Enhanced characterization of solid solitary pulmonary nodules with Bayesian analysis-based computer-aided diagnosis

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.

IMPROVED MARKING AND CHARACTERIZING OF PULMONARY NODULES ON DIGITAL RADIOGRAPHS USING A COMPUTER-AIDED DIAGNOSIS SYSTEM

Objective To evaluate and reduce inter-observer variations in the detection and characterization of pulmonary nodules on digital radiograph （DR） chest images. Methods Two hundreds and thirty-two new posterior-anterior DR chest images were collected from out-patient screening patients. Consensus was reached by two experienced radiologists on the marking, rating, and segmentation of small actionable nodules ranged from 5 to 15 mm in diameter using a computer-aided diagnosis （CAD） system. Both their own nodule findings and the computer＇s automatic nodule detection results were analyzed to make the consensus. Nodules identified together with corresponding likelihood rating and segmentation results were referred as ＂Gold Stand- ard＂. Two un-experienced radiologists were asked to first mark and characterize suspicious nodules independently, then were allowed to consult the computer nodule detection results and change their decisions. Results Large inter-observer variations in pulmonary nodule identification and characterization on DR chest images were observed between un-experienced radiologists. Un-expefienced radiologists could greatly benefit from the CAD system, including substantial decrease of inter-observer variation and improvement of nodule detection rates. Moreover, radiologists with different levels of skillfulness could achieve similar high level performance after using the CAD system. Conclusion The CAD system shows a high potential for providing a valuable assistance to the examination of DR chest images.

Ultra-low-dose chest computed tomography with model-based iterative reconstruction in the analysis of solid pulmonary nodules:A prospective study

BACKGROUND Incidental pulmonary nodules are an increasingly common finding on computed tomography(CT)scans of the thorax due to the exponential rise in CT examin-ations in everyday practice.The majority of incidental pulmonary nodules are benign and correctly identifying the small number of malignant nodules is cha-llenging.Ultra-low-dose CT(ULDCT)has been shown to be effective in diagnosis of respiratory pathology in comparison with traditional standard dose techniques.Our hypothesis was that ULDCT chest combined with model-based iterative reconstruction(MBIR)is comparable to standard dose CT(SDCT)chest in the analysis of pulmonary nodules with significant reduction in radiation dose.AIM To prospectively compare ULDCT chest combined with MBIR with SDCT chest in the analysis of solid pulmonary nodules.METHODS A prospective cohort study was conducted on adult patients(n=30)attending a respiratory medicine outpatient clinic in a tertiary referral university hospital for surveillance of previously detected indeterminate pulmonary nodules on SDCT chest.This study involved the acquisition of a reference SDCT chest followed immediately by an ULDCT chest.Nodule identification,nodule characterisation,nodule measurement,objective and subjective image quality and radiation dose were compared between ULDCT with MBIR and SDCT chest.RESULTS One hundred solid nodules were detected on ULDCT chest and 98 on SDCT chest.There was no significant difference in the characteristics of correctly identified nodules when comparing SDCT chest to ULDCT chest protocols.Signal-to-noise ratio was significantly increased in the ULDCT chest in all areas except in the paraspinal muscle at the maximum cardiac diameter level(P<0.001).The mean subjective image quality score for overall diagnostic acceptability was 8.9/10.The mean dose length product,computed tomography volume dose index and effective dose for the ULDCT chest protocol were 5.592 mGy.cm,0.16 mGy and 0.08 mSv respectively.These were significantly less than the SDCT chest protocol(P<0.001)and represent a radiation dose reduction of 97.6%.CONCLUSION ULDCT chest combined with MBIR is non-inferior to SDCT chest in the analysis of previously identified solid pulmonary nodules and facilitates a large reduction in radiation dose.

Advancements in Medication Rule for Pulmonary Nodules: A Review of Current Research Progress

This paper reviewed the literature on medication rule of pulmonary nodules in recent years. It is found that contemporary doctors pay more attention to regulating Qi, clearing heat and detoxifying, eliminating phlegm, dissolving phlegm and dissipating masses. They use mild drugs, cold and warm treatments in parallel, combining the tastes of pungent, bitterness, and sweetness at the same time. The treatment focuses on the five viscera with emphasis on the lung meridian while also considering the spleen and stomach functions as well as soothing liver stagnation. This information aims to provide some reference for clinical treatment of pulmonary nodules.

