Chronic thromboembolic pulmonary hypertension is associated with a loss of total lung volume on computed tomography

BACKGROUND Although lung volumes are usually normal in individuals with chronic thromboembolic pulmonary hypertension(CTEPH),approximately 20%-29%of patients exhibit a restrictive pattern on pulmonary function testing.AIM To quantify longitudinal changes in lung volume and cardiac cross-sectional area(CSA)in patients with CTEPH.METHODS In a retrospective cohort study of patients seen in our hospital between January 2012 and December 2019,we evaluated 15 patients with CTEPH who had chest computed tomography(CT)performed at baseline and after at least 6 mo of therapy.We matched the CTEPH cohort with 45 control patients by age,sex,and observation period.CT-based lung volumes and maximum cardiac CSAs were measured and compared using the Wilcoxon signed-rank test and the Mann-Whitney u test.RESULTS Total,right lung,and right lower lobe volumes were significantly reduced in the CTEPH cohort at follow-up vs baseline(total,P=0.004;right lung,P=0.003;right lower lobe;P=0.01).In the CTEPH group,the reduction in lung volume and cardiac CSA was significantly greater than the corresponding changes in the control group(total,P=0.01;right lung,P=0.007;right lower lobe,P=0.01;CSA,P=0.0002).There was a negative correlation between lung volume change and cardiac CSA change in the control group but not in the CTEPH cohort.CONCLUSION After at least 6 mo of treatment,CT showed an unexpected loss of total lung volume in patients with CTEPH that may reflect continued parenchymal remodeling.

Radiomic features from computed tomography to differentiate invasive pulmonary adenocarcinomas from non-invasive pulmonary adenocarcinomas appearing as part-solid groundglass nodules

Objective:We aim to investigate radiomic imaging features extracted in computed tomography(CT)images to differentiate invasive pulmonary adenocarcinomas(IPAs)from non-IPAs appearing as part-solid ground-glass nodules(GGNs),and to incorporate significant radiomic features with other clinically-assessed features to develop a diagnostic nomogram model for IPAs.Methods:This retrospective study was performed,with Institutional Review Board approval,on 88 patients with a total of 100 part-solid nodules(56 IPAs and 44 non-IPAs)that were surgically confirmed between February 2014and November 2016 in the First Affiliated Hospital of China Medical University.Quantitative radiomic features were computed automatically on 3D nodule volume segmented from arterial-phase contrast-enhanced CT images.A set of regular risk factors and visually-assessed qualitative CT imaging features were compared with the radiomic features using logistic regression analysis.Three diagnostic models,i.e.,a basis model using the clinical factors and qualitative CT features,a radiomics model using significant radiomic features,and a nomogram model combining all significant features,were built and compared in terms of receiver operating characteristic(ROC)curves.Decision curve analysis was performed for the nomogram model to explore its potential clinical benefit.Results:In addition to three visually-assessed qualitative imaging features,another three quantitative features selected from hundreds of radiomic features were found to be significantly(all P<0.05)associated with IPAs.The diagnostic nomogram model showed a significantly higher performance[area under the ROC curve(AUC)=0.903]in differentiating IPAs from non-IPAs than either the basis model(AUC=0.853,P=0.0009)or the radiomics model(AUC=0.769,P<0.0001).Decision curve analysis indicates a potential benefit of using such a nomogram model in clinical diagnosis.Conclusions:Quantitative radiomic features provide additional information over clinically-assessed qualitative features for differentiating IPAs from non-IPAs appearing as GGNs,and a diagnostic nomogram model including all these significant features may be clinically useful in preoperative strategy planning.

