Values of high-resolution computed tomography and pulmonary function tests in managements of patients with chronic hepatitis C virus infection

AIM:To investigate pulmonary involvement via pulmonary function tests (PFT) and high-resolution computed tomocjraphy (HRCT) in patients with chronic hepatitis C virus (HCV) infection. METHODS:Thirty-four patients with chronic HCV infection without diagnosis of any pulmonary diseases and 10 healthy cases were enrolled in the study,PFT and HRCT were performed in all cases. RESULTS:A decrease lower than 80% of the predicted value was detected in vital capacity in 9/34 patients,in forced expiratory volume in one second in 8/34 patients,and in forced expiratory flow 25-75 in 15/34 patients,respectively.Carbon monoxide diffusing capacity (DLCO) was decreased in 26/34 patients.Findings of interstitial pulmonary involvement were detected in the HRCT of 16/34 patients.Significant difference was found between controls and patients with HCV infection in findings of HRCT (X^2=4.7,P=0.003).Knodell histological activity index (KHAI) of 28/34 patients in whom liver biopsy was applied was 9.0±4.7.HRCT findings,PFT values and DLCO were not affected by KHAI in patients with HCV infection.In these patients,all the parameters were related with age. CONCLUSION:We suggest that chronic hepatitis C virus infection may cause pulmonary interstitial involvement without evident respiratory symptoms.

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.

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.

The value of CT pulmonary angiography to the diagnosis of right ventricular dysfunction due to acute pulmonary embolism:compared with ultrasonographic cardiography

To analyze the value of CT pulmonary angiography（CTPA） in assessing right ventdcular dysfunction（RVD） after acute pulmonary embolism. Methods：Thirty-six patients with CTPA-confirmed PE who underwent ultrasonic cardiography（UCG） within the ensuing 24 hours were retrospectively reviewed. According to the severity of the disease, the patients were divided into the massive PE group（24 cases） and non-massive PE group（12 cases） respectively. CT scans were analyzed for findings suggestive of RVD. Scans were considered positive for RVD if the right ventricle was dilated（RVd/LVd 〉 1） or if the interventricular septum was straightened or deviated towards the left ventricle. Results were then compared with the results of UCG to estimate the value of CTPA in detecting RVD associated with PE, Results：In all cases, compared with UCG, the diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value of CTPA was 84.61%, 78.26%, 3.892, 0.197, 68.75% and 90% respectively. Kappa value was 0.60, which suggested moderate agreement between CTPA and UCG in the whole level. In the massive PE group, the diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value of CTPA was 84.61%, 72.73%, 3.103, 0.212, 78.57% and 80% respectively. Kappa value was 0.58, which suggested moderate agreement between CTPA and UCG in the massive PE group. In the non-massive PE group, the diagnostic specificity of CTPA was 83.33%. By statistics, the value of RVd/LVd had significant difference between the massive PE and the non-massive PE group. Conclusion：CTPA can reliably detect RVD through the evaluation of cardiac morphology. However, this result requires confirmation using a larger prospective cohort study.

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.

Contrast-enhanced CT of Pulmonary Embolism: Report of 20 cases

Objectives To study the characteristic of pulmonary embolism （PE） in contrast-enhanced CT. Methods The radiological features were described in 20 patients with lobar and proximal PE diagnosed with a Toshiba Xpress/SX CT scanner after contrast material was administrated. Results There were 7 cases of pulmonary embolism （ PE ） secondary to lower limb deep vein thrombosis （DVT）, of which 2 cases were related to sauna bath. We grouped the cases according to their extensiveness of embolism： mild, moderate, severe, or complete embolism. Mild embolism： the emboli occupied less than 30%, of the inner diameter of pulmonary artery （PA）. Median embolism： the emboli occupied 30 -50% of the PA diameter. Severe embolism： the emboli occupied over half of the PA （50%）, but there were contrast flow. Completed embolism： there was no contrast found around the emboli. The direct sign of PE was a filling defect or no opacification in the affected branch of pulmonary artery （PA）. There were 9 other secondary signs： （1）widen PA, （2）enlarged right ventricle and the right atrium, （3）increased translucency of the lung and decreased bronchovascular shadows, （4）shrunken pulmonary veins liked dried rattan, （5）decreased left atrium and the left ventricle size, （6）shifting of interventricular septum to the left and posterior direction, （7）The lateral lung parenchyma demonstrated in a triangular shape, （8）pleural effusion and （9）pericardiacle effusion. Conclusions The diagnosis of PE was revealed by 10 radiological signs by contrast-enhanced CT.With full understanding of the pathophysiological basis of these 10 signs ： correct diagnosis of pulmonary embolism can be made. PE is commonly caused by lower limb. And sauna bath is one of the main predisposing causes.