Hyperparathyroidism presented as multiple pulmonary nodules in hemodialysis patient status post parathyroidectomy:A case report

BACKGROUND Primary hyperparathyroidism is typically caused by a single parathyroid adenoma.Ectopic parathyroid adenomas occur as well,with cases involving various sites,including the mediastinum,presenting in varying frequencies.Secondary hyperparathyroidism develops in the context of chronic kidney disease,primarily due to vitamin D deficiency,hypocalcemia,and hyperphosphatemia.It is frequently diagnosed in patients undergoing dialysis.This article presents a rare case of hyperparathyroidism involving multiple hyperplastic parathyroid glands with pulmonary seeding in a 50-year-old female patient undergoing hemodialysis(HD).CASE SUMMARY The patient had a history of parathyroidectomy 10 years prior but developed recurrent hyperparathyroidism with symptoms of pruritus and cough with sputum during a period of routine dialysis.Radiographic imaging revealed multiple nodules in both lungs,with the largest measuring approximately 1.35 cm.Surgical histopathology confirmed the presence of hyperplastic parathyroid glands within the pulmonary tissue.After tumor resection surgery via videoassisted thoracic surgery with wedge resection,the patient was discharged in stable condition and in follow-up her symptoms showed improvement.CONCLUSION This article describes hyperparathyroidism presenting as pulmonary nodules in a patient undergoing postparathyroidectomy HD,highlighting diagnostic challenges and a positive outcome from tumor resection surgery.

Phase II Clinical Study of Three-Dimensional Printed Coplanar Template Combined with CT-Guided Percutaneous Core Needle Biopsy of Pulmonary Nodules in Elderly Patients

Background: As the population age structure gradually ages, more and more elderly people were found to have pulmonary nodules during physical examinations. Most elderly people had underlying diseases such as heart, lung, brain and blood vessels and cannot tolerate surgery. Computed tomography (CT)-guided percutaneous core needle biopsy (CNB) was the first choice for pathological diagnosis and subsequent targeted drugs, immune drugs or ablation treatment. CT-guided percutaneous CNB requires clinicians with rich CNB experience to ensure high CNB accuracy, but it was easy to cause complications such as pneumothorax and hemorrhage. Three-dimensional (3D) printing coplanar template (PCT) combined with CT-guided percutaneous pulmonary CNB biopsy has been used in clinical practice, but there was no prospective, randomized controlled study. Methods: Elderly patients with lung nodules admitted to the Department of Oncology of our hospital from January 2019 to January 2023 were selected. A total of 225 elderly patients were screened, and 30 patients were included after screening. They were randomly divided into experimental group (Group A: 30 cases) and control group (Group B: 30 cases). Group A was given 3D-PCT combined with CT-guided percutaneous pulmonary CNB biopsy, Group B underwent CT-guided percutaneous pulmonary CNB. The primary outcome measure of this study was the accuracy of diagnostic CNB, and the secondary outcome measures were CNB time, number of CNB needles, number of pathological tissues and complications. Results: The diagnostic accuracy of group A and group B was 96.67% and 76.67%, respectively (P = 0.026). There were statistical differences between group A and group B in average CNB time (P = 0.001), number of CNB (1 vs more than 1, P = 0.029), and pathological tissue obtained by CNB (3 vs 1, P = 0.040). There was no statistical difference in the incidence of pneumothorax and hemorrhage between the two groups (P > 0.05). Conclusions: 3D-PCT combined with CT-guided percutaneous CNB can improve the puncture accuracy of elderly patients, shorten the puncture time, reduce the number of punctures, and increase the amount of puncture pathological tissue, without increasing pneumothorax and hemorrhage complications. We look forward to verifying this in a phase III randomized controlled clinical study. .