Radiomics model for distinguishing tuberculosis and lung cancer on computed tomography scans

BACKGROUND Pulmonary tuberculosis(TB)and lung cancer(LC)are common diseases with a high incidence and similar symptoms,which may be misdiagnosed by radiologists,thus delaying the best treatment opportunity for patients.AIM To develop and validate radiomics methods for distinguishing pulmonary TB from LC based on computed tomography(CT)images.METHODS We enrolled 478 patients(January 2012 to October 2018),who underwent preoperative CT screening.Radiomics features were extracted and selected from the CT data to establish a logistic regression model.A radiomics nomogram model was constructed,with the receiver operating characteristic,decision and calibration curves plotted to evaluate the discriminative performance.RESULTS Radiomics features extracted from lesions with 4 mm radial dilation distances outside the lesion showed the best discriminative performance.The radiomics nomogram model exhibited good discrimination,with an area under the curve of 0.914(sensitivity=0.890,specificity=0.796)in the training cohort,and 0.900(sensitivity=0.788,specificity=0.907)in the validation cohort.The decision curve analysis revealed that the constructed nomogram had clinical usefulness.CONCLUSION These proposed radiomic methods can be used as a noninvasive tool for differentiation of TB and LC based on preoperative CT data.

Evaluation of the dual vascular supply patterns in ground-glass nodules with a dynamic volume computed tomography

BACKGROUND In recent years,the detection rate of ground-glass nodules(GGNs)has been improved dramatically due to the popularization of low-dose computed tomography(CT)screening with high-resolution CT technique.This presents challenges for the characterization and management of the GGNs,which depends on a thorough investigation and sufficient diagnostic knowledge of the GGNs.In most diagnostic studies of the GGNs,morphological manifestations are used to differentiate benignancy and malignancy.In contrast,few studies are dedicated to the assessment of the hemodynamics,i.e.,perfusion parameters of the GGNs.AIM To assess the dual vascular supply patterns of GGNs on different histopathology and opacities.METHODS Forty-seven GGNs from 47 patients were prospectively included and underwent the dynamic volume CT.Histopathologic diagnoses were obtained within two weeks after the CT examination.Blood flow from the bronchial artery[bronchial flow(BF)]and pulmonary artery[pulmonary flow(PF)]as well as the perfusion index(PI)=[PF/(PF+BF)]were obtained using first-pass dual-input CT perfusion analysis and compared respectively between different histopathology and lesion types(pure or mixed GGNs)and correlated with the attenuation values of the lesions using one-way ANOVA,student’s t test and Pearson correlation analysis.RESULTS Of the 47 GGNs(mean diameter,8.17 mm;range,5.3-12.7 mm),30(64%)were carcinoma,6(13%)were atypical adenomatous hyperplasia and 11(23%)were organizing pneumonia.All perfusion parameters(BF,PF and PI)demonstrated no significant difference among the three conditions(all P>0.05).The PFs were higher than the BFs in all the three conditions(all P<0.001).Of the 30 GGN carcinomas,14 showed mixed GGNs and 16 pure GGNs with a higher PI in the latter(P<0.01).Of the 17 benign GGNs,4 showed mixed GGNs and 13 pure GGNs with no significant difference of the PI between the GGN types(P=0.21).A negative correlation(r=-0.76,P<0.001)was demonstrated between the CT attenuation values and the PIs in the 30 GGN carcinomas.CONCLUSION The GGNs are perfused dominantly by the PF regardless of its histopathology while the weight of the BF in the GGN carcinomas increases gradually during the progress of its opacification.

Chronic obstructive pulmonary disease as a risk factor for lung cancer

The association between chronic obstructive pulmonary disease(COPD) and lung cancer has long been a subject of intense debate. The high prevalence of COPD in elderly smokers inevitably strengthens their coincidence. In addition to this contingent coincidence, recent studies have revealed a close association between the two diseases that is independent of the smoking history; that is, the existence of COPD is an independent risk factor for the development of lung cancer. Molecular-based evidence has been accumulating as a result of the efforts to explain the underlying mechanisms of this association. These mechanisms may include the following: the retention of airborne carcinogens followed by the activation of oncogenes and the suppression of tumor suppressor genes; the complex molecular mechanism associated with chronic inflammation in the distal airways of patients with COPD; the possible in-volvement of putative distal airway stem cells; and gel netic factors that are common to both COPD and lung cancer. The existence of COPD in patients with lung l cancer may potentially affect the process of diagnosis, surgical resection, radiotherapy, chemotherapy, and end-of-life care. The comprehensive management of COPD is extremely important for the appropriate treatment of lung cancer. Surgical resections with the aid of early interventions for COPD are often possible, even for patients with mild-to-moderate COPD. New challenges, such as lung cancer CT screening for individuals t at high risk, are now in the process of being implemented. Evaluating the risk of lung cancer in patients with COPD may be warranted in community-based lung cancer screening.