Pulmonary involvement in inflammatory bowel disease

AIM:To determine the relationship of pulmonary abnormalities and bowel disease activity in inflammatory bowel disease(IBD).METHODS:Thirty ulcerative colitis(UC)and nine Crohn's disease patients,and 20 control subjects were enrolled in this prospective study.Detailed clinical information was obtained.Extent and activity of the bowel disease were established endoscopically.Each patient underwent pulmonary function tests and high-resolution computed tomography(HRCT).Blood samples for measurement of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),angiotensin converting enzyme and total IgE were delivered by the patients.RESULTS:Ten(25.6%)patients had respiratory symptoms.A pulmonary function abnormality was present in 22 of 39 patients.Among all patients,the most prevalent abnormalities in lung functions were a decrease in forced expiratory volume in 1 s(FEV1),FEV1/forced vital capacity(FVC),forced expiratory flow(FEF)25%-75%,transfer coefficient for carbon monoxide(DLCO),DLCO/alveolar volume.Increased respiratory symptoms score was associated with high endoscopic activity index in UC patients.Endoscopic and clinical activities in UC patients were correlated with FEV1,FEV1/FVC,and FEF 25%-75%.Smoking status,duration of disease and medication were not correlated with pulmonary physiological test results,HRCT abnormalities,clinical/endoscopic disease activity,CRP,ESR or total IgE level or body mass index.CONCLUSION:It is important that respiratory manifestations are recognized and treated early in IBD.Otherwise,they can lead to destructive and irreversible changes in the airway wall.

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.

双源CTLungVessles软件对肺栓塞诊断的应用研究

目的探讨双源CT Lung Vessles软件肺动脉成像对肺栓塞（PE）诊断和临床应用价值。方法对66例疑似PE患者进行双源CT双能量肺动脉扫描，数据经后处理得到肺动脉血管图（CTPA）、Lung Vessles图，对每一例正常者肺部任意一部位的CTPA图像及LungVessles图肺动脉一致性分析，做尼口阳d系数检验。以CTPA为诊断标准，计算以 Lung Vessles软件诊断PE的灵敏度、特异度、阳性预测值及阴性预测值。结果每一例正常者（共32例）肺部任意一部位的CTPA图像及LungVessles图肺动脉一致性好，Kappa值为0．71，P〈0．05。Lung Vessles软件诊断灵敏度高为100％，特异性为93．8％，但存在假阳性，阳性预测值为94．4％，阴性预测值为100％。结论双源CT Lung Vessles软件显示肺动脉与CTPA显示肺动脉一致性好；Lung Vessles软件诊断PE患者灵敏度高为100％，特异性为93．8％。

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.

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.

CT平扫与CTPA在肺栓塞邻近肺组织血供变化中的诊断价值对比

目的:对比分析CT平扫与CT肺动脉血管成像(CTPA)在肺栓塞邻近肺组织血供变化中的诊断价值。方法:回顾性分析120例急性肺栓塞患者,其中主肺动脉栓塞(主肺动脉栓塞组)、左右肺动脉干栓塞(左右肺动脉干栓塞组)、叶间动脉栓塞(叶间动脉栓塞组)各40例。3组均行肺部CT平扫及CTPA。3组CT值与CTPA血流参数行Pearson相关性分析。3组CT值行logistic回归分析。采用ROC曲线分析各组CT值对肺栓塞邻近肺组织血供变化的诊断效能。结果:3组的CT值与肺毛细血管嵌压(PCWP)、肺动脉舒张压(PAPd)、肺动脉收缩压(PAPs)均呈正相关(均P<0.05)。多因素logistic回归分析显示,PCWP、PAPd、PAPs是影响各组CT值的独立危险因素(均P<0.05)。主肺动脉栓塞组平扫CT值诊断肺组织血供变化的敏感度为82.12%、特异度为81.31%、AUC为0.735,左右肺动脉干栓塞组分别为83.10%、82.10%、0.741,叶间动脉栓塞组分别为80.01%、82.00%、0.723。结论:CT平扫可准确反映肺栓塞邻近肺组织血供变化,可作为临床诊断肺栓塞的间接征象。