Comparison of two reader modes of computer-aided diagnosis in lung nodules on low-dose chest CT scan

Low-dose computerized tomography(LDCT)scanning is of great significance for monitoring and management of pulmonary nodules on chest computerized tomography(CT).Nevertheless,the malignant potential of these nodules is often difficult to detect,especially for some smaller pulmonary nodules on LDCT images.Recent advances using the state-of-art computer-aided detection(CAD)system have attempted to address this problem by identifying small nodules that can be easily missed during clinical practice.CAD is used in two reading modes:Concurrent-reader(CR)mode or second-reader(SR)mode.In this study,we prospectively evaluated the efficiency of a CAD system's SR and CR modes in detecting pulmonary nodules on LDCT.We found that the SR mode improves pulmonary nodule detection regardless of the dose and ex-perience level,especially for interns in the low-dose setting.The CR mode maintains the sensi-tivity of SR mode while significantly decreasing reading times.

Neural network-based computer-aided diagnosis in distinguishing malignant from benign solitary pulmonary nodules by computed tomography

Background Computer-aided diagnosis （CAD） of lung cancer is the subject of many current researches. Statistical methods and artificial neural networks have been applied to more quantitatively characterize solitary pulmonary nodules （SPNs）. In this study, we developed a CAD scheme based on an artificial neural network to distinguish malignant from benign SPNs on thin-section computed tomography （CT） images, and investigated how the CAD scheme can help radiologists with different levels of experience make diagnostic decisions. Methods Two hundred thin-section CT images of SPNs with proven diagnoses （135 small peripheral lung cancers and 65 benign nodules） were analyzed. Three clinical features and nine CT signs of each case were studied by radiologists, and the indices of qualitative diagnosis were quantified. One hundred and forty nodules were selected randomly to form training samples, on which the neural network model was built. The remaining 60 nodules, forming test samples, were presented to 9 radiologists with 3-20 years of clinical experience, accompanied by standard reference images. The radiologists were asked to determine whether a nodule was malignant or benign first without and then with CAD output. Diagnostic performance was evaluated by receiver operating characteristic （ROC） analysis. Results CAD outputs on test samples had higher agreement with pathological diagnoses （Kappa=0.841, P〈0.001）. Compared with diagnostic results without CAD output, the average area under the ROC curve with CAD output was 0.96 （P〈0.001） for junior radiologists, 0.94 （P=0.014） for secondary radiologists and 0.96 （P=0.221） for senior radiologists, respectively. The differences in diagnostic performance with CAD output among the three levels of radiologists were not statistically significant （P=0.584, 0.920 and 0.707, respectively）. Conclusions This CAD scheme based on an artificial neural network could improve diagnostic performance and assist radiologists in distinguishing malignant from benign SPNs on thin-section CT images.

Role of the texture features of images in the diagnosis of solitary pulmonary nodules in different sizes

Objective： To explore the role of the texture features of images in the diagnosis of solitary pulmonary nodules （SPNs） in different sizes. Materials and methods： A total of 379 patients with pathologically confirmed SPNs were enrolled in this study. They were divided into three groups based on the SPN sizes： ≤10, 11-20, and 〉20 mm. Their texture features were segmented and extracted. The differences in the image features between benign and malignant SPNs were compared. The SPNs in these three groups were determined and analyzed with the texture features of images. Results： These 379 SPNs were successfully segmented using the 2D Otsu threshold method and the self-adaptive threshold segmentation method. The texture features of these SPNs were obtained using the method of grey level co-occurrence matrix （GLCM）. Of these 379 patients, 120 had benign SPNs and 259 had malignant SPNs. The entropy, contrast, energy, homogeneity, and correlation were 3.5597±0.6470, 0.5384±0.2561, 0.1921±0.1256, 0.8281±0.0604, and 0.8748±0.0740 in the benign SPNs and 3.8007±0.6235, 0.6088±0.2961, 0.1673±0.1070, 0.7980±0.0555, and 0.8550±0.0869 in the malignant SPNs （all P〈0.05）. The sensitivity, specificity, and accuracy of the texture features of images were 83.3%, 90.0%, and 86.8%, respectively, for SPNs sized 〈10 mm, and were 86.6%, 88.2%, and 87.1%, respectively, for SPNs sized 11-20 mm and 94.7%, 91.8%, and 93.9%, respectively, for SPNs sized 〉20 mm. Conclusions： The entropy and contrast of malignant pulmonary nodules have been demonstrated to be higher in comparison to those of benign pulmonary nodules, while the energy, homogeneity correlation of malignant pulmonary nodules are lower than those of benign pulmonary nodules. The texture features of images can reflect the tissue features and have high sensitivity, specificity, and accuracy in differentiating SPNs. The sensitivity and accuracy increase for larger SPNs.

