Objective To explore the efficacy of a novel detection technique of circulating tumor cells (CTCs) to identify benign and malignant lung nodules. Methods Nanomagnetic CTC detection based on polypeptide with epithelial cell adhesion molecule (EpCAM)-specific recognition was performed on enrolled patients with pulmonary nodules. There were 73 patients including 48 patients with malignant lesions as a malignant group and 25 patients with benign lesion as a benign group. There were 13 males and 35 females at age of 57.0±11.9 years in the malignant group and 11 males and 14 females at age of 53.1±13.2 years in the benign group. e calculated the differential diagnostic efficacy of CTC count, and conducted subgroup analysis according to the consolidation-tumor ratio, while compared with PET/CT on the efficacy. Results CTC count of the malignant group was significantly higher than that of the benign group (0.50/ml vs. 0.00/ml, P<0.05). Subgroup analysis according to consolidation tumor ratio (CTR) revealed that the difference was statistically significant in pure ground glass (pGGO) nodules 1.00/mlvs. 0.00/ml, P<0.05), but not in part-solid or pure solid nodules. For pGGO nodules, the area under the receiver operating characteristic (ROC) curve of CTC count was 0.833, which was significantly higher than that of maximum of standardized uptake value (SUVmax) (P<0.001). Its sensitivity and specificity was 80.0% and 83.3%, respectively. Conclusion The peptide-based nanomagnetic CTC detection system can differentiate malignant tumor and benign lesions in pulmonary nodules presented as pGGO. It is of great clinical potential as a noninvasive, nonradiating method to identify malignancies in pulmonary nodules.
Objective To improve accuracy of clinical diagnosis through analyzing the CT characteristics and clinical manifestations of patients with benign lung diseases whose CT manifestations initially led to a suspicion of lung cancer. Methods This study collected 2 239 patients of benign lung disease verified by postoperative pathology in the Department of Thoracic Surgery, Beijing Chao-yang Hospital from June 2006 to December 2016. Lesions of 173 patients (101 males and 72 females with a mean age of 56.0 years) were considered very likely to be malignant on preoperative contrast CT scan, which were sorted to 20 types of lung diseases, and the 20 types of diseases contained 907 patients diagnosed or misdiagnosed. Statistical analyses were performed using the CT and clinical characteristics of the 173 patients. Results Among the 907 patients with benign lung disease, the benign pathologies that were most commonly misdiagnosed by preoperative enhanced CT were pulmonary leiomyoma (100.0%), pulmonary actinomycosis (75.0%), pulmonary cryptococcosis (71.4%), sclerosing hemangioma (50.0%) and organizing pneumonia (44.2%). Among the 173 patients with benign diseases, the most common diseases were tuberculosis (29.5%), organizing pneumonia (28.9%), pulmonary hamartoma (6.4%) and pulmonary abscess (6.4%). In the 173 patients, 17.3% had fever, 56.6% coughing, 8.7% yellow sputum, 28.9% hemoptysis, 16.2% chest pain, 18.5% elevated leukocyte counts and 4.6% elevated carcinoembryonic antigen levels. Most of the CT manifestations consisted of nodular or mass shadows, 70.5% of which had foci≤3 cm and manifestations were similar to those of lung cancer, such as a spiculated margin (49.1%), lobulation (33.5%), pleural indentation (27.2%) and significant enhancement (39.3%). Furthermore, some patients had uncommon tumor signs, such as calcification (12.7%), central liquefactive necrosis (18.5%), satellite foci (9.8%) and multiple pulmonary nodules (42.2%). Moreover, 24.3% of the patients had enlarged lymph nodes of the mediastinum or hilum. Conclusion As the CT manifestations of some benign lung conditions are similar to those of lung cancer, careful differential diagnosis is necessary to identify the basic characteristics of the disease when the imaging results are ambiguous, and the diagnosis of a lung disease need incorporate the patients' clinical characteristics and a comprehensive analysis.
