Towards clinical implementation of an AI-algorithm for detection of cervical spine fractures on computed tomography.

BACKGROUND: Artificial intelligence (AI) applications can facilitate detection of cervical spine fractures on CT and reduce time to diagnosis by prioritizing suspected cases. PURPOSE: To assess the effect on time to diagnose cervical spine fractures on CT and diagnostic accuracy of a commercially available AI application. MATERIALS AND METHODS: In this study (June 2020 - March 2022) with historic controls and prospective evaluation, we evaluated regulatory-cleared AI-software to prioritize cervical spine fractures on CT. All patients underwent non-contrast CT of the cervical spine. The time between CT acquisition and the moment the scan was first opened (DNT) was compared between the retrospective and prospective cohorts. The reference standard for determining diagnostic accuracy was the radiology report created in routine clinical workflow and adjusted by a senior radiologist. Discrepant cases were reviewed and clinical relevance of missed fractures was determined. RESULTS: 2973 (mean age, 55.4 ± 19.7 [standard deviation]; 1857 men) patients were analyzed by AI, including 2036 retrospective and 938 prospective cases. Overall prevalence of cervical spine fractures was 7.6 %. The DNT was 18 % (5 min) shorter in the prospective cohort. In scans positive for cervical spine fracture according to the reference standard, DNT was 46 % (16 min) shorter in the prospective cohort. Overall sensitivity of the AI application was 89.8 % (95 % CI: 84.2-94.0 %), specificity was 95.3 % (95 % CI: 94.2-96.2 %), and diagnostic accuracy was 94.8 % (95 % CI: 93.8-95.8 %). Negative predictive value was 99.1 % (95 % CI: 98.5-99.4 %) and positive predictive value was 63.0 % (95 % CI: 58.0-67.8 %). 22 fractures were missed by AI of which 5 required stabilizing therapy. CONCLUSION: A time gain of 16 min to diagnosis for fractured cases was observed after introducing AI. Although AI-assisted workflow prioritization of cervical spine fractures on CT shows high diagnostic accuracy, clinically relevant cases were missed.

Diagnostic Performance of Rectal CT for Staging Rectal Cancer: Comparison with Rectal MRI and Histopathology.

Purpose: To compare the diagnostic performance of rectal CT with that of high-resolution rectal MRI and histopathology in assessing rectal cancer. Materials and Methods: Sixty-seven patients with rectal cancer who underwent rectal CT with rectal distension using sonographic gel and high-resolution MRI were enrolled in this study. The distance from the anal verge/anorectal junction, distance to the mesorectal fascia (MRF), extramural depth (EMD), extramesorectal lymph node (LN) involvement, extramural venous invasion (EMVI), and T/N stages in rectal CT/MRI were analyzed by two gastrointestinal radiologists. The CT findings of 20 patients who underwent radical surgery without concurrent chemoradiotherapy were compared using histopathology. Interclass correlations and kappa statistics were used. Results: The distance from the anal verge/anorectal junction showed an excellent intraclass correlation between CT and MRI for both reviewers. For EMD, the distance to the MRF, presence of LNs, extramesorectal LN metastasis, EMVI, T stage, and intermodality kappa or weighted kappa values between CT and MRI showed excellent agreement. Among the 20 patients who underwent radical surgery, T staging, circumferential resection margin involvement, EMVI, and LN metastasis on rectal CT showed acceptable concordance rates with histopathology. Conclusion: Dedicated rectal CT may be on par with rectal MRI in providing critical information to patients with rectal cancer.

Post-mortem CT radiomics for the prediction of time since death.

OBJECTIVES: Post-mortem interval (PMI) estimation has long been relying on sequential post-mortem changes on the body as a function of extrinsic, intrinsic, and environmental factors. Such factors are difficult to account for in complicated death scenes; thus, PMI estimation can be compromised. Herein, we aimed to evaluate the use of post-mortem CT (PMCT) radiomics for the differentiation between early and late PMI. METHODS: Consecutive whole-body PMCT examinations performed between 2016 and 2021 were retrospectively included (n = 120), excluding corpses without an accurately reported PMI (n = 23). Radiomics data were extracted from liver and pancreas tissue and randomly split into training and validation sets (70:30%). Following data preprocessing, significant features were selected (Boruta selection) and three XGBoost classifiers were built (liver, pancreas, combined) to differentiate between early (< 12 h) and late (> 12 h) PMI. Classifier performance was assessed with receiver operating characteristics (ROC) curves and areas under the curves (AUC), which were compared by bootstrapping. RESULTS: A total of 97 PMCTs were included, representing individuals (23 females and 74 males) with a mean age of 47.1 ± 23.38 years. The combined model achieved the highest AUC reaching 75% (95%CI 58.4-91.6%) (p = 0.03 compared to liver and p = 0.18 compared to pancreas). The liver-based and pancreas-based XGBoost models achieved AUCs of 53.6% (95%CI 34.8-72.3%) and 64.3% (95%CI 46.7-81.9%) respectively (p > 0.05 for the comparison between liver- and pancreas-based models). CONCLUSION: The use of radiomics analysis on PMCT examinations differentiated early from late PMI, unveiling a novel image-based method with important repercussions in forensic casework. CLINICAL RELEVANCE STATEMENT: This paper introduces the employment of radiomics in forensic diagnosis by presenting an effective automated alternative method of estimating post-mortem interval from targeted tissues, thus paving the way for improvement in speed and quality of forensic investigations. KEY POINTS: • A combined liver-pancreas radiomics model differentiated early from late post-mortem intervals (using a 12-h threshold) with an area under the curve of 75% (95%CI 58.4-91.6%). • XGBoost models based on liver-only or pancreas-only radiomics demonstrated inferior performance to the combined model in predicting the post-mortem interval.

