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.

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.

Initial computed tomography findings of invasive pulmonary aspergillosis in non-hematological patients

Background The computed tomography （CT） findings of invasive pulmonary aspergillosis （IPA） are unclear in non- hematological patients. The present study was a retrospective evaluation of CT images in non-hematological patients with IPA. Methods All adult patients who met the 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group （EORTC/MSG） criteria for proven or probable IPA were included during a 5-year study at our institutions. Initial CT findings in our cohort were retrospectively reviewed by two independent thoracic radiologists blinded to patient demographics and clinical outcomes. The presence, pattern, and distribution of abnormalities were recorded. Results Twenty-three non-hematological patients with pathologically confirmed IPA were included in our study. Areas of ground-glass opacities were present in 14 patients （61%）, which were bilateral in 10 patients and unilateral in four. This pattern mainly involved the middle and upper lung zones. Air-space consolidation was identified in 12 patients （52%）, and the areas were distributed along the bronchus or subpleura in most cases. Other findings, including five small nodules （22%）, three macronodules （13%）, and one halo sign （4%）, were less common. Conclusions CT findings of IPA in non-hematological patients frequently manifested as acute bronchopneumonia, and ground-glass opacities and air-space consolidations were the most common CT findings of IPA in these patients.

The diagnostic rules of peripheral lung cancer preliminary study based on data mining technique

Objective： To discuss the clinical and imaging diagnostic rules of peripheral lung cancer by data mining technique, and to explore new ideas in the diagnosis of peripheral lung cancer, and to obtain early-stage technology and knowledge support of computer-aided detecting （CAD）. Methods： 58 cases of peripheral lung cancer confirmed by clinical pathology were collected. The data were imported into the database after the standardization of the clinical and CT findings attributes were identified. The data was studied comparatively based on Association Rules （AR） of the knowledge discovery process and the Rough Set （RS） reduction algorithm and Genetic Algorithm（GA） of the generic data analysis tool （ROSETTA）, respectively. Results： The genetic classification algorithm of ROSETTA generates 5 000 or so diagnosis rules. The RS reduction algorithm of Johnson＇s Algorithm generates 51 diagnosis rules and the AR algorithm generates 123 diagnosis rules. Three data mining methods basically consider gender, age, cough, location, lobulation sign, shape, ground-glass density attributes as the main basis for the diagnosis of peripheral lung cancer. Conclusion： These diagnosis rules for peripheral lung cancer with three data mining technology is same as clinical diagnostic rules, and these rules also can be used to build the knowledge base of expert system. This study demonstrated the potential values of data mining technology in clinical imaging diagnosis and differential diagnosis.

Attention Based Multi-Patched 3D-CNNs with Hybrid Fusion Architecture for Reducing False Positives during Lung Nodule Detection

In lung nodules there is a huge variation in structural properties like Shape, Surface Texture. Even the spatial properties vary, where they can be found attached to lung walls, blood vessels in complex non-homogenous lung structures. Moreover, the nodules are of small size at their early stage of development. This poses a serious challenge to develop a Computer aided diagnosis (CAD) system with better false positive reduction. Hence, to reduce the false positives per scan and to deal with the challenges mentioned, this paper proposes a set of three diverse 3D Attention based CNN architectures (3D ACNN) whose predictions on given low dose Volumetric Computed Tomography (CT) scans are fused to achieve more effective and reliable results. Attention mechanism is employed to selectively concentrate/weigh more on nodule specific features and less weight age over other irrelevant features. By using this attention based mechanism in CNN unlike traditional methods there was a significant gain in the classification performance. Contextual dependencies are also taken into account by giving three patches of different sizes surrounding the nodule as input to the ACNN architectures. The system is trained and validated using a publicly available LUNA16 dataset in a 10 fold cross validation approach where a competition performance metric (CPM) score of 0.931 is achieved. The experimental results demonstrate that either a single patch or a single architecture in a one-to-one fashion that is adopted in earlier methods cannot achieve a better performance and signifies the necessity of fusing different multi patched architectures. Though the proposed system is mainly designed for pulmonary nodule detection it can be easily extended to classification tasks of any other 3D medical diagnostic computed tomography images where there is a huge variation and uncertainty in classification.

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.

