Objective To explore the diagnosis and treatment strategies for elderly patients with ground-glass opacity (GGO). MethodsThe imaging features and postoperative pathological findings of the elderly patients with pulmonary GGO receiving surgery in our hospital from 2017 to 2019 were retrospectively analyzed. The patients were divided into an elderly patient group and a non-elderly patient group based on their age. Results Finally 575 patients were included in the study. There were 281 elderly patients, including 83 males and 198 females, with an average age of (67.0±5.3) years. There were 294 non-elderly patients, including 88 males and 206 females, with an average age of (49.1±7.3) years. Compared with the non-elderly patients, elderly GGO patients showed the following distinct clinical features: long observation time for lesions (P=0.001), high proportion of rough edges of GGO (P<0.001), significant pleural signs (P＜0.001) and bronchial signs (P＜0.001), and high proportion of type Ⅱ-Ⅳ GGO (P<0.001), lobectomy type (P=0.013), and invasive lesions reported in postoperative pathology (P<0.001). There was no statistical difference in the average hospital stay between the two groups (P=0.106). Multivariate logistic regression analysis showed that GGO diameter and GGO type were the main factors affecting the operation. Observation time, GGO diameter, GGO type and pleural signs were the main influencing factors for postoperative pathological infiltrative lesions. The cut-off value of GGO diameter in predicting infiltrating lesions was 10.5 mm in the elderly patients group. Conclusion The size and type of GGO are important factors in predicting invasive lesions and selecting surgical methods. Elderly patients with radiographic manifestations of type Ⅱ-Ⅳ GGO lesions with a diameter greater than 10.5 mm should be closely followed up.
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.
ObjectiveTo explore value of CT imaging features in differentiating pathological grades of pancreatic neuroendocrine neoplasms (pNENs). MethodsThe patients with pNENs admitted to the Sichuan Provincial People’s Hospital from October 2017 to December 2023 were retrospectively collected. The enrolled patients were assigned into a low-grade (G1+G2) pNENs and high-grade (G3+neuroendocrine carcinoma) pNENs. Then, the differences in gender, age, presence of neuroendocrine symptoms, tumor location, tumor diameter, clarity of the tumor boundary, cystic change, capsule, dilation of the biliary and pancreatic ducts, pancreatic parenchymal atrophy, vascular invasion, liver metastasis, lymph node metastasis, tumor enhancement pattern, Ct values in each phase, and the ratio of Ct value of the tumor to that of the normal pancreas (T/N value) between the low-grade pNENs and high-grade pNENs were compared. Subsequently, the multivariate logistic regression analysis was used to screen the CT imaging features with statistical significance and the receiver operating characteristic (ROC) curve was use to differentiate high-grade from low-grade pNENs. ResultsA total of 47 pNENs patients were enrolled, including 36 low-grade and 11 high-grade cases. Compared with the low-grade pNENs, the patients with high-grade pNENs had higher proportions of pancreaticobiliary duct dilation (χ2=9.124, P=0.003) and vascular invasion (χ2=10.967, P=0.001), more mild enhancement (χ2=9.192, P=0.010), larger tumor diameter (Z=–2.378, P=0.017), and lower Ct values and T/N ratios in the arterial and venous phases (P=0.001, P=0.032, P=0.006, P=0.018). The multivariate logistic regression analysis showed that the pancreaticobiliary duct dilation, vascular invasion, and decreased Ct value in the arterial phase were the predictive factors for the high-grade pNENs. The areas under the ROC curves of these three indicators for distinguishing low-grade from high-grade pNENs were 0.760, 0.749, and 0.843, respectively, the Ct value in the arterial phase had the strongest discriminatory ability, and its cutoff value was 78 HU. ConclusionsThe results of this study suggest that pancreatic ductal dilation, vascular invasion, and Ct value in arterial phase play important roles in differentiating high-grade pNENs from low-grade pNENs. Ct value in arterial phase has the greatest diagnostic efficiency.
