Chest CT quantitative parameters in patients with acute exacerbation of chronic obstructive pulmonary disease:Correlations with blood eosinophil level

Objective To observe the correlations of chest CT quantitative parameters in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with blood eosinophil(EOS)level.Methods Chest CT data of 162 AECOPD patients with elevated eosinophils were retrospectively analyzed.The patients were divided into low EOS group(n=105)and high EOS group(n=57)according to the absolute counting of blood EOS.The quantitative CT parameters,including the number of whole lung bronchi and the volume of blood vessels,low-attenuation area percentage(LAA%)of whole lung,of left/right lung and each lobe of lung,as well as the luminal diameter(LD),wall thickness(WT),wall area(WA)and WA percentage of total bronchial cross-section(WA%)of grade 3 to 8 bronchi were compared between groups.Spearman correlations were performed to analyze the correlations of quantitative CT parameters with blood EOS level.Results LAA%of the whole lung,of the left/right lung and each lobe of lung,as well as of the upper lobe of right lung LD grade 4,middle lobe of right lung WT grade 5,upper lobe of right lung WA grade 4,middle lobe of right lung WA grade 5 and lower lobe of left lung WA grade 3 in low EOS group were all higher than those in high EOS group(all P<0.05).Except for the upper lobe of right lung LD grade 4,the above quantitative CT indexes being significant different between groups were all weakly and negatively correlated with blood EOS level(r=-0.335 to-0.164,all P<0.05).Conclusion Chest CT quantitative parameters of AECOPD patients were correlated with blood EOS level,among which LAA%,a part of WT and WA were all weakly negatively correlated with blood EOS level.

Values of high-resolution computed tomography and pulmonary function tests in managements of patients with chronic hepatitis C virus infection

AIM:To investigate pulmonary involvement via pulmonary function tests (PFT) and high-resolution computed tomocjraphy (HRCT) in patients with chronic hepatitis C virus (HCV) infection. METHODS:Thirty-four patients with chronic HCV infection without diagnosis of any pulmonary diseases and 10 healthy cases were enrolled in the study,PFT and HRCT were performed in all cases. RESULTS:A decrease lower than 80% of the predicted value was detected in vital capacity in 9/34 patients,in forced expiratory volume in one second in 8/34 patients,and in forced expiratory flow 25-75 in 15/34 patients,respectively.Carbon monoxide diffusing capacity (DLCO) was decreased in 26/34 patients.Findings of interstitial pulmonary involvement were detected in the HRCT of 16/34 patients.Significant difference was found between controls and patients with HCV infection in findings of HRCT (X^2=4.7,P=0.003).Knodell histological activity index (KHAI) of 28/34 patients in whom liver biopsy was applied was 9.0±4.7.HRCT findings,PFT values and DLCO were not affected by KHAI in patients with HCV infection.In these patients,all the parameters were related with age. CONCLUSION:We suggest that chronic hepatitis C virus infection may cause pulmonary interstitial involvement without evident respiratory symptoms.

Utility of Spiral Computed Tomography in the Study of Dislocation of Cricoarytenoid Joint

The cricoarytenoid relationship presented with spiral computed tomography was demonstrated and the reconstruction of arytenoid dislocation was presented by using multiplanar reconstruction algorithms. Fifteen patients with arytenoid dislocation documented by fiberoptic laryngoscopy and strobovideolaryngoscopy and 10 normal persons were displayed by spiral computed tomography (CT). A making design of our own had been used to diagnose arytenoid dislocation on axial CT image. Results showed that dislocation of cricoarytenoid joint was consistently demonstrated on several of the overlapping thin axial reconstructions in each of the 15 patients, in whom asymmetry of the bilateral cricoarytenoid joints was noted on axial images. It was found that on the glottic-fissure level the basal angle on abnormal side was larger in 8 patients than that on the normal side and smaller in 7 patients in patient group, whereas right basal angle was equal to the left in 8 subjects, except 2 in control group. There was statistically significant difference in the number of the equal to two basal angles of glottic fissure between control group and patient group (P<0.025). High-quality sagittal and coronal reconstructive images often were helpful in confirming or clarifying the complex arytenoid orientations. The findings that two-side basal angle was not equal in triangle of glottic fissure can be used as an objective parameter to diagnose arytenoid dislocation. Spiral CT is a useful adjunct in the diagnosis and treatment of dislocation of cricoarytenoid joint.