Objective To compare the clinicopathological features of hilar cholangiocarcinoma (HCCA) and hilar benign diseases, and then explore the value of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) in the differential diagnosis between them. Methods Clinical data of 65 patients (54 patients with HCCA and 11 patients with hilar benign diseases) who were diagnosed as HCCA and received treatment from January 2011 to October 2015 in our hospital were retrospectively analyzed. Comparison of clinical data of HCCA patients and patients with hilar benign diseases in age, gender, disease duration, clinical manifestation, laboratory examination, and imaging examination was performed, and the receiver operating characteristic curve (ROC) was used to explore the value of CA19-9 and CEA in differential diagnosis between hilar benign diseases and HCCA. Results The age, levels of serum CA19-9, CEA, alanine aminotransferase (ALT), total bilirubin (BILT), and direct bilirubin (BILD) of HCCA group were significantly higher than that in benign group (P<0.05). However, the gender, disease duration, clinical manifestations (including jaundice, abdominal discomfort, fever, and weight loss), serum aspartate aminotransferase (AST), serum alkaline phosphatase (ALKP), and imaging findings (including hilar mass, intrahepatic bile duct dilatation, thickening of the bile duct wall, lymph node enlargement, vascular invasion, and gallbladder invasion) had no significant difference between the 2 groups (P>0.05). The ROC curve results showed that, when cut-off point for CA19-9 was 233.15 U/mL, the sensitivity was 56% and specificity was 91%; when cut-off point for CEA was 2.98 ng/mL, the sensitivity was 61% and specificity was 90%. Conclusions For the differential diagnosis between HCCA and hilar benign diseases, the elderly patients with high levels of serum transaminase and bilirubin were more likely to be malignant. It is more likely to be malignant when the serum CA19-9>233.15 U/mL or CEA>2.98 ng/mL.
Hepatic angiomyolipoma (HAML) is a rare benign mesenchymal tumor of the liver, which has highly variable imaging appearances, often leads to missed diagnosis and misdiagnosis. The images of 2 patients with HAML confirmed by pathology were presented in this study, and the typical imaging features of the HAML, the underlying pathophysiological mechanism, and the differential diagnosis were briefly summarized so as to deepen the understanding of HAML and to improve the diagnosis and differential diagnosis abilities of HAML, then reduce the rates of missed diagnosis and misdiagnosis of the HAML.
Objective To develop and validate a composite model (PAH score) based on dual-center data, integrating logistic regression and machine learning approaches, to improve the preoperative differential diagnostic efficacy for appendiceal mucinous neoplasms (AMNs). MethodsA dual-center retrospective case-control design was adopted. The study included 108 AMNs patients and 230 healthy controls from The 900th Hospital of Joint Logistics Support Force (January 2014 to November 2024) and Sanming First Hospital Affiliated to Fujian Medical University (December 2018 to December 2023) for feature screening and model construction. Additionally, 258 patients with pathologically confirmed chronic appendicitis (CA) from the same period were included as the differential validation group. Predictors were screened using leastabsolute shrinkage and selection operator combined with traditional logistic regression, and four machine learning algorithms—random forest, support vector machine, gradient boosting, and decision tree—were applied to rank feature importance. Core variables consistently identified by both approaches were integrated to construct a logistic regression model. Based on the model results, the PAH score was formulated, and its performance in distinguishing AMNs from CA was validated. An online visualization platform for AMNs risk prediction was subsequently developed. ResultsBaseline characteristics were balanced between the AMNs group and healthy control group, as well as between the AMNs group and CA group (P>0.05). Multivariate logistic regression identified prognostic nutritional index (PNI, OR=0.81), albumin-to-globulin ratio (AGR, OR=0.37), and hemoglobin to red blood cell distribution width ratio (HRR, OR=0.36) as independent predictors of AMNs (all P<0.001). All four machine learning algorithms consistently ranked PNI, AGR, and HRR as the top three important features. Based on these findings, a PAH model was constructed, and the PAH score was calculated using the standardized regression coefficient weighting method as follows: PAH score=20.8–0.21×PNI–0.99×AGR–1.01×HRR. The model demonstrated excellent discriminative ability for AMNs, with an area under the curve (AUC) of 0.918. The Hosmer-Lemeshow test indicated good calibration between predicted and observed probabilities (P=0.925). Decision curve analysis (DCA) showed significant net clinical benefit within the risk threshold range of 0.05–0.95. Bootstrap internal validation confirmed robust model performance (AUC=0.911). The median PAH score was significantly higher in the AMNs group than that of the CA group (MD=1.78, P<0.001). For distinguishing AMNs from CA, the PAH score achieved an AUC of 0.758. At the optimal cutoff value (–1.00), sensitivity was 70%, specificity was 76%, and accuracy rate was 74%. The Hosmer-Lemeshow test again confirmed good calibration (P=0.106), and Bootstrap validation indicated stable performance (AUC=0.783). DCA further demonstrated considerable net benefit within the threshold range of 0.20–0.95. ConclusionsThe PAH score developed in this study effectively predicts the risk of AMNs and accurately differentiates AMNs from CA, showing promising clinical application potential. However, as an exploratory study, further validation through multicenter, large-sample, prospective studies with diverse control groups is needed to enhance the generalizability and stability of the scoring system.
