Background: In 2010, the International Atomic Energy Agency launched the “3A’s campaign” as an effective tool for primary cancer prevention. In 2011, the American Association of Physicists in Medicine recommended t...Background: In 2010, the International Atomic Energy Agency launched the “3A’s campaign” as an effective tool for primary cancer prevention. In 2011, the American Association of Physicists in Medicine recommended the size specific dose estimate (SSDE). Objectives: To audit doses of Coronary CT Angiography (Coronary CTA) in tertiary care referral center. Methods: We reviewed 998 consecutive Coronary CTA (from 2007 to 2012). Doses (CTDIvol mGy), DLP (mGy*cm), effective dose (DLP*0.014, mSv) were on-line archived. SSDE was estimated retrospectively. Appropriateness score was evaluated for exams performed from the 2010. Results: Overall median dose per Coronary CTA was 49.7 mGy for CTDIvol, 55.5 mGy for SSDE, 994.96 mGy*cm for DLP, 13.9 mSv for effective dose. Median DLP decreased over time (1452.94 in 2007, 1605.56 in 2008, 1113.49 in 2009, 759.99 in 2010, 448.61 in 2011 and 497.88 mGy*cm in 2012, p < 0.0001). SSDE was proportional to the size dependent factor (SDF);in patients with SDF > 1 (88%) CTDIvol underestimated SSDE (48.49 vs 57.19 mGy), whilst in patients with SDF < 1 (12%) CTDIvol overestimated SSDE (56.46 vs 50.3 mGy). Scans were appropriate in 58%, uncertain in 24%, and inappropriate in 18% of cases. Doses were similar in appropriate, uncertain or inappropriate examinations and in excellent-to-good (81%) vs. sufficient-to-poor (19%) image quality exams. Conclusions: Coronary CTA reference doses can be very misleading. SSDE can allow individual technique optimization. The dose is similar in appropriate and inappropriate examinations, and unrelated to image quality. The rate of inappropriate examinations is still too high even after dissemination of guidelines.展开更多
Objectives To compare the different patterns of coronary artery calcification (CAC) in acute and chronic coronary syndromes utilizing electron beam computed tomography. Background Pathologic, angiographic, and intraco...Objectives To compare the different patterns of coronary artery calcification (CAC) in acute and chronic coronary syndromes utilizing electron beam computed tomography. Background Pathologic, angiographic, and intracoronary ultrasound studies revealed sharp differences in the plaque morphology between patients with acute versus chronic coronary syndromes. Whether there are different patterns of coronary artery calcification in patients with stable angina pectoris (SAP) and in those with unstable angina pectoris (UAP) or acute myocardial infarction (AMI), however, remains unclear. Methods Two hundred and sixty - four patients, including 67 with SAP, 94 with UAP and 103 with AMI were studied with electron beam computed tomography for analysis of coronary artery calcification and with selective coronary angiography for determination of atherosclerotic lesions. CAC prevalence and calcium score were compared among three groups, and relation of CAC to the severity of atherosclerotic disease in the SAP and UAP patients was separately analyzed. Results Prevalence of CAC was 100 % in the SAP patients, significantly higher than the 87. 23 % in UAP patients and 86. 41 % among the patients with AMI ( P < 0. 05) . More patients and arteries in the SAP group had severe forms of calcium than those in the UAP and AMI group ( P < 0. 01), and the mean LN [CS + 1] (natural logarithm transformation of calcium score) of the SAP patients was much greater than that of the UAP and AMI patients (P < 0.001). The distribution of vessels with various CAC by luminal stenosis was different between SAP and UAP patients. The average CAC extent of the infarct - related arteries was less severe than that of the noninfarct - related arteries. Conclusions U-tilizing electron beam computed tomography, we demonstrated that there exist different patterns of coronary artery calcification in patients with acute versus chronic coronary syndromes, which may provide insight into the differences observed in the clinical and pathologic development between these two types of coronary artery disease.展开更多
随着鼻窦CT诊断和鼻内镜诊疗技术的发展，大量鼻部疾病导致的头痛得以治愈。根据2004年国际头痛协会的分类，鼻源性头痛的第二种类型——黏膜接触点性头痛（mucosa contact point headache），因为缺少典型的鼻部症状，而分散就诊于其...随着鼻窦CT诊断和鼻内镜诊疗技术的发展，大量鼻部疾病导致的头痛得以治愈。根据2004年国际头痛协会的分类，鼻源性头痛的第二种类型——黏膜接触点性头痛（mucosa contact point headache），因为缺少典型的鼻部症状，而分散就诊于其他学科，长期得不到合理诊疗。我们近期总结了多例临床上没有典型的鼻部症状，而是以各种类型的头痛为主诉就诊于神经内科等专科的患者，经过会诊筛查，确诊为鼻源性黏膜接触点性头痛，通过鼻内镜手术治愈。其中包括1组女性患者，长期被误认为是月经前期头痛，通过治疗证明是黏膜接触点性头痛的一种特殊存在形式，撰文总结如下。展开更多
