The inside dope: cocaine,condoms, and computed tomography

This article is a commentary on the preceding article by J. Hierholzer     

Work-related Stress,Musculoskeletal Disorder Complaints,and Stress Symptoms among Radiographers in the Northern Part of Jordan

ObjectiveThe aims of this study were to report the variation in work-related stressor (WRS) and musculoskeletal disorder (MSD) complaints across three major hospitals in the northern part of Jordan and to examine the correlations between stressors, MSD complaints, and stress symptoms using a questionnaire.MethodsA qualified radiographer distributed a questionnaire in the radiology department at three hospitals, including a governmental public hospital (GH), a university educational hospital (UH), and a private hospital (PH). The questionnaire included demographic, WRS, management and responsibility stressors, stress symptoms, stress relievers, and MSD complaints sections. A total of 74 radiographers (GH = 28, UH = 29, PH = 17) agreed to participate after signing a consent form.ResultsThe average age ranged from 30.8 ± 3.3 to 33.6 ± 1.4 (P = .6), and the average experience ranged from 6.2 ± 2.5 to 8 ± 1.2 years (P = .7) in the hospitals. The number of men was higher than women only in the UH (ratio = 2.6). The number of diploma degree holders was higher than the number of bachelor’s degree holders only in the GH (ratio = 3). Stress symptoms such as depression and MSD complaints such as low back pain in the GH were significantly higher than the other hospitals. There was a significant correlation (Spearman correlation coefficient = 0.61, P = .04) between WRS and MSD complaints.ConclusionThe GH had more MSD complaints and stress symptoms than the other hospitals. WRSs were correlated significantly with MSD complaints. Encouraging the radiographers to attend work stress management sessions may help in reducing the level of stress.     

Hepatic abscesses in the immunocompromised patient: Role of CT in detection,diagnosis, management,and follow-up

Newer cytotoxic and immunosuppressive agents and more aggressive oncologic treatment protocols have resulted in an increased incidence of opportunistic infections in the immunocompromised host. Clinical symptoms and laboratory data are often nonspecific and definitive diagnosis may be difficult to establish. The role of CT in the detection, diagnosis, management, and followup of various hepatic opportunistic infections in 9 immunocompromised hosts is presented.In 5 of 6 patients, CT-guided needle aspiration resulted in definitive diagnosis. In 3 patients, surgical intervention was obviated by abscess drainage using CT guidance. There is clearly a role for CT not only in the detection but also in the definitive diagnosis, treatment, and follow-up of abscesses in the immunocompromised host.     

Correlation of 18F-FDG PET/CT SUVmax with clinical features,D-dimer and LDH in patients with primary intestinal lymphoma

ObjectiveTo investigate the characteristics of fluorine-18-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) maximum standardized uptake value (SUVmax) in primary intestinal lymphoma (PIL) and its correlation with D-dimer and lactate dehydrogenase (LDH).MethodsFifty-two patients diagnosed with PIL from June 2016 to December 2019 were analyzed. All patients underwent 18F-FDG PET/CT. The relationships between SUVmax and different pathological subtypes, clinical stages and risk grades were analyzed. The correlations between SUVmax and Ki-67, LDH and D-dimer were determined. Additionally, PET/CT imaging results were collected from 35 patients with primary intestinal cancer (PIC) and compared with the imaging features of PIL.ResultsSUVmax was significantly different between PIL and PIC groups and various PIL pathological subgroups. Patients in the high-risk PIL group had markedly higher SUVmax values than the intermediate-risk and low-risk groups. A significant positive correlation was observed between SUVmax and Ki-67 in patients with PIL. SUVmax was significantly different between the elevated and normal D-dimer groups. D-dimer showed a positive correlation with SUVmax.Conclusion18F-FDG PET/CT SUVmax reflects the aggressiveness of lymphoma to a certain degree, is correlated with Ki-67 and determines the risk grades of PIL. Moreover, it facilitates differential diagnosis, clinical staging and treatment based on D-dimer levels.     

