Clinical significance of mesenteric panniculitis-like abnormalities on abdominal computerized tomography in patients with malignant neoplasms

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.

Temporal Trends in Radiation Dose Associated with Coronary Computed Tomography Angiography

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.

The Different Patterns of Coronary Artery Calcification in Acute and Chronic Coronary Syndromes Determined by Electron Beam Computed Tomography

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.

Application of polycapillary x ray lens to eliminate both the effect of x ray source size and scatter of the sample in laboratory tomography

A tomography device based on a conventional laboratory x ray source, polycapillary parallel x ray lens （PPXRL）, and polycapillary collimating x ray lens （PCXRL） is designed. The PPXRL can collect the divergent x ray beam from the source and focus it into a quasi-parallel x ray beam with a divergence of 4.7 rarad. In the center of quasi-parallel x ray beam, there is a plateau region with an average gain in power density of 13.8 and a diameter of 630μm. The contrast of the image can be improved from 28.9% to 56.0% after adding the PCXRL between the sample and the detector.

Comparison of preoperative TN staging of gastric carcinoma by endoscopic ultrasonography with CT examination

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月经前期发作的鼻源性头痛

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。

食管黏膜下异物的CT诊断

总结1995-2004年10年间治疗的351例食管异物患者其中首次手术未发现异物12例，X线透视检查无阳性表现15例。此27例患者．经CT薄层扫描确诊，行食管镜检查取出并治愈，现报道如下。

多层CT灌注成像诊断周围型肺癌及与微血管密度对照研究

目的:探讨多层螺旋CT(MSCT)灌注成像技术诊断肺癌的临床价值及其与肿瘤微血管密度(MVD)的相关性。方法:利用16层MSCT灌注成像技术前瞻性研究38例经手术病理证实的肺肿瘤(周围型肺癌25例,肺良性肿块13 例),并与25例肺癌的免疫组化法MVD进行相关性研究。采用Perfusion 2体部肿瘤灌注软件包分析以下灌注参数:血液流速(BF)、血流量(BV)、平均通过时间(MTT)和表面通透性(PS)。结果:肺癌各项CT灌注参数值均高于肺良性肿块, 其中MTT和PS值在两组之间差异有显著性意义(P<0．05),BV值差异有极显著性意义(P<0．01);肺癌的MVD明显高于肺良性肿块(P<0．05),肺腺癌MVD高于肺鳞癌(P<0．05);肺癌仅BV值与其MVD呈正相关性(r=0．852,P< 0．01)。结论:MSCT灌注成像有助于周围型肺癌的诊断及与良性肿瘤的鉴别诊断,其病理基础与肿瘤微血管密度有关。

降低毫安秒对新生儿头颅CT质量的影响

目的探讨新生儿头颅CT扫描中降低mAs与图像质量的关系及低剂量CT扫描的可行性。方法将80例新生儿头颅CT检查随机分为三组进行前瞻性研究，其中100mAs组35例，225mAs组21例，260mAs组24例。由两名有经验的放射医师以双盲的方法使用4分制评分，对三组图像中头部六个部位的解剖结构的清晰度进行评分，说明CT图像质量的优良程度。使用方差分析检查三组图像质量评分有无显著性差异。结果所有图像质量均能满足诊断要求。2个阅读者对三组不同毫安秒图像中1～6解剖部位的总评分差异均无显著性，对每一个解剖部位的评分中，260mAs组及225mAs组稍高于100mAs组，但三组中两两比较无显著性差异（P〉0．05）。结论应用100mAs低剂量新生儿头颅CT扫描是可行的，图像质量能够满足临床要求。

A CT-based radiomics nomogram for prediction of human epidermal growth factor receptor 2 status in patients with gastric cancer

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.

Findings of non-pathologic perfusion defects by CT arterial portography and non-pathologic enhancement of CT hepatic arteriography

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多层螺旋CT诊断冠状动脉疾病的发展趋势

多层螺旋CT(multidetector spiral computed tomography,MDCT)在CAD诊断领域的主要适应证有:测定冠状动脉钙化积分(coronary artery calcium score,CACS)、CT冠状动脉造影、评价心肌功能及冠心病(coronary artery disease,CAD)在治疗后的随访。据报道,CACS用于诊断CAD的敏感性范围在68.0%～100%,特异性范围在21.0%～100%。高CACS是一个敏感性很高但特异性相对较低的指标,与常规冠状动脉造影(coronary angiography,CAG)相比,16排MDCT的冠状动脉造影在诊断冠状动脉狭窄(350%)时具有中高度敏感性和高度阴性预测值(negative predictive value,NPV)。与之相比,64排MDCT的敏感性和NPV更高,但特异性与阳性预测值(positive predictive value,PPV)却无明显提高。将冠状动脉形态学与心肌灌注功能研究相结合,是今后CAD的研究方向。

Role of cardiac CTA in estimating left ventricular volumes and ejection fraction

Left ventricular ejection fraction(LVEF)is an impor-tant predictor of cardiac outcome and helps in makingimportant diagnostic and therapeutic decisions suchas the treatment of different types of congestive heartfailure or implantation of devices like cardiac resynchro-nization therapy-defibrillator.LVEF can be measuredby various techniques such as transthoracic echo-cardiography,contrast ventriculography,radionuclidetechniques,cardiac magnetic resonance imaging andcardiac computed tomographic angiography(CTA).Thedevelopment of cardiac CTA using multi-detector rowCT(MDCT)has seen a very rapid improvement in thetechnology for identifying coronary artery stenosis andcoronary artery disease in the last decade.During theacquisition,processing and analysis of data to studycoronary anatomy,MDCT provides a unique opportunityto measure left ventricular volumes and LVEF simulta-neously with the same data set without the need foradditional contrast or radiation exposure.The develop-ment of semi-automated and automated software to measure LVEF has now added uniformity,efficiency and reproducibility of practical value in clinical practice rather than just being a research tool.This article will address the feasibility,the accuracy and the limitations of MDCT in measuring LVEF.

