In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute ...In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.展开更多
BACKGROUND Minute Pulmonary Meningothelial-like Nodules(MPMNs)are rare benign pulmonary nodules,which are more common in elderly women and have a higher detection rate in lung tissues of patients with lung malignant d...BACKGROUND Minute Pulmonary Meningothelial-like Nodules(MPMNs)are rare benign pulmonary nodules,which are more common in elderly women and have a higher detection rate in lung tissues of patients with lung malignant diseases.Its origin is not yet clear.At present,there are few reports on the diagnostic methods such as imaging and pathological manifestations of MPMNs.This article reports a 70-year-old female patient with pulmonary adenocarcinoma combined with MPMNs and reviews of the relevant literature.CASE SUMMARY A 70-year-old women was admitted to our institution with feeling sour in her back and occasional cough for more than 2 mo.Computerized electronic scanning scan and 3D reconstruction images in our institution showed there were multiple ground-glass nodules in both of her two lungs.The biggest one was in the apicoposterior segment of left upper lobe,about 2.5 mm×9 mm in size.We performed thoracoscopic resection of the left upper lung apicoposterior segment of the patient,and the final pathological report was minimally invasive adenocarcinoma.Re-examination of high resolution computed tomography 21 mo after surgery showed multiple ground-glass nodules in both lungs,and a new groundglass nodule was found in the superior segment of the right lower lobe.We took pathological biopsy of the right upper lung and right lower lung nodules for the patient under thoracoscopy.The histomorphology of the right lower lobe nodule showed multiple lesions in the lung tissue,and the small foci in the alveolar septum were distributed in mild form of the aggregation of short spindle cells.The immunohistochemistry showed that the lesion was epithelial membrane antigen(EMA)(+),somatostatin receptor 2a(SSTR2a)(+),S-100(-),chromogranin A(-),Syn(-),cytokeratin(-)and HMB-45(-).The final diagnosis was minimally invasive adenocarcinoma,accompanied by MPMNs.We recommend that patients continue to receive treatment after surgery and to do regular follow-up observations.CONCLUSION The imaging manifestations of MPMNs are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of MPMNs immunohistochemistry and shows that MPMNs are positive for EMA,SSTR2a,and progesterone receptor.展开更多
Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes (breast cancer, prostate cancer, colon cancer, and pancreatic cancer) of cancer-r...Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes (breast cancer, prostate cancer, colon cancer, and pancreatic cancer) of cancer-related mortality combined (1). About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed (2). Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality (3). More recently,展开更多
BACKGROUND Paragonimiasis is a food-borne parasitic infection caused by lung flukes of the genus Paragonimus. Although the most common site of infection is the pleuropulmonary area, the parasite can also reach other p...BACKGROUND Paragonimiasis is a food-borne parasitic infection caused by lung flukes of the genus Paragonimus. Although the most common site of infection is the pleuropulmonary area, the parasite can also reach other parts of the body on its journey from the intestines to the lungs, ending up in locations such as the brain,abdomen, skin, and subcutaneous tissues. Ectopic paragonimiasis is difficult to diagnose due to the rarity of this disease.CASE SUMMARY Here, we report a rare case of simultaneous breast and pulmonary paragonimiasis in a woman presenting painless breast mass and lung nodule with a history of eating raw trout. To confirm the diagnosis, serologic testing and tissue confirmation of the breast mass were performed. The patient was treated with surgical resection of the mass and praziquantel medication.CONCLUSION Ectopic paragonimiasis is difficult to diagnose due to the rarity of this disease.Thus, thorough history-taking and clinical suspicion of parasitic infection are important.展开更多