CT guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB) was performed in twenty four sputum negative cases of small peripheral pulmonary lesions smaller than 2 cm in diameter, which are not easi...CT guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB) was performed in twenty four sputum negative cases of small peripheral pulmonary lesions smaller than 2 cm in diameter, which are not easily diagnosed or accessible to fibrobron choscopes. After thin slide scanning and localization with Somatom DR H computed tomography, pulmonary nodules were biopsied with a 20 Gauge needle guided by a ruler specially designed. Biopsy materials were used for cyto and histopathologic examinations. The diagnosis accuracy of biopsy was evaluated by the result of postoperative pathology and/or follow up for 2 years. Sixteen pulmonary lesions were proved to be malignant and 8 were benign. The sensitivity was 75.0% (12/16), speciti vity 100% (8/8) and accuracy 83.3% (20/24) according to cytopathology and 87.5% (14/16), 100% (8/8), 91.7% (22/24) by histopathology, respectively. Two cases of early stage peripheral lung cancer were detected and proved by operation. CT guided PTFNAB is safe and quick for diagnosis with high accuracy for small peripheral pulmonary lesions which are usually negative in sputum examination and bronchoscopy. PTFNAB should be routinely used in the diagnosis of lung neoplasms.展开更多
Objective: To develop and validate a computed tomography(CT)-based radiomics nomogram for predicting human epidermal growth factor receptor 2(HER2) status in patients with gastric cancer.Methods: This retrospective st...Objective: To develop and validate a computed tomography(CT)-based radiomics nomogram for predicting human epidermal growth factor receptor 2(HER2) status in patients with gastric cancer.Methods: This retrospective study included 134 patients with gastric cancer(HER2-negative: n=87;HER2-positive: n=47) from April 2013 to March 2018, who were then randomly divided into training(n=94) and validation(n=40) cohorts. Radiomics features were obtained from the CT images showing gastric cancer. Least absolute shrinkage and selection operator(LASSO) regression analysis was utilized for building the radiomics signature. A multivariable logistic regression method was applied to develop a prediction model incorporating the radiomics signature and independent clinicopathologic risk predictors, which were then visualized as a radiomics nomogram. The predictive performance of the nomogram was assessed in the training and validation cohorts.Results: The radiomics signature was significantly associated with HER2 status in both training(P<0.001) and validation(P=0.023) cohorts. The prediction model that incorporated the radiomics signature and carcinoembryonic antigen(CEA) level demonstrated good discriminative performance for HER2 status prediction,with an area under the curve(AUC) of 0.799 [95% confidence interval(95% CI): 0.704-0.894] in the training cohort and 0.771(95% CI: 0.607-0.934) in the validation cohort. The calibration curve of the radiomics nomogram also showed good calibration. Decision curve analysis showed that the radiomics nomogram was useful.Conclusions: We built and validated a radiomics nomogram with good performance for HER2 status prediction in gastric cancer. This radiomics nomogram could serve as a non-invasive tool to predict HER2 status and guide clinical treatment.展开更多
AIM To clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography(CT).METHODS All abdominal CT scans performed at North Shore University HealthS ystem showing mesenteric pan...AIM To clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography(CT).METHODS All abdominal CT scans performed at North Shore University HealthS ystem showing mesenteric panniculitis from January 2005 to August 2010 were identified in the Radnet(Rad Net Corporation, Los Angeles, CA) database. Patients with a new or known diagnosis of a malignancy were included for this analysis. Longitudinal clinical histories were obtained from electronic medical records.RESULTS In total, 147794 abdominal CT scans were performed during the study period. Three hundred and fiftynine patients had mesenteric panniculitis(MP)-like abnormalities on their abdominal CT. Of these patients, 81 patients(22.6%) had a known history of cancer at the time of their CT scan. Nineteen(5.3%) had a new diagnosis of cancer in concurrence with their CT, but the majority of these(14/19, 74%) were undergoing CT as part of a malignancy evaluation. Lymphomas were the most common cancers associated with MPlike findings on CT(36 cases, 