Efficacy of thoracoscopic anatomical segmentectomy for small pulmonary nodules

BACKGROUND Small pulmonary nodules are tissue shadows and thoracoscopic segmentectomy in China is still at the exploratory stage with limited application.AIM To evaluate the efficacy of thoracoscopic anatomical segmentectomy for small pulmonary nodules.METHODS Medical records of 86 patients with small pulmonary nodules treated at our hospital between August 2016 and October 2019 were retrospectively analyzed;40 cases who underwent thoracoscopic lobectomy were set as a reference group,and 46 cases who underwent thoracoscopic anatomical segmentectomy were set as an observation group.Preoperative and postoperative parameters were measured in both groups,including the percentage of forced expiratory volume in the first second(FEV1%),the percentage of forced vital capacity(FVC%),and the FEV1/FVC ratio(FEV1/FVC).Patients with positive pathological diagnosis received tests for neuron-specific enolase,carbohydrate antigen 125(CA125),CA19-9,and squamous cell carcinoma antigen.Intraoperative bleeding volume,drainage volume,the number of dissected lymph nodes,drainage time,hospital stay,treatment cost,postoperative complications,and postoperative pain condition were compared between the two groups.RESULTS No significant difference was observed in the results of four serum tumor marker(CA125,CA19-9,squamous cell carcinoma antigen,and neuron-specific enolase),the number of dissected lymph nodes,treatment cost,or preoperative pulmonary ventilation index between the two groups.Intraoperative bleeding volume,drainage volume,drainage time,hospital stay,and visual analogue scale score were significantly lower in the observation group(P<0.05).The results of FEV1%,FVC%,and FEV1/FVC were significantly higher in the observation group(P<0.05).CONCLUSION The efficacy of thoracoscopic anatomical segmentectomy and lobectomy for small pulmonary nodules shows no significant difference in terms of lesion removal,but anatomical segmentectomy is less invasive with fewer postoperative complications and less influence on lung function.

Comparison of three mathematical prediction models in patients with a solitary pulmonary nodule

