Objective To evaluate the clinical features,diagnosis,treatment,and outcome of intralobar pulmonary sequestration (ILS). Methods Patients who were diagnosed with ILS in our hospital between January 1988 and January 20...Objective To evaluate the clinical features,diagnosis,treatment,and outcome of intralobar pulmonary sequestration (ILS). Methods Patients who were diagnosed with ILS in our hospital between January 1988 and January 2009 were retrospectively reviewed. We recorded the clinical symptoms,imaging findings,operative technique,complications,and outcome of these patients. Results Forty-seven patients (25 men and 22 women) with an average age of 32.3 years were enrolled. Forty-two patients had symptoms including cough and hemoptysis. Chest X-ray,computed tomography (CT),magnetic resonance imaging (MRI),and angiography were performed. Thoracotomy was performed in 45 patients,while thoracoscopy was performed in 2 patients. Lobectomy was the most common treatment procedure. Massive bleeding developed in 2 patients due to injury of aberrant supplying artery intraoperatively,1 patient had atrial fibrillation,1 patient had thrombosis of upper extremity postoperatively. All patients were confirmed the diagnosis pathologically,4 accompanied with bronchogenic cyst,15 with bronchiectasis,8 with infection,2 with aspergilloma,and 1 with carcinoid. No late complications occurred. Conclusions ILS is rare,surgery is recommended because some patients may have potential severe complications. Contrast enhanced CT and three-dimensional reconstruction is the best diagnostic method. Both thoracotomy and thoracoscopy are appropriate for the selected candidates.展开更多
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 inv...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.展开更多
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 retrospectivel...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.展开更多
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/S...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.展开更多
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 non...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.展开更多
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 tr...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.展开更多
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 protocol...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.展开更多
We report a case of an anomalous pulmonary vein on chest X-ray resembling a scimitar sign in an 80-year-old female undergoing investigation of syncope.Multislice computed tomography(CT) with multiplanar reformatting a...We report a case of an anomalous pulmonary vein on chest X-ray resembling a scimitar sign in an 80-year-old female undergoing investigation of syncope.Multislice computed tomography(CT) with multiplanar reformatting and maximum intensity projections demonstrated an aberrant right inferior pulmonary vein coursing inferomedially towards the diaphragm before turning superiorly and draining normally into the left atrium.The diagnosis of an incidental meandering right pulmonary vein was established.The case is used to review the literature on this rare pulmonary anomaly,including pathogenesis,its relationship with scimitar syndrome and scimitar variant,and diagnosis,with an emphasis on the role modern CT techniques can play in noninvasive diagnosis.A revision to the nomenclature of pulmonary vascular anomalies is proposed to help reduce confusion in the literature.展开更多
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 ca...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.展开更多
文摘Objective To evaluate the clinical features,diagnosis,treatment,and outcome of intralobar pulmonary sequestration (ILS). Methods Patients who were diagnosed with ILS in our hospital between January 1988 and January 2009 were retrospectively reviewed. We recorded the clinical symptoms,imaging findings,operative technique,complications,and outcome of these patients. Results Forty-seven patients (25 men and 22 women) with an average age of 32.3 years were enrolled. Forty-two patients had symptoms including cough and hemoptysis. Chest X-ray,computed tomography (CT),magnetic resonance imaging (MRI),and angiography were performed. Thoracotomy was performed in 45 patients,while thoracoscopy was performed in 2 patients. Lobectomy was the most common treatment procedure. Massive bleeding developed in 2 patients due to injury of aberrant supplying artery intraoperatively,1 patient had atrial fibrillation,1 patient had thrombosis of upper extremity postoperatively. All patients were confirmed the diagnosis pathologically,4 accompanied with bronchogenic cyst,15 with bronchiectasis,8 with infection,2 with aspergilloma,and 1 with carcinoid. No late complications occurred. Conclusions ILS is rare,surgery is recommended because some patients may have potential severe complications. Contrast enhanced CT and three-dimensional reconstruction is the best diagnostic method. Both thoracotomy and thoracoscopy are appropriate for the selected candidates.
文摘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.
基金This work was supported by National"Eleventh-five"Scientific Item(2006BAI01A06)Shen-zhen City Luohu District Foundation (2007029)
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘We report a case of an anomalous pulmonary vein on chest X-ray resembling a scimitar sign in an 80-year-old female undergoing investigation of syncope.Multislice computed tomography(CT) with multiplanar reformatting and maximum intensity projections demonstrated an aberrant right inferior pulmonary vein coursing inferomedially towards the diaphragm before turning superiorly and draining normally into the left atrium.The diagnosis of an incidental meandering right pulmonary vein was established.The case is used to review the literature on this rare pulmonary anomaly,including pathogenesis,its relationship with scimitar syndrome and scimitar variant,and diagnosis,with an emphasis on the role modern CT techniques can play in noninvasive diagnosis.A revision to the nomenclature of pulmonary vascular anomalies is proposed to help reduce confusion in the literature.
基金the National"Eleventh-five"Scientific Item(No.2006BAI01A06)Shen-zhen City Luohu District Foundation(No.2007029)
文摘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.