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

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

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

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

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.

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

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

Liver involvement in patients with COVID-19 infection:A comprehensive overview of diagnostic imaging features

During the first wave of the pandemic,coronavirus disease 2019(COVID-19)infection has been considered mainly as a pulmonary infection.However,different clinical and radiological manifestations were observed over time,including involvement of abdominal organs.Nowadays,the liver is considered one of the main affected abdominal organs.Hepatic involvement may be caused by either a direct damage by the virus or an indirect damage related to COVID-19 induced thrombosis or to the use of different drugs.After clinical assessment,radiology plays a key role in the evaluation of liver involvement.Ultrasonography(US),computed tomography(CT)and magnetic resonance imaging(MRI)may be used to evaluate liver involvement.US is widely available and it is considered the first-line technique to assess liver involvement in COVID-19 infection,in particular liver steatosis and portal-vein thrombosis.CT and MRI are used as second-and third-line techniques,respectively,considering their higher sensitivity and specificity compared to US for assessment of both parenchyma and vascularization.This review aims to the spectrum of COVID-19 liver involvement and the most common imaging features of COVID-19 liver damage.

冈上肌出口位摄片诊断肩峰下撞击综合征的价值

目的:探讨冈上肌出口位X线片在诊断肩峰下撞击综合征中的应用价值。方法:回顾性分析58例经临床证实为肩峰下撞击综合征患者的冈上肌出口位X线表现,根据Bigliani肩峰分型标准进行分型,测量肩峰-肱骨头(A-H)值。结果:58例患者中,Ⅰ型11例(18.96%),Ⅱ型21例(36.21%),Ⅲ型26例(44.83%)。肩峰下间隙狭窄27例(A-H值<1cm),肩锁关节骨质增生12例,冈上肌肌腱钙化6例。结论:冈上肌出口位摄片能够提供肩峰分型的直接依据,可观察肩峰下滑动间隙、肩峰端骨赘的存在及冈上肌肌腱的钙化,对肩峰下撞击综合征的诊断具有病因学意义,并在一定程度上为骨科医生选择治疗方案提供了重要的影像依据。

CT引导下经皮穿刺活检在肌骨病变中的诊断价值

目的:评价CT引导下经皮穿刺活检在骨骼肌肉系统病变中的诊断价值。方法:在CT引导下经皮穿刺活检骨骼肌肉系统病变319例。结果:273例获得病理诊断,占85.6%(273?319),29例穿刺取得的病理组织不足,占9.1%(29?319),17例穿刺活检不成功,占5.3%(17?319)。257例具手术病理结果的病例中,212例穿刺结果和手术结果相符,45例不相符,其组织学定性的准确率为82.5%(212?257)。结论:CT引导下经皮穿刺活检是骨骼肌肉系统病变有效的诊断方法,可以使大多数患者避免切开活检;诊断的准确性和病变的组织学类型有关,少见病和取材的局限性是病理确诊困难甚至误诊的主要原因,而囊性和硬化性病灶是活检失败的主要原因。

血友病性肌骨假肿瘤患者骨骼的影像学表现

目的探讨血友病性肌骨假肿瘤(HPOM)骨骼变化的影像表现。方法收集HPOM患者16例,均为男性,其中A型12例为,B型4例;轻、中度分别为1例、15例。凝血四项中活化部分凝血活酶均延长,12例凝血因子Ⅷ下降,4例凝血因子Ⅸ下降。所有患者均接受CT及MR检查。结果单发骨病变4例,多发骨病变4例,多处肌/骨病变8例。骨质破坏表现为囊样型、囊样膨胀型、纯溶骨型、骨膜增生型、骨皮质受压型。部分病变存在钙化、软组织肿块,骨病变与软组织病变可相连或不连。结论 HPOM患者骨骼影像学变化具有多样性,其CT密度或MR信号改变具有不同时期血肿特征。

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

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

CT导引经皮肌肉骨骼穿刺活检(102例报道)

目的:探讨CT导引下经皮肌肉骨骼穿刺活检操作技术,评价其在肌肉骨骼病变诊断的价值。方法:102例CT引导下肌肉骨骼穿刺活检病例均行2-3点取材,肌肉软组织穿刺活检45例,骨骼穿刺活检例57例、其中骨骼并软组织穿刺活检40例。所有病例有手术、切开活检病理或临床随访资料。结果:102例肌肉骨骼病变的穿刺活检总正确率为83.3%(85/102)。软组织、骨骼病变穿刺活检正确率分别为95.6%(43/45)、71.9%(41/57),其中骨骼并软组织穿刺活检正确率95.0%(38/40),软组织与骨骼病变间比较差异有统计学意义(P<0.05)。大病灶(直径>3 cm)组、小病灶(直径≤3 cm)组穿刺活检正确率分别为88.7%(55/62)、75.0%(30/40),二者之间比较差异有统计学意义(P<0.05)。结论:CT导引下经皮肌肉骨骼活检是一种安全、简便、有效的诊断和鉴别诊断方法,对大病灶诊断准确率优于小病灶,多点及多种成分取材能提高正确率。