Background： Effective methods for managing patients with solitary pulmonary nodules（SPNs） depend critically on the predictive probability of malignancy.Methods： Between July 2009 and June 2011, data on gender, age, cancer history, tumor familial history, smoking status, tumor location, nodule size, spiculation, calcification, the tumor border, and the final pathological diagnosis were collected retrospectively from 154 surgical patients with an SPN measuring 3-30 mm. Each final diagnosis was compared with the probability calculated by three predicted models—the Mayo, VA, and Peking University（PU） models. The accuracy of each model was assessed using area under the receiver operating characteristics（ROC） and calibration curves.Results： The area under the ROC curve of the PU model [0.800; 95% confidence interval（CI）： 0.708-0.891] was higher than that of the Mayo model（0.753; 95% CI： 0.650-0.857） or VA model（0.728; 95% CI： 0.623-0.833）; however, this finding was not statistically significant. To varying degrees, calibration curves showed that all three models overestimated malignancy.Conclusions： The three predicted models have similar accuracy for prediction of SPN malignancy, although the accuracy is not sufficient. For Chinese patients, the PU model may has greater predictive power.Background： Here, we introduced our short experience on the application of a new CUSA Excel ultrasonic aspiration system, which was provided by Integra Lifesciences corporation, in skull base meningiomas resection.Methods： Ten patients with anterior, middle skull base and sphenoid ridge meningioma were operated using the CUSA Excel ultrasonic aspiration system at the Neurosurgery Department of Shanghai Huashan Hospital from August 2014 to October 2014. There were six male and four female patients, aged from 38 to 61 years old（the mean age was 48.5 years old）. Five cases with tumor located at anterior skull base, three cases with tumor on middle skull base, and two cases with tumor on sphenoid ridge.Results： All the patents received total resection of meningiomas with the help of this new tool, and the critical brain vessels and nerves were preserved during operations. All the patients recovered well after operation.Conclusions： This new CUSA Excel ultrasonic aspiration system has the advantage of preserving vital brain arteries and cranial nerves during skull base meningioma resection, which is very important for skull base tumor operations. This key step would ensure a well prognosis for patients. We hope the neurosurgeons would benefit from this kind of technique.Background： The purposes of this study were to explore the effects of high mobility group protein box 1（HMGB1） gene on the growth, proliferation, apoptosis, invasion, and metastasis of glioma cells, with an attempt to provide potential therapeutic targets for the treatment of glioma. Methods： The expressions of HMGB1 in glioma cells（U251, U-87 MG and LN-18） and one control cell line（SVG p12） were detected by real time PCR and Western blotting, respectively. Then, the effects of HMGB1 on the biological behaviors of glioma cells were detected： the expression of HMGB1 in human glioma cell lines U251 and U-87 MG were suppressed using RNAi technique, then the influences of HMGB1 on the viability, cycle, apoptosis, and invasion abilities of U251 and U-87 MG cells were analyzed using in a Transwell invasion chamber. Also, the effects of HMGB1 on the expressions of cyclin D1, Bax, Bcl-2, and MMP 9 were detected. Results： As shown by real-time PCR and Western blotting, the expression of HMGB1 significantly increased in glioma cells（U251, U-87 MG, and LN-18） in comparison with the control cell line（SVG p12）; the vitality, proliferation and invasive capabilities of U251 and U-87 MG cells in the HMGB1 siR NA-transfected group were significantly lower than those in the blank control group and negative control（NC） siR NA group（P〈0.05） but showed no significant difference between the blank control group and NC siR NA group. The percentage of apoptotic U251 and U-87 MG cells was significantly higher in the HMGB1 siR NA-transfected group than in the blank control group and NC siR NA group（P〈0.05） but was similar between the latter two groups. The HMGB1 siR NA-transfected group had significantly lower expression levels of Cyclin D1, Bcl-2, and MMP-9 protein in U251 and U-87 MG cells and significantly higher expression of Bax protein than in the blank control group and NC siR NA group（P〈0.05）; the expression profiles of cyclin D1, Bax, Bcl-2, and MMP 9 showed no significant change in both blank control group and NC siR NA group. Conclusions： HMGB1 gene may promote the proliferation and migration of glioma cells and suppress its effects of apoptosis. Inhibition of the expression of HMGB1 gene can suppress the proliferation and migration of glioma cells and promote their apoptosis. Our observations provided a new target for intervention and treatment of glioma.

Correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules and tumor size

Objective： To evaluate the correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules and tumor size. Methods： Sixty-eight patients with malignant solitary pulmonary nodules （SPNs） （diameter 〈4 cm） underwent multi-location dynamic contrast material-enhanced （nonionic contrast material was administrated via the antecubitai vein at a rate of 4mL/s by using an autoinjector, 4×5 mm or 4×2.5 mm scanning mode with stable table were performed）. Precontrast and postcontrast attenuation on every scan was recorded. Blood flow （BF）, peak, height （PHSPN）, ratio of peak height of the SPN to that of the aorta （SPN-to-A ratio） and mean transit time （MTT） were calculated. The correlation between the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules and tumor size were assessed by means of linear regression analysis. Results： No significant correlations were found between the tumor size and each of the peak height （PHSPN） （35.79±10.76 Hu）, ratio of peak height of the SPN to that of the aorta （SPN-to-A ratio）, （14.27%±4.37） and blood flow （BF） （30.18 mL/min/100 g±9.58） （r=0.180, P=0.142〉0.05; r=0.205, P=0.093〉0.05; r=0.008, P=0.947〉0.05）. Conclusion： No significant correlations were found between the tumor size and each of the quantifiable parameters of blood flow pattern derived with dynamic CT in malignant solitary pulmonary nodules.