摘要:目的:研究胸腺瘤與前縱隔(血管前間隙)淋巴瘤的MSCT表現,提高對二者的診斷與鑒別診斷能力。方法:回顧性分析經手術病理證實的30例胸腺瘤與18例血管前間隙淋巴瘤MSCT表現,著重觀察腫瘤的密度、形態及其與周圍結構的關系。結果:30例胸腺瘤中,24例良性胸腺瘤與鄰近大血管分界清晰,腫塊表現 “D”字或反“D”字狀,平掃CT值16~59 Hu,增強CT值20~110 Hu;6例侵襲性胸腺瘤邊界不清,呈分葉狀、不規則形,密度不均,平掃CT值23~42 Hu,增強CT值23~60 Hu。18例淋巴瘤中,單發于前上縱隔者6例,其余12例呈多結節、腫塊狀,侵入血管間隙生長,致大血管受壓,增強掃描呈輕度強化,常伴有其它部位淋巴結增大。結論:MSCT能清晰顯示胸腺瘤與前縱隔淋巴瘤的影像學表現特征,并能有效提高對二者的鑒別診斷。Abstract: Objective: To diagnosis and differentiate thymoma and malignant lymphoma in the anterior mediastinum on the basis of multislice CT (MSCT) imaging features. Methods:We retrospectively reviewed 30 cases with thymoma and 18 cases with malignant lymphoma proven by surgery and pathology.More attention was put on the density, morphology and relation with the surrounding structures of the tumors. Results: The CT manifestations of 30 cases of thymoma were shown as: For 24 cases of benign thymoma, the boundaries were clear, the shapes were “D” signs or contra“D” signs, CT attenuation value were 1659Hu and 20110Hu on unenhanced and contrastenhanced scanning. For 6 cases of malignant thymoma, the boundaries were unclear, the shapes were lobulated or irregular, the density was heterogeneous, CT attenuation value were 2342Hu and 2360Hu on unenhanced and contrastenhanced scanning. For 18 cases of malignant lymphoma, 6 cases were located at anterior mediastinum, 12 cases were nodes or multiple mass, enveloped the neighboring vessel structures, mildly enhanced on contrastenhanced scanning, and associated with enlargement of lymph nodes in other place. Conclusion: MSCT can display the imaging features of thymoma and anterior mediastinal lymphoma, and effectively differentiate thymoma and mediastinal lymphoma.
To investigate the computed tomography (CT) characteristics and differential diagnosis of high altitude pulmonary edema (HAPE) and COVID-19, CT findings of 52 cases of HAPE confirmed in Medical Station of Sanshili Barracks, PLA 950 Hospital from May 1, 2020 to May 30, 2020 were collected retrospectively. The size, number, location, distribution, density and morphology of the pulmonary lesions of these CT data were analyzed and compared with some already existed COVID-19 CT images which come from two files, “Radiological diagnosis of COVID-19: expert recommendation from the Chinese Society of Radiology (First edition)” and “A rapid advice guideline for the diagnosis and treatment of 2019 novel corona-virus (2019-nCoV) infected pneumonia (standard version)”. The simple or multiple ground-glass opacity (GGO) lesions are located both in the HAPE and COVID-19 at the early stage, but only the thickening of interlobular septa, called “crazy paving pattern” belongs to COVID-19. At the next period, some increased cloudy shadows are located in HAPE, while lesions of COVID-19 are more likely to develop parallel to the direction of the pleura, and some of the lesions show the bronchial inflation. At the most serious stage, both the shadows in HAPE and COVID-19 become white, but the lesions of HAPE in the right lung are more serious than that of left lung. In summary, some cloudy shadows are the feature of HAPE CT image, and “crazy paving pattern” and “pleural parallel sign” belong to the COVID-19 CT, which can be used for differential diagnosis.