BACKGROUND Pulmonary benign metastatic leiomyoma(PBML),which is very rare,is a type of benign metastatic leiomyoma(BML).Here,we report a case of PBML,finally diagnosed through multidisciplinary team(MDT)discussions,an...BACKGROUND Pulmonary benign metastatic leiomyoma(PBML),which is very rare,is a type of benign metastatic leiomyoma(BML).Here,we report a case of PBML,finally diagnosed through multidisciplinary team(MDT)discussions,and provide a literature review of the disease.CASE SUMMARY A 55-year old asymptomatic woman was found to have bilateral multiple lung nodules on a chest high-resolution computed tomography(HRCT)scan.Her medical history included total hysterectomy for uterine leiomyoma.The patient was diagnosed with PBML,on the basis of her clinical history,imaging manifestations,and computed tomography(CT)-guided percutaneous lung puncture biopsy,via MDT discussions.As the patient was asymptomatic,she received long-term monitoring without treatment.A follow-up of chest HRCT after 6 mo showed that the PBML lung nodules were stable and there was no progression.CONCLUSION For patients with a medical history of hysterectomy and uterine leiomyoma with lung nodules on chest CT,PBML should be considered during diagnosis based on the clinical history,imaging manifestations,CT-guided percutaneous lung puncture biopsy,and MDT discussions.展开更多
Objective:To comprehensively and accurately analyze the out-performance of low-dose chest CT(LDCT)vs.standard-dose CT(SDCT).Methods:The image quality,size measurements and radiation exposure for LDCT and SDCT protocol...Objective:To comprehensively and accurately analyze the out-performance of low-dose chest CT(LDCT)vs.standard-dose CT(SDCT).Methods:The image quality,size measurements and radiation exposure for LDCT and SDCT protocols were evaluated.A total of 117 patients with extra-thoracic malignancies were prospectively enrolled for non-enhanced CT scanning using LDCT and SDCT protocols.Three experienced radiologists evaluated subjective image quality independently using a 5-point score system.Nodule detection efficiency was compared between LDCT and SDCT based on nodule characteristics(size and volume).Radiation metrics and organ doses were analyzed using Radimetrics.Results:The images acquired with the LDCT protocol yielded comparable quality to those acquired with the SDCT protocol.The sensitivity of LDCT for the detection of pulmonary nodules(n=650)was lower than that of SDCT(n=660).There was no significant difference in the diameter and volume of pulmonary nodules between LDCT and SDCT(for BMI<22 kg/m^(2),4.37 vs.4.46 mm,and 43.66 vs.46.36 mm^(3);for BMI>22 kg/m^(2),4.3 vs.4.41 mm,and 41.66 vs.44.86 mm^(3))(P>0.05).The individualized volume CT dose index(CTDI_(vol)),the size specific dose estimate and effective dose were significantly reduced in the LDCT group compared with the SDCT group(all P<0.0001).This was especially true for dose-sensitive organs such as the lung(for BMI<22 kg/m^(2),2.62 vs.12.54 mSV,and for BMI>22 kg/m^(2),1.62 vs.9.79 mSV)and the breast(for BMI<22 kg/m^(2),2.52 vs.10.93 mSV,and for BMI>22 kg/m^(2),1.53 vs.9.01 mSV)(P<0.0001).Conclusion:These results suggest that with the increases in image noise,LDCT and SDCT exhibited a comparable image quality and sensitivity.The LDCT protocol for chest scans may reduce radiation exposure by about 80% compared to the SDCT protocol.展开更多
Objective The purpose of this study is to appraise the value of incremental dynamic enhanced computed tomography in surgical treatment of patients with solitary pulmonary nodules(SPNs).Methods The data of 42 cases wit...Objective The purpose of this study is to appraise the value of incremental dynamic enhanced computed tomography in surgical treatment of patients with solitary pulmonary nodules(SPNs).Methods The data of 42 cases with solitary pulmonary nodules who underwent surgical treatment from May 2002 to June 2003 in our hospital were collected to find the relationship between preoperative dynamic enhanced CT image and postoperative pathology.Result All bronchogenic carcinoma showed significant enhancement after intravenous 100 mL iodinated contrast material.The average degree of enhancement of bronchogenic carcinoma was significantly different from that of tuberculoma and other benign lesions.Conclusion Dynamic enhanced computed tomography is very valuable in distinguishing between malignant nodules and benign ones.Emphasis should be paid to lymph nodes in the dynamic enhanced computed tomography,which is useful both to the diagnosis of SPN and for surgical treatment.展开更多