双源CT心肌桥的检出率、解剖病理学特征及其临床意义

目的：利用双源CT观察心肌桥（MB）的出现率和解剖病理学特征，探讨其检出的临床意义。材料与方法：2006年12月～2007年3月，共有272例患者因怀疑冠状动脉疾病或体检而进行了双源CT 冠状动脉血管成像（DSCTCA）检查。根据美国心脏病学会的冠状动脉分段标准确认其有无、位置和解剖病理学改变。根据DSCTCA表现及临床症状，将所有病例分为3组：1组，合并冠状动脉疾病组；2组，无冠状动脉疾病但有临床症状组；3组，无冠状动脉疾病也无临床症状组。对3组患者MB的解剖学特点进行统计学处理。15例患者进行了常规冠状动脉造影（CAG），观察两组MB检出率的差别。随机选择10例前降支MB患者进行4D电影显示以观察MB在心动周期内的变化情况。结果：272例进行了DSCTCA的患者中，63例检出79支MB，出现率为23.2%（63/272）。MB的平均长度为（2.14±0.83）cm，深度为（0.33±0.10）cm。63例中，49例（78%，49/63）患者为单支MB，其中7段29支，8段17支，9段1支，16段2支；12例（19%，12/63）为双支MB，其中以7段和8段共存最常见（42%，5/12）；2例（3%，2/63）3支MB。79支MB中，40支位于7段，24支位于8段，7支位于9段，4支位于16段，3支位于13段，1支位于10段。3组患者之间的统计学分析显示，1组患者的年龄明显大于2组和3组（P=0.001），MB更长（P=0.041），深度更深（P=0.021）。CAG提示4支MB，而DSCTCA显示20支MB，两者之间的差别有统计学意义（P＜0.001)。10例MB患者的4D电影显示MB收缩期变窄，舒张期恢复正常，类似CAG的“挤牛奶”效应。结论：本组冠状动脉MB的检出率为23.2%。利用DSCTCA可以可靠而生动地检测MB，确认其解剖病理学改变，解释一些患者的临床症状，在可疑冠状动脉疾病患者的处理中有重要的临床意义。     

CT显示胃癌病灶体积、强化程度、病理指标与胃周淋巴结转移的相关性研究

目的分析CT显示胃癌病灶体积、增强前后强化差值、组织分化程度、免疫组化指标与胃周淋巴结转移的相关性,探讨CT征象及病理指标预测淋巴结转移的可能性。方法回顾性分析57例行胃癌根治术患者的术前CT图像,测量CT图像上病变体积、增强前后强化差值,术后评估病变的分化程度,p53、Ki-67、表皮生长因子受体（EGFR）表达水平及胃周淋巴结转移情况。按是否有胃周淋巴结转移将患者分为两组,比较转移组与无转移组在CT显示胃癌病灶体积、强化差值及病理指标方面的差异。应用多因素方差分析筛选以上参数中预测胃周淋巴结转移的独立因素,并对独立因素与转移淋巴结数量进行相关性分析,对计量预测因素用受试者工作特征（ROC）曲线选出最佳预测界值。结果 36例患者手术证实胃周淋巴结转移,余21例未见淋巴结转移。转移患者病灶的CT体积[（33.0±25.0）cm^3]显著大于无转移患者[（33.0±25.0）cm^3 vs.（6.4±4.4）cm^3,P〈0.05],但两者强化差值无显著差异。淋巴结转移患者病变的EGFR阳性率（24/36）明显高于无转移患者（9/21）（P〈0.05）,但两者Ki-67和p53指标差异无统计学意义。多因素方差分析进一步表明,仅有肿瘤体积及分化程度可作为预测淋巴结转移的独立因素（P〈0.05）,且肿瘤体积与转移淋巴结数量呈显著正相关,6 cm3为肿瘤体积对转移淋巴结的最佳预测界值（灵敏度100.0%,特异度87.5%）。低分化患者的淋巴结转移数也显著高于中分化患者（P〈0.05）。结论 CT上胃癌病灶体积及组织分化程度与胃周淋巴结转移具有一定相关性,可能有助于提高对淋巴结转移的预测。     