Comparison of magnetic resonance imaging and computed tomography to measure preoperative parameters of children with pectus excavatum

Importance:Pectus excavatum (PE) is the most common thoracic wall deformity in children,we need a method which could be used to evaluate pulmonary functions and effects on development.Objective:To evaluate the use of 3D T 1-weighted (3 DT 1) and mDIXON magnetic resonance imaging (MRI) sequences for measuring the thoracic parameters and morphology of children with PE,comparing the measurements with those made on computed tomography (CT).Methods:This is a retrospective study of children with thoracic deformities who were hospitalized at the Department of Thoracic Surgery of the Heart Center,Beijing Children's Hospital,between June 2014 and June 2015.Chest CT was performed first,with the MRI scanning then being performed 0-3 days later.The mDIXON sequences were obtained in inspiratory and expiratory phases and the 3DT1 sequences were obtained during free breathing.Thoracic volume was measured using the acquired images.Results:The lung volumes measured on mDIXON MRI and CT were highly correlated,with the Haller index not being significantly different between the two methods.Bland-Altman analyses showed that lung,cardiac,and retrosternal parameters were similar between the two methods.Pulmonary parameters were higher with the end-inspiratory phase mDIXON images than with the end-expiratory phase images,as expected,while cardiac parameters were unaffected by the respiratory phase.Interpretation:Thoracic volumes measured on mDIXON MRI in combination with held respiration could reflect lung volume functions and help in observing the movement functions of the lungs and heart.The method could be used instead of CT,avoiding subjecting the patient to potentially harmful radiation.

侵袭性肺曲霉菌感染CT征象的早期表现及其随访观察

目的：提高对侵袭性肺曲霉菌感染（IPA）早期影像表现及随访中影像演变的认识。方法：回顾性分析22例IPA患者经平均96d随访（20~692d）的141次（平均6.4次）CT图像，动态观察IPA的影像特征、数量和大小的变化。结果：IPA首次检查的早期多表现为大小不等的结节，平均为1.39cm（范围0.3~3.7cm）。病变多发为主要形式，平均5.3个（范围1~20个）。病变周围伴有晕征是早期较为特征性的改变，出现率为77.3%（17/22）。在7~14d的影像随访期间，结节病变无论是数量还是大小在此期间均表现为增加的趋势，平均大小1.64cm（0.4~4.2cm），平均病变数量5.8个（1~23个）。平均23d（15~30d）时出现的空气半月征和空洞强烈提示IPA的诊断。结论：IPA好发于免疫缺陷患者，结节周围的晕征为CT的早期特征性表现，熟悉IPA的CT影像表现及演变过程对疾病的诊断、预后评价有重要意义。

免疫正常肺曲霉菌患儿的CT表现

目的探讨免疫正常肺曲霉菌病患儿的CT表现。方法回顾分析经临床确诊的15例无基础疾病及免疫缺陷肺曲霉菌病患儿的临床资料和CT表现。结果 15例中,13例表现为肺内多发结节,其中细支气管周围分布10例,粟粒结节7例;12例实变,其中沿肺叶分布6例,小斑片影6例;6例支气管扩张,其中呈柱状扩张5例,呈串珠状扩张1例;6例支气管壁增厚;5例空洞,在上中(舌)肺叶支气管周围分布4例,厚壁空洞4例,薄壁空洞1例。随访发现12例痊愈,2例未愈,1例死亡。结论年龄小于2岁免疫正常儿童长期发热,CT主要表现为肺内小结节、实变、支气管扩张及空洞时,应该高度警惕肺曲霉菌感染的可能性。

血清抗原检测联合肺部CT诊断侵袭性肺曲霉病的探讨

目的:评价1,3-β-D-葡聚糖(G)和血清半乳甘露聚糖(GM)实验,联合肺部CT检查对非粒细胞缺乏患者侵袭性肺曲霉病(IPA)的诊断作用。方法:对浙江大学医学院附属第一医院呼吸科、感染科、肾内科和重症监护室临床怀疑IPA的113患者进行肺部CT检查及G、GM实验。参照欧洲癌症治疗组织及真菌病研究组(EORTC/MSG)制定的诊断标准,分为确诊,临床诊断,拟诊和非曲霉感染。对比血清学检查和肺部CT诊断IPA的敏感性和特异性,观察患者抗真菌治疗的疗效和预后。结果:确诊IPA的4例,临床诊断36例,拟诊16例,非曲霉感染57例。发现GM实验的敏感性(50.0%)明显高于G实验(30.0%),特异性分别是84.2%和87.7%。IPA肺部CT特征性改变诊断的敏感性为30.0%,肺部CT特征性影像学表现联合GM实验的诊断敏感性与单纯GM实验相当(47.5%vs 50.0%),而特异性明显提高(100%vs 84.2%)。结论:对于怀疑IPA的非粒缺患者,依靠GM实验联合CT的影像学改变有一定的敏感性,同时有较好的特异性。