Dynamic contrast-enhanced MRI versus ^(18)F-FDG PET/CT: Which is better in differentiation between malignant and benign solitary pulmonary nodules?

Objective： To prospectively compare the discriminative capacity of dynamic contrast enhanced-magnetic resonance imaging（DCE-MRI） with that of^18F-fluorodeoxyglucose（^18F-FDG） positron emission tomography/computed tomography（PET/CT） in the differentiation of malignant and benign solitary pulmonary nodules（SPNs）.Methods： Forty-nine patients with SPNs were included in this prospective study. Thirty-two of the patients had malignant SPNs, while the other 17 had benign SPNs. All these patients underwent DCE-MRI and ^18F-FDG PET/CT examinations. The quantitative MRI pharmacokinetic parameters, including the trans-endothelial transfer constant（K^trans）, redistribution rate constant（Kep）, and fractional volume（Ve）, were calculated using the Extended-Tofts Linear two-compartment model. The ^18F-FDG PET/CT parameter, maximum standardized uptake value（SUV（max））, was also measured. Spearman＇s correlations were calculated between the MRI pharmacokinetic parameters and the SUV（max） of each SPN. These parameters were statistically compared between the malignant and benign nodules. Receiver operating characteristic（ROC） analyses were used to compare the diagnostic capability between the DCE-MRI and ^18F-FDG PET/CT indexes.Results： Positive correlations were found between K^trans and SUV（max）, and between K（ep） and SUV（max）（P〈0.05）.There were significant differences between the malignant and benign nodules in terms of the K^trans, K（ep） and SUV（max） values（P〈0.05）. The areas under the ROC curve（AUC） of K^trans） K（ep） and SUV（max） between the malignant and benign nodules were 0.909, 0.838 and 0.759, respectively. The sensitivity and specificity in differentiating malignant from benign SPNs were 90.6% and 82.4% for K^trans; 87.5% and 76.5% for K（ep）; and 75.0% and 70.6%for SUV（max）, respectively. The sensitivity and specificity of K^trans and K（ep） were higher than those of SUV（max）, but there was no significant difference between them（P〉0.05）.Conclusions： DCE-MRI can be used to differentiate between benign and malignant SPNs and has the advantage of being radiation free.

Blood flow patterns of solitary pulmonary nodules with enhancement

Objective： To evaluate the efficacy of dynamic multi-slice spiral computed tomography （MSCT） for providing quantitative information about blood flow patterns of solitary pulmonary nodules （SPNs）. Methods： Seventy-eight patients with SPNs （diameter 〈 4 cm; 68 malignant; 10 active inflammatory） were underwent multi-location dynamic contrast material-enhanced serial CT （nonionic contrast material was administrated via the antecubital vein at a rate of 4 mLJs by using an autoinjector, 4 × 5 mm or 4 × 2.5 mm transverse scanning mode with stable table were performed）. Sixteen series CT scans （16 scans each for the first and second series and one scan each for the rest series） were obtained during 9 min scanning period. Precontrast and postcontrast attenuation on every scan was recorded. Perfusion, peak height and ratio of peak height of the SPN to that of the aorta were calculated. Perfusion was calculated from the maximum gradient of the time-attenuation curve and the peak height of the aorta. Results： No statistically significant difference in the peak height was found between malignant （35.79 ± 10.76 Hu） and active inflammatory （39.76 ± 4.59 Hu） （t = 1.148, P = 0.255 〉 0.05）. SPN-to-aorta ratio （14.27% ± 4.37） and perfusion value （30.18 mL/min/100 g ± 9.58） in malignant SPNs were significantly lower than those of active inflammatory （18.51% ± 2.71, 63.44 mL/min/100 g ± 43.87） （t = 2.978, P = 0.004 〈 0.05; t = 5.590, P 〈 0.0001）. Conclusion： The quantitative information about blood flow patterns of malignant and active inflammatory SPNs is different. SPN-to-aorta ratio and perfusion value are helpful in differentiating malignant nodules from active inflammatory.