Diagnostic Accuracy of Computed Tomography to Exclude Pheochromocytoma: A Systematic Review,Meta-analysis,and Cost Analysis

ObjectivesTo assess the diagnostic accuracy of unenhanced computed tomography (CT) attenuation values to exclude a pheochromocytoma in the diagnostic work-up of patients with an adrenal incidentaloma and to model the associated difference in diagnostic costs.MethodsThe MEDLINE and Embase databases were searched from indexing to September 27, 2018, and studies reporting the proportion of pheochromocytomas on either side of the 10–Hounsfield unit (HU) threshold on unenhanced CT were included. The pooled proportion of pheochromocytomas with an attenuation value greater than 10 HU was determined, as were the modeled financial costs of the current and alternative diagnostic approaches.ResultsOf 2957 studies identified, 31 were included (N=1167 pheochromocytomas). Overall risk of bias was low. Heterogeneity was not observed between studies (Q=11.5, P=.99, I²=0%). The pooled proportion of patients with attenuation values greater than 10 HU was 0.990 (95% CI, 0.984-0.995). The modeled financial costs using the new diagnostic approach were €55 (～$63) lower per patient.ConclusionPheochromocytomas can be reliably ruled out in the case of an adrenal lesion with an unenhanced CT attenuation value of 10 HU or less. Therefore, determination of metanephrine levels can be restricted to adrenal tumors with an unenhanced CT attenuation value greater than 10 HU. Implementing this novel diagnostic strategy is cost-saving.     

颅眶沟通性肿瘤的CT诊断与临床及病理分析

目的:分析,探讨这类肿瘤的CT表现及临床,病理特点,以提高对这类肿瘤的认识和诊断水平,方法:采用头部横断加冠状,平扫加增强的CT扫描检查,结果:颅眶沟通瘤15例,其中原发于眼眶向颅内生长者7例,原发于颅内向眼眶生长者8例,结论:CT扫描的高密谋分辨度率,使这类肿瘤得以显示,提高了对这类肿瘤的认识和论断水平,为临床正确处治提供依据.     

非典型性、恶性脑膜瘤的CT、MRI与良性脑膜瘤对比研究

目的　探索恶性脑膜瘤的ＣＴ、ＭＲＩ特征以提高临床影像学的诊断正确率。方法　对比分析了１５ 例经病理证实的恶性脑膜瘤和２０ 例良性脑膜瘤的ＣＴ、ＭＲＩ表现。结果　恶性脑膜瘤的结构非均质性（７／１５）、分叶及结节特征（１０／１５） 和短粗的硬膜尾征形态（４／１５） 均明显高于良性组（ Ｐ＜ ００５）。结论　良、恶性脑膜瘤在影像学表现方面存在某些明显差异性,认识恶性脑膜瘤的影像特征可以减少术前误诊。     

髓外浆细胞瘤CT、MRI及18F-FDG PET/CT表现

目的 探讨髓外浆细胞瘤（EMP）CT、MRI及¹⁸F-FDG PET/CT表现。方法 回顾性分析14例经病理证实的EMP的CT、MRI及¹⁸F-FDG PET/CT资料,观察病灶特征。结果 4例接受CT检查,病灶均以等密度为主,1例邻近骨质破坏,但无明显骨质硬化改变。7例接受MR检查,病灶信号均匀,T1WI呈等或稍低信号,T2WI以等或稍高信号为主,其中2例病灶内或周边可见流空血管影。增强扫描病灶呈均匀或不均匀中-重度强化,部分病灶边缘可见细小血管影,5例增强MRI病灶内可见强化更为显著的间隔。9例接受¹⁸F-FDG PET-CT扫描,7例表现为等密度软组织肿块或结节影,2例仅表现为局部软组织增厚伴结节状,均伴团块状中-重度放射性摄取增高,SUV最大值8.43±3.33。结论 CT、MRI及¹⁸F-FDG PET/CT在诊断EMP、鉴别诊断、指导临床治疗方案和预后评估等方面存在一定价值。     

Pancreatic cavernous hemangioma: CT,MRI, US,and angiography characteristics

A large pancreatic cavernous hemangioma was found in a 30-year-old man with abdominal distention. Plain and contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and angiography were performed prior to operation. Contrast-enhanced CT and angiography showed a large poorly enhanced hypovascular tumor at the head of the pancreas. But MRI and US disclosed findings compatible with a cavernous hemangioma.     