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.

Single-lung transplantation for pulmonary alveolar microlithiasis: A case report

BACKGROUND Pulmonary alveolar microlithiasis(PAM)is a rare idiopathic lung disease characterized by the accumulation of innumerable microliths.Currently,effective therapeutics for PAM are not available,and the only treatment for end-stage lung disease is lung transplantation(LuTx).Further,there are few reports that focus on LuTx for the treatment of PAM,and the follow-up reports of postoperative imaging are even rarer.CASE SUMMARY A 52-year-old man presented to Shanghai Pulmonary Hospital in 2017 after experiencing shortness of breath and exacerbation.The patient was diagnosed with PAM and referred for single-LuTx(SLuTx)on March 14,2018.Preoperative imaging results from a chest X-ray demonstrated bilateral,diffuse,symmetrical,sandstorm-like radiopaque micronodules,and pneumothorax and a computed tomography scan revealed minute,calcified military nodules in both lungs.We performed a left SLuTx,and intraoperative pathology was consistent with PAM.One week after surgery,a chest X-ray revealed slight exudation of the left lung,and one month later,the left transplanted lung exhibited good dilation,mild pulmonary perfusion injury with local infection,and left pleural effusion.Fiberoptic bronchoscopy revealed left hyperplastic granulation at the left bronchial anastomosis.Multiple sputum cultures suggested the presence of Klebsiella pneumoniae and Acinetobacter baumannii.The last follow-up was conducted in April 2019;the patient recovered well.CONCLUSION This case presents the imaging findings of a patient with PAM before and after LuTx and confirms the effectiveness of LuTx for the treatment of this disease.

肺实性结节半自动体积测量提高观察者间Lung-RADS评分一致性

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。

CT引导下经皮肺穿刺活检术并发症发生的影响因素分析

背景与目的 计算机断层扫描引导下经皮肺穿刺活检术(computed tomography guided percutaneous lung biopsy,CT-PLB)是目前临床广泛应用的肺部病变诊断方式,但其为有创检查,最常见的并发症为气胸和肺出血,严重时可危及生命。本研究旨在分析影响CT-PLB不同并发症发生的独立危险因素,以降低并发症发生率。方法回顾性分析2018年5月至2019年12月于我院行CT-PLB且临床资料完整的605例患者的资料。依病变位置分为胸膜下组和非胸膜下组,根据并发症分为气胸组、肺出血组、气胸合并肺出血组及无气胸/肺出血组,计算各并发症的发生率。分析影响不同并发症发生的危险因素及各并发症的独立危险因素。结果气胸发生率为34.1%,肺出血发生率为28.1%,同时发生气胸及肺出血63例,发生率为10.8%。影响胸膜下组气胸发生的独立危险因素为病变大小(P=0.002)。影响非胸膜下组气胸发生的独立危险因素为穿刺针走行区域平扫CT值(P=0.035)、穿刺针经过肺组织长度(P=0.003)、穿刺针经过胸壁厚度(P=0.020);影响非胸膜下组肺出血发生的独立危险因素为穿刺针经过肺组织长度(P<0.001)、穿刺针走行区域△CT值(P=0.001)、病变大小(P=0.034)及患者体位(P=0.014)。影响气胸、肺出血同时发生的独立危险因素为穿刺针经过肺组织长度(P<0.001)、穿刺针走行区域△CT值(P<0.001)。结论 CT-PLB是一种安全、有效的诊断方式,对肺部占位性病变具有较高的诊断价值,选择合适的穿刺方案可减少气胸、肺出血等并发症,提高诊疗效率。