[Clinical characteristics and CT findings of Pneumocystis Jirovecii pneumonia in 46 cases with hematological diseases].

Objective: To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. Methods: A retrospective analysis was carried out in 46 patients with proven pneumocystis pneumonia (PJP) in the Hospital of Hematology, Chinese Academy of Medical Sciences between January 2014 and December 2021. All patients had multiple chests CT and related laboratory examinations, imaging typing were conducted based on the initial CT presentation, and the distinct imaging types were analyzed against the clinical data. Results: In the analysis, there were 46 patients with proven pathogenesis, 33 males, and 13 females, with a median age of 37.5 (2-65) years. The diagnosis was validated by bronchoalveolar lavage fluid (BALF) hexamine silver staining in 11 patients and clinically diagnosed in 35 cases. Of the 35 clinically diagnosed patients, 16 were diagnosed by alveolar lavage fluid macrogenomic sequencing (BALF-mNGS) and 19 by peripheral blood macrogenomic sequencing (PB-mNGS) . The initial chest CT presentation was categorized into 4 types, including ground glass (GGO) type in 25 cases (56.5%) , nodular type in 10 cases (21.7%) , fibrosis type in 4 cases (8.7%) , and mixed type in 5 cases (13.0%) . There was no substantial discrepancy in CT types among confirmed patients, BALF-mNGS diagnosed patients and PB-mNGS diagnosed patients (χ(2)=11.039, P=0.087) . The CT manifestations of confirmed patients and PB-mNGS diagnosed patients were primarily GGO type (67.6%, 73.7%) , while that of BALF-mNGS diagnosed patients were nodular type (37.5%) . Of the 46 patients, 63.0% (29/46) had lymphocytopenia in the peripheral blood, 25.6% (10/39) with positive serum G test, and 77.1% (27/35) with elevated serum lactate dehydrogenase (LDH) . There were no great discrepancies in the rates of lymphopenia in peripheral blood, positive G-test, and increased LDH among different CT types (all P>0.05) . Conclusion: The initial chest CT findings of PJP in patients with hematological diseases were relatively prevalent with multiple GGO in both lungs. Nodular and fibrosis types were also the initial imaging findings for PJP.

Difference of anterior and posterior orbital development in patients with congenital microphthalmia: a retrospective cohort study from China.

AIM: To evaluate volume differences between anterior and posterior orbit and demographic characteristics of Chinese patients with congenital microphthalmia. METHODS: A retrospective cohort study, involving 169 unilateral congenital microphthalmia patients aged between 1 and 57 years old was conducted. Three-dimensional images of the orbit were generated from past CT scans, and digital orbital volume comprehensive measurement was done. The measured data included orbital volume (OBV), posterior orbital volume (POV), orbital width (OBW), orbital height (OBH), orbital depth (OBD), and posterior orbital area ratio. RESULTS: Significant differences were observed among OBV, POV, OBW, OBH, and OBD of the affected and unaffected eyes in different age-based groups (all P<0.001). Among them, OBH had the greatest different. The mean microphthalmic to contralateral ratio (MCR) of OBV, POV, OBW, and OBH continuously increased from 1 to 3 years old, whereas the MCR of POV decreased from 3 to 17 years old. The MCR of OBD was not found to be correlated to age. There was no significant difference between OBV, POV, OBW, and OBH in ages from 13 years old to adulthood (all P>0.05). The difference in posterior orbital area ratio between the affected and unaffected groups was not statistically significant (P>0.05). CONCLUSION: OBH is maximally affected, whereas OBD is minimally affected by microphthalmia. Posterior orbital retardation began 2y prior to orbital retardation and occurred at 3 years old in the affected eye, suggesting that intervention therapy should be done before the age of 4.

Detection and size measurements of kidney stones on virtual non-contrast reconstructions derived from dual-layer computed tomography in an ex vivo phantom setup.