CT动态增强扫描对肌骨肿瘤与瘤样病变诊断价值的研究

目的:研究CT动态增强扫描的时间-密度曲线对肌骨肿瘤与瘤样病变的诊断价值。材料与方法:40例肌骨肿瘤与瘤样病变行平扫与增强后单层动态扫描,绘制出病变与健侧对应点的时间-密度曲线。分别测量曲线的强化幅度A、斜率K,计算出病变与对应点强化幅度之比RA,分析曲线的形态并将其分为两个类型。结果:良、恶性病变A、RA、曲线类型之间有显著性的差异P<005;而K之间无显著性差异P>005。A≤20Hu的良性病变与A>20Hu恶性病变所占的比例分别为666%,727%,二者之间有显著性差异P=0024。RA≤25良性病变与RA>25的恶性病变所占的比例分别为75%,7144%,二者之间有极显著差异性P=0003。良性病变的曲线以Ⅱ型为主,占667%12/18;恶性病变以Ⅰ型为主,占864%19/22,二者之间的差异也具有极显著性P=0001。结论:CT动态增强扫描所得的时间-密度曲线对鉴别良、恶性肌骨肿瘤与瘤样病变有一定的实用价值,A、RA、曲线类型为有鉴别价值的指标。

肋骨病变外周化投照的应用及分析

目的探讨肋骨非外伤性病变X线检查的有效投照方法。方法276位受检者在常规拍摄正位及前后斜位X线片的同时,加照病变外周化斜位片。比较两组方法的诊断效果。结果276例受检者中,常规正位及前后斜位X线片有38例发现病变,而病变外周化斜位片中61例发现病变。结论肋骨病变外周化斜位投照是诊断肋骨非外伤性疾病的更有效摄片方法。

Comparative Study on 16-slice CT Coronary Angiography vs Con-ventional Coronary Angiography―A Report of 38 Cases

The clinical application of 16-slice CT coronary angiography （CTCA） and the impact of plaques differently characterized on assessing coronary artery stenosis were evaluated. Thirty-eight patients with coronary artery disease diagnosed by conventional coronary angiography （CAG） underwent 16-slice CTCA （collimation： 16×0.75 mm; rotation time： 420 msec; kernel： 35f; effective current： 500 mAs; tube voltage： 120 kV）. The interval between CTCA and CAG was within one month. CTCA was evaluated by consensus of two independent experienced radiologists unknowing CAG findings. Original images, maximum intensity projections and multiplanar reconstructions were used to assess coronary artery stenosis. For a determined plaque an attenuation value ≥ 130 HU was considered as calcified, and 〈130 HU noncalcified. The plaques were then classified into significant calcification （extensive calcification）, medium calcification （small isolated calcification） and noncalcification. The diagnostic accuracy of 16-slice CTCA findings as well as to detect ≥50% stenoses caused by plaques was evaluated respectively regarding CAG as the standard of reference. In comparison with CAG findings, the sensitivity, specificity, positive and negative predictive value derived from CTCA for mild stenosis （〈50%） were 72.7%, 38.5%, 50%, 62.5%, respectively; for moderate stenosis （50%-75%） 82.4%, 72.7%, 70%, 84.2%, resepctively; and for severe coronary stenosis （〉75%） 85%, 90.5%, 81%, 92.7% respectively. With the increase of stenoses degree, the value of CTCA was greater. For the classification of the plaque calcification with ≥50% stenosis CTCA attained the sensitivity, specificity, positive and negative predictive value for severe calcificatoin 73.3% 22.2%, 61.1% and 33.3%, respectively; for moderate calcification 70%, 55.6%, 63.6% and 62,5%, respectively; for noncalcification 93.8%, 85.7%, 93.8% and 85.7% respectively. CTCA was restricted in assessing coronary artery stenosis in the presence of calcification, but CTCA value was much improved in assessing non-calcified stenosis. It was concluded that 16-slice CTCA could provide useful information about coronary artery stenosis, especially for severe stenosis （≥ 50%） and non-calcified plaque. Since CTCA is a noninvasive technique, it may be useful in screening coronary artery disease.

Role of Radiological Investigations of COVID-19 Patients with Pneumonia, Karachi Pakistan

The study was conducted to determine the role of radiological investigation in assessing the severity of COVID-19 pneumonia with the help of chest X-ray (CXR), high resolution computed tomography (HRCT), and ultrasound. This was a retrospective study conducted on 105 COVID-19 patients with symptoms of fever, cough, dyspnea, loss of sense of smell and taste, body ache. Diagnostic tests PCR were positive for COVID-19 included from Medicare Cardiac and General Hospital and Jinnah Medical College Hospital Korangi (JMCH) from April to November 2020. Written informed consent was taken from all participants. This study was approved by ethical review committee, Jinnah Medical & Dental College. Real time-PCR (RT-PCR) was done for the confirmation. Radiological imaging including Chest X-ray, HRCT chest, and ultrasound was done to study the severity of symptoms. Sixty-five patients had mild to moderate symptoms with oxygen saturation between 96% - 98% and 30 patients with severe pneumonia had between saturation 50% - 55%. Patients with mild symptoms were followed up by chest X-ray showing mostly normal chest X-rays but single or patches of ground glass opacities (HRCT). HRCT of 10 patients with low oxygen saturation 50% were already done showing bilateral peripheral patchy consolidation predominantly involving mid and lower lobes. 3 patients presented with patchy lung opacities and ultrasound showing similar findings with pleural effusion and ascites. Radiological imaging, specially CT-Scan was highly significant for diagnosing COVID-19 and severity of infection even in patients with negative PCR. Chest X-ray and ultrasound were also found to be a very useful tool.