基于HRCT图像对纤维化性间质性肺疾病与慢性阻塞性肺疾病的肺容积定量的比较研究

目的:比较纤维化性间质性肺疾病(F-ILD)与慢性阻塞性肺疾病(COPD)中反映病变肺容积的CT定量参数并观察其与肺功能指标的相关性。方法:回顾性分析所有患者资料;包括F-ILD患者76例,以第1秒用力呼气容积率(FEV1%)预测值(预测值在±1%以内)1∶1匹配COPD患者76例,年龄、性别匹配的健康对照组70例;分析CT定量参数包括全肺容积、低衰减区百分比(LAA%)、高衰减区百分比(HAA%)及总肺破坏面积百分比(DLA%),肺功能参数包括用力肺活量(FVC%)、FEV1%、总肺活量(TLC%)、一氧化碳弥散能力(DLco%)及综合生理指数(CPI);采用受试者工作特征(ROC)曲线分析基于视觉评估和CT定量参数反应肺气肿和肺纤维化的诊断效能。结果:肺功能指标FVC%pred在各组间具有差异性,DLco%pred及TLC%pred在F-ILD与COPD组间具有差异性,相比于健康对照组,FEV1%pred在各组间具有差异性(P均<0.05);F-ILD组全肺容积明显低于其他各组,HAA%明显高于其他各组,COPD组LAA%明显高于其他各组,健康对照组DLA%明显低于其他各组(P均<0.05);LAA%和HAA%分别对肺气肿和肺纤维化的检测具有高敏感性和高特异性(LAA%:AUC=0.835;HAA%:AUC=0.934);LAA%、HAA%及DLA%与肺功能指标呈负相关,与CPI呈正相关(P均<0.05);在COPD组、F-ILD组及所有患者中,DLA%与DLco%呈显著负相关(P均<0.05);在F-ILD组,DLA%与CPI呈显著正相关(P均<0.05)。结论:定量CT参数LAA%、HAA%及DLA%与肺功能相关,能客观反映F-ILD与COPD患者异常肺容积,另外对肺气肿与肺纤维化有较好的诊断效能。

CT定量参数联合NLR与COPD合并Ⅱ型呼吸衰竭患者肺功能的相关性及预测预后的价值

目的:探讨CT定量参数联合中性粒细胞/淋巴细胞比值(NLR)与慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者肺功能的相关性及预后预测价值。方法:将2021年1月-2022年12月在本院诊治的122例COPD合并II型呼吸衰竭患者作为研究对象。治疗前所有患者行1.0 mm薄层胸部CT扫描,使用Philips IntelliSpacePortal工作站内的COPD软件,测量并记录肺总容量、肺气肿容量、最大吸气末容积(MIV)、最大呼气末容积(MEV),并计算肺体积百分比(LVP)。对患者血液内的中性粒细胞和淋巴细胞浓度进行检测,计算并记录两者的比值(NLR)。采用耶格肺功能检测仪对患者的肺功能进行评估,记录用力肺活量(FVC)和一秒用力呼气容积(FEV1)。观察患者自入院治疗起90天内是否发生难以纠正的呼吸衰竭、心绞痛、心肌梗死、心力衰竭、心源性猝死、多脏器功能障碍及死亡等不良事件,将患者分为预后不良组和预后良好组。采用t检验方法比较2组间CT定量参数及NLR的差异,应用Pearson相关性分析评估CT定量参数、NLR与肺功能指标的相关性,采用受试者工作特征(ROC)曲线评估CT定量参数和NLR在患者预后预测中的效能。结果:MIV、MEV、NLR分别与FVC、FEV1呈负相关(P均<0.05),而肺体积百分比与FVC、FEV1均无统计学相关性(P均>0.05)。预后良好者89例,预后不良者33例。预后良好组的MIV、MEV和NLR显著低于预后不良组,差异均有统计学意义(P<0.05);而肺体积在两组间比较差异无统计学意义(P>0.05)。CT定量参数(MIV、MEV)及NLR预测患者COPD合并II型呼吸衰竭患者预后的AUC分别为0.709(95%CI:0.601~0.816)、0.820(95%CI:0.744~0.895)和0.895(95%CI:0.825~0.965),三者联合预测患者预后的AUC达0.935(95%CI:0.882~0.988)。结论:CT定量参数(MIV、MEV)及NLR与COPD合并II型呼吸衰竭患者的肺功能具有相关性,且三者联合对预测患者预后具有较的效能。