OBJECTIVES: To systematically investigate the usability of virtual non-contrast reconstructions (VNC) derived from dual-layer CT (DLCT) for detection and size measurements of kidney stones with regards to different degrees of surrounding iodine-induced attenuation and radiation dose. METHODS: Ninety-two kidney stones of varying size (3-14 mm) and composition were placed in a phantom filled with different contrast media/water mixtures exhibiting specific iodine-induced attenuation (0-1500 HU). DLCT-scans were acquired using CTDIvol of 2 mGy and 10 mGy. Conventional images (CI) and VNC0H-1500HU were reconstructed. Reference stone size was determined using a digital caliper (Man-M). Visibility and stone size were assessed. Statistical analysis was performed using the McNemar test, Wilcoxon test, and the coefficient of determination. RESULTS: All stones were visible on CI0HU and VNC200HU. Starting at VNC400 HU, the detection rate decreased with increasing HU and was significantly lower as compared to CI0HU on VNC≥ 600HU (100.0 vs. 94.0%, p < 0.05). The overall detection rate was higher using 10 mGy as compared to 2 mGy protocol (87.9 vs. 81.8%; p < 0.001). Stone size was significantly overestimated on all VNC compared to Man-M (7.0 ± 3.5 vs. 6.6 ± 2.8 mm, p < 0.001). Again, the 10 mGy protocol tended to show a better correlation with Man-M as compared to 2 mGy protocol (R2 = 0.39-0.68 vs. R2 = 0.31-0.57). CONCLUSIONS: Detection and size measurements of kidney stones surrounded by contrast media on VNC are feasible. The detection rate of kidney stones decreases with increasing iodine-induced attenuation and with decreasing radiation dose as well as stone size, while remaining comparable to CI0HU on VNC ≤ 400 HU. KEY POINTS: • The detection rate of kidney stones on VNC depends on the surrounding iodine-induced attenuation, the used radiation dose, and the stone size. • The detection rate of kidney stones on VNC decreases with greater iodine-induced attenuation and with lower radiation dose, particularly in small stones. • The visibility of kidney stones on VNC ≤ 400 HU remains comparable to true-non-contrast scans even when using a low-dose technique.

Optimal radiological gallbladder lesion characterization by combining visual assessment with CT-based radiomics.

OBJECTIVES: Differentiating benign gallbladder diseases from gallbladder cancer (GBC) remains a radiological challenge because they can appear very similar on imaging. This study aimed at investigating whether CT-based radiomic features of suspicious gallbladder lesions analyzed by machine learning algorithms could adequately discriminate benign gallbladder disease from GBC. In addition, the added value of machine learning models to radiological visual CT-scan interpretation was assessed. METHODS: Patients were retrospectively selected based on confirmed histopathological diagnosis and available contrast-enhanced portal venous phase CT-scan. The radiomic features were extracted from the entire gallbladder, then further analyzed by machine learning classifiers based on Lasso regression, Ridge regression, and XG Boosting. The results of the best-performing classifier were combined with radiological visual CT diagnosis and then compared with radiological visual CT assessment alone. RESULTS: In total, 127 patients were included: 83 patients with benign gallbladder lesions and 44 patients with GBC. Among all machine learning classifiers, XG boosting achieved the best AUC of 0.81 (95% CI 0.72-0.91) and the highest accuracy rate of 73% (95% CI 65-80%). When combining radiological visual interpretation and predictions of the XG boosting classifier, the highest diagnostic performance was achieved with an AUC of 0.98 (95% CI 0.96-1.00), a sensitivity of 91% (95% CI 86-100%), a specificity of 93% (95% CI 90-100%), and an accuracy of 92% (95% CI 90-100%). CONCLUSIONS: Machine learning analysis of CT-based radiomic features shows promising results in discriminating benign from malignant gallbladder disease. Combining CT-based radiomic analysis and radiological visual interpretation provided the most optimal strategy for GBC and benign gallbladder disease differentiation. KEY POINTS: Radiomic-based machine learning algorithms are able to differentiate benign gallbladder disease from gallbladder cancer. Combining machine learning algorithms with a radiological visual interpretation of gallbladder lesions at CT increases the specificity, compared to visual interpretation alone, from 73 to 93% and the accuracy from 85 to 92%. Combined use of machine learning algorithms and radiological visual assessment seems the most optimal strategy for GBC and benign gallbladder disease differentiation.

