Prenatal Diagnosis of Proximal Femoral Focal Deficiency Combining Ultrasound and Computer Tomography

Four cases of proximal femoral focal deficiency (PFFD) in an otherwise healthy infant are described. Antenatal diagnosis was made at 27, 23, 23 and 18 weeks of gestation by routine ultrasound (US) examination. Computer Tomography (CT) was performed after 30 weeks of gestation and confirmed the images obtained by US. The diagnosis was confirmed after delivery. These cases illustrate the importance of combining US and CT to improve accuracy of prenatal diagnosis of skeletal disorders.

Value of CT scan in the diagnosis of primary large bowel lymphoma

Objective: To study the CT imaging of primary large bowel lymphoma and evaluate the value of CT scan. Methods: CT reports of 8 patients with proven primary large bowel lymphoma were retrospectively reviewed. Plain CT scans were done on all patients, enhanced CT scans simultaneously with 5-10 mm section thickness, and 5-10 mm table increments in 6 cases. Results: Primary involved sites were on the cecum (n=3), the ascending colon (n=2), and the rectum (n=1). The tumor was found in multiple areas of the large bowel in 2 cases. CT appearance fell into 3 typical patterns in our study. The first was focal mass type in 2 cases, with one combined with intussusception and retroperitoneal adenopathy; the second was segmental annular involvement type in 3 cases, with one of them combined with mesenteric adenopathy; the last was diffuse involvement type in 2 cases. Multiple nodules were seen in the rectum in 1 case. Conclusion: CT was found to be accurate in detecting the primary sites and complications of lymphoma, and evaluating invasion of adjacent structures; Focal mass type, segmental annular involvement type and diffuse involvement type are the main patterns of CT features in the primary large bowel lymphoma; The features revealed by CT scan are suggestive of primary large bowel lymphoma in some cases.

A controlled study of positron-emission-tomography and positron-emission-tomography/computed tomography in differential diagnosis of solitary pulmonary nodules—report of 60 cases

The differential diagnosis of solitary pulmonary nodules （SPNs） remains a challenge. It is acknowledged that combining positron-emission tomography （PET） and computed tomography （CT） offers the most reliable noninvasive method for the diagnosis of SPNs. Since Townsend et al1 developed integrated PET/CT in 1999, this technique has increasingly been introduced into clinical practice. To date, nuclear medicine physicians have usually undertaken PET/CT diagnosis, but the question is surfacing as how to make full use of the information of CT image to improve the accuracy of SPN diagnosis. To answer this question, we performed a retrospective study on 60 patients with SPNs.

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.

Ischemic colitis masquerading as colonic tumor:Case report with review of literature

Ischemic colitis can mimic a carcinoma on computed tomographic (CT) imaging or endoscopic examination. A coexisting colonic carcinoma or another potentially obstructing lesion has also been described in 20% of the cases of ischemic colitis. CT scan can differentiate it from colon cancer in 75% of cases. However, colonoscopy is the preferred method for diagnosing ischemic colitis as it allows for direct visualization with tissue sampling. Varied presentations of ischemic colitis have been described as an ulcerated or submucosal mass or as a narrowed segment of colon with ulcerated mucosa on colonoscopy. Awareness and early recognition of such varied presentations of a common condition is necessary to differentiate from a colonic carcinoma, and to avoid unnecessary surgery and related complications.

Utility of CT in differentiating liver metastases of well-differentiated gastroenteropancreatic neuroendocrine neoplasms from poorly-differentiated neuroendocrine neoplasms

Objective： To determine the capability of dynamic enhanced computed tomography（CT） to differentiate liver metastases（LMs） of well-differentiated from poorly-differentiated gastroenteropancreatic neuroendocrine neoplasms（GEP-NENs）.Methods： Patients with LMs of GEP-NENs who underwent dynamic enhanced CT examination in Peking University Cancer Hospital from January 2009 to October 2015 were included and data were retrospectively analyzed. We assessed the qualitative and quantitative CT features to identify the significant differentiating CT features of LMs of poorly-differentiated GEP-NENs from those of well-differentiated GEP-NENs using univariate analysis and a multivariate logistic regression model.Results： The study included 22 patients with LMs of well-differentiated GEP-NENs and 32 patients with LMs of poorly-differentiated GEP-NENs. Univariate analysis revealed statistically significant differences between the LMs of well-and poorly-differentiated GEP-NENs in terms of feeding arteries（36.4% vs. 75.0%, χ2=8.061,P=0.005）, intratumoral neovascularity（18.2% vs. 59.4%, χ2=9.047, P=0.003）, lymphadenopathy（27.3% vs. 81.2%,χ2=15.733, P〈0.001）, tumor-to-aortic ratio in the hepatic arterial and portal venous phase（T-A/AP： 0.297±0.080 vs.0.251±0.059, t=2.437, P=0.018; T-A/PVP： 0.639±0.138 vs. 0.529±0.117, t=3.163, P=0.003） and tumor-to-liver ratio in the hepatic arterial phase（T-L/AP： 1.108±0.267 vs. 0.907±0.240, t=2.882, P=0.006）. The LMs of poorlydifferentiated GEP-NENs showed more feeding arteries, more intratumoral neovascularity, more lymphadenopathy and a lower tumor-to-aortic ratio. Multivariate analysis suggested that intratumoral neovascularity [P=0.015, OR=0.108, 95% confidence interval（95% CI）, 0.018–0.646], lymphadenopathy（P=0.001,OR=0.055, 95% CI, 0.009–0.323） and T-A/PVP（P=0.004, OR=5.3 E–5, 95% CI, 0.000–0.044） were independent factors for differentiating LMs of poorly-differentiated from well-differentiated GEP-NENs.Conclusions： Dynamic enhanced CT features（intratumoral neovascularity, lymphadenopathy and T-A/PVP）are useful in the pathological classification of LMs of GEP-NENs.