Multicentric hyaline-vascular Castleman's disease in the retroperitoneum

BACKGROUND:Castleman’s disease is a rare lymphoproliferative disease of unknown cause.Most multicentric cases described have been of the plasma-cell variety.This article presents a case of multicentric hyaline-vascular Castleman’s disease in the retroperitoneum with the ultrasonographic and computed tomography(CT)imaging manifestations. METHODS:During routine physical examination,a mass was detected in the left abdomen of a 53-year-old man with no signs or symptoms.The patient underwent ultrasoundguided aspiration biopsy and operative excision after laboratory examination,ultrasonography,and CT. RESULTS:Ultrasonography demonstrated a dominant hypoechogenic mass with hypervascularity in the retroperitoneum.CT detected a relatively homogenous enhanced lesion and several satellite nodules.After the mass and several lymph nodes were resected, histopathologic examination demonstrated a lymphocytepredominant infiltrate surrounding the germinal centres and extensive capillary proliferation,consistent with the hyaline-vascular type of Castleman’s disease.The patient received postoperative chemotherapy and remained free of recurrence 3 months later. CONCLUSION:Ultrasonography and contrast-enhanced CT can provide a positive differential diagnosis of hyalinevascular Castleman’s disease which is a kind of giant lymph node hyperplasia with hypervascularity.

Solitary hyoid plasmacytoma with unicentric Castleman disease:A case report and review of literature

BACKGROUND Solitary plasmacytoma and unicentric Castleman disease(UCD)are rare lymphoproliferative disorders characterized by monoclonal plasma cells and a single set of locally enlarged lymph nodes,respectively.CASE SUMMARY A 48-year-old Han Chinese man presented to our department with a neck mass and progressive foreign body sensation in his throat.18F-FDG positron emission tomography revealed focally increased radioactivity centered around the hyoid,and computed tomography(CT)revealed osteolytic lesions.Histopathology revealed Castleman-like features and CD138/CD38-positive mature plasma cells.Systemic work-up ruled out the possibility of POEMS syndrome,lymphoma,and multiple myeloma,leading to a final diagnosis of solitary hyoid plasmacytoma with UCD.The patient underwent partial hyoid resection and selective neck dissection,followed by intensity-modulated radiotherapy.99mTc-MDP singlephoton emission computed tomography/CT reevaluation showed neither local recurrence nor distant bone metastasis at the 40-mo follow-up.CONCLUSION The diagnostic process and differential diagnosis of this rare case provided valuable educational information to clinicians.

CASTLEMAN＇S DISEASE OF THE ABDOMINAL REGION IN ADOLESCENT

Objective To describe the CT features of abdominal Castleman's disease(CD)in adolescent.Methods Abdomen CT of four adolescents ranging in age from 7 years to 17 years diagnosed as abdominal region CD were reviewed.One case was retroperitoneal CD;one case was lesser omentum CD;and the other two cases were mesenteric CD.Three of four cases underwent post enhancement,and one case was only done no contrast CT as the reason of media hypersusceptibility.One case underwent needle biopsy.Three cases were removed by surgical resection.Results Isolated or multiple well-defined homogenous masses with homogenously enhanced after underwent enhancement was the common finding in these four cases.Conclusion Recognition of the CT features and highlights the histological specimen of CD is helpful to diagnose CD.

