The value of computed tomography scanning for the detection of coronary artery disease in patients with idiopathic pulmonary fibrosis

Background and objective: Patients with idiopathic pulmonary fibrosis (IPF) have a higher prevalence of coronary artery disease and this could have an impact on their outcomes. We investigated the predictive ability of coronary artery calcification, assessed by routine CT, which may predict the presence of coronary artery disease. Methods: The study cohort consisted of patients with IPF and with left heart catheterization data plus CT scans from July 2003 to July 2008. Grades of coronary calcification on CT were compared with left heart catheterization determination of coronary artery disease. Results: There were 57 patients in whom left heart catheterization review demonstrated significant coronary artery disease in 28.1% (16/57), mild disease in 40.3% (23/57) and none in 31.6% (18/57). The median time interval between the catheterization and the reviewed CT scan was 39 days. The sensitivity of moderate to severe calcification for significant coronary artery disease was 81%, while the specificity was 85%, with an associated odds ratio of 25.2 (4.64–166, P < 0.005). There was excellent agreement among three radiologists in the grading of coronary calcification. Conclusions: Coronary calcification, as assessed by routine CT of the chest, has very good performance characteristics in predicting underlying significant coronary artery disease in patients with IPF. The routine availability of this study enables the ready screening for coronary artery disease in IPF patients.     

Idiopathic calcinosis of the areola of the nipple

Idiopathic calcinosis cutis involving the breast is a rare condition. Previously reported cases were detected by mammography without specific cutaneous findings. We report a case of idiopathic calcinosis of the areola of the nipple in a 32-year-old Korean woman that has unique clinical features resembling scrotal calcinosis.     

Giant calcinosis revealing systemic sclerosis

Calcinosis is a complication of systemic sclerosis, most often occurring more than several years after diagnosis. We report the case of a man who developed severe calcinosis in shoulders and hips occurring before other systemic sclerosis' symptoms.     

肿瘤样钙质沉着症的X线、CT及MRI表现

目的：总结肿瘤样钙质沉着症的临床特点、影像学特点及鉴别诊断,增加对该病的认识,减少临床误诊率。资料与方法：结合文献分析1例病理确诊的肿瘤样钙质沉着症患者的临床资料及影像学表现。结果：该病病因不明,发病年龄较小,女性较男性发病率高。X线、CT、MRI呈特征性皮下无定形的致密钙斑,伴有软弱无力等临床表现。血清钙与磷代谢可正常。结论：影像学特征性的表现,伴有缓慢长大的质硬肿块等临床症状时,要考虑肿瘤样钙质沉着症的可能。     

Serum osteoprotegerin levels and the extent of vascular calcification in haemodialysis patients.

BACKGROUND: Osteoprotegerin (OPG) is a glycoprotein that inhibits osteoclast differentiation and activity. OPG-deficient mice develop severe osteoporosis and medial arterial calcification. The expression of OPG is detected in early atherosclerotic lesions in non-uraemic patients. We examined whether serum OPG is associated with aortic calcification in haemodialysis patients. METHODS: Serum OPG was measured in 102 patients who were undergoing haemodialysis. The aortic calcification index (ACI) was assessed by computed tomography scans. RESULTS: Serum OPG level, measured by enzyme-linked immunosorbent assay, was significantly greater in patients with higher ACI than in those with lower ACI. There was a direct relationship between ACI and serum OPG levels and a positive association between OPG and ACI (r = 0.483, P<0.0001). Multiple regression analyses indicated that serum OPG levels were independently associated with the severity of aortic calcification (P<0.0001). CONCLUSIONS: These findings show that serum OPG levels are associated with the extent of vascular calcification, suggesting that OPG may be involved in the development of vascular calcification in haemodialysis patients.     

Clinical significance of subcutaneous calcinosis in patients with systemic sclerosis. Does diltiazem induce its regression?