临床-CT环境影像组学鉴别慢性阻塞性肺疾病背景下周围型肺癌与肺炎性肿块

目的观察临床-CT环境影像组学鉴别慢性阻塞性肺疾病(COPD)背景下周围型肺癌(PLC)与肺炎性肿块的价值。方法回顾性分析经病理证实PLC的86例COPD(PLC组)及155例肺炎性肿块COPD(炎性肿块组),按7∶3比例将其分为训练集(n=170)及测试集(n=71);基于增强CT勾画病灶ROI1(不均匀强化区)、ROI2(均匀强化区)、ROI3(肿瘤周围带),生成相应Radscore 1、2、3。比较组间临床资料、常规CT及环境影像组学资料,行logistic回归分析,建立临床模型、CT环境影像组学模型及临床-CT环境影像组学模型,评估其鉴别PLC与肺炎性肿块的效能。结果病灶形态、强化方式、Radscore 2及3均为鉴别COPD背景下PLC与肺炎性肿块的因素(P均<0.05)。基于此建立的临床模型、CT环境影像组学模型及临床-CT环境影像组学模型鉴别训练集COPD背景下PLC与肺炎性肿块的曲线下面积(AUC)分别为0.763、0.859及0.892,在测试集分别为0.729、0.843及0.882;临床-CT影像组学模型AUC最高(P均<0.05),其准确率为83.53%、敏感度为81.97%、特异度为84.40%。结论临床-CT环境影像组学有助于鉴别COPD背景下PLC与肺炎性肿块。

高分辨率低剂量胸部CT在健康体检中的应用价值

目的探讨高分辨率低剂量CT(HRLDCT)在无症状健康体检者筛查肺部疾病和肺外病变的应用价值。方法回顾性分析于2011年1月—2021年12月在广州市第一人民医院行胸部HRLDCT检查的1940例无症状健康体检者的影像学资料,由两位研究者分别评估和记录所有受检者的每一个阳性CT病征征象,分析各个阳性CT征象在总受检人群中的检出情况、各个阳性CT征象在性别、年龄分层中的分布情况,以及肺外阳性CT征象检出情况。比较肺癌和肺良性结节在不同性别、不同年龄段分布中的检出情况。结果共有1831例受检者存在阳性CT征象,总检出率为94.38%,共检出3339个阳性CT征象。检出率最高的阳性CT征象是肺部良性结节(1630例,84.02%)。在973例男性受检者中,检出肺癌22例(2.26%),肺良性结节815例(83.73%);在967例女性受检者中,检出肺癌19例(1.96%),肺良性结节815例(84.28%),肺癌与肺良性结节在不同性别间的检出率比较差异无统计学意义(P=0.64,χ^(2)=0.214)。肺部阳性CT征象的检出率随年龄的增长而升高,肺癌与肺良性结节最多见于51~60岁受检人群中,两者在51~60岁和61~70岁中的检出率比较差异有统计学意义(P=0.038,χ^(2)=4.32)。此外,检出最多的肺外其他阳性CT征象为脂肪肝,共497例(25.62%),其次是冠状动脉钙化173例(8.90%)。结论HRLDCT在胸部的健康体检中可同时用于肺部疾病的筛查及发现肺外异常征象,具有较高的临床应用价值。

双能量CT肺灌注成像评价急性肺栓塞严重程度的可行性研究

目的分析双源CT双能量肺灌注成像（DEPI）技术评价急性肺动脉栓塞（APE）严重程度的可行性。方法经双源CT诊断APE24例,采用Lung PBV软件进行数据处理,得到CT肺血管图像（CTPA）和DEPI,分别计算每位患者的灌注缺损指数、栓塞指数及双室短轴最大径比（RV/LV）,依据患者严重程度分为严重APE组（n=9）和非严重APE组（n=15）,比较两组灌注缺损指数、栓塞指数及RV/LV,并进行Spearman等级相关分析。结果严重APE组的灌注缺损指数、栓塞指数及RV/LV中位数分别为32.5%（15.0%62.5%）、45.0%（27.5%75.0%）和1.16（1.041.45）,而非严重APE组分别为12.5%（0%37.5%）、12.5%（2.5%42.5%）和1.03（0.851.41）,严重APE组的各项指标均高于非严重组,两组间差异有统计学意义（P〈0.05）。相关分析显示,灌注缺损指数与RV/LV及栓塞指数均呈正相关（分别为r=0.635,P〈0.05;r=0.790,P〈0.05）。结论采用双源CT双能量肺灌注成像技术评价APE严重程度具有一定可行性。