Bone diseases in rabbits with hyperparathyroidism: computed tomography, magnetic resonance imaging and histopathology

Background Hyperparathyroidism （HPT） occurs at an early age and has a high disability rate. Unfortunately, confirmed diagnosis in most patients is done at a very late stage, when the patients have shown typical symptoms and signs, and when treatment does not produce any desirable effect. It has become urgent to find a method that would detect early bone diseases in HPT to obtain time for the ideal treatment. This study evaluated the accuracy of high field magnetic resonance imaging （MRI） combined with spiral computed tomography （SCT） scan in detecting early bone diseases in HPT, through imaging techniques and histopathological examinations on an animal model of HPT. Methods Eighty adult rabbits were randomly divided into two groups with forty in each. The control group was fed normal diet （Ca：P = 1：0.7）; the experimental group was fed high phosphate diet （Ca：P = 1：7） for 3, 4, 5, or 6-month intervals to establish the animal model of HPT. The staging and imaging findings of the early bone diseases in HPT were determined by high field MRI and SCT scan at the 3rd, 4th, 5th and 6th month. Each rabbit was sacrificed after high field MRI and SCT scan, and the parathyroid and bones were removed for pathological examination to evaluate the accuracy of imaging diagnosis. Results Parathyroid histopathological studies revealed hyperplasia, osteoporosis and early cortical bone resorption. The bone diseases in HPT displayed different levels of low signal intensity on T1WI and low to intermediate signal intensity on T2WI in bone of stage 0, Ⅰ, Ⅱ or Ⅲ, but showed correspondingly absent, probable, osteoporotic and subperiosteal cortical resorption on SCT scan. Conclusion High field MRI combined with SCT scan not only detects early bone diseases in HPT, but also indicates staging, and might be a reliable method of studying early bone diseases in HPT.

Impact of X-radiation in the management of COVID-19 disease

Coronaviruses are a diverse group of viruses that infect both animals and humans.Even though the existence of coronavirus and its infection to humans is not new,the 2019-novel coronavirus(nCoV)caused a major burden to individuals and society i.e.,anxiety,fear of infection,extreme competition for hospitalization,and more importantly financial liability.The nCoV infection/disease diagnosis was based on non-specific signs and symptoms,biochemical parameters,detection of the virus using reverse-transcription polymerase chain reaction(RTPCR),and X-ray-based imaging.This review focuses on the consolidation of potentials of X-ray-based imaging modality[chest-X radiography(CXR)and chest computed tomography(CT)]and low-dose radiation therapy(LDRT)for screening,severity,and management of COVID-19 disease.Reported studies suggest that CXR contributed significantly toward initial rapid screening/diagnosis and CT-imaging to monitor the disease severity.The chest CT has high sensitivity up to 98%and low specificity for diagnosis and severity of COVID-19 disease compared to RT-PCR.Similarly,LDRT compliments drug therapy in the early recovery/Less hospital stays by maintaining the physiological parameters better than the drug therapy alone.All the results undoubtedly demonstrated the evidence that X-ray-based technology continues to evolve and play a significant role in human health care even during the pandemic.

胸部Castleman病的X线和CT表现与病理对照

目的 讨论胸部Castleman病X线和CT表现以及病理特征。资料与方法 胸部Castleman病 12例 ,男 5例 ,女 7例 ,平均年龄 35岁。局限型 10例 ,弥漫型 2例。均经手术和病理证实。结果 病理上包括透明血管型 10例和浆细胞型 2例。X线和CT扫描 :10例局限型为平均直径 4.9cm大小的单发软组织肿块 ,位于中纵隔或肺门者4例 ,前纵隔和后纵隔各 3例。平扫CT值平均 40HU ,增强扫描呈早期显著均匀强化 ,CT值平均 133HU ,延迟扫描仍持续强化 ,CT值平均 92HU ,2例伴有中央区分支状钙化。 2例弥漫型表现为双侧中等量胸腔积液 ,纵隔内多个直径1～ 2cm大小的淋巴结 ,胸膜下小结节影和支气管血管束周围结节影。术前CT误诊率为 83.3%。结论 胸部局限型Castleman病以强化明显或中央伴有分支状钙化的巨大孤立肿物为特征 ,CT增强扫描有助于明确诊断和临床分型。弥漫型Castleman病的影像学表现复杂多样 ,确诊主要依靠病理和免疫组织化学检查。