The aim of this study was to prospectively assess the accuracy gain of Bayesian analysis-based computeraided diagnosis(CAD) vs human judgment alone in characterizing solitary pulmonary nodules(SPNs) at computed tomogr...The aim of this study was to prospectively assess the accuracy gain of Bayesian analysis-based computeraided diagnosis(CAD) vs human judgment alone in characterizing solitary pulmonary nodules(SPNs) at computed tomography(CT). The study included 100 randomly selected SPNs with a definitive diagnosis. Nodule features at first and follow-up CT scans as well as clinical data were evaluated individually on a 1 to 5 points risk chart by 7 radiologists, firstly blinded then aware of Bayesian Inference Malignancy Calculator(BIMC) model predictions. Raters' predictions were evaluated by means of receiver operating characteristic(ROC) curve analysis and decision analysis. Overall ROC area under the curve was 0.758 before and 0.803 after the disclosure of CAD predictions(P = 0.003). A net gain in diagnostic accuracy was found in 6 out of 7 readers. Mean risk class of benign nodules dropped from 2.48 to 2.29, while mean risk class of malignancies rose from 3.66 to 3.92. Awareness of CAD predictions also determined a significant drop on mean indeterminate SPNs(15 vs 23.86 SPNs) and raised the mean number of correct and confident diagnoses(mean 39.57 vs 25.71 SPNs). This study provides evidence supporting the integration of the Bayesian analysis-based BIMC model in SPN characterization.展开更多
Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemi...Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemic area. Methods: A quasi-observational study was conducted in the Pneumology Department of Yaounde Jamot Hospital (Cameroon) from January to March 2014. This included six observers (two chest physicians, two radiologists, two end-training residents in medical imaging) and 47 frontal CXRs (4 of diffuse interstitial lung disease, 6 normal, 7 of lung cancers, 7 of bacterial pneumonia, 23 of PTB). The sample size was calculated on the basis of an expected 0.47 Kappa with a spread of 0.13 (α = 5%, CI = 95%) for six observers and five diagnostic items. The analysis of concordance was focused on the detection of nodules, cavitary lesions, pleural effusion, adenomegaly and diagnosis of PTB and lung cancer. These intervals of kappa coefficient were considered: discordance (0.81). Results: The average score for the detection of caverns was the highest (58.3%) followed by that of the correct diagnosis of tuberculosis (49.3%). Pneumologists had the highest proportions of correct diagnosis of tuberculosis (69.6% and 73.9%) and better inter-observer agreement (k = 0.71) for PTB diagnosis. Observers were more in agreement for the detection of nodules (0.32 - 0.74), adenomegalies (0.43 - 0.69), and for the diagnosis of cancer (0.22 - 1) than for the diagnosis of tuberculosis (0.19 - 0.71). Disagreements were more frequent for the detection of pleural effusions (-0.08 - 0.73). Conclusion: The inter-observer agreement varies with the type of lesions and diagnosis. Pneumologists were most effective for the diagnosis of pulmonary tuberculosis. Observers were more in agreement for the detection of nodules and the diagnosis of cancer than for the diagnosis of pulmonary tuberculosis.展开更多
