The spleen in Hodgkin disease: diagnostic value of CT

Findings of CT of the spleen were compared with those of histologic examination in 35 patients who had Hodgkin disease. CT provides a simple way to calculate splenic size. This index is also of value in the assessment of the histologic state of the spleen. An accuracy rate of 91%, specificity of 94%, and a sensitivity of 89% in diagnosing splenic localization of lymphoma was found in this study.     

Pulmonary arterial hypertension: thin-section CT predictors of epoprostenol therapy failure

PURPOSE: To correlate pretherapeutic thin-section computed tomographic (CT) findings in patients with pulmonary hypertension with the risk of fatality with treatment with epoprostenol. MATERIALS AND METHODS: Seventy-three consecutive patients with severe pulmonary hypertension treated with epoprostenol were retrospectively separated into two groups. The first group included 12 patients who had a fatal outcome with epoprostenol therapy. The second group (n = 61) was a reference group of patients with epoprostenol-induced clinical improvement. Pretherapeutic thin-section CT scans of each patient were reviewed. RESULTS: Poorly defined nodular opacities (P =.003), septal lines (P =.04), pleural effusion (P =.01), and adenopathy (P =.009) strongly correlated with a risk of clinical worsening with treatment. In six patients in group 1, postmortem examination of the lung revealed either pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis. CONCLUSION: On pretherapeutic thin-section CT scans, poorly defined nodular opacities, septal lines, pleural effusion, and adenopathy should raise suspicion for pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis and provoke possible further evaluation before epoprostenol therapy.     

心力衰竭患者左室Tei指数与左室收缩功能的相关性分析

目的 探讨心力衰竭患者左室Tei指数、左室收缩功能指标二者相关性.方法 应用脉冲多普勒超声测量104例左心衰竭患者的左室Tei指数,运用实时三维超声心动图测量104例左心衰竭患者的左心室舒张末期容积(LV-EDV)、左心室收缩末期容积(LVESV)及射血分数(LVEF),分析心力衰竭患者Tei指数与LVEDV、LVESV及LVEF的相关性.结果 左心衰竭患者Tei指数与LVEDV和LVESV有较好的正相关性(r=0.634,P=0.000;r=0.788,P=0.000),与LVEF有较好的负相关性(r=-0.758,P=0.000).结论 左心衰竭患者左室Tei指数、左室收缩功能指标二者为密切相关,联合应用为准确评价左心衰患者左室整体功能提供有价值的信息.     

Pulmonary hypertension: CT of the chest in pulmonary venoocclusive disease

OBJECTIVE: Pulmonary venoocclusive disease is a rare cause of pulmonary hypertension that is often difficult to distinguish from severe primary pulmonary hypertension. Unfortunately, medical treatment of primary pulmonary hypertension with prostacyclin can be fatal in patients with venoocclusive disease, and an early pretreatment diagnosis of this uncommon condition is critical. The aim of our study was to evaluate this disease noninvasively using CT of the chest. MATERIALS AND METHODS: We reviewed cross-referenced records from 1996 to 2001 in our departments of radiology and pathology and identified 15 patients with initial pretreatment CT scans who had pathologically confirmed pulmonary venoocclusive disease. Their CT scans were compared with the CT scans of 15 consecutive patients with pathologically confirmed primary pulmonary hypertension. All patients had undergone a postmortem or posttransplantation examination. RESULTS: Ground-glass opacities were significantly more frequent in pulmonary venoocclusive disease (p = 0.003); the opacities were abundant with random zonal predominance and preferentially centrilobular distribution (p = 0.03). Subpleural septal lines and adenopathy were also significantly more frequent (p < 0.0001). CONCLUSION: On the initial pretreatment chest CT scan, the presence of ground-glass opacities (particularly with a centrilobular distribution), septal lines, and adenopathy are indicative of pulmonary venoocclusive disease in patients displaying pulmonary hypertension. Caution should be exercised before vasodilator therapy is initiated in the patients whose scans show such radiologic abnormalities.     

老年高血压合并慢性心衰患者左心室容积参数的特征

目的：探讨老年高血压合并慢性心衰患者左心室容积参数的特征。方法：老年高血压合并慢性心衰患者108例,于入院48h内行彩色多普勒超声心动图检查,按左室射血分数（EF）降低的程度分为3组。对照组40例,为同期住院、无心衰证据的老年高血压患者。检测各组的左室舒张末内径（LVED）、室间隔舒张末厚度（IVS）、左室后壁舒张末厚度（LVPW）、左室心肌重量（LVMW）及一个新的指标——左室容积指数（LVVI）。结果：（1）超声心动图各项参数在3组心衰患者之间存在显著差异（P〈0．001）;（2）与对照组比较,EF正常的心衰患者LVED减小（P〈0．001）,LVPW增加（P〈0．0001）,LVVI显著减小（P〈0．0001）;（3）EF轻度降低的心衰患者LVED增大（P〈0．05）,LVPW增加（P〈0．001）,LVVI与对照组无显著差异;（4）EF显著降低的心衰患者LVED和LVVI增大非常显著（P〈0．0001）,LVPW与对照组无显著差异。结论：应用超声心动图测量左室容积参数,有助于区分老年高血压合并慢性心衰的不同临床类型。     