Objective To observe the multimodal imaging features and explore the treatment of parafoveal exudative vascular anomaly complex (PEVAC). Methods A retrospective study. Six patients (6 eyes) with PEVAC diagnosed in Tianjin Eye Hospital were included in this study from July 2018 to December 2021. All patients were female with monocular disease. The age was (61.1±9.3) years. All patients showed a sudden painless decline in monocular vision with metamorphopsia. All patients underwent best corrected visual acuity (BCVA), color fundus photography, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT angiography (OCTA). Indocyanine green angiography (ICGA) was performed in 4 eyes. In 6 eyes, 3 eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drug; 5 eyes were treated with micropulse laser photocoagulation and/or local thermal laser photocoagulation; 1 eye was treated with photodynamic therapy. Five patients were followed up for (9.2±7.4) months, and 1 patient was lost. At follow-up, the same equipment and methods were used as at the initial diagnosis. The clinical manifestations, multimodal image features and treatment response were observed. Results Baseline BCVA of affected eyes were ranged from 0.1 to 0.5. PEVAC was isolated in 6 eyes, and the fundus showed isolated hemangioma-like leision, accompanied by small bleeding and hard exudation. There were 2 isolated hemangiomatous lesions adjacent to each other in 2 eyes. In the early stage of FFA, punctate high fluorescence lesions near the macular fovea were seen, and the leakage was enhanced in the late stage. There was no leakage in the early stage of ICGA, or slight leakage with late scouring. OCT showed an oval lesion with high reflection wall and uneven low reflection. The central macular thickness (CMT) was (431±76) μm. OCTA showed blood flow signals in PEVAC, 2 eyes in the superficial capillary plexus (SCP), and it was also observed in the deep capillary plexus (DCP), but the intensity of blood flow signal was slightly weaker than that in the SCP. The blood flow signal was visible only in DCP in 2 eyes. SCP and DCP showed similar intensity of blood flow signals in 2 eyes. After treatment, the bleeding was absorbed basically in 4 eyes, the hard exudation partially subsided, the CMT decreased, the intercortical cystic cavity of the fovea nerve decreased, the hemangiomatous lesions narrowed, and BCVA increased. In 1 eye, the macular sac was reduced and partially absorbed by hard exudation, which was later relapsed due to blood pressure fluctuation.ConclusionsThe majority of PEVAC patients had monocular onset. The fundus is characterized by solitary or structure with strong reflex walls, with or without retinal cysts, hard exudates, and subretinal fluid, and visible blood flow signals inside.
ObjectiveTo analyze the pathological manifestations and imaging characteristics of bronchiolar adenoma (BA).MethodsThe clinical data of 11 patients with BA who received surgeries in our hospital from January 2019 to September 2020 were retrospectively analyzed, including 5 males and 6 females aged 40-73 (62.40±10.50) years. The intraoperative rapid freezing pathological diagnosis, postoperative pathological classification, cell growth pattern, nuclear proliferation index Ki-67 and other immunohistochemical staining combined with preoperative chest CT imaging characteristics were analyzed.ResultsThe average preoperative observation time was 381.10±278.28 d. The maximum diameter of imaging lesions was 5-27 (10.27±6.34) mm. Eight (72.7%) patients presented with irregular morphology of heterogeneous ground-glass lesions, and 3 (27.3%) patients presented with pure ground-glass lesions. There were 10 (90.9%) patients with vascular signs, 8 (72.7%) patients with vacuolar signs, 1 (9.1%) patient with bronchus sign, 3 (27.3%) patients with pleural traction and 9 (81.8%) patients with burr/lobular sign. The surgical methods included sub-lobectomy in 10 patients and lobectomy in 1 patient. Five (45.5%) patients were reported BA by intraoperative frozen pathology. The postoperative pathological classification included 8 patients with distal-type and 3 patients with proximal-type, and the maximum diameter of the lesions was 4-20 (8.18±5.06) mm. Eight (72.7%) patients showed characteristic bilayer cell structure under microscope, and 10 (90.9%) patients showed thyroid transcription factor 1 expression in pathological tissues. The expression of NapsinA in intracavity cells was found in 9 (81.8%) patients. The Ki-67 index of the lesion tissue was 1%-5% (3.22%±1.72%).ConclusionThe pathological features and imaging findings of BA confirm the premise that BA is a neoplastic lesion. However, to identify BA as a benign or inert tumor needs more clinical data and evidence of molecular pathological studies.