Research questions. How does a virtual bronchoscopy navigation system (VBNS) improve prediction of candidate bronchus across a range of doctors investigating a range of lesions with Endobronchial ultrasound (EBUS) gui...Research questions. How does a virtual bronchoscopy navigation system (VBNS) improve prediction of candidate bronchus across a range of doctors investigating a range of lesions with Endobronchial ultrasound (EBUS) guide sheath? To what extent do benefits of virtual bronchoscopic pre-procedure navigation apply to experienced versus inexperienced bron- choscopists? Methods: Using archived EBUS Guide sheath cases, a comparison was made between identified candidate 4th order bronchus by Computerised tomography (CT) evaluation versus that identified after virtual path creation. Results: From 7 archived cases, 14 doctors identified the correct bronchus in 94 of 98 assessments (95%). Percentage of cases where there was an improvement in localisation by 2 or more 4th order bronchi was 39.8% overall (28.6% – 51.0%), 26.6 for experienced and 53.1 for inexperienced bronchoscopists (p < 0.02). The absolute mean number of 4th order bronchi different between CT and VBNS was 2.0 ± 2.6 overall, 1.2 (range 0-6) for experienced, and 2.8 (range 0-11) for inexperienced bronchoscopists. Virtual Path software calculation time was 8.1 ± 2.7 minutes, compared to 3.6 ± 2.1 minutes by CT. Conclusion: VBNS allowed rapid accurate assessment with minimal software training. Greatest benefits in reduction of procedure time were obtained in inexperienced bronchoscopists, and VBNS could allow more rapid skill development in EBUS GS in these doctors.展开更多
Lung cancer is the leading cause of mortality in the world affectingboth men and women equally.When a radiologist just focuses on the patient’sbody, it increases the amount of strain on the radiologist and the likeli...Lung cancer is the leading cause of mortality in the world affectingboth men and women equally.When a radiologist just focuses on the patient’sbody, it increases the amount of strain on the radiologist and the likelihoodof missing pathological information such as abnormalities are increased.One of the primary objectives of this research work is to develop computerassisteddiagnosis and detection of lung cancer. It also intends to make iteasier for radiologists to identify and diagnose lung cancer accurately. Theproposed strategy which was based on a unique image feature, took intoconsideration the spatial interaction of voxels that were next to one another.Using the U-NET+Three parameter logistic distribution-based technique, wewere able to replicate the situation. The proposed technique had an averageDice co-efficient (DSC) of 97.3%, a sensitivity of 96.5% and a specificity of94.1% when tested on the Luna-16 dataset. This research investigates howdiverse lung segmentation, juxta pleural nodule inclusion, and pulmonarynodule segmentation approaches may be applied to create Computer AidedDiagnosis (CAD) systems. When we compared our approach to four otherlung segmentation methods, we discovered that ours was the most successful.We employed 40 patients from Luna-16 datasets to evaluate this. In termsof DSC performance, the findings demonstrate that the suggested techniqueoutperforms the other strategies by a significant margin.展开更多
目的:研究3D-Slicer软件实性肺结节体积测量对不同观察者在肺部影像报告数据系统(lung CT screening reporting and data system,Lung-RADS)分类一致性中的影响。方法:纳入76例患者中的76个实性结节。由3位放射科医师分别采用手动和3D-S...目的:研究3D-Slicer软件实性肺结节体积测量对不同观察者在肺部影像报告数据系统(lung CT screening reporting and data system,Lung-RADS)分类一致性中的影响。方法:纳入76例患者中的76个实性结节。由3位放射科医师分别采用手动和3D-Slicer软件半自动体积测量方法获得结节的直径与体积,并转化为相应的Lung-RADS评分,其中2分为阴性,3分及以上为阳性。采用同类相关系数(intraclass correlation coefficient,ICC)及Bland-Altman指数来评价观察者间直径与体积测量的一致性,Kappa分析评价观察者间Lung-RADS评分及阳性/阴性组间的一致性。结果:ICC分析结果显示手动直径测量的一致性(0.994~0.996)明显低于半自动体积测量的一致性(0.997~0.998),同时Bland-Altman指数分析结果显示手动直径测量的偏倚高于半自动体积测量。采用半自动体积测量,能够比手动直径测量明显提高观察者间Lung-RADS评分及阳性/阴性之间的一致性(0.963~0.975及0.957~0.977 vs.0.833~0.866及0.863~0.892)。结论:3D-Slicer半自动体积测量能够提高实性肺结节观察者间大小测量的一致性,相应的Lung-RADS分类一致性也随之提高。展开更多
近年来,随着肺结节的比例升高,术前经皮肺穿刺活检或经支气管镜活检越来越受到重视。大量临床证据也证实,Ⅰ期非小细胞肺癌(non-small cell lung cancer,NSCLC)的肺穿刺活检是安全可行的。但是,由于肺磨玻璃结节的组织学特点,与实性结...近年来,随着肺结节的比例升高,术前经皮肺穿刺活检或经支气管镜活检越来越受到重视。大量临床证据也证实,Ⅰ期非小细胞肺癌(non-small cell lung cancer,NSCLC)的肺穿刺活检是安全可行的。但是,由于肺磨玻璃结节的组织学特点,与实性结节相比穿刺时更容易发生出血或咳嗽,肿瘤细胞在血流或气流冲击下可能会沿着肺泡壁或针道种植,导致胸膜复发和气腔播散(spread through air spaces,STAS),尤其是胸膜下结节合并有脏层胸膜侵犯和淋巴细胞浸润时需要慎重选择。展开更多
文摘In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.