Chest radiographs in congestive heart failure: response to therapy in acute and chronic heart disease

Thirty-four men with left ventricular mechanical dysfunction were admitted to an intensive care unit with either an acute myocardial infarction (Group 1, n = 18) or worsening of clinical respiratory signs and symptoms in the setting of a chronic congestive cardiomyopathy (Group 2, n = 16). On admission, all individuals had pulmonary venous hypertension classified as at least Grade 3 by standard radiographic criteria. In each subject, mean pulmonary capillary wedge pressure (mm Hg), extravascular lung water (EVLW) (ml/kg), and chest radiographs were serially evaluated. In the patients in whom pharmacologic therapy successfully returned left ventricular filling pressures to near normal levels (less than or equal to 15 mm Hg), the chest radiograph returned to its baseline level (defined by the discharge radiograph) later in the patients with chronic heart failure (5.1 +/- 1.0 days) than in the patients with acute myocardial infarctions (2.1 +/- 1.2 days, p less than 0.01). Radiographic changes in extravascular water (interstitial and alveolar edema) mirrored changes in EVLW, although EVLW was initially greater in Group 2 (16.3 +/- 1.8 ml/kg) than in Group 1 (10.7 +/- 1.3 ml/kg, p less than 0.01). In the patients in whom filling pressures either worsened or changed less than 3 mm Hg, EVLW and chest radiographs did not markedly change. It is concluded that changes in radiographic pulmonary edema mirror changes in indicator-dilution measurements of EVLW. Radiographic phase lag represents a slow decline in EVLW after therapy for heart failure, which is prolonged in patients with chronic failure and greater EVLW.     

Intestinal pneumatosis in adults: diagnostic and prognostic value

Intestinal pneumatosis (IP) has been traditionally associated with intestinal infarction and poor outcome in adults; recent studies have questioned its clinical value. To assess its diagnostic and prognostic significance, we have retrospectively evaluated 102 patients correlating the CT finding of gastrointestinal parietal gas with clinical data and outcome. Fifty-three patients (52%) had surgical evidence of intestinal infarction. In the remaining patients, a variety of lesions were found including intestinal obstruction, cancer, volvulus, ulcer, hernia, trauma, Crohn's disease, diverticulitis, and iatrogenic causes. We observed the presence of portal vein gas (PVG) associated to IP in 25.5% of cases. In patients having both IP and PVG, intestinal infarction was observed in 69.2% of cases. In our series, overall mortality was 30.4% (31/102), and when PVG was present, it rose to 50% (13/26). In our study, IP has been observed in a broad range of lesions with very different prognosis, the most frequent of which was intestinal infarction. When associated to PVG, there was a much higher prevalence of intestinal infarct, and the prognosis was definitively worse.     

CT平扫对急性胰腺炎及并发症诊断和预测预后的价值

目的 分析腹部CT扫描在急性胰腺炎并发症诊断及预测预后中的价值.方法 选取急性胰腺炎患者151例,分析腹部CT中常见表现与患者并发症和死亡的关系.对比不同Balthazar CT 严重指数 (CTSI)分级患者的预后情况.结果 CT中具有脂肪肝、胸腔积液、肝上间隙积液、肾上腺受侵(AGI)、肾周间隙受侵(PSI)和胃裸区受侵(GBAI)的患者,其并发症发生率显著高于上述CT征象阴性患者(P<0.05).随着CTSI分级加重,患者的禁食时间、发热时间、住院时间、血淀粉酶恢复时间逐渐延长,假性囊肿、中转手术、器官衰竭发生率和死亡率逐渐上升(P<0.05).结论 重度脂肪肝、AGI、GBAI、PSI和肝上间隙积液为急性胰腺炎患者并发症和死亡的危险因素.     

Portomesenteric vein gas: diagnostic and prognostic value

Portomesenteric pneumatosis has been traditionally associated with intestinal infarction and poor outcome; however, recent studies have questioned its clinical value. To assess its diagnostic and prognostic significance we have retrospectively evaluated 47 patients correlating the CT finding of portomesenteric vein gas with clinical data and outcome. Thirty-nine patients (83%) had surgical evidence of intestinal infarction, four had necrotic small bowel volvulus (8.5%), two had blunt trauma, one had necrotic gastric volvulus, and one a gastric mucosal lesion induced by a nasogastric tube. Fifteen patients survived (31.9%); only 8/39 patients with intestinal infarction survived. Portomesenteric pneumatosis is a reliable marker of intestinal infarction and poor outcome; however, in trauma patients this sign is associated with a better prognosis. Electronic Publication     

Acute pancreatitis: prognostic value of CT

In 83 patients with acute pancreatitis, the initial computed tomographic (CT) examinations were classified by degree of disease severity (grades A-E) and were correlated with the clinical follow-up, objective prognostic signs, and complications and death. The length of hospitalization correlated well with the severity of the initial CT findings. Abscesses occurred in 21.6% of the entire group, compared with 60.0% of grade E patients. Pleural effusions were also more common in grade E patients. Grades A and B patients did not have abscesses, and none died, regardless of the number of prognostic signs. Abscesses were seen in 80.0% of patients with six to eight prognostic signs, compared with 12.5% of those with zero to two. The use of prognostic signs with initial CT findings results in improved prognostic accuracy. Early CT examination of patients with acute pancreatitis is a useful prognostic indicator of morbidity and mortality.     