36%), with follicular lymphoma being the most frequent subtype(17/36). A variety of solid tumors, most commonly prostate(7) and renal cell cancers(6) also were seen. CT follow up was obtained in 56 patients. Findings in the mesentery were unchanged in 45(80%), worsened in 6(11%), and improved in 5 patients(9%). Positron emission tomography(PET) scans performed in 44 patients only showed a positive uptake in the mesenteric mass in 2 patients(5%). CONCLUSION A new diagnosis of cancer is uncommon in patients with CT findings suggestive of MP. MP-like mesenteric abnormalities on CT generally remain stable in patients with associated malignancies. PET scanning is not recommended in the evaluation of patients with mesenteric panniculitis-like findings on CT.展开更多
Objective:To investigate the rol e of CT scanning in diagnosing severe acute respiratory syndrome(SARS). Methods: One hundred and twelve times of spiral CT scanning, 106 t imes on the chest with standard pulmonary and...Objective:To investigate the rol e of CT scanning in diagnosing severe acute respiratory syndrome(SARS). Methods: One hundred and twelve times of spiral CT scanning, 106 t imes on the chest with standard pulmonary and mediastinal window, 5 on the brain and once on the abdomen, were performed in 82 patients (37 males and 45 females ) of SARS. Results: Bilateral shadows showed in 66 patients (80.48%) and unil ateral shadow in 16 (19.52%). The lung CT findings were sub pleural focal con solidation in 26 patients (31.70%), flaky cloudy opacity in 53 (64.63%), large a rea consolidation in 9 (10.97%), ground glass blurry shadow in 31 (37.80%), a lveolar substantive shadow in 14 (17.07%) and interstitial changes in 16 (19.51% ). The pulmonary CT signs of SARS were relatively characterized by: (1) The lesi ons tending to multiply occur, mostly to be bilaterally distributed and commonly involved in the lower lung field. (2) The lung shadows mostly showed as sub pleural focal consolidation, flaky cloudy shadow, large area consolidation, grou nd glass blurry shadow, and often accompanied with signs of broncho inflat ion. (3) Having opacified nodular shadows in the alveolar cavities. (4) Rapid pr ogressions or changes on the size, amount, and distribution of the lesions likel y to be found in dynamic observation of chest X ray and CT scanning, i.e., ma rkedly dynamic changes found within 24 to 48 hrs. Lesions with these characteris tics may be recognized as pulmonary changes possibly induced by SARS. Complicati ons were found in 6 patients (7.31%), including tuberculosis of lung and brain a ccompanied with pneumomediastinum in one patient, secondary infection of lung in 2, pneumothorax in 1, pulmonary fungus in 1, and pyothorax in 1.Conclusion: CT scanning is a sensitive method for diagnosis of SAR S, by which more accurate assessment of the abnormal changes of lung and occurre nce of complications in SARS patients can be made.展开更多
文摘Background: In 2010, the International Atomic Energy Agency launched the “3A’s campaign” as an effective tool for primary cancer prevention. In 2011, the American Association of Physicists in Medicine recommended the size specific dose estimate (SSDE). Objectives: To audit doses of Coronary CT Angiography (Coronary CTA) in tertiary care referral center. Methods: We reviewed 998 consecutive Coronary CTA (from 2007 to 2012). Doses (CTDIvol mGy), DLP (mGy*cm), effective dose (DLP*0.014, mSv) were on-line archived. SSDE was estimated retrospectively. Appropriateness score was evaluated for exams performed from the 2010. Results: Overall median dose per Coronary CTA was 49.7 mGy for CTDIvol, 55.5 mGy for SSDE, 994.96 mGy*cm for DLP, 13.9 mSv for effective dose. Median DLP decreased over time (1452.94 in 2007, 1605.56 in 2008, 1113.49 in 2009, 759.99 in 2010, 448.61 in 2011 and 497.88 mGy*cm in 2012, p < 0.0001). SSDE was proportional to the size dependent factor (SDF);in patients with SDF > 1 (88%) CTDIvol underestimated SSDE (48.49 vs 57.19 mGy), whilst in patients with SDF < 1 (12%) CTDIvol overestimated SSDE (56.46 vs 50.3 mGy). Scans were appropriate in 58%, uncertain in 24%, and inappropriate in 18% of cases. Doses were similar in appropriate, uncertain or inappropriate examinations and in excellent-to-good (81%) vs. sufficient-to-poor (19%) image quality exams. Conclusions: Coronary CTA reference doses can be very misleading. SSDE can allow individual technique optimization. The dose is similar in appropriate and inappropriate examinations, and unrelated to image quality. The rate of inappropriate examinations is still too high even after dissemination of guidelines.