Clinical significance of multislice spiral CT scans in hepatic veins occlusion in Budd-Chiari syndrome

Background Budd-Chiari syndrome with hepatic vein occlusion （HVBCS） can induce severe portal hypertension and liver damage. We retrospectively analyzed hepatic CT features of HVBCS and evaluated the usefulness of triphasic enhancement of CT examinations and CT angiography （CTA） in its diagnosis. Methods Twenty-five cases with HVBCS, confirmed by digital subtraction angiography （DSA）, received a triphasic enhancement CT scan within one week before DSA. The CTA images of the relevant blood vessels were reconstructed with maximum intensity projection, volume rendering and oblique reformat techniques. Results Compared with DSA, the detection rate of transverse CT and CTA images for abnormal hepatic vein were 81.7% （58/71） and 95.8% （68/71） （X^2=7.044, P=-0.008）, for membranous obstruction were 47.4% （9/19） and 84.2% （16/19） respectively （X^2 =5.729, P=-0.017 ）, for segmental obstruction were 88.0% （22/25） and 100% （25/25） respectively （X^2=1.418, P=-0.234）. The detection rates for hepatic vein stenosis were 100% with each method. Diffuse hepatomegaly was found in all 6 cases in acute phase and 3 of 19 cases in chronic phase who had severe obstruction of three hepatic veins without patent intrahepatic collaterals. The other 16 cases in chronic phase had hepatatrophia to different extents related to the obstructed hepatic vein. All in acute phase and 15 in chronic phase presented typical patchy enhancement initially in caudate lobe and perihilar areas and enlarged with time delay. In all cases, parenchyma areas with atrophy, necrosis and congestion demonstrated lower and later enhancement. In all the parts, which had normal enhancement at least one patent outflow hepatic vein, accessory hepatic vein or collateral vessel was detected.Conclusion Dynamic enhancement CT examination by multislice spiral CT not only could improve the diagnosis of HVBCS by CTA technique, but also could noninvasively provide anatomical information and reveal damage to the hepatic parenchyma.

Radiological features of lung changes caused by avian influenza subtype A H5N1 virus： report of two severe adult cases with regular follow-up

Several subtypes of avian influenza A have been shown to cross the species barrier and infect humans, leadingto human cases of avian influenza） Till June 2, 2009, globally there were 433 confirmed human cases of avian influenza caused by H5N1 virus, with a death rate of 60.5%.3 This is far higher than the reported 11% death rate of severe acute respiratory syndrome （SARS）.4 The epidemiologic features of human case of influenza A subtype H5N1 virus infection consist of high incidence rate in cold weather, high susceptibility in population of younger age associated with rapid onset of the disease and devastating illness in humans.12＇5＇6 H5N1 virus is mostly transmitted to humans directly through contact with infected birds or their secretions and the patients present with an influenza type illness with fever, cough, sore throat, malaise, and gastrointestinal symptoms; which can result in a rapidly progressive primary viral pneumonia and respiratory failure.2 Patients above the age of 5 years are likely to have an adverse course of disease.5

Analysis on the imaging features of AIDS with pulmonary fungal infection

Background Pulmonary fungal infection is one type of the common opportunistic infections in AIDS patients. The disease is hard to diagnose because of its complicated imaging features. The objective of this study was to investigate the imaging performance characteristics of pulmonary fungal infection in AIDS patients.Methods Fifty-one patients with AIDS complicated with pulmonary fungal infection and 56 patients of non-AIDS with pulmonary fungal infection were examined by CT scans and high-resolution CT scans. The contrast enhanced scans were performed in patients with the mass or suspected enlarged mediastinal lymph nodes. Results were compared between the two groups.Results The most common fungal infection in the two groups of patients was Candida albicans. The infection rates were 54.8% （28 cases） in the group （AIDS patients with pulmonary fungal infection） and 58.3% （32 cases） in another group （non-AIDS patients with pulmonary fungal infection）. In the two groups, the difference in diffuse distribution and the difference in incidence of affected upper and lower lobes in the bilateral lung fields were statistically significant. The differences in patchy or large consolidation shadow, cavitas, enlarged lymph nodes in mediastinum and pleural effusion were also significant when comparing the two groups.Conclusions The lesion in most of AIDS patients with pulmonary fungal infection tends to exhibit diffuse distribution,patchy or large consolidation shadow covering a more extensive region. The differences between AIDS with pulmonary fungal infection and non-AIDS with pulmonary fungal infection are statistically significant in lesion location and complicated imaging features. The most common fungal infection in AIDS patients is Candida albicans.