CT征象联合纹理分析鉴别硬化性肺泡细胞瘤与周围型肺癌的价值

目的探讨CT征象联合纹理分析鉴别硬化性肺泡细胞瘤(pulmonary sclerosing pneumocytoma,PSP)与周围型肺癌(peripheral lung cancer,PLC)的价值。方法选取经病理证实的PSP患者136例及PLC患者131例,以7∶3的比例将所有病例随机分为训练集和验证集。分析两组病变CT特征及静脉期薄层CT图像纹理特征,用筛选出的特征参数构建多因素二元logistic回归模型并绘制ROC曲线,计算AUC值,评价各模型诊断PSP与PLC的效能。结果训练集和验证集两组间形态、钙化、液化坏死、分叶、毛刺、胸膜凹陷征、空洞、纵隔/肺门淋巴结肿大和16组最佳纹理参数差异有统计学意义(P<0.05)。CT特征模型由分叶、毛刺、胸膜凹陷征及纵膈/肺门淋巴结肿大组成;纳入训练集回归模型的最佳纹理参数共5组,分别为Perc.10%、S(3,0)SumAverg、S(4,0)SumAverg、S(4,4)SumAverg及WavEnLH_s-1。训练集中CT特征模型与CT纹理参数模型诊断PSP与PLC的AUC分别为0.847、0.851,二者间差异无统计学意义(P=0.912);CT特征联合纹理参数模型诊断两组病变的AUC最高,为0.939,其准确度、灵敏度和特异度分别为85.0%、82.1%和93.5%。验证集中影像学特征联合纹理参数模型诊断两组病变的AUC为0.923,高于CT影像特征模型(AUC=0.864;Z=2.627,P=0.009)和CT纹理参数模型(AUC=0.832;Z=2.147,P=0.031)。结论CT征象联合纹理分析对于鉴别PSP与PLC具有较好的诊断价值。

胸部CT影像学特征对肺腺癌亚实性结节脏层胸膜侵犯的预测价值

目的:探讨胸部CT影像学特征在肺腺癌亚实性结节(SSN)脏层胸膜侵犯(VPI)中的临床预测价值。方法:回顾性收集2016年5月-2021年12月在本院经手术切除和病理确诊为肺腺癌SSN的患者103例。男34例,女69例,年龄25~82岁,平均(58.5±10.2)岁。病理组织学诊断结果VPI阳性组19例(18.45%),VPI阴性组84例(81.55%)。记录患者的年龄、性别等临床资料。所有患者术前均行胸部CT检查。阅读CT影像学征象,包括位置、径线、密度、分叶征、毛刺征及胸膜凹陷征等。结节与胸膜关系(NPR)分为四种亚型:Ⅰ型,1条线相连;Ⅱ型,多条线相连;Ⅲ型,窄基底相贴;Ⅳ型,宽基底相贴。单因素分析比较VPI阳性组和阴性组在临床和CT影像学特征间的差异,将单因素分析差异有统计学意义的指标纳入多因素Logistic回归分析,通过受试者操作特征(ROC)曲线建立预测模型。结果:103例患者包括非实性结节49例(47.57%)和部分实性结节54例(52.43%)。VPI阳性组和阴性组的性别和年龄差异无统计学意义(P=0.883、0.151)。非实性结节VPI发生率为8.16%(4/49),低于部分实性结节27.78%(15/54),差异有统计学意义(P=0.01)。NPR四种亚型发生VPI的比例分别为Ⅰ型6.82%(3/44)、Ⅱ型15.00%(3/20)、Ⅲ型28.00%(7/25)和Ⅳ型42.86%(6/14),差异具有统计学意义(P=0.011)。结节密度和NPR分型是预测肺腺癌SSN的VPI状态的独立危险因素。ROC结果显示,结节密度诊断VPI的曲线下面积(AUC)为0.663,敏感度为78.9%,特异度为53.6%;NPR分型诊断VPI的AUC为0.726,敏感度为68.4%,特异度为69.0%;两者联合诊断VPI的AUC为0.804,敏感度为73.7%,特异度为70.2%。结论:肺腺癌亚实性结节的CT影像学特征有助于脏层胸膜侵犯的术前评估,结节密度和结节与胸膜关系分型是预测脏层胸膜侵犯的独立危险因素。