BLOOD FLOW PATTERN AND QUANTITATIVE STUDY IN SOLITARY PULMONARY NODULES WITH DYNAMIC CONTRAST-ENHANCED MRI

Objective To evaluate the efficacy of contrast enhanced dynamic MRI in differentiating solitary pulmonary nodules（SPNs）. Methods Eighty-three patients with SPNs undertaken contrast enhanced dynamic MRI. Time-signal intensity curve （T-SI Curve） was made. Peak height （PH） , steepest slope （SS）, maximum enhancement （ Emax ） and the enhancement rates of signal intensity were recorded at the frst （ E1 ）, second （ E2 ）, third （ E3 ） , fourth （ E4 ） , fifth （E5）, and sixth （ E6 ） minute after injection. Results Malignant nodules and inflammatory nodules enhanced significantly higher than benign nodules, and malignant nodules and inflammatory nodules showed obviously higher PH, SS, Emax, El-E6 values than benign nodules （ P 〈 0. 01 ）. There were no sig- nificant differences in PH, SS, Emax, E1-E6 values between malignant nodules and inflammatory nodules （P 〉 0. 05）. Conclusion Contrast enhanced dynamic MR imaging can provide SPNs＇ hemodynamic information and is helpful in differentiating SPNs.

Complete Thoracoscopic Segmentectomy and Pulmonary Lobectomy in the Treatment of Small Pulmonary Nodules

Objective:To compare the clinical effect of complete thoracoscopic segmentectomy and pulmonary lobectomy for pulmonary nodules.Methods:In this study,176 patients with pulmonary nodules were treated in Changshu Hospital Affiliated to Nanjing University of Chinese Medicine from January 2019 to June 2021;according to the type of surgery,the patients were divided into group A(complete thoracoscopic segmentectomy)and group B(complete thoracoscopic pulmonary lobectomy),and the clinical effects were analyzed.Results:The intraoperative blood loss,postoperative drainage volume,postoperative hospitalization days,and lung function of patients in group A were significantly better than those in group B(P<0.05),while there was no significant difference in the number of dissected lymph nodes.Conclusion:The clinical effect of complete thoracoscopic segmentectomy for patients with small pulmonary nodules is more significant;it does not only ensure lymph node dissection,but also improve surgical-related indicators and treatment safety as well as speed up the recovery of pulmonary function.Its clinical application value is worthy of key analysis by medical institutions.

Difference in microvascular structure between benign and malignant pulmonary nodules and its relationship with CT enhancement

Objective： To investigate the enhancement basis and the mechanisms of solitary pulmonary nodules （SPNs） by comparing the differences in microvascular structure between benign and malignant lesions. Methods： Dynamic contrast-enhanced CT scan was performed on 53 patients with SPNs （diameter〈3 cm, 38 peripheral lung cancers, 5 hamartomas, 10 inflammatory lesions） using a Siemens Plus S or a Marconi MX8000 multi slices spiral CT scanner. The time-attenuation curves were interpreted. The microvascular density （MVD） and the continuity of the microvessels＇ basemental membrane in the dissected specimens were observed with the ABC （avldin-biotin complex） immuno-histochemical method in all patients. Results ：The CT enhancement values of lung cancer （49.05± 16.08 HU） and inflammatory lesions （49.59±21.30 HU） were significantly higher than those of hamartoma （8.98±4.56 HU） t=7.48, P〈0.051 t=8.35, P〈0.05）. But the enhancement of lung cancer was similar to that of inflammatory lesions （t=0.76, P±0. 05）. The time attenuation curve of inflammatory lesions tended to increase faster and reached a higher peak compared to the lung cancer, and both of them maintained a high plateau after crossing. The hamartoma showed a slight increase in the time-attenuation curve and demonstrated a lowplateau curve. The MVD of SPNs was positively correlated with CT enhancement （r=0. 8051）. The microvascular counts of peripheral lung cancer （48.45±10. 09） and inflammatory lesions （49. 60±19. 94） were significantly higher than those of hamartoma （8.70±7. 30） （t=11. 64, P〈0.001, t=6. 09, P〈0. 001 ）, but no significant difference was found between lung cancer and inflammatory lesions （t= -0.26, P=0.799）. There was no difference in the continuity of basement membrane between nodules with anen haneement less than 30 HU and those with an enhancement higher than 30HU （X^2=3. 13, P〉0.05 ）. Conclusion： The microvascular counts mainly contribute to the enhancement value of SPNs. The basement membrane is not related to nodule enhancement, but it might influence the pattern of the time-attenuation curve.