侵袭性肺曲霉菌病的MSCT表现

目的:探讨侵袭性肺曲霉菌病的MSCT表现。方法:回顾性分析19例经病理证实的侵袭性肺曲霉菌病的MSCT表现。结果:MSCT表现为小结节影(1～3cm)14例(73.6%,14/19),大结节或团块影(>3cm)6例(31.6%,6/19);肺段或亚段分布的实变影8例(42.1%,8/19),磨玻璃影3例(15.8%,3/19);6例(31.6%,6/19)合并CT晕圈征,5例(26.3%,5/19)合并空气新月征或空洞影,2例(10.5%,2/19)可见中心低密度征,5例(26.3%,5/19)合并胸水。结论:侵袭性肺曲霉菌病的主要征象是单发或多发的结节伴空洞形成及肺段或亚段的实变,而出现结节晕圈征和空气新月征时,则高度提示侵袭性肺曲霉菌病。

CT引导下经皮肺活检对肺曲霉病的诊断价值

目的:探讨CT引导下经皮肺活检对肺曲霉病的诊断价值。方法:对34例接受CT引导下肺活检的肺曲霉病患者的临床资料进行回顾性分析。结果:穿刺活检病理确诊30例,4例未确诊病例后经手术病理证实为肺曲霉病。临床表现:咳嗽25例,咳痰20例,发热18例,咯血6例,胸痛5例,胸闷、呼吸困难5例,无症状者(体检发现肺部病变)3例。影像学表现:结节15例(单发6例,多发9例),肿块7例,实变灶5例,斑片影4例及新月征3例。血半乳甘露聚糖试验阳性率67.6%(23/34)。病理学改变以坏死性炎症为主。并发症:气胸17.6%(6/34),1例需放置胸腔引流管,其余自行吸收;针道出血5例,少量咯血1例,均未特殊处理,症状自行缓解。结论:CT引导下经皮肺活检是确诊肺曲霉病的一种安全、有效的方法。

侵袭性肺曲菌病CT诊断(附17例报告)

目的:探讨侵袭性肺曲菌病(IPA)的CT表现。方法:回顾性分析经手术、病理证实的17例侵袭性肺曲菌病CT表现。结果:17例中患糖尿病3例,白血病3例,淋巴瘤2例,骨髓瘤2例,肺结核2例,肺癌术后1例,肾移植后1例,红斑狼疮长期服用激素1例,类风湿性关节炎长期服用激素1例,未患其它疾病者1例。17例中病变近胸膜下呈楔形大片状实变阴影6例,其中3例两肺伴多发结节样阴影;病变呈团块状阴影6例,团块边缘较光整,其中3例团块影内见大小不等小空洞,2例团块有轻微分叶,1例团块边缘略有"晕征";病变呈多发小结节病灶和多发小斑片状影散在分布两肺3例,小结节病灶边缘有"晕征";多发小斑片状影散在分布两肺2例,密度低,边缘模糊,呈磨玻璃样表现。结论:侵袭性肺曲菌病CT征象主要为楔形实变、团块状影、多发结节影及小斑片状影,多发结节伴"晕征"时应提示侵袭性肺曲菌病可能。

肺曲菌球病63例临床分析

目的探讨肺曲菌球病的临床特征和治疗方案。方法回顾性分析2008．1—2014．10年收治63例病理确诊肺曲菌球病患者的临床诊治情况。结果HCT〈37％24例，血清前白蛋白（PA）〈200mg／L 20例，LY〈1．5×10^9／L19例；肺结核空洞22例，支气管扩张症19例，6例无明确基础疾病；咳嗽46例，咯血59例，大咯血29例。典型影像学表现48例，误诊4例，漏诊11例；可见纵隔淋巴结23例，短径小于1cm，淋巴结活检提示反应性增生。病灶位于左肺上叶17例，右肺上叶29例。肺功能检查：总弥散量低于比弥散量（t=-9．422，P〈0．001）；均行外科手术治疗；58例随访影像学未见复发；大咯血与相关危险因素的Logistic分析，肺结核空洞OR=6．113，P=0．008，空洞或空腔内长径OR=2．410，P=0．004。结论肺曲菌球病咯血和咳嗽为主要症状；病灶多位于双肺上叶，影像学特征典型，大咯血患者的曲菌球长径、空洞或空腔长内径长于非大咯血患者；弥散功能有一定特征性；首选手术治疗；肺结核空洞和空洞或空腔内长径是大咯血的危险因素。