Evaluación multimodal del hematoma subdural crónico

Introducción: El hematoma subdural crónico es la complicación tardía más frecuente del trauma craneoencefálico. Su diagnóstico precoz y el tratamiento oportuno permiten la evolución favorable y curación de los pacientes. Objetivo: Sistematizar los diferentes ejes de clasificación del hematoma subdural crónico, que permitan la evaluación multimodal con una orientación más precisa de la técnica quirúrgica. Métodos: Se realizó una revisión bibliográfica en las principales bases de datos disponibles, centrada en las diferentes clasificaciones clínicas y radiológicas del hematoma subdural crónico y se seleccionaron 26 artículos. Se escogieron las principales clasificaciones y escalas y se aplicaron en 22 pacientes, obteniéndose resultados preliminares. Resultados: Las escalas de evaluación clínica de Bender, Marckwalder y la clasificación de Gordon Firing son las más conocidas, sin embargo, existen clasificaciones tomográficas que tienen en cuenta la densidad, la homogeneidad del hematoma que son de gran importancia en la selección de la técnica quirúrgica. La presencia de membranas y tabiques aparecen solo incluidas dentro de la valoración de la densidad del hematoma. Existen otras con valor predictivo que identifican aquellos factores relacionados con las recurrencias, desde antes de la cirugía, las mismas se consideran un factor de mal pronóstico para la evolución final de los pacientes con este tipo de hematomas. Conclusiones: La evaluación preoperatoria exige de la aplicación de múltiples escalas, la identificación y caracterización de las membranas es importante para personalizar la técnica quirúrgica, en busca de disminuir la morbilidad y mortalidad posoperatoria.

Introduction: Chronic subdural hematoma is the most frequent late complication of cranioencephalic trauma. The early diagnosis and correct treatment allow the recovery of patients. Objective: To systematize the different criteria of classification of chronic subdural hematoma that leads the multimodal evaluation for more effective selection of surgical technique. Methods: A review of literature about chronic subdural hematoma was done in the main database focused on different clinical and radiological classifications and 26 articles were selected. The main classifications and scales were chosen and applied to 22 patients, obtaining preliminary results. Results : Benders, Marckwalder and Gordon Firing scales are the most common, nevertheless there are tomographic classifications that include density, homogeneity of hematoma that are of great importance in the selection of the surgical technique. The presence of membranes and septum are only included in the evaluation of hematoma density. There are some others with predictive value that identify those factors related to recurrences before surgery that are considered a bad prognosis to the final evolution of these patients with this type of hematoma. Conclusions: The previous evaluation to surgery requires the use of different scales, the identification and characterization of membranes are important to select the optimum surgical technique to decrease morbidity and mortality after surgery.

A new classification of atlas fracture based on CT reconstruction and its clinical significance / 中华骨科杂志

Objective:To investigate the clinical significance of a new classification system for atlas fractures based on pre- and post-treatment CT features, with a focus on diagnosis and treatment.Methods:A retrospective analysis was conducted on 75 cases of cervical vertebra fractures treated at the Sixth Hospital of Ningbo City between January 2015 and December 2020. The study included 44 males and 31 females, with an average age of 53.3±13.0 years (range: 27-81 years). The fractures were classified according to the Landells classification, resulting in 12 cases of type I, 13 cases of type II, 33 cases of type III, 9 cases that were difficult to classify due to fracture lines located at anatomical junctions, and 8 cases that could not be classified using the Landells classification due to diverse injury mechanisms. To establish a new preliminary classification for cervical vertebra fractures, the researchers considered whether the fracture line in the CT images involved the facet joint surface of the atlas, the impact on bilateral half-rings, and the displacement distance of the fracture ends. Five spinal surgeons were randomly selected to classify the CT images of the 75 patients using the new classification method. After one month, the imaging data of the 75 cases of cervical vertebra fractures were randomized and reclassified to assess the reliability and repeatability of the classification.Results:The new cervical vertebra fracture classification method comprised three types based on whether the fracture line involved the facet joint surface of the atlas: type A (no involvement of the facet joint surface of the atlas), type B (involvement of one side of the facet joint surface with intact contralateral half-ring), and type C (involvement of one side of the facet joint surface with fractured contralateral half-ring). Additionally, based on the maximum displacement distance between the fracture ends (>4 mm), six subtypes were identified: subtype 1 (≤4 mm displacement) and subtype 2 (>4 mm displacement). Consequently, the subtypes were classified as A1, A2, B1, B2, C1, and C2. According to the new classification method, the 75 patients included 17 cases of A1, 12 cases of A2, 7 cases of B1, 13 cases of B2, 12 cases of C1, and 14 cases of C2. The classification demonstrated excellent consistency, as assessed by the five doctors, with Kappa values of 0.85 and 0.91 for reliability and repeatability, respectively. At the final follow-up, all conservatively treated patients achieved bone healing, while four surgically treated patients experienced non-union of the fracture ends but exhibited good fusion between the atlas and axis. The remaining surgically treated patients achieved bony union without complications such as loosening or fracture of internal fixation.Conclusion:The new cervical vertebra fracture classification method, based on CT imaging features, comprehensively covers common clinical cases of cervical vertebra fractures and demonstrates excellent consistency. It provides valuable clinical guidance for the diagnosis and treatment of cervical vertebra fractures.