Castleman病的CT表现(附9例报告)

目的分析Castleman病的CT表现,提高对其的认识。资料与方法回顾性分析9例经手术病理证实的Castleman病患者CT表现,总结其特征。结果9例中5例位于纵隔和右肺门,左颈部和腹膜后各2例。9例中局限型8例,弥漫型1例。局限型8例病理诊断均为透明血管型,CT平扫与肌肉相比呈等密度;动态增强CT扫描,多数肿块动脉期明显强化,在延迟期均表现为持续强化,强化程度接近大动脉。弥漫型1例为浆细胞型,表现为腹膜后多个软组织结节,轮廓光整,轻度强化。结论Castleman病的CT表现与组织病理学密切相关,局限透明血管型CT表现具有一定特征性;弥漫浆细胞型无特征性影像学表现,确诊依赖组织病理学。

Differential diagnosis of coronavirus disease 2019 from community-acquired-pneumonia by computed tomography scan and follow-up

Objective Coronavirus disease 2019(COVID-19)is currently the most serious infectious disease in the world.An accurate diagnosis of this disease in the clinic is very important.This study aims to improve the differential ability of computed tomography(CT)to diagnose COVID-19 and other community-acquired pneumonias(CAPs)and evaluate the short-term prognosis of these patients.Methods The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province,China from January 21 to February 28,2020 were retrospectively analysed.The CT manifestations of the two groups were recorded and compared.A correlation analysis was used to examine the relationship between COVID-19 and age,size of lung lesions,number of involved lobes,and CT findings of patients.The factors that were helpful in diagnosing the two groups of patients were identified based on specificity and sensitivity.Results The typical CT findings of COVID-19 are simple ground-glass opacities(GGO),GGO with consolidation or grid-like changes.The sensitivity and specificity of the combination of age,white blood cell count,and ground-glass opacity in the diagnosis of COVID-19 were 92.7 and 66.1%,respectively.Pulmonary consolidation,fibrous cords,and bronchial wall thickening were used as indicators to exclude COVID-19.The sensitivity and specificity of the combination of these findings were 78.0 and 63.6%,respectively.The follow-up results showed that 67.8%(112/165)of COVID-19 patients had abnormal changes in their lung parameters,and the severity of the pulmonary sequelae of patients over 60 years of age worsened with age.Conclusions Age,white blood cell count and ground-glass opacity have high accuracy in the early diagnosis of COVID-19 and the differential diagnosis from CAP.Patients aged over 60 years with COVID-19 have a poor prognosis.This result provides certain significant guidance for the diagnosis and treatment of new coronavirus pneumonia.

多中心型Castleman病的CT表现特征及其病理学基础

目的:探讨多中心型Castleman病(MCD)的CT表现特征及其病理学基础。方法:回顾性分析经手术病理证实的9例MCD患者的CT表现及病理资料。所有患者均行CT平扫和增强扫描。结果:9例患者中1例为透明血管型,8例为浆细胞型,且其中1例为多中心型CD继发大B细胞淋巴瘤。增大淋巴结位于颈部7例,腋窝8例,胸部7例,腹部6例,腹股沟区6例,平扫呈软组织密度,增强扫描呈明显均匀强化。2例浆细胞型可见肺内病变,其中1例以双肺多发磨玻璃病灶及薄壁空腔为主,1例以弥漫性分布的小结节和多发小叶间隔增厚为主。所有患者中伴脾脏增大4例,伴肝脏及脾脏增大1例,以其中1例继发大B细胞淋巴瘤者脾脏增大明显,最大径≥15.0cm。结论:MCD的CT表现以全身多部位的多发淋巴结增大为主,平扫呈软组织密度,增强扫描呈明显均匀强化,其肺内表现为肺间质性病变,浆细胞型MCD伴脾脏明显增大时有继发淋巴瘤的可能。