Decision-tree analysis for cost-effective management of solitary pulmonary nodules in China

AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the management of SPN: computed tomography(CT) alone, CT plus CT-guided automated cutting needle biopsy(ACNB), CT plus positron emission tomography/computed tomography(PET/CT), CT plus diffusionweighted magnetic resonance imaging(DWI) plus PET/CT. RESULTS: The prevalence of lung cancer among SPN discovered in the clinical setting was approximately 50%. The CT plus ACNB strategy had higher diagnostic accuracies(87% vs 81%), with a cost saving of $1945 RMB per patient, and reducing unnecessary thoracotomy by 16.5%; this was associated with a 4.5% missed diagnosis rate. CT plus DWI plus PET/CT strategy also had higher accuracies(95% vs 81%), with a cost saving of $590 RMB per patient, and reducing unneces-sary thoracotomy by 13.5%; this was accompanied by 0.3% missed diagnosis rate. CT plus PET strategy is cost effective at a prevalence rate of 0-34%, but there was a larger prevalence range of lung cancer for CT plus ACNB strategy(from 0 to 0.6) and CT plus DWI plus PET/CT strategy(from 0 to 0.64). CONCLUSION: CT plus DWI plus PET/CT strategy was cost-effective, and had a higher accuracy accompanied by a lower missed diagnosis rate than CT plus ACNB strategy.

Analysis of 96 cases of solitary pulmonary nodule diagnosed by MSCT

Objective:The aim of this study was to explore the diagnostic value of multi-slice computer tomography(MSCT) in solitary pulmonary nodule(SPN).Methods:Contrastive analysis of the differences of CT signs between benign and malignant SPN.Results:The typical sign of pleural indentation was a reliable sign for lung cancers.Vacuole sign suggested lung cancer highly.Blood vessels cluster involving the vein alone had big opportunity to lung cancer.Type I tumor-bronchial relation was the most common relation in lung cancers.Type V tumor–bronchial relation was the most common relation in benign SPN.Conclusion:MSCT had a very high diagnostic value in SPN.

Bronchoscopic Diagnosis of Solitary Pulmonary Nodules with the Use of NIR Spectroscopy

Background: Recently, SPN has become a much more frequently encountered issue in bronchology. Efficient and reliable guidance method for SPN morphological proof is highly needed. Objectives: The aim of study was to compare the diagnostic values of NIR (near infrared) spectroscopy with EBUS for SPN diagnostic. Fluoroscopic guidance with TBB and needle biopsy were done in all patients. Methods: In our study, we used two types of monitoring systems. Fluoroscopic guidance was combined with either a radial EBUS or a NIR spectroscopy probe for tissue confirmation. 139 male and 71 female patients, having a medial age of 68 years with CT/PET findings of metabolically active SPN were examined between 2/2010 and 2/2013. We designed an instrument for measurement of the penetration of the NIR through lung tissue. Indicating and source fibers were navigated towards the SPN. An EBUS radial probe was used, during fluoroscopic navigation. Results: The statistical analysis of the results obtained showed a comparative specificity and sensitivity of the NIR spectroscopy, with radial EBUS. Conclusions: NIR spectroscopy produced similar efficacies as the radial EBUS. However, the number of positive biopsies was more dependent upon the ability to direct the confirmatory device to the SPN during fluoroscopic guidance than on the type of the device.