基金the National Natural Science Foundation of China,No.81972829.
文摘BACKGROUND Minute Pulmonary Meningothelial-like Nodules(MPMNs)are rare benign pulmonary nodules,which are more common in elderly women and have a higher detection rate in lung tissues of patients with lung malignant diseases.Its origin is not yet clear.At present,there are few reports on the diagnostic methods such as imaging and pathological manifestations of MPMNs.This article reports a 70-year-old female patient with pulmonary adenocarcinoma combined with MPMNs and reviews of the relevant literature.CASE SUMMARY A 70-year-old women was admitted to our institution with feeling sour in her back and occasional cough for more than 2 mo.Computerized electronic scanning scan and 3D reconstruction images in our institution showed there were multiple ground-glass nodules in both of her two lungs.The biggest one was in the apicoposterior segment of left upper lobe,about 2.5 mm×9 mm in size.We performed thoracoscopic resection of the left upper lung apicoposterior segment of the patient,and the final pathological report was minimally invasive adenocarcinoma.Re-examination of high resolution computed tomography 21 mo after surgery showed multiple ground-glass nodules in both lungs,and a new groundglass nodule was found in the superior segment of the right lower lobe.We took pathological biopsy of the right upper lung and right lower lung nodules for the patient under thoracoscopy.The histomorphology of the right lower lobe nodule showed multiple lesions in the lung tissue,and the small foci in the alveolar septum were distributed in mild form of the aggregation of short spindle cells.The immunohistochemistry showed that the lesion was epithelial membrane antigen(EMA)(+),somatostatin receptor 2a(SSTR2a)(+),S-100(-),chromogranin A(-),Syn(-),cytokeratin(-)and HMB-45(-).The final diagnosis was minimally invasive adenocarcinoma,accompanied by MPMNs.We recommend that patients continue to receive treatment after surgery and to do regular follow-up observations.CONCLUSION The imaging manifestations of MPMNs are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of MPMNs immunohistochemistry and shows that MPMNs are positive for EMA,SSTR2a,and progesterone receptor.
文摘Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes (breast cancer, prostate cancer, colon cancer, and pancreatic cancer) of cancer-related mortality combined (1). About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed (2). Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality (3). More recently,
文摘BACKGROUND Paragonimiasis is a food-borne parasitic infection caused by lung flukes of the genus Paragonimus. Although the most common site of infection is the pleuropulmonary area, the parasite can also reach other parts of the body on its journey from the intestines to the lungs, ending up in locations such as the brain,abdomen, skin, and subcutaneous tissues. Ectopic paragonimiasis is difficult to diagnose due to the rarity of this disease.CASE SUMMARY Here, we report a rare case of simultaneous breast and pulmonary paragonimiasis in a woman presenting painless breast mass and lung nodule with a history of eating raw trout. To confirm the diagnosis, serologic testing and tissue confirmation of the breast mass were performed. The patient was treated with surgical resection of the mass and praziquantel medication.CONCLUSION Ectopic paragonimiasis is difficult to diagnose due to the rarity of this disease.Thus, thorough history-taking and clinical suspicion of parasitic infection are important.