文摘Objectives To compare the different patterns of coronary artery calcification (CAC) in acute and chronic coronary syndromes utilizing electron beam computed tomography. Background Pathologic, angiographic, and intracoronary ultrasound studies revealed sharp differences in the plaque morphology between patients with acute versus chronic coronary syndromes. Whether there are different patterns of coronary artery calcification in patients with stable angina pectoris (SAP) and in those with unstable angina pectoris (UAP) or acute myocardial infarction (AMI), however, remains unclear. Methods Two hundred and sixty - four patients, including 67 with SAP, 94 with UAP and 103 with AMI were studied with electron beam computed tomography for analysis of coronary artery calcification and with selective coronary angiography for determination of atherosclerotic lesions. CAC prevalence and calcium score were compared among three groups, and relation of CAC to the severity of atherosclerotic disease in the SAP and UAP patients was separately analyzed. Results Prevalence of CAC was 100 % in the SAP patients, significantly higher than the 87. 23 % in UAP patients and 86. 41 % among the patients with AMI ( P < 0. 05) . More patients and arteries in the SAP group had severe forms of calcium than those in the UAP and AMI group ( P < 0. 01), and the mean LN [CS + 1] (natural logarithm transformation of calcium score) of the SAP patients was much greater than that of the UAP and AMI patients (P < 0.001). The distribution of vessels with various CAC by luminal stenosis was different between SAP and UAP patients. The average CAC extent of the infarct - related arteries was less severe than that of the noninfarct - related arteries. Conclusions U-tilizing electron beam computed tomography, we demonstrated that there exist different patterns of coronary artery calcification in patients with acute versus chronic coronary syndromes, which may provide insight into the differences observed in the clinical and pathologic development between these two types of coronary artery disease.
文摘随着鼻窦CT诊断和鼻内镜诊疗技术的发展，大量鼻部疾病导致的头痛得以治愈。根据2004年国际头痛协会的分类，鼻源性头痛的第二种类型——黏膜接触点性头痛（mucosa contact point headache），因为缺少典型的鼻部症状，而分散就诊于其他学科，长期得不到合理诊疗。我们近期总结了多例临床上没有典型的鼻部症状，而是以各种类型的头痛为主诉就诊于神经内科等专科的患者，经过会诊筛查，确诊为鼻源性黏膜接触点性头痛，通过鼻内镜手术治愈。其中包括1组女性患者，长期被误认为是月经前期头痛，通过治疗证明是黏膜接触点性头痛的一种特殊存在形式，撰文总结如下。
文摘CT guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB) was performed in twenty four sputum negative cases of small peripheral pulmonary lesions smaller than 2 cm in diameter, which are not easily diagnosed or accessible to fibrobron choscopes. After thin slide scanning and localization with Somatom DR H computed tomography, pulmonary nodules were biopsied with a 20 Gauge needle guided by a ruler specially designed. Biopsy materials were used for cyto and histopathologic examinations. The diagnosis accuracy of biopsy was evaluated by the result of postoperative pathology and/or follow up for 2 years. Sixteen pulmonary lesions were proved to be malignant and 8 were benign. The sensitivity was 75.0% (12/16), speciti vity 100% (8/8) and accuracy 83.3% (20/24) according to cytopathology and 87.5% (14/16), 100% (8/8), 91.7% (22/24) by histopathology, respectively. Two cases of early stage peripheral lung cancer were detected and proved by operation. CT guided PTFNAB is safe and quick for diagnosis with high accuracy for small peripheral pulmonary lesions which are usually negative in sputum examination and bronchoscopy. PTFNAB should be routinely used in the diagnosis of lung neoplasms.
基金supported by the National Key Research and Development Program of China (No. 2017YFC1309100)National Natural Scientific Foundation of China (No. 81771912, 81601469, and 81701782)+1 种基金the Science and Technology Planning Project of Guangdong Province (No. 2017B020227012)the Science and Technology Planning Project of Guangzhou (No. 20191A011002).