Diagnostic value of thin-layer three-dimensional reconstruction technology combined with personalized scanning for benign and malignant solid solitary pulmonary nodules / 中国基层医药

Objective:To investigate the diagnostic value of thin-layer three-dimensional reconstruction technology combined with personalized scanning for benign and malignant solid solitary pulmonary nodules.Methods:The clinical data of 140 patients with solid solitary pulmonary nodules admitted to Jiangshan People's Hospital form January 2020 to July 2021 were retrospectively analyzed. These patients consisted of 40 patients with benign solid solitary pulmonary nodules (benign group) and 100 patients with malignant solid solitary pulmonary nodules (malignant group). All patients underwent thin-layer three-dimensional reconstruction combined with personalized scanning. The pulmonary nodule signs achieved by thin-layer three-dimensional reconstruction combined with personalized scanning and the diagnostic performance of the combined technology were compared between benign and malignant groups.Results:The proportions of patients with lung cavity sign, lobular sign, vascular convergence sign, vacuole sign, emphysema distribution sign, split pleura sign, and distal perforating vascular sign in the malignant group were 11.0%, 81.0%, 77.0%, 49.0%, 6.0%, 10.0% and 31.0%, respectively, and they were 42.5%, 62.5%, 55.0%, 27.5%, 20.0%, 32.5%, and 5.0%, respectively in the benign group ( χ2 = 15.80, 5.00, 5.66, 4.55, 4.76, 8.96, 9.33, all P < 0.05). The most sensitive sign was lobular sign, which had the highest efficiency, up to 82.0%, in differentiating benign and malignant pulmonary nodules. Conclusion:Lung cavity sign, lobular sign, vascular convergence sign, vacuole sign, emphysema distribution sign, split pleura sign, and distal perforating vascular sign differ greatly between patients with benign and malignant solid solitary pulmonary nodules. Lobular sign has the highest sensitivity in differentiating benign and malignant solid solitary pulmonary nodules. Thin-layer three-dimensional reconstruction combined with personalized scanning has a diagnostic value for benign and malignant solid solitary pulmonary nodules.

Multi-slice spiral CT manifestations of perivascular epithelioid cell tumors / 中国基层医药

Objective:To investigate CT manifestations of perivascular epithelioid cell tumors.Methods:The multi-slice spiral CT manifestations in 11 patients with perivascular epithelioid cell tumors which were pathologically confirmed in the First Affiliated Hospital of Shantou University Medical College between October 2012 and August 2021 were retrospectively analyzed.Results:Perivascular epithelioid cell tumors were located in the kidney of eight patients, in the right lobe of the liver of two patients, and in the descending colon of one patient. The largest tumor, approximately 20.0 cm × 26.0 cm × 11.0 cm, was located in the kidney. The smallest tumor, 2.4 cm × 2.6 cm × 3.4 cm, was located in the colon. CT plain scans showed uniform density without bleeding, calcification, or fat in two patients, and non-uniform density with fatty change in two patients. Contrast-enhanced CT images showed non-uniform enhancement in the arterial phase in 10 patients and uniform enhancement in one patient. Contrast-enhanced CT images showed decreased degrees of enhancement of the lesions in 11 patients from the portal venous phase to the delayed phase and dilated and tortuous vascular shadows in 11 patients.Conclusion:The multi-slice spiral CT manifestations of perivascular epithelioid cell tumors are characteristic and the multi-slice spiral CT is of value for the diagnosis of perivascular epithelioid cell tumors.

Correlation analysis between muscle CT measurement parameters, energy expenditure and risk of acute exacerbation in patients with stable chronic obstructive pulmonary disease / 中国医师进修杂志

