lung cancer underwent chest MR imaging including DWI before and at the end of the first cycle of chemotherapy. The tumor's mean ADC value and diameters on MR images were calculated and compared. The grouping reference was based on serial CT scans according to Response Evaluation Criteria in Solid Tumors. Logistic regression was applied to assess treatment response prediction ability of ADC value and diameters. RESULTS: The change of ADC value in partial response group was higher than that in stable disease group (P = 0.004). ROC curve showed that ADC value could predict treatment response with 100% sensitivity, 64.71% specificity, 57.14% positive predictive value, 100% negative predictive value, and 82.7% accuracy. The area under the curve for combination of ADC value and longest diameter change was higher than any parameter alone (P ≤ 0.01). CONCLUSIONS: The change of ADC value may be a sensitive indicator to predict early response to chemotherapy in lung cancer. Prediction ability could be improved by combining the change of ADC value and longest diameter.