肺曲菌病的MSCT表现和诊断价值

目的探讨肺曲菌病的MSCT表现和诊断价值。方法本组病例收集于2002年12月至2006年12月,分别经手术病理和治疗随访证实,男性4例,女性3例,年龄44～83岁,平均51岁。5例有轻重不一的发热、咳嗽、胸痛、铁锈色痰或血丝痰,2例无任何症状和体征。采用SIEMENSSENSATION4层或16层螺旋CT,3例仅平扫,4例平扫+增强。增强用非离子碘对比剂80～100ml,经肘静脉自动高压注射器给予,流率2～3ml/s。常规摄横断面片,肺窗:WW1500HU,WC-500HU;纵隔窗:WW400HU,WC40HU。4例加行多方位图像重建(MPR)。结果病灶位于右肺3例,左肺4例。3例表现为孤立性实质性结节,直径8mm～27mm,类圆形,边缘可见棘突及"晕影"。4例为空洞性结节,直径17mm～110mm,其中2例具有"新月"征,2例具有"滚珠"征。结论肺曲菌病早期影像表现缺乏特征性,当病变局限形成曲菌球尤其具备"新月征"和"滚珠征"者是CT诊断的可靠依据。

Prospective Study of Low-and Standard-dose Chest CT for Pulmonary Nodule Detection:A Comparison of Image Quality,Size Measurements and Radiation Exposure

Objective:To comprehensively and accurately analyze the out-performance of low-dose chest CT(LDCT)vs.standard-dose CT(SDCT).Methods:The image quality,size measurements and radiation exposure for LDCT and SDCT protocols were evaluated.A total of 117 patients with extra-thoracic malignancies were prospectively enrolled for non-enhanced CT scanning using LDCT and SDCT protocols.Three experienced radiologists evaluated subjective image quality independently using a 5-point score system.Nodule detection efficiency was compared between LDCT and SDCT based on nodule characteristics(size and volume).Radiation metrics and organ doses were analyzed using Radimetrics.Results:The images acquired with the LDCT protocol yielded comparable quality to those acquired with the SDCT protocol.The sensitivity of LDCT for the detection of pulmonary nodules(n=650)was lower than that of SDCT(n=660).There was no significant difference in the diameter and volume of pulmonary nodules between LDCT and SDCT(for BMI<22 kg/m^(2),4.37 vs.4.46 mm,and 43.66 vs.46.36 mm^(3);for BMI>22 kg/m^(2),4.3 vs.4.41 mm,and 41.66 vs.44.86 mm^(3))(P>0.05).The individualized volume CT dose index(CTDI_(vol)),the size specific dose estimate and effective dose were significantly reduced in the LDCT group compared with the SDCT group(all P<0.0001).This was especially true for dose-sensitive organs such as the lung(for BMI<22 kg/m^(2),2.62 vs.12.54 mSV,and for BMI>22 kg/m^(2),1.62 vs.9.79 mSV)and the breast(for BMI<22 kg/m^(2),2.52 vs.10.93 mSV,and for BMI>22 kg/m^(2),1.53 vs.9.01 mSV)(P<0.0001).Conclusion:These results suggest that with the increases in image noise,LDCT and SDCT exhibited a comparable image quality and sensitivity.The LDCT protocol for chest scans may reduce radiation exposure by about 80% compared to the SDCT protocol.

侵袭型肺曲霉菌病CT影像变化初步研究

目的:探讨侵袭型肺曲霉菌病(IPA)的CT征象演变,提高对侵袭型肺曲霉菌病的认识和早期诊断。方法:回顾分析24例经皮肺部穿刺活检病理证实并且行一系列CT复查的侵袭型肺曲霉菌病的CT表现。结果:在IPA诊断第1天,"晕征"的出现率为82.5%;在中位天数3天、7天、14天,"晕征"出现率分别为68%、22%和19%,"新月形空气征"的出现率分别为8%、28%和63%,非特异性肺实变的出现率分别为31%、50%和18%。在IPA诊断后第1～7天(中位天数),病灶体积和数目逐渐增大;7～14天,病灶大小维持相对恒定,而病灶数目则呈下降趋势。结论:"晕征"是IPA早期征象,"新月形空气征"是IPA的晚期征象。"晕征"持续时间较短,对高度怀疑为IPA的患者,胸部CT扫描应及早进行,理想的CT扫描时间应在IPA发病5天以内,在早期积极抗真菌治疗的同时,应注意积极恢复骨髓造血功能。