Objective:To explore the correlation between muscle CT measurement parameters, energy expenditure and acute exacerbation in patients with stable chronic obstructive pulmonary disease (COPD).Methods:The clinical data of 146 patients with stable COPD from March 2020 to November 2021 in Lu′an Hospital Affiliated to Anhui Medical University (Lu′an People′s Hospital) were retrospectively analyzed. The clinical data were recorded; the lung function was measured by bronchodilator test. The cross-sectional area and CT value of the pectoral muscle were measured by reconstructed CT images of the mediastinum; the total energy consumption was calculated by Weir formula. Acute exacerbations within 3 and 12 months were recorded. Multivariate Logistic regression was used to analyze the independent risk factors for acute exacerbation in patients with stable COPD. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of total energy expenditure, pectoral muscle cross-sectional area and pectoral muscle CT value for predicting acute exacerbation in patients with stable COPD.Results:Among 146 patients with stable COPD, 38 cases (26.03%) developed acute exacerbation within 3 months (acute exacerbation group), and 108 cases (73.97%) did not develop acute exacerbation (non-acute exacerbation group). The proportion of age<60 years old, rate of acute exacerbation within 12 months and rate of pulmonary function grading Ⅲ to Ⅳ in acute exacerbation group were significantly higher than those in non-acute exacerbation group: 71.05% (27/38) vs. 47.22% (51/108), 52.63% (20/38) vs. 30.56% (33/108) and 63.16% (24/38) vs. 37.96% (41/108), the total energy consumption, pectoral muscle cross-sectional area and pectoral muscle CT value were significantly lower than those in non-acute exacerbation group: (2 036.28 ± 163.13) J/d vs. (2 389.59 ± 204.71) J/d, (28.79 ± 3.45) cm 2 vs. (31.61 ± 4.56) cm 2 and (29.79 ± 3.06) HU vs. (34.52 ± 4.38) HU, and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that age ≥60 years old, lower total energy expenditure, smaller pectoral muscle cross-sectional area and lower pectoral muscle CT value were independent risk factors for acute exacerbation in patients with stable COPD ( OR = 26.493, 1.015, 1.245 and 1.437; 95% CI 3.745 to 187.405, 1.008 to 1.022, 1.002 to 1.546 and 1.109 to 1.861; P<0.01 or <0.05). The ROC curve analysis result showed that combined prediction of the total energy consumption, pectoral muscle cross-sectional area and pectoral muscle CT value for acute exacerbation in patients with stable COPD had the largest area under the curve (0.962), with a sensitivity of 86.1%, a specificity of 80.8%, and the optimal cutoff values of 2 206.12 J/d, 32.39 cm 2 and 31.63 HU, respectively. Conclusions:The elderly age, smaller pectoral muscle cross-sectional area, lower pectoral muscle CT value and lower total energy expenditure are independent risk factors for acute exacerbation in patients with stable COPD. The combination of pectoral muscle cross-sectional area, pectoral muscle CT value and total energy expenditure has a good predictive effect on the risk of acute exacerbation in patients with stable COPD, and relevant indexes can be paid attention to in clinical treatment.

Clinical characteristics and CT findings of Pneumocystis Jirovecii pneumonia in 46 cases with hematological diseases / 中华血液学杂志

Objective: To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. Methods: A retrospective analysis was carried out in 46 patients with proven pneumocystis pneumonia (PJP) in the Hospital of Hematology, Chinese Academy of Medical Sciences between January 2014 and December 2021. All patients had multiple chests CT and related laboratory examinations, imaging typing were conducted based on the initial CT presentation, and the distinct imaging types were analyzed against the clinical data. Results: In the analysis, there were 46 patients with proven pathogenesis, 33 males, and 13 females, with a median age of 37.5 (2-65) years. The diagnosis was validated by bronchoalveolar lavage fluid (BALF) hexamine silver staining in 11 patients and clinically diagnosed in 35 cases. Of the 35 clinically diagnosed patients, 16 were diagnosed by alveolar lavage fluid macrogenomic sequencing (BALF-mNGS) and 19 by peripheral blood macrogenomic sequencing (PB-mNGS) . The initial chest CT presentation was categorized into 4 types, including ground glass (GGO) type in 25 cases (56.5%) , nodular type in 10 cases (21.7%) , fibrosis type in 4 cases (8.7%) , and mixed type in 5 cases (13.0%) . There was no substantial discrepancy in CT types among confirmed patients, BALF-mNGS diagnosed patients and PB-mNGS diagnosed patients (χ(2)=11.039, P=0.087) . The CT manifestations of confirmed patients and PB-mNGS diagnosed patients were primarily GGO type (67.6%, 73.7%) , while that of BALF-mNGS diagnosed patients were nodular type (37.5%) . Of the 46 patients, 63.0% (29/46) had lymphocytopenia in the peripheral blood, 25.6% (10/39) with positive serum G test, and 77.1% (27/35) with elevated serum lactate dehydrogenase (LDH) . There were no great discrepancies in the rates of lymphopenia in peripheral blood, positive G-test, and increased LDH among different CT types (all P>0.05) . Conclusion: The initial chest CT findings of PJP in patients with hematological diseases were relatively prevalent with multiple GGO in both lungs. Nodular and fibrosis types were also the initial imaging findings for PJP.

[Comparison of multislice spiral CT and MRI in diagnosis of occult fracture of knee joint with meniscus and ligament injury].