Objective To study the imaging features of the hip joint by measuring the imaging parameters of spine, pelvis, and hip joint before and after total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS) undergoing THA so as to provide reference for selection of operation methods and prosthesis. Methods Between January and July 2015, 38 patients (56 hips) with AS underwent primary THA as AS group, and 36 patients (45 hips) with osteonecrosis of the femoral head underwent THA as control group. There was no significant difference in side (χ2=1.14,P=0.95). The acetabular abduction angle (ABA), acetabular anteversion angle (AVA), center collum diaphyseal (CCD), offset, height from rotation center to lesser trochanter (HRCLT), femoral intertrochanteric distance (FID) were measured by CT three-dimensional morphology. The canal flare index (CFI), cortical thickness index (CTI), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured by X-ray film before operation. The AVA, ABA, and the filling ratio were measured on the postoperative X-ray film. Results There was no significant difference in preoperative AVA and ABA and postoperative ABA between 2 groups (P>0.05), but significant difference was found in postoperative AVA (t=6.71,P=0.00). The mean PI, SS, and PT in AS group were 48.37° (range, 41-58°), 5.64°(range, 2-11°), and 12.85° (range, 5-26°), respectively. There was significant difference in CCD, CFI, and CTI between 2 groups (t=3.63,P=0.04;t=5.12,P=0.02;t=3.91,P=0.04), but offset, HRCLT, and FID all showed no significant difference (t=0.41,P=0.36;t=0.33,P=0.56;t=0.59,P=0.12). On the basis of the Noble classification, medullary cavity of the femur was rated as chimney type, ordinary type, and champagne flute type in 32, 18, and 6 hips of AS group, and in 4, 28, and 13 hips of control group respectively. Filling ratio of distal segment in AS group was significantly lower than that in control group (t=5.64,P=0.02), but there was no significant difference in the filling ratio of middle and proximal segments between 2 groups (t=0.29,P=0.61;t=0.55,P=0.13). Conclusion Compared with patients having osteonecrosis of the femeral head, there is no significant difference in preoperative AVA and ABA, but postoperative AVA significantly increase in patients with AS. Because AS patients have mainly chimney type medullary cavity of the femur, the filling ratio of middle and distal segment is lower when tapered stems are used, and the filling ratio of anatomic stems is higher.
Objective To summarize ultrasonography, CT and (or) MRI imaging features of cystic liver lesions so as to improve its diagnostic accuracy. Methods The literatures relevant imaging studies of different types of cystic liver lesions at home and abroad were searched. Then with the etiology as clue, the imaging fetures of ultrasonography, CT and (or) MRI plain scan and enhancement scan were summarized. Results The cystic liver lesions had many types, their imaging findings were different and existed overlaps. The diagnosis and differential diagnosis of atypical cases were difficult. ① For the simple hepatic cyst, it was a round cystic mass with water-like echo, density and signal. The boundary was clear, and there was no separation in the cyst, without contrast enhancement. The sensitivity and specificity of diagnosing were higher by ultrasonography and MRI as compared with CT. ② For the bile duct hamartoma and Caroli diease, they were manifested as multiple cysts, widely distributed in the whole liver, without enhancement for the most lesions. The multiple cystic lesions without communicating with the bile duct was the key sign of differential diagnosis for these two dieases. ③ Enhancing mural nodules were more common in cystadenocarcinoma than cystadenoma. The accurate diagnosis of biliary cystadenoma depended on combination of ultrasonography, CT, and MRI findings. ④ For the cystic liver metastatic tumor, it was multiple cystic neoplasms in the liver parenchyma or around the liver. CT was the main method for the diagnosis, and which showed that the density was lower than that of the liver parenchyma, peripheral ring-enhanced lesion as enhanced scan. It was easy to distinguish with simple hepatic cyst by MRI. ⑤ For the cystic hepatocellular carcinoma, it presented as a multilocular cystic solid tumor. The presence of tumor thrombus in portal vein could help to the diagnosis. ⑥ For the undifferentiated embryonal sarcoma, CT plain scan showed the cystic low density mass with clear boundary, the edge with calcification, enhanced scan showed that the soft tissue composition presented continuous strengthening sign. There was no specific signal in MRI plain scan, and the periphery of the tumor was slowly strengthening. ⑦ For the liver abscess, it was easy to diagnose because it had different characteristic features in different pathological phase, but it was misdiagnosis of intrahepatic cholangiocarcinoma when its symptoms were atypical. ⑧ The ultrasonography and the CT were the optimal methods for the hepatic cystic echinococcosis and the hepatic alveolar echinococcosis respectively. The significances of imaging were to determine the activity of hydatid cyst and to identify anatomy structure among alveolar echinococcosis, bile duct and blood vessel, and judge invasion or not, MRCP was important for diagnosis. Conclusions Abdominal ultrasonography could be used as the first choice for diagnosis of cystic liver lesions, CT and MRI could be used as effective supplementary methods for it. A combination of various imaging techniques is key to diagnosis. Moreover, number and morphology of lesion, and solid component or not are important imaging features of diagnosis and differential diagnosis of cystic liver lesion.