文摘Objective: To develop and validate a computed tomography(CT)-based radiomics nomogram for predicting human epidermal growth factor receptor 2(HER2) status in patients with gastric cancer.Methods: This retrospective study included 134 patients with gastric cancer(HER2-negative: n=87;HER2-positive: n=47) from April 2013 to March 2018, who were then randomly divided into training(n=94) and validation(n=40) cohorts. Radiomics features were obtained from the CT images showing gastric cancer. Least absolute shrinkage and selection operator(LASSO) regression analysis was utilized for building the radiomics signature. A multivariable logistic regression method was applied to develop a prediction model incorporating the radiomics signature and independent clinicopathologic risk predictors, which were then visualized as a radiomics nomogram. The predictive performance of the nomogram was assessed in the training and validation cohorts.Results: The radiomics signature was significantly associated with HER2 status in both training(P<0.001) and validation(P=0.023) cohorts. The prediction model that incorporated the radiomics signature and carcinoembryonic antigen(CEA) level demonstrated good discriminative performance for HER2 status prediction,with an area under the curve(AUC) of 0.799 [95% confidence interval(95% CI): 0.704-0.894] in the training cohort and 0.771(95% CI: 0.607-0.934) in the validation cohort. The calibration curve of the radiomics nomogram also showed good calibration. Decision curve analysis showed that the radiomics nomogram was useful.Conclusions: We built and validated a radiomics nomogram with good performance for HER2 status prediction in gastric cancer. This radiomics nomogram could serve as a non-invasive tool to predict HER2 status and guide clinical treatment.
基金Supported by An unrestricted grant from the Keyser Family Fund(partly)
文摘AIM To clarify the association of malignancy with mesenteric panniculitis-like changes on computed tomography(CT).METHODS All abdominal CT scans performed at North Shore University HealthS ystem showing mesenteric panniculitis from January 2005 to August 2010 were identified in the Radnet(Rad Net Corporation, Los Angeles, CA) database. Patients with a new or known diagnosis of a malignancy were included for this analysis. Longitudinal clinical histories were obtained from electronic medical records.RESULTS In total, 147794 abdominal CT scans were performed during the study period. Three hundred and fiftynine patients had mesenteric panniculitis(MP)-like abnormalities on their abdominal CT. Of these patients, 81 patients(22.6%) had a known history of cancer at the time of their CT scan. Nineteen(5.3%) had a new diagnosis of cancer in concurrence with their CT, but the majority of these(14/19, 74%) were undergoing CT as part of a malignancy evaluation. Lymphomas were the most common cancers associated with MPlike findings on CT(36 cases, 36%), with follicular lymphoma being the most frequent subtype(17/36). A variety of solid tumors, most commonly prostate(7) and renal cell cancers(6) also were seen. CT follow up was obtained in 56 patients. Findings in the mesentery were unchanged in 45(80%), worsened in 6(11%), and improved in 5 patients(9%). Positron emission tomography(PET) scans performed in 44 patients only showed a positive uptake in the mesenteric mass in 2 patients(5%). CONCLUSION A new diagnosis of cancer is uncommon in patients with CT findings suggestive of MP. MP-like mesenteric abnormalities on CT generally remain stable in patients with associated malignancies. PET scanning is not recommended in the evaluation of patients with mesenteric panniculitis-like findings on CT.
文摘Objective:To investigate the rol e of CT scanning in diagnosing severe acute respiratory syndrome(SARS). Methods: One hundred and twelve times of spiral CT scanning, 106 t imes on the chest with standard pulmonary and mediastinal window, 5 on the brain and once on the abdomen, were performed in 82 patients (37 males and 45 females ) of SARS. Results: Bilateral shadows showed in 66 patients (80.48%) and unil ateral shadow in 16 (19.52%). The lung CT findings were sub pleural focal con solidation in 26 patients (31.70%), flaky cloudy opacity in 53 (64.63%), large a rea consolidation in 9 (10.97%), ground glass blurry shadow in 31 (37.80%), a lveolar substantive shadow in 14 (17.07%) and interstitial changes in 16 (19.51% ). The pulmonary CT signs of SARS were relatively characterized by: (1) The lesi ons tending to multiply occur, mostly to be bilaterally distributed and commonly involved in the lower lung field. (2) The lung shadows mostly showed as sub pleural focal consolidation, flaky cloudy shadow, large area consolidation, grou nd glass blurry shadow, and often accompanied with signs of broncho inflat ion. (3) Having opacified nodular shadows in the alveolar cavities. (4) Rapid pr ogressions or changes on the size, amount, and distribution of the lesions likel y to be found in dynamic observation of chest X ray and CT scanning, i.e., ma rkedly dynamic changes found within 24 to 48 hrs. Lesions with these characteris tics may be recognized as pulmonary changes possibly induced by SARS. Complicati ons were found in 6 patients (7.31%), including tuberculosis of lung and brain a ccompanied with pneumomediastinum in one patient, secondary infection of lung in 2, pneumothorax in 1, pulmonary fungus in 1, and pyothorax in 1.Conclusion: CT scanning is a sensitive method for diagnosis of SAR S, by which more accurate assessment of the abnormal changes of lung and occurre nce of complications in SARS patients can be made.