OBJECTIVE: To investigate the diagnostic value of multislice spiral CT (MSCT) and MRI in occult fracture of knee joint with meniscus and ligament injury. METHODS: From January 2020 to March 2021, 63 patients with knee occult fracture with meniscus and ligament injury, including 41 males and 22 females, aged from 21 to 67 years old, with an average of (44.35±8.77) years old, the course of disease ranged from 1 to 6 days, with an average of (4.64±1.75) days, the body mass index (BMI) was (19.85±2.78) kg/m2. MSCT and MRI data of 63 patients were collected and statistically analyzed to evaluage their diagnist value. RESULTS: The detection of MRI for occult knee fravtures with meniscus and ligament injury, joint cavity effusion, bone marrow edema, and articular surface injury were 100.00% (63/63), 95.24% (60/63), 42.86% (27/63) and 36.51% (23/63), respectively. The detection rates of MSCT were 49.21% (31/63), 41.27% (26/63), 0.00% (0/63) and 1.59% (1/63), respectively, significantly lwver than that of MRI (P<0.05). The diagnostic sensitivity, specificity and accuracy of MRI were significantly higher than those of MSCT(P<0.05). CONCLUSION: The sensitivity, specificity and accuracy of magnetic resonance imaging in the diagnosis of occult fracture of knee joint with meniscus and ligament injury are significantly better than that of MSCT. MRI has higher accuracy in the diagnosis of peripheral tissue diseases such as joint cavity, articular surface and bone marrow, and can reduce the risk of clinical misdiagnosis.

Are preoperative CT variables associated with the success or failure of subsequent ventral hernia repair: nested case-control study.

OBJECTIVES: Systematic review of CT measurements to predict the success or failure of subsequent ventral hernia repair has found limited data available in the indexed literature. To rectify this, we investigated multiple preoperative CT metrics to identify if any were associated with postoperative reherniation. METHODS: Following ethical permission, we identified patients who had undergone ventral hernia repair and had preoperative CT scanning available. Two radiologists made multiple measurements of the hernia and abdominal musculature from these scans, including loss of domain. Patients were divided subsequently into two groups, defined by hernia recurrence at 1-year subsequent to surgery. Hypothesis testing investigated any differences between CT measurements from each group. RESULTS: One hundred eighty-eight patients (95 male) were identified, 34 (18%) whose hernia had recurred by 1-year. Only three of 34 CT measurements were significantly different when patients whose hernia had recurred were compared to those who had not; these significant findings were assumed contingent on multiple testing. In particular, preoperative hernia volume (recurrence 155.3 cc [IQR 355.65] vs. no recurrence 78.2 [IQR 303.52], p = 0.26) nor loss of domain, whether calculated using the Tanaka (recurrence 0.02 [0.04] vs. no recurrence 0.009 [0.04], p = 0.33) or Sabbagh (recurrence 0.019 [0.05] vs. no recurrence 0.009 [0.04], p = 0.25) methods, differed between significantly between groups. CONCLUSIONS: Preoperative CT measurements of ventral hernia morphology, including loss of domain, appear unrelated to postoperative recurrence. It is likely that the importance of such measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique. KEY POINTS: • Preoperative CT scanning is often performed for ventral hernia but systematic review revealed little data regarding whether CT variables predict postoperative reherniation. • We found that the large majority of CT measurements, including loss of domain, did not differ significantly between patients whose hernia did and did not recur. • It is likely that the importance of CT measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique.

Combination of CT/MRI LI-RADS with CEUS can improve the diagnostic performance for HCCs.

BACKGROUND & AIMS: To compare the classifications for focal liver lesions smaller than 3 cm by the CEUS and CT/MRI LI-RADS and explore the discrepancy between the two classifications strategies. METHODS: Focal liver lesions with a size smaller than 3 cm undergoing CEUS and CT/MRI (MR required on a 3.0 T magnet) within 1 month were enrolled. Each nodule was categorized according to the CEUS LI-RADS v2017 (usLI-RADS) and CT/MRI LI-RADS v2018. Intermodality agreement between the usLI-RADS and LI-RADS for CT/MRI was assessed. The reasons for inconsistent classifications by the CEUS and CT/MRI LI-RADS were clarified. RESULTS: A total of 213 lesions were included. The positive predictive value (PPV) for HCCs of LR-3, 4 and 5 were 57.1% (95% CI: 32.6-78.6), 75.0% (95% CI: 62.3-84.5) and 94.2% (95% CI: 88.9-97.0) for CT/MRI and 37.5% (95% CI: 18.5-61.4), 56.0% (95% CI: 37.1-73.3) and 97.9% (95% CI: 94.1-99.3) for CEUS, respectively. CECT/MRI and CEUS LI-RADS had a poor agreement in classification with a kappa value of 0.254 (P < 0.001). 84 lesions (39.4%) were classified inconsistently in CT/MRI and CEUS LI-RADS. 40 lesions classified as LR-3 or LR-4 by CT/MRI were upgraded by CEUS. 21 lesions classified as LR-4 or LR-5 by CT/MRI were downgraded by CEUS. We reclassified the lesion in CT/MRI LR-3 and LR-4 by CEUS. The PPVs for HCCs in reclassified LR-3, LR-4 and LR-5 were 27.3% (95% CI: 9.7-56.6), 41.7% (95% CI: 26.2-69.0) and 94.2% (95% CI: 89.3-97.0), respectively, which decreased the incidences of HCCs in CT/MRI LR-3 and LR-4. CONCLUSION: Lesions in CT/MRI LR-3 and 4 have a higher probability of being HCCs than those in usLR-3 and 4, respectively. Reclassification of lesions in CT/MRI LR-3 and 4 using CEUS can help the corresponding HCCs get a definite diagnosis.