The prognostic value of ventilatory efficiency with beta-blocker therapy in heart failure

PURPOSE: Beta-blockade (BB) has been shown to improve outcomes among patients with heart failure (HF). The impact this pharmacological approach has on the prognostic information gained from cardiopulmonary exercise testing (CPX) is, however, unclear. METHODS: Four hundred seventeen subjects diagnosed with HF underwent CPX. The numbers of subjects prescribed and not prescribed a BB agent were 167 and 250, respectively. Subjects were tracked for cardiac-related mortality after CPX. RESULTS: Values are reported for the no-BB versus the BB group throughout. Age (57.9 +/- 13.3 vs 55.6 +/- 12.5), peak VO2 (16.2 +/- 5.7 vs 16.5 +/- 5.5 mL x kg(-1) x min(-1)), VE/VCO2 slope (34.2 +/- 9.0 vs 33.2 +/- 7.4), and peak RER (1.07 +/- 0.16 vs 1.05 +/- 0.14) were similar between groups (P > 0.05). Multivariate Cox regression analysis revealed that the VE/VCO2 slope was the superior predictor of death in both groups (chi-square: 71.9, P < 0.001; and 18.4, P < 0.001). The optimal threshold values for VE/VCO2 slope in the no-BB and BB groups were 36.0 and 34.3, respectively. CONCLUSIONS: The results of the present study indicate that BB does not alter the prognostic value/characteristics of the VE/VCO2 slope. Findings from previous investigations examining the prognostic significance of CPX predominantly using HF groups not receiving a BB agent may, therefore, still be applicable in modern-day clinical practice.     

基于心脏磁共振组织追踪初步探究左心房功能预测缺血性心脏病患者预后的价值

目的:初步探究左心房功能预测缺血性心脏病患者出现主要不良心血管事件(MACEs)的价值。方法:回顾性搜集2018年10月-2020年7月共30名确诊缺血性心脏病患者,在二腔心、四腔心层面分别勾画左心房储存期、导管期以及泵血期的心内膜、心外膜轮廓,得到各期左心房容积,采用心脏磁共振组织追踪技术自动生成左心房应变-时间曲线以及应变率-时间曲线并得到左心房三期射血分数、应变以及应变率。采用受试者操作特征(ROC)曲线计算左心房功能参数对于缺血性心脏病患者出现MACEs的预测价值。采用Bland-Altman图评价两位有心脏磁共振诊断经验的医生测量左心房功能参数的一致性。结果:MACEs组左心房储存期射血分数[(37.85±13.86)%vs.(48.40±10.95)%,P=0.028]、应变[13.40(7.25,15.80)%vs. 19.20(13.38,24.68)%,P=0.011],导管期应变[4.6(2.65,7.38)%vs. 9.2(6.5,11.20)%,P=0.003]以及泵血期应变率[-0.65(-1.3,-0.5)/s vs.-1.55(-1.83,-1.00)/s...     

Acute liver failure due to trovafloxacin: CT findings

Symptomatic drug-induced hepatic adverse events due to trovafloxacin, a new fluoroquinolone antibiotic, are uncommon, but recent severe reactions have led to restriction on its use. We report the clinical course and computed tomography findings in a patient who developed acute liver failure shortly after commencing treatment with trovafloxacin. Extensive hepatic necrosis occurred and the patient ultimately died of her liver disease.     

Black blood MRI has diagnostic and prognostic value in the assessment of patients with pulmonary hypertension

European Radiology - Double inversion recovery (DIR) “black blood” MRI suppresses the signal from flowing blood, slow flowing blood causes incomplete suppression resulting in pulmonary...     

Pulmonary Aspergillus chest wall involvement in chronic granulomatous disease: CT and MRI findings

Pulmonary Aspergillus infection in patients with chronic granulomatous disease tends to involve the chest wall and consequently carries a high mortality rate. We report the findings of computed tomography (CT) and magnetic resonance imaging (MRI) in three such cases. One patient underwent both CT and MRI, one, CT only, and one, MRI only. In all three, both CT and MRI demonstrated pulmonary consolidations with direct extension to the adjacent chest wall. In both patients who were examined by CT, scans revealed permeative osteolytic changes of adjacent rib or spine compatible with osteomyelitis. In both patients who were examined by MRI, adjacent chest wall involvement was depicted on T1-weighted images and showed increased signal intensity on T2-weighted images. In one of these patients, the chest wall lesion was well defined on T2-weighted images, an appearance compatible with abscess. Epidural extension was demonstrated on MRI in the other patient, who later developed paraparesis. We suggest that CT and MRI have a complementary role in evaluating chest wall invasion by pulmonary Aspergillus infection in chronic granulomatous disease.