鼻咽癌复发的CT分析

目的 提高对鼻咽癌复发的认识，回顾50例鼻咽癌复发的CT影像资料及临床资料，把鼻咽癌复发的CT诊断因素分为病灶区域的变化、病灶密度的变化以及颅神经受损的变化：分析其变化的原因，并把病灶的区域变化划分分原灶的复发、边缘性灶的复发和异灶的复发；了解区域复发的机率性；而病灶密度的变化主要是与放疗后纤维化肿块的相互区别。通过分析，对鼻咽癌复发的诊断，单因素一般较难，要综合上述因素分析，并结合临床，才能提高诊断率。

Time-resolved multispectral X-ray imaging with multi-channel Kirkpatrick-Baez microscope for plasma diagnostics at Shenguang-II laser facility

A time-resolved multispectral X-ray imaging approach with new version of multi-channel Kirkpatrick- Baez （KB） microscope is developed for laser plasma diagnostics at the kilo joule-class Shenguang-II laser facility （SG-II）. The microscope uses a total external reflection mirror in the sagittal direction and an array of multilayer mirrors in the tangential direction to obtain multiple individual high-resolution, high- throughput, and quasi-monochromatic X-ray images. The time evolution of the imploded target in multiple X-ray energy bands can be acquired when coupled with an X-ray streak camera. The experimental result of the time-resolved 2.5 and 3.0 keV dual-spectral self-emission imaging of the undoped CH shell target on SG-II is given.

肺部真菌感染的CT影像学特点

目的:探讨肺部真菌感染的CT影像学特点,提高对该病的认识。方法:回顾性分析26例经病理、真菌培养、临床治疗随访证实的肺部真菌感染的CT表现。结果:26例病变均累及多个肺段、肺叶和/或两侧肺,而且多种病变形态共存,其中肺炎性浸润实变、结节型12例,炎性浸润实变、肿块型3例,炎性浸润实变、结节、肿块型5例,多发结节型11例,结节、肿块型5例;13例出现"晕征",3例有"空气半月征";12例合并空洞,5例曲菌球,7例有楔形实变影,4例胸腔积液。结论:肺部真菌感染CT表现为病变呈多灶性、多态性,真菌感染的"晕征"及楔形实变影是早期肺部真菌感染的较特征性CT表现。

CT Manifestations of Lung Changes and Complications in Patients with Severe Acute Respiratory Syndrome

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.

Clinical and imaging findings in patients with severe acute respiratory syndrome

Objective To investigate the clinical and imaging characteristics of severe acute respiratory syndrome (SARS), and to study their relationship Methods Forty six SARS confirmed patients were admitted to our hospital from February to April, 2003 X ray examination documents were available in all cases and chest CT scanning was acquired in 6 cases, which were analyzed retrospectively, accompanied by their clinical features Results Fever was found in 97 8% of the patients Clinical symptoms were mild, but X ray and CT findings were distinct CT scanning demonstrated ground glass like lesions and large patchy exudation and consolidation at the early stage in 6 cases Different findings on radiography and CT were related to the different phases of the disease After treatment, most lesions were absorbed completely, but slowly in patients with multi lobe consolidation and/or extensive interstitial infiltration Conclusion Special clinical and imaging findings could be found in SARS cases The prognosis of SARS patients is related to the degree of lesions detected by radiography and CT

CT virtual bronchoscopy: imaging method and clinical application

To evaluate the imaging method and clinical application of CT virtual bronchoscopy (CTVB) Methods Fifty two patients with bronchial and pulmonary diseases were studied with CTVB All patients underwent fiberoptic bronchoscopy and patients with lung cancers were confirmed pathologically Lung cancer of center type was found in 46 patients, postoperative lung cancer in 4, tracheal adenoidcystic carcinoma in 1, and bronchial diverticulum in 1 CTVB was performed using Navigator Smooth software on the workstation(Advantage Windows 3 1, GE Medical Systems) Source images included slice thickness of 3?mm or 5?mm, pitch of 1 0 or 1 5, 1 0?mm or 2 0?mm interval (overlap more than 60%) reconstruction Results CTVB could reveal vividly the tracheo^bronchial lumens, the cartilage rings, the carina and the left and right main bronchi, down to the fourth order of bronchial orifices, mimicing fiberoptic bronchoscopy Among 46 patients with lung cancers of center type, fiberoptic bronchoscopy showed the masses in 45 patients and CTVB displayed the masses in 42 The sensitivity of CTVB was 93 3% and its accuracy was 93 5% (χ 2=1 33, 0 10< P <0 25) The tumors appeared as masses or nodules, causing bronchial stenosis (n=35) or occlusion (n=7). The bronchial rings near the masses were blurred, smooth or absent in contrast to the findings of fiberoptic endoscopy Postoperative bronchial stump (n=4) appeared to be smooth Bronchial diverticulum exhibited a local concavity on CTVB and local protrusion on surface shadow display (SSD) CTVB could pass through the stenotic bronchi and detect the occlusive bronchi from the distal end Conclusions The sensitivity of CTVB in detecting bronchial masses was higher than that of fiberoptic bronchoscopy Combined with multiplanar reconstruction (MPR) and CTVB can demonstrate the extraluminal extension of tumors As a noninvasive examining method, however, CTVB is limited to observe mucosal abnormalities and to obtain histologic samples