基于CT薄层影像特征的肺结节良恶性评估

目的制订肺结节分级评估系统(PNI-GARS),评价其在肺结节良恶性评估中的应用价值。资料与方法回顾性分析180例患者共200个肺结节,采用PNI-GARS进行分级评定,计算PNI-GARS分级的准确度、敏感度、特异度、阴性预测值、阳性预测值。结果Ⅰ、Ⅱ级的阴性预测值分别为100.0%、97.2%,Ⅲa、Ⅲb、Ⅲc、Ⅳ级的阳性预测值分别为53.8%、85.7%、93.3%、100.0%。将Ⅰ、Ⅱ级归为阴性结节,Ⅲa级及以上归为阳性结节,PNI-GARS分级的准确度、敏感度、特异度、总阳性预测值分别为89.5%、99.3%、68.3%、87.2%。将Ⅰ、Ⅱ、Ⅲa级归为阴性结节,Ⅲb～Ⅳ级归为阳性结节,PNI-GARS分级的准确度、敏感度、特异度、总阳性预测值分别为88.5%、89.1%、87.3%、93.8%。排除Ⅲa级,将Ⅰ、Ⅱ级归为阴性结节,Ⅲb～Ⅳ级归为阳性结节,PNI-GARS分级的准确度、敏感度、特异度、总阳性预测值分别为94.8%、99.2%、84.3%、93.8%。结论 PNIGARS能有效地分类CT筛查出的肺结节,在肺结节的良恶性评估中有较高的应用价值。

肺结核并发肺部真菌感染的CT表现特征分析

目的探讨肺结核并发肺部真菌感染的CT表现特征，并进行观察分析。方法回顾性分析112例经病理组织学或细菌学，以及临床确诊的肺结核并发肺部真菌感染患者的CT表现特征，根据并发真菌感染的种类将患者分为曲霉菌组（61例）、念珠菌组（48例）、隐球菌组（3例），总结比较组间CT表现特征。结果肺结核并发常见真菌感染的发生率分别为曲霉菌组54．4％0（61／112）、念珠菌组42．9％（48／112）、隐球菌组2．7％（3／112）。其中曲霉菌组与念珠菌组比较，各项临床症状（咳嗽、咯痰、发热、咯血丝痰、胸痛）差异均无统计学意义（P值均〉0．05）。肺结核并发真菌感染的CT表现常见斑片影96例（85．7％）、结节影95例（84．8％）、空洞影93例（83．0％）、树芽征改变74例（66．1％）、磨玻璃样密度影60例（53．6％）。念珠菌组与曲霉菌组肺部感染病灶累及肺叶较广，且曲霉菌组累及3个肺叶以上者（98．0％，47／48）明显多于念珠菌组（80．3%，49／61），差异有统计学意义（X^2=7．91，P=0．005）。曲霉菌组在斑片影（93．4％，57／6i）、空洞影（93．4％，57／61）、磨玻璃样密度影（63．9％，39／61）表现上较念珠菌组（77．1%，37／48；72．9％，35／48；39．6％，19／48）多见，而念珠菌组以树芽征（79．2％，38／48）、段性或大叶性实变影（39．6％，19／48）较曲霉菌组（59．0％，36／61；3．3％，2／61）多见，差异均有统计学意义（X^2=6．06，P=0．014；X^2=8．60，P=0．003；X^2=6．40，P=0．011；X^2=5．00，P=0．025；X^2=22．76，P=0．000）。曲霉菌组中93．4％（57／61）的感染者可见曲菌球表现，其中37例为典型曲菌球。隐球菌组仅3例，均可见结节影，多位于胸膜下，且1例结节内可见内壁光滑的空洞。结论肺结核并发真菌感染有一定CT表现特征，CT扫描显示的图像特征有助于提示真菌感染的可能，具有一定的诊断价值。

双源CT大螺距前瞻扫描在胸痛三联症成像中的应用

目的探讨双源CT大螺距前瞻扫描在胸痛三联症排查中的成像质量及受心率变化的影响。资料与方法从拟行胸痛三联检查的患者中连续选取32例,采用随机数字表法分为研究组和对照组,对照组16例采用64排回顾式螺旋扫描,研究组16例采用双源大螺距前瞻扫描,比较两组主动脉及肺动脉CT值、噪声、信噪比(SNR)、对比噪声比(CNR)、辐射剂量,并对冠状动脉图像进行主观评分。结果两组主动脉及肺动脉CT值、噪声、SNR、CNR差异均无统计学意义(P>0.05),但研究组冠状动脉评分优秀率(85.5%)低于对照组(93.9%)(χ2=8.33,P<0.05)。考虑受心率波动过大的影响,排除对照组5例和研究组4例心率波动>5次/min的患者后,重新比较两组图像冠状动脉主观评分,差异无统计学意义(χ2=0.12,P>0.05)。对照组辐射剂量为(20.8±6.2)m Sv,明显高于研究组的(2.3±0.4)m Sv(t=17.142,P<0.01)。结论应用双源螺旋CT大螺距前瞻扫描行胸痛三联排查,对于心率<80次/min且波动<5次/min的患者成功率高,图像质量与回顾性扫描无显著差异,但辐射剂量减少,仅为(2.3±0.4)m Sv,具有潜在的应用和推广价值。