基于临床及影像指标对肺癌患者预后及危险因素的分析

目的:基于临床及影像指标探讨肺癌患者的预后及危险因素。方法:前瞻性分析93例肺癌患者的临床及影像资料,根据预后将其分为生存组75例和死亡组18例。结果:死亡组年龄、男性发病率、吸烟比例均大于生存组,第1秒用力呼气容积占预计值的百分比(FEV1%)、用力肺活量占预计值的百分比(FVC%)、1秒率占预计值的百分比(FEV1/FVC%)均低于生存组,肿瘤确诊时Ⅳ期比例大于生存组,支气管扩张、支气管管壁增厚、肺气肿、肺不张、间质性炎症发生率均高于生存组,主动脉直径、肺动脉直径、肿瘤体积更大,中央型、鳞癌发生率均大于生存组(均P<0.05)。经多因素分析发现,肿瘤分期和FVC%是肺癌患者预后不良的危险因素。结论:肺癌患者生存组和死亡组在多项临床及影像指标方面存在显著性差异,其中肿瘤分期和FVC%是肺癌患者预后不良的危险因素。

Solitary pulmonary nodules： comparison of multi-slice computed tomography perfusion study with vascular endothelial growth factor and microvessel density

Background The solitary pulmonary nodule （SPN） is one of the most common findings on chest radiographs. The objectives of clinical practice are to differentiate malignant nodules from benign nodules in the least invasive way and to make a specific diagnosis. This study was aimed to evaluate the correlation between perfusion imaging features and microvessel density （MVD） and vascular endothelial growth factors （VEGF） in SPNs using multi-slice computed tomography （MSCT）; and to provide the theoretical basis for SPN blood flow pattern and blood flow quantitative features. Also, the study called for the discussion of the method＇s clinical application value in the differential diagnosis of benign and malignant SPNs.Methods Sixty-eight patients with SPN underwent multi-location dynamic contrast enhanced （nonionic contrast material was administrated via the antecubital vein at a rate of 4 ml/s） MSCT. Precontrast and postcontrast attenuations on every scan was studied. Perfusion, peak height, and the ratio of the peak height of the SPN to that of the aorta were analyzed. Perfusion was calculated using the maximum gradient of the time-density curves （TDC） and the peak height of the aorta. The quantitative parameters （perfusion, peak height, ratio of peak height of the SPN to that of the aorta） of the blood flow pattern were compared with MVD and the VEGF expression of immunohistochemistry. Results The perfusion peak heights of malignant （（96.15±11.55） HU） and inflammatory （（101.15±8.41） HU） SPNs were significantly higher than those of benign （（47.24±9.15） HU） SPNs （P 〈0.05, P 〈0.05）. Ratios of SPN-to-aorta of malignant and inflammatory SPNs were significantly higher than those of benign SPNs （P 〈0.05, P 〈0.05）. No significant differences were found between the peak height and SPN-to-aorta ratio of malignant SPNs and inflammatory SPNs （P 〉0.05, P 〉0.05）. The precontrast densities of inflammatory SPNs were lower than those of malignant SPNs （P 〈0.05）. Perfusion values of malignant and inflammatory SPNs were significantly higher than those of the benign SPNs （P 〈0.05, P 〈0.05）. The VEGF positive expressions appeared in 32 patients with malignant SPNs and 2 patients with benign SPNs, and the average value of the MVD was higher in patients with malignant SPNs （36.88±6.76） than in patients with either benign （4.51±0.60） or inflammatory （26.11±5.43） SPNs （P 〈0.05, P 〈0.05）. There were statistically significant correlations between the CT perfusion feature and the MVD. The highest correlation was between the peak height of SPN and the MVD （r=0.657, P 〈0.05）.Conclusions Tumor microvessel density and VEGF expression facilitate the exploration of the pathophysiological basis of CT perfusion in SPNs. Multi-slice CT perfusion has shown strong positive correlations with angiogenesis in SPNs.