基金the Chongqing Science and Technology Committee,No.cstc2019jscxmsxmX0184.
文摘BACKGROUND Pulmonary benign metastatic leiomyoma(PBML),which is very rare,is a type of benign metastatic leiomyoma(BML).Here,we report a case of PBML,finally diagnosed through multidisciplinary team(MDT)discussions,and provide a literature review of the disease.CASE SUMMARY A 55-year old asymptomatic woman was found to have bilateral multiple lung nodules on a chest high-resolution computed tomography(HRCT)scan.Her medical history included total hysterectomy for uterine leiomyoma.The patient was diagnosed with PBML,on the basis of her clinical history,imaging manifestations,and computed tomography(CT)-guided percutaneous lung puncture biopsy,via MDT discussions.As the patient was asymptomatic,she received long-term monitoring without treatment.A follow-up of chest HRCT after 6 mo showed that the PBML lung nodules were stable and there was no progression.CONCLUSION For patients with a medical history of hysterectomy and uterine leiomyoma with lung nodules on chest CT,PBML should be considered during diagnosis based on the clinical history,imaging manifestations,CT-guided percutaneous lung puncture biopsy,and MDT discussions.
文摘Objective:To comprehensively and accurately analyze the out-performance of low-dose chest CT(LDCT)vs.standard-dose CT(SDCT).Methods:The image quality,size measurements and radiation exposure for LDCT and SDCT protocols were evaluated.A total of 117 patients with extra-thoracic malignancies were prospectively enrolled for non-enhanced CT scanning using LDCT and SDCT protocols.Three experienced radiologists evaluated subjective image quality independently using a 5-point score system.Nodule detection efficiency was compared between LDCT and SDCT based on nodule characteristics(size and volume).Radiation metrics and organ doses were analyzed using Radimetrics.Results:The images acquired with the LDCT protocol yielded comparable quality to those acquired with the SDCT protocol.The sensitivity of LDCT for the detection of pulmonary nodules(n=650)was lower than that of SDCT(n=660).There was no significant difference in the diameter and volume of pulmonary nodules between LDCT and SDCT(for BMI<22 kg/m^(2),4.37 vs.4.46 mm,and 43.66 vs.46.36 mm^(3);for BMI>22 kg/m^(2),4.3 vs.4.41 mm,and 41.66 vs.44.86 mm^(3))(P>0.05).The individualized volume CT dose index(CTDI_(vol)),the size specific dose estimate and effective dose were significantly reduced in the LDCT group compared with the SDCT group(all P<0.0001).This was especially true for dose-sensitive organs such as the lung(for BMI<22 kg/m^(2),2.62 vs.12.54 mSV,and for BMI>22 kg/m^(2),1.62 vs.9.79 mSV)and the breast(for BMI<22 kg/m^(2),2.52 vs.10.93 mSV,and for BMI>22 kg/m^(2),1.53 vs.9.01 mSV)(P<0.0001).Conclusion:These results suggest that with the increases in image noise,LDCT and SDCT exhibited a comparable image quality and sensitivity.The LDCT protocol for chest scans may reduce radiation exposure by about 80% compared to the SDCT protocol.
文摘Objective The purpose of this study is to appraise the value of incremental dynamic enhanced computed tomography in surgical treatment of patients with solitary pulmonary nodules(SPNs).Methods The data of 42 cases with solitary pulmonary nodules who underwent surgical treatment from May 2002 to June 2003 in our hospital were collected to find the relationship between preoperative dynamic enhanced CT image and postoperative pathology.Result All bronchogenic carcinoma showed significant enhancement after intravenous 100 mL iodinated contrast material.The average degree of enhancement of bronchogenic carcinoma was significantly different from that of tuberculoma and other benign lesions.Conclusion Dynamic enhanced computed tomography is very valuable in distinguishing between malignant nodules and benign ones.Emphasis should be paid to lymph nodes in the dynamic enhanced computed tomography,which is useful both to the diagnosis of SPN and for surgical treatment.