侵袭性肺曲霉菌病的影像学诊断

目的探讨侵袭性肺曲霉菌病(IPA)的X线及CT表现,提高对该病的认识。方法回顾性分析经病原学或病理组织学证实的IPA6例(男4例、女2例)。基础病变包括肾移植术后5例及白血病1例,全部病例均行胸部X线及CT检查。结果4例表现为多发斑片状及片状影,其中2例伴空洞形成,1例表现为多发小结节影,1例表现为单发团块状影。影像诊断肺霉菌病3例,误诊3例。结论IPA的影像学表现无特异性,影像学检查结合临床资料对本病的诊断有一定价值。

侵袭性肺曲霉菌感染螺旋CT检查影像学特征及与其预后关系分析

目的:分析侵袭性肺曲霉菌感染的CT特征表现与疾病预后。方法:对168例疑似侵袭性肺曲霉菌感染患者进行多层螺旋CT(MSCT)检查,以痰培养或活组织病理学检查结果作为金标准,探讨MSCT对侵袭性肺曲霉菌感染的诊断价值,分析其影像学特征及预后。结果:168例疑似患者中,最终确诊为侵袭性肺曲霉菌感染者132例;以痰培养或活组织病理学检查结果为金标准,MSCT正确诊断侵袭性肺曲霉菌感染125例,正确排除侵袭性肺曲霉菌感染31例;MSCT对侵袭性肺曲霉菌感染的诊断准符合率、灵敏度、特异度、阳性预测值、阴性预测值、误诊率及漏诊率分别为92.9%、94.7%、86.1%、96.2%、81.6%、13.9%及5.3%。病灶在左肺26.4%,右肺32.0%,双肺41.6%;肺上叶56.0%,中下叶44.0%;肺外周带70.4%,内中带29.6%。侵袭性肺曲霉菌感染在MSCT的以结节、晕轮征、空洞最为常见,结节以单侧上肺多发多见,晕轮征以单侧、上肺多发为主,空洞以上肺、多发为主。血液病与非血液病患者在斑片影、团块影以及实变影方面比较具有统计学差异(P<0.05)。经治疗,结节、晕轮征及空洞等MSCT特征性表现治愈好转组显著少于恶化死亡组(P<0.05或P<0.01)。结论:MSCT能够客观显示肺内病变的部位、数目、形态学特征,对侵袭性肺曲霉菌感染具有较高的诊断价值,同时对于治疗过程中病情的监测以及预后评估也具有重要作用。

Discrepancies in the clinical and radiological profiles of COVID-19:A case-based discussion and review of literature

The current gold standard for the diagnosis of coronavirus disease-19(COVID-19)is a positive reverse transcriptase polymerase chain reaction(RT-PCR)test,on the background of clinical suspicion.However,RT-PCR has its limitations;this includes issues of low sensitivity,sampling errors and appropriate timing of specimen collection.As pulmonary involvement is the most common manifestation of severe COVID-19,early and appropriate lung imaging is important to aid diagnosis.However,gross discrepancies can occur between the clinical and imaging findings in patients with COVID-19,which can mislead clinicians in their decision making.Although chest X-ray(CXR)has a low sensitivity for the diagnosis of COVID-19 associated lung disease,especially in the earlier stages,a positive CXR increases the pre-test probability of COVID-19.CXR scoring systems have shown to be useful,such as the COVID-19 opacification rating score which helps to predict the need of tracheal intubation.Furthermore,artificial intelligence-based algorithms have also shown promise in differentiating COVID-19 pneumonia on CXR from other lung diseases.Although costlier than CXR,unenhanced computed tomographic(CT)chest scans have a higher sensitivity,but lesser specificity compared to RT-PCR for the diagnosis of COVID-19 pneumonia.A semi-quantitative CT scoring system has been shown to predict short-term mortality.The routine use of CT pulmonary angiography as a first-line imaging modality in patients with suspected COVID-19 is not justifiable due to the risk of contrast nephropathy.Scoring systems similar to those pioneered in CXR and CT can be used to effectively plan and manage hospital resources such as ventilators.Lung ultrasound is useful in the assessment of critically ill COVID-19 patients in the hands of an experienced operator.Moreover,it is a convenient tool to monitor disease progression,as it is cheap,non-invasive,easily accessible and easy to sterilise.Newer lung imaging modalities such as magnetic resonance imaging(MRI)for safe imaging among children,adolescents and pregnant women are rapidly evolving.Imaging modalities are also essential for evaluating the extra-pulmonary manifestations of COVID-19:these include cranial imaging with CT or MRI;cardiac imaging with ultrasonography(US),CT and MRI;and abdominal imaging with US or CT.This review critically analyses the utility of each imaging modality to empower clinicians to use them appropriately in the management of patients with COVID-19 infection.