肺部恶性肿瘤立体定向放射治疗后影像学动态变化规律

目的 肺部恶性肿瘤立体定向放射治疗(stereotactic radiation therapy,SRT)后计算机断层扫描(computed tomography,CT)图像的动态变化是一个复杂而连续的过程,容易引起误诊。探讨SRT后肿瘤及其周边正常肺组织的CT图像动态变化的规律。方法 回顾性分析2018—2021年在南京医科大学附属肿瘤医院接受SRT的104例肺部恶性肿瘤患者的临床资料,根据纳入条件,由研究者诊断小组对每次CT图像进行评估和动态比较,记录SRT后肿瘤本身及周边正常肺组织形态学变化和时序特征。结果 104例患者共109个病变。94个(86.2%)病灶呈现残存病灶与周边放射性肺损伤融合形成肿块样实变,可分为3个阶段。发生期:治疗后3个月(范围为1~9个月),胸部CT呈病灶周围絮状渗出性改变。发展期:治疗后4.5个月(范围为1.5~15.5个月),呈密度更高的斑片条索影和/或纤维化实变影。影像稳定前期:治疗后13个月(范围为5.5~39个月),呈纤维化实变逐渐吸收、固结或收缩并与病灶融合形成最终的肿块样实变,伴或不伴随纤维化移动,最终趋于稳定。15例(14.4%)患者周围肺组织无明显改变,仅表现为病灶本身变化,达到影像学稳定的中位时间为治疗后10个月(范围为2.5~15.5个月)。65个(59.6%)病灶影像稳定期肿块样实变长径比初始病变增加了20%以上。进入发展期时间越短,影像稳定阶段肿块样实变长径可能越大(P=0.021)。结论 SRT后肿瘤本身及周边正常肺组织通常会出现连续动态影像学改变,最终多数患者残存病灶与周边肺组织纤维化融合形成肿块样实变。多数患者肿块样实变长径较SRT前增加20%以上。

肺淋巴管平滑肌瘤病高分辨率CT分析

目的:分析并总结肺淋巴管平滑肌瘤病(PLAM)的高分辨率CT(HRCT)影像特征,探讨胸部HRCT对该病的诊断价值。方法:回顾性分析50例于上海市黄浦区香山中医医院LAM中医特色专科门诊就诊的PLAM患者的HRCT资料,总结其典型的CT表现,包括弥漫囊样影及不同表现的肺间质病变等。结果:50例确诊的PLAM患者HRCT影像显示双肺弥漫性囊状影及肺间质病变的不同表现,部分病例出现胸腔积液、气胸病史、肺部感染及支气管扩张征象。结论:胸部HRCT检查所提供的影像学表现在PLAM干预中具有显著价值,可为疾病的后续诊治提供有效依据,提高疾病诊断准确性。

不同大小肺炎性假瘤的CT形态学分析及淋巴结变化规律

目的 探讨不同大小肺炎性假瘤(pulmonary inflammatory pseudotumor, PIP)的计算机断层扫描(computed tomography, CT)形态学特征及其淋巴结的变化规律。方法 选取经组织病理学证实为肺炎性假瘤的患者56例,按病灶大小分为两组:A组(最大径≤3.0 cm34例),B组(最大径>3.0 cm22例),分析比较两组CT影像学特点及淋巴结表现差异。采用组内相关系数(ICC)及Kappa检验评价2位医师测量数据的一致性,并用Bland-Altman法进一步可视化一致性测量结果。结果 两组在支气管血管束增粗、桃尖征、血管集束征、邻近胸膜增厚及淋巴结肿大方面差异均有统计学意义(P<0.05),B组出现以上征象的比例更大。进一步比较两组淋巴结,发现同侧肺门淋巴结更容易在B组中显示,且大小显著高于A组,差异有统计学意义(P<0.05)。2位医师测量PIP相关数据的一致性均良好或优秀(ICC与Kappa值范围为0.61~0.85),Bland-Altman法分析显示,2位医师评价淋巴结径线的一致性和稳定性较好。结论 不同大小的PIP在CT检查表现存在一定的差异性,本文有助于影像科及临床医师更深刻地认识此病、减少误诊。