胸腹部局灶型Castleman病的CT和MRI征象分析

目的 探讨胸腹部局灶型Castleman病（LCD）的CT、MRI征象,进一步提高对本病的认识。方法 回顾性分析20例经手术病理证实的LCD的CT和MRI影像资料,包括肿块的位置、大小（最长径）、形态、边缘、钙化、内部密度或信号、强化程度及强化方式、滋养血管及周围淋巴结卫星灶等情况。结果 纵隔4例,腹腔4例,腹膜后12例,大小1~9cm（平均4.5cm）;边缘光滑15例（75%）,边缘不清1例,部分不清4例;肾形或类肾形15例（75%）,类圆形4例,不规则形1例;6例钙化（30%）为斑块、分支状或弧形;14例（70%）平扫为较均匀密度或信号改变,4例MR平扫为较均匀信号,T1WI呈低或略低信号,T2WI抑脂呈略高或等信号,DWI略高信号,所有病灶动脉期明显强化伴后期持续强化;滋养血管11例（55%）;周围淋巴结卫星灶14例（70%）。结论 肾形外观,质地均匀、持续且明显强化是胸腹部LCD一定特征表现,滋养血管、周围卫星灶及病灶内钙化存在可提示LCD诊断。

局灶性透明血管型Castleman病的影像学表现与病理特点

目的分析局灶性透明血管型Castleman病(HV-LCD)的影像特征和病理特点,提高诊断准确率。方法回顾性分析经手术病理证实的11例局灶性HV-CD患者的影像及病理资料。结果 11例局灶性HV-CD中,4例位于颈部,4例位于腹膜后,2例位于肠系膜,1例位于纵隔。10例行CT检查,2例行MRI检查,5例行多普勒超声检查。所有病例病灶均呈软组织肿块灶,10例为单发,1例多发位于双侧颈部,所有病灶未见明显钙化灶。MRI平扫呈均匀等T1,长T2信号; 5例多普勒超声检查表现为圆形,椭圆形低回声光团,4例其内可见丰富血流信号显示。CT及MRI增强扫描:动脉期6例明显强化,5例静脉期及延时期强化范围扩大。9例病灶分布在大血管旁,周围小血管增多,6例周围可见增大的淋巴结。结论对于局灶性HV-CD,多种影像学检查与病理相互印证,对于本病的诊断具有重要价值。

胸部Castleman病的CT表现特点

目的探讨胸部Castleman病的CT影像特点,进一步提高该病的影像诊断水平。方法回顾性分析6例经临床病理证实的Castleman病的临床资料及CT表现。结果 6例中,中纵膈3例,后纵膈1例,右肺门2例,平扫呈均匀等密度,增强扫描多数呈均匀明显强化,强化程度接近于大血管,部分病灶内见灶性低密度。结论胸部Castleman病具有典型的CT表现特征,CT具有较高的诊断价值。

Castleman病CT影像特征

目的探讨Castleman病的CT影像特征,提高对Castleman病的认识,减少术前误诊.方法对13例经病理学证实为Castleman病的临床资料及CT影像资料进行回顾性分析.结果局灶型9例,其中胸部4例(肺内2例,纵隔2例),腹部5例(腹腔1例、腹膜后4例);9例局灶型术后病理均为透明血管型.多中心型4例,分布于肺、腋窝及腹股沟.术后病理结果:透明血管型10例、浆细胞型1例、混合型2例.所有病例CT平扫均表现为软组织密度的肿块或结节,境界清楚,2例局灶型肿块内见斑点状、分支状钙化灶;增强扫描9例局灶型动脉期病灶均明显强化,延时期强化程度有减低,但呈持续强化,3例局灶型肿块周围见散在增大的淋巴结,病理证实为反应性淋巴结炎.4例多中心型表现无明显特征性,2例动脉期明显强化,2例轻-中度强化,1例延迟期强化较动脉期明显.结论局灶型Castleman病以透明血管型多见,CT具有一定的特征性,表现为境界清楚的软组织密度肿块,动脉期明显强化、延迟期强化有减退,但呈持续强化,可伴有钙化及卫星灶;但多中心型Castleman病CT相对无明显特征.