室管膜瘤的CT及MRI表现与病理 ——光镜、电镜和免疫组化对照研究

目的:提高室管膜瘤的CT及MRI诊断水平。方法:进行77例室管膜瘤的CT及MRI表现与手术病理——光镜、电镜超微结构与免疫组化对照研究。结果:位于脑室32例,脑内45例。CT显示不规则形或类圆形混合密度肿块或稍高密度肿块伴斑点状钙化,境界清楚,边缘分叶状。MRI显示T1WI呈不均匀低信号,T2WI呈高信号。选择乳头型室管膜瘤的电镜显示:在胞质见微绒毛呈直棒状或形成菊形团,常见胶质丝。免疫组化检查:Vimentin显示阳性;Cytokeratin、EMA显示阴性。结论:进行室管膜瘤的CT及MRI表现与病理对照研究,有助于CT及MRI诊断及鉴别。     

Liver metastases from colorectal cancer: imaging with superparamagnetic iron oxide (SPIO)-enhanced MR imaging,computed tomography and positron emission tomography

The literature about superparamagnetic iron oxide-enhanced MR imaging, computed tomography (CT) and PET (positron emission tomography using fluorine-18 labelled fluoro-deoxy-glucose) in detection of liver metastases (LM) from colorectal cancer is reviewed in this update. Special emphasis is given to studies with surgical standard of reference allowing for the lesion-by-lesion sensitivity to be determined. Based on the review, it is concluded that state-of-the-art anatomical imaging, e.g., SPIO-enhanced MR imaging and multidetector CT (MDCT), must be considered more sensitive than PET in detection of individual LM, due to technical developments in MR imaging, such as liver specific contrast agents, modern sequences and high performance gradients, and in modern MDCT have increased the performance of these modalities. MR imaging with a liver specific contrast agent is recommended for the preoperative evaluation before liver surgery for LM because of high sensitivity and better discrimination between small LM and cysts compared to MDCT. PET or PET/CT can be used for detection of extra-hepatic tumor before liver surgery.     

Hepatic intraarterial lipiodol: Technique,semiologic patterns,and value for hepatic tumors

Hepatic intraarterial lipiodol (HIAL) coupled with computed tomography (CT) was used in a homogeneous series of 138 cases. All patients received 10 ml lipiodol emulsion injected by an arterial route; there were no serious complications. Four semiologic patterns were observed. Aside from nodular regenerative hyperplasia occurring in the absence of cirrhosis, HIAL gave no false-positive indications of tumor, as demonstrated by a series of 20 patients with uncomplicated cirrhosis evaluated for over 12 months. Comparison of ultrasonography, CT, angiography, and HIAL coupled with CT for exploration of hepatomas revealed the marked superiority of HIAL/CT for both tumor detection and lesion localization (search for daughter tumors).     

肿瘤患者脑局部葡萄糖代谢变化的SPM分析

目的用18F-脱氧葡萄糖(18F-FDG)PET显像和SPM软件研究分析肿瘤患者脑局部葡萄糖代谢的变化.方法研究对象为20例确诊为无脑疾患的恶性肿瘤患者和20例健康志愿者.18F-FDG-PET显像后,用统计参数显像(SPM)法比较分析肿瘤患者和健康志愿者脑葡萄糖代谢的差别.结果 SPM分析显示肿瘤患者的的脑岛、松果体、顶叶皮质、小脑蚓部、颞叶和前额叶都表现为不同程度的葡萄糖代谢低下.结论肿瘤病人的抑郁表现与脑葡萄糖代谢降低相关,SPM方法是一种客观和直观的分析脑功能性变化的工具.