Objective To explore the clinical and imaging features of patients with acute dizziness and assess their associations with 3-month prognosis. Methods We enrolled adult patients with a chief complaint of acute dizziness, who were admitted to the Neurological Clinic at the Emergency Department of West China Hospital, Sichuan University between January 1st and May 31st 2022. We collected clinical and imaging features at baseline for each patient. The primary outcome was recurrent dizziness within 3 months after index dizziness. Secondary outcome was stroke within 3 months after index dizziness. Results A total of 1 322 patients who visited the Neurological Clinic were included, of which 617 (46.7%) had a chief complaint of acute dizziness. Among 222 patients who performed emergent brain and neck CT angiography, 1 patient presented with intracerebral haemorrhage. Among the remaining 221 patients, 206 patients completed 3-month follow-up, with 76 patients reported recurrent dizziness and 7 patients had stroke (6 ischaemic, 1 hemorrhagic). The multivariate logistic regression showed that chronic dizziness duration and parenchymal hypodensity on brain CT were each associated with a higher risk of recurrent dizziness. Compared with those who did not report stroke, the stroke patients were more likely to present with hypertension, headache symptoms, and exhibit parenchymal hypodensity on baseline CT (P<0.05). Conclusions In patients with acute dizziness, those with chronic dizziness duration and parenchymal hypodensity on baseline CT were associated with a higher risk of 3-month recurrent dizziness. Acute dizziness patients experiencing 3-month stroke often have hypertension, headache symptoms, and parenchymal hypodensity on baseline CT.
Objective To use imaging features of pulmonary nodules to predict the risk of lymph node metastasis in patients with cT1-stage non-small cell lung cancer (NSCLC), providing a reference for clinical decision-making. Methods A retrospective analysis was conducted on the imaging features and postoperative pathological results of cT1 NSCLC patients who underwent surgical treatment at Linyi People’s Hospital from July 2019 to July 2022. Patients were grouped and analyzed according to lymph node metastasis status. Results A total of 1 123 patients were included, comprising 471 males and 652 females, with a median age of 59 (52, 66) years. Comparative analysis revealed that sex, age, nodule location, nodule size on imaging, solid component size, consolidation tumor ratio (CTR), average CT value, and tumor proximity to the pleura all influenced lymph node metastasis. A nomogram was constructed, indicating that the probability of lymph node metastasis in cT1 NSCLC was positively correlated with solid component size, CTR, and average CT value of the pulmonary nodule, and negatively correlated with patient age. The area under the receiver operating characteristic curve was 0.929. Conclusion For cT1 NSCLC patients, the probability of lymph node metastasis can be predicted by measuring the solid component size, CTR, and average CT value of the pulmonary nodule, in conjunction with patient age. However, relying solely on pulmonary nodule imaging characteristics is insufficient to determine a specific lymph node dissection strategy.
ObjectiveTo explore the CT imaging features and independent risk factors for cystic pulmonary nodules and establish a malignant probability prediction model. Methods The patients with cystic pulmonary nodules admitted to the Department of Thoracic Surgery of the First People's Hospital of Neijiang from January 2017 to February 2022 were retrospectively enrolled. They were divided into a malignant group and a benign group according to the pathological results. The clinical data and preoperative chest CT imaging features of the two groups were collected, and the independent risk factors for malignant cystic pulmonary nodules were screened out by logistic regression analysis, so as to establish a prediction model for benign and malignant cystic pulmonary nodules. ResultsA total of 107 patients were enrolled. There were 76 patients in the malignant group, including 36 males and 40 females, with an average age of 59.65±11.74 years. There were 31 patients in the benign group, including 16 males and 15 females, with an average age of 58.96±13.91 years. Multivariate logistic analysis showed that the special CT imaging features such as cystic wall nodules [OR=3.538, 95%CI (1.231, 10.164), P=0.019], short burrs [OR=4.106, 95%CI (1.454, 11.598), P=0.008], cystic wall morphology [OR=6.978, 95%CI (2.374, 20.505), P<0.001], and the number of cysts [OR=4.179, 95%CI (1.438, 12.146), P=0.009] were independent risk factors for cystic lung cancer. A prediction model was established: P=ex/(1+ex), X=–2.453+1.264×cystic wall nodules+1.412×short burrs+1.943×cystic wall morphology+1.430×the number of cysts. The area under the receiver operating charateristic curve was 0.830, the sensitivity was 82.9%, and the specificity was 74.2%. ConclusionCystic wall nodules, short burrs, cystic wall morphology, and the number of cysts are the independent risk factors for cystic lung cancer, and the established prediction model can be used as a screening method for cystic pulmonary nodules.