COVID-19 CT Scan Lung Segmentation: How We Do It.

The National Health Systems have been severely stressed out by the COVID-19 pandemic because 14% of patients require hospitalization and oxygen support, and 5% require admission to an Intensive Care Unit (ICU). Relationship between COVID-19 prognosis and the extent of alterations on chest CT obtained by both visual and software-based quantification that expresses objective evaluations of the percentage of ventilated lung parenchyma compared to the affected one has been proven. While commercial applications for automatic medical image computing and visualization are expensive and limited in their spread, the open-source systems are characterized by not enough standardization and time-consuming troubles. We analyzed chest CT exams on 246 patients suspected of COVID-19 performed in the Emergency Department CT room. The lung parenchyma segmentation was obtained by a threshold-based method using the open-source 3D Slicer software and software tools called "Segment Editor" and "Segment Quantification." For the three main characteristics analyzed on lungs affected by COVID-19 pneumonia, a specifical densitometry value range was defined: from - 950 to - 700 HU for well-aerated parenchyma; from - 700 to - 250 HU for interstitial lung disease; from - 250 to 250 HU for parenchymal consolidation. For the well-aerated parenchyma and the interstitial alterations, the procedure was semi-automatic with low time consumption, whereas consolidations' analysis needed manual interventions by the operator. After the chest CT, 13% of the sample was admitted to intensive care, while 34% of them to the sub-intensive care. In patients moved to intensive care, the parenchyma analysis reported a higher crazy paving presentation. The quantitative analysis of the alterations affecting the lung parenchyma of patients with COVID-19 pneumonia can be performed by threshold method segmentation on 3D Slicer. The segmentation could have an important role in the quantification in different COVID-19 pneumonia presentations, allowing to help the clinician in the correct management of patients.

Caracterización tomográfica de las membranas en pacientes con hematoma subdural crónico

Introducción: El hematoma subdural crónico es un hematoma encapsulado por dos membranas interna y externa. Existen diferentes clasificaciones imagenológicas que incluyen las características de estas lesiones, pero la presencia de las membranas y sus características es un aspecto poco descrito. Objetivo: Describir las características tomográficas de las membranas de los hematomas subdurales crónicos. Métodos: Se realizó un estudio descriptivo en el Servicio de Neurocirugía en conjunto con el Servicio de Imagenología, del Hospital Universitario Manuel Ascunce Domenech durante el año 2021. Se incluyeron 20 pacientes adultos que fueron operados con el diagnóstico de hematoma subdural crónico. Las membranas se caracterizaron de acuerdo con su densidad, grosor, número de capas, morfología y extensión. Resultados: Predominaron los pacientes de más de 65 años del sexo masculino, con hematomas unilaterales más frecuentes del lado izquierdo. El volumen promedio fue de 150 ml y el diámetro fue de 3 cm. Fueron más frecuentes las membranas finas, hiperdensas, incompletas, de una sola capa y la morfología fue variable. Conclusiones: Las membranas que conforman el hematoma subdural crónico pueden observarse en la tomografía axial computarizada. Se han encontrado diferentes tipos de membranas de acuerdo con su densidad, grosor, morfología, extensión y presencia de tabiques. La presencia de una membrana gruesa o fina con tabiques, puede tener indicación de una craneotomía que permita la resección cuidadosa de la membrana parietal y la apertura suficiente de la visceral para facilitar la re expansión cerebral y disminuir la incidencia de recolecciones.

Introduction: Chronic subdural hematoma is a hematoma encapsulated by two internal and external membranes. There are different imaging classifications that include the characteristics of these lesions, but the presence of the membranes and their characteristics is a little described aspect. Objective: To describe the tomographic characteristics of the membranes of chronic subdural hematomas. Methods: A descriptive study was carried out in the Neurosurgery service in conjunction with the Imaging service of the Manuel Ascunce Domenech University Hospital during the year 2021. 20 adult patients who underwent surgery with the diagnosis of chronic subdural hematoma were included. The membranes were characterized according to their density, thickness, number of layers, morphology and extension. Results: Male patients over 65 years of age predominated, with more frequent unilateral hematomas on the left side. The average volume was 150 ml and the diameter was 3 cm. Thin, hyperdense, incomplete, single-layer membranes were more frequent, and the morphology was variable. Conclusions: The membranes that make up the chronic subdural hematoma can be seen on computerized axial tomography. Different types of membranes have been found according to their density, thickness, morphology, extension and presence of septa. The presence of a thick or thin membrane with septa may indicate a craniotomy that allows careful resection of the parietal membrane and sufficient opening of the visceral membrane to facilitate brain re-expansion and reduce the incidence of recollections.