文摘The aim of this study was to prospectively assess the accuracy gain of Bayesian analysis-based computeraided diagnosis(CAD) vs human judgment alone in characterizing solitary pulmonary nodules(SPNs) at computed tomography(CT). The study included 100 randomly selected SPNs with a definitive diagnosis. Nodule features at first and follow-up CT scans as well as clinical data were evaluated individually on a 1 to 5 points risk chart by 7 radiologists, firstly blinded then aware of Bayesian Inference Malignancy Calculator(BIMC) model predictions. Raters' predictions were evaluated by means of receiver operating characteristic(ROC) curve analysis and decision analysis. Overall ROC area under the curve was 0.758 before and 0.803 after the disclosure of CAD predictions(P = 0.003). A net gain in diagnostic accuracy was found in 6 out of 7 readers. Mean risk class of benign nodules dropped from 2.48 to 2.29, while mean risk class of malignancies rose from 3.66 to 3.92. Awareness of CAD predictions also determined a significant drop on mean indeterminate SPNs(15 vs 23.86 SPNs) and raised the mean number of correct and confident diagnoses(mean 39.57 vs 25.71 SPNs). This study provides evidence supporting the integration of the Bayesian analysis-based BIMC model in SPN characterization.
文摘Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemic area. Methods: A quasi-observational study was conducted in the Pneumology Department of Yaounde Jamot Hospital (Cameroon) from January to March 2014. This included six observers (two chest physicians, two radiologists, two end-training residents in medical imaging) and 47 frontal CXRs (4 of diffuse interstitial lung disease, 6 normal, 7 of lung cancers, 7 of bacterial pneumonia, 23 of PTB). The sample size was calculated on the basis of an expected 0.47 Kappa with a spread of 0.13 (α = 5%, CI = 95%) for six observers and five diagnostic items. The analysis of concordance was focused on the detection of nodules, cavitary lesions, pleural effusion, adenomegaly and diagnosis of PTB and lung cancer. These intervals of kappa coefficient were considered: discordance (0.81). Results: The average score for the detection of caverns was the highest (58.3%) followed by that of the correct diagnosis of tuberculosis (49.3%). Pneumologists had the highest proportions of correct diagnosis of tuberculosis (69.6% and 73.9%) and better inter-observer agreement (k = 0.71) for PTB diagnosis. Observers were more in agreement for the detection of nodules (0.32 - 0.74), adenomegalies (0.43 - 0.69), and for the diagnosis of cancer (0.22 - 1) than for the diagnosis of tuberculosis (0.19 - 0.71). Disagreements were more frequent for the detection of pleural effusions (-0.08 - 0.73). Conclusion: The inter-observer agreement varies with the type of lesions and diagnosis. Pneumologists were most effective for the diagnosis of pulmonary tuberculosis. Observers were more in agreement for the detection of nodules and the diagnosis of cancer than for the diagnosis of pulmonary tuberculosis.
文摘Research questions. How does a virtual bronchoscopy navigation system (VBNS) improve prediction of candidate bronchus across a range of doctors investigating a range of lesions with Endobronchial ultrasound (EBUS) guide sheath? To what extent do benefits of virtual bronchoscopic pre-procedure navigation apply to experienced versus inexperienced bron- choscopists? Methods: Using archived EBUS Guide sheath cases, a comparison was made between identified candidate 4th order bronchus by Computerised tomography (CT) evaluation versus that identified after virtual path creation. Results: From 7 archived cases, 14 doctors identified the correct bronchus in 94 of 98 assessments (95%). Percentage of cases where there was an improvement in localisation by 2 or more 4th order bronchi was 39.8% overall (28.6% – 51.0%), 26.6 for experienced and 53.1 for inexperienced bronchoscopists (p < 0.02). The absolute mean number of 4th order bronchi different between CT and VBNS was 2.0 ± 2.6 overall, 1.2 (range 0-6) for experienced, and 2.8 (range 0-11) for inexperienced bronchoscopists. Virtual Path software calculation time was 8.1 ± 2.7 minutes, compared to 3.6 ± 2.1 minutes by CT. Conclusion: VBNS allowed rapid accurate assessment with minimal software training. Greatest benefits in reduction of procedure time were obtained in inexperienced bronchoscopists, and VBNS could allow more rapid skill development in EBUS GS in these doctors.