ObjectiveTo investigate the research progress of etiology, pathogenesis, diagnosis, differential diagnosis, and treatment of granulomatous lobular mastitis (GLM). MethodA comprehensive analysis was conducted by reviewing the domestic and foreign literatures on GLM and combining with clinical experience. ResultsGLM was a relatively rare chronic inflammatory disease of the breast, and the number of patients had been increasing in recent years. It mainly occured in multiparous women of childbearing age. Clinically, it was characterized by a hard breast mass with or without redness and pain, and severe cases might be accompanied by nodular erythema and arthritis. Bacterial infection, especially Corynebacterium kroppenstedtii and autoimmunity were considered to be the main causes of GLM. The diagnosis of GLM needed to combine with medical history, clinical manifestations, histopathological findings, imaging findings, and laboratory tests. A multidisciplinary team for diagnosis and treatment of GLM should be established to improve the diagnostic accuracy and reduce misdiagnosis. At present, the treatment methods for GLM were mainly conservative treatment and surgical treatment, including follow-up observation, antibiotic treatment, glucocorticoid treatment, immunosuppressive therapy, surgical treatment, traditional Chinese medicine treatment, and combined treatment. ConclusionsAt present, the incidence of GLM is on the rise, but its etiology and pathogenesis are still unclear. The diagnosis needs to combine with many aspects, and it is recommended that the multidisciplinary team could improve the accuracy of diagnosis. There is still no unified standard for the selection and timing of treatment. Clinicians’ experience and patients’ wishes should be taken into account when choosing treatment options in clinical practice. Prospective and high-quality multicenter clinical trials and evidence-based medicine practice are still needed to further improve diagnosis and treatment of GLM.
Objective To conclude the CT manifestations and pathological features of low-grade appendiceal mucinous neoplasms. Methods We reviewed the clinical and CT findings of 24 patients with low-grade appendiceal mucinous neoplasms, who were confirmed by pathology within 1 month after CT examination in SichuanProvincial People’s Hospital from January 2018 to December 2020. The distribution, morphological characteristics, cyst wall and internal characteristics, CT value and enhancement characteristics of tumors were be detected in detail. Results ① Distribution: of the 24 patients, 22 patients located in the appendix area of the right lower quadrant, 2 patients located in the right middle abdomen, and 2 patients located in the pelvic cavity. ② Morphological characteristics: of the 24 patients, 15 patients manifested as tubular, 3 patients manifested as ellipsoidal, 5 patients manifested as saccular, and 1 patient manifested as irregular shape. The average length of tumors was about 6.4 cm (4.2–12.0 cm), and the average short diameter of tumors was about 2.2 cm (0.8–5.0 cm). The short diameter of 17 patients were more than 1.5 cm. ③ The cyst wall and internal characteristics: all the 24 patients demonstrated as cystic mass, 6 patients had evenly thin and smooth cyst wall, and other 18 patients had uneven cyst wall. Of all the patients,8 patients had arc-shaped, punctate or eggshell-like calcification. ④ The CT value and enhancement characteristics: 24 patients examined by plain CT scan, 22 patients showed uniform low density (the CT value were 7–25 HU), 2 patients contained some slightly high density, 16 patients examined by enhanced CT, the cyst wall, separation, or mural nodules of 8 patients were slightly or moderately enhanced. ⑤ Pathological results: of all the gross specimens, 15 patients showed tubular dilation, 9 patients showed partial or complete dilation as cystic mass. All the 24 patients had gelatinous or mucinous contents. Microscopically, all the patients showed low-grade mucinous epithelial hyperplasia, submucosa, and mucosal muscle atrophy, accompanied by fibrosis or calcification. Conclusion Low-grade appendiceal mucinous neoplasms show some specific CT manifestations, recognize these features can improve the accuracy of preoperative CT.
Tumor chemotherapy is a treatment method that employs chemotherapeutic drugs to eradicate cancer cells. These drugs are cytotoxic, meaning they can affect both tumor cells and normal cells. In recent years, there has been a gradual increase in chemotherapy-induced liver injury. Chemotherapy-induced parenchymal liver injury often manifests as diffuse lesions, although focal lesions can occasionally be observed. There is a diversity in the pathogenesis and pathological changes of chemotherapy-induced focal liver disease. Radiologically, there is often challenging in differentiating chemotherapy-induced focal liver disease from hepatic metastases. Therefore, early and accurate diagnosis of this condition poses a certain challenge in clinical practice. This article presents the radiological findings of a case of chemotherapy-induced focal liver disease induced by chemotherapy for gastric cancer, and summarizes the radiological features and differential diagnostic points of chemotherapy-induced focal liver disease, aiming to enhance the understanding of this type of lesion among radiologists and clinicians and reduce related missed diagnoses and misdiagnoses.