A case of leptospirosis simulating colon cancer with liver metastases

We report a case of a 61-year-old man who presented with fatigue,abdominal pain and hepatomegaly.Computed tomography (CT) of the abdomen showed hepatomegaly and multiple hepatic lesions highly suggestive of metastatic diseases.Due to the endoscopic finding of colon ulcer,colon cancer with liver metastases was suspected.Biochemically a slight increase of transaminases,alkaline phosphatase and gammaglutamyl transpeptidase were present;α- fetoprotein,carcinoembryogenic antigen and carbohydrate 19-9 antigen serum levels were normal.Laboratory and instrumental investigations,including colon and liver biopsies revealed no signs of malignancy.In the light of spontaneous improvement of symptoms and CT findings,his personal history was revaluated revealing direct contact with pigs and their tissues.Diagnosis of leptospirosis was considered and confirmed by detection of an elevated titer of antibodies to leptospira.After two mo,biochemical data,CT and colonoscopy were totally normal.

Large cell carcinoma of lung: analysis of CT signs and review of the literature

Objective: Large cell carcinoma of lung is a very rare tumor. The clinical characteristics and CT imaging feature of large cell carcinoma of lung were discussed in this article. Methods: Eight cases of large cell carcinoma of lung proven by post-operational pathology were retrospectively analyzed from 2000 to 2005 and the literature on it was reviewed. Results: All 8 cases were men. The average age of patients was 64.88 years. Seven cases were smokers. Six cases had obvious chest stuffy, short breath, thrill dry cough. Hereinto 3 cases had cardinal red blood sputum. CT images of large cell carcinoma of lung were represented as single and peripheral mass or nodule. The distribution of large cell carcinoma of lung was short of some rule. 75% focus had clear finitude. One case showed internal calcification and 2 cases showed cavity. They did not show internal fat density. Conclusion: Large cell carcinoma of lung is difficult to be diagnosed before operation. Its CT finding is nonspecific.

Diagnostic Value of CT Colonography in Colorectal Carcinoma

OBJECTIVE To investigate the value of CT colonography （CTC） in diagnosis and preoperative staging of colorectal carcinoma.METHODS CTC was performed on 33 patients who were suspected of having colorectal carcinoma. The results of CTC were compared with those of a pathological examination.RESULTS Among the 22 patients who were diagnosed with colorectal carcinoma by CTC, 20 cases were confirmed by pathology. The diagnostic sensitivity and specificity were 100% （20/20） and 84.6% （11/13） respec- tively. The accuracy of showing carcinoma pathologic patterns was 90% （18/20）. The sensitivity and specificity were both 100% in the mass type; 77.8% and 100% in the infiltrating type; 100% and 85.7% in the ulcerated type. The accuracy of staging Dukes＇ carcinbma was 75%. The sensitivity and specificity were 100% and 94.1% for Dukes＇A; 80% and 73.3% for Dukes＇ B： 60% and 100% in Dukes＇ C： 71.4% and 100% for Dukes＇ D.CONCLUSION CTC produces a high success rate and provides considerable diagnostic information for both an accurate diagnosis of colorectal carcinoma and staging before operation,

X线、CT在减压性骨坏死早期诊断中的价值

目的探讨X线、CT在减压性骨坏死(dysbaric osteonecrosis,DON)早期诊断中的价值。方法随机选择66名潜水员为观察组;50名正常者为对照组。分别行双肩、双髋、双膝关节X线及CT检查,分析两种检查方法对早期DON征象的检出率。结果观察组X线检出病灶共36个,其中单纯囊变病灶9个,单纯钙化病灶21个,钙化与囊变共存者3个。CT显示观察组病灶共119个,其中单纯囊变病灶21个,单纯钙化病灶58个,钙化与囊变共存者20个。CT显示对照组钙化病灶56个;囊变病灶0个。结论在DON早期诊断中CT对钙化、囊变征象的检出率显著高于X线(P<0.05);囊变可作为诊断DON的早期征象;钙化虽然敏感性较高但特异性较差,因此只能作为诊断DON早期诊断的参考征象。