气管性支气管患者单肺通气的研究进展

气管性支气管(TB)是一种罕见的先天性气管异常,指起源于气管的右肺上叶支气管。TB通常无明显症状,常因其他疾病行纤维支气管镜检查或CT检查时意外检出。根据气管性支气管开口的位置和可能的解剖变异,TB患者单肺通气对麻醉科医师是巨大挑战。本文根据Conacherl分型,对TB的诊断和单肺通气管理进行综述,以期为此类患者提供更完善的麻醉管理。

1517例无症状体检患者的肺部LDCT筛查结果分析

目的:分析使用低剂量计算机体层摄影(LDCT)在无症状体检患者中的筛查结果。方法:选取2020年9月-2023年9月于本院进行肺部检查的1 517例无症状患者作为研究对象,依据体检者一般资料将其分为低危组(n=1 081)、中危组(n=333)与高危组(n=103),分析其筛查结果。结果:LDCT筛查结果显示,1 517例体检者中有206例呈现阳性(166例为单发结节,40例为多发结节),810例呈现半阳性,共有1 016例结节,且有9例确诊为肺癌(其中早期肺癌7例,所占比例为77.78%);其中,低危组结节检出率为64.01%(692/1 081),中危组结节检出率为73.27%(244/333),高危组结节检出率为77.67%(80/103),高危组、中危组结节检出率与低危组存在明显差异(P<0.05);9例肺癌中男性4例,女性5例,吸烟3例(其中无女性吸烟者),非吸烟者6例(其中女性5例),有7例体检者长期处于被动吸烟暴露环境中,低危组肺癌确诊率为0.46%(5/1 081),中危组肺癌确诊率为0.90%(3/333),高危组肺癌确诊率为0.97%(1/103),三组肺癌确诊率比较差异不显著(P>0.05);随访结果显示,结节筛查假阳率为8.77%(57/650)。结论:LDCT可用于无症体检人群的早期肺癌筛查,早诊率可达77.78%,并且假阳率较低。

低剂量和常规剂量螺旋CT胸部平扫对肺部结节显示的差异分析

目的探讨早期肺癌中24排螺旋CT低剂量扫描的应用价值。方法取2022年1月至2023年10月我院接收的42例肺结节及早期肺癌患者。入选患者均接受24排螺旋CT常规剂量和低剂量扫描,分析、比较其扫描结果。结果2组肺结节直径及其检出率比较差异无统计学意义(P>0.05);低剂量组确诊率较常规剂量组高,而漏诊率低(P<0.05);2组图像优良率比较差异无统计学意义(P>0.05);低剂量组的最小红斑量(MERD)、剂量长度乘积(DLP)、扫描总电流时间积(mAs)及权重CT剂量指数(CTDIW)指标均较常规剂量组低,而有效扫描mAs指标则较高(P<0.05)。结论在肺部结节和早期肺癌诊断中,24排螺旋CT低剂量扫描可提高肺结节检出率,且辐射损害小,利于后期方案的针对性实施。

The dynamic study of the pulmonary artery obstruction degree and the right ventricular function in massive pulmonary embolism on CT pulmonary angiography

Objective： To analyze the value of CTPA in assessing the dissolve of embolus and the function of the right ventricle dynamically. Methods：Twenty-three cases of massive pulmonary embolism were analyzed retrospectively. The pulmonary artery obstruction index and the right ventricular function parameters were collected and analyzed on CTPA before thrombolytic therapy, 24 hours and 14 days after therapy, respectively. Results：The pulmonary artery obstruction index decreased gradually, and there was significant difference before therapy, 24 hours and 2 weeks after therapy. Twenty-four hours after therapy, the maximal short axes diameter and the maximal transverse area of right ventricle（RVd, RV~） decreased significantly, the maximal short axes diameter and the maximal transverse area of left ventricle（LVd, LVs） increased significantly, and the RVd/LVd, RVs/LVS decreased apparently. The pulmonary artery symbolic pressure before and 24 hours after therapy were apparently different. There was no significant difference between azygos vein, the super vena cava, the main pulmonary artery and vein reflux before and after therapy. Conclusion：CTPA can evaluate the pulmonary artery obstruction degree and right ventricular function dynamically.