Castleman病的影像学表现与手术、病理对照分析

目的探讨Castleman病的CT、MR及血管造影的影像学特征,以期在术前做出正确诊断。方法回顾性分析经手术、病理证实的16例Castleman病患者的临床、影像、手术及病理资料。结果 16例患者按病理分型:透明血管型12例,浆细胞型1例,混合型3例。按临床分型:为局灶型13例,多中心型3例。影像学表现:CT扫描15例,平扫表现病灶为直径1.3～20 cm[平均(6.21±4.75)cm]大小的单发、多发结节或软组织肿块,其中1例盆腔病变内可见簇状钙化;增强扫描病灶动脉期显著强化且与动脉几乎同步强化;浆细胞型病灶呈轻-中度强化。MR检查4例,MRI 2例,1例考虑盆腔海绵状血管瘤可能,1例后纵隔囊性占位,MRI+MRA 1例,诊断Castleman病,MRA 1例诊断为颈动脉体瘤,此例同时做数字减影血管造影,诊断为甲状腺实质性肿瘤。结论透明血管型Castleman病的影像表现与病理类型密切相关,CT及MRI增强表现有其特征,具有重要的诊断价值。而浆细胞型Castleman病影像表现不典型,术前诊断困难。

腹膜后局限型Castleman病的CT及MR表现

目的分析腹膜后局限型Castleman病的影像学特征,并参考病理分型,提高对该疾病的认识。方法回顾性分析经手术病理证实的10例患者的影像学资料,10例均行CT平扫及增强扫描,5例行MR平扫及增强扫描,分析其影像学表现并总结其特征。结果本组病变病理包括透明血管型8例和浆细胞型2例。CT平扫为等密度病灶,4例伴有钙化,1例伴有囊变,CT增强扫描示7例透明血管型病灶有明显持续强化,1例透明血管型病变与2例浆细胞型病灶呈轻度中度强化。5例行MR扫描,4例为透明血管型,1例为浆细胞型。平扫T1WI呈等或略低信号、T2WI呈高信号,DWI均为较高信号,增强扫描5例均有明显持续强化。结论腹膜后局限型Castleman病以透明血管型居多,影像学表现与病理分型密切相关,透明血管型明显持续强化,且钙化常见,而浆细胞型无明显特异性。

局灶性castleman病的CT诊断与鉴别诊断

目的讨论局灶性castleman(CD)病的CT诊断与鉴别诊断。方法回顾性分析15例局灶性CD患者的影像学资料,并与临床和病理结果进行分析,所有患者均行CT增强扫描。结果右肺门旁6例,前纵膈2例,腹腔1例,腹膜后2例,眼眶2例,锁骨下2例。病理分型14例为透明血管型,1例为浆细胞型。平扫大多为密度均匀的软组织肿块,CT值平均为42HU,边界清楚。2例内部可见斑点状、分叉状钙化。增强扫描呈明显及显著强化,CT值抬升31~99HU,3例其内可见点条状及裂隙状未强化区,4例病灶周围可见卫星灶及迂曲血管影。结论 LCD大多边界清晰,密度均匀,增强扫描大多明显均匀强化,静脉期呈持续明显强化,结合临床无明显症状应考虑本病。

Castleman’s病的CT影像表现与分析

目的:探讨Castleman’s病的CT表现及其诊断价值。方法:回顾性分析7例经病理证实的Castleman’s病的临床资料和CT表现,并与病理结果进行对比分析。结果:病变部位:颈部2例,纵隔1例,肠系膜1例,腹腔内2例,腹膜后1例;临床分型均属于局灶型,病理分型均属于透明血管型。CT表现:CT平扫示病灶均为等密度,2例伴有钙化;增强扫描示病灶均有明显强化。结论:Castleman’s病的CT表现与病理类型密切相关,其特征性的CT表现具有较高的诊断价值。