OBJECTIVE—To establish whether diltiazem reduces subcutaneous calcinosis (SCC) in patients with systemic sclerosis (SSc), and whether this calcinosis is related to other signs or symptoms.
METHODS—47 patients with SSc were evaluated and divided into two groups according to the presence or absence of SCC.
RESULTS—Among the 12 patients with SCC who were treated with diltiazem and had sequential hand radiographs (differential time between the two radiographs: 7.8±4 years), there was a slight radiological improvement in three patients only. More patients with SCC had anticentromere antibodies than patients without (p=0.003), fewer had anti-Scl 70 antibodies (p=0.01), more had telangiectasia and giant capillaries (p=0.04 and 0.048 respectively), and SCC patients had significantly fewer capillaries at the nailfold (p=0.03).
CONCLUSION—These results do not clearly indicate that diltiazem is effective in calcinosis associated with SSc. Among the patients with SSc, those who also had SCC exhibited a distinctive autoimmune profile and more severe cutaneous capillary injury than those without SCC.

Keywords: systemic sclerosis; scleroderma; calcinosis; diltiazem     

基于深度学习的乳腺X线摄影钙化检测系统对乳腺可疑钙化的检出效能

目的 评价基于深度学习（DL）的乳腺X线摄影钙化检测系统对乳腺可疑钙化的检出效能。方法 回顾分析932例接受乳腺X线检查患者的头足位（CC）和内外斜位（MLO）资料,由2名低年资医师和DL系统盲法独立阅片,一名高年资医师审核结果。比较DL系统与低年资医师检出敏感度差异,结合双向表χ²检验,评价不同BI-RADS分类、钙化形态和分布影响。结果 针对3 728幅影像（932例）,标记可疑钙化274例。2名低年资医师和DL系统的检出敏感度分别是76.64%（210/274）、82.12%（225/274）和99.64%（273/274）。DL系统检出敏感度不受钙化形态、分布、BI-RADS分类等因素的影响（P均>0.05）,而低年资医师对无定形钙化和团簇分布钙化的敏感度明显降低（P均<0.05）。结论 基于DL的乳腺X线影像钙化检出系统检出对可疑形态钙化的敏感度高且稳定,可辅助临床医师减少漏检。     

同型半胱氨酸对大鼠血管钙化模型的影响

目的　探讨同型半胱氨酸 (Hcy)对心血管系统异位钙化的影响。方法　建立大鼠血管钙化模型 (维生素D3加尼古丁 ,VDN) ,将 4 0只大鼠分为 4组 :A组 (对照组 ) ;B组 (VDN组 ) ;C组 (VDN +Hcy组 ) ;D组 (Hcy组 )。 5周后测大鼠体重、尾动脉压后处死 ,测主动脉长度及心脏重量 ,用原子吸收分光光度计测定主动脉钙含量 ,用逆转录聚合酶链反应 (RT PCR)检测 4组大鼠主动脉骨桥蛋白 (OP)mRNA表达。结果　经VDN处理后使大鼠体重减轻 ,而Hcy对大鼠体重无影响 ;去除体重减轻的因素 ,4组大鼠胸腹主动脉长度差异无显著改变 ;VDN及Hcy处理均不影响大鼠心率及尾动脉压 ;VDN大鼠主动脉钙含量较对照组增加 14 .1倍 ,Hcy的加入使其进一步升高达 18.9倍 ,两者相比 ,差异有显著性意义 (P <0 .0 1) ,单纯Hcy处理大鼠的主动脉钙含量无明显变化 ;VDN大鼠主动脉检出OPmRNA表达 ,Hcy促进此表达增加 5 6 .76 % ,对照组大鼠主动脉内无OPmRNA表达 ,单独给予大鼠Hcy处理不能诱发主动脉内OPmRNA表达。结论　Hcy促进VDN大鼠主动脉钙沉积及OPmRNA表达 ,其可能是钙化的促进因子     

Tumoral calcinosis in a patient with hypoparathyroidism,sensorineural deafness,and renal dysplasia syndrome undergoing hemodialysis

We describe a hemodialysis patient with hypoparathyroidism due to HDR (hypoparathyroidism, sensorineural deafness, and renal dysplasia) syndrome caused by GATA3 mutation. She presents tumoral calcinosis which is a rare complication of end‐stage renal failure. A novel mutation of GATA3 is identified in this patient.