基金supported by the Ministry of SMEs and Startups (MSS),Korea,under the“Startup growth technology development program (R&D,S3125114)”by the Ministry of Small and Medium-sized Enterprises (SMEs)and Startups (MSS),Korea,under the“Regional Specialized Industry Development Plus Program (R&D,S3246057)”supervised by the Korea Institute for Advancement of Technology (KIAT).
文摘Lung cancer is the leading cause of mortality in the world affectingboth men and women equally.When a radiologist just focuses on the patient’sbody, it increases the amount of strain on the radiologist and the likelihoodof missing pathological information such as abnormalities are increased.One of the primary objectives of this research work is to develop computerassisteddiagnosis and detection of lung cancer. It also intends to make iteasier for radiologists to identify and diagnose lung cancer accurately. Theproposed strategy which was based on a unique image feature, took intoconsideration the spatial interaction of voxels that were next to one another.Using the U-NET+Three parameter logistic distribution-based technique, wewere able to replicate the situation. The proposed technique had an averageDice co-efficient (DSC) of 97.3%, a sensitivity of 96.5% and a specificity of94.1% when tested on the Luna-16 dataset. This research investigates howdiverse lung segmentation, juxta pleural nodule inclusion, and pulmonarynodule segmentation approaches may be applied to create Computer AidedDiagnosis (CAD) systems. When we compared our approach to four otherlung segmentation methods, we discovered that ours was the most successful.We employed 40 patients from Luna-16 datasets to evaluate this. In termsof DSC performance, the findings demonstrate that the suggested techniqueoutperforms the other strategies by a significant margin.
文摘目的:研究3D-Slicer软件实性肺结节体积测量对不同观察者在肺部影像报告数据系统(lung CT screening reporting and data system,Lung-RADS)分类一致性中的影响。方法:纳入76例患者中的76个实性结节。由3位放射科医师分别采用手动和3D-Slicer软件半自动体积测量方法获得结节的直径与体积,并转化为相应的Lung-RADS评分,其中2分为阴性,3分及以上为阳性。采用同类相关系数(intraclass correlation coefficient,ICC)及Bland-Altman指数来评价观察者间直径与体积测量的一致性,Kappa分析评价观察者间Lung-RADS评分及阳性/阴性组间的一致性。结果:ICC分析结果显示手动直径测量的一致性(0.994~0.996)明显低于半自动体积测量的一致性(0.997~0.998),同时Bland-Altman指数分析结果显示手动直径测量的偏倚高于半自动体积测量。采用半自动体积测量,能够比手动直径测量明显提高观察者间Lung-RADS评分及阳性/阴性之间的一致性(0.963~0.975及0.957~0.977 vs.0.833~0.866及0.863~0.892)。结论:3D-Slicer半自动体积测量能够提高实性肺结节观察者间大小测量的一致性,相应的Lung-RADS分类一致性也随之提高。
文摘近年来,随着肺结节的比例升高,术前经皮肺穿刺活检或经支气管镜活检越来越受到重视。大量临床证据也证实,Ⅰ期非小细胞肺癌(non-small cell lung cancer,NSCLC)的肺穿刺活检是安全可行的。但是,由于肺磨玻璃结节的组织学特点,与实性结节相比穿刺时更容易发生出血或咳嗽,肿瘤细胞在血流或气流冲击下可能会沿着肺泡壁或针道种植,导致胸膜复发和气腔播散(spread through air spaces,STAS),尤其是胸膜下结节合并有脏层胸膜侵犯和淋巴细胞浸润时需要慎重选择。