Diagnostic accuracy of CT scan in abdominal blunt trauma

Objective： To evaluate the sensitivity and specificity of CT scan findings in patients with blunt abdominal trauma admitted to the university hospital. Methods： All the patients with blunt abdominal trauma admitted at a tertiary teaching trauma center in Iran between 2005 and 2007 were enrolled in this study. In the absence of any clinical manifestations, the patients underwent a diagnostic CT scan. Laparatomy was performed in those with positive CT results. Others were observed for 48 hours and discharged in case no problem was reported; otherwise they underwent laparatomy. Information on patients＇ demographic data, mechanism of trauma, indication for CT scan, CT scan findings, results of laparotomy were gathered. The sensitivity, specificity and accuracy of the CT-scan images in regard with the organ injured were calculated. The sensitivity, specificity and accuracy of the CT scan were calculated in each case. Results： CT scan had the highest sensitivity for detecting the injuries to liver （100%） and spleen （86.6%）. The specificity of the method for detecting retroperitoneal hematoma （100%） and injuries to kidney （93.5%） was higher than other organs. The accuracy of CT images to detect the injuries to spleen, liver, kidney and retroperitoneal hematoma was reported to be 96.1%, 94.4%, 91.6% and 91.6% respectively. Conclusion： The findings of the present study reveal that CT scan could be considered as a good choice, especially for patients with blunt abdominal trauma in teaching hospitals where the radiologic academic staff is not present in the hospital in the night shifts.

Clinical value of bedside abdominal sonography performed by certified sonographer in emergency evaluation of blunt abdominal trauma

Purpose:To investigate the accuracy and efficiency of bedside ultrasonography application performed by certified sonographer in emergency patients with blunt abdominal trauma.Methods:The study was carried out from 2017 to 2019.Findings in operations or on computed tomography(CT)were used as references to evaluate the accuracy of bedside abdominal ultrasonography.The time needed for bedside abdominal ultrasonography or CT examination was collected separately to evaluate the efficiency of bedside abdominal ultrasonography application.Results:Bedside abdominal ultrasonography was performed in 106 patients with blunt abdominal trauma,of which 71 critical patients received surgery.The overall diagnostic accordance rate was 88.68%.The diagnostic accordance rate for liver injury,spleen injury,kidney injury,gut perforation,retroperitoneal hematoma and multiple abdominal organ injury were 100%,94.73%,94.12%,20.00%,100%and 81.48%,respectively.Among the 71 critical patients,the diagnostic accordance rate was 94.37%,in which the diagnostic accordance rate for liver injury,spleen injury,kidney injury,gut perforation and multiple abdominal organ injury were 100%,100%,100%,20.00%and 100%.The mean time for imaging examination of bedside abdominal ultrasonography was longer than that for CT scan(4.45±1.63 vs.2.38±1.19)min;however,the mean waiting time before examination(7.37±2.01 vs.16.42±6.37)min,the time to make a diagnostic report(6.42±3.35 vs.36.26±13.33)min,and the overall time(17.24±2.33 vs.55.06±6.96)min were shorter for bedside abdominal ultrasonography than for CT scan.Conclusion:Bedside ultrasonography application provides both efficiency and reliability for the assessment of blunt abdominal trauma.Especially for patients with free peritoneal effusion and critical patients,bedside ultrasonography has been proved obvious advantageous.However,for negative bedside ultrasonography patients with blunt abdominal trauma,we recommend further abdominal CT scan or serial ultrasonography scans subsequently.

New scoring system for intra-abdominal injury diagno- sis after blunt trauma

Objective： An accurate scoring system for intra-abdominal injury （IAI） based on clinical manifesta- tion and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is de- signed to provide a new scoring system for a better diagno- sis of IAI after blunt trauma. Methods： This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma （BAT） admitted to the emergency department （ED） of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient＇s history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi- square test and logistic regression were done. Factors with significant relationship with CT scan were imported in multi- variate regression models, where a coefficient （13） was given based on the contribution of each of them. Scoring systemwas developed based on the obtained total [3 of each factor. Results： Altogether 261 patients （80.1% male） were enrolled （48 cases of IAI）. A 24-point blunt abdominal trauma scoring system （BATSS） was developed. Patients were di- vided into three groups including low （score〈8）, moderate （8≤score〈12） and high risk （score≥ 12）. In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans （specificity 100%）. Conversely, all high risk patients had positive CT-scan findings （sensitivity 100%）. The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS （sensitivity=99.3%）. Conclusion： The present scoring system furnishes a high